Clotting Dysfunction in Sepsis: A Role for ROS and Potential for Therapeutic Intervention

Sepsis is regarded as one of the main causes of death among the critically ill. Pathogen infection results in a host-mediated pro-inflammatory response to fight infection; as part of this response, significant endogenous reactive oxygen (ROS) and nitrogen species (RNS) production occurs, instigated by a variety of sources, including activated inflammatory cells, such as neutrophils, platelets, and cells from the vascular endothelium. Inflammation can become an inappropriate self-sustaining and expansive process, resulting in sepsis. Patients with sepsis often exhibit loss of aspects of normal vascular homeostatic control, resulting in abnormal coagulation events and the development of disseminated intravascular coagulation. Diagnosis and treatment of sepsis remain a significant challenge for healthcare providers globally. Targeting the drivers of excessive oxidative/nitrosative stress using antioxidant treatments might be a therapeutic option. This review focuses on the association between excessive oxidative/nitrosative stress, a common feature in sepsis, and loss of homeostatic control at the level of the vasculature. The literature relating to potential antioxidants is also described.

Erdheim-Chester disease – case report

Summary Erdheim-Chester disease (ECD) belongs to the malignant polyostotic sclerotic forms of non-Langerhans histiocytosis. During abnormal prolipheration of pathologic histiocytes (foam cells), involved structures become hypertrophic with increased density followed by scarring. Mostly the diaphysis and metaphysis of long bones of lower limbs with typical pain are involved. According to the WHO, the disease is classified as histiocytic neoplasia. We refer on a 74-year-old female patient with expansive process in the region of upper clivus and sphenoidal bone on the right side. Histological testing confirmed this very rare disease that affects about 600 patients over the world. Key words Erdheim-Chester – foamy histiocytes – sclerosis – fibrosis

Diagnostic Difficulties and Management of Childhood Lymphoma: A Case Report

Primary dural lymphoma is a rare pathology, it is part of the malignant lymphoma of the central nervous system and it can reach the extradural or subdural space. We report a case of a little boy of three years and two months admitted to the Department of Neurosurgery CHU JRA for multiple swellings in the scalp associated with an altered general condition. The CT scan revealed a multiple extra-axial expansive process with retro-orbital extension responsible for an important exophthalmos as well as at the scalp level. Anatomopathological examination of the dura mater biopsy revealed a malignant non-Hodgkin's small cell lymphoma. The patient underwent chemotherapy of 05 sessions and the evolution was marked by the persistence of the symptoms. The post chemotherapy brain scan showed considerable extension of the lesions. The next step would be radiotherapy.

Clinical treatment of Idiopathic Benign Intracranial Hypertension (IIH): case report

Introduction: Headache is one of the most common complaints in medicine, being divided into primary or secondary. Idiopathic Benign Intracranial Hypertension (IBIH) is one of the causes of secondary headache, where there is an increase in intracranial pressure in the absence of an expansive process. Goals: To present the management of IBIH refractory to conventional treatment. Methodology: Clinical evaluation of the patient, review of her medical record and review of literature related to the topic. Case report: RMC, female, 55 years old, short stature, BMI 48, presented in 2018 repetitive pictures of severe headache, without improvement factors, associated with visual disturbances that evolved to amausore, sporadic loss of balance and slowing pupillary reflexes, mood disorders and easy cry. Magnetic resonance and fundscopy were inconclusive, and CSF puncture found an opening pressure of 20 cm of water. After CSF puncture, the patient showed instantaneous vision improvement, and therapy with Acetazolamide was introduced, which controlled and kept her ophthalmological symptoms stable. Angina conditions were only resolved with the introduction of Lamotrigine. RESULTS: The most commonly prescribed medication for IBIH, Acetazolamide, controlled the reported patient’s ophthalmological condition, but not the pain episodes. When this medication alone cannot control the condition, the association of other medications or surgical conduct is indicated. The association of Acetazolamide with Lamotrigine was extremely important to solve the patient’s pain episodes, making her clinical management positive. Conclusion: The combination of Lamotrigine and Acetazolamide has been shown to be an excellent form of outpatient treatment for IBIH.

Report of intradural aneurysm in the cavernous segment of the internal carotid artery presented with subarachnoid hemorrhage and oculomotor palsy

Background: Aneurysms of the cavernous segment of the internal carotid artery (ICA) do not usually cause subarachnoid hemorrhage (SAH). We report a patient who presented with this condition due to a ruptured aneurysm located on the posterior genu of the cavernous segment, raising the question of what factors could have led to such evolution. Case Description: A 55-year-old male patient presented with sudden, intense thunderstorm headache, associated with complete palsy of the left oculomotor nerve and neck stiffness. Cranial computed tomography (CT) showed no SAH, but showed an expansive process in the sella turcica, consistent with a pituitary macroadenoma. After that, SAH was confirmed by lumbar puncture (Fisher I). Cranial angio-CT revealed an intradural saccular aneurysm in the cavernous segment of the left ICA. The patient underwent cranial microsurgery for cerebral aneurysm clipping. Unlike the normal anatomic pattern, the cavernous segment of the carotid artery in this patient was located in the intradural compartment. Conclusion: Intradural rupture of proximal cavernous segment carotid aneurysms is rare. We review the literate for such cases and discuss the possible causes.

Capital Accumulation, Environmental Pollution, and Public Health Challenges in the Nigerian Petroleum Industry: Lessons on Market Criminology

Petroleum exploration activities started in Nigeria’s Niger Delta in the early twentieth century as part of the expansive process of primitive accumulation instituted by the British colonial administration to advance its economic interest. Since petroleum resources were discovered in commercial quantities in the region in 1956, transnational extraction corporations (including Shell, Chevron, and ExxonMobil) in collaboration with the emergent domestic compradors have plundered the resource wealth. While decades of crude oil and gas production in the region have enormously enriched the captors of the petroleum industry, the host communities have suffered debilitating economic and health consequences. This article discusses the public health challenges resulting from this predatory political economy, along the lines of a bourgeoning body of literature that conceptualizes preventable market-driven harms as criminal.

Non-puerperal uterine inversion associated with myomatosis

SUMMARY Uterine inversion is an uncommon complication of the puerperium and it is an even rarer complication of the non-puerperal period. In this way, uterine inversions are classified into two groups, being of puerperal origin due to obstetric problems and non-puerperal origin due to gynecological problems. In general, a non-puerperal uterine inversion occurs as a possible complication of a sub mucosal leiomyoma, after an expansive process, a dilation of the cervix occurs and thus its protuberance over the vaginal canal.

Improved Syringe Extruder for Improved Processing of Biological Materials

3 dimensional (3D) printing evolved during the last decade to a consumer friendly and affordable craft. Furthermore, implementations of this techniques in the field of biotechnological research and development within laboratories is a very expansive process. Bio-printers’ prices cover a wide spectrum and most basic models are available for around 5000€. On the other end, high-end printer machines with a vast variety of features are available for several hundreds of thousands of euros. Thus, due to the immense potential in the field of Biotechnology the availability of this technology for research purpose should be enhanced. A developed ecological syringe extruder prototype for processing of biological based gels has been further improved. The original prototype was capable to processing multiple layers of agar with concentrations of 1% and 2.5%. Based on these results the prototype was revised regarding printing process parameter, which include among others applied forces to the substrate, air-ventilation, and heating of the substrate. The process behavior will be simulated with computational fluid dynamics for the processing of biological based substrate. After a concluding validation these results are intended to be implemented into a new design for improved processing of a variety of bioinks.

LESSONS DERIVING FROM AN EASY LAPAROSCOPIC CHOLECYSTECTOMY

Gallstone is a very frequent condition, therefore laparoscopic cholecystectomy - the gold standard in the treatment of the above mentioned pathology - is the most frequent surgical intervention performed in the surgery departments in the country and abroad. At the same time, it is the laparoscopic surgery with the highest number of intraoperative incidents and accidents. Thus, in a surgical environment dominated by the stress of injuring the main bile duct, extracting the piece and sending it for the anatomical pathology examination remains on a secondary level. This is why we would like to discuss a problem related to laparoscopic cholecystectomy which is less approached in the specialty literature. Patient B, admitted to the General Surgery and Emergency Clinic III of the University Emergency Hospital of Bucharest (UESB) – medical chart (M.C.), aged 66 with a surgical history – a simple, uncomplicated laparoscopic cholecystectomy, undergone ​​two years before, with a good postoperative evolution – came to the emergency room with diffuse abdominal pain, more pronounced on the right flank. The clinical, biological and imaging evaluation performed did not reveal any pathological aspects, except for the abdominal-pelvic CT scan with a contrast agent which revealed an expansive process in the right hypochondrium lining the costal side of the liver segment VI. The tumour was surgicaly removed; the extemporaneous histopathological examination was inconclusive about the origin of the tumoral formation (adenocarcinoma of the digestive tract ). The key to the diagnosis was obtained in an administrative manner because, when the discharge letter delivered at the time of the cholecystectomy was reviewed, the absence of the result of the anatomical pathology examination of the cholecystectomy piece was noticed. The respective clinic was contacted and the result of the anatomical pathology examination was obtained, i.e. adenocarcinoma of the gallbladder. After 3 months from the surgery the patient returned with a left breast tumor with the HP diagnosis of invasive ductal carcinoma and a total Madden mastectomy wa performed. After 5 more months, surgery was necessary again for a parietal epigastic tumor - with the anatomical pathology result of cholangiocarcinoma. The author reports the case because he believes that this is further proof of the necessity of sending any cholecystectomy piece, and broadly speaking, any excised piece, for the HP examination. Moreover the patient's attention should be drawn to the necessity of returning to the clinic to take the anatomical pathology result because this result may require the reconsideration of therapeutic conduct.

Gender in the New Education Policy 2016 in the Making

There is no doubt that until now significant progress has been made to include gender in the Indian education policy. Further, it is also recognized that investment in the education of both boys and girls with focus on equity is consistently the most powerful and important indicator of national development, as well as being a vehicle for the advancement of the present and future generations of children. Therefore, leaving out issues of gender and girls’ education puts a question mark on the future vision of society. Right now, the new education policy is in the making, after a gap of 24 years. There are two documents in the public domain. The first one was an outcome of a very extensive and expansive process of consultations. This article interrogates the process of policy formulation by looking at texts of these two reports as primary data sources. The central concern in this article is to show the complete or near complete gender blindness or exclusion of concerns regarding education of girls and women in the two documents. As a result, there is no or hardly any space given to them in these documents which presumably will go into the formulation of the new education policy. What is required is a focus on equality and a transformative conception of gender inclusiveness in the new policy, which will ensure meaningful and realistic inclusion of gender concerns.