Intrapelvic Kirschner wire Migration following Developmental Dysplasia of Hip Surgery and Laparoscopic Removal.

Salter innominate osteotomy remains the most commonly performed pelvic osteotomy for the Developmental Dysplasia of Hip in children after 18 months of age up to six years. Kirschner wire (K- wire) is used to fix the bone graft across the osteotomy site. Of the several complications of the pelvic osteotomy, K- wire migration into the pelvis is rare and only a few case reports are reported. We present a case of a 2-year-old girl with Right sided Developmental Dysplasia of Hip who underwent Femoral shortening and Salter innominate osteotomy, presented three months later with intrapelvic migration of k-wire. Paediatric Surgery consult was obtained and K-wire was removed laparoscopically without any complications successfully.

Efficacy and tolerability of isocitrate dehydrogenase inhibitors in patients with acute myeloid leukemia: A systematic review of clinical trials.

BACKGROUND: Acute myeloid leukemia (AML) is a hematological malignancy due to anomalous differentiation and proliferation of hematopoietic stem cells with myeloid blast buildup. Induction chemotherapy is considered the first line of treatment in most patients with AML. However, targeted therapy in the form of FLT-3, IDH, BCL-2, and immune checkpoint inhibitors, can be considered as the first line depending on their molecular profile, resistance to chemotherapy, comorbidities, etc. This review aims to assess the tolerability and efficacy of isocitrate dehydrogenase (IDH) inhibitors in AML. METHODS: We searched Medline, WOS, Embase, and clinicaltrials.gov. PRISMA guidelines were followed in this systematic review. 3327 articles were screened, and 9 clinical trials (N = 1119) were included. RESULTS: In randomized clinical trials (RCTs), objective response (OR) was reported in 63-74% of the patients with IDH inhibitors + azacitidine as compared to 19-36 % of the patients with azacitidine monotherapy in newly diagnosed (ND) medically unfit patients. Survival rates were significantly improved with the use of ivosidenib. OR was reported in 39.1-46 % of the patients who relapsed/refractory to chemotherapy. ≥Grade 3 IDH differentiation syndrome and QT prolongation were reported in 3.9-10 % and 2-10 % of the patients, respectively. CONCLUSION: IDH inhibitors (ivosidenib for IDH-1 and enasidenib for IDH-2) are safe and effective in treating ND medically unfit or relapsed refractory patients with IDH mutation. However, no survival benefit was reported with enasidenib. More randomized multicenter double-blinded clinical studies are needed to confirm these results and compare them with other targeting agents.

Edible bird's nest protects histomorphology of rat's uterus against cadmium (Cd) toxicity through a reduction of Cd deposition and enhanced antioxidant activity.

Cadmium (Cd) is often associated with reproductive disorders of mammals. Edible bird's nest (EBN) is a natural food product made of swiftlet's salivary secretion used to make their nests and it has been consumed as a tonic food for decades. This research aimed to study the protective effects of EBN against Cd-induced uterine toxicity in Sprague Dawley rats. Thirty (30) female Sprague Dawley rats were assigned into five groups as follows: group 1- negative control (NC) received distilled water; group 2 - positive control (PC) administered with CdCl2, 5 mg/kg BW; while groups EBN-1, EBN-2, and EBN-3 received CdCl2 (5 mg/kg BW) plus graded concentrations of 60, 90 and 120 mg/kg BW of EBN, respectively. After four weeks of daily oral treatment, rats were euthanized to collect the uterus for evluations of histopathological changes, Cd concentrations and Metallothionein (MT) expressions using H&E stain, inductive coupled plasma mass spectrometry (ICP-MS) and immunohistochemistry, respectively. Blood samples were collected for superoxide dismutase (SOD) analysis using SOD assay kit. Results revealed that the CdCl2 without EBN supplement (PC) group had elevated levels of Cd in the uterus along with increased MT expressions and decreased SOD enzyme activity as compared to the NC group. Moreover, uterine histopathological changes, including glandular cysts and loss of normal structure of luminal epithelium (LE) and glandular epithelium (GE) were found in the PC group. Interestingly, groups treated with CdCl2 along with EBN (EBN1, EBN2, EBN3) showed lower levels of uterine tissue Cd deposition and MT expression, lower degenerative changes with normal histomorphology of glands, and increased SOD activity as compared to the PC group. Overall, the findings revealed that oral exposure to Cd at a dose of 5 mg/kg BW resulted in significant alterations in the rat's uterus. However, the toxicity effect was averted by EBN treatment in a dose dependant manner; highest protection achieved with EBN 120 mg/kg BW, through a possible detoxification mechanism and prevention of Cd deposition.