Atypical presentation of obstructed hemivagina and ipsilateral renal anomaly

Herlyn-Werner-Wunderlich Syndrome, otherwise known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare Müllerian anomalyconsisting of uterine didelphys, hemivaginal septum, and ipsilateral renal agenesis. Patients often present at the onset of menarche with abdominal pain and a pelvic mass from an obstructed hemivagina. We report a child who presented with a febrile urinary tract infection and upon further workup was found to have OHVIRA

Psychedelics, meditation, and self-consciousness

In recent years, the scientific study of meditation and psychedelic drugs has seen remarkable developments. The increased focus on meditation in cognitive neuroscience has led to a cross-cultural classification of standard meditation styles validated by functional and structural neuroanatomical data. Meanwhile, the renaissance of psychedelic research has shed light on the neurophysiology of altered states of consciousness induced by classical psychedelics, such as psilocybin and LSD, whose effects are mainly mediated by agonism of serotonin receptors. Few attempts have been made at bridging these two domains of inquiry, despite intriguing evidence of overlap between the phenomenology and neurophysiology of meditation practice and psychedelic states. In particular, many contemplative traditions explicitly aim at dissolving the sense of self by eliciting altered states of consciousness through meditation, while classical psychedelics are known to produce significant disruptions of self-consciousness, a phenomenon known as drug-induced ego dissolution. In this article, we discuss available evidence regarding convergences and differences between phenomenological and neurophysiological data on meditation practice and psychedelic drug-induced states, with a particular emphasis on alterations of self-experience. While both meditation and psychedelics may disrupt self-consciousness and underlying neural processes, we emphasize that neither meditation nor psychedelic states can be conceived as simple, uniform categories. Moreover, we suggest that there are important phenomenological differences even between conscious states described as experiences of self-loss. As a result, we propose that self-consciousness may be best construed as a multidimensional construct, and that “self-loss,” far from being an unequivocal phenomenon, can take several forms. Indeed, various aspects of self-consciousness, including narrative aspects linked to autobiographical memory, self-related thoughts and mental time travel, and embodied aspects rooted in multisensory processes, may be differently affected by psychedelics and meditation practices. Finally, we consider long-term outcomes of experiences of self-loss induced by meditation and psychedelics on individual traits and prosocial behavior. We call for caution regarding the problematic conflation of temporary states of self-loss with “selflessness” as a behavioral or social trait, although there is preliminary evidence that correlations between short-term experiences of self-loss and long-term trait alterations may exist

Epigenetics and airways disease

Epigenetics is the term used to describe heritable changes in gene expression that are not coded in the DNA sequence itself but by post-translational modifications in DNA and histone proteins. These modifications include histone acetylation, methylation, ubiquitination, sumoylation and phosphorylation. Epigenetic regulation is not only critical for generating diversity of cell types during mammalian development, but it is also important for maintaining the stability and integrity of the expression profiles of different cell types. Until recently, the study of human disease has focused on genetic mechanisms rather than on non-coding events. However, it is becoming increasingly clear that disruption of epigenetic processes can lead to several major pathologies, including cancer, syndromes involving chromosomal instabilities, and mental retardation. Furthermore, the expression and activity of enzymes that regulate these epigenetic modifications have been reported to be abnormal in the airways of patients with respiratory disease. The development of new diagnostic tools might reveal other diseases that are caused by epigenetic alterations. These changes, despite being heritable and stably maintained, are also potentially reversible and there is scope for the development of 'epigenetic therapies' for disease

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Hip and groin pain in sub-elite South African footballers

Background. Groin injuries are common in football. This can be attributed to the nature of the sport involving rapid accelerations, decelerations, abrupt directional changes and kicking. Groin injuries require lengthy rehabilitation times and predispose players to further injuries. Previous groin injury is a risk factor for future groin injuries, suggesting players are inadequately rehabilitated or the original cause has not been addressed.Objectives. To describe the prevalence, nature and treatment patterns of groin injuries in sub-elite players, and to investigate differences in hip strength and range of motion between players with and without a history of groin injury.Method. Thirty sub-elite, senior university male players were interviewed and questioned regarding groin injuries sustained in the preceding three years. They were assessed using the HAGOS questionnaire, and underwent isokinetic hip flexion/extension strength, adductor squeeze and range of motion tests.Results. Seventeen players (57%) reported having a previous groin injury, with an average score of 83 (16) [mean (SD)] on the HAGOS, compared with 92 (5) for non-injured players. Of the previously injured players, 29% did not seek treatment from a medical professional. Injuries included adductor strain (35%), inguinal-related (18%), iliopsoas-related (12%) and hip joint pathology (6%). The average time off was 25 days. There were no significant differences in isokinetic hip flexion/extension strength, adductor strength and range of motion.Conclusion. The prevalence of groin injuries in this population is relatively high (57%) and requires lengthy rehabilitation time. The HAGOS is a suitable tool to identify groin pain in this population within the sports and recreation and quality of life subscales. Isokinetic hip strength and range of motion testing lacked sensitivity in detecting deficits in players with a previous groin injury. Only two-thirds of injured players consulted a medical practitioner, increasing the likelihood that rehabilitation was inadequate. It is therefore recommended that player/coach education regarding injury management improve in order to reduce subsequent injuries.Keywords. HAGOS, groin injury, prevalence, range of motion, isokinetic strengt

No relationship between gastrointestinal parasite intensities or mercury burdens on fluctuating asymmetry in Common Eider (Somateria mollissima) mandibles

Mercury (Hg) emissions have increased since 1950 and biomagnification in Arctic ecosystems can affect animals, particularly at higher trophic levels. Exposure to Hg can negatively affect young developing animals, resulting in altered morphology and ultimately, lower fitness. We examined the relationship of mandible fluctuating asymmetry (FA) with gastrointestinal helminth intensity and breast muscle Hg concentration in Common Eider (Somateria mollissima borealis). Procrustes analysis of variance indicated significant FA but relatively high measurement error. Based on multiple linear regression modelling, there was no significant relationship between FA and Hg concentration or parasite burden. There may be a mismatch in trying to relate amount of Hg and parasite intensity in adults to FA that would have occurred early in life during skeletal development

The clinical outcome and activity levels of patients under 55 years treated with distal humeral hemiarthroplasty for distal humeral fractures: minimum 2-year follow-up

Background: The aim of the present study was to describe the clinical outcomes and activity levels of young patientsafter distal humeral hemiarthroplasty (DHH).Methods: Six patients under 55 years (mean 44 years; range 29 years to 52 years) treated with DHH at a meanpostoperative time of 81 months (range 24 months to 133 months) were studied retrospectively. Two other patients hadbeen revised for aseptic loosening and were excluded.Results: The mean Mayo Elbow Score (MEPS) (88), Subjective Elbow Value (SEV) (89), Quick Disabilities of the Arm,Shoulder and Hand (QuickDASH) (12) and American Shoulder and Elbow Surgeons (ASES) elbow pain (6), function (23)and satisfaction scores (9) were satisfactory. The mean University of California, Los Angeles (UCLA) activity score was 7.2.Conclusions: Although only rarely indicated, DHH has satisfactory clinical outcomes in young patients and allowsa higher level of function than is generally advised after total elbow arthroplasty