Perihepatic abscesses caused by dropped appendicoliths in a child

A dropped appendicolith is a well-known complication of laparoscopic appendectomy that may occur because of stone expulsion from the appendix, before or during surgery, and typically manifests as a focal, subcentimeter area of high attenuation with or without associated abscess. Dropped appendicoliths may act as niduses for infection and may result in the future development of abscess formation. We report the case of a 10-year-old pediatric patient who developed 2 perihepatic abscesses caused by 2 appendicoliths that were inadvertently dropped during laparoscopic surgery. Keywords: Appendicitis, CT, Dropped appendicolith, Absces

Inborn Errors of Intermediary Metabolism in Critically Ill Mexican Newborns

Inborn errors of intermediary metabolism (IEiM) are complex diseases with high clinical heterogeneity, and some patients who have severe enzyme deficiencies or are subjected to stress (catabolism/infections) actually decompensate in the neonatal period. In this study, we performed metabolic tests on 2025 newborns in Mexico admitted to 35 neonatal intensive care units or emergency wards (NICUs/EWs) over a 6-year period, in whom a metabolic disorder was clinically suspected. Of these 2025 newborns with sickness, 11 had IEiM, revealing a prevalence of 1:184. Clinical characteristics and outcomes of the newborns with confirmed IEiM are shown. Of these 11 patients, 4 had isolated methylmalonic acidemia, 3 had maple syrup urine disease, 2 had urea cycle disorders, 1 had 3-hydroxy-3-methylglutaric acidemia, and 1 had isovaleric acidemia. During the first week of life (average 3 days), all of these newborns presented with impaired alertness, hypotonia, feeding difficulties, and vomiting along with metabolic acidosis and hyperammonemia. Of the 11 newborns with IEiM, 7 died, leading to a mortality rate of 64%. In conclusion, the differential diagnosis of newborns admitted to the NICU/EW must include IEiM, requiring systematic screening of this population

Atomic-resolution structures from fragmented protein crystals with the cryoEM method MicroED

Traditionally, crystallographic analysis of macromolecules has depended on large, well-ordered crystals, which often require significant effort to obtain. Even sizable crystals sometimes suffer from pathologies that render them inappropriate for high-resolution structure determination. Here we show that fragmentation of large, imperfect crystals into microcrystals or nanocrystals can provide a simple path for high-resolution structure determination by the cryoEM method MicroED and potentially by serial femtosecond crystallography