Pediatric immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder with variable clinical outcomes. While most children experience spontaneous remission, 10 to 20% progress to chronic ITP. Early prediction to chronicity remains a clinical challenge. This study aimed to develop and validate a logistic regression-based model integrating immune features to predict chronicity in ITP among children. In this prospective cohort study, we stratified 108 pediatric ITP patients into newly diagnosed with remission (n = 48), progressors (n = 13), and chronic ITP (n = 47). We analyzed peripheral blood using multicolor flow cytometry for 79 immune subsets. We recorded clinical variables including bleeding symptoms, platelet count, and recent infections/vaccinations. We performed multivariable logistic regression using immune parameters alone and in combination with clinical features. Model performance was assessed via 5-fold cross-validation and validated on the progressor cohort. Patients with Chronic ITP Exhibited a Distinct Immunological Feature Characterized by Reduced CD4/CD8 Ratio, na & iuml;ve Th and na & iuml;ve Tc Cell and Increased Effector Memory, Tc Cell Percent, Senescent T Cell (CD57+, PD1+), B Memory and Class Switched Memory B Cells. The Immune-Only Model Identified Reduced na & iuml;ve Cytotoxic T Cells [CD8(+)CD27(+)CD45RA(+)] and Increased Double-Negative B Cells [CD19(+)CD27(-)IgD(-)] as Key Predictors (Accuracy 71.6%, Area under the Receiver Operating Characteristic Curve (AUC) 0.761, p < 0.001), Correctly Classifying 8/13 (61.5%) Progressors. In the Combined Model, Increased Frequencies of Class-Switched Memory (CSW) B Cells [CD19 + CD27 + IgM-IgD-], Terminally Differentiated Effector Cytotoxic [CD8(+)CD28(-)] T Cells, more Specific Double Negative (DN) B Cells Population of CD21-/lowCD38-Cells[CD19 + CD21-/Low CD38-CD27-IgD-] and Clinically, Epistaxis and Absence of Abrupt Onset of Bleeding Were Associated with Chronicity, Improving Overall Accuracy 82.8%, (AUC 0.905, p < 0.001) and Correctly Classifying 10/13 (76.92%) Progressors. Integration of clinical features with detailed immune profiling enables early and accurate prediction of chronic ITP in children. These findings support its potential in selecting appropriate management strategies warranting validation in larger multicentric cohorts.
Introduction and importance: The Onodi cell is a pneumatized posterior ethmoidal cell situated lateral and superior to the sphenoid sinus. It lies in close proximity to the posterior ethmoidal artery and the optic nerve. Isolated Onodi sinusitis is a rare condition but carries a high risk of optic nerve injuries. Presentation of case: We report the case of an 86-year-old Caucasian woman with unilateral isolated Onodi sinusitis, incidentally diagnosed on a routine CT scan performed to investigate a general decline in health. Diagnostic methods, appropriate management, and follow-up are described. Clinical discussion: The incidence of the sphenoethmoidal air cell, also known as the Onodi cell, has been reported to range from 51% to 60% in Asian cadaveric studies. Although isolated Onodi sinusitis is exceptionally rare, it has important clinical implications due to its close anatomical relationship with critical neurovascular structures. Early and accurate diagnosis, followed by appropriate management, is essential to ensure a favorable outcome. Conclusion: Isolated Onodi cell sinusitis is exceptionally rare. The management of this condition should be tailored to each individual clinical situation, combining surgical and medical approaches.
Introduction: Preduodenal portal vein (PDPV) is a rare congenital anomaly that is usually asymptomatic but may cause duodenal obstruction when associated with other congenital anomalies. The combination of PDPV with annular pancreas and polysplenia is rare and may present with failure to thrive. Case presentation: A female infant at 10 months presented with persistent non-bilious vomiting since birth and poor weight gain. On initial evaluation, the infant had dehydration with electrolyte imbalance. Fluid and electrolyte correction was done. An upper gastrointestinal contrast study demonstrated a dilated stomach with delayed gastric emptying and features of partial duodenal obstruction. Contrast-enhanced computed tomography revealed a preduodenal portal vein with polysplenia causing duodenal obstruction. The patient was planned for an exploratory laparotomy. Intraoperatively, a preduodenal portal vein associated with annular pancreas and polysplenia was identified, along with a thickened gastric wall. A gastrojejunostomy was performed due to the patient's compromised nutritional status. Postoperative recovery was uneventful. Oral clear liquids were initiated on postoperative day 3, feeds were gradually advanced, and the patient was discharged on a full oral diet on postoperative day 6. At six-month follow-up, the infant was asymptomatic and had gained 2 kg in weight. Conclusion: Preduodenal portal vein and annular pancreas should be included in the differential diagnosis of infants who have failure to thrive and non-bilious vomiting.
Device deactivation in patients with heart failure is an increasingly relevant clinical and ethical challenge as the use of cardiovascular implantable electronic devices expands. Current guidelines affirm the ethical and legal permissibility of deactivating life-sustaining devices, including implantable cardioverter-defibrillators, pacemakers, and mechanical circulatory support systems, when requested by patients or surrogates with decision-making capacity. Importantly, guidelines from professional societies recommend that discussions about device deactivation be included in the pre-implantation consent process. However, clinical practice reveals persistent gaps in advance care planning, with device deactivation discussions remaining infrequent. Deactivating implantable cardioverter defibrillators can prevent painful and unnecessary shocks at the end of life, which may otherwise prolong dying without improving quality of life. Multidisciplinary involvement, including palliative care consultation, is essential to support patient-centered decision-making and symptom management. This review synthesizes the latest evidence and consensus on device deactivation in heart failure, emphasizing the need for communication, initiated early in the disease course, as well as individualized care, and integration of patient preferences throughout the disease trajectory.
