Accumulation of oxysterols in the erythrocytes of COVID-19 patients as a biomarker for case severity.

BACKGROUND: Due to the high risk of COVID-19 patients developing thrombosis in the circulating blood, atherosclerosis, and myocardial infarction, it is necessary to study the lipidome of erythrocytes. Specifically, we examined the pathogenic oxysterols and acylcarnitines in the erythrocyte homogenate of COVID-19 patients. These molecules can damage cells and contribute to the development of these diseases. METHODS: This study included 30 patients and 30 healthy volunteers. The erythrocyte homogenate extract was analyzed using linear ion trap mass spectrometry combined with high-performance liquid chromatography. The concentrations of oxysterols and acylcarnitines in erythrocyte homogenates of healthy individuals and COVID-19 patients were measured. Elevated levels of toxic biomarkers in red blood cells could initiate oxidative stress, leading to a process known as Eryptosis. RESULTS: In COVID-19 patients, the levels of five oxysterols and six acylcarnitines in erythrocyte homogenates were significantly higher than those in healthy individuals, with a p-value of less than 0.05. The mean total concentration of oxysterols in the red blood cells of COVID-19 patients was 23.36 ± 13.47 µg/mL, while in healthy volunteers, the mean total concentration was 4.92 ± 1.61 µg/mL. The 7-ketocholesterol and 4-cholestenone levels were five and ten times higher, respectively, in COVID-19 patients than in healthy individuals. The concentration of acylcarnitines in the red blood cell homogenate of COVID-19 patients was 2 to 4 times higher than that of healthy volunteers on average. This finding suggests that these toxic biomarkers may cause the red blood cell death seen in COVID-19 patients. CONCLUSIONS: The abnormally high levels of oxysterols and acylcarnitines found in the erythrocytes of COVID-19 patients were associated with the severity of the cases, complications, and the substantial risk of thrombosis. The concentration of oxysterols in the erythrocyte homogenate could serve as a diagnostic biomarker for COVID-19 case severity.

Comparative effectiveness of dual antiplatelet therapy versus monotherapy in patients with ischemic stroke.

OBJECTIVES: To compare the effectiveness of aspirin-clopidogrel dual antiplatelet therapy (DAPT) with aspirin or clopidogrel antiplatelet monotherapy (AM) in patients with ischemic stroke. METHODS: It was a single-center, retrospective cross-sectional study of medical records of ischemic stroke patients admitted at King Abdulaziz University Hospital between January 2015 and October 2019. The primary endpoints were ischemic stroke recurrence, rehospitalization, and all-cause mortality between DAPT and AM. Kaplan-Meier and Cox proportional hazard analyses were employed in univariate and multivariate time-to-event analyses. RESULTS: The median time to recurrence of ischemic stroke was 15.0 months (95% confidence interval [CI], 8.586-23.01) for DAPT and 20.4 months (95% CI, 9.872-30.928) for the AM. The median survival time until all-cause mortality was 8.0 months (95% CI, 2.893-13.107) for DAPT and 14.1 months (95% CI, 8.173-19.97) for the AM. No statistically significant reductions in the instantaneous risks of recurrence (hazard ratio [HR], 1.27; 95% CI, 0.59-2.72; p=0.54), re-hospitalization (HR, 0.95; 95% CI, 0.59-1.48; p= 0.77), and mortality (HR, 1.04; 95% CI, 0.48-2.26; p=0.92) were found between the DAPT and AM groups. CONCLUSION: The DAPT was not superior to AM in reducing recurrence and mortality events in patients with ischemic stroke. Rehospitalization due to the sequelae of the composite of stroke, angina, and myocardial infarction was higher in the DAPT group.

Dissociation of water on atomic oxygen-covered Rh nanoclusters supported on graphene/Ru(0001).

We studied the dissociation of water (H2O*, with * denoting adspecies) on atomic oxygen (O*)-covered Rh nanoclusters (RhO* ) supported on a graphene film grown on a Ru(0001) surface [G/Ru(0001)] under ultrahigh-vacuum conditions and with varied surface-probe techniques and calculations based on density-functional theory. The graphene had a single rotational domain; its lattice expanded by about 5.7% to match the Ru substrate structurally better. The Rh clusters were grown by depositing Rh vapors onto G/Ru(0001); they had an fcc phase and grew in (111) orientation. Water adsorbed on the Rh clusters was dissociated exclusively in the presence of O*, like that on a Rh(111) single-crystal surface. Contrary to the case on Rh(111)O* , excess O* (even at a saturation level) on small RhO* clusters (diameter of 30-34 Å) continued to promote, instead of inhibiting, the dissociation of water; the produced hydroxyl (OH*) increased generally with the concentration of O* on the clusters. The difference results from more reactive O* on the RhO* clusters. O* on RhO* clusters activated the dissociation via both the formation of hydrogen bonds with H2O* and abstraction of H directly from H2O*, whereas O* on Rh(111)O* assisted the dissociation largely via the formation of hydrogen bonds, which was readily obstructed with an increased O* coverage. As the disproportionation (2 OH* → H2O* + O*) is endothermic on the RhO* clusters but exothermic on Rh(111)O* , OH* produced on RhO* clusters showed a thermal stability superior to that on the Rh(111)O* surface-thermally stable up to 400 K.

Retraction: Laparoscopic Port Site Hernia: A Rare Etiology of Intestinal Obstruction.

[This retracts the article DOI: 10.7759/cureus.19681.].

The Prevalence and Associated Risk Factors for Neonatal Thrombocytopenia Among Newborns Admitted to the Neonatal Intensive Care Unit.

Background Thrombocytopenia is the most prevalent hematological condition in neonates that develops in the neonatal intensive care unit (NICU). This set of illnesses is caused by either decreased platelet production due to placental insufficiency, increased platelet breakdown (consumption), or a combination of the two causes. Based on platelet count, it is defined as mild, moderate, or severe thrombocytopenia, with early and late onset. Purpose The purpose of this study is to determine the prevalence of thrombocytopenia and the factors that contribute to it in newborns hospitalized in the neonatal critical care unit at the Maternity and Children Hospital in Al Ahsa, Saudi Arabia. Methods This descriptive retrospective cross-sectional study was carried out at the NICU of the Maternity and Children Hospital in Al Ahsa, Saudi Arabia, over the span of one year (August 2022 to August 2023) among hospitalized neonates with thrombocytopenia. Thrombocytopenia is defined as a platelet count of 150,000 or less. These patients were monitored until they recovered or died. Results The inclusion criteria were met by a total of 242 newborns with thrombocytopenia. Half of the neonates (57%) were full-term, with Apgar scores greater than 5 at the first (84%) and fifth (93%) minutes, respectively. The great majority of individuals (84%) experienced early-onset thrombocytopenia of mild severity (62%) and were asymptomatic (93%). The majority of the cases resolved spontaneously, with only 21% requiring platelet transfusion. There was a significant relationship discovered between gestational age and the severity of thrombocytopenia, with very preterm infants having moderate to severe thrombocytopenia, as well as birth weight (p=0.001). Furthermore, neonates with severe thrombocytopenia had a considerably higher mortality rate (p=0.001). Conclusion The mortality and morbidity of newborns with perinatal risk for neonatal thrombocytopenia can be reduced with timely detection of the cause and development of thrombocytopenia, as well as adequate and early care.

Prevalence and Risk Factors of Irritable Bowel Syndrome Among Adults in Al-Qunfudah Governorate, Saudi Arabia.

Background Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder and is linked to numerous psychiatric abnormalities. Objectives In Al-Qunfudah governorate, this study was done to estimate the prevalence of IBS and its associated risk factors among adults. Material and methods The Rome IV criteria and GAD-7 (General Anxiety Disorder-7) were used in this community-based cross-sectional study. A total of 335 adults from the general population made up the sample, which was chosen using a convenience (non-probability) sampling technique. The required data were collected through the dissemination of the survey link online through different electronic platforms. Results The total prevalence of IBS was 30.4% (n = 102), with females having a greater prevalence (55.9%, n = 57 out of 102). GAD was found in 15.8% of the total participants (n = 53). Significant relationships were discovered between IBS and marital status, education, occupation, smoking status, IBS history, and anxiety levels (p-values were <0.001, 0.023, 0.006, 0.016, <0.001, and <0.001, respectively). According to regression analysis, being single, having a family history of IBS, and having a generalized anxiety disorder were all risk factors for IBS. Conclusion In this study, the prevalence of IBS among adults in Al-Qunfudah governorate, Saudi Arabia, was shown to be 30.4%. Further, approximately 16% of individuals had generalized anxiety disorder. Being unmarried, having a positive family history of IBS, and suffering from GAD were all risk factors for developing IBS. People need to be educated on the symptoms and consequences of IBS. We also propose that those suffering from IBS symptoms seek a second opinion from a doctor to manage this problem and its impact on their quality of life.

Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review.

INTRODUCTION: The middle turbinate (MT) is the most important anatomical structure inside the nasal cavity and a landmark in the identification of skull base, ethmoid cells, and lamina papyracea. Postoperatively, lateralizationof the MT can cause synechia and obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses. OBJECTIVE: To review the current literature about the outcome of different techniques used intraoperatively to prevent lateralization of MT after functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS: This retrospective narrative literature review provides a summary of current and past research publications about different techniques used intraoperatively to prevent MT lateralization after FESS. RESULTS: Many methods have been described to prevent the lateralization of MT and synechiae formation. These methods include controlled synechiae, suture lateralization, metal clips, partial resection of MT, middle meatus implants, and steroid-eluting implants and stents. CONCLUSION: The ideal FESS should include preservation of the MT, reducing its lateralization, and preventing synechia formation.Different techniques have been discovered in an attempt to prevent this complication.

A Case Report of Late Diagnosis of Bilateral Choanal Atresia.

Choanal atresia (CA) is a congenital closure of the posterior nasal choanae. The closure can be unilateral or bilateral. Since the first report of CA, there have been controversies regarding its pathogenesis and the effectiveness of surgical approaches. The few cases reported in the literature were not diagnosed immediately after birth. We present a case of delayed presentation of CA. The patient was born pre-term (35 weeks) by cesarean section. He was diagnosed with bilateral CA by history, physical examination, endoscopic and radiologicalimages at five months of age. Congenital bilateral CA is rarely discovered in neonatal patients after one week of age, therefore few such cases have been reported in the literature. Nasal endoscopy and computed tomography help diagnose CA before planning surgery. Several surgical approaches for repairing congenital CA have been reported, including the transnasal and transpalatal routes. Endoscopic transnasal choanoplasty is currently the preferred approach. Though CA is a rare congenital malformation, there are cases with a delayed diagnoses reported in the literature. These findings raise the question of whether all newborns are obligate nasal breathers. Although rare, bilateral CA should be suspected in infants who exhibit difficulty with feeding and bilateral nasal obstruction, as in such cases it is impossible to feed and breathe simultaneously.

Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors.

BACKGROUND: Surgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery. METHODS: Patients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed. RESULTS: The SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3-13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4-7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1-8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2-5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%]. CONCLUSIONS: SSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.

Laparoscopic Port Site Hernia: A Rare Etiology of Intestinal Obstruction.

Small intestinal obstruction is a common indication for hospitalization and emergency surgeries. The most frequent etiologies are adhesions, hernia, and benign or malignant neoplasms. Abdominal imaging plays an important role in making the diagnosis and evaluating the complications of the obstruction. We report a case of a young woman who presented with sudden abdominal pain and vomiting. She had a relevant past medical history of sickle cell disease and multiple episodes of biliary colic for which she underwent laparoscopic cholecystectomy two months before her current presentation. Laboratory findings indicated mild inflammation in the form of elevated C-reactive protein and erythrocyte sedimentation rate with the leukocytes count in the upper normal limits. Abdominal computed tomography demonstrated a knuckle of small bowel incarcerated in the port location of the previous laparoscopy. The bowel was reduced and the defect was repaired. The patient had complete resolution of her symptoms following the surgery. The case highlighted the importance of considering port-site hernia as an etiology of bowel obstruction in the relevant clinical settings since laparoscopic operations are being increasingly performed.