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Background: Given the sparse data on the renin-angiotensin system (RAS) and its biological effector molecules ACE1 and ACE2 in pediatric COVID-19 cases, we investigated whether the ACE1 insertion/deletion (I/D) polymorphism could be a genetic marker for susceptibility to COVID-19 in Egyptian children and adolescents., Methods: This was a case-control study included four hundred sixty patients diagnosed with COVID-19, and 460 well-matched healthy control children and adolescents. The I/D polymorphism (rs1799752) in the ACE1 gene was genotyped by polymerase chain reaction (PCR), meanwhile the ACE serum concentrations were assessed by ELISA., Results: The ACE1 D/D genotype and Deletion allele were significantly more represented in patients with COVID-19 compared to the control group (55% vs. 28%; OR = 2.4; [95% CI: 1.46-3.95]; for the DD genotype; P = 0.002) and (68% vs. 52.5%; OR: 1.93; [95% CI: 1.49-2.5] for the D allele; P = 0.032). The presence of ACE1 D/D genotype was an independent risk factor for severe COVID-19 among studied patients (adjusted OR: 2.6; [95% CI: 1.6-9.7]; P < 0.001., Conclusions: The ACE1 insertion/deletion polymorphism may confer susceptibility to SARS-CoV-2 infection in Egyptian children and adolescents., Impact: Recent studies suggested a crucial role of renin-angiotensin system and its biological effector molecules ACE1 and ACE2 in the pathogenesis and progression of COVID-19. To our knowledge, ours is the first study to investigate the association of ACE1 I/D polymorphism and susceptibility to COVID-19 in Caucasian children and adolescents. The presence of the ACE1 D/D genotype or ACE1 Deletion allele may confer susceptibility to SARS-CoV-2 infection and being associated with higher ACE serum levels; may constitute independent risk factors for severe COVID-19. The ACE1 I/D genotyping help design further clinical trials reconsidering RAS-pathway antagonists to achieve more efficient targeted therapies., (© 2024. The Author(s).)

Cardiovascular disease is the leading cause of mortality and morbidity worldwide. One of the main risk factors for cardiovascular events is hypertension. The use of antihypertensive drugs can protect against these events. It occurs directly through the control of hypertension and indirectly through other cardiovascular effects. This meta-analysis and systematic review aimed to assess the impact of various antihypertensive medications (ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, etc.) on blood pressure and various cardiovascular outcomes. A thorough search was conducted using several online databases and search engines, including PubMed, Google Scholar, ScienceDirect, Medline, Embase, and others. RCTs evaluating the impact of antihypertensive medications on BP and other cardiovascular events like coronary heart disease and stroke were included in this study. Included were studies detailing the use of antihypertensive medication in monotherapy. The meta-analysis was done using RevMan version 5.4 software (Cochrane Collaboration, London, UK). Means and standard deviations were extracted for the continuous variables and events, and the total sample number was extracted for the dichotomous variables. This analysis encompassed a total of 18 RCTs of the elderly population. The data for each variable was extracted independently, and analysis was performed. Overall, systolic blood pressure (SBP) revealed an impact of -11.88, CI=95% (-20.56, -3.19). The diastolic blood pressure (DBP) showed -5.41, CI=95% (-9.62, -1.20), myocardial infarction 0.92, CI=95% (0.82, 1.04), stroke 0.83, CI=95% (0.74, 0.94), and cardiovascular mortality 0.93, CI=95% (0.86, 1.00). Heterogeneity was present due to the variable sample size of the studies and other unidentified biases. In conclusion, there was a significant reduction in the elderly population's risk of stroke, myocardial infarction, and cardiovascular death when antihypertensive medications were taken., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Chaudhry et al.)

Patients diagnosed with coronavirus disease (CVD) who experience cardiovascular complications or have pre-existing cardiovascular disease are at an increased risk of death. The primary heart-related consequences associated with COVID-19 encompass venous thromboembolism, shock, heart failure, arrhythmias, myocarditis, acute myocardial infarction, and acute cardiac damage. The coronavirus has the potential to induce cardiovascular complications or exacerbate pre-existing CVD through various mechanisms. These mechanisms include dysregulation of the renin-angiotensin-aldosterone system; direct viral toxicity; damage to endothelial cells; formation of blood clots and subsequent inflammation, a phenomenon known as thromboinflammation; an excessive immune response known as cytokine storm; and an imbalance between the demand and supply of oxygen in the body. In this study, we comprehensively analyze the cardiovascular symptoms, histology, and underlying mechanisms associated with COVID-19. Our aim is to contribute to the identification of future research objectives and aid in the advancement of therapeutic management approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Siddique et al.)

Lower extremity wounds with exposed bone and tendon often need coverage to allow the underlying tissue to regenerate prior to skin graft. The surgeon is limited in his or her choices to augment tissue regeneration in these types of complicated cases; for instance, autologous skin should not be placed on exposed bone or tendon and is at risk for contracture when placed over the joints. Therefore, novel technologies are necessary to provide a scaffolding for tissue to regenerate and allow for a successful graft. One such technology is an esterified hyaluronic acid matrix (eHAM), which can provide a proper scaffold for endothelial cell migration and aid in angiogenesis. The eHAM is made of two layers: a layer of hyaluronic acid covered with a silicone layer. In this retrospective chart review, we describe our usage of eHAM to provide scaffolding for tissue regeneration prior to grafting in 15 cases of complicated lower extremity wounds with exposed bone and tendon. The average patient age was 45.8 years, and all patients had multiple medical comorbidities, such as poorly controlled diabetes mellitus, hypertension, and nicotine addiction. Patient wound types were diverse, including traumatic wounds, chronic diabetic foot ulcers, and thermal or electric burns. Thirteen of the 15 cases were treated successfully with eHAM. In these cases, definitive coverage with split-thickness skin grafting was effective and limb salvage was successful. In the 13 successful cases, the mean time to split-thickness skin graft was 22.9 ± 7.0 days. All patients continue to do well at follow-up (ranging from 6 to 48 weeks), with minimal complications reported. Given the success rate with eHAM in this challenging population, we conclude that eHAM can be a treatment option for similar cases., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association.)

The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.

Amniotic band sequence is a complex congenital anomaly in which infants with typically no known genetic mutation have bands of maternal amniotic tissue wrapped around body parts, most commonly the limbs and digits. The authors report a novel variation on this presentation in 3 patients from 2 centers with complex craniofacial clefting and amniotic band sequence. They presented with hypertelorism, different forms of complex craniofacial clefting, and bands connecting ipsilateral hands to facial clefts, with digital-facial translocation in 2 cases. These findings support a model in which complex craniofacial clefts result in areas of exposed, sticky, and temporally and spatially coincident mesenchyme within the embryo that are susceptible to adherence of ipsilateral fetal hands. This strongly supports the intrinsic and adhesion theories of the etiology of amniotic band syndrome.