Methylome and transcriptome data integration reveals potential roles of DNA methylation and candidate biomarkers of cow Streptococcus uberis subclinical mastitis

Background:Mastitis caused by different pathogens including Streptococcus uberis(S.uberis)is responsible for huge economic losses to the dairy industry.In order to investigate the potential genetic and epigenetic regulatory mecha‑nisms of subclinical mastitis due to S.uberis,the DNA methylome(whole genome DNA methylation sequencing)and transcriptome(RNA sequencing)of milk somatic cells from cows with naturally occurring S.uberis subclinical mastitis and healthy control cows(n=3/group)were studied.Results:Globally,the DNA methylation levels of CpG sites were low in the promoters and first exons but high in inner exons and introns.The DNA methylation levels at the promoter,first exon and first intron regions were nega‑tively correlated with the expression level of genes at a whole‑genome‑wide scale.In general,DNA methylation level was lower in S.uberis‑positive group(SUG)than in the control group(CTG).A total of 174,342 differentially methylated cytosines(DMCs)(FDR<0.05)were identified between SUG and CTG,including 132,237,7412 and 34,693 DMCs in the context of CpG,CHG and CHH(H=A or T or C),respectively.Besides,101,612 methylation haplotype blocks(MHBs)were identified,including 451 MHBs that were significantly different(dMHB)between the two groups.A total of 2130 differentially expressed(DE)genes(1378 with up‑regulated and 752 with down‑regulated expression)were found in SUG.Integration of methylome and transcriptome data with MethGET program revealed 1623 genes with signifi‑cant changes in their methylation levels and/or gene expression changes(MetGDE genes,MethGET P‑value<0.001).Functional enrichment of genes harboring≥15 DMCs,DE genes and MetGDE genes suggest significant involvement of DNA methylation changes in the regulation of the host immune response to S.uberis infection,especially cytokine activities.Furthermore,discriminant correlation analysis with DIABLO method identified 26 candidate biomarkers,including 6 DE genes,15 CpG‑DMCs and 5 dMHBs that discriminated between SUG and CTG.Conclusion:The integration of methylome and transcriptome of milk somatic cells suggests the possible involve‑ment of DNA methylation changes in the regulation of the host immune response to subclinical mastitis due to S.uberis.The presented genetic and epigenetic biomarkers could contribute to the design of management strategies of subclinical mastitis and breeding for mastitis resistance.

Acute Renal Failure in the Elderly in the Nephrology Department of Aristide Le Dantec Hospital in Senegal: About 45 Cases

Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.

Experimental and computational study of annealed nickel sulfide quantum dots for catalytic and antibacterial activity

This research investigates the hydrothermal synthesis and annealing duration effects on nickel sulfide(NiS_(2) quantum dots(QDs)for catalytic decolorization of methylene blue(MB)dye and antimicrobial efficacy.QD size increased with longer annealing,reducing catalytic activity.UV–vis,XRD,TEM,and FTIR analyses probed optical structural,morphological,and vibrational features.XRD confirmed NiS2's anorthic structure,with crystallite size growing from 6.53 to 7.81 nm during extended annealing.UV–Vis exhibited a bathochromic shift,reflecting reduced band gap energy(Eg)in NiS_(2).TEM revealed NiS_(2)QD formation,with agglomerated QD average size increasing from 7.13 to 9.65 nm with prolonged annealing.Pure NiS_(2) showed significant MB decolorization(89.85%)in acidic conditions.Annealed NiS_(2) QDs demonstrated notable antibacterial activity,yielding a 6.15mm inhibition zone against Escherichia coli(E.coli)compared to Ciprofloxacin.First-principles computation supported a robust interaction between MB and NiS_(2),evidenced by obtained adsorption energies.This study highlights the nuanced relationship between annealing duration,structural changes,and functional properties in NiS_(2)QDs,emphasizing their potential applications in catalysis and antibacterial interventions.

Factors Associated with Renal Impairment in Patients on Tenofovir for Chronic Hepatitis B in Yaoundé (Cameroon)

Background: Tenofovir (TFV) is widely used to treat patients with hepatitis B virus (HBV) infection. But kidney abnormalities are the main concern using this drug. Few studies have described the renal impairment due to the TFV in chronic hepatitis B (CHB) in Sub-Saharan Africa. The objective was to evaluate factors associated with renal impairment observed in patients on TFV for CHB. Method: It was a hospital based cross sectional prospective study carried out from June 2023 to July 2023 in Yaoundé (Cameroon) and included any patient treated with TFV for CHB during at least a period of 6 months. For each participant, we collected in the medical report socio-demographic data, clinical data, baseline creatinine, treatment information (type of TFV which was Disoproxil Fumarate (TDF) or Alafenamide (TAF), duration). Then, we collected blood samples to measure serum creatinine and phosphate levels and urine dipstick analysis. Factors associated with renal impairment were assessed with the Odds Ratio. A p value of Results: A total of 60 participants were included. The median age was 44 years [36-55] and median duration of TFV therapy was 17.5 months [11.7-25.7]. The prevalence of reduced eGFR (Conclusion: Kidney function was impaired in some patients receiving TFV for CHB. It should be monitored, particularly after 36 months and for those receiving TDF prodrug.

Synthesis of Silver Nanoparticles from Honeybees and Its Antibacterial Potential

Honeybees (Apis mellifera) are important pollinators of flowering plants and agricultural crops contributing annually to billions of dollars in revenues to crop production. Honeybees have an average lifespan between 8 weeks to 5 years. Dead honeybees are abundantly available in beehives and can be utilized as an alternative source to synthesize nanoparticles. In recent years, biologically synthesized nanoparticles have been preferred over their chemical counterparts. However, honeybee-based-green synthesis of nanoparticles has not been explored yet. Herein, we report the biosynthesis of silver nanoparticles from honeybees and its antibacterial activity. The synthesis of silver nanoparticles was monitored visually through a gradual change in color. Furthermore, the biosynthesized nanoparticles were confirmed and characterized by UV-visible spectroscopy. Scanning Electron Microscope was utilized to analyze the average size and morphologies of the biosynthesized nanoparticles. Subsequently, the antibacterial potential of the biosynthesized silver nanoparticles was tested against selected Gram-positive and Gram-negative bacterial strains. It was found that a distinct color change from yellow to brown in the reaction solution suggested the formation of silver nanoparticles. The biosynthesized nanoparticles exhibited absorption maxima at 430 nm. The SEM analysis confirmed the spherical and cuboidal shape of the biosynthesized silver nanoparticles with a size range between 10 - 40 nm. Furthermore, the biosynthesized silver nanoparticles exhibited strong antimicrobial potential against tested Gram-positive and Gram-negative bacteria strains by aggregating on the cell surface. This study showcases the biomedical and agricultural applications of biosynthesized silver nanoparticles from honeybee wings. .

Endometriosis beyond the Pelvis: A Case Series of Cutaneous Endometriosis and Literature Review

Introduction: Cutaneous endometriosis is an uncommon but well-known skin disorder that represents about 0.5% to 1% of all endometriosis. The objective of this case series is to report clinical presentation, diagnosis, and management of various forms of cutaneous endometriosis. Material and Methods: It was an observational, retrospective and descriptive review of cases presenting with cutaneous endometriosis among Cameroonian women managed at the gynaecological outpatient department of Yaounde Gynaeco-Obstetric and Pediatric Hospital. All the following parameters were analysed: age, parity, previous pelvic surgery, presenting symptoms and duration, associated symptoms, localizations, imaging, size of the lesion, other localization of endometriosis, management and histopathological results. Results: we reported 4 cases of cutaneous endometriosis, with 3 umbilical endometriosis and 1 abdominal scar endometriosis. Patient age ranged from 28 to 39 years with an average of 33 years. All patients described infertility (two primary and two secondary) and two had a history of abdominal surgery. All patients presented local cyclical signs such as pain, swelling, color change and bleeding. The duration of symptoms varied from 2 to 3 years and the size of lesions ranged from 2 to 3.5 cm for umbilical lesions and was 9 cm for abdominal scar endometriosis. In all cases, no imaging was required for the diagnosis, which was suspected on the basis of patient’s history and the cyclical nature of local signs, followed by wide surgical excision and confirmation on histopathology. Conclusion: Cutaneaous endometriosis is a rare benign condition. Umbilical endometriosis seems to be the main cutaneous localization and can be described as primary or secondary. Even if its diagnosis must be confirmed by histopathology, it should be considered in patient with cutaneous cyclic signs such as pain, swelling or bleeding with or without history of abdominal surgery.

Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis

AIM:To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA). METHODS:Sixty-nine ulcerative colitis patients (39 F,30 M) dependent upon/refractory to steroids were treated with GMA. Steroid dependency,clinical activity index (CAI),C reactive protein (CRP) level,erythrocyte sedimentation rate (ESR),values at baseline,use of immunosuppressant,duration of disease,and age and extent of disease were considered for statistical analysis as predictive factors of clinical response. Univariate and multivariate logistic regression models were used. RESULTS:In the univariate analysis,CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission. In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390,95% Confidence interval (CI):0.176-0.865,Wald 5.361,P = 0.0160] and low CAI levels at baseline (4 < CAI <7) (OR = 0.770,95% CI:0.425-1.394,Wald 3.747,P = 0.028) proved to be effective as factors predicting clinical response. CONCLUSION:GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.

A clinical report of entangled neonates' umbilical cord with queen's fur in Persian cat

A 3-year-old Persian queen was referred to Teaching Veterinary Hospital while 3 neonates' umbilical cords were entangled with the queen's tail hair.Close inspection of the cat showed that the umbilical cords of 3 kittens had twisted around together and entangled with the moms' hairs in the base of tail region.Also this complex has been warped around the left tarsus of one of the involved kittens and caused swelling and skin darkness in the involved limb.Operation was carried out urgently.After cutting the queen's involved hairs the kittens were released.Then the twisted umbilical cords and the hairs were isolated from the umbilical cord and the involved leg was released from the umbilical cords and the twisted umbilical cords were separated from each other.During one week follow up,dry gangrene occurred in the distal extremity of the injured limb and consequently,amputation was performed on the distal part of tibia.Our clinical findings suggest that long hair coats of queens could be a maternal life threatening factor for neonates' life.

Clinical and pathological findings of concurrent poxvirus lesions and aspergillosis infection in canaries

Objective:To investigate clinical,pathological and mycological findings in canaries,in which pox lesions and Aspergillus fumigatus(A.fumigatus)infection were observed simultaneously.Methods:This study was performed on a breeding colony(about 100 canaries)affected by fatal wasting disease.Necropsy was undertaken on 10 severely affected canaries,and gross lesions were recorded.Samples from internal organs displaying lesions were obtained for histopathological evaluation.Tracheal swap samples of internal organs of the all infected animals with lesions at necropsy were cultured in Sabouraud Dextrose Agar for mycological examination.Results:At necropsy,caseous foci were determined in the lungs,on the air sacs,liver,spleen,heart.Swelling of the eyelids,diffuse hemorrhages in the subcutaneous tissue with small papular lesions of the skin were other typical necropsy findings.Histopathologically,pathognomonic eosinophilic intracytoplasmic inclusion bodies,which called Bollinger bodies,in both skin cells and vacuolated air way epithelial cells confirmed canary pox infection.Moreover,histopathological examination of the white-yellowish caseous foci revealed necrotic granulomatous reaction consisting of macrophages,heterophil leukocytes and giant cells encapsulated with a fibrous tissue.After the culture of the tissue samples,the formation of bluish green colonies confirmed A.fumigatus infection.Conclusions:Canary pox has been known as the disease that can result in high losses in a short time,as a re-emerging disease that has not been present during recent years in canary flocks in Iran.So,the current paper provides useful information to prevent misdiagnosed of canary pox disease which can cause secondary mycotic infection.

Treatment of cows with clinical endometritis Ⅲ as cows affected by pyometra-Non antibiotic treatment of severe clinical endometritis

Objective: To confirm the efficacy of non-antibiotic treatment with prostaglandin F2α(PGF2α) in dairy cows affected by severe clinical endometritis in (30±3) days in milk. Methods: Cows with clinical endometritis Ⅲ (n=399) were aligned into three groups randomly. The first group (n=115) received PGF2α, the second group (n=84) received intrauterine infusion (IUI) of oxytetracycline 10% + PGF2α, and the third group (n=200) received IUI. Cows were inseminated following estrus. The pregnancy status, parity, calving and artificial insemination season, ovaries with corpus luteum at the time of treatment, dystocia, body condition score and treatment groups were included in data analysis. Results: Total pregnancy rate was 40.1% after the first insemination and 94.2% after the third insemination. Overall pregnancy rate of treated cows with IUI+PGF2α(84.5%) was significantly lower than the treated cows with PGF2α(98.3%) or IUI (96%) (P<0.05). The first service pregnancy rate of inseminated cows in summer (14.3%) was lower in comparison with cows inseminated in spring (40.4%), fall (41.4%) and winter (51.7%) (P<0.05). Conclusions: PGF2α could treat severe clinical endometritis in dairy cows with corpus luteum in comparison with other treatments.

Clinical Profile of Stroke-Study Conducted in the Batticaloa Teaching Hospital, Sri Lanka

Stroke as a disease entity has significantly increased the morbidity, incapacity, and mortality in Sri Lanka. In the west, it is the 3rd most common cause of death. In addition to that, it is a disturbing and restricting cerebrovascular disease with a substantial amount of remaining shortage leading on to emotional and financial burden on the family and society. A hospital-based retrospective study was conducted at Teaching Hospital Batticaloa, Sri Lanka from July 1, 2016, to October 31, 2016. During the study period, data were collected from the medical records. Out of 34 patients, 21 (61.8%) were males and 13 (38.2%) were females. The male to female ratio was 1.6:1. Out of 34 patients, 17 (50%) were affected in the left side and 17 (50%) were affected on the right side. The most common risk factor was hypertension with 79.4%, and next to that diabetes mellitus (41.2%), smoking (23.5%), alcohol (20.6%), past history of Stroke (17.6%) and ischaemic heart disease (IHD) (14.7%). Stroke due to infarction is more common than haemorrhage. In this study, both right and left sides were affected equally. In order to prevent this devastating stroke, acknowledgment of risk factors for stroke is prime importance for the healthcare workers as well as public.

Presence of Virulence-Associated Genes and Ability to Form Biofilm among Clinical Isolates of <i>Escherichia coli</i>Causing Urinary Infection in Domestic Animals

Background: Urinary tract infection caused by Escherichia coli is a frequently observed condition both in humans and animals. Uropathogenic E. coli (UPEC) has been shown to have a pathogenicity island that enables them to infect the urinary tract. Because there is little information about the presence of UPEC-associated virulent genes in animal isolates this work was carried out with the intent to enhance the understanding about the strains of E.coli that cause infections in animals. Results: We screened 21 E. coli strains isolated causing urinary tract infection in domestic animals. Primers were designed to amplify urinary infection-associated genes. Nine genes, papA, tcpC, fyuA, tpbA, Lma, hylA, picU, tonB, and flicC were then amplified and sequenced. Different from the human isolate CFT073, all the animals E. coli lack some of the pathogenesis-associated genes. Genes encoding for proteins used to scavenge iron appear not to be so necessary during animal infections as they are in human infection. In further investigation of phenotypic properties, it was observed that animal UPECs have significantly more impaired ability to form biofilms than human UPEC strain. Conclusions: This study identified significant differences between human and animal UPECs. This may have its roots in the fact that it is difficult to determine if an animal has symptoms. Future studies will focus on some of the observations.

Spontaneous Intracerebral Hemorrhage: Epidemiology, Clinical Profile and Short-Term Outcome in a Tertiary Hospital in Sub-Saharan Africa

Background: Data on spontaneous intracerebral haemorrhagic (SICH) are scarce in Africa. Our objectives were to determine the prevalence of SICH, describe the clinical profile, aetiology and evaluate the prognosis (fatality case, functional outcome) of patients in a tertiary health care hospital in Cameroon. Methods: This was a hospital-based retrospective cohort which included patients with SICH and followed up for 6 months after stroke. Subarachnoid haemorrhage, cerebral venous thrombosis with bleeding or bleeding related with ischemic or brain tumour were excluded. Predictive factors were obtained using multiple logistic regression and survival by Kaplan Meier method. Results: The prevalence of SICH was 37% with male predominance (64.0%), a mean age of 55.6 ± 11.8 years. Deep coma was found in 30.3% on admission. The basal ganglion was the most frequent location of haemorrhage (85.1%) while intraventricular blood effusion, mass effect, cerebral oedema and herniation occurred in 31.4%, 25.7%, 8.8% and 5.0% respectively. Hypertension (57.5%) was the most common aetiology. The mean length of hospitalization was 9.0 ± 7.7 days and chest infection (30.7%) was the most frequent complication. The cumulative case fatality rate after 24 hours (day 1), during admission, month 1 and month 3 was 9.6%, 39.9%, 46.0%, 59.8% respectively. On multivariate analysis, GCS < 9 [OR (95% CI) = 3.538 (1.086 - 11.526), p = 0.036] and NIHSS 15 - 24 [OR (95% CI) = 7.498 (1.306 - 43.029), p = 0.024] were independent predictors of in-hospital mortality while mass effect [OR (95% CI) = 3.563 (1.217 - 10.432), p = 0.020] and hyperthermia [OR (95% CI) = 4.645 (1.341 - 16.085), p = 0.015] predict poor functional outcome. Six-month survival was 37.8%. Conclusion: About one-third of stroke patient were haemorrhagic. Hypertension is the leading CVRF and aetiology of spontaneous ICH. About 1 over 2 patients with SICH would die within 3 months while 50% of survivors would have a poor functional outcome at 6th month.

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon

Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are localized in the fallopian tubes. The occurrence of molar tubal ectopic pregnancy coexisting with intrauterine pregnancy is uncommon and consequently not often considered a diagnostic possibility. Case Report: We report the case of a 25-year-old woman, gravida 4 para 1, who complained of vaginal spotting and lower abdominal pain after 6 weeks of amenorrhea following clomiphene citrate ovarian stimulation. Transvaginal Ultrasonography revealed an intrauterine pregnancy and an unruptured left tubal ectopic pregnancy. She underwent successful laparoscopic salpingectomy while the intra-uterine pregnancy was allowed to continue. The ectopic pregnancy tissue histology reported an ectopic partial molar pregnancy. She subsequently had a normal vaginal delivery at 39 weeks and 3 days and her follow-up was uneventful. Conclusion: Heterotopic pregnancy is a rare but life-threatening condition. It should be suspected in a pregnant woman with a risk factor of multiple gestations who presents vaginal bleeding and lower abdominal pain in the context of early pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating the ectopic component. Routine histological examination of tubal specimens must be taken very seriously because some findings like molar pregnancies may require specific management.

The Impact of Creative Group Teaching and Educational Booklet Methods on Interpersonal Communications among Midwives in Clinical Setting

Group discussion teaching technique for small groups and encouragement of critical but constructive and creative thinking for finding new and efficient solutions can lead to provision of better health and medical services that is defined in clinical setting, as the clinical psychology finds a way for curing and education. The present study was conducted with the aim to compare the effects of creative group teaching and educational booklet on interpersonal skills of midwives in a clinical setting. The present study was conducted on 97 midwifery graduates working in hospitals in Kerman Province, in two groups of educational booklet (49 midwives) and educational workshop (48 midwives) who participated in a 3-day creative teaching workshop in summer 2015. Creative problem-solving teaching intervention group was taught through educational workshop method, including small group and team working, group discussion and mini lectures. Midwifery 1 intervention group was provided with an educational booklet validated by professors of Nursing and Midwifery School for independent and individual study by midwives working in Kerman Province hospitals. The two groups were matched in terms of personal details. Hospitals were randomly selected, and midwives were selected by quota sampling. Interpersonal communication skills of both groups were assessed before and after intervention, and two months later using Interpersonal Communication Skills Test. The results obtained were analyzed in SPSS-16 using descriptive statistics, including frequency and percentage, mean and standard deviation, and inferential statistics including U-Mann-Whitney, paired t, independent t, repeated measures ANOVA tests at significance level of P P P P P < 0.001). Both teaching methods improved midwives’ interpersonal communication skills. Therefore, standardized educational booklets which produce cost-effective similar results are recommended.

Mutations in Plasmodium knowlesi Kelch protein 13 and the dihydropteroate synthase gene in clinical samples

Objective:To determine the genetic diversity,natural selection and mutations in Plasmodium(P.)knowlesi drug resistant molecular markers Kelch 13 and dhps gene in clinical samples of Malaysia.Methods:P.knowlesi full-length gene sequences Kelch 13 gene(PkK13)from 40 samples and dhps gene from 30 samples originating from Malaysian Borneo were retrieved from public databases.Genetic diversity,natural selection,and phylogenetic analysis of gene sequences were analysed using DNAsp v5.10 and MEGA v5.2.Results:Seventy-two single nucleotide polymorphic sites(SNPs)across the full-length PkK13 gene(63 synonymous substitutions and 9 non-synonymous substitutions)with nucleotide diversity ofπ~0.005 was observed.Analysis of the full-length Pkdhps gene revealed 73 SNPs andπ~0.006(44 synonymous substitutions and 29 non-synonymous substitutions).A high number of haplotypes(PkK13;H=37 and Pkdhps;H=29)with haplotype diversity of Hd~0.99 were found in both genes,indicating population expansion.Nine mutant alleles were identified in PkK13 amino acid alignment of which,7(Asp3Glu,Lys50Gln,Lys53Glu,Ser123Thr,Ser127Pro,Ser149Thr and Ala169Thr)were within the Plasmodium specific domain,2(Val372Ile and Lys424Asn)were in the BTB/POZ domain and no mutation was observed within the kelch propeller domain.The 29 non-synonymous mutations in the Pkdhps gene were novel and only presented in exon 1 and 2.Conclusions:Monitoring the mutations from clinical samples collected from all states of Malaysia along with clinical efficacy studies will be necessary to determine the drug resistance in P.knowlesi.

Development of micro/nanostructured‒based biomaterials with biomedical applications

Natural biomaterials are now frequently used to build biocarrier systems,which can carry medications and biomolecules to a target region and achieve a desired therapeutic effect.Biomaterials and polymers are of great importance in the synthesis of nanomaterials.The recent studies have tended to use these materials because they are easily obtained from natural sources such as fungi,algae,bacteria,and medicinal plants.They are also biodegradable,compatible with neighborhoods,and non-toxic.Natural biomaterials and polymers are chemically changed when they are linked by cross linking agents with other polymers to create scaffolds,matrices,composites,and interpenetrating polymer networks employing microtechnology and nanotechnology.This review highlights how microengineered and nanoengineered biomaterials are utilized to produce efficient drug-delivery systems and biomedical and biological therapies and how innovative sources of biomaterials have been identified.

“I Dread the Heart Surgery but it Keeps My Child Alive”—Experiences of Parents of Children with Right Ventricular Outflow Tract Anomalies during the Assessment for Cardiac Reoperation

Background:Parents of children with complex right ventricular outflow tract(RVOT)anomalies are confronted with their child’s need for heart surgery early in life and repeated reoperations later on.Preoperative assessment needs to be performed whenever an indication for reoperation is suspected.The aim was to illuminate the experiences of parents of children diagnosed with RVOT anomalies,in particular,how they experience their child’s heart disease and everyday life during the assessment and after the decision on whether to perform a reoperation.Method:Individual interviews(n=27)were conducted with nine parents on three occasions between 2014 and 2016 and analyzed using reflexive thematic analysis.Results:The analysis resulted in the following five main coexisting themes:The heart surgery keeps my child alive illuminates parents’experiences during and after the assessment and emphasizes that heart surgery,although dreaded,is central for their child’s survival;Everyday struggles illuminates the different struggles parents had to face to ensure that their child would be in the best possible condition;the remaining three themes,Unconditional love,Trust in life,and Togetherness,illuminate the ways in which the parents gained inner strength and confidence in their everyday lives.Conclusion:Although the parents were grateful for the assessment and had learned to navigate among the fears it aroused,they experienced several distressing situations during the assessment process that should be addressed.By inviting both the parents and their child to participate in the child’s care,individualized support can take into account the needs of both parents and child.

Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of experience.Methods: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual CICO-situation.Results: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure airway.Conclusions: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.

Congenital Absence of Pericardium:The Largest Systematic Review in the Field on 247 Worldwide Cases(1977-Now)

Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case reports and case series,due to the lack of large studies on CAP.However,it represents the largest analysis in the field.Due to the rarity of CAP establishing an International Registry is recommended.