Fluid Buildup Research Articles

Pneumonia Disease Detection Using Chest X-Rays and Machine Learning

Pneumonia is a deadly disease affecting millions worldwide, caused by microorganisms and environmental factors. It leads to lung fluid build-up, making breathing difficult, and is a leading cause of death. Early detection and treatment are crucial for preventing severe outcomes. Chest X-rays are commonly used for diagnoses due to their accessibility and low costs; however, detecting pneumonia through X-rays is challenging. Automated methods are needed, and machine learning can solve complex computer vision problems in medical imaging. This research develops a robust machine learning model for the early detection of pneumonia using chest X-rays, leveraging advanced image processing techniques and deep learning algorithms that accurately identify pneumonia patterns, enabling prompt diagnosis and treatment. The research develops a CNN model from the ground up and a ResNet-50 pretrained model This study uses the RSNA pneumonia detection challenge original dataset comprising 26,684 chest array images collected from unique patients (56% male, 44% females) to build a machine learning model for the early detection of pneumonia. The data are made up of pneumonia (31.6%) and non-pneumonia (68.8%), providing an effective foundation for the model training and evaluation. A reduced size of the dataset was used to examine the impact of data size and both versions were tested with and without the use of augmentation. The models were compared with existing works, the model’s effectiveness in detecting pneumonia was compared with one another, and the impact of augmentation and the dataset size on the performance of the models was examined. The overall best accuracy achieved was that of the CNN model from scratch, with no augmentation, an accuracy of 0.79, a precision of 0.76, a recall of 0.73, and an F1 score of 0.74. However, the pretrained model, with lower overall accuracy, was found to be more generalizable.

Risk Factors for Shunt Failure in Pediatric Patients with Hydrocephalus: A Systematic Literature Review

Background: Hydrocephalus in pediatric patients is a severe neurological condition requiring timely and effective treatment to prevent life-threatening complications. Shunt placement is the primary intervention to manage cerebrospinal fluid buildup, but shunt failure remains a persistent and critical challenge in clinical practice. This study aimed to evaluate the risk factors influencing shunt success and explore infection prevention strategies to enhance treatment outcomes for pediatric patients. Methods: Using a systematic review of relevant literature accessed through PubMed, we analyzed studies selected based on strict inclusion criteria, including research type and publication year. Key findings from this analysis underscore several critical aspects: risk factors for shunt failure, the efficacy of innovative technologies, and infection prevention strategies. Results: Advanced devices like the Sophy valve and El-Shafei shunt system demonstrate promising potential in improving treatment outcomes, particularly in adult patients. However, their applicability in pediatric cases requires further exploration. Infection prevention strategies are vital to reducing complications, with approaches such as postoperative antibiotics and the use of antibiotic-impregnated cerebrospinal fluid shunt catheters proving effective in lowering postoperative infection rates. A cost-benefit analysis further highlights the economic viability of AISC utilization in standard practice. A comprehensive understanding of shunt failure risk factors and infection control measures is essential for optimizing pediatric hydrocephalus treatment. While new technologies and preventive strategies show significant promise, additional research comparing these innovations with conventional methods is necessary to fully establish their safety and efficacy. Conclusion: This study provides a foundation for advancing more effective, efficient, and economically viable treatment approaches for pediatric hydrocephalus patients.

Pericardial effusion in an Indian context: clinical insights and dynamics from a tertiary care centre

BackgroundPericardial effusion (PE) indicates the build-up of fluid within the pericardial sac, which encases the heart. The present study was undertaken to assess the clinical profile, etiology of pericardial effusion and to determine the correlation of cardiac tamponade and constrictive pericarditis with etiology.MethodsA prospective observational hospital based longitudinal study was undertaken among the 88 newly diagnosed and known patients of pericardial effusion who are above 18 years. The clinical profile of pericardial effusion including history, examination, standard lab parameters routinely done including thyroid function tests, HIV Serology, ECG, Echocardiography and imaging if done (HRCT thorax), pericardial fluid analysis (if performed) were elicited.ResultsMajority of the patients were males (55.7%), with a mean age of 51.3 years. Among the 88 patients of pericardial effusion, 20 had cardiac tamponade, 13 individuals were diagnosed with constrictive pericarditis. Dyspnea was the most common presenting complaint (65.9%). Chronic kidney disease / uremia is the most common cause of pericardial effusion accounting for 25%, followed by neoplastic (20.5%) and tuberculosis (17%). While in cardiac tamponade patients neoplasm followed by tuberculosis were the most common etiology, patients with constrictive pericarditis had tuberculosis followed by chronic kidney disease as the most common etiology. Echocardiography features were not significantly different according to the etiology of the pericardial effusion (p > 0.05). Thickened pericardium found in the echocardiography showed maximum specificity (76.9%), while thickened fluid/exudates showed maximum sensitivity (65.2%) and negative predictive value (77.1%) for tuberculous pericardial effusion.ConclusionChronic kidney disease, closely followed by infections (mostly tuberculosis), are the frequent causes of PE in the present settings. Breathlessness is the most frequent clinical feature in the patients of PE. Fibrin strands, thickened pericardium, thickened fluid in Echocardiography assists in diagnosing tubercular pericardial effusion. Cardiomegaly in chest X-ray or CT scans should further prompt towards diagnosing pericardial effusion. It is essential to incorporate these findings into the clinical practice, by evaluating the patients presenting with breathlessness for PE. CKD needs to be placed on par with tuberculosis while suspecting the etiology of the PE in the present settings. ADA levels in pericardial fluid (> 40) can be considered as a specific marker for tubercular PE.

A CONCEPT PAPER: “THE DEVELOPMENT OF SKY ARMS: A NOVEL SYSTEM FOR ALLEVIATING EDEMA USING THE 4D DEVELOPMENT MODEL”

Millions of people worldwide suffer from oedema, a condition that frequently shows up as swelling in the upper extremities and is characterized by an abnormal buildup of fluid in tissues. Efficient management of oedema is crucial for alleviating symptoms and improving patient outcomes, typically achieved through elevating the limbs to aid in fluid drainage. However, current methods, such as traditional arm slings and bandages connected to IV stands, have significant drawbacks, including limited adaptability, discomfort, inadequate support, and environmental issues due to frequent bandage changes. This concept paper introduces Sky Arms, an innovative device designed to revolutionise the management of upper limb oedema. Sky Arms is a limb elevation device incorporating cutting-edge materials, digital technology, dynamic customisation, and data-driven feedback. It will be developed using the 4D Development Model to provide a user-friendly, secure, and adaptable experience. This study explores the features of Sky Arms, the role of the 4D Model in enhancing therapy effectiveness, the potential impact on patient care and recovery, and the opportunities for collaboration in the social sciences, education, and innovation. Sky Arms offers a promising solution to the persistent problem of oedema through the implementation of the 4D Development Model. This study highlights its innovative methodology and potential benefits, advocating for interdisciplinary cooperation to bring this technology to fruition. Sky Arms represents a significant advancement in oedema treatment, offering the potential for improved patient outcomes, a higher quality of care, and reduced healthcare costs.

Saudi Awareness of Chronic Kidney Disease Risk Factors

Background: Complex disorder CKD involves excessive fluid and waste buildup in the circulation, causing structural or functional damage to the kidneys. This article used general Saudi population data to assess public understanding of chronic kidney disease risk factor among adults. Methodology: The present study is a cross-sectional investigation that included a sample of 1111 participants from the Kingdom of Saudi Arabia, all of whom were above the age of eighteen and represented both genders. The data was analyzed utilizing Microsoft Excel and SPSS software. The findings of this study encompassed a total of 1111 participants, with 67.9% identifying as females and 32.1% as males. A total of 23.7% of the participants indicated that they had a family member who had been diagnosed with renal illness. Among this group, 51% reported that the affected family member belonged to the first-class category. A majority of respondents (71.6%) indicated possessing a moderate level of knowledge, while a smaller proportion (17.5%) reported having little knowledge. Conversely, only 11% of participants claimed to possess a high level of knowledge. A total of 44.9% of participants indicated a moderate attitude, while 39.9% reported a low attitude score. Only 15.2% of respondents reported a high attitude score. Conclusion: Based on the present research, it was determined that the participants exhibited a commendable comprehension of chronic kidney diseases (CKDs), with findings aligning with previous investigations conducted in Saudi Arabia and surpassing those from diverse nations. Furthermore, the participants in our research had a favorable disposition towards chronic kidney diseases (CKDs), aligning with findings from previous studies.

Assessment of Dyspnea, ECOG and Karnofsky Performance Scaleafter VATS Pleurodesis in Patients with Malignant Pleural Effusions

Background: Malignant pleural effusions (MPE) are a pathological build-up of fluid and cancer cells within the pleural space. Patients have a significantly impaired quality and quantity of life, as this condition usually indicates an advanced disease. Video-assisted thoracoscopic (VATS) pleurodesis is a minimally invasive and effective treatment modality for patients with MPE.Material and Methods: We conducted a retrospective study of 60 patients with MPE treated with VATS pleurodesis. Success rates within a one-month follow-up, the intensity of dyspnea, Karnofsky and ECOG Performance Status Scales before and after the procedure, and length of hospital stay were observed. Results: VATS pleurodesis had a high success rate at the end of a one-month follow-up. A statistically significant difference was observed regarding the intensity of dyspnea, Karnofsky, and ECOG Performance Status before and after VATS pleurodesis. The average length of hospital stay was 7.5 days for these patients.Conclusion: Video-assisted thoracoscopic (VATS) pleurodesis is associated with low morbidity and a high success rate and is a reliable treatment modality for patients with MPE.

Abstract A060: Identification of tumour-specific variants from pleural effusion cell-free DNA as diagnostic markers of cancers affecting the lungs

Abstract Background: Pleural mesothelioma (PM) can be difficult to diagnose due to a combination of the growth pattern of the tumour, the invasive nature of the biopsy procedure and the frailty of the patient. Some patients with PM develop a build-up of fluid around their lungs as their first clinical symptom. This fluid can make breathing difficult and is routinely drained as part of standard care. Currently, a cytological test can be performed to identify if PM cells are present in the fluid, however, while this is a specific test, it lacks sensitivity. We examined if (a) cell-free DNA (cfDNA) originating from tumours affecting the lung could be detected in this fluid and (b) if this cfDNA could be determined as coming from PM compared to non-small cell lung cancer (NSCLC), due to changes in genes that only occur in these types of tumours. Methods: Using the QIAamp MinElute ccfDNA Kit, we were able to isolate sufficient concentrations of cfDNA from pleural effusions (n=80) derived from patient samples procured by our colleagues at Southmead Hospital with either PM or NSCLC to perform gene panel sequencing. Using the QIAseq Targeted DNA Pro Human Lung Cancer Research Panel, with additional booster primers covering BAP1 and SETD2, we performed the library preparation in-house. Data analysis was carried out using the QIAGEN CLC Genomics Workbench, with the specific workflows for the gene panels and results were filtered by QC, proportion of variant reads and variant read count. Data were compared to expected variant frequencies published in TCGA. Results: Tumour-specific cfDNA was isolated from pleural effusions in the majority of samples tested. In a proportion of these, variants indicative of a specific type of tumour (PM or NSCLC) were readily detectable, at slightly lower than the expected frequencies than reported in TCGA. Conclusions and future work: This approach can act as a 'rule-in' clinically diagnostic test for the presence of PM or NSCLC in a higher proportion of people that can currently be identified through cytology testing. These individuals could be spared from receiving an invasive biopsy to diagnose their tumour. We are currently working on (i) increasing the sensitivity of this approach to identify more cases and (ii) if a bioinformatic method can identify tumour-specific copy number alterations from the gene panel sequencing data. Citation Format: Connie MacKinnon, Dr Colette Mustard, Dr Nicole Brace, Dr Beth Sage, Jenny Symonds, Colin Nixon, Dr Anna Bibby, A/Prof Antonia Pritchard. Identification of tumour-specific variants from pleural effusion cell-free DNA as diagnostic markers of cancers affecting the lungs [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A060.

Current Review of Heart Failure-Related Risk and Prognostic Factors.

Heart failure (HF) is a complex clinical syndrome characterized by the heart's inability to maintain sufficient circulation, leading to inadequate organ perfusion and fluid buildup. A thorough understanding of the molecular, biochemical, and hemodynamic interactions that underlie this condition is essential for improving its management and enhancing patient outcomes. Recent advancements in cardiovascular research have emphasized the critical role of microRNAs (miRNAs) as post-transcriptional regulators of gene expression, playing an important part in the development and progression of HF. This review aims to explore the contributions of miRNAs, systemic congestion markers, and traditional biomarkers to the pathophysiology of heart failure, with the objective of clarifying their prognostic value and potential clinical applications. Among the miRNAs studied, miR-30d, miR-126-3p, and miR-483-3p have been identified as key players in processes such as left ventricular remodeling, regulation of pulmonary artery pressure, and adaptation of the right ventricle. These findings underscore the importance of miRNAs in modulating the structural and functional changes seen in HF. Beyond the heart, HF affects multiple organ systems, including the kidneys and liver, with markers of dysfunction in these organs-such as worsening renal function and liver stiffness-being closely linked to increased morbidity and mortality. This highlights the interdependence of the heart and other organs, where systemic congestion, indicated by elevated venous pressures, exacerbates organ dysfunction. In this context, traditional biomarkers like natriuretic peptides and cardiac troponins remain vital tools in the diagnosis and management of HF. Natriuretic peptides reflect ventricular strain, while troponins are indicators of myocardial injury, both of which are critical for risk stratification and monitoring disease progression. Emerging diagnostic techniques, such as lung ultrasonography and advanced echocardiographic methods, offer new ways to assess hemodynamic status, further aiding therapeutic decision-making. These techniques, alongside established biomarkers, provide a more comprehensive approach to understanding the complexities of heart failure and managing its impact on patients. In conclusion, miRNAs, systemic congestion markers, and traditional biomarkers are indispensable for understanding HF pathophysiology and determining patient prognosis. The integration of novel diagnostic tools with existing biomarkers holds the promise of improved strategies for the management of heart failure. However, further research is needed to validate their prognostic value and refine their role in optimizing treatment outcomes.

Antisecretory Factor 16 (AF16): A Promising Avenue for the Treatment of Traumatic Brain Injury—An In Vitro Model Approach

Traumatic brain injury (TBI) is caused by an external mechanical force to the head, resulting in abnormal brain functioning and clinical manifestations. Antisecretory factor (AF16) is a potential therapeutic agent for TBI treatment due to its ability to inhibit fluid secretion and decrease inflammation, intracranial pressure, and interstitial fluid build-up, key hallmarks presented in TBI. Here, we investigated the effect of AF16 in an in vitro model of neuronal injury, as well as its impact on key components of the autophagy pathway and mitochondrial dynamics. N2Awt cells were treated with AF16, injured using a scratch assay, and analysed using confocal microscopy, correlative light and electron microscopy (CLEM), flow cytometry, and western blotting. Our results reveal that AF16 enhances autophagy activity, regulates mitochondrial dynamics, and provides protection as early as 6 h post-injury. Fluorescently labelled AF16 was observed to localise to lysosomes and the autophagy compartment, suggesting a role for autophagy and mitochondrial quality control in conferring AF16-associated neuronal protection. This study concludes that AF16 has potential as a therapeutic agent for TBI treatment through is regulation of autophagy and mitochondrial dynamics.

A case report of bilateral psoas abscess with co-existing gluteal abscess in Pott`s disease of the spine in a middle-aged woman in a Specialist Hospital

Psoas abscess (PA) is the buildup of suppurative fluid in the fascia surrounding the psoas/iliopsosas muscle, is a rare condition, with diagnostic difficulty. Pott`s disease also called spinal tuberculosis occurs due to extra pulmonary tuberculosis. Backpain, fever, weight loss, lump in the groin and limping are its main symptoms. Curable by administering antitubercular therapy and sensitive antimicrobials with analgesics for indicative relief. Surgical procedures can be carried out to eliminate the accrued fluid based on the inter individual degree of presentation. In this case report, we report a rare case of bilateral psoas abscess with co-existing gluteal abscess and Potts’s disease. A 48-year old female presented with complaints of backpain, limping, lump in the flank/buttock and fever of two weeks. Abdominopelvic computed tomography scan showed massive right iliopsoas muscle collection with extension into the ipsilateral gluteal region and subcutaneous tissue. Similar collection was seen in the left psoas muscle superiorly. The bone window of the lumbosacral spine showed the anterior wedged collapse of the vertebral bodies with gibbus deformity. The patient had spontaneous rupture of the gluteal collection and surgical drainage of the right iliopsoas and left psoas collection was done. Anti-Kochs therapy was commenced and patient is currently doing great. The introduction of computed tomography (CT) and magnetic resonance imaging (MRI) has greatly improved the diagnosis of psoas abscess with Pott`s disease or in its isolated forms.

Research examining microcirculatory dynamics in diseases that cause oedema using skin blood flow and skin reperfusion pressure

Oedema is a build-up of fluid in the tissues in the body. It can develop due to diseases including heart failure and kidney disease. It usually occurs in the limbs, where it can cause discomfort, joint stiffness or pain. However, fluid can also accumulate in the brain, which is called cerebral oedema or in the blood vessels serving the lungs, called pulmonary oedema. A type of oedema called pitting oedema is more prevalent than the other type, non-pitting oedema. In order to treat the condition, the underlying cause must be resolved. Treatment can involve diuretics to help the release of fluids, positioning to encourage draining or compression to force fluids away. Researchers at the Faculty of Rehabilitation at Reiwa Health Sciences University led by Dr Haruki Kogo are examining the microcirculatory dynamics of diseases that cause oedema using skin blood flow and skin reperfusion pressure. They have developed a device that can diagnose oedema and confirmed the reproducibility and validity of the device. They have registered the trademark and plan to commercialise the device for use in clinical and research settings. The device is able to measure the depth of the surface imprint in pitting oedema patients, simplifying the evaluation of pitting oedema, which will be extremely useful in clinical settings. The researchers tested the device across two hospitals, comparing the results with results obtained from the popular circumference measurement method and ultrasound imaging measurement. The team found that there was a strong correlation between measurements from the device and the tissue thickness measurement derived from the ultrasound. This confirmed that the device is a reliable gauge for the measurement of oedema.

A Wearable Gait-Analysis Device for Idiopathic Normal-Pressure Hydrocephalus (INPH) Monitoring.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a progressive neurologic disorder (fluid build-up in the brain) that affects 0.2-5% of the UK population aged over 65. Mobility problems, dementia and urinary incontinence are symptoms of iNPH but often these are not properly evaluated, and patients receive the wrong diagnosis. Here, we describe the development and testing of a wearable device that records and analyses a patient's gait. The movement patterns, expressed as quantitative data, allow clinicians to improve the non-invasive diagnosis of iNPH as well as monitor the management of patients undergoing treatment. The wearable sensor system comprises a miniature electronic unit that attaches to one ankle of the patient via a simple Velcro strap. The unit monitors acceleration along three axes with a sample rate of 60 Hz and transmits the data via a Bluetooth communication link to a tablet or smart phone running the Android and the iOS operating systems. The software package extracts statistics based on stride length, stride height, distance walked and speed. Analysis confirmed that the system achieved an average accuracy of at least 98% for gait tests conducted over distances 9 m. Using this device will improve the diagnostic process and management of iNPH and the treatment and management of this condition.

A-097 Body Fluid Validation for 11 Analytes on a Chemistry Analyzer

Abstract Background Most clinical chemistry assays are intended for use in serum, plasma, urine, and/or CSF with no performance characteristics on body fluids. However, testing of body fluids can be medically necessary for certain diagnoses. Such as determining the cause of fluid buildup in peritoneal spaces, pleural effusions, whether effusions are transudates or exudates, and even diagnosing some joint disorders. To provide these medically necessary tests, the burden is on the laboratory to perform regulatory-required validations. Herein is the validation of 11 clinical chemistry analytes in several common body fluids. Methods Mixing and stability studies were performed for the following analytes on the Roche cobas c702 (Roche Diagnostics), using the methods intended for use with serum/plasma samples: Albumin, Amylase, Bilirubin, Urea Nitrogen, Cholesterol, Creatinine, Glucose, Lactate Dehydrogenase, Lipase, Protein, and Triglycerides. Six individual fluid samples were mixed with the intended use matrix in 3 ratios: 1:3, 1:1, and 3:1. The following matrices were evaluated: pleural, peritoneal, JP drainage, synovial, and pancreatic cyst fluids. Stabilities were tested for 7 days at room temperature (RT) and 2-8°C. A maximum dilution study was also performed for Amylase. Results Mixing Study: The results are shown in the table below: Stability: For most body fluids, analytes were stable for 7 days at RT and 2-8 °C. The following analytes displayed shorter stability at RT: Bilirubin (peritoneal: 2 days, pleural: 1 day, JP drainage: 1 day), Urea Nitrogen (JP drain fluid: 2 days), Lipase (peritoneal fluid 5 days), and Triglycerides (peritoneal fluid: 5 days). Lactate dehydrogenase in pleural fluid showed a stability of 5 days at RT and 2 days at 2-8 °C. Maximum Dilution A 1:505 compounded manual and automated dilution displayed a <7% bias. Conclusions No sample matrix interferences were observed for any of the body fluids-analyte pairs tested allowing for this medically necessary testing.

Management of Late onset Capsular Bag Distension Syndrome with Capsular Bag Lavage

Capsular bag distention syndrome (CBDS) is one of the rare causes of decrease in vision following cataract surgery with signs such as a shallower anterior chamber, unexpected myopic vision, and the build-up of fluid between the implanted lens and the posterior capsule. We report a patient with late onset diminution of vision, following uneventful phacoemulsification with continuous curvilinear capsulorhexis (CCC) and in-the-bag intra ocular lens (IOL) implantation: Post capsular bag lavage the CBDS resolved immediately with no complications and the vision improved to 6/9 after 2 weeks post op. Our case highlights the safety and efficacy of capsular bag lavage technique.

Malignancy of Malignant Ascites: A Comprehensive Review of Interplay between Biochemical Variables, Tumor Microenvironment and Growth Factors.

Malignant ascites, a buildup of fluid in the abdominal cavity, is a serious consequence of many malignancies. This review aims to comprehend the biochemical makeup of malignant ascites, such as pH, cholesterol, protein, etc., which is crucial to developing therapeutics with better treatment outcomes and hence correlate with corresponding prognostic value. The unique tumour microenvironment exhibited by malignant ascites and the crosstalk between inflammatory cells, cytokines and chemokines, interactions between tumour and non-tumour cell types, activation of vital cell signalling pathways within the TME for VEGF-regulated sustained angiogenesis, cancer progression and metastasis is highlighted. This review addresses the need to develop comprehensive assay platforms to identify various biochemical aspects of ascites, to discover the interactions of the tumour microenvironment and to study VEGF-regulated permeability that can expedite early diagnosis and progression of ascites.

Surgical Management of Penoscrotal Filariasis by Reconstructive Penoscrotoplasty: An Experience from a Tertiary Healthcare Centre

Abstract Chronic lymphedema has a number of etiological causes that affect the lymphatic drainage system. It is characterized by the gradual buildup of protein-rich fluid in the subcutaneous tissue. Any of the body components may be involved, and the causes may vary from congenital to acquired. Lymphedema and subcutaneous tissue thickening are characteristics of external genital elephantiasis. As a result, the skin has a pachyderm-like look. For the sufferer, this pathology is invalidating. Often, reconstructive surgery is the only option for restoring the external genitalia’s appearance and functionality. We report a case series of patients who presented with giant penoscrotal filariasis and were successfully managed with reconstructive penoscrotoplasty.

Gross hematuria and congestive heart failure – two sides of the same coin

Poststreptococcal glomerulonephritis (PSGN) is an immune-mediated disease following infection with nephritogenic strains of group A β-hemolytic Streptococcus (GAS), affecting children aged of 2 to 10. We report 2 different presentations of PSGN from “Grigore Alexandrescu” Hospital. Case 1: A 5 years old girl was admitted for gross hematuria. Investigations revealed: anemia, inflammatory syndrome, mild nitrogen retention syndrome, elevated ASO and low levels of serum C3, nephritic-range proteinuria and severe hematuria. she received antibiotic treatment with initial improvement. A relapse occurred in one week, a second course of antibiotic and corticosteroids was necessary. Case 2: A 15-year-old girl was admitted for acute cardiac failure, hypertension and oliguria. Investigations revealed anemia, nitrogen retention, dyslipidemia, inflammatory syndrome, high ASO titers, low serum C3, microscopic hematuria, nephrotic-range proteinuria. She had fluid build-up in both lungs and pericardium. The diagnosis was PSGN and congestive heart failure (volume overload). She received antibiotics, diuretics and ACE inhibitors. PSGN is re-emerging in pediatric practice due to the resurgence of streptococcal infections within children's communities. The clinical presentation might be highly variable, ranging from hematuria to heart failure. Clinicians should be aware and actively consider this diagnosis.

Topological indices based VIKOR assisted multi-criteria decision technique for lung disorders.

Lung disorders involve swelling, inflammation, and muscle tightening around the airways, with symptoms such as coughing, wheezing, shortness of breath, and abnormal fluid build-up. The global prevalence of these conditions is rising, highlighting the need for extensive research to alleviate their severity and symptoms. Due to the chronic nature and recurrence of these disorders, the human body often develops immunity and side effects to certain medications. Therefore, developing novel and appropriate drug combinations is crucial. This study analyzes a dataset of lung disorder drugs, characterized by various topological indices. The structures of 16 drugs used to treat lung disorders are correlated with their physical properties using degree-based graph invariants. When considering specific attributes, the VIKOR (VlseKriterijumska Optimizacija I Kompromisno Resenje) method provides an optimal ranking for each drug. The QSPR results highlight the effectiveness of this approach in drug prioritization, offering valuable insights for clinical decision-making and drug development. This methodology can enhance the strategic selection of treatments for lung disorders, leading to improved patient care and better resource allocation.

PpIX-enabled fluorescence-based detection and photodynamic priming of platinum-resistant ovarian cancer cells under fluid shear stress.

Over 75% percent of ovarian cancer patients are diagnosed with advanced-stage disease characterized by unresectable intraperitoneal dissemination and the presence of ascites, or excessive fluid build-up within the abdomen. Conventional treatments include cytoreductive surgery followed by multi-line platinum and taxane chemotherapy regimens. Despite an initial response to treatment, over 75% of patients with advanced-stage ovarian cancer will relapse and succumb to platinum-resistant disease. Recent evidence suggests that fluid shear stress (FSS), which results from the movement of fluid such as ascites, induces epithelial-to-mesenchymal transition and confers resistance to carboplatin in ovarian cancer cells. This study demonstrates, for the first time, that FSS-induced platinum resistance correlates with increased cellular protoporphyrin IX (PpIX), the penultimate downstream product of heme biosynthesis, the production of which can be enhanced using the clinically approved pro-drug aminolevulinic acid (ALA). These data suggest that, with further investigation, PpIX could serve as a fluorescence-based biomarker of FSS-induced platinum resistance. Additionally, this study investigates the efficacy of PpIX-enabled photodynamic therapy (PDT) and the secretion of extracellular vesicles under static and FSS conditions in Caov-3 and NIH:OVCAR-3 cells, two representative cell lines for high-grade serous ovarian carcinoma (HGSOC), the most lethal form of the disease. FSS induces resistance to ALA-PpIX-mediated PDT, along with a significant increase in the number of EVs. Finally, the ability of PpIX-mediated photodynamic priming (PDP) to enhance carboplatin efficacy under FSS conditions is quantified. These preliminary findings in monolayer cultures necessitate additional studies to determine the feasibility of PpIX as a fluorescence-based indicator, and mediator of PDP, to target chemoresistance in the context of FSS.

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap.

Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap. This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24 minutes after indocyanine green (ICG) lymphography injection. Standardized procedures were implemented for all participants in both hospitals. The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN). However, the left SCIP zone lymphatic vessels were directed opposite to the ILN. The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was toward the ILN, although only single-side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.