Foreign body aspiration presenting with asthma-like symptoms

Aspiration of a foreign body into the tracheobronchial tree is rare in adults. In the majority of these cases there is an underlying condition such as mental retardation, depressed mental status, impairment in the swallowing reflex, neurological impairment, alcohol or sedative abuse, or complications from dental manipulations that contributed to the aspiration. These patients are commonly misdiagnosed with asthma and typically do not respond to mainstay anti-inflammatory and/or bronchodilator therapy. We describe the case of a patient with a foreign body aspiration in the upper trachea not recognized by radiographic studies that presented with asthma-type symptoms

Foreign Body Aspiration Presenting with Asthma-Like Symptoms

Aspiration of a foreign body into the tracheobronchial tree is rare in adults. In the majority of these cases there is an underlying condition such as mental retardation, depressed mental status, impairment in the swallowing reflex, neurological impairment, alcohol or sedative abuse, or complications from dental manipulations that contributed to the aspiration. These patients are commonly misdiagnosed with asthma and typically do not respond to mainstay anti-inflammatory and/or bronchodilator therapy. We describe the case of a patient with a foreign body aspiration in the upper trachea not recognized by radiographic studies that presented with asthma-type symptoms

Endothelial cell activation, reduced endothelial cell reparative capacity, and impaired endothelial-dependent vasodilation after anger provocation

The experience of anger increases the acute and long-term risks of incident cardiovascular disease (CVD) events [1] and [2]. The mechanism(s) whereby anger is associated with increased CVD risk remains to be fully characterized. One promising candidate mechanism is endothelial dysfunction. Endothelial dysfunction, as evidenced by impaired endothelial-dependent vasodilation, is an early pathogenic process underlying atherosclerosis development and CVD onset. More recent investigations have elucidated the cellular pathways underlying endothelial dysfunction. Endothelial cell (EC) injury can be assessed by measuring circulating levels of EC-derived microparticles (EMPs), which are phospholipid rich, submicron particles derived and released from the membranes of activated or apoptotic ECs [3]. In addition, the discovery of circulating, bone marrow-derived endothelial progenitor cells (EPCs) capable of EC repair and regeneration [4] suggests that endothelial function represents a balance between ongoing injury and repair. We previously reported that anger provocation acutely impairs arterial vasomotion in apparently healthy individuals [5]. We conducted a study to examine the acute effects of anger provocation not only on arterial vasodilation but also on levels of EMPs and bone marrow-derived EPCs. To our knowledge, this is the first report concerning the adverse effects of anger provocation on cellular pathways underlying EC health

Examining Dissociation in Maltreated Preschool Children

The purpose of this study is to examine dissociation in a population of preschool-age foster children with documented cases of maltreatment. Data were collected from participants in the Early Intervention Foster Care program (EIFC), a randomized efficacy trial based on the empirically evaluated Multidimensional Specialized Foster Care program. Dissociative symptoms were assessed using three subscales of the Child Behavior Checklist (CBCL) that have been previously published in the trauma literature. Because the three subscales were highly intercorrelated, items were combined for a Exploratory Factor Analysis. Two distinct factors were found that may comprise new subscales assessing dissociative symptomatology and post-traumatic arousal symptomatology. In order to test their predictive validity, analyses compared the foster care sample and a community sample with no known maltreatment history and also compared dissociation across maltreatment categories. Implications for the use of dissociation as an adaptive coping mechanism are discussed

A case of bilateral submandibular gland mucoceles in a 16-month-old child

Mucoceles are common benign cystic lesions of the oral cavity that develop following extravasation or retention of mucous material from the major or minor salivary glands. Mucoceles are usually located in the lower lip (60 to 70% of cases), and the floor of the mouth is only involved in 6 to 15% of cases. Submandibular gland mucocele is extremely rare but should be considered in the differential diagnosis of swelling at the submandibular triangle in young children. We present the rare case of a 16-month-old child who was diagnosed with bilateral submandibular gland mucocele, presenting as serial swellings in both submandibular regions. We removed the cystic mass with the submandibular and sublingual glands to prevent recurrence

Laparoscopic nephrectomy for giant staghorn calculus with non-functioning kidneys: Is associated unsuspected urothelial carcinoma responsible for conversion? Report of 2 cases

BACKGROUND-: Neglected renal stones remain a major cause of morbidity in developing countries. They not only result in functional impairment of affected kidney, but also act as an important predisposing factor for development of urothelial neoplasms. It is not uncommon to miss an associated urothelial tumor in a patient of nephrolithiasis preoperatively. CASE PRESENTATION-: In last 3 years, we came across two patients with giant staghorn calculus and poorly functioning kidneys who underwent laparoscopic nephrectomy. In view of significant perirenal adhesions & loss of normal tissue planes both these patients were electively converted to open surgery. The pathological examination of specimen revealed an unsuspected urothelial carcinoma in both these patients. The summary of our cases and review of literature is presented. CONCLUSION-: It is important to keep a differential diagnosis of associated urothelial malignancy in mind in patient presenting with long standing renal calculi. The exact role of a computerized tomography and cytology in preoperative workup for detection of possible associated malignancy in such condition is yet to be defined. Similarly if laparoscopic dissection appears difficult during nephrectomy for a renal calculus with non-functional kidney, keeping a possibility of associated urothelial malignancy in mind it is advisable to dissect in a plane outside gerotas fascia as for radical nephrectomy

A Mechanistic Model and Therapeutic Interventions for COVID-19 Involving a RAS-Mediated Bradykinin Storm

Neither the disease mechanism nor treatments for COVID-19 are currently known. Here, we present a novel molecular mechanism for COVID-19 that provides therapeutic intervention points that can be addressed with existing FDA-approved pharmaceuticals. The entry point for the virus is ACE2, which is a component of the counteracting hypotensive axis of RAS. Bradykinin is a potent part of the vasopressor system that induces hypotension and vasodilation and is degraded by ACE and enhanced by the angiotensin1-9 produced by ACE2. Here, we perform a new analysis on gene expression data from cells in bronchoalveolar lavage fluid (BALF) from COVID-19 patients that were used to sequence the virus. Comparison with BALF from controls identifies a critical imbalance in RAS represented by decreased expression of ACE in combination with increases in ACE2, renin, angiotensin, key RAS receptors, kinogen and many kallikrein enzymes that activate it, and both bradykinin receptors. This very atypical pattern of the RAS is predicted to elevate bradykinin levels in multiple tissues and systems that will likely cause increases in vascular dilation, vascular permeability and hypotension. These bradykinin-driven outcomes explain many of the symptoms being observed in COVID-19

Anti-Diabetic Medications for the Pharmacologic Management of NAFLD

As a chronic disease encompassing a wide spectrum of liver-related histologic damage, nonalcoholic fatty liver disease (NAFLD) is becoming a global epidemic with significant impacts on all-cause morbidity and mortality. Insulin resistance and type 2 diabetes mellitus predispose individuals to NAFLD and related complications. Therefore, timely intervention with anti-diabetic medications may prevent and delay the development of NAFLD or have a therapeutic implication. The focus of this review is to evaluate the evidence supporting the efficacy of anti-diabetic medications in the treatment of NAFLD. While many of these anti-diabetic agents have shown to improve biochemical parameters, their effect on hepatic histology is limited. Among anti-diabetic medications, only thiazolidinediones and glucagon-like peptide-1 receptor agonists demonstrate significant improvement in hepatic histology

Intergenerational Relationships between Trauma, Dissociation, and Emotion

xvii, 103 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number.The purpose of this study was to investigate intergenerational relationships between trauma, dissociation, and emotion. Short and long term consequences of betrayal trauma on cognitive and emotion coping strategies in a sample of 67 mother-child dyads were explored. Group comparison, correlation, and regression strategies were used to examine relationships between the following variables: maternal and child trauma histories, maternal and child dissociation, maternal alexithymia, and child emotion coping strategies in response to distressful events. Experiences of high betrayal trauma were found to be related to higher levels of dissociation in both children and mothers. Furthermore, mothers who experienced high betrayal trauma in childhood and were subsequently interpersonally revictimized in adulthood were shown to have higher levels of dissociation than a group of mothers who had experienced high betrayal trauma in childhood but were not revictimized in adulthood. This may indicate that dissociation from a history of childhood betrayal trauma involves a persistent unawareness of future threats in the environment. Additional evidence consistent with this hypothesis was found. Maternal revictimization status was related to child interpersonal trauma history, suggesting that a dissociative unawareness for threats may extend to children. More generally, an association was found between maternal interpersonal trauma history and child interpersonal trauma history. Maternal dissociation was also predictive of maternal alexithymia. This relationship was examined because mothers high in alexithymia were hypothesized to display deficits in emotion socialization that could put their children at greater risk for dissociation. Evidence consistent with a relationship between maternal alexithymia and child dissociation was found. Furthermore, a significant association between maternal alexithymia level and child emotion coping strategy was revealed. Children with highly alexithymic mothers displayed higher levels of passive emotion coping strategies on a task assessing their reactions to a distressful parent-child event. This study provides evidence that the experience of parental trauma has intergenerational effects on children. It is an important first step towards longitudinal studies that can provide additional clarification of the nature of the relationships between these variables, as well as parent-child intervention studies that may help to prevent child trauma exposure and reduce symptomatology.Committee in charge: Jennifer Freyd, Chairperson, Psychology; Jennifer Ablow, Member, Psychology; Philip Fisher, Member, Psychology; Debra Eisert, Outside Member, Special Education and Clinical Science