Secondary Immunodeficiency.

The field of medicine is constantly changing and, as healthcare providers, we are fortunate to be practicing in a time when patients are living longer and novel therapeutic options continue to evolve. However, these new advances may be associated with adverse effects that practitioners need to be aware of. Some of these impair the immune system leading to secondary immunodeficiencies (SID) that increase host susceptibility to infections and other complications.

Multimodal Therapy May be Key to Improving Survival for Octogenarians Undergoing Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: An American Multicenter Analysis.

Background: As the population ages, the number of octogenarians with pancreatic ductal adenocarcinoma (PDAC) continues to rise. Morbidity and mortality following pancreatectomy have improved owing to safer surgery and better chemoradiation regimens. This study compares the outcomes and multimodality utilization in octogenarians (≥80 years) who underwent pancreaticoduodenectomy (PD) for PDAC, with a younger cohort.

Prenatal diagnosis following preimplantation genetic testing (PGT): recommendations of the Italian Society of Human Genetics (SIGU).

This document aims to provide good practice recommendations in order to support maternal-foetal medicine specialists, clinical geneticists and clinical laboratory geneticists in the management of pregnancies obtained after the transfer of an embryo tested with preimplantation genetic testing (PGT). It was drafted by geneticists expert in preimplantation genetics and prenatal genetic diagnosis belonging to the "Working Group in Cytogenomics, Prenatal and Reproductive Genetics" of the "Italian Society of Human Genetics" (SIGU). In particular, the paper addresses the diagnostic algorithm to be applied in prenatal follow-up depending on the type of PGT performed, the results obtained and the related diagnostic value based on the most recent literature data and Italian and international recommendations.

Pericapsular nerve group cryoneurolysis as an option for palliative nonoperative management of hip fracture in a patient with end-stage medical comorbidities.

Purpose: We report the use of a pericapsular nerve group (PENG) cryoneurolysis for longer-term analgesia in a patient with a hip fracture and severe medical comorbidities as an alternative to hip fracture surgery.

Clinical Features: A frail but lucid and fully autonomous 97-yr-old female from an assisted living facility sustained a subcapital fracture of her right proximal femur following a ground level fall. She had significant comorbidities including end-stage respiratory disease.

Maternal cell-free DNA in early pregnancy for preeclampsia screening: a systematic review.

Purpose: To quantify the separation between maternal blood cell-free (cf)DNA markers in preeclampsia and unaffected pregnancies and compare with existing markers. This approach has not been used in previous studies.

Methods: Comprehensive systematic literature search of PubMed to identify studies measuring total cfDNA, fetal cf(f)DNA or the fetal fraction (FF) in pregnant women.

Determining the QRS axis: visual estimation is equal to calculation.

Background: The QRS axis of the electrocardiogram (ECG) is often considered in clinical practice, but its determination is frequently limited to a rough estimation, such as "normal", with left or right deviation, and superior or inferior in the case of premature ventricular complexes (PVCs). However, a more exact determination of the QRS axis may be warranted in certain scenarios, such as to determine the origin of PVCs more precisely, and is attainable by visual estimation using the hexaxial reference system.

Objectives: The aim of this study was to determine how well such an estimation of the QRS axis would correlate with the axis calculated by formulas.

Adnexal torsion in middle childhood: a rare cause of abdominal pain.

Adnexal torsion is a rare cause of abdominal pain in middle childhood and, in general, the diagnosis is often delayed due to the lack of specificity of symptoms and imaging tests. We describe the case of a girl in middle childhood who came to the emergency department for pain in the right iliac fossa of approximately 15 hours of evolution associated with partial refusal of food intake and vomiting. The initial examination showed normal vital signs, a soft abdomen, pain on palpation in the lower region, but no signs of peritoneal irritation, a mild leucocytosis with no other signs of infection and the initial abdominal ultrasound showed no objective pathology.

Management of severe post-bariatric hypoglycaemia with octreotide delivered via a Tandem t:slim insulin pump.

A woman in her 40s presented with severe post-bariatric hypoglycaemia that persisted despite nutritional therapy and pharmacological therapy with acarbose and subcutaneous octreotide with meals. The nutritional limitations were difficult to sustain, and she developed adverse effects to the pharmacological therapy, and hence, doses could not be increased. She was subsequently treated with subcutaneous octreotide via an insulin pump, with a continuous basal rate and additional bolus doses with meals.

Intensive care unit acquired weakness and physical rehabilitation in the ICU.

Approximately half of critically ill adults experience intensive care unit acquired weakness (ICUAW). Patients who develop ICUAW may have negative outcomes, including longer duration of mechanical ventilation, greater length of stay, and worse mobility, physical functioning, quality of life, and mortality. Early physical rehabilitation interventions have potential for improving ICUAW; however, randomized trials show inconsistent findings on the efficacy of these interventions.

A fatal case of enterovirus A71-induced meningoencephalitis following allogenic hematopoietic stem cell transplantation.

Enterovirus A71 (EV-A71) is a major pathogen responsible for hand, foot, and mouth disease (HFMD) in infants and children. EV-A71 infection represents an epidemic in the Asia-Pacific region, and can cause serious central nervous system (CNS) infections in immunocompromised patients that can result in paralysis, disability, or death. There have been few reports in the literature concerning EV-A71 CNS infections after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult patients.

Dynamic responses and adsorption mechanisms of Chlamydomonas reinhardtii extracellular polymeric substances under Cd, Cu, Pb, and Zn exposure.

Extracellular polymeric substances (EPS) can effectively attenuate heavy metal mobility in aquatic ecosystems and reduce metal toxicity to cells. However, a systematic study of microalgae EPS responses and their adsorption behaviors, characteristics, and mechanisms under different heavy metal exposures has not been performed. In this study, EPS extracted from Chlamydomonas reinhardtii CC-125 was analyzed for compositional changes (monosaccharides and proteins) under Cd, Cu, Pb, and Zn treatments.

Intestinal Obstruction and Neurotoxicity Associated With Water Bead Ingestion.

Water beads are superabsorbent polymer balls. They were originally marketed for agricultural and decorative applications and are now sold as sensory toys. They can be harmful to children in 2 ways.

Radiation-induced osteosarcoma of the frontoparietal calvaria 6 years after oligodendroglioma treatment: illustrative case.

Background: Radiation-induced sarcoma (RIS) is an exceptionally rare occurrence following radiation therapy, and manifestation usually occurs after a several-year latency period. Herein, the authors report the development of a radiation-induced osteosarcoma of the frontoparietal calvaria following treatment for an oligodendroglioma in an 84-year-old woman.

Observations: The patient had been diagnosed with a grade III anaplastic oligodendroglioma when she was 78 years old.

Antioxidant and anti-inflammatory function of walnut green husk aqueous extract (WNGH-AE) on human hepatocellular carcinoma cells (HepG2) treated with t-BHP.

Oxidative damage, oxidative inflammation, and a range of downstream diseases represent significant threats to human health. The application of natural antioxidants and anti-inflammatory agents can help prevent and mitigate these associated diseases. In this study, we aimed to investigate the effectiveness of walnut green husk (WNGH) as an antioxidant and anti-inflammatory agent in an in vitro setting.

Classification of CT scan and X-ray dataset based on deep learning and particle swarm optimization.

In 2019, the novel coronavirus swept the world, exposing the monitoring and early warning problems of the medical system. Computer-aided diagnosis models based on deep learning have good universality and can well alleviate these problems. However, traditional image processing methods may lead to high false positive rates, which is unacceptable in disease monitoring and early warning.

Severe bradycardia in patients with obstructive sleep apnoea and good early response to CPAP.

Background: Obstructive sleep apnoea (OSA) may lead to heart rhythm abnormalities including bradycardia. Our aim was to ascertain clinical and echocardiographic parameters in patients with OSA in whom severe bradycardia was detected in an outpatient setting, as well as to evaluate the efficacy of CPAP therapy on heart rate normalization at the early stages of treatment.

Methods: Fifteen patients mild, moderate or severe OSA and concomitant bradycardia were enrolled.

Osteopathic Manipulative Treatment for Postconcussive Symptoms: A Case Report.

Concussions are a common form of mild traumatic brain injury characterized by a transient alteration of cerebral function leading to a range of physical, cognitive, and emotional symptoms. Postconcussive symptoms (PCSs) usually resolve in about a week but can persist in 10% to 15% of patients. If left untreated, PCS can profoundly affect a patient's life.

Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives.

The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia.

HELICOBACTER PYLORI ERADICATION TREATMENTS AND RISK OF ALZHEIMER DISEASE: A CASE-CONTROL STUDY NESTED IN THE FINNISH POPULATION.

Background: Helicobacter pylori (H. pylori) has been inconsistently associated with risk of Alzheimer disease. The exposure assessment period has often overlapped with the prodromal time of Alzheimer disease.

Levothyroxine malabsorption following sleeve gastrectomy.

Summary: Oral levothyroxine (LT4) is prescribed worldwide for hypothyroidism. Bariatric surgery for patients with obesity has shown a substantial, long-term weight loss and considerable improvement of obesity-related diseases. LT4 malabsorption represents a significant cause of refractory hypothyroidism, well known after malabsorptive bariatric surgery such as Roux-en-Y gastric bypass.