Daily Ards Research Analysis

This study assesses the diagnostic and prognostic value of cervicovaginal amniotic fluid (CVAF) podocalyxin (PDX) and nephrin levels in pregnancies with classic and high preterm premature rupture of membranes (PPROM), focusing on neonatal outcomes. This prospective study included 144 singleton pregnancies between 22 and 34 weeks, classified as classic PPROM (n = 74), high PPROM (n = 32), and controls (n = 38). CVAF and serum samples were analyzed using enzyme-linked immunosorbent assay to quantify PDX and nephrin levels. Receiver operating characteristic curves evaluated diagnostic performance. Logistic regression identified predictors of respiratory distress syndrome and bronchopulmonary dysplasia. CVAF PDX and nephrin levels were significantly higher in the classic PPROM group (35.05 ± 5.55 and 12.88 ± 3.85 ng/mL, respectively) compared to high PPROM and control groups. Receiver operating characteristic analysis demonstrated excellent diagnostic performance for distinguishing classic PPROM, with area under the curve values of 0.92 (95% confidence interval [CI]: 0.88-0.96) for PDX and 0.93 (95% CI: 0.89-0.97) for nephrin. In multivariable logistic regression, elevated PDX was independently associated with bronchopulmonary dysplasia (odds ratio = 1.32, 95% CI: 1.10-1.59), while elevated nephrin predicted respiratory distress syndrome (odds ratio = 1.18, 95% CI: 1.02-1.36). These findings support their utility as noninvasive biomarkers for both diagnosis and risk stratification in PPROM. CVAF PDX and nephrin demonstrated significant diagnostic and prognostic value in differentiating PPROM subtypes and may be useful for neonatal risk stratification. These findings suggest that CVAF PDX and nephrin levels may serve as noninvasive tools for early identification of high-risk PPROM cases, potentially guiding timely intervention and targeted neonatal care.

Ascaris lumbricoides is one of the most prevalent helminthic infections worldwide, yet disseminated disease is rare. In resource-limited settings, delayed diagnosis can lead to severe complications, including multiorgan dysfunction and acute respiratory distress syndrome (ARDS). There are only sporadic case reports describing the management of this entity with mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO). We report the case of a previously healthy 2-year-old girl from rural Colombia with a one-month history of abdominal pain and diarrhea. Stool examination confirmed A. lumbricoides infection, and abdominal ultrasound revealed intestinal pseudo-obstruction. Initial management included anti-parasitic therapy and surgery. Patient's condition deteriorated to refractory hypoxemia, biventricular dysfunction, and two cardiac arrests. Peripheral veno-arterial ECMO was initiated by a mobile team in the referring hospital, followed by air transfer to a tertiary center. During the early days of ECMO support, the patient developed complications related to the underlying disease, including anastomotic dehiscence with intraluminal roundworms, bloodstream infection, and cerebral septic emboli, which required repeat surgery and escalation of antimicrobial therapy. After 10 days of ECMO, biventricular and pulmonary recovery allowed decannulation. The patient was discharged one month later in good physical condition, without neurological deficits, and with a pulmonary rehabilitation plan. This case illustrates how extreme socioeconomic disparities can lead to the coexistence of highly preventable parasitic diseases with advanced life-support interventions such as ECMO. Much like the magical realism of One Hundred Years of Solitude, the use of such technology in an isolated, resource-limited setting may seem improbable, yet it reflects a pressing reality. Bridging these contrasts requires both technological capacity and strong public health strategies to close the gaps in knowledge, access, and outcomes.

BACKGROUND: There are few reports of postoperative acute pancreatitis (AP) in patients with acute type A aortic dissection (ATAAD), but we reported a case of ATAAD complicated by AP and later reoperation for intraperitoneal hemorrhage. We discussed the causes of AP in this patient and summarized some of the experiences of postoperative management of patients with ATAAD involving the celiac trunk and/or superior mesenteric artery. CASE PRESENTATIONS: A 44-year-old male patient was diagnosed with ATAAD and underwent partial resection of the ascending aorta with graft replacement and total aortic arch graft replacement with stented elephant trunk surgery 8 h after admission, and the operation was successful. Due to poor oxygenation function of acute respiratory distress syndrome (ARDS) after surgery, the patient was treated with mechanical ventilation for a long time, which was followed by bloodborne infection and systemic inflammatory response syndrome. Abdominal distension occurred 20 days after surgery, and was diagnosed as acute pancreatitis (AP), and intraperitoneal bleeding occurred on the 39th postoperative day during conservative treatment. On the 40th day after surgery, the patient underwent exploratory laparotomy, during which multiple abscesses around the pancreas were found, and the venous vessels in the tail of the pancreas were eroded, ruptured and hemorrhaged by infected lesions, and the abdominal abscess was cut and drained and the spleen was removed. The patient gradually recovered and was discharged on the 65th day after surgery. No special discomfort was reported during the outpatient follow-up. CONCLUSIONS: This case suggests that for ATAAD patients involving the abdominal trunk and/or superior mesenteric artery, especially those with systemic inflammatory response syndrome, dynamic serum amylase and abdominal CT examination are necessary to help us diagnose AP earlier and detect its complications.