Diabetic fetopathy associated with bilateral adrenal hyperplasia and ambiguous genitalia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Many fetal malformations can occur because of maternal diabetes. However, ambiguous genital organs have never been reported as an associated finding in the literature. This is the first report of associated ambiguous genital organ and bilateral adrenal hyperplasia in a case of diabetic fetopathy.</p> <p>Case presentation</p> <p>A 19-year-old Thai primigravida with familial history of diabetes mellitus (DM) was diagnosed as having gestational DM type 2, based on 100 g oral glucose tolerance test, and was poorly controlled with insulin injections. Delayed targeted ultrasonography at 28 weeks gestation revealed multiple fetal anomalies. The woman underwent low transverse cesarean section at 30 weeks gestation due to preterm labor and transverse lie. The newborn with ambiguous genitalia was delivered but expired after birth. Autopsy findings revealed alobar holoprosencephaly, a prominent forehead, hypotelorism, an absent nose, absent bilateral ears, median cleft lip and palate, preaxial polydactyly of the right hand, accessory spleens, single umbilical artery, markedly enlarged adrenal glands and ambiguous external genitalia The subsequent fetal chromosomal study revealed 46,XX.</p> <p>Conclusion</p> <p>We describe a case of diabetic fetopathy with classic facial malformation and preaxial hallucal polydactyly which has been proposed as a marker of diabetic embryopathy. Bilateral adrenal hyperplasia with ambiguous genitalia, an uncommon associated anomaly, was also identified. It is controversial whether adrenal hyperplasia can be a novel feature of diabetic fetopathy or just a coincidental finding. Further observation and adequate investigation are needed in such cases.</p

Herpes Simplex Virus Type 1 Infection Facilitates Invasion of Staphylococcus aureus into the Nasal Mucosa and Nasal Polyp Tissue

Background: Staphylococcus aureus (S. aureus) plays an important role in the pathogenesis of severe chronic airway disease, such as nasal polyps. However the mechanisms underlying the initiation of damage and/or invasion of the nasal mucosa by S. aureus are not clearly understood. The aim of this study was to investigate the interaction between S. aureus and herpes simplex virus type 1 (HSV1) in the invasion of the nasal mucosa and nasal polyp tissue. Methodology/Principal Findings: Inferior turbinate and nasal polyp samples were cultured and infected with either HSV1 alone, S. aureus alone or a combination of both. Both in turbinate mucosa and nasal polyp tissue, HSV1, with or without S. aureus incubation, led to focal infection of outer epithelial cells within 48 h, and loss or damage of the epithelium and invasion of HSV1 into the lamina propria within 72 h. After pre-infection with HSV1 for 24 h or 48 h, S. aureus was able to pass the basement membrane and invade the mucosa. Epithelial damage scores were significantly higher for HSV1 and S. aureus co-infected explants compared with control explants or S. aureus only-infected explants, and significantly correlated with HSV1-invasion scores. The epithelial damage scores of nasal polyp tissues were significantly higher than those of inferior turbinate tissues upon HSV1 infection. Consequently, invasion scores of HSV1 of nasal polyp tissues were significantly higher than those of inferior turbinate mucosa in the HSV1 and co-infection groups, and invasion scores of S. aureus of nasal polyp tissues were significantly higher than those of inferior turbinate tissues in the co-infection group. Conclusions/Significance: HSV1 may lead to a significant damage of the nasal epithelium and consequently may facilitate invasion of S. aureus into the nasal mucosa. Nasal polyp tissue is more susceptible to the invasion of HSV1 and epithelial damage by HSV1 compared with inferior turbinate mucosa

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

The Effect of the Small Indian Mongoose (Urva auropunctatus), Island Quality and Habitat on the Distribution of Native and Endemic Birds on Small Islands within Fiji

This study investigated the effect of the presence of introduced mongoose, environmental quality and habitat on the distribution of native and endemic birds on 16 small islands within Fiji. In total, 9055 birds representing 45 species were observed within four key habitats (forest, villages, crop land and coastal vegetation) on the 16 islands, half of which had mongoose present. Previous studies attribute bird declines and extirpation anecdotally to the mongoose. The presence of mongoose, environmental quality and habitat type had a measurable influence on observed extant native and endemic bird communities. We conclude that three ground birds; Gallirallus phillipensis, Anas supericiliosa and Porphyrio porhyrio were negatively influenced by the presence of mongoose and that Ptilinopus perousii, Phigys solitarius, Chrysoenas victor, Ducula latrans, Clytorhyrchus vitiensis, Pachycephala pectoralis, Prospeia tabunesis, and Foulehaio carunculata were particularly dependent on good quality forest habitat. Conservation priorities in relation to protecting Fiji’s endemic birds from the effect of mongoose are discussed and preventative measures suggested

Mothers Frequent Caves: Lactation Affects Chimpanzee (Pan troglodytes verus) Cave Use in Southeastern Senegal

Caves play an important ecological role for nonhuman primates in Africa and Asia. Savanna chimpanzees (Pan troglodytes verus) living in the Mandingue plateau of Senegal and Mali use caves for thermoregulation, where these refugia provide a cool microclimate during the hot, dry season. In this study, we examined cave use frequency for a chimpanzee community in southeastern Senegal. We used images from a camera trap placed at the mouth of a large laterite cave to investigate the hypotheses that sex, reproductive state, and seasonality influence the frequency of cave use. The camera collected 14,053 still images of chimpanzees between 2011 and 2013 over 325 camera trap days. Our results indicate no difference in cave use frequency between males and females overall. However, female reproductive state did significantly influence cave use, with lactating mothers using the cave more frequently than both males and nonlactating females. Chimpanzees used the cave during the hottest times of the day and were more likely to visit the cave during periods of low water availability and high maximum temperatures associated with the dry season. These results suggest the importance of thermoregulation in extreme heat for all individuals, and specifically for lactating females with nursing infants that likely experience higher metabolic and hydration stress. This study provides insight into the dynamics of primate cave use by contributing evidence that chimpanzee cave use may be influenced by reproductive states in addition to thermoregulatory needs

Neandertal spatial patterns and occupation dynamics: a regional focus on the central region in Mediterranean Iberia

En el siguiente trabajo se estudian varios conjuntos pertenecientes al Paleolítico medio procedentes del mediterráneo peninsular ibérico con el objetivo de examinar los patrones de ocupación y las estrategias de gestión del territorio. Se presta especial atención al abastecimiento de las materias primas y los comportamientos tecnológicos, los datos procedentes de la fauna y los análisis microespaciales. La variabilidad en los tipos de ocupación de los distintos conjuntos nos muestra una gran diversidad y una multitud de factores, aunque no parece tener una sola explicación cultural, funcional, temporal o ambiental. Más bien son explicaciones que responden a una amplia variabilidad en los comportamientos técnicos observados y que se explican en función de las propias necesidades de las poblaciones dentro de cada región. Los resultados obtenidos nos permiten analizar los datos y compararlos en el contexto del sudoeste de Europa de cara a elaborar un primer enfoque de las estrategias de subsistencia de los neandertales y su movilidad en una región hasta ahora poco conocida desde este punto de vista.HAR2017-85,153-P/MICINNPROMETEO/2017/060HAR2016-76,760-C3-1-P/MICINNThis paper focuses on the study of some Middle Palaeolithic assemblages from Mediterranean Iberia to examine Neanderthal occupation patterns and territory management strategies, paying special attention to raw material procurement and technological behaviours, zooarchaeological data and microspatial patterning. The site occupation types are variable, and some of the results may have more importance than is immediately apparent, but there does not seem to be a single cultural, functional, temporal or environmental explanation. Rather, the wide variability in the technical behaviours observed can be explained with reference to the particular requirements of the populations in each specific region. The results obtained allow us to interrogate the data and, drawing comparisons with the southwest European context, establish an initial approach to Neanderthal subsistence strategies and mobility in a region so far little known in this regard