Spontaneous haemoperitoneum caused by a bleeding gastric gastrointestinal stromal tumour.

Spontaneous haemoperitoneum is described as a collection of blood in the peritoneal cavity due to non-traumatic aetiology. Common causes in the literature include splenic, hepatic and gynaecological pathology. Patients with spontaneous haemoperitoneum usually present with non-specific dull aching abdominal pain. Spontaneous haemoperitoneum can only be radiologically diagnosed and, if not treated in time, is life threatening. Rupture of a gastrointestinal stromal tumour (GIST) presenting as a spontaneous haemoperitoneum is a rare event. Gastric GIST presents as ambiguous abdominal pain, complications of which include melena, obstruction and rupture. This is a report of a male patient in his early 60s who presented with acute abdominal pain. A contrast-enhanced CT of the abdomen showed haemoperitoneum with an unknown source of origin. Diagnostic laparoscopy showed a bleeding exophytic mass arising from the stomach, which was resected. Thus, early diagnosis with proper imaging and prompt treatment has a favourable outcome.

Assessing the Yield of Reduced Duration-EEG Recordings in Children: A Cross-Sectional Study.

Introduction An EEG is an important tool in the diagnosis of neurological diseases. Performing an EEG on children can be challenging due to their tendency to not cooperate for the recommended duration. We aim to optimize the duration of EEG recording in children by finding the optimal duration of recording. Materials and methods A single-center prospective observational study was done after appropriate ethical clearance. Children aged 0-14 were recruited and examined, and the recommended EEG was done. Data were collected and analyzed. Results Of the 112 EEGs analyzed, 29 EEGs were normal, i.e., no diagnostic anomaly was noticed. In the remaining 83 EEGs, if the duration of the EEG was reduced to 20 minutes, it resulted in missing the diagnostic anomaly in 20 cases (24.1%; 95% CI: 11.2%-26.2%). Reducing the duration of the EEG recording to 10 minutes resulted in missing 63 of the diagnostic anomalies (75.9%; 95% CI: 46.6%-65.6%). Of the 86 drug-induced EEGs, 22 were normal (25.6%; 95% CI: 16.8%-36.1%). Of the 24 routine EEGs, seven were normal (29.2%; 95% CI: 12.6%-51.1%). Of the two sleep-deprived EEGs, neither was normal (0.0%; 95% CI: 0.0%-84.1%). Conclusion In our study, we observed that optimization of the duration of EEG recording can be done to 20 minutes in all populations. We also observed that if we find a diagnostic abnormality early during EEG recording, then continuation of the EEG may not be necessary to make a valid report. Having said so, having a negative EEG may not necessarily rule out a diagnosis. We did not find the superiority of any of the EEG protocols over others, as their yield was comparable.

When all that should close remains open: a tale of gastroschisis, exstrophy of bladder, spina bifida and limb defects.

A primigravida in the extremist-affected region of a third-world nation gave birth to a newborn who was remotely consulted through video rounds from the capital of the state. Unfortunately, these abnormalities are often overlooked and left untreated. The baby had multiple limb defects, gastroschisis, exstrophy of the bladder and spina bifida. Tragically, the newborn did not survive due to the lack of clinical and surgical expertise in the area. It is crucial to emphasise the importance of establishing e-clinics for expectant mothers in underserved areas, providing them with access to high-quality anomaly scans.

A Hybrid Form of Telemedicine and Quality Improvement: A Unique Way to Extend Intensive Care Services to Neonates.

OBJECTIVES: To evaluate the impact of hybrid support (tele-mentoring and conventional support) on adverse outcome among neonates admitted to 10 special newborn care units (SNCUs) in Chhattisgarh. METHODS: This before-and-after study was conducted at 10 SNCUs in Chhattisgarh in 2022. Conventional support was given earlier and later, that was supplemented with tele-rounds which were carried out using Skype technology. The principal investigator (PI) visited each unit for one day per month to kickstart quality improvement (QI) projects and provide guidance. Patient outcome data were collected on clinical sepsis proportion, IV fluid usage, antibiotic usage, length of stay, referral and mortality. RESULTS: A total of 2807 babies across 10 units were assessed. This was retrospectively correlated with 5169 babies in these units in the year before the intervention was started. The percentage of clinical neonatal sepsis cases decreased from 53.4% to 29.4% (P < 0.05). IV fluid usage dropped from 40% to 22.2% (P < 0.05). The initiation and continuation of kangaroo mother care (KMC) increased from 55.5% to 93.8% (P < 0.05). The average length of stay decreased from 5.5 ± 0.97 d to 4 ± 0.2 d (P < 0.05). Oxygen utilization decreased from 39.3% to 33.6% (P < 0.05). The proportion of antibiotic usage decreased from 50.2% to 39.7% (P < 0.05). The mortality rate decreased from 8.18% to 6.99% (P < 0.05). Referral rate decreased from 13.12% to 11.93% (P < 0.05). CONCLUSIONS: The implementation of a QI package through hybrid support, which includes tele-mentoring, supportive supervision visits, and local QI project advocacy, proves to be an effective approach in enhancing newborn intensive care.

The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring.

PURPOSE OF REVIEW: Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. RECENT FINDINGS: Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.

Chia Phenolic Extract Appear to Improve Small Intestinal Functionality, Morphology, Bacterial Populations, and Inflammation Biomarkers In Vivo (Gallus gallus).

Phenolic compounds can act as a substrate for colonic resident microbiota. Once the metabolites are absorbed and distributed throughout the body, they can have diverse effects on the gut. The objective of this study was to evaluate the effects of the intra-amniotic administration of a chia phenolic extract on intestinal inflammation, intestinal barrier, brush border membrane functionality, intestinal microbiota, and morphology in vivo (Gallus gallus model). Cornish-cross fertile broiler eggs, at 17 days of embryonic incubation, were separated into groups as follows: non-injected (NI; this group did not receive an injection); 18 MΩ H2O (H2O; injected with ultrapure water), and 10 mg/mL (1%) chia phenolic extract (CPE; injected with phenolic extract diluted in ultrapure water). Immediately after hatch (21 days), chickens were euthanized and their small intestine, cecum, and cecum content were collected and analyzed. The chia phenolic extract reduced the tumor necrosis factor-alpha (TNF-α) and increased the sucrose isomaltase (SI) gene expression, reduced the Bifidobacterium and E. coli populations, reduced the Paneth cell diameter, increased depth crypt, and maintained villus height compared to the non-injected control group. Chia phenolic extract may be a promising beneficial compound for improving intestinal health, demonstrating positive changes in intestinal inflammation, functionality, microbiota, and morphology.

A Curious Case of an Accented Extra Nose.

There have been about 60 cases of supernumerary nostril reported. We encountered a 38 weeker, male child with supernumerary nostril and midline congenital nevus which was later locally excised. The uniqueness of our case is the presence of an entirely well-formed nostril perched on top on the normal nose.

Effects of dietary fiber on intestinal iron absorption, and physiological status: a systematic review of in vivo and clinical studies.

The benefits of dietary fiber on intestinal health have been well established. However, there is no consensus on the dietary fiber effects on mineral absorption. The objective of this systematic review is to discuss the evidence on the dietary fiber effects on iron absorption and iron status-related biomarkers. A comprehensive search of 3 databases: PubMed, Scopus and Web of Science was carried out. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and a total of 32 studies were included with 9 of them clinical studies and 23 in vivo. The studies included assessment of dietary fiber in the form of fructo-oligosaccharides, galacto-oligosaccharides, inulin, pectin, guar gum, oligofructose, xylo-oligosaccharides, and mannan-oligosaccharide. Hemoglobin (n = 21) and fractional iron absorption (n = 6) were the most frequently reported outcomes. The results showed no significant correlations between consumption of dietary fiber to iron absorption/status-related biomarkers. However, the current evidence may not be substantial to invalidate the recommendation of dietary fiber as an agent to improve dietary iron bioavailability, and absorption. In conclusion, there is a need to conduct further clinical trials with long dietary fiber intervention focusing on population at high risk for iron deficiency.

Empire Apple (Malus domestica) Juice, Pomace, and Pulp Modulate Intestinal Functionality, Morphology, and Bacterial Populations In Vivo (Gallus gallus).

Approximately $20 billion of apple sales are generated annually in the United States. With an estimated 5 million tons produced yearly in the U.S. within the last decade, apple consumption is considered ubiquitous. Apples are comprised of bioactive constituents such as phytochemicals and prebiotics that may potentiate intestinal health and the gut microbiome. This study aimed to evaluate the effects of Empire apple juice, pomace, and pulp soluble extracts on intestinal functionality, morphology, and the microbiome in vivo (Gallus gallus). There were five treatment groups: non-injected (NI); 18 MΩ H2O (H2O); 6% apple juice (AJ); 6% apple pomace (APo); 6% apple pulp (APu). The eggs were treated by intra-amniotic administration of the samples on day 17 of incubation. After hatching, the blood, tissue, and cecum samples were collected for further analyses­including duodenal histomorphology, hepatic and duodenal mRNA expression, and cecal bacterial populations. Crypt depth was significantly (p < 0.5) shortest in AJ when compared to APo and APu. APo and APu soluble extracts significantly improved villi surface area compared to NI and H2O control groups. The highest count of Paneth cells per crypt was observed in APo as compared to all groups. In addition, the expression of brush border membrane micronutrient metabolism and functional proteins varied between treatments. Lastly, Lactobacillus cecal microbial populations increased significantly in the AJ group, while AJ, APu, and APu increased the abundance of Clostridium (p < 0.5). Ultimately, these results indicate the potential of Empire apple pomace to improve host intestinal health and the gut microbiome.

Effect of Black Corn Anthocyanin-Rich Extract (Zea mays L.) on Cecal Microbial Populations In Vivo (Gallus gallus).

Black corn has been attracting attention to investigate its biological properties due to its anthocyanin composition, mainly cyanidin-3-glucoside. Our study evaluated the effects of black corn extract (BCE) on intestinal morphology, gene expression, and the cecal microbiome. The BCE intra-amniotic administration was evaluated by an animal model in Gallus gallus. The eggs (n = 8 per group) were divided into: (1) no injection; (2) 18 MΩ H2O; (3) 5% black corn extract (BCE); and (4) 0.38% cyanidin-3-glucoside (C3G). A total of 1 mL of each component was injected intra-amniotic on day 17 of incubation. On day 21, the animals were euthanized after hatching, and the duodenum and cecum content were collected. The cecal microbiome changes were attributed to BCE administration, increasing the population of Bifidobacterium and Clostridium, and decreasing E. coli. The BCE did not change the gene expression of intestinal inflammation and functionality. The BCE administration maintained the villi height, Paneth cell number, and goblet cell diameter (in the villi and crypt), similar to the H2O injection but smaller than the C3G. Moreover, a positive correlation was observed between Bifidobacterium, Clostridium, E. coli, and villi GC diameter. The BCE promoted positive changes in the cecum microbiome and maintained intestinal morphology and functionality.

Alterations in Intestinal Brush Border Membrane Functionality and Bacterial Populations Following Intra-Amniotic Administration (Gallus gallus) of Catechin and Its Derivatives.

Catechin is a flavonoid naturally present in numerous dietary products and fruits (e.g., apples, berries, grape seeds, kiwis, green tea, red wine, etc.) and has previously been shown to be an antioxidant and beneficial for the gut microbiome. To further enhance the health benefits, bioavailability, and stability of catechin, we synthesized and characterized catechin pentaacetate and catechin pentabutanoate as two new ester derivatives of catechin. Catechin and its derivatives were assessed in vivo via intra-amniotic administration (Gallus gallus), with the following treatment groups: (1) non-injected (control); (2) deionized H2O (control); (3) Tween (0.004 mg/mL dose); (4) inulin (50 mg/mL dose); (5) Catechin (6.2 mg/mL dose); (6) Catechin pentaacetate (10 mg/mL dose); and (7) Catechin pentabutanoate (12.8 mg/mL dose). The effects on physiological markers associated with brush border membrane morphology, intestinal bacterial populations, and duodenal gene expression of key proteins were investigated. Compared to the controls, our results demonstrated a significant (p < 0.05) decrease in Clostridium genera and E. coli species density with catechin and its synthetic derivative exposure. Furthermore, catechin and its derivatives decreased iron and zinc transporter (Ferroportin and ZnT1, respectively) gene expression in the duodenum compared to the controls. In conclusion, catechin and its synthetic derivatives have the potential to improve intestinal morphology and functionality and positively modulate the microbiome.

Comparing the Effects of Concord Grape (Vitis labrusca L.) Puree, Juice, and Pomace on Intestinal Morphology, Functionality, and Bacterial Populations In Vivo (Gallus gallus).

This is a preliminary study evaluating the effect of different fractions of Concord grapes (Vitis labrusca L.) on the brush border membrane (BBM) morphology, duodenal gene expression, and specific gut bacterial populations. For this study, we utilized a unique intraamniotic approach, wherein, the test substances are administered into the amnion of the Gallus gallus egg (on day 17). The embryo orally consumes the amniotic fluid along with the injected test substance before the hatch. We randomly divided ~50 fertilized eggs into 5 groups including 6% grape (juice, puree, and pomace) along with controls (no injection and diluent­H2O). The grape juice was prepared by crushing the grapes; the grape residues were used as pomace. The grape puree included the grape skin, endocarp, mesocarp, and juice but not the seeds. On day 21, the hatch day, the blood, pectoral muscle, liver, duodenum, and large intestine were harvested. Our results showed no significant differences in blood glucose, pectoral glycogen level, or body weight. However, significant (p < 0.05) differences in duodenal and liver gene expression were observed between the treatment groups. The grape puree treatment resulted in higher Clostridium numbers and lower Bifidobacterium numbers when compared to all other groups. In summary, the dietary consumption of grape polyphenols has the potential to beneficially modulate aspects of intestinal health provided their concentration is limited.

Alterations in Intestinal Brush Border Membrane Functionality and Bacterial Populations Following Intra-Amniotic Administration (Gallus gallus) of Nicotinamide Riboside and Its Derivatives.

Nicotinamide riboside (NR) acts as a nicotinamide adenine dinucleotide (NAD+) precursor where NR supplementation has previously been shown to be beneficial. Thus, we synthesized and characterized nicotinamide riboside tributyrate chloride (NRTBCl, water-soluble) and nicotinamide riboside trioleate chloride (NRTOCl, oil-soluble) as two new ester derivatives of nicotinamide riboside chloride (NRCl). NRCl and its derivatives were assessed in vivo, via intra-amniotic administration (Gallus gallus), with the following treatment groups: (1) non-injected (control); and injection of (2) deionized H2O (control); (3) NRCl (30 mg/mL dose); (4) NRTBCl (30 mg/mL dose); and (5) NRTOCl (30 mg/mL dose). Post-intervention, the effects on physiological markers associated with brush border membrane morphology, intestinal bacterial populations, and duodenal gene expression of key proteins were investigated. Although no significant changes were observed in average body weights, NRTBCl exposure increased average cecum weight. NR treatment significantly increased Clostridium and NRCl treatment resulted in increased populations of Bifidobacterium, Lactobacillus, and E. coli. Duodenal gene expression analysis revealed that NRCl, NRTBCl, and NRTOCl treatments upregulated the expression of ZnT1, MUC2, and IL6 compared to the controls, suggesting alterations in brush border membrane functionality. The administration of NRCl and its derivatives appears to trigger increased expression of brush border membrane digestive proteins, with added effects on the composition and function of cecal microbial populations. Additional research is now warranted to further elucidate the effects on inflammatory biomarkers and observe changes in the specific intestinal bacterial populations post introduction of NR and its derivatives.

Complicated Severe Appendicitis in a 58-Year-Old Female After COVID-19 Infection: A Coincidence or an Association?

Acute appendicitis (AA) remains the most common cause of acute abdomen worldwide. Although overall mortality in developed countries is low, complication due to perforation, abscess formation, stump appendicitis and intra-abdominal sepsis is associated with increased morbidity. Throughout the COVID-19 pandemic, an increasing proportion of complicated appendicitis has been reported. In this case, we present a 58-year-old female with a remote history of COVID-19 infection and severe appendicitis, complicated by sepsis. Viral infection has previously been proposed as a cause of appendicitis. Our report aims to describe our patient's course and comment on a potential association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, as well as future diagnostic and management considerations.

Carcinoma Erysipeloides With Clinical and Dermatoscopic Features: An Overlooked Clinical Manifestation of Breast Cancer.

Carcinoma erysipeloides (CE) is an atypical finding among women with breast cancer. CE clinically presents as an erythematous patch or plaque resembling superficial skin infections such as cellulitis or erysipelas. CE can also be the first indication of an underlying breast cancer. Therefore, it is imperative for clinicians to recognize this rare entity for early diagnosis and improving prognosis and outcomes in breast cancer patients. Here, we present a 68-year-old female patient with a history of breast cancer, who developed recurrence of cancer with typical clinical features of CE. Hence, we aim to increase awareness of this rare entity. We also report the dermatoscopic features of CE, which to the authors' knowledge have not been previously documented in literature.

Zinc Biofortified Cowpea (Vigna unguiculata L. Walp.) Soluble Extracts Modulate Assessed Cecal Bacterial Populations and Gut Morphology In Vivo (Gallus gallus).

BACKGROUND: Biofortification is a method that improves the nutritional value of food crops through conventional plant breeding. The aim of this study was to evaluate the effects of intra-amniotic administration of soluble extracts from zinc (Zn) biofortified and Zn standard cowpea (Vigna unguiculata L. Walp.) flour on intestinal functionality and morphology, inflammation, and gut microbiota, in vivo. METHODS: Seven treatment groups were utilized: (1) No Injection; (2) 18 MΩ H2O; (3) 50 mg/mL Inulin; (4) 50 mg/mL BRS Pajeú soluble extract (Zn standard); (5) 50 mg/mL BRS Aracê soluble extract (Zn biofortified); (6) 50 mg/mL BRS Imponente soluble extract (Zn biofortified); (7) 50 mg/mL BRS Xiquexique soluble extract (Zn biofortified). RESULTS: Treatment groups with BRS Imponente and BRS Xiquexique reduced the abundance of Clostridium and E. coli when compared with all other experimental groups. All cowpea soluble extracts increased villi goblet cell number (total), specifically acidic goblet cell type number per villi relative to inulin and 18MΩ H2O groups. Moreover, BRS Xiquexique increased the crypt goblet diameter and the crypt depth compared to all treatments and controls. The Zn content in the Zn biofortified cowpea flours was higher when compared to the Zn standard flour (BRS Pajeú), and the phytate: Zn molar ratio was lower in the Zn biofortified flours compared to the Zn standard flour. In general, all cowpea soluble extracts maintained the gene expression of proteins involved with Zn and iron absorption, brush border membrane (BBM) functionality and inflammation compared to inulin and 18MΩ H2O. CONCLUSIONS: This study demonstrates the potential nutritional benefit of standard and biofortified cowpea treatment groups to improve intestinal morphology, BBM functionality, inflammation, and gut microbiota, with the highest effect of BRS Xiquexique soluble extracts to improve assessed cecal microflora populations and intestinal morphology.

Pulmonary Manifestations in Von Recklinghausen's Disease: A Rare Presentation.

Neurofibromatosis type 1 is a genetic disease that leads to a specific collection of symptoms. Most patients over time develop cutaneous manifestations, which include neurofibromas, freckling, or even cafe-au-lait spots. In general, patients with NF1 have a shorter life expectancy than non-affected individuals. This report aims to present our patient with NF1 and one of its rare manifestations, neurofibromatosis with diffuse lung disease. Hopefully, by describing this case and our patient's condition, it will serve as a resource to those treating similar patients.

Quinoa Soluble Fiber and Quercetin Alter the Composition of the Gut Microbiome and Improve Brush Border Membrane Morphology In Vivo (Gallus gallus).

Quinoa (Chenopodium quinoa Willd.), a gluten-free pseudo-cereal, has gained popularity over the last decade due to its high nutritional value. Quinoa is a rich source of proteins, carbohydrates, fibers, tocopherols (Vitamin E), unsaturated fatty acids and a wide range of polyphenols. The study used Gallus gallus intra-amniotic feeding, a clinically validated method, to assess the effects of quinoa soluble fiber (QSF) and quercetin 3-glucoside (Q3G) versus control. Quercetin is a pharmacologically active polyphenol found in quinoa. Six groups (no injection, 18 Ω H2O, 5% inulin, 1% Q3G, 5% QSF, 1% Q3G + 5% QSF) were assessed for their effect on the brush border membrane (BBM) functionality, intestinal morphology and cecal bacterial populations. Our results showed a significant (p < 0.05) improvement in BBM morphology, particularly goblet and Paneth cell numbers, in the group administered with quinoa and quercetin. However, there were no significant changes seen in the expression of the genes assessed both in the duodenum and liver between any of the treatment groups. Furthermore, fibrous quinoa increased the concentration of probiotic L. plantarum populations compared to the control (H2O). In conclusion, quercetin and quinoa fiber consumption has the potential to improve intestinal morphology and modulate the microbiome.

Saffron (Crocus sativus L.) Flower Water Extract Disrupts the Cecal Microbiome, Brush Border Membrane Functionality, and Morphology In Vivo (Gallus gallus).

Saffron (Crocus sativus L.) is known as the most expensive spice. C. sativus dried red stigmas, called threads, are used for culinary, cosmetic, and medicinal purposes. The rest of the flower is often discarded, but is now being used in teas, as coloring agents, and fodder. Previous studies have attributed antioxidant, anti-inflammatory, hepatoprotective, neuroprotective, anti-depressant, and anticancer properties to C. sativus floral bio-residues. The aim of this study is to assess C. sativus flower water extract (CFWE) for its effects on hemoglobin, brush boarder membrane (BBM) functionality, morphology, intestinal gene expression, and cecal microbiome in vivo (Gallus gallus), a clinically validated model. For this, Gallus gallus eggs were divided into six treatment groups (non-injected, 18 Ω H2O, 1% CFWE, 2% CFWE, 5% CFWE, and 10% CFWE) with n~10 for each group. On day 17 of incubation, 1 mL of the extracts/control were administered in the amnion of the eggs. The amniotic fluid along with the administered extracts are orally consumed by the developing embryo over the course of the next few days. On day 21, the hatchlings were euthanized, the blood, duodenum, and cecum were harvested for assessment. The results showed a significant dose-dependent decrease in hemoglobin concentration, villus surface area, goblet cell number, and diameter. Furthermore, we observed a significant increase in Paneth cell number and Mucin 2 (MUC2) gene expression proportional to the increase in CFWE concentration. Additionally, the cecum microbiome analysis revealed C. sativus flower water extract altered the bacterial populations. There was a significant dose-dependent reduction in Lactobacillus and Clostridium sp., suggesting an antibacterial effect of the extract on the gut in the given model. These results suggest that the dietary consumption of C. sativus flower may have negative effects on BBM functionality, morphology, mineral absorption, microbial populations, and iron status.