Early insulin-resistance, T2D and treatment options in childhood

Background T2D (Type 2 Diabetes) represents just the tip of the iceberg of the complex metabolic alterations associated with obesity and other clinical conditions associated to impaired adipose tissue storage. Summary Available data have suggested the presence of a continuous spectrum of metabolic alterations developed in the progression from IR to T2D, most of which are likely preventable through the early characterization of all the multiple risk factors involved. Therefore, the complete characterization of the natural history of the disease and the major modifiable factors represents a milestone in the daily care of young subject at risk for the development of impaired glucose metabolism early in life. This review will focus on the main components defining the risk of IR and T2D in childhood with a specific focus on the main aspects of treatment options available in children and adolescents. Key messages Impaired adipose tissue storage documented in obesity results in a continuous spectrum of metabolic alterations ranging from IR to T2DM. These metabolic alterations are mostly likely preventable through the early characterization of all the multiple risk factors involved. The complete characterization of the disease and of the major modifiable factors represent a milestone in the daily care of young subject at risk for the development of impaired glucose metabolism early in life.

Giant compressive emphysema: a rare complication of COVID-19

Background The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a new ribonucleic acid (RNA) beta-coronavirus, responsible for a worldwide pandemic. Very few cases of SARS-COV-2-related emphysema have been described, except among patients with chronic obstructive pulmonary disease. The thoracic CT scan is the key examination for the diagnosis and allows to evaluate the severity of the pulmonary involvement. The prognosis of the patient with giant emphysema (GE) on coronavirus disease 2019 (COVID-19) in critical or severe form remains poor. We report an original case of COVID-19 pneumonia, critical form, complicated by a giant compressive left emphysema of 22.4 cm in a young subject without respiratory comorbidities. Case presentation A 34-year-old man was hospitalized for left laterothoracic pain. He had no prior medical history. The physical examination revealed tympany on percussion of the left lung. The CT scan confirmed COVID-19 pneumonia with 95% lung involvement. Also, the presence of a voluminous left sub pleural emphysema of 22.4 cm with compression of the ipsilateral pulmonary parenchyma as well as the mediastinal structures towards the right side. The diagnosis COVID-19 pneumonia, critical form, complicated by a compressive left giant emphysema was made. He was put on oxygen, a dual antibiotic therapy, a corticotherapy, and curative doses of enoxaparin. A thoracic drainage surgery was performed at 24th day of hospitalization, which confirmed the giant emphysema. The patient remains on long-term oxygen therapy. Conclusion The COVID-19 has polymorphic manifestations, pneumonia is the most important one. There are relatively few reports associating COVID-19 and emphysema; furthermore, reports associating COVID-19 and giant emphysema are extremely scarce. CT scans can confirm the diagnosis and differentiate it from a pneumothorax. The pulmonary prognosis of the association of COVID-19 in its severe or critical form with giant emphysema remains poor.

Brain volumetric MRI study in healthy adolescent and young person’s using automated method

Objective: Adolescence is a critical period for the maturation of neurobiological processes that underlie higher cognitive functions and social and emotional behaviour. However, there are limited studies that investigated brain volumes in healthy adolescents and young persons. The aim of this study was to compare the Grey Matter (GM), White Matter (WM) and some specific brain subcortical volumes such as hippocampus and amygdala between healthy adolescents and young groups by using VolBrain. Material and Methods: Magnetic resonance imaging brain scans were retrospectively obtained from 20 healthy adolescent and young subjects. The mean ages of the adolescent and young persons were 13±1 and 24±2, respectively. Brain parenchyma (BP), GM, WM and asymmetry features were calculated using VolBrain, and the GM and WM volumes of each subjects were compared with those of the both groups. The current study to examine whether regional gray matter (GM), white matter (WM), cerebrospinal fluid (CSF), some brain subcortical structures volumes differed between healthy adolescent and young groups. Also, of the whole brain, hemispheres, and hippocampus, amigdala of adolescent and young subject volumes were measured with an automated method. Results: We have observed that the young group was found to have a 4 % less in volume of GM, when compared with adolescent groups. Conclusion: Our data indicate that quantitative structural Magnetic Resonance Imaging (MRI) data of the adolescent brain is important in understanding the age-related human morphological changes.

Spectrum of Clinical Presentation and Surgical Outcome in Patients with Chronic Subdural Haemorrhage: A Retrospective Study

Introduction: Chronic subdural haematomas are one among common neurosurgical emergencies especially affecting elderly male. Usually, presents with subacute Cerebro Vascular Accident (CVA), impaired higher mental function and sometimes with reversible dementia. Rarely, it presents with end stage herniation. Burr Hole Drainage (BHD) is the most popular and worldwide procedure of choice and it successfully address the problem in majority of cases. However, in a small group of patients it needs a wider craniotomy to deal with the subdural membrane which is mainly associated with recurrence of the entity. Aim: To evaluate the comparative incidence of various clinical presentation and analysing the outcome of different treatment modalities in different subgroups of patients with chronic subdural haemorrhage with respect to complication and survivality. Materials and Methods: This retrospective study enrolled data of 100 consecutive patients of subacute (n=30) and chronic subdural haematoma (n=70) who were admitted and undergone neurosurgical management of Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Odisha between September 2018 to September 2020. Variables were collected from patient’s records at discharge and analysed with respect to spectrum of clinical presentation and surgical outcome of different treatment modalities and problems associated with it. Results: The mean age group was 57.39 years and headache was the most common clinical presentation in the present study (86%) followed by hemiparasis (74%). BHD was carried out in 94 patients (94%). Primary craniotomy and membrane excision was carried out in 5 patients. Secondary craniotomy was performed in 1 patient after early re-accumulation and clinical deterioration. The outcome was assessed utilising Glasgow outcome scale with total five deaths in the series. Conclusion: Chronic Subdural Haemorrhage (CSDH) a problem of late adulthood (5th to 6th decade) which mostly follows two to three weeks after trauma. It needs proper preoperative assessment and requires timely intervention with skilled nursing care for early recovery. Post-traumatic subacute subdural haematoma in young subject and alcoholics needs special attention during course of their treatment. Bilateral puppilary failure, low Glasgow Coma Scale (GCS) and seizure association are risk factors for poor outcome.

Intracardiac Thrombus Revealing Coronavirus Disease 2019 (COVID-19). About a Case, Renaissance University Hospital Center in N’Djamena (Chad)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) called COVID-19 is often associated with thrombotic complications, especially in severe cases. We report a case of COVID-19 revealed by a right intraatrial thrombus to emphasize the risk of thromboembolic diseases linked to this pathology. He was a young subject, 41 years old, with no notable history. He complained of asthenia and precordialgia. Echocardiography showed the presence of a right intraatrial thrombus and laboratory tests confirmed COVID-19. Under medical treatment combining antithrombotics, chloroquine and azithromycin, the thrombus regressed, and the markers of inflammation were normalized after 12 days. One month later, the patient remained clinically stable with normal echocardiography.