Severe Cases Research Articles

Outcomes of COVID-19 in Pregnant Women: A Retrospective Analysis of 300 Cases in Jordan

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient’s records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p < 0.01), (r = 0.376, p < 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value <0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p < 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes.

Pyroptosis regulation by Salmonella effectors

The genus Salmonella contains the most common foodborne pathogens frequently isolated from food-producing animals and is responsible for zoonotic infections in humans and animals. Salmonella infection in humans and animals can cause intestinal damage, resulting in intestinal inflammation and disruption of intestinal homeostasis more severe cases can lead to bacteremia. Pyroptosis, a proinflammatory form of programmed cell death, is involved in many disease processes. Inflammasomes, pyroptosis, along with their respective signaling cascades, are instrumental in the preservation of intestinal homeostasis. In recent years, with the in-depth study of pyroptosis, our comprehension of the virulence factors and effector proteins in Salmonella has reached an extensive level, a deficit persists in our knowledge regarding the intrinsic pathogenic mechanisms about pyroptosis, necessitating a continued pursuit of understanding and investigation. In this review, we discuss the occurrence of pyroptosis induced by Salmonella effectors to provide new ideas for elucidating the regulatory mechanisms through which Salmonella virulence factors and effector proteins trigger pyroptosis could pave the way for novel concepts and strategies in the clinical prevention of Salmonella infections and the treatment of associated diseases.

Invasive Pneumococcal Diseases in People over 65 in Veneto Region Surveillance

Background: Elderly individuals over 65, along with children under 5, are the most affected by invasive pneumococcal diseases (IPDs). Monitoring vaccination coverage and conducting surveillance are essential for guiding evidence-based prevention campaigns and public health measures. Methods: Since 2007, the Veneto Region has relied on three sources for surveillance of invasive bacterial infections, contributing to an increase in reported IPD cases. This study analyzed notifications related to individuals aged ≥65 years from 2007 to 2023. Results: A total of 1527 cases of IPDs in elderly individuals were reported between 2007 and 2023. The notification rate significantly increased from 5.61 to 14.63 per 100,000 inhabitants, despite underreporting during the COVID-19 pandemic. Cases associated with sepsis increased from 3.89 to 9.58 per 100,000, while notifications of meningitis and case fatality rates remained stable at 1.5 per 100,000 and 11.8%, respectively. Serotyping was not performed in 52% of the notifications. The most common serotypes were 3 (21.6%), 8 (11.1%), and 19A (5.0%), with fluctuations over time. There was a significant decline in serotypes covered by PCV7 and PCV13 and an increase in non-vaccine serotypes. Conclusions: The regional surveillance system allows for an increasingly comprehensive profile of the epidemiological landscape of IPDs in Veneto. However, the surveillance of pneumococcal infections still presents challenges. The currently available data are likely to be underestimated, mainly referring to the most severe cases, and the serotyping necessary to identify the etiological agent is still not often performed.

Self-perceptual blindness to mental fatigue in mining workers

Mental fatigue is a psychophysiological state that adversely impacts performance in cognitive tasks, increasing risk of occupational hazards. Given its manifestation as a conscious sensation, it is often measured through subjective self-report. However, subjective measures are not always true measurements of objective fatigue. In this study, we investigated the relationship between objective and subjective fatigue measurements with the preventive AccessPoint fatigue assay in Chilean mine workers. Subjective fatigue was measured through the Samn-Perelli scale, objective fatigue through a neurocognitive reaction time task. We found that objective and subjective fatigue do not correlate (−0.03 correlation coefficient, p < 0.001). Moreover, severe fatigue cases often displayed absence of subjective fatigue coupled with worse cognitive performance, a phenomenon we denominated Perceptual Blindness to fatigue. These findings highlight the need for objective fatigue measurements, particularly in high-risk occupational settings such as mining. Our results open new avenues for researching mechanisms underlying fatigue perception and its implications for occupational health and safety.

Outcomes in Pediatric Cholesteatoma.

The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database. Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022. Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids. A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38). TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.

Update on management of cerebral venous thrombosis.

This review intends to systematize the diagnostic and treatment approach to cerebral venous thrombosis (CVT), highlighting key studies that have been recently published. In light of the recent pandemic, new risk factors for CVT have emerged. Contrast-enhanced MRI and susceptibility-weighted imaging have been shown to offer increased sensitivity for detecting cortical vein thrombosis.Dabigatran seems to be as effective and well tolerated as warfarin for long-term anticoagulation. Partial venous recanalization often occurs in patients treated with anticoagulation only, as early as 8 days after treatment onset. For patients with CVT and impending brain herniation, two-thirds of those who undergo decompressive craniectomy survive, with one-third being functionally independent 6 months after diagnosis. CVT is an unusual type of cerebrovascular disease that mostly affects women of fertile age. Risk factors should be identified and addressed. Diagnosis relies on confirmation of venous sinus and/or vein thrombosis, usually by CT venography or MRI. Anticoagulation is the cornerstone of treatment. Despite the lack of high-quality evidence, endovascular treatment is often considered in severe cases. Special populations require tailored approaches. About 80% achieve mRS 0-1, but residual symptoms often affect quality of life and the ability to return to work.

Virtual cleaning of sooty mural hyperspectral images using the LIME model and improved dark channel prior

Murals, as important carriers of cultural heritage and historical records, showcase artistic, aesthetic, social, and political significance. In ancient times, religious activities such as burning incense and candles in temples led to many murals being polluted by soot, causing them to darken, lose details, and, in severe cases, completely blacken. As a result, the development of efficient virtual cleaning methods has become a key strategy for addressing this issue. In this study, we use synthetic true colour and false colour images in different bands of the hyperspectral spectrum, and use a guided filter fusion technique to fuse these two images into a new image of the sooty mural. Through analyzing the histograms and colour distribution scatterplots of the synthetic sooty mural images, we observed significant similarities to low-luminance images. To enhance the synthesized murals, we applied the LIME model. In addition, comparisons of the histograms and colour distribution scatterplots of the enhanced sooty mural images with those of haze images revealed notable similarities. Therefore, we applied the dark channel prior algorithm to remove soot from the mural images. Considering that soot particles are larger than haze particles, we introduced guided filtering to refine the transmission map and created a nonlinear transformation function to enhance its details. In terms of both visual perception and quantitative analysis, the proposed method significantly outperforms previous methods in the virtual cleaning of sooty murals. This technology can not only restore the colours and details of murals but also provide new clues for subsequent mural studies, allowing people to once again appreciate the true beauty of the murals.

Progressive familial intrahepatic cholestasis: a brief review of the literature and our own clinical observation

Progressive familial intrahepatic cholestasis is one of the causes of direct hyperbilirubinemia in young children and the need for its diagnosis arises after the exclusion of such more common causes of cholestasis as biliary atresia, Alajille syndrome, as well as infectious and medicinal hepatopathies. The basic diagnostic feature that allows us to suspect the pathology in question is the absence of an increase in the level of γ-glutamine trans peptidase. To date, 12 types of progressive familial intrahepatic cholestasis have been described. For most of them, both severe cases with neonatal manifestation and rapid progression to cirrhosis, as well as variants with late development and a relatively benign course, are described. The article presents brief genetic and phenotypic characteristics of all 12 types of pathology. The author presents his own observation of a patient whose clinical and laboratory picture corresponded to Byler’s syndrome, but the identified genetic characteristics did not correspond to any of the known types.

A IMPORTÂNCIA DA FISIOTERAPIA EM LUXAÇÃO DE PATELA EM CÃES

Physical therapy in cases of patellar luxation in dogs is an essential therapeutic approach that aims not only to alleviate pain but also to restore functionality and prevent future complications. Patellar luxation can result in significant discomfort and difficulty in locomotion, affecting the animal's quality of life. The physiotherapeutic intervention is designed to address these issues through a set of techniques that include muscle strengthening exercises, which help stabilize the knee joint, and stretching, which improves flexibility and range of motion. Hydrotherapy, for example, is often used to allow low-impact exercises, reducing stress on the joints while promoting muscle strengthening. Additionally, manual therapy can be applied to relieve muscle tension and improve blood circulation in the affected area. Physical therapy not only accelerates post-surgical recovery when surgery is necessary but can also be an effective alternative for conservative management in less severe cases. By tailoring treatment protocols to the specific needs of each dog, physical therapy significantly contributes to the rehabilitation and overall well-being of the animals, standing out as a fundamental part of the multidisciplinary treatment of patellar luxation.

Implementation of a genotyped African population cohort, with virtual follow-up: A feasibility study in the Western Cape Province, South Africa

Background There is limited knowledge regarding African genetic drivers of disease due to prohibitive costs of large-scale genomic research in Africa. Methods We piloted a cost-effective, scalable virtual genotyped cohort in South Africa, with participant recruitment using a tiered informed consent model and DNA collection by buccal swab. Genotype data was generated using the H3Africa Illumina micro-array, and phenotype data was derived from routine health data of participants. We demonstrated feasibility of nested case control genome wide association studies using these data for phenotypes type 2 diabetes mellitus (T2DM) and severe COVID-19. Results 2267346 variants were analysed in 459 participant samples. 78.6% of SNPs and 74% of samples passed quality control (QC). Principal component analysis showed extensive ancestry admixture in study participants. For 1780 published COVID-19-associated variants, 3 SNPs in the pre-imputation data and 23 SNPS in the imputed data were significantly associated with severe COVID-19 cases compared to controls. For 2755 published T2DM associated variants, 69 SNPs in the pre-imputation data and 419 SNPs in the imputed data were significantly associated with T2DM cases when compared to controls. Conclusions The results shown here are illustrative of what will be possible as the cohort expands in the future. Here we demonstrate the feasibility of this approach, recognising that the findings presented here are preliminary and require further validation once we have a sufficient sample size to improve statistical significance of findings. We implemented a genotyped population cohort with virtual follow up data in a resource-constrained African environment, demonstrating feasibility for scale up and novel health discoveries through nested case-control studies.

Clinico-epidemiological profiling of dengue patients in a non-endemic region of Bangladesh.

This study aimed to characterise the clinical and epidemiological profiles of dengue patients and their outcomes during an ongoing outbreak in a non-endemic region of Bangladesh. This prospective observational study analysed 805 confirmed dengue cases during August-December 2023. Data on demographic, clinical and laboratory profiles, as well as outcomes, were gathered using a structured questionnaire. Statistical analysis was conducted using SPSS 25. The mean age of dengue patients was 31.5 (±12.2) y, with the majority being males (81.2%). All 805 patients experienced fever, 792 (98.4%) had headaches, 698 (86.7%) had myalgia, 601 (74.7%) had persistent vomiting and 598 (74.3%) had abdominal pain. Bleeding was observed in 191 (23.7%) patients and neurological symptoms were seen in 209 (25.9%) patients. Most patients (n=781, 97%) exhibited non-severe symptoms, while 3% (n=24) had severe symptoms. Among the 24 severe cases, four (16.7%) patients were reported to have encephalitis and one (4.2%) patient had meningoencephalitis. Moreover, 365 patients (45.3%) had travelled to an endemic region who were predominantly males (n=327, 89.6%). Most dengue patients recovered well with rapid fluid replacement therapy (n=754, 93.7%). The 2023 dengue outbreak in a non-endemic area of Bangladesh primarily impacted males, young adults, with the majority presenting non-severe symptoms. Further studies are essential to validate and build upon these results.

The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox.

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

Early use of long-acting injectable antipsychotics in bipolar disorder type I: An expert consensus.

Long-acting injectable antipsychotics (LAIs) are not routinely offered to patients living with bipolar disorder type I (BP-I), despite widespread evidence that supports their benefits over oral antipsychotics, particularly in early disease. A round-table meeting of psychiatrists convened to discuss barriers and opportunities and provide consensus recommendations around the early use of LAIs for BP-I. LAIs are rarely prescribed to treat BP-I unless a patient has severe symptoms, sub-optimal adherence to oral antipsychotics, or has experienced multiple relapses. Beyond country-specific accessibility issues (e.g., healthcare infrastructure and availability/approval status), primary barriers to the effective use of LAIs were identified as attitudinal and knowledge/experience-based. Direct discussions between healthcare providers and patients about treatment preferences may not occur due to a preconceived notion that patients prefer oral antipsychotics. Moreover, as LAIs have historically been limited to the treatment of schizophrenia and the most severe cases of BP-I, healthcare providers might be unaware of the benefits LAIs provide in the overall management of BP-I. Improved treatment adherence associated with LAIs compared to oral antipsychotics may support improved outcomes for patients (e.g., reduced relapse and hospitalization). Involvement of all stakeholders (healthcare providers, patients, and their supporters) participating in the patient journey is critical in early and shared decision-making processes. Clinical and database studies could potentially bridge knowledge gaps to facilitate acceptance of LAIs. This review discusses the benefits of LAIs in the management of BP-I and identifies barriers to use, while providing expert consensus recommendations for potential solutions to support informed treatment decision-making.

Endocrine dysregulation in COVID-19: molecular mechanisms and insights

This review describes the impact of COVID-19 on the endocrine system, focusing on cortisol signaling and growth factor-induced endocrine resistance. As expected, SARS-CoV-2 infection induces systemic inflammation, resulting in stimulation of the adrenal glands leading to elevated cortisol levels with normal adrenocorticotropic hormone (ACTH) levels. The cytokine storm could also stimulate cortisol production. However, in some instances, cortisol levels rise independently of ACTH due to a phenomenon known as “pseudo-Cushing’s syndrome,” where adrenal glands become less responsive to ACTH. Plasma proteomic analyses showed that this pattern was variably observed among COVID-19 patients, potentially involving calcium dysregulation and GNAS-regulated activities, ultimately impacting the regulation of microvascular permeability. COVID-19 also exhibited a syndrome resembling endocrine resistance, governed by receptor tyrosine kinase signaling pathways. Mild cases displayed elevated activity of EGFR and MMP9, along with increased expression of survival factors like Bax and Bcl2. In contrast, more severe cases involved IGFR-I and enhanced NOTCH signaling, with altered expression of Bcl2, AKT1, and MAPK8. In summary, these findings describe the complex interplay between COVID-19 and endocrine pathology, particularly endocrine resistance. These insights suggest potential endocrine targets for therapeutic interventions to improve short- and long-term outcomes for COVID-19 patients.

Changes of the microbiome as a predictor of comorbidity in gastrostomy patients

Dysphagia as a symptom of dysfunction of the digestive system occurs in patients with various pathologies and in severe cases requires the formation of a nutrient fistula. The presence of a stoma is a source of additional pathological changes. Changes in the microbiota of gastrostomy patients is an issue that is practically not covered in the scientific literature. The purpose of the study is to determine characteristic changes in the microbiota of the oral cavity, stomach and intestines caused by nutritional stoma and their clinical significance. Materials and methods. The study included 20 children fed through a gastrostomy tube and 10 children fed by mouth. Group 1 consisted of patients with a gastrostomy installed in less than 1 year, group 2 - in periods of more than 1 year, group 3 - children without gastrostomy. All patients underwent a standard examination in a gastroenterological hospital and 16S rRNA sequencing of aspirates from 3 biotopes - mouth, stomach and intestines. An assessment of physical development and bioimpedance measurements was carried out, and a group of patients with sarcopenia was identified. Results. In all three biotopes of patients with gastrostomies, a pronounced disturbance of microbiological homeostasis was found. In the oral cavity, the number of anti-carious microorganisms is reduced and, on the contrary, the level of periodontogenic strains is increased. This fact is the cause of the occurrence of comorbid conditions and requires the appointment of local therapy with probiotic strains approved for use. Changes in the gastric microbiome after gastrostomy placement are characterized by a high degree of H. pylori contamination against the background of a decrease in anti-inflammatory protection. Determining the level of bacteria of the genera Prevotella, Parabacteroides, Porphyromonas in the stomach can become a marker of concomitant chronic inflammatory changes in the mucous membrane of the upper gastrointestinal tract, a high risk of developing peptic ulcers and its complications. The state of the gut microbiome correlates with underweight, BMI, proportion of fat mass and active cell mass. The development of sarcopenia in gastrostomy patients is one of the possible dangerous comorbid conditions, one of the diagnostic criteria of which is a decrease in the level of Phylum Fusobacteriota bacteria.

Early detection and management of congenital pulmonary airway malformation in a newborn with stable clinical course

Introduction: Congenital pulmonary airway malformation (CPAM) is a rare developmental lung anomaly characterized by cystic lung lesions, constituting about 25% of congenital pulmonary anomalies. It typically occurs sporadically and is not significantly associated with race, age, or other maternal factors. The prenatal course of CPAM can vary based on factors such as lesion size, mediastinal shift, and associated anomalies. While the overall prognosis is generally favorable in the absence of severe complications like hydrops fetalis, which can adversely affect outcomes, management strategies include corticosteroids, thoracoamniotic shunt (TAS), and, in severe cases, open fetal surgery or the EXIT procedure. Postnatal surgical excision usually offers a curative outcome with an excellent prognosis. Without surgical intervention, there are risks of recurrent infections and, rarely, malignant transformation. Effective prenatal detection significantly impacts clinical decision-making and neonatal outcomes, and the necessity and timing of surgery for asymptomatic infants remain subjects of ongoing debate, underscoring the need for personalized, multidisciplinary care. Case Report: A female infant, delivered at 38 weeks via Cesarean section, was diagnosed with CPAM following routine prenatal ultrasound. Presence of extensive cystic regions in the right lung confirmed the diagnosis and a CPAM volume ratio (CVR) of 0.37 indicated a low risk of severe complications. The pregnancy was largely uneventful, with maternal chronic hypertension managed by Nifedipine and mild intermittent asthma. Postnatal chest radiography corroborated the CPAM diagnosis, while an abdominal ultrasound investigated intrahepatic calcifications. Maternal screening for cytomegalovirus and toxoplasmosis yielded negative results, and postnatally, the infant also tested negative for both infections. The neonate, though asymptomatic and stable, required close monitoring in the neonatal intensive care unit to prevent potential respiratory compromise. Conclusion: Advances in prenatal imaging have greatly improved the early detection and management of CPAM, allowing for targeted neonatal care and strategic planning. This case highlights the importance of a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, neonatologists, and pediatric thoracic surgeons in the effective management of CPAM. Early identification and diligent postnatal monitoring are essential for ensuring optimal outcomes and minimizing the risk of complications. The coordinated care and strategic decision-making exemplified in this case underscore the potential for enhanced neonatal health and long-term well-being through comprehensive management of congenital anomalies.

Pathomorphological changes in the lung tissues of Syrian hamsters during experimental infection with SARS‐COV‐2

The new coronavirus infection caused by SARS‐CoV‐2 is a dangerous respiratory disease. The aim of the investigation was to study the pathomorphological changes in lungs of Syrian hamsters infected with SARS‐CoV‐2 as is necessary for adequate therapy and prevention of the disease.Syrian hamsters of the SPF category were infected intranasally with a dose of 5×105TCID50 SARS‐CoV‐2/human/RUS/Nsk‐FRCFTM‐1/2020). Animals were euthanised on days 3, 6, 10, 14 and 21 after infection and the lungs were collected. To determine virus replication real‐time RT‐PCR was used. The lungs was used for histological examination. Statistics was performed using Statistics for Windows 10 software.Specific pathological lesions characterising the inflammatory process were detected in all groups of animals. The severity of pathological changes and the volume of lung tissue lesions varied depending on the stage of the disease. The most severe lesions were observed on days 6–10. By day 21, the process of organ structure restoration was noticed.The study showed that pathological changes in the Syrian hamster’s lungs caused by experimental infection with the SARS‐CoV‐2 were multifaceted and complex. In mild cases, congestion and infiltration are observed, and in severe cases, atelectasis and pulmonary edema were life‐threatening. The most severe lesions in lungs were noted on days 6–10. By day 21, the process of restoration was observed.

Epidemiology, presentation, management and outcomes of patients with acute epiglottitis - A 10-year retrospective study based on a tertiary hospital in northern China.

This study aimed to explore the new clinical characteristics and trends of acute epiglottitis (AE) in northern China. A retrospective, observational study was conducted on patients diagnosed with AE between January 2014 and December 2023 at a single-center medical institution in northern China. The clinical profiles of patients with AE were investigated. This study encompassed 366 AE patients (M: F = 1.79:1). The average age of the patients was 47.31 ± 13.18 years, and 33.4% patients had comorbidities. Common initial symptoms: sore throat (93.17%), dysphagia (48.09%), fever (10.65%). Dyspnea reported in 14.48%. AE incidence rose annually over a decade, with mild seasonal variations.Laryngoscopy remains the primary means of confirming AE. Almost all patients received intravenous antibiotic therapy, and 98% of them were also treated with corticosteroids. Emergency airway intervention needed in 2.73% (cricothyroidotomy: 0.54%; tracheotomy: 2.19%). Among all patients, 353 (96.44%) had a good prognosis, 1 death (0.27%) from cardiopulmonary arrest during tracheotomy, 1 anoxic encephalopathy (0.27%) after tracheotomy in the emergency room due to intubation failure. The incidence rate of AE is on the rise. Even if airway intervention is rarely required, clinicians must maintain a high degree of vigilance and conduct early identification of risk factors and emergencies that could progress severe cases into life-threatening. Furthermore, the development of safe and efficacious management strategies is crucial to prevent catastrophic complications and safeguard patient lives.

Temporary osteosynthesis of the tibial bones in repair of multiple and combined injuries

Background The incidence of injury worldwide remains high, with a global estimate of 6763 cases per 00,000 population (95 % confidence interval 6412–7147). Trauma to the limbs is a common injury to an individual anatomical area during multiple or combined trauma that accounts for 40 % to 85.2 % of cases. Assessment of the effectiveness of different fixation options and development of treatment algorithms are essential for patients with tibial fractures and multiple (combined) injuries.The objective was to determine how often temporary tibia fixation is applied for patients with multiple and combined injuries.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), CyberLeninka between 2008 and 2023 using search words and phrases: tibial injuries, osteosynthesis of lower limbs, multiple injuries, combined injuries, temporary osteosynthesis of the tibial bones.Results and discussion A differentiated approach to the repair of bone fractures resulting from multiple and combined injuries is mostly common with the choice of fixation technique depending on the severity of injury and the severity of the patient’s condition. The definitive internal bone fixation is normally used for stable patients, “damage control” strategy is secured for borderline and severe cases using primary temporary external fixation followed by staged surgical intervention. There is no generally accepted strategy for the use of early mobilization of long bone fractures as a component of anti-shock measures in a polytrauma patient.Conclusion Certain issues remain unresolved, including the use of osteosynthesis for tibial fractures in some cohorts of patients, the optimal time of transition to definitive internal fixation, the possibility of using extrafocal osteosynthesis as a definitive treatment, the optimal configuration and assemblies to be employed. The lack of high-quality randomized controlled trials in this field is an important limitation.

MANEJO DO HERPES-VÍRUS FELINO: MEDICINA DE ABRIGO

Infection by feline herpesvirus type 1 (FHV-1) is one of the main respiratory diseases in cats, often associated with other pathogens. The virus, which has double-stranded DNA and is sensitive to disinfectants and adverse conditions, proliferates in high-density environments, such as shelters, where stress compromises the immunity of the felines. Transmission mainly occurs through contact with secretions from infected cats, leading to inflammation and cellular necrosis. Clinical symptoms vary depending on the viral load, route of exposure, and the cat's immune status. After an incubation period of 2 to 6 days, symptoms such as depression, sneezing, fever, and loss of appetite appear, followed by nasal and ocular discharge, which may progress to secondary bacterial infection. In severe cases, especially in young or debilitated cats, viral pneumonia may occur. Diagnosis of the feline respiratory complex (FRC) involves clinical and laboratory tests, such as PCR and X-rays, and screening of new cats is fundamental for controlling the infection. Clinical management focuses on stress reduction, hydration, nebulization, and nutritional support. Treatment includes antivirals to reduce viral replication, as well as antibiotics for secondary infections. Vaccination with live attenuated virus, starting at nine weeks of age, is crucial, although it does not provide full protection. Measures such as quarantine, isolation, and disinfection are essential to control the spread of FHV-1. Collaboration between shelters, veterinarians, and animal protection organizations is vital for implementing effective measures and ensuring the welfare of cats, recognizing the importance of early detection and proper management.