Rejected

During diving, Weddell seals (Leptonychotes weddellii) experience repeated hypoxemia. To mediate hypoxic tissue damage, Weddell seals employ vasoconstriction favoring vital organs (e.g. brain, lung, adrenals) resulting in reduced oxygen delivery to visceral and peripheral tissues. Weddell seals therefore experience periods of local ischemia associated with vasoconstriction followed by reoxygenation and return of perfusion at the surface. Ischemia-reperfusion injury (IRI) is the expected result from reduced blood flow and localized hypoxia, followed by reoxygenation and reperfusion. A typical human response to IRI induces inflammation. We studied the inflammatory response of Weddell seals to determine whether its downregulation could be a mechanism by which seals avoid hypoxic and IRI injury. Weddell seal white blood cells (n=12) demonstrate a reduced immune reaction (mean ± stdev 247± 200 fold induction of IL-6 from baseline) compared to human monocytes (n=6 replicates, THP-1 cells 3091 ± 1126 fold IL-6 induction, t-test p<0.0001) when exposed to an inflammatory stimulus in vitro (10 ng/mL lipopolysaccharide). To evaluate species differences in gene pathways associated with the immune response, we conducted RNA-seq and identified distinct transcriptomic profiles between species. We next evaluated the inflammatory response of Weddell seal primary cells (monocytes and pulmonary endothelial cells) resulting from hypoxia and reoxygenation. By simulating this natural stressor, we aim to discover whether the response of immune cells is an important component of molecular protection against IRI inflammatory sequelae in diving seals.

Gut microbiota has been reported to protect from lung viral infection in animal models by stimulating type-I interferon signaling. Type-I interferons can have direct antiviral activity while also stimulating antibody-producing B cells. Antibodies against Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV2) have been correlated to faster infection clearance and protection against reinfection. A specific 4-strain probiotic combination (Pediococcus acidilactici CECT7483 plus Lactoplantibacillus plantarum CECT7484, CECT7485 and CECT30292) was recently studied in a randomized, quadruple-blinded, placebo-controlled trial in 300 SARS-CoV2-infected, symptomatic ambulatory patients (NCT04517422). Study subjects did not receive corticosteroids or antivirals. Compared to placebo, probiotic intervention (2×10 cfu/day for 30 days) achieved faster symptom clearance and increased SARS-CoV2-specific immunoglobulins M and G (IgM and IgG). We hypothesize these effects could be related to increased type-I interferon signaling.

The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children.

Thorough physical examination is a must for proper diagnosis of medical diseases and to elucidate all physical findings. Abdominal pain is a very common presentation to Emergency Department, compromising 5%-10% of all visits, and around a quarter are discharged with no particular diagnosis. Pyocolpos is one of those presentations that requires a thorough physical examination, including that of the external genitalia. A 3-year-old girl presented with recurrent history of abdominal pain and a recent history of fever with acute abdomen picture-like presentation, with difficulty voiding over the past few days. She was previously assessed for recurrent abdominal pain, without any identifiable etiology. Upon inspection for indwelling catheter insertion, absence of the vaginal introitus was noted with a bulging mass and an imperforate hymen. Pyocolpos was diagnosed and drained following hymenotomy. Pyocolpos is a rare complication of hydrocolpos. Enlarged vagina causes extrinsic compression to nearby structures, such as the bladder trigone and ureters, causing hydronephrosis, hydroureter, and other sequel including acute kidney injury and urosepsis. An imperforate hymen must be considered in the differential for chronic and recurrent abdominal pain, and can be easily identified by a thorough physical examination, including that of the external genitalia, which is a must in today's every medical practice.

Pseudomelanosis duodeni is a rare finding usually described as a black/brown speckled or tattooed appearance of the intestinal mucosa. Although an incidental finding, it has been associated with different medications and chronic medical conditions such as diabetes mellitus and chronic renal failure. We describe an elderly male who presented with epigastric pain and melena. Endoscopy showed pseudomelanosis duodeni related to intravenous (IV) iron transfusion. To our knowledge, this is the first report of pseudomelanosis duodeni related to IV iron use. In spite of its benign nature, the diagnosis of pseudomelanosis duodeni is essential to rule out other serious medical conditions that mimic its physical findings.

The primary purpose of the current study was to determine the value of the shunt surgery and/or prophylactic antiepileptic therapy, in patients after mild traumatic brain injury (mTBI) with ventricular dilatation (VD) and incipient cognitive impairment, in the prevention of cognitive deterioration and probably in the development of dementia. Based on the following criteria: a) mTBI b) VD detected in CT scan during admission, and c) the presence of one of the following: i) dizziness, ii) headache, and iii) seizures, admitted to the Emergency Department between January 2010 and January 2020, we enrolled 127 of 947 eligible subjects. The subjects were divided into five groups: Group A (control group): only VD illustration in CT scan, Group B: incipient dementia, who had a more insidious onset presenting with cognitive dysfunctions at indefinite ages, Group C: shunt system (SH)/antiepileptic drugs (AEDs) presenting with cognitive dysfunction and urinary incontinence or gait disturbances or both, that were treated as idiopathic normal-pressure hydrocephalus (iNPH) with the surgical placement of an SH and AED therapy (standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily), and Group D: AED, presenting with cognitive dysfunctions at indefinite ages and one or two episodes of seizures in the past, treated with AED from the very first moment of initiation with a standard AED phenytoin (1000 mg loading dose followed by 300 mg) daily. Overall, improvement in daily activities was achieved in 14.1% (18 of 127 patients), recording a significantly higher performance in group D (5.5%) rather than in groups A (1.5%), B (3.1%), and C (3.9%), (p < 0.05). We concluded that changes in VD (ΔVD) were associated with improvement in mRS (ΔmRS ≥ 1) – daily activities and mental status. ΔVD was also independently associated with reduced daily activities during the long-term follow-up. Interestingly, therapeutic shunting and AED in patients with a history of epilepsies may have a positive impact on the development of mental status impairment. This is a novel observation that has to be confirmed by more extensive multicenter studies in the future.

Lumbar spinal stenosis, a narrowing of the spinal canal around the spinal neurovascular structures, is a common etiology for lower back and leg pain in older people. Sciatica, a frequent symptom of lumbar spinal stenosis, typically presents with sharp and/or aching pain that originates in the buttock, extends to the thigh, and radiates into the foot and toes; in addition, it can be accompanied by weakness of the associated lower extremity. In individuals with sciatica-related persistent symptoms or functional limitations or both, spinal decompression surgery may be necessary. A cerebrospinal fluid leak is a potential complication of lumbar spinal stenosis surgery; it is frequently–yet not always–accompanied by a postural headache. The cerebrospinal fluid leak can result from an intraoperative tear or postoperatively. Albeit a more common adverse event after body contouring surgery, seroma–a postoperative serous fluid collection that is usually detectable as a palpable or visible fluid wave on clinical examination–has also been observed as a complication following lumbar spinal stenosis surgery. A man who experienced an intra-operative accidental dural tear during lumbar spinal stenosis surgery is described. A large cerebrospinal fluid leak that involved both the laminectomy bed and the subcutaneous tissue of his back subsequently developed; the leak eventually presented as duro-cutaneous fistulas without headache. His doctors misinterpreted the cerebrospinal fluid leak as a seroma; this may have occurred since not only did the color of the persistent and continuously dripping fluid varied from being clear to slightly tinged pink, but also the patient never had a headache or any other symptoms associated with a cerebrospinal fluid leak. When his lower back was appropriately evaluated with magnetic resonance imaging, the diagnosis of a large cerebrospinal fluid leak was established. In conclusion, lumbar spinal stenosis back surgery can be associated with postoperative complications, including cerebrospinal fluid leak and–less frequently–seroma. However, following lumbar spinal stenosis surgery, the absence of a headache does not exclude the possibility of a cerebrospinal fluid leak. Also, the presence of fluid leaking from the surgical site after lumbar spinal stenosis back surgery should not only prompt the clinician to entertain the possibility of a surgery-associated cerebrospinal fluid leak but also to obtain additional diagnostic studies–such as magnetic resonance imaging–to establish the diagnosis.

Superior vena cava (SVC) syndrome is a clinical entity with signs and symptoms resulting from obstruction of blood flow through the SVC. The resulting obstruction leads to edema in the upper body, including the head, neck, and upper extremities. Clinical signs and symptoms can include plethora, cyanosis, dyspnea, stridor, cough, and hoarseness, as well as more serious complications such as cerebral edema leading to headache, confusion, and coma. Here, we present an interesting case of a 66-year-old female, with a medical history of esophageal cancer in remission and thyroid cancer currently undergoing radiation therapy, who was admitted for facial and upper extremity swelling. The initial impression was of angioedema or an allergic reaction. Imaging studies showed thrombus in the SVC resulting in SVC syndrome. The patient was treated with heparin initially, with a plan for an interventional radiologist to perform catheter-guided thrombolysis. However, the patient became unstable and ended up requiring mechanical ventilation. The patient was eventually discharged on oral anticoagulants. This case was rare as the patient developed SVC syndrome from venous thrombosis in the absence of any external tumor compression or as a result of an intravascular catheter.

Late onset Wilson disease (WD) is a rare form of WD. WD has variability of clinical presentations from acute liver failure to chronic liver disease (CLD). The hepatic and neurological variants of WD have wider variations.

Open trigger finger release is generally performed in the operating room in an outpatient setting. Its complication rate widely varies between 1% and 43%. Our goal was to determine whether performing this surgery in the clinic is a safe and viable alternative to performing this surgery in the operating room.