Challenges in Diagnosing Sudden Death Caused by Acute Hemorrhagic Pancreatitis: An Autopsy-Based Case Report.

Forensic pathologists frequently encounter cases of sudden natural death. Most sudden natural deaths are attributed to cardiac causes. Acute pancreatitis, especially hemorrhagic pancreatitis, is an infrequent yet critical contributor to sudden death. The role of a forensic pathologist is imperative in such cases to find out the cause of the sudden death and to either confirm or refute any allegations. In this context, we describe a case of a 34-year-old male who experienced sudden death due to acute hemorrhagic pancreatitis, highlighting the need for a detailed autopsy, pathophysiological insights, and diagnostic challenges.

Sudden Death Caused by Gastroesophageal Varices Rupture: Insights From an Autopsy-Based Case Series Unraveling the Pathological Events.

Sudden death is characterized by natural yet unexpected death, typically occurring within 24 hours from the onset of the patient's symptoms. While the majority of sudden deaths stem from cardiac issues/causes, there are instances where non-cardiac factors are at play. One such scenario involves hemorrhage from ruptured esophageal varices, a complication that stems from portal hypertension. Portal hypertension can manifest due to a range of pre-hepatic, hepatic, and post-hepatic conditions, with liver cirrhosis being the primary culprit. Although sudden death cases linked to the gastrointestinal system are relatively rare, the rupture of gastroesophageal varices, precipitating severe morbidity and a high mortality rate, represents a life-threatening condition. In this context, we present a case series encompassing five instances of sudden natural deaths arising from the rupture of gastroesophageal varices.

Maturity-Onset Diabetes of the Young: Mutations, Physiological Consequences, and Treatment Options.

Maturity-Onset Diabetes of the Young (MODY) is a rare form of diabetes which affects between 1% and 5% of diagnosed diabetes cases. Clinical characterizations of MODY include onset of diabetes at an early age (before the age of 30), autosomal dominant inheritance pattern, impaired glucose-induced secretion of insulin, and hyperglycemia. Presently, 14 MODY subtypes have been identified. Within these subtypes are several mutations which contribute to the different MODY phenotypes. Despite the identification of these 14 subtypes, MODY is often misdiagnosed as type 1 or type 2 diabetes mellitus due to an overlap in clinical features, high cost and limited availability of genetic testing, and unfamiliarity with MODY outside of the medical profession. The primary aim of this review is to investigate the genetic characterization of the MODY subtypes. Additionally, this review will elucidate the link between the genetics, function, and clinical manifestations of MODY in each of the 14 subtypes. In providing this knowledge, we hope to assist in the accurate diagnosis of MODY patients and, subsequently, in ensuring they receive appropriate treatment.

Neurogenin-3 Enteric Endocrinopathy: A Rare Case of Pediatric Congenital Diarrhea and Diabetes Mellitus.

Disorders of intestinal enteroendocrine cells (EEC) are a rare cause of congenital diarrhea and diabetes. The gene NEUROG3 is essential in EEC differentiation, and mutations in this gene lead to a paucity of EEC in the intestine and pancreas, often presenting clinically as congenital diarrhea and diabetes mellitus. We present the earliest known diagnosis of NEUROG3-associated enteric endocrinopathy, which was identified on a neonatal diabetes genetic panel sent at 4 weeks of age. Our patient presented with severe diarrhea, malnutrition, electrolyte derangements, and neonatal diabetes. He was started on parenteral nutrition at 3 months of age for nutritional and hydration support and required long-acting insulin for his diabetes. We demonstrate significant reduction in EEC, including cells expressing glucagon-like peptide-1, in intestinal biopsies from our patient, raising the possibility that loss of glucagon-like peptide-1 contributes to NEUROG3-associated diarrhea and diabetes mellitus. This case advances our understanding of the presentation, diagnosis, and management of this rare disease.

A randomized double-blind placebo controlled pilot study of probiotics in adolescents with severe obesity.

PURPOSE: The purpose of the study is to assess the effect of probiotic supplementation on gut microbiota and insulin resistance in adolescents with severe obesity. METHODS: Through a randomized, double blind, placebo-controlled, 12-week pilot clinical trial, 15 adolescents with severe obesity received either an oral probiotic 'Visbiome®' (n = 8) or placebo (n = 7). Anthropometry, fasting glucose, insulin, hs-CRP and stool for microbiome and calprotectin were collected at baseline (week 0) and 12 weeks after intervention. RESULTS: Among completers (n = 4 in each of the two groups), mean change in fasting glucose was significantly lower in the probiotic group (0 ± 4 mg/dL) as compared to the placebo group (6.3 ± 1.7 mg/dL) (p = 0.028). Gut microbial Firmicutes to Bacteroidetes (F/B) ratio had a greater decline from week 0 to week 12 in the probiotic group (mean 17.7 ± 25.1 to 2.39 ± 2.0, respectively) but was not statistically significant (p = 0.06) as compared to in the placebo group (mean 12.8 ± 18.2 to 6.9 ± 5.61, respectively) (p = 0.89). Weight and BMI (mean ± SD) trended to remain stable in the treatment group (-1.07 ± 6.1 kg and -0.3 ± 2.2 kg/m2 respectively) as compared to the placebo group (3.9 ± 5.1 kg, 1.0 ± 1.6 kg/m2) but was not significant (p = 0.12 for weight and 0.38 for BMI). No significant change in the fasting insulin, HOMA-IR, or serum and stool inflammatory markers were noted between the two groups (p > 0.05). One participant in the treatment arm reported adverse effects of gastrointestinal intolerance. CONCLUSION: Probiotic therapy with Visbiome® may improve the fasting glucose and possibly decrease the gut microbial F/B ratio as compared to placebo in adolescents with severe obesity. Future larger studies are required to confirm these findings.U.S. Clinical Trial Registry number: NCT03109587. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00855-7.

Sotos syndrome with a novel mutation in the NSD1 gene associated with congenital hypothyroidism.

Childhood overgrowth syndromes are relatively rare. A generalized overgrowth syndrome should be suspected when tall stature and macrocephaly are present, after ruling out nutritional excess and endocrinopathies. Sotos syndrome is a well-described overgrowth syndrome due to haploinsufficiency of the NSD1 gene. We present a case of an infant with permanent congenital hypothyroidism, who had tall stature and macrocephaly by 7 months of age. He was noted to have typical facial features, mild gross motor and speech delay, and scoliosis by 13 months of age. Gene sequencing revealed a heterozygous novel c6076_6087del12: p.Asn2026_Thr2029del variant in exon 20 of the NSD1 gene, pathogenic for Sotos syndrome. Congenital hypothyroidism with Sotos syndrome has been infrequently reported and may expand the spectrum of disease characteristics. Early diagnosis of overgrowth syndromes is important for developmental follow up and multidisciplinary care coordination.

Autonomous magnetic microbots for environmental remediation developed by organic waste derived carbon dots.

Biodegradable precursors for micro/nanobots development are key requirements for several sustainable applications. In this regard, we propose an innovative solution for water purification at minimum cost and efforts where organic waste is used for the treatment of organic pollutants. Herein, catalytic magnetic microbots were developed by functionalizing iron oxide nanoparticles with carbon dots (C-Dots), which were synthesized by using household waste such as potato peels as precursors. The speed of these autonomously propelling bots indeed is found very promising for large distance swimming even in viscous medium by using hydrogen peroxide as fuel. These microbots catalytically propel and degrade toxic polar as well as sparingly water-soluble industrial dyes without any external agitation. The degradation of dyes was confirmed by mass-spectra analysis. Furthermore, these microbots can efficiently degrade a mixture of dyes and reused without compromising its performance significantly. Additionally, rate constant (K) and activation energy (Ea) were also determined to establish the catalytic nature of the bots. The present microbots acted as nanozyme owing to its synergistic catalytic activity of Fe3O4 and C-Dots for degradation of mixture of toxic dyes, essential for large scale water treatment.

Corrigendum to "Green synthesis of metallic nanoparticles as effective alternatives to treat antibiotics resistant bacterial infections: A review" [Biotechnol. Rep. 25 (2020) e00427].

[This corrects the article DOI: 10.1016/j.btre.2020.e00427.].

Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone-Related Peptide-Secreting Renal Tumor: Abusive Fractures Accompanying a Parathyroid Hormone-Related Peptide-Secreting Tumor.

BACKGROUND: When evaluating an infant with unexplained fractures for child abuse, it is important to evaluate for possible causes of underlying bone fragility. CASE: A 7-month-old infant was found to have a parathyroid hormone (PTH)-related peptide-secreting mesoblastic nephroma. In spite of having an elevated serum calcium, depressed serum phosphate, and high levels of PTH-related peptide, he had no demineralization or other hyper parathyroid-related bone changes. Instead, he had multiple classic metaphyseal lesions, fractures of differing ages including a proximal clavicle fracture, and current and past bruising. No fractures typical of bone insufficiency were present. These findings are highly indicative of abuse in addition to his hormone-secreting tumor. CONCLUSIONS: In spite of this child's abuse findings, endogenous or tumor-related hyper PTH should be in the differential of underlying bone fragility. Children with disorders that could cause injury susceptibility can also be abused.

Outbreak of COVID-19: A Detailed Overview and Its Consequences.

INTRODUCTION: After the outbreak from Wuhan City of China, COVID-19, caused by SARS-CoV-2, has become a pandemic worldwide in a very short span of time. The high transmission rate and pathogenicity of this virus have made COVID-19 a major public health concern globally. Basically, the emergence of SARS-CoV-2 is the third introduction of a highly infectious human epidemic coronavirus in the twenty-first century. Various research groups have claimed bats to be the natural host of SARS-CoV-2. However, the intermediate host and mode of transmission from bat to humans are not revealed yet. The COVID-19 cost hundreds and thousands of lives and millions are facing the consequences. The objective of this chapter was to analyze the outbreak of COVID-19 and problems faced globally. METHODS: All published relevant literature from scientific sources and reputed news channels are considered to write the current review. RESULTS: Generally, elder persons and more particularly people with underlying medical conditions are found to be highly vulnerable to severe infection and prone to fatal outcomes. Unfortunately, there is no specific treatment with clinically approved drugs or vaccines to treat this disease. Several research groups have been investigating the efficacies of several antiviral and repurposed drugs. Currently, most of the SARS-COV-2 vaccines are at the preclinical or clinical stage of development. The latest research progress on the epidemiology, clinical characteristics, pathogenesis, diagnosis, and current status of therapeutic intervention indicates that still a specific drug or vaccine needs to come up for the effective treatment of the pandemic COVID-19. It is observed that various aspects of social life, economic status, and healthcare systems are majorly affected by this pandemic. CONCLUSION: It is concluded that the outbreak of COVID-19 has severely affected each and every field, such as social, scientific, industrial, transport, and medical sectors. Irrespective of tremendous efforts globally, few vaccines are now available for the prevention of the disease. Specific drug is not available publicly for the treatment of COVID-19. Prevention of air pollution that can aggravate COVID-19 has been suggested. Therefore, as of now, social distancing and sanitization practices are the only options available for the prevention of the disease for many.

Combination therapy of biogenic C-dots and lysozyme for enhanced antibacterial and antibiofilm activity.

Nearly 80% of human chronic infections are caused due to bacterial biofilm formation. The increased resistance against the conventional antimicrobial agents makes it difficult to treat the biofilm-related infections. The antibiotics resistance developed by planktonic cells has also become a major threat for human. Therefore, we have attempted here to develop an effective alternative strategy to overcome the issues of antibiotics resistance of bacteria. Upon synthesis, biogenic C-dots were combined with lysozymes which were further encapsulated into chitosan nanocarrier to form C-dots carrier (CDC). The as-synthesized C-dots were found irregular shaped and the average size of C-dots and CDC were 8 ± 2 nm and 450 ± 50 nm, respectively. To ensure secure and targeted delivery of C-dots and lysozyme we have employed chitosan, a biodegradable and natural biopolymer, as a delivery system. The study of time-dependent bacterial growth and flow cytometry analysis demonstrated that CDC can exhibit a synergistic bactericidal activity against the antibiotics resistant recombinant E. coli cells. Further, we have shown that the CDC could be a potent agent for both prevention of biofilm formation and eradication of preformed biofilm. In addition, we have observed that our drug delivery system is hemocompatible in nature making it suitable for in vivo applications. Therefore, we believe that the combination therapy of C-dots and lysozyme may be used as an excellent antibacterial and antibiofilm strategy.

Nanocomposite of Ag nanoparticles and catalytic fluorescent carbon dots for synergistic bactericidal activity through enhanced reactive oxygen species generation.

Microwave mediated synthesis of catalytic fluorescent carbon dots (Cdots) has been reported using biodegradable starch as precursor. The as-synthesized Cdots were then characterized using various techniques such as fluorescence spectroscopy, fourier-transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM) and x-ray photoelectron spectroscopy (XPS) analysis. Interestingly, Cdots showed high catalytic activity in the photo-reduction of Ag+ to silver nanoparticles (Ag NPs). During the photo-reduction process, no additional surface passivating agents was needed to stabilize the Ag NPs. Further, TEM results indicated the formation of Cdot-Ag NP nanocomposite i.e. Ag NPs surrounded with Cdots, and the emission intensity of Cdots was significantly decreased whereas the lifetime of Cdots remained almost unaltered in the presence of Ag NPs following static quenching. Finally, combination therapy of Cdots and Ag NPs using Cdot-Ag NP nanocomposite was performed which indicated synergistic bactericidal activity against antibiotic resistant recombinant E. coli bacteria. The treatment elevated the reactive oxygen species (ROS) level as compared to its individual components. Additionally, the flow cytometer study demonstrated that combination therapy causing bacterial cell wall perforation that was possibly leading to synergistic bactericidal activity against both Gram positive and Gram negative bacteria. The presence of Cdots on the surface of the Ag NPs due to their ground state complexation, possibly facilitated electrons towards Ag NPs which enhanced the ROS production in comparison to only Ag NPs.

Green synthesis of metallic nanoparticles as effective alternatives to treat antibiotics resistant bacterial infections: A review.

Due to development of bacterial resistance to the conventional antibiotics, the treatment of bacterial infections has become a major issue of concern. The unprescribed and uncontrolled use of antibiotics has lead to the rapid development of antibiotic resistance in bacterial strains. Therefore, the development of novel and potent bactericidal agents is of great clinical importance. Interestingly, metallic nanoparticles (NPs) have been proven to be promising alternative to antibiotics. NPs interact with the important cellular organelles and biomolecules like DNA, enzymes, ribosomes, and lysosomes that can affect cell membrane permeability, oxidative stress, gene expression, protein activation, and enzyme activation. Since, NPs target multiple biomolecules concurrently; it becomes very difficult for bacteria to develop resistance against them. Currently, there are different physical and chemical methods utilized for NPs synthesis. However, most of these processes are costly and potentially hazardous for the living organisms and environment. Therefore, there is a need to develop an eco-friendly and cost-effective method of synthesis. Recently, the 'green synthesis' approaches are gaining a lot of attention. It is demonstrated that living organisms like bacteria, yeast, fungi, and plant cells can reduce inorganic metal ions into metal NPs by their cellular metabolites. Both the yield and stability of biogenic NPs are quite satisfactory. In the current article, we have addressed the green synthesis of various metal NPs reported till date and highlighted their different modes and mechanisms of antibacterial properties. It is highly anticipated that biogenic metallic NPs could be viable and economical alternatives for treating drug resistant bacterial infections in near future.

Role of surface charge in enhancing antibacterial activity of fluorescent carbon dots.

Herein, different surface charged carbon dots (Cdots) were synthesized by using diethylene glycol as a carbon source with various amine containing surface passivating agents. The synthesis method is very simple and fast microwave oven-based, that results in almost similar sized positive, negative and uncharged fluorescent Cdots which has been confirmed by zeta potential analysis in our case. The formation of Cdots was confirmed by characterization using fluorescence spectroscopy, transmission electron microscopy, XRD, FT-IR, and XPS spectroscopy. To find out relative bactericidal activity of these Cdots, green fluorescence protein expressing recombinant E. coli bacteria were taken as a model system. Time-dependent bacterial growth and FACS study demonstrated that both uncharged Cdots and positively charged Cdots were showing better bactericidal activity as compared to negative charged Cdots. The Cdots caused elevation of reactive oxygen species level, which is possibly leading to bacterial cell death.

The Impact of "Mom/Dad of the Day" Cards, Newborn Heart Auscultation, and Father Skin-to-Skin Care on Parent-Newborn Bonding.

Texas Tech Pediatrics at Northwest Texas Hospital System in Amarillo, Texas, currently practices giving "Mom/Dad of the Day" cards to all new parents, offering the opportunity for fathers to auscultate the newborn heart sound, and encouraging maternal and paternal skin-to-skin contact. New parents were asked to fill out 2 anonymous surveys regarding these practices. Survey results showed statistically significant positive responses by the parents for subjective improvement in fetal sleep and feeding as well as parental confidence and preparedness for taking care of their newborn. Additionally, these practices are desired by parents, with 96% fathers recommending that the hospital routinely offering opportunities for heart auscultation and 94% parents recommending "Mom/Dad of the Day" cards for all future parents in the hospital. Small, nonmedical initiatives such as these are well received and can be feasibly adopted in more hospitals to improve patient quality of care.

Family-Centered Care to Complement Care of Sick Newborns: A Randomized Controlled Trial.

OBJECTIVE: To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate. DESIGN: Randomized controlled trial. SETTING: Tertiary referral nursery (October 2010 to March 2012). PARTICIPANTS: 295 neonates randomized at the time of hospitalization in neonatal intensive care unit. INTERVENTION: Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors. OUTCOME MEASURE: Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate. RESULTS: Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)]. CONCLUSION: There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

Urinary biomarkers as indicator of chronic inflammation and endothelial dysfunction in obese adolescents.

BACKGROUND: Obesity is a pro-inflammatory state that may predispose patients to acute coronary syndrome characterized by chronic low grade inflammation resulting in endothelial dysfunction (ED). The aim of the study was to evaluate urinary biomarkers of inflammation and ED in adolescents with obesity. METHODS: Sixty three subjects were recruited for the study. Twenty healthy adolescents with normal body mass (NW), 14 overweight (OW), 29 obese (OA) subjects were selected. An EndoPat 2000 device was used to measure the reactive hyperemia index (RHI). First morning fasting urine samples were tested for interleukin 6 (IL-6), endothelin 1 (ET-1), alpha-1-acid glycoprotein (AGP), tumor necrosis factor- α (TNF-α) and corrected to urinary creatinine. RESULTS: Urinary TNF-α was significantly higher in OA group (52.4 ± 15.3 pg/mg) compared to adolescents with NW (14.1 ± 1.2 pg/mg, P = 0.04). ET-1 levels were found to be higher in OW (5.18 ± 1.6 pg/mg) compared with NW (3 · 47 ± 0.3 pg/mg, P = 0.24); and higher in OA (8.48 ± 3.1 pg/mg) compared to both NW (P = 0.19) and OW (P = 0.40). Similarly a higher AGP level was observed in OW (864.8 ± 156 ng/mg) and OA (808.3 ± 186 ng/mg) compared to NW (653 ± 69 ng/mg) (P = 0.16 & 0.49 respectively). Inflammatory markers namely, TNF-α, IL-6 and AGP significantly and positively correlated with each other and with ET-1, a marker for endothelial dysfunction. This significant correlation was also observed when tested separately in the subgroups (NW, OW and OA). There were no differences in RHI levels among the study groups. CONCLUSION: Urinary TNF-alpha is significantly elevated in obese adolescents and correlates with urinary ET-1, which is recognized as a biomarker for endothelial dysfunction. Since obesity is a chronic inflammatory state, elevated urinary TNF-alpha might be used as a non invasive tool to monitor the level of that inflammation.

Diagnostic paradox: Ruptured aneurysm of sinus of Valsalva simulating tricuspid valve endocarditis.

Rupture of aneurysm of sinus of Valsalva into the right atrium mimicking tricuspid valve endocarditis is a rare presentation. We review a case of spontaneous rupture of aneurysm of sinus of Valsalva into the right atrium presenting as a murmur. Transthoracic echocardiogram showed a mobile mass that appeared to be attached to the tricuspid valve leaflet with moderate tricuspid regurgitation suggestive of tricuspid valve endocarditis. The diagnosis was confirmed as spontaneous rupture of noncoronary sinus in to the right atrium by transesophageal echocardiogram. Patient recovered completely after surgical repair.