Annals of Medicine and Surgery最新文献

Hemoglobin, the vital protein responsible for oxygen transport in the bloodstream, plays an indispensable role in sustaining life and cellular function. Traditionally viewed through the lens of hematology and respiratory physiology, hemoglobin is now being explored as a key determinant of healthy aging and human longevity. As the primary regulator of tissue oxygenation, its efficiency influences mitochondrial activity, energy metabolism, and organ vitality - all of which are central to lifespan regulation. Emerging evidence suggests that both low and excessively high hemoglobin levels are linked to increased morbidity and mortality in aging populations, underscoring the need for homeostatic balance. The dynamic interplay between hemoglobin concentration, erythropoiesis, hypoxia-inducible pathways, and oxidative stress reveals a complex biochemical network influencing aging at the molecular level. Hemoglobin's oxidative byproducts, if unchecked, can induce cellular senescence, compromise immune responses, and contribute to degenerative conditions commonly associated with advanced age.

Introduction and importance: Williams-Campbell syndrome (WCS) is a rare congenital syndrome that can lead to bronchiectasis. Although commonly found in pediatric age groups, it can also be seen in adults due to delayed diagnosis with respiratory symptoms of cough, sputum, and wheezing.

Presentation of case: A 31-year-old male presented with an incidental finding of bilateral cystic lesions in the lung field for which high-resolution computed tomography of the chest was done, which showed bilateral multiple cystic lesions without any clinical findings except mild inspiratory wheeze.

Clinical discussion:

Diagnosis: Any suspected case of bronchiectasis must undergo imaging: chest radiograph or computed tomography scan, along with blood investigations, sputum tests, and, if needed, a biopsy to help establish a diagnosis. Diagnosis of WCS is made after exclusion of common causes, which can be cystic fibrosis, foreign body aspiration, tuberculosis, COPD, and congenital causes like bronchomalacia, Mounier-Kuhn syndrome, tracheoesophageal fistula, etc.

Therapeutic intervention: Chest physiotherapy, antibiotic therapy, vaccination, and pulmonary rehabilitation are primary modes of treatment. En bloc lung transplantation can be done in some cases.

Conclusion: Diagnosis is made by ruling out all other causes of bronchiectasis, but a dynamic CT scan confirms the diagnosis. Chest physiotherapy and antibiotics are the treatment of choice.

Introduction and importance: Chronic kidney disease (CKD) is recognized as one of the leading causes of human death. This case highlights the importance of whole-exome sequencing (WES) and genetic diagnosis in families.

Case presentation: A 4-year-old girl (subject) was diagnosed with CKD along with her father, grandfather, and grandmother. The subject was first evaluated at 4 years of age because of black urine problem. On early diagnosis, it was kidney stones. She was suspected to be affected with kidney disorder by ultrasound and is being evaluated for the presence genetic variations by WES. We identified a missense variation in GRHPR gene c.494 G>A in subject, and her 27-year-old father was also identified with the same variation in the GRHPR gene. On follow-up, kidney stones were removed via extracorporeal shock wave lithotripsy (ESWL). Following ESWL sections, the subject was stable and sent home.

Clinical discussion: Genetic diagnoses are essential for identifying diseases, which aid in early diagnosis and control to spread within families. This case highlights the value of advanced genetic testing in nephrology for precision diagnosis and family risk assessment.

Conclusion: A multidisciplinary approach and timely intervention in CKD are vital to prevent complications in families.

[This corrects the article DOI: 10.1097/MS9.0000000000002657.].

Anemia affects an estimated 40% of children globally, with iron deficiency, chronic disease, hemoglobinopathies, and acute blood loss as leading causes. In addition to impairing oxygen delivery, anemia can disrupt normal hemostasis, leading to a range of coagulation abnormalities, including thrombocytopenia, reactive thrombocytosis, platelet dysfunction, altered coagulation factor levels, and abnormal fibrinolysis. The type and severity of these coagulation changes vary according to the underlying anemia etiology, influencing the risk of bleeding or thrombotic complications. This narrative review synthesizes current clinical and laboratory evidence on coagulation disturbances in pediatric anemia, highlighting their prevalence, pathophysiologic mechanisms, and clinical manifestations. Emphasis is placed on practical strategies for risk assessment, integrating standard laboratory evaluations - complete blood count, coagulation panel, and platelet function assays - with clinical features to identify children at highest risk for adverse outcomes. The review also discusses implications for individualized management, including etiology-directed therapy, supportive hemostatic measures, and caregiver education to improve safety and outcomes. Future research priorities include the development of standardized risk stratification tools and evidence-based pediatric management guidelines to optimize care in this vulnerable population. This review underscores the need for early coagulation monitoring in anemic children and recommends integrating clinical features with laboratory markers to enhance risk stratification and guide timely, individualized management.

Background: Infertility, affecting approximately 17.5% of individuals worldwide, is increasing globally, making oocyte donation an important reproductive option. However, it is associated with physical and psychological risks, as well as social stigma. The primary aim of this systematic review and meta-analysis is to estimate the prevalence of depression among women undergoing oocyte donation, and the secondary aim is to assess changes in depressive symptoms before and after the donation process.

Methods: A systematic and thorough literature search was performed from 1 January 1990 to 31 December 2024 using PubMed, Web of Science, Scopus, and Embase databases. Reference lists of relevant articles, as well as Google Scholar, were manually reviewed to identify additional eligible studies. The risk of bias of included studies was independently assessed using the Hoy checklist for prevalence studies. Meta-analyses were conducted utilizing STATA version 18.0, applying a random-effects model to account for potential heterogeneity among studies.

Results: The meta-analysis of five studies estimated a pooled depression prevalence of 2% [95% confidence interval (CI): 0-6%; I ² = 57.7%] among women considered for oocyte donation. No publication bias was detected, and meta-regression showed no significant association between age and depression prevalence (P = 0.84). Additionally, no significant change in depression scores was observed before and after donation (Hedge's g = -0.09, 95% CI: -1.92 to 1.74; I ² = 3.3%).

Conclusions: Depression affects a small but notable proportion of women undergoing oocyte donation, with no significant changes in depressive symptoms before and after the procedure.

Chronic COVID, characterized by persistent symptoms following acute SARS-CoV-2 infection, is increasingly linked to sustained immune dysregulation, particularly cytokine storms that drive chronic inflammation and multi-organ complications. Understanding the mechanisms underlying cytokine dysregulation in chronic COVID is essential for developing effective therapeutic strategies aimed at restoring immune balance and mitigating long-term morbidity. This review critically examines current immunomodulatory strategies for managing cytokine storms in chronic COVID, including corticosteroids, cytokine-specific biologics, Janus kinase inhibitors, and emerging cell-based therapies. Additionally, the role of biomarker-guided precision medicine in personalizing treatment to optimize efficacy and safety is discussed. Challenges such as patient heterogeneity, timing and duration of therapy, and potential adverse effects are also addressed. Future research directions emphasize the need for robust clinical trials, novel therapeutic development, and integrated multidisciplinary care to improve patient outcomes. By tailoring immunomodulatory approaches based on individual immune profiles, it is possible to enhance the management of cytokine-driven inflammation in chronic COVID and advance the field toward more effective, personalized treatments.