ASPLORO OPEN ACCESS PUBLICATIONS
An international, peer-reviewed open access journal in which it addresses not only health related issues (disease, infection, genetic disorder, growth impairment etc.), but also aims to cover topics related to the physical, emotional and social well-being of children.
An umbilical cord hernia (UCH) is a form of abdominal wall defect, affecting 6 out of every 10,000 newborns. The persistence of urachus is an embryonic remnant that connects the bladder to the abdominal wall at the level of the umbilicus, being yet more uncommon. We reviewed the literature, searching in PubMed, under the terms “Hernia of umbilical cord”, “Congenital hernia of cord” and “Persistent Urachus”. Only a few similar cases of both pathologies associated described were found. Our main objective is to highlight the distinct clinical features, embryogenesis, prognosis and associated anomalies of two infrequent embryopathies. And to describe a infrequent case of both abnormalities presenting simultaneously.
UCH are often misdiagnosed with other abdominal wall deffects, such as omphalocele, umbilical hernias, gastroschisis and umbilical cord cysts. The normal cord insertion, adequate muscle development of the abdominal wall and a wall defect less than 5cm is what differentiates it from an omphalocele. UCH has a low morbidity overall, as it is not associated with other anomalies. The most frequently observed urachal malformations are the persistence of a urachus and urachal cyst. The prenatal diagnosis of patent urachus is made by ultrasound or magnetic resonance, being easily mistaken with abdominal wall defects, confirming the diagnosis with an ultrasound at birth. The persistence of urachus may resolve spontaneously, if not, surgical resolution is recommended. Similar to a UCH, a patent urachus shows little association with other malformations.
It is important to know the clinical presentation and the diagnostic perinatal methods employed for appropriate management and favorable results for both pathologies. This relies on knowing when to suspect possible associated anomalies and when complementary studies might be needed. It is also important to be aware that there is the possibility of a UCH and a patent urachus existing simultaneously.
Biosimilar medicines are highly similar to FDA approved reference biologics. The sponsor’s intended use claim plays an important role in the use of biosimilar medicines in specialty therapy categories such as immunology, endocrinology, oncology. The new biosimilar products approved by the FDA, play a pivotal role in the clinical treatments of patients suffering from life-threatening diseases such as cardiac myopathies, carcinoma, sarcoma, lymphoma. The US biosimilar approval process requires a thorough characterization of the new biosimilars with a clinically meaningful outcome. Sponsors of new biosimilars follow the appropriate ICH guidelines in regard to clinical PK/PD, safety and efficacy studies. The FDA guidances for extrapolation and interchangeability state that data derived from clinical studies should be adequate to demonstrate purity, potency, safety and the intended clinical use of the new biosimilar in comparison to previously approved licensed biologics. This article emphasizes the FDA’s quality system approach to the design of studies for clinical applications for designated specialty therapy categories.
Diabetes has been a crucial medical and social problem worldwide. For adequate nutritional therapy, there have been discussions concerning Calorie Restriction (CR) and Low Carbohydrate Diet (LCD). We have investigated glucose variability of diabetic patients applying CR, LCD, continuous glucose monitoring (CGM) and applied FreeStyle Libre which is flash glucose monitoring (FGM). The patient is a 40-year-old female with type 2 diabetes mellitus (T2DM), who showed BMI 20.7, postprandial blood glucose 257 mg/dL. HbA1c 12.1%, Glycoalbumin 31.6% (11.6-16.4), serum C-peptide 2.0 ng/ml and unremarkable data of liver function, renal, lipids. She was provided the intervention of three stages, which are i) CR with 60% carbohydrate in Day 1-2, ii) LCD meal with 12% carbohydrate in Day 3-5; iii) LCD + Sodium-glucose cotransporter 2 (SGLT2) inhibitor (Ipragliflozin L-Proline 50mg) in Day 6-12. The glucose profile was measured by FreeStyle Libre Pro (Abbott) for 14 days. The daily profile of blood glucose was abruptly decreased on Day 6. Time percentage of satisfactory blood glucose 70-180 mg/dL (/24h) was 0%, 0%, 2%, 14%, 0%, 54%, 100% in Day 1-7, respectively. These results suppose the acute clinical efficacy of SGLT2 inhibitor, and this report would become a reference for future diabetic practice and research.
Objective: Pump size exterior artificial pancreas that will keep the glucose between 120 – 150mg/dl.
Method: The whole project based on the idea that we should already know one insulin unit how much is able to go down the glucose and one glucagons unit how much is able to increase the glucose. Less than 120 mg/dl it uses glucagons. More than 150 mg/dl it uses insulin. The pump checks the glucose automatically for every 8 minutes. The pump (which is software decision) will choose between insulin or glucagons base in an internal database table with prerequisite glucose values and the insulin or glucagons units requiring for each glucose value (adaptive database table for each diabetic). The pump (the software) is able to choose how many insulin or glucagon units it should use (that is not based on what the diabetic will eat, but base on the current glucose level that received from the sensor which is located in the human body, needle and sensor are one piece). The insulin should have a work duration of 8 minutes and works instantly.
Result: I choose 120 mg/dl as the lowest allowance glucose level as this level is secure for the diabetic (there is a time to prevent big hypoglycemia).
Conclusion: This project offers to diabetics insulin injections freedom, hypoglycemia prevention, run emergency tests, ideally for all ages, endocrinologists will have the software to adapt the internal database table of the pump for each diabetic needs.
Introduction: Pneumopericardium is defined as a collection of air or gas in the pericardium, and considered a rare and innocuous condition. It may progress to tension and cardiac tamponade and may become life-threatening in many instances. In this publication, we will share the case of a pneumopericardium which occurred for middle-aged women treated for liver carcinoma after a laparotomic surgery.
Discussion: Pneumopericardium was once defined as a collection of air or gas in the pericardium, and considered a rare and innocuous condition. The most common etiology of pneumopericardium is blunt trauma. Also, air may dissect into the mediastinum from the retroperitoneal space following the perforation of a hollow viscous or infection with gas-producing organisms. Other causes of pneumopericardium include iatrogenic complications during chest or abdominal surgeries. Diagnosis of spontaneous pneumopericardium can often be made with a formal two-view Chest X-Ray or CT scan. The treatment of air in the pericardial space depends on the type of pneumopericardium present and whether or not there is associated cardiac tamponade. However, tension pneumopericardium can be effectively relieved by pericardiocentesis or tube decompression and the underlying cause subsequently determined.
Conclusion: In conclusion, surgeons should be aware of the possibility of pneumopericardium for patients with chest pain after a laparoscopic procedure and look for electrocardiographic abnormalities. It is important to outline the important role of the chest CT scan to search for pneumothorax or pneumomediastinum.
Introduction: Operative treatment of mallet finger fractures is generally recommended for patients in whom more than one-third of the articular surface is involved with volar subluxation. We present a case of conservative treatment with chronic nonunion of a mallet finger fracture after failed mallet finger surgery.
Presentation of Case: A 16-year-old boy presented with a bony fragment (mallet formation) of his left long finger. The fragment occupied 40% of the articular surface, with volar subluxation of the distal phalanx. Percutaneous needle curettage of the fracture site and pinning were performed. Six weeks later, the fragment was displaced and had rotated. Hence, all the pins were removed, and a splint was applied. The fracture displayed nonunion and volar subluxation of the distal phalanx. The patient continued with the splinting, and the fracture finally healed. At 27 months after the surgery, radiological examination showed very good remodeling of the distal interphalangeal joint surface with anatomic joint congruence. Functional results at 27 months were good according to Crawford’s classification.
Conclusion: Chronic nonunion of a mallet finger can be cured conservatively even when a fracture gap is seen along with displacement of the fragment and volar subluxation of the distal phalanx.