Abnormal systemic venous connection possibly associated with a persistent right umbilical vein; a case report

BACKGROUND: Abnormal venous connections involving a persistent right umbilical vein are rare. In a minority of cases the liver is entirely bypassed and the condition is associated with multiple congenital malformations. CASE PRESENTATION: The described case illustrates a systemic venous drainage that was severely abnormal in a newborn girl with a truncus arteriosus type II congenital heart defect. Injection of contrast medium through the umbilical vein catheter revealed a very peculiar venous connection that passed anterio-laterally through the right hemithorax before crossing in an oblique fashion towards the superior vena cava. CONCLUSIONS: This venous drainage may be the result of a persistent right umbilical vein connecting with the superior vena cava

Airway management in simulated restricted access to a patient - can manikin-based studies provide relevant data?

<p>Abstract</p> <p>Background</p> <p>Alternatives to endotracheal intubation (ETI) are required when access to the cranial end of the patient is restricted. In this study, the success rate and time duration of standard intubation techniques were compared with two different supraglottic devices. Two different manikins were used for the study, and the training effect was studied when the same manikin was repeatedly used.</p> <p>Methods</p> <p>Twenty anaesthesiologists from the Air Ambulance Department used iGEL^™, laryngeal tube LTSII^™and Macintosh laryngoscopes in two scenarios with either unrestricted (scenario A) or restricted (scenario B) access to the cranial end of the manikin. Different manikins were used for ETI and placement of the supraglottic devices. The technique selected by the physicians, the success rates and the times to completion were the primary outcomes measured. A secondary outcome of the study was an evaluation of the learning effect of using the same manikin or device several times.</p> <p>Results</p> <p>In scenario A, all anaesthesiologists secured an airway using each device within the maximum time limit of 60 seconds. In scenario B, all physicians secured the airway on the first attempt with the supraglottic devices and 16 (80%) successfully performed an ETI with either the Macintosh laryngoscope (n = 13, 65%) or with digital technique (n = 3, 15%). It took significantly longer to perform ETI (mean time 28.0 sec +/- 13.0) than to secure an airway with the supraglottic devices (iGel™: mean 12.3 sec +/- 3.6, LTSII™: mean 10.6 sec +/- 3.2). When comparing the mean time required for the two scenarios for each supraglottic device, there was a reduction in time for scenario B (significant for LTSII^™: 12.1 versus 10.6 seconds, p = 0.014). This may be due to a training effect using same manikin and device several times.</p> <p>Conclusions</p> <p>The amount of time used to secure an airway with supraglottic devices was low for both scenarios, while classic ETI was time consuming and had a low success rate in the simulated restricted access condition. This study also demonstrates that there is a substantial training effect when simulating airway management with airway manikins. This effect must be considered when performing future studies.</p

Eat the Rich : The Aftermath of the Meme Stock Craze: An Empirical Analysis

Recently, the r/wallstreetbets subreddit has sent shock waves through the financial industry. The subreddit has been the subject of widespread discussion regarding the unintuitive price actions caused by the platform activity. This thesis examines recent changes in the WallStreetBets (WSB) phenomenon, particularly after the meme stock craze in 2021. In addition, it examines relationships between WSB activity and stock data and whether it is possible to utilize findings in a trading algorithm producing abnormal returns. The results identify the meme stock craze as an outlier period, where in the following period the impact of WSB activity returns to normal levels corresponding to the pre-2021 period. In addition, the results demonstrate a significant relationship between WSB activity and stock data, particularly for the mentions activity on the subreddit. Moreover, this thesis finds a profitable strategy adjusted for biases by maximizing the Sharpe ratio, which also provides a strong abnormal return. In a broader sense, its results are promising in relation to the utilization of big data and quantitative methods in analyzing social media and applying the findings to a financial strategy.nhhma

Reduced Dicer expression in the cord blood of infants admitted with severe respiratory syncytial virus disease

<p>Abstract</p> <p>Background</p> <p>Respiratory syncytial virus (RSV) is one of the most important causes of pediatric hospital admissions in the developed world. The ribonuclease Dicer is an important regulator of gene expression and cellular function via RNA interference, and may also have anti-viral functions. A previous microarray analysis of the cord blood of 5 patients with RSV disease suggested downregulation of <it>Dicer</it>. In order to further investigate whether reduced <it>Dicer </it>expression can predispose newborns to RSV disease, we have analyzed the gene expression of <it>Dicer </it>in the cord blood of 37 infants with confirmed RSV disease.</p> <p>Methods</p> <p>The cord blood of 2108 newborns was collected. 51 had a positive nasopharyngeal aspirate for RSV <1 year, and were grouped according to disease severity. 37 had sufficient cord blood RNA of good quality. <it>Dicer </it>gene expression was assessed by qPCR analysis of cord blood using a TaqMan low-density array and compared to control infants who did not present with RSV disease using the Mann-Whitney test.</p> <p>Results</p> <p>There was significant downregulation of <it>Dicer </it>in the severe disease group: relative quantity 0.69 (95% CI: 0.56 - 0.87), p = 0.002. There was no significant downregulation in the mild disease group.</p> <p>Conclusions</p> <p>We demonstrate reduced <it>Dicer </it>expression in the cord blood of infants with severe RSV disease, prior to RSV exposure. We theorize that this may predispose to RSV disease by disruption of leukocyte gene regulation or direct anti-viral RNA interference mechanisms.</p

Procalcitonin; a feasible biomarker for severe bacterial infections in Obstetrics and Gynecology?

Non peer reviewe

Anti-Inflammatory MicroRNAs and Their Potential for Inflammatory Diseases Treatment

Inflammation is a complicated biological and pathophysiological cascade of responses to infections and injuries, and inflammatory mechanisms are closely related to many diseases. The magnitude, the complicated network of pro- and anti-inflammatory factors, and the direction of the inflammatory response can impact on the development and progression of various disorders. The currently available treatment strategies often target the symptoms and not the causes of inflammatory disease and may often be ineffective. Since the onset and termination of inflammation are crucial to prevent tissue damage, a range of mechanisms has evolved in nature to regulate the process including negative and positive feedback loops. In this regard, microRNAs (miRNAs) have emerged as key gene regulators to control inflammation, and it is speculated that they are fine-tune signaling regulators to allow for proper resolution and prevent uncontrolled progress of inflammatory reactions. In this review, we discuss recent findings related to significant roles of miRNAs in immune regulation, especially the potential utility of these molecules as novel anti-inflammatory agents to treat inflammatory diseases. Furthermore, we discuss the possibilities of using miRNAs as drugs in the form of miRNA mimics or miRNA antagonists

Survival after prolonged resuscitation with 99 defibrillations due to Torsade De Pointes cardiac electrical storm: a case report

A 48-year-old previously healthy woman suffered witnessed cardiac arrest in hospital. She achieved return of spontaneous circulation and was transferred to the intensive care unit. During the following 3 hours, she suffered a cardiac electrical storm with 98 episodes of Torsade de Pointes ventricular tachycardia rapidly degenerating to ventricular fibrillation. She was converted with a total of 99 defibrillations. There was no response to the use of any recommended anti arrhythmic drugs. However, the use of bretylium surprisingly stabilized her heart rhythm and facilitated placing of a temporary pacemaker. Overdrive pacing prevented further arrhythmias and was life saving. A number of beneficial factors may have contributed to the good neurological outcome. Further investigations gave no explanation for her cardiac electrical storm

Childhood Hearing Loss in Developing Countries: From Multidisciplinary Team Work to Public Health

This chapter will highlight the common causes of hearing loss in children and emphasize on the fact that most of the hearing loss is due to causes that are preventable. We know that hearing loss in childhood not only impacts on the child’s learning and social interaction with the child’s peers and society, but also has economic implications when the child grows into an adult. Public health awareness is therefore paramount in preventing a large chunk of the hearing gloss and therefore greatly contributes to making sure that the child grows into a productive citizen of the society that the child grows or lives in

Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

<p>Abstract</p> <p>Introduction</p> <p>Endotracheal intubation (ETI) has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement.</p> <p>Method</p> <p>We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS). The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it.</p> <p>Results</p> <p>In the risk assessment, we assigned a high probability (29%) for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers.</p> <p>Conclusion</p> <p>Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.</p