Case Report Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children's Hospital of Georgia for suspected postobstructive pulmonary edema (POPE) after tonsillectomy/adenoidectomy (T&A). The patient's respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a leftsided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS) and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility

Postobstructive Pulmonary Edema following Tonsillectomy/Adenoidectomy in a 2-Year-Old with Poland-Moebius Syndrome

A 2-year-old male with Poland-Moebius syndrome was transferred from a local hospital to the Pediatric ICU at Children’s Hospital of Georgia for suspected postobstructive pulmonary edema (POPE) after tonsillectomy/adenoidectomy (T&A). The patient’s respiratory status ultimately declined and he developed respiratory failure. Imaging suggested pulmonary edema as well as a left-sided pneumonia. Echocardiogram showed pulmonary hypertension and airway exam via direct fiberoptic bronchoscopy revealed tracheomalacia and bronchomalacia. He developed acute respiratory distress syndrome (ARDS) and remained intubated for ten days. This case highlights the association between congenital upper body abnormalities with cranial nerve dysfunction and the development of POPE with delayed resolution of symptoms. Patients with upper body abnormalities as above are at great risk of postoperative complications and should therefore be managed in a tertiary-care facility

Presence of single nucleotide polymorphisms in transforming growth factor β and insulin-like growth factor 1 in class II malocclusions due to retrognathic mandible

Aim: The aim of this study was to evaluate specific single nucleotide polymorphisms (SNP) of transforming growth factor-beta (TGF-β) (rs1800469) and insulin-like growth factor-1 (IGF-1) (rs17032362) genes in Class II individuals with a normal maxilla and retrognathic (short) mandible. Materials and methods: The study had 25 participants: 5 were assigned to the control group, which had a normal maxilla and mandible, and 20 to the experimental group, which had a structurally retrognathic mandible and a normal maxilla. The polymerase chain reaction was used with preselected primers after which Sanger sequencing was used to identify individual mutations. Results: SNP at rs1800469 (TGF-β) in the study and control groups showed significant difference (p=0.009). The Odds Ratio of 5.28 signified that the individuals with SNP at rs1800469 were at 5.28 times higher risk of developing mandibular retrognathism. The IGF SNP showed its presence in experimental group but was not statistically significant. Conclusion: Our study reports for the first time on the association between TGF-β SNP and mandibular retrognathism. Other SNP also showed its presence in the study group and its complete absence from control group directs us for further research

Presence of single nucleotide polymorphisms in transforming growth factor β and insulin-like growth factor 1 in class II malocclusions due to retrognathic mandible

Aim: The aim of this study was to evaluate specific single nucleotide polymorphisms (SNP) of transforming growth factor-beta (TGF-β) (rs1800469) and insulin-like growth factor-1 (IGF-1) (rs17032362) genes in Class II individuals with a normal maxilla and retrognathic (short) mandible. Materials and methods: The study had 25 participants: 5 were assigned to the control group, which had a normal maxilla and mandible, and 20 to the experimental group, which had a structurally retrognathic mandible and a normal maxilla. The polymerase chain reaction was used with preselected primers after which Sanger sequencing was used to identify individual mutations. Results: SNP at rs1800469 (TGF-β) in the study and control groups showed significant difference (p=0.009). The Odds Ratio of 5.28 signified that the individuals with SNP at rs1800469 were at 5.28 times higher risk of developing mandibular retrognathism. The IGF SNP showed its presence in experimental group but was not statistically significant. Conclusion: Our study reports for the first time on the association between TGF-β SNP and mandibular retrognathism. Other SNP also showed its presence in the study group and its complete absence from control group directs us for further research

Predictive Role of Proteinuria in Urinary Tract Infection

Introduction: Urine culture is considered as holy grail in diagnosis of Urinary Tract Infection (UTI). However, the significance of preliminary urinalysis cannot be neglected. Aim: To evaluate proteinuria as a predictor of UTI. Materials and Methods: This study was conducted at the Department of Microbiology, Dr. Baba Saheb Ambedkar Hospital, New Delhi, India, over a period of three months (April 2015 to June 2015). Urine specimens from clinically suspected cases of UTI were analysed microscopically for pyuria and by reagent strip test for albuminuria. The results were correlated with urine culture findings. Antimicrobial resistance for various antimicrobials was compared among proteinuria positive and negative cases. Statistical analysis was done by Fisherfs-exact test and p-value was calculated. A p-value .0.05 was considered significant. Results: A total of 369 urine samples received for both routine microscopy and culture, out of which 73 were proteinuria positive. Out of these 73 samples, 32 were culture positive while 41 were culture negative. Among culture positive, 62.5% patients were symptomatic (20/32) while 37.5% were asymptomatic (12/32). Their age ranged from five months to 83 years. Male to female ratio was 1:1.5. Association between culture positivity and proteinuria was statistically significant (p<0.001) with 43.8% positive predictive value. Pyuria was observed in 42.5% cases. Out of 296 proteinuria negative samples, 36 were culture positive. ƒÀ-lactam antibiotic resistance among proteinuria positive cases and chloramphenicol resistance among proteinuria negative cases was significantly high. Conclusion: Proteinuria as a urinalysis parameter may have good predictive power combined with the clinical presentation to diagnose UTI

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous