[HAIR STRAIGHTENING - NOT STRAIGHTFORWARD].

INTRODUCTION: The rising popularity of hair straightening in younger ages has become a medical issue, since glycolic acid and formaldehyde may be present, even in "formaldehyde-free" labeled products. Formaldehyde - a colorless material, evaporates during the hair straightening procedure, inhaled and absorbed into the blood stream causing oxidative stress and cytotoxic damage to the proximal tubule cells leading to acute kidney injury (AKI). Glycolic acid is processed to glyoxylate and eventually to oxalate, whose deposition may also cause AKI. We present three cases of female teenagers with AKI, recently after a hair straightening procedures. All patients had features of tubular damage and kidney biopsies in the first 2 cases showed acute tubular necrosis (ATN), one with oxalate deposition and the other with unidentified depositions. Two cases required acute dialysis, and shortly after commencing it, kidney function rapidly improved. We believe that in the presented cases, the prompt dialysis cleared a nephrotoxic ingredient, allowing improvement of renal function, therefore preventing long-standing and maybe, even permanent damage. This case presentation highlights the danger of hair straightening products in pediatric populations aiming to increase its index of suspicion among adult and pediatric nephrologists.

Aberrant left coronary artery from the pulmonary artery with patent ductus arteriosus - a case report and review of the literature.

BACKGROUND: Aberrant left coronary artery from pulmonary artery (ALCAPA) is a very rare congenital heart defect. Its coexistence with patent ductus arteriosus (PDA) is extremely rare. The high pressures created by the left-to-right shunt in the pulmonary arteries can delay symptoms and create a real challenge in diagnosing ALCAPA. Missing this diagnosis can have severe results, including extensive ischemia and sudden death. CASE PRESENTATION: We present a case of an infant born with a large PDA. Initially treated conservatively, however, due to congestive heart failure and lack of weight gain, she underwent surgical ligation of the PDA at the age of four and a half months. Following surgery, she developed pulmonary edema. Echocardiography revealed decreased ventricular function. ECG revealed ST elevations on lateral leads, and serum troponin was significantly increased. The patient underwent cardiac magnetic resonance imaging (MRI), which revealed signs of wall ischemia and decreased function of the left ventricle (LV) with unclear coronary anatomy. Diagnostic catheterization revealed an ALCAPA. She underwent surgical intervention, and the left coronary artery was re-implanted in the aortic sinus. Follow-up revealed slow improvement of cardiac function. DISCUSSION AND LITERATURE REVIEW: The coexistence of PDA and ALCAPA is a very rare occurrence. We found at least 10 reported cases in the literature. Delayed diagnosis might be detrimental. The prognosis of these patients is variable. CONCLUSION: An unusual post-surgical course following PDA repair requires a high index of suspicion and appropriate evaluation for ALCAPA, preferably with angiography.

Recent use of formaldehyde-'free' hair straightening product and severe acute kidney injury.

Formaldehyde is present in hair straightening products even when labeled as formaldehyde-free. Inhaled absorption of formaldehyde causes renal tubular cytotoxicity. We report a teenager who developed severe acute kidney injury requiring renal replacement therapy shortly after exposure to a formaldehyde-'free' hair straightening product. Kidney biopsy showed acute tubular necrosis and images compatible with microcalcifications. Kidney function improved while on continuous venous-venous hemodialysis.