Child Neglect: What Is It, What Causes It and How We Can Minimize It?

Almost all forms of abuse include child neglect, and still the professional and clinical community is only now starting to focus attention to this phenomenon and its short- and long-term effects. This paper begins with defining child neglect, what causes parents to neglect the children which they are supposed to love and protect, and the protective factors that parents and the community must be aware of and utilize in protecting kids.

Autosomal Recessive Autism: Cure of the Major Autistic Features

Background: We have previously reported our extensive experiences with autism disorders and their treatments, and we showed the possibility of curing the major autistic features with a new therapeutic approach which included individualized courses of intramuscular cerebrolysin as the main therapy for the main autistic features. Our previously published experiences included observing the occurrence of atypical autism associated with evidence of mental retardation in four brothers from outside Baghdad, each two of them from two unrelated families. The four patients were treated based on our extensive published experiences with the pharmacological treatments of autism disorders; however, the follow-up and the outcome of treatments of these four children were not described in the previous publications. The aim of this paper is to report the cure of the major autistic features in 2 brothers with autosomal recessive autism. Patients and methods: It was possible to follow the first two brothers for only few weeks and to see them after the first course of treatment, however, the second brothers were followed for more than one year, and it was possible to achieve cure of the main autistic features. Results: After one short course, the first two brothers showed slight but noticeable improvement. The younger brother showed some reduction in autistic features as he developed rather an acceptable eye contact. However, the two brothers were still not responding to name and didn’t say any word. After, treatment, the second two brothers showed no autistic features, and experienced significant improvements in speech and cognitive functions. The older brother was not having autistic features after eighth months, and was obeying commands, but was still saying only few words. The younger brother joined primary school and was doing well apart from some behavioral problems especially running away from school and sometimes breaks things. Conclusion: In this paper, cure of autism has been achieved in two boys with autosomal recessive disorder. However, cure of autism in older children has never been expected to totally normalizes them, as the patients have already lost several years of learning, social adaptation, and maturation of personality and behavior.

Mortality Rate in Covid-19 Positive Patients with Acute Kidney Injury Requiring Hemodialysis

Introduction: According to statistics till April, 2020 1,995,983 cases and 131,037 deaths have been reported globally with COVID-19 being a global threat posing great challenges to the healthcare system. Clinical data reviews and researchers have revealed that COVID-19 affects multiple organ especially liver, kidney and heart with primary damage to the respiratory system. Acute kidney injury and COVID-19 infection has been found to be linked to each other but the etiology remains unclear still. Method: This is an observational retrospective study conducted in nephrology department of Patel Hospital, Karachi. Data was collected retrospectively from medical records of patients. The study was carried out during the time period of March, 2020 till May 2021 for duration of 15 months. Patients with positive COVID-19 PCR and having AKI requiring hemodialysis were included in the study. Data was collected by complete evaluation of COVID-19 patient records and their symptoms, clinical status and final outcome during their hospital stay was noted. Results: The frequency of acute kidney injury requiring hemodialysis in our tertiary care setup was found to be 12.2% (n=41). Amongst these there were 53.7% males (n=22) and 46.3% females (n=19) and the mean age of patients was found to be 64.82+ 11.2 years. The mean level of lymphocyte count was found to be 11.3 + 4.8 *109/L. The in hospital mortality of COVID-19 positive patients having AKI was documented to be 73.2% (n=30) as shown in table-4. The other group of patients included 11 patients who recovered from acute kidney injury after hemodialysis sessions and were discharged from the hospital. Conclusion: Since COVID-19 infection became pandemic in 2020 there still needs to be a lot of research done in different populations. Hospitalized patients with COVID-19 infection should be Screen for kidney impairment and provided proper treatment. There has been found a very close association between the severity of acute kidney injury and mortality among the critically ill patients.

Ethical and Bioethical Aspects in the Use of Stem Cells in Chronic Spinal Cord Injuries

One of the fundamental dogmas maintained in neuroscience until the last century held that regeneration of the nervous system cannot occur in stages of adult life. However, it has been shown in several species during the postnatal stage and throughout life, that new neurons continue to be generated in some places in the human body. Objectives: The research was: to evaluate ethical and bioethical aspects in patients who were treated with an autologous stem cell implant in chronic spinal cord injuries. Method. An analysis is made of the ethical aspects that accompany the implantation of autologous stem cells in chronic spinal cord injuries. The results are evaluated at the "Enrique Cabrera" Surgical Clinical Teaching Hospital. Results: Ethical dilemmas are expressed and that have, among their relevant principles, the inviolability of human life. In higher animals, stem cells according to their evolutionary state can be embryonic and somatic or adult. Currently there is an extraordinary controversy about which stem cells to use from embryonic or adult ones, a debate in which both scientific, ethical, religious, social and political aspects have been included. One aspect of the scientific debate is related to the generative capacity of tumors by embryonic cells. From the ethical point of view, it has been argued that the use of human embryonic stem cells implies the destruction of embryos and it has been considered that life begins at the same moment of the union of the sperm with the ovum and that this would be equivalent to the destruction of a human life which would not be justifiable. Others do not agree with these criteria and argue that their use to save lives through research or therapy would be justified. Conclusions The physical disability produced by a chronic spinal cord injury raises an ethical dilemma about the use of stem cells, anticipating that the main controversy about this action has to do fundamentally with the way in which they are obtained.

Goldberg Shprintzen Syndrome: The Novel Association with Congenital Unilateral Anorchia (Monorchism)

Background: Goldberg Shprintzen syndrome is a very rare autosomal recessive mental-growth retardation syndrome associated with characteristic facial dysmorphism, Hirschsprung disease, and a variety of neurological abnormalities, and abnormalities on brain imaging studies. However, the association of the syndrome with congenital unilateral absence of the testis (monorchism) has not been reported before. We have previously reported the thirty fourth and thirty fifth cases of the syndrome which occurred in Iraqi brothers, and described a novel therapeutic approach which was used to treat the younger brother. The aim of this paper is to report the novel association of Goldberg Shprintzen syndrome with congenital right monorchism. Patients and methods: T.A.S, the younger of two brothers with Goldberg Shprintzen syndrome was first seen at the age of four years and 10 months at the pediatric neuro-psychiatric clinic on the 29th of August, 2019. He had spastic right hemiparesis and was unable to walk alone, and was not saying any word and had characteristic facial features including hypertelorism, narrow palpebral fissures, open mouth, and laterally lifted ear. He also had neonatal intestinal obstruction which was attributed to Hirschsprung disease, and was treated surgically with resection and colostomy. The boy was treated successfully with novel therapeutic approach and experienced improvement in cognitive abilities, speech, and motor function, and after treatment was able to walk alone. Results: During July, 2021, the family reminded us that the child had single testis in the scrotum, and during early infancy an MRI study failed to find any second testis anywhere. An ultrasound was performed and showed normal left testis. However, the right testis could not found in the right hemi-scrotal sac nor with the right inguinal canal or within the abdomen. Thus, the ultrasound confirmed the earlier MRI findings which suggested congenital absence of the right testis (monorchism). Conclusion: This paper reported the novel association of Goldberg Shprintzen syndrome with monorchism, and this case represented the third case of congenital syndromic monorchism in the world.

Quality of Information Available on YouTube Videos Pertaining to Bariatric Surgery

YouTube is one of the most frequently used online sources providing easy access to health information with a large, diverse, and searchable video library. However, an unregulated policy and lack of peer-review process are important disadvantages. Accordingly, while based on thousands of surgical, animated, oral presentation and patient-experience videos, the information provided by YouTube videos is considered questionable in terms of quality, accuracy and credibility.

Factors Affecting the Selection of the Bariatric Surgeon-A Survey Study

There are various factors considerd by the patients in the process of selecting the hospital and the surgeon like professional sertifications. The experience of the surgeon for all types of surggeries has a great influence on the patients' preference. In some surgical procedures patients prefer gender concordant surgeons like gynecological operations. These factors have been evaluated in many studies regarding different types of operations.

Exploring Solitary Bone Plasmacytoma: A Rare Case Report

The Solitary Bone Plasmacytoma (SBP) is a rare oncologic disease corresponding to less than 5% of the malignant neoplasms of the plasma cells. It is characterized as a localized aggressive tumor consequent to the accumulation of monoclonal plasma cell neoplasms and, due to the rarity of the disease, there are only few clinical studies reporting it especially regarding prognostic factors and treatment. Here, we report a fatal clinical case of SPB in Roraima, the northernmost state of Brazil. The study shows a case of solitary bone plasmacytoma on the femur, where the patient was submitted to the preconized radiotherapy cycles. However, over approximately four-years following the diagnose, the patient required multi-modal approach to guarantee quality of life during the survival time. Finally, this study explores SBP-related issues and examines the challenges physicians face when managing the care of patients with SBP.

Shear Bond Strength of Repaired Ceramic-Metal Restorations Using Different Bonding Agents with Different Surface Treatments

Background: Fracture of ceramic-metal restorations is a major problem facing the dentists and the patients. There are several bonding systems currently available in the market to repair the fractured ceramic-metal restorations inside or outside the oral cavity. Purpose: The purpose of this study was to test the efficiency of repairing of metal-ceramic restorations using different bonding systems with different surface treatments. This efficiency was tested through the conduction of shear bond strength of the composite bonded to the porcelain and to nickel-chromium alloy using three different bonding agents (Excite, AdheSE, and Prompt L-Pop) with four different surface treatments (sandblasting and enchant, diamond stone roughening, sandblasting and hydrofluoric acid etching, or without surface treatment). Materials and Methods: A total of 120 specimens were prepared, 60 specimens from porcelain and 60 specimens from nickel-chromium alloy. Each group was divided into three equal subgroups, 20 specimens each, corresponding to the 3 bonding agents used. Each subgroup was further subdivided into four subgroups, 5 specimens each, corresponding to the surface treatment procedures. Bonding agents applied over all specimens and cured, followed by application of a micro-hybrid light-cured composite resin (Tetric Ceram). Thermal cycling was done for all specimens between 5°C and 55°C for 1000 cycles with a 10-second dwell time. Shear bond strength test was conducted using a universal testing machine ata cross-head speed of 0.5 mm/min. Results: The highest shear bond strength value recorded for the porcelain specimens bonded with Excite bonding agent with surface treatment sandblasting and hydrofluoric acid etching. In metal groups, the AdheSE bonding agent showed the highest shear bond strength value with the same surface treatment of the porcelain specimens. It was observed that sandblasting followed by hydrofluoric acid etching produced the most effective treatment method for porcelain and metal surfaces. Conclusion: The most effective technique for repairing metal ceramic restoration was sandblasting with hydrofluoric acid etching as surface treatment together with AdheSE or Excite bonding agents.

Acetaminophen Intoxication with Fulminant Hepatic Failure Salvaged by Plasmapheresis

Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no systematic studies to prove its effectivity. Case Presentation An 18-year-old girl was admitted with reduced responsiveness for one day with a few episodes of diarrhea. On admission, she was febrile and had a GCS of 10/15, otherwise normal neurology. She had marked right hypochodrial tenderness, deep icterus, and a pulse of 120 beats per minute, with a blood pressure of 80/50 mmHg; fluid resuscitation with inotropic support was done. Initial investigations revealed severe metabolic acidosis, hemoglobin of 9.5 g/dL, white blood cell count 13,500/mm3, and platelet 119,000 per µL. The prothrombin time (PT) international normalized ratio (INR) was 4.7, and the activated partial thromboplastin time (APTT) was 38.6. The alanine aminotransferase (ALT) level was 8118 U/L, and aspartate aminotransferase (AST) was 3883 U/L with a total bilirubin of 107 µmol/L. The diagnosis of acute liver failure following acetaminophen intoxication was made and managed with intravenous NAC, pantoprazole cover, intravenous ceftriaxone, metronidazole, thiamine, and vitamin K. Fresh frozen plasma and platelets were given for severe coagulopathy. She was started with plasmapheresis at the intensive care unit (ICU), where she had a significant improvement, though she developed hospital-acquired pneumonia, which was successfully managed. Subsequently, her liver functions returned to the baseline, and she was discharged after a psychiatric assessment. Conclusion A high degree of suspicion needs to be adopted to diagnose acetaminophen-induced acute liver failure when a patient presents with hepatic encephalopathy, and plasmapheresis can be considered a life-saving measure adjunct to the NAC.