Novel Two-Infusion Pump Technique for Exchange Transfusion in a Hyperbilirubinemic Neonate

Neonatal hyperbilirubinemia is a common concern in newborns, with ABO blood group incompatibility serving as a significant risk factor for severe jaundice. This case report outlines the successful management of a 2.5 kg female infant born to a primigravida mother with ABO incompatibility-induced hyperbilirubinemia. The neonate, born at 38.4 weeks via lower segment cesarean section, exhibited signs of jaundice at 91 hours of life, prompting screening and subsequent confirmation of serum bilirubin levels 26.4. The decision was made using the American Academy of Pediatrics (AAP) and categorized the child under high risk according to age and bilirubin level to implement a complete exchange transfusion using a novel approach with two infusion pumps. The unique aspect of this case lies in introducing a two-infusion pump technique, one to infuse and one to extract blood by inserting the IV set in opposite directions in the infusion pump to perform the exchange transfusion, aiming to minimize complications associated with traditional methods. Careful handling of umbilical venous and arterial lines, coupled with aseptic precautions, sought to mitigate the risk of sepsis. The procedure, conducted over two hours, demonstrated stability in vital signs and was monitored with a transcutaneous bilirubinometer. Post-transfusion, repeat serum bilirubin tests showed a decrease in bilirubin of 10.1, indicating the success of the novel exchange transfusion method. The infant was discharged after a five-day hospital stay, showcasing this innovative approach's potential efficacy and safety. This case contributes to the evolving strategies in neonatal care and emphasizes the importance of tailored interventions in managing hyperbilirubinemia associated with ABO incompatibility.

A novel approach to assess diet diversity: a development of the Nutritional Functional Diversity indicator

Background and aims

Diversity is a key element of diet quality. The Food Variety Score (FVS) is used to assess diversity, especially in low- and middle-income countries. It sums up the number of foods consumed ignoring their nutrient content. A more suitable index should combine the number of foods consumed and their nutritional composition. We adapted the Nutritional Functional Diversity indicator (NFD), proposed by ecologists, to measure diversity in the human diet. We compared NFD and FVS evaluating subjects' distributions across quartiles of the two diversity indices. To evaluate which one reflected a higher diet quality, we estimated associations between these two diversity indices and diet quality measures, i.e., the Mediterranean Diet Score (MDS) and the Healthy Eating Index-2015 (HEI-2015). Associations were expressed by odds ratios (OR) and corresponding 95% confidence intervals (CI).

Materials and methods

We used the data of controls only derived from an integrated series of hospital-based case-control cancer studies conducted in different Italian areas. The NFD identifies groups of foods based on a set of nutrients according to a cluster analysis. Some steps are required: creating a food-nutrient matrix; clustering of the Euclidean food-food distance matrix to identify groups of foods with nutritional (dis)similarities; and calculating the NFD as the ratio between the sum of branch lengths of the dendrogram belonging to the number of foods consumed by individuals (i.e., subject-specific diversity) and the sum of all branch lengths of the dendrogram (i.e., maximal diversity).

Results

More than one quarter of individuals (28.4%) were differently classified within quartiles of the two diversity indices. For both indices, increasing the diversity level increased the risk for adhering to MDS (OR for NFD = 11.26; 95% CI: 7.88-16.09, and OR for FVS = 6.80; 95% CI: 4.84-9.54) and to HEI-2015 (OR for NDF = 2.86; 95% CI: 2.39-3.42, and OR for FVS = 2.72; 95% CI: 2.27-3.26). Associations were stronger for NFD.

Conclusion

Our findings showed a greater ability of NFD to assess diet quality quantifying the degree of diversity.

Antiviral Approach to Cytomegalovirus Infection: An Overview of Conventional and Novel Strategies

Human cytomegalovirus (HCMV) is a herpesvirus capable of establishing a lifelong persistence in the host through a chronic state of infection and remains an essential global concern due to its distinct life cycle, mutations, and latency. It represents a life-threatening pathogen for immunocompromised patients, such as solid organ transplanted patients, HIV-positive individuals, and hematopoietic stem cell recipients. Multiple antiviral approaches are currently available and administered in order to prevent or manage viral infections in the early stages. However, limitations due to side effects and the onset of antidrug resistance are a hurdle to their efficacy, especially for long-term therapies. Novel antiviral molecules, together with innovative approaches (e.g., genetic editing and RNA interference) are currently in study, with promising results performed in vitro and in vivo. Since HCMV is a virus able to establish latent infection, with a consequential risk of reactivation, infection management could benefit from preventive treatment for critical patients, such as immunocompromised individuals and seronegative pregnant women. This review will provide an overview of conventional antiviral clinical approaches and their mechanisms of action. Additionally, an overview of proposed and developing new molecules is provided, including nucleic-acid-based therapies and immune-mediated approaches.

Effective superior vena cava isolation using a novel C-shaped approach

Introduction

Superior vena cava (SVC) isolation has been proposed as part of the ablation strategy for atrial fibrillation. However, circumferential isolation of the SVC can lead to late-onset complications, such as SVC stenosis.

Methods

We describe a detailed observation of the SVC conduction pattern and present a newly developed approach for SVC isolation that involves creating a C-shaped non-circumferential ablation line while sparing the lateral segment.

Results

Twelve consecutive patients were included in the study, all of whom achieved bidirectional block during the ablation procedure.

Discussion

This approach to SVC isolation is effective and has the potential to reduce ablation related complications; however, larger studies and long-term follow-up is warranted to confirm these findings.

Corticosteroids commonly prescribed in pediatric patients undergoing full-mouth rehabilitation under general anesthesia: A retrospective study

Dental treatment under GA is a compelling method for giving therapeutically important consideration to those youngsters who might be intellectually juvenile, exceptionally restless, medicinally split the difference, or unfit to get treatment in a customary office setting. While the traditional work on concerning corticosteroids is likely innocuous and perhaps gainful with lower prophylactic dosages and the nature of oral admission was additionally unaffected. The study aimed to investigate commonly prescribed corticosteroids in children undergoing full-mouth dental management under general anesthesia. A single-centered retrospective study among pediatric patients treated under general anesthesia of the age group of 0-13 years. The sample size is 124. Data were collected and tabulated. Data were statistically analyzed using the SPSS software version 23. Chi-square test and Pearson correlation were done using the software and P < 0.05 was considered statistically significant. The results show that 79.67% commonly prescribed dexamethasone, whereas 20.33% use hydrocortisone, providing the age groups between 0 and 3 has higher prescribing of corticosteroids. From this study, it is concluded that since the P value was more than 0.05, there is no significant statistical difference that has been analyzed. Dexamethasone is the commonly prescribed corticosteroid in children undergoing full-mouth rehabilitation under GA, followed by hydrocortisone.

Process Modelling, Scale-Up and Characterization of Acetaminophen Spray Dried Milk Powder as Novel Pediatric Dosage Form

PURPOSE

Successful drug therapy in children is contingent upon hassle-free administration of pediatric dosage forms. Pediatric patients suffer from difficulty in swallowing due to weak esophagus muscles in their early age. Considering this challenge liquid formulations are preferred over solid dosage form among pediatric patients to avoid the possibility of choking which can be a serious life-threatening condition in children. The main aim of the present research work was to develop a reconstitutable amorphous acetaminophen spray-dried milk powder (ASDM) as novel pediatric formulation.

METHODS

ASDM was prepared by spray drying process and the spray drying process was optimized using Box-Behnken design to study the effect of spray drying process parameters at X₁ [inlet temperature], X₂ [aspiration rate] and X₃ [feed rate] to Y₁ [% yield], Y₂ [angle of repose], Y₃ [Hausner's Ratio] and Y₄ [Carr's Index] as dependent variables of ASDM. In addition, each batch was characterized for particle size by polarized light microscopy and drug entrapment.

RESULTS

Predicted parameters from optimized spray drying process model were successfully employed to manufacture a scale up cum validation batch of ASDM, which showed notably improved yield and desirable flow properties. The scale-up validation batch was further characterized using thermal analysis, diffraction studies, spectroscopic analysis, dispersion studies, stability APAP in dispersion formulation and formulation stability studies to confirm the physico-chemical stability of ASDM.

CONCLUSIONS

Thus, ASDM for oral use can serve as a promising pediatric formulation and the developed prototype formulation can be further extended to future newly discovered drugs with similar characteristics.

Novel control strategies for mosquito-borne diseases

Mosquito-borne diseases are an increasing global health challenge, threatening over 40% of the world's population. Despite major advances in malaria control since 2000, recent progress has stalled. Additionally, the risk of Aedes-borne arboviruses is rapidly growing, with the unprecedented spread of dengue and chikungunya viruses, outbreaks of yellow fever and the 2015 epidemic of Zika virus in Latin America. To counteract this growing problem, diverse and innovative mosquito control technologies are currently under development. Conceptually, these span an impressive spectrum of approaches, from invasive transgene cassettes with the potential to crash mosquito populations or reduce the vectorial capacity of a population, to low-cost alterations in housing design that restrict mosquito entry. This themed issue will present articles providing insight into the breadth of mosquito control research, while demonstrating the requirement for an interdisciplinary approach. The issue will highlight mosquito control technologies at varying stages of development and includes both opinion pieces and research articles with laboratory and field-based data on control strategy development. This article is part of the theme issue 'Novel control strategies for mosquito-borne diseases'.

Molecular Mechanisms and Emerging Therapeutics for Osteoporosis

Osteoporosis is the most common chronic metabolic bone disease. It has been estimated that more than 10 million people in the United States and 200 million men and women worldwide have osteoporosis. Given that the aging population is rapidly increasing in many countries, osteoporosis could become a global challenge with an impact on the quality of life of the affected individuals. Osteoporosis can be defined as a condition characterized by low bone density and increased risk of fractures due to the deterioration of the bone architecture. Thus, the major goal of treatment is to reduce the risk for fractures. There are several treatment options, mostly medications that can control disease progression in risk groups, such as postmenopausal women and elderly men. Recent studies on the basic molecular mechanisms and clinical implications of osteoporosis have identified novel therapeutic targets. Emerging therapies targeting novel disease mechanisms could provide powerful approaches for osteoporosis management in the future. Here, we review the etiology of osteoporosis and the molecular mechanism of bone remodeling, present current pharmacological options, and discuss emerging therapies targeting novel mechanisms, investigational treatments, and new promising therapeutic approaches.

Tracheostomy during COVID-19 pandemic-Novel approach

Background

This study describes a novel approach in reducing SARS‐CoV‐2 transmission during tracheostomy.

Methods

Five patients underwent tracheostomy between April 1, 2020 and April 17, 2020. A clear and sterile plastic drape was used as an additional physical barrier against droplets and aerosols. Operative diagnosis; droplet count and distribution on plastic sheet and face shields were documented.

Results

Tracheostomy was performed for patients with carcinoma of tonsil (n = 2) and nasopharynx (n = 1), and aspiration pneumonia (n = 2). Droplet contamination was noted on all plastic sheets (n = 5). Droplet contamination was most severe over the central surface at 91.5% (86.7%‐100.0%) followed by the left and right lateral surfaces at 5.2% (6.7%‐10.0%) and 3.3% (6.7%‐10.0%), respectively. No droplet contamination was noted on all face shields.

Conclusion

Plastic drapes can help reduce viral transmission to health care providers during tracheostomy. Face shields may be spared which in turn helps to conserve resources during the novel coronavirus disease 2019 pandemic.

Transesophageal Echocardiography During Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Novel Approach

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive, lengthy procedure for patients with peritoneal metastases. It is associated with fairly high morbidity and mortality as compared with other non-vascular intra-abdominal surgeries. Fluid and hemodynamic management is challenging and not well established, particularly in patients with a low ejection fraction (EF). This case details the successful intraoperative anesthetic management of a patient with an ejection fraction of 20% undergoing CRS/HIPEC using the addition of intraoperative transesophageal echocardiography (TEE) as an adjunct to central venous pressure (CVP), urine output (UOP), and calculated stroke volume variation (SVV) for goal-directed resuscitation and blood pressure support.

A practical tool for assessing ecosystem services enhancement and degradation associated with invasive alien species

Current approaches for assessing the effects of invasive alien species (IAS) are biased toward the negative effects of these species, resulting in an incomplete picture of their real effects. This can result in an inefficient IAS management. We address this issue by describing the INvasive Species Effects Assessment Tool (INSEAT) that enables expert elicitation for rapidly assessing the ecological consequences of IAS using the ecosystem services (ES) framework. INSEAT scores the ecosystem service "gains and losses" using a scale that accounted for the magnitude and the reversibility of its effects. We tested INSEAT on 18 IAS in Great Britain. Here, we highlighted four case studies: Harmonia axyridis (Harlequin ladybird), Astacus leptodactylus (Turkish crayfish), Pacifastacus leniusculus (Signal crayfish) and Impatiens glandulifera (Himalayan balsam). The results demonstrated that a collation of different experts' opinions using INSEAT could yield valuable information on the invasive aliens' ecological and social effects. The users can identify certain IAS as ES providers and the trade-offs between the ES provision and loss associated with them. This practical tool can be useful for evidence-based policy and management decisions that consider the potential role of invasive species in delivering human well-being.

Curved periacetabular osteotomy via a novel intermuscular approach between the sartorius and iliac muscles

INTRODUCTION

Herein, we describe and evaluate a curved periacetabular osteotomy (CPO) via an intermuscular approach (IM-CPO) between the sartorius and iliac muscles.

METHODS

Between January 2009 and January 2016, IM-CPO was performed in 17 joints (16 patients), and a traditional CPO was performed in 17 joints. The length of incision at wound closure, operative time, intraoperative blood loss, serum creatinine kinase (CK) level the day after surgery, correctional angle, walking ability assessed using the gait items of the Harris Hip Score (at 3 and 6 months after surgery), and perioperative complications were evaluated. Group differences were assessed using t-tests.

RESULTS

The IM-CPO and CPO groups did not differ in the mean operative time (130 minutes and 124 minutes, respectively), mean serum CK the day after surgery (349 IU/L and 425 IU/L, respectively), or mean correctional angle (24.9° and 24.6°, respectively). The mean incision length was significantly shorter in the IM-CPO group (8.3 cm) compared to that in the CPO group (9.5 cm). The mean walking ability was significantly higher in the IM-CPO group (24.2 points) compared to that in the CPO group (20.9 points) at 3 months after surgery, but not at 6 months after surgery (26.4 points and 24.9 points, respectively). No serious complications were observed in either group.

CONCLUSION

In addition to demonstrating a similarly satisfactory correctional angle, IM-CPO is anticipated to enable early weight-bearing and recovery of walking ability. Thus, IM-CPO is considered a superior surgical technique.