Connexin 43: A Target for the Treatment of Inflammation in Secondary Complications of the Kidney and Eye in Diabetes

Of increasing prevalence, diabetes is characterised by elevated blood glucose and chronic inflammation that precedes the onset of multiple secondary complications, including those of the kidney and the eye. As the leading cause of end stage renal disease and blindness in the working population, more than ever is there a demand to develop clinical interventions which can both delay and prevent disease progression. Connexins are membrane bound proteins that can form pores (hemichannels) in the cell membrane. Gated by cellular stress and injury, they open under pathophysiological conditions and in doing so release ‘danger signals’ including adenosine triphosphate into the extracellular environment. Linked to sterile inflammation via activation of the nod-like receptor protein 3 inflammasome, targeting aberrant hemichannel activity and the release of these danger signals has met with favourable outcomes in multiple models of disease, including secondary complications of diabetes. In this review, we provide a comprehensive update on those studies which document a role for aberrant connexin hemichannel activity in the pathogenesis of both diabetic eye and kidney disease, ahead of evaluating the efficacy of blocking connexin-43 specific hemichannels in these target tissues on tissue health and function.

Complications of Stroke

Stroke is one of the leading causes of disability and mortality and can cause a serious socioeconomic burden. Some of the comorbidities and secondary complications of stroke can threaten the patient's life or cause serious pain or negatively affect the patient's involvement in rehabilitation or worsen daily life activities or make it difficult to bring the patient into the community and workplace. This chapter focuses on the symptoms and signs, diagnosis, and management of these comorbidities and complications. It highlights diagnosis and treatment of cardiac problems, sleep disorders, deep vein thrombosis, pulmonary embolism, dysphagia, malnutrition, and pneumonia. Depression, central post-stroke pain, upper limb problems after stroke, spasticity, bladder dysfunction are also discussed in this chapter.

Subcutaneous emphysema: how can we prevent and treat it?

Subcutaneous emphysema is described as an uncommon complication resulting from the passage of compressed air to the fascial planes and is associated, in dentistry, with restorative, endodontic treatments, periodontal surgery and extractions, the latter with a higher incidence. Early diagnosis, appropriate approach and ordering of imaging tests prevent secondary complications, such as local infection and progression to deep cervical and thoracic fascial spaces. Thus, the present clinical case reports the transoperative occurrence of subcutaneous emphysema during extraction of the lower third molar, its indicated treatment and how we can avoid this type of complication

Advanced Physiotherapy of Supracondylar Femur Fracture with Implant In situ: A Case Report

Patient main concerns were restriction of movements of right knee and pus discharge from wound over right knee. In this case, the main clinical findings were a substantial loss in range of motion at right knee joints. There was also fixed flexion deformity seen over right knee. Diagnosis of the case was non united operated infected case of supracondylar femur fracture right side with implant in situ. In these types of circumstances, therapeutic approaches have been demonstrated to be useful. A 35-year-old male visited the orthopaedics who referred department of physiotherapy with complaints of restriction of movement of right knee and pus discharge from wound over right knee. Patient was examine in standing and supine position .On inspection, patient keeps right hip in flexion, knee in flexion patella pointing upwards and foot in equinus. According to the research, starting weight-bearing too soon can lead to failure of implant and mal-union. Supracondylar femoral fracture is a challenging condition to deal with and is associated with many secondary complications. An important role is played by physiotherapist in rehabilitation and supracondylar femur fracture management.

Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Cerebral Vasospasm: Mechanisms, Pathomorphology, Diagnostics, Treatment

Cerebral vessels constriction is one of the leading causes of mortality and disability in patients with acute cerebral circulatory disorders. The most dangerous type of acute cerebrovascular disease accompanied by high mortality is ruptured cerebral aneurysms with subarachnoidal hemorrhage (SAH). Following a constriction of the cerebral vessels on the background of SAH is the reason for brain ischemia. This chapter will focus on the mechanisms of formation of cerebral vascular spasm, pathomorphological aspects of the cerebral vessels constriction, and the stages of vascular spasm—the development of constrictive-stenotic arteriopathy, contractural degeneration of smooth muscle cells, and endothelial damage. We will cover classifications of cerebral vessels constriction by prevalence and severity, modern methods of clinical and instrumental diagnostics and treatment including paroxysmal sympathetic hyperactivity syndrome associated with the development of secondary complications, a longer stay of the patients in the ICU, higher disability and mortality.

Clinical and radiological assessment of rhinomaxillary syndrome in Hansen’s disease

Background: More than four million people today live with Hansen’s disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen’s disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims: This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen’s disease. Methods: This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results: Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60–89) years, age at diagnosis 20 (6–43) years and time since diagnosis 46 (26–70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including “saddle nose” (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations: Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion: Until Hansen’s disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

Complete splenic infarction in association with COVID-19

COVID-19 predominantly affects the respiratory system. As a novel disease, understanding of its management and complications continues to grow. Herein, we present a case of almost complete splenic infarction in a patient with COVID-19 pneumonia. This case highlights the need to maintain diagnostic vigilance whilst investigating secondary complications of COVID-19. It is also important to stress the high incidence of thromboembolic complications in patients with COVID-19, which may occur anywhere in the vasculature.

Does female genital mutilation/cutting have any effect on normal birth?

Background: World Health Organization’s (WHO) defines female genital mutilation (FGM) as all procedures involving the total or partial removal of female external genitalia without any medical reasons. It is estimated that about 100 million women worldwide are circumcised. After circumcision compications such as bleeding, infection, shock, menstrual irregularity, dysuria, frequent urinary tract infections, pelvic pain and difficulty in sexual intercourse occur with varying frequencies.Methods: In this article, we aimed to discuss normal vaginal delivery results of 45 term pregnant cases with 3 types of female genital multilation/circumcision. We know that the vaginal entrance is closed as a result of adhesions in the genital area due to circumcision and secondary complications may develop.Results: The mean age of 45 patients included in the study was 26.2±8.78 years. Considering the postpartum complications, bilateral labial tissue ruptures in 15 cases, followed by vaginal hematoma in 9 cases, anal sphincter damage in 11 cases, deep episiotomy tears in 8 cases, periurethral tears in 8 cases, deep cervical tears in 8 cases, vulvar epidermoid cyst ruptures in 4 cases and 4 cases. perineal body ruptures were seen in 4 cases, vulvar hematoma in 4 cases, and vaginal mucosal damage in 9 cases.Conclusions: It has been shown once again that FGM/C is a method that completely changes the female vaginal anatomy and has very serious delivery complications. It is obvious that serious educations and studies need to be done in the countries where this method is applied.