Complete Penile Necrosis in a Patient With Heparin-induced Thrombocytopenia: A Case Report

AbstractPenile necrosis is a rare condition that has been mostly described in association with diabetes mellitus and end-stage renal disease. We report an unusual case of acute penile necrosis because of heparin-induced thrombocytopenia. A 75-year-old man presented with acute renal failure and experienced cardiac complications during the hospitalization. The patient was treated twice with intravenous heparin. He developed symptoms of penile necrosis 4 days after the reintroduction of heparin. At that moment, the platelet count dropped by 61%, and the analysis of heparin-pf4 antibodies was positive for heparin-induced thrombocytopenia. The patient underwent a total penectomy and a perineal urethrostomy

Patrón termográfico en tiempo real para el monitoreo de reperfusión testicular intraoperatorio en caso de torsión testicular

Paciente de 5 años de edad con historia de 8 horas de torsión testicular es llevado a cirugía. Se realiza registro imaginonlógico termográfico seriado en tiempo real del momento en que se realiza la destorsión utilizando una cámara infrarroja FLIR One. La temperatura escrotal previa a la cirgía era de 43,6°C del lado afectado y 41,7°C del lado sano. La temperatura corporal del paciente era de 36,8°C. Inmediatemente el testiculo fue extraído y previo a la destorsión, la temperatura era de 31,5°C. A los 30 segundos de la destorsión la temperatura aumentó a 34,3°C. El uso de termografía intraoperatoria permite identificar cambios discretos que se correlacionan con aumento del flujo testicular. Estudios futuros se enfocarán en establecer variables predictorias de sobrevida del parenquima testicular al igual que definir variables intraoperatorias para definir manejos quirurgicos como orquiectomia, preservación con flap de tunica vaginal entre otras.294-298A 5-year-old patient presents to the emergency department with testicular torsion. Intraoperative sequential infrared thermographic images were registered in real-time using a FLIR One (FLIR Systems, Inc., Wilsonville, OR, US) infrared camera. The temperatures of the scrotum and the testis prior to scrotal exploration were 43.6°C on the affected side, and 41.7°C on the contralateral side. The core temperature of the patient was 36.8°C. Immediately after the tunica vaginalis had been opened and the testis had been brought out through the incision, the temperature of the testicle was 31.5°C. After 30 seconds of being detorted, the temperature increased to 34.3°C. The use of intraoperative infrared thermographic imaging helps to detect discrete changes in testicular temperature, which suggests it may be useful to objectively assess reperfusion. Future studies will require more patients to correlate postoperative blood flow to the injured testis as well as volume changes after surgery to see if the intraoperative thermography findings can be used as a predictive tool for postoperative outcomes

Neonatal Mass Urine Screening Approach for Early Detection of Mucopolysaccharidoses by UPLC-MS/MS

Mucopolysaccharidoses (MPSs) are lysosomal storage disorders caused by deficiencies of enzymes involved in the catabolism of glycosaminoglycans (GAGs). Various treatments such as enzyme replacement therapy and/or hematopoietic stem cell transplant are available for MPSs. Early initiation of treatment improves the outcome and delays the onset of symptoms, highlighting the need for newborn screening for MPSs. The main objective of this project was to devise and validate a multiplex urine filter paper method for GAG analysis using a tandem mass spectrometry (MS/MS) approach to screen newborns for MPSs. Eluted urine samples from 21-day-old newborns were evaporated and a methanolysis reaction was performed. Samples were resuspended and analyzed using a UPLC-MS/MS system. A one-minute chromatographic method allowed the absolute quantification of heparan sulfate (HS), dermatan sulfate (DS), and creatinine. Method validation revealed high precision (< 9% relative standard deviation) and accuracy (< 7% bias) for all analytes. The reference values normalized to creatinine obtained by the analysis of five hundred 21-day-old newborn urine samples were 34.6 +/-6.2 mg/mmol of creatinine and 17.3 +/-3.9 mg/mmol of creatinine for HS and DS, respectively. We present a rapid and efficient method for populational newborn urine screening using MS/MS, which could also be applied to high-risk screening

Asthma Control Score Based on Filled Medication Prescriptions: A Validation Study

BACKGROUND: Periodic measurement of disease control is recommended to characterize asthma and monitor treatment

The production of an infant formula with a minimally processed route impacts its nutritional, physiological and sensorial qualities

International audienc

Electroencephalographic markers of idiopathic hypersomnia : where we are and where we are going

Purpose of the review: Idiopathic hypersomnia is a poorly defined nosological entity and has important phenotype heterogeneity. Moreover, diagnosing idiopathic hypersomnia is challenging as patients can report significant symptoms but may not meet diagnostic criteria on standard objective tests. Advanced analyses of electroencephalographic (EEG) activity could provide objective markers of idiopathic hypersomnia and explain part of its pathophysiology and heterogeneity. In fact, the EEG signal recorded during wakefulness and sleep not only captures sleep macroarchitecture, but also homeostatic sleep process efficiency, strength of neural synchrony during sleep, sleep consolidation and changes in cognitive processes. In this review, we will present current and potential markers of idiopathic hypersomnia, with a focus on sleep propensity. We will also discuss EEG changes occurring in sleep deprivation condition and recovery nights, as well as those observed in other central hypersomnolence conditions, namely narcolepsy type-1 and type-2. Recent findings: Among EEG markers studied in sleep deprivation and narcolepsy are those derived from sleep macroarchitecture (sleep consolidation, sleep stage proportion, sleep-stage transitions, sleep onset in rapid-eye movement sleep) and microarchitecture (slow-wave activity, spindles), spectral analysis of the waking electroencephalographic signal and cognitive event-related potentials. To date, no clear objective EEG markers of idiopathic hypersomnia exist, as studies were generally performed on small samples, used heterogeneous protocols (including changes of diagnostic criteria that occurred over time) and most of them focused on more traditional macroarchitecture sleep analyses. Summary: Based on studies of sleep deprivation and narcolepsy, further studies are needed to understand the EEG signal in idiopathic hypersomnia. Future studies should take advantage of the richness and the complexity of the EEG signal and verify whether subgroups of hypersomniac patients exist

Position of the French Working Group on Perioperative Haemostasis (GIHP) on viscoelastic tests: What role for which indication in bleeding situations?

Purpose: Viscoelastic tests (VETs), thromboelastography (TEG®) and thromboelastometry (ROTEM®) are global tests of coagulation performed on whole blood. They evaluate the mechanical strength of a clot as it builds and develops after coagulation itself. The time required to obtain haemostasis results remains a major problem for clinicians dealing with bleeding, although some teams have developed a rapid laboratory response strategy. Indeed, the value of rapid point-of-care diagnostic devices such as VETs has increased over the years. However, VETs are not standardised and there are few recommendations from the learned societies regarding their use. In 2014, the recommendations of the International Society of Thrombosis and Haemostasis (ISTH) only concerned haemophilia. The French Working Group on Perioperative haemostasis (GIHP) therefore proposes to summarise knowledge on the clinical use of these techniques in the setting of emergency and perioperative medicine. Methods: A review of the literature. Principal findings: The role of the VETs seems established in the management of severe trauma and in cardiac surgery, both adult and paediatric. In other situations, their role remains to be defined: hepatic transplantation, postpartum haemorrhage, and non-cardiac surgery. They must be part of the global management of haemostasis based on algorithms defined in each centre and for each population of patients. Their position at the bedside or in the laboratory is a matter of discussion between clinicians and biologists. Conclusion: VETs must be included in algorithms. In consultation with the biology laboratory, these devices should be situated according to the way each centre functions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Maternal high-protein diet during pregnancy modifies rat offspring body weight and insulin signalling but not macronutrient preference in adulthood

Supplementary Materials: The following are available online at http://www.mdpi.com/2072-6643/11/1/96/s1, Methods S1: Animal procedure details during each experimental period, Methods F1: Example, for each diet group, of voxel masks of total (a), subcutaneous (b) and visceral adipose (c) tissues on the section 47/95 frompictures obtained by MRI. Volume of adipose tissues was determined by quantification of the voxel’s mask, from all sections of each rat, directly converted to mm3 by the software. MRI, Magnetic resonance imaging, Table S1: P Primers, Table S2: Gut hormones in plasma on PND105, Table S3: Gene expression in adipose tissue and hypothalamus on PND105International audienceDiet of mothers during gestation may impact offspring phenotype. This study evaluated the consequences of a maternal High-Protein (HP) diet during gestation on food preferences and phenotypic characteristics in adult rat offspring. Dams were fed a HP or a Normal-Protein (NP) isocaloric diet during gestation only. Weaned female pups were divided into 3 diet groups: NP control or one of two dietary self-selection (DSS) conditions. In DSS1, offspring had a free choice between proteins (100%) or a mix of carbohydrates (88%) and lipids (12%). In DSS2, the choice was between proteins (100%), carbohydrate (100%) or lipids (100%). DSS2 groups consumed more of their energy from protein and lipids, with a decreased carbohydrate intake (p < 0.0001) compared to NP groups, regardless of the maternal diet. Offspring from HP gestation dams fed the DSS2 diet (HPDSS2) had a 41.2% increase of total adiposity compared to NPDSS2 (p < 0.03). Liver Insulin receptor and Insulin substrate receptor 1 expression was decreased in offspring from HP compared to NP gestation dams. These results showed the specific effects of DSS and maternal diet and data suggested that adult, female offspring exposed to a maternal HP diet during foetal life were more prone to adiposity development, in response to postweaning food conditions