Case report: Coexistence of Jacobs syndrome, congenital adrenal hyperplasia, and ambiguous genitalia in a male infant.

Key Clinical Message: Jacobs syndrome and congenital adrenal hyperplasia are separate entities but share common clinical features such as ambiguous genitalia. Further studies are needed to conclude the relationship between Jacobs syndrome and congenital adrenal hyperplasia. Abstract: A 5-month-old male infant was evaluated for ambiguous genitalia. Examination revealed cryptorchidism, inguinal hernia, long phallus, and Grade 3 scrotal hypospadias. Serum 17-OH progesterone was high and chromosomal analysis showed 47XYY/45XO. A diagnosis of Jacobs and CAH was made. The parents were counseled about the patient's condition. He was given hydrocortisone and referred to the pediatric surgeon for further management.

A case report of hypokalemic periodic muscular weakness secondary to Sjögren's syndrome with distal renal tubular acidosis.

Key Clinical Message: An underlying autoimmune condition should be suspected in patients who presented with periodic muscular weakness secondary to distal RTA that leads to hypokalemia because distal RTA is commonly associated with autoimmune disorders such as Sjögren's syndrome. Abstract: A 22-year-old female presented with a sudden onset of bilateral weakness in both upper and lower limbs. The patient had a history of muscular weakness secondary to hypokalemia and dryness of the eyes for the last 3 years. Laboratory investigations revealed decreased potassium and metabolic acidosis. Further investigations confirmed distal renal tubular acidosis (RTA) and Sjögren's syndrome. A diagnosis of distal RTA secondary to Sjögren's syndrome was made. Her potassium levels were replaced, and she was discharged with oral potassium supplements, steroids, and artificial tears.

General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances.

Obesity has long been linked to adverse health effects over time. As the prevalence of obesity continues to rise, it is important to anticipate and minimize the complications that obesity brings in the anesthesia setting during surgery. Anesthetic departments must recognize the innumerable risks when managing patients with obesity undergoing surgery, including anatomical and physiological changes as well as comorbidities such as diabetes, cardiovascular diseases, and malignancies. Therefore, the purpose of this review is to analyze the current literature and evaluate the current and recent advances in anesthetic care of obese patients undergoing surgery, to better understand the specific challenges this patient population faces. A greater understanding of the differences between anesthetic care for obese patients can help to improve patient care and the specificity of treatment. The examination of the literature will focus on differing patient outcomes and safety precautions in obese patients as compared to the general population. Specifically highlighting the differences in pre-operative, intra-operative, and post-operative care, with the aim to identify issues and present possible solutions.

The educational, social, and emotional impact of COVID19 on Rohingya youth: Implications for educators and policymakers.

The COVID-19 pandemic has greatly impacted the lives of many around the world, particularly refugee and immigrant communities. In the United States, millions of children and youth had to quickly shift from in-person to remote learning, encountering new challenges and uncertainties in their overall educational experiences. This study explored some of the impacts of the COVID-19 pandemic on the educational, socialization, and mental and emotional health and wellbeing of Rohingya refugee youth from Myanmar resettled in the United States. Through in-depth qualitative interviews with 15 Rohingya refugees ages 12-17, we found that Rohingya youth's experiences with COVID-19 pandemic presented both challenges and opportunities. The challenges included unavailability of personal space to conduct school work, difficulties adjusting to online school due to computer literacy levels, and familial responsibilities that often conflicted with their schooling, as well as feelings of boredom and sadness that consequently impacted their emotional and mental health state. Youth also noted opportunities such as spending more time with their parents who were unable to work due to the pandemic as well as feeling helpful in acting as caregivers to their siblings and in working alongside their parents. Implications for policymakers and educators are also discussed.

Lipopolysaccharide from Rhodobacter spheroids modulate toll-like receptors expression and tissue damage in an animal model of bilateral renal ischemic reperfusion injury.

Ischemic reperfusion injury (IRI) of the kidneys is a direct sequela of surgical procedures associated with the interruption of blood supply. The pathophysiology of IRI is complicated, and several inflammatories, apoptosis, and oxidative stress pathways are implicated. Among the major receptors directly involved in renal IRI are the toll-like receptors (TLRs), specifically TLR2 and TLR4. In this study, we investigated the effects of Lipopolysaccharide from Rhodobacter Sphaeroides (TLR2 and TLR4 antagonist, LPS-RS) and the ultrapure form (pure TLR4 antagonist, ULPS-RS) on the histopathological changes and TLRs expression in an animal model of bilateral renal IRI. Forty-eight adult male rats were allocated into six groups (N=8) as follows: sham group (negative control without IRI), control group (rats underwent bilateral renal ischemia for 30 minutes and 2 hours of reperfusion), vehicle group (IRI+ vehicle), LPS-RS group (IRI+ 0.5 mg/kg of LPS-RS), ULPS-RS group (IRI+ 0.1 mg/kg of ULPS-RS), ULPS-RSH group (IRI+ 0.2 mg/kg of ULPS-RS). Significant improvement in the histopathological damages induced by renal IRI was found in the ULPS-RS treated groups at both doses compared with the control group. The protective effect of ULPS-RS was associated with significantly reduced TLR4 expression without affecting TLR2. Regarding LPS-RS, the tested dose adversely affected the renal tissues as manifested by the histopathological findings, although it similarly affected TLRs expression as ULPS-RS. Our results demonstrated that ULPS-RS was renoprotective while LPS-RS had no protective effect against the tissue damages induced by renal IRI.

Synergistic effects of pomegranate and rosemary extracts in combination with antibiotics against antibiotic resistance and biofilm formation of Pseudomonas aeruginosa.

The combination of plant extract and antibiotic represents a template for developing of antibiofilm drugs. This study investigated the synergistic effects of pomegranate/rosemary/antibiotic combinations against antibiotic resistance and biofilm formation of Pseudomonas aeruginosa. The results showed that 17 (85%) of total P. aeruginosa isolates were biofilm producers; however, 5 (25%) isolates were demonstrated as a strong biofilm producer. The highest MIC level (1024 µg/ml) of tested antibiotics against strong biofilm producer isolates was observed with piperacillin, however the MIC ranges of ceftazidime, gentamycin, imipenem, and levofloxacin against these isolates were reached to (256-1024 µg/ml), (32-1024 µg/ml), (8-1024 µg/ml), and (8-512 µg/ml), respectively. PS-1 was the representative isolate for strong biofilm formation and high antibiotic resistance. 16S rRNA gene analysis suggested that PS-1 (accession No. MN619678) was identified as a strain of P. aeruginosa POA1. Pomegranate and rosemary extracts were the most effective extracts in biofilm inhibition, which significantly inhibited 91.93 and 90.83% of PS-1 biofilm, respectively. Notably, the synergism between both plant extracts and antibiotics has significantly reduced the MICs of used antibiotics at the level lower than the susceptibility breakpoints. Pomegranate/rosemary/antibiotic combinations achieved the highest biofilm eradication, which ranging from 90.0 to 99.6%, followed by the eradication ranges of pomegranate/rosemary combination, rosemary, and pomegranate extracts, which reached to (76.5-85.4%), (53.1-73.7%), and (41.2-71.5%), respectively. The findings suggest that pomegranate/rosemary/antibiotic combinations may be an effective therapeutic agent for antibiotic resistance and biofilm formation of P. aeruginosa.

Truckies' Nutrition and Physical Activity: A Cross-sectional Survey in Queensland, Australia.

Truck drivers are at increased risk of diet- and physical activity-related chronic diseases. Despite this, there is a paucity of data about Australian truck drivers' diet and physical activity behaviors. A multiple choice and short response survey was distributed to truck drivers attending an Australian Truck Show. The survey asked about self-reported health, source of health information, number of serves of fruit, vegetables, unhealthy food, and sugary drink consumed per day, and frequency of moderate- and vigorous-intensity physical activity per week. The survey was completed by 231 truck drivers---almost all were male, with a mean age of 46 (range 20 to 71) years. Over 85% of survey respondents worked more than 9 hrs per day. Nearly 75% acknowledged the need to make changes to improve their health. Half consumed fewer serves of fruit and 88% consumed fewer serves of vegetables than national recommendations. Over 63% consumed at least one serve of unhealthy foods per day, and 65% drank at least one can of sugary drink per day. Most (80%) undertook less than moderate- and vigorous-intensity physical activity levels provided in national recommendations. Of concern, almost 90% of drivers had above the recommended body mass index---approximately 60% were obese. This is almost double the proportion found in the general population. These findings highlight the importance of health promotion to help drivers make better choices about their health behaviors, which are often underpinned by the limitations of their work environment. Health promotion in transport industry workplaces should be an important topic for future research.