Children, medical radiation and the environment: An important dialogue

Urgent health concerns: Clinical issues associated with accidental ingestion of new metal-blade-containing sticks for heated tobacco products

INTRODUCTION

Recently, a concerning pattern has emerged in clinical settings, drawing attention to the potential health risks associated with the accidental ingestion, mostly by children, of a new Heated Tobacco Product (HTP) stick, which contains a sharp metal blade inside.

METHODS

Following a webinar of the Joint Action on Tobacco Control 2 project, where data on adverse health incidents related to novel tobacco and nicotine products from EU Member States were presented, the Milan Poison Control Center (PCC) conducted a case series study on the accidental ingestion of blade-containing HTP sticks in Italy, between July 2023 and February 2024. The data in the medical records were analyzed to identify the age distribution, clinical presentation symptoms, performed diagnostic procedures, and medical management.

RESULTS

Overall, 40 cases of accidental ingestion of HTP sticks were identified and are described. A total of 33 (82.5%) children (infants and toddlers, mean age 12.3 ± 3.3 months) were hospitalized. Of these, 29 underwent abdominal X-rays, two children underwent esophagogastroduodenoscopy, and one child suffered from cut injuries to the tonsillar pillar and genian mucosa, requiring anesthesia for fibroscopy. The observed clinical cases associated with new HTP sticks containing a metal blade occurred over just eight months. This issue required the immediate implementation of corrective measures to mitigate health risks. The Ministry of Health issued an alert regarding the dangers related to the accidental ingestion of the stick and imposed more visible warnings on the package.

CONCLUSIONS

It is of the utmost importance to raise awareness among both the general public and medical practitioners to prevent further cases of accidental ingestion of HTP sticks by infants and toddlers, and ensure a prompt and informed response in emergency situations.

Comprehensive Analysis System for Automated Respiratory Cycle Segmentation and Crackle Peak Detection

Digital auscultation is a well-known method for assessing lung sounds, but remains a subjective process in typical practice, relying on the human interpretation. Several methods have been presented for detecting or analyzing crackles but are limited in their real-world application because few have been integrated into comprehensive systems or validated on non-ideal data. This work details a complete signal analysis methodology for analyzing crackles in challenging recordings. The procedure comprises five sequential processing blocks: (1) motion artifact detection, (2) deep learning denoising network, (3) respiratory cycle segmentation, (4) separation of discontinuous adventitious sounds from vesicular sounds, and (5) crackle peak detection. This system uses a collection of new methods and robustness-focused improvements on previous methods to analyze respiratory cycles and crackles therein. To validate the accuracy, the system is tested on a database of 1000 simulated lung sounds with varying levels of motion artifacts, ambient noise, cycle lengths and crackle intensities, in which ground truths are exactly known. The system performs with average F-score of 91.07% for detecting motion artifacts and 94.43% for respiratory cycle extraction, and an overall F-score of 94.08% for detecting the locations of individual crackles. The process also successfully detects healthy recordings. Preliminary validation is also presented on a small set of 20 patient recordings, for which the system performs comparably. These methods provide quantifiable analysis of respiratory sounds to enable clinicians to distinguish between types of crackles, their timing within the respiratory cycle, and the level of occurrence. Crackles are one of the most common abnormal lung sounds, presenting in multiple cardiorespiratory diseases. These features will contribute to a better understanding of disease severity and progression in an objective, simple and non-invasive way.

An evaluation of DNA double strand break formation and excreted guanine species post whole body PET/CT procedure

Ionizing radiation-induced oxidation and formation of deoxyribonucleic acid (DNA) double strand breaks (DSBs) are considered the exemplar of genetic lesions. Guanine bases are most prone to be oxidized when DNA and Ribonucleic acid (RNA) are damaged. The repair processes that are initiated to correct this damage release multiple oxidized guanine species into the urine. Hence, the excretion of guanine species can be related with the total repair process. Our study quantified the total DSBs formation and the amount of guanine species in urine to understand the DNA break and repair process after whole body (WB) exposure to 18F-FDG positron emission tomography/computed tomography (PET/CT). A total of 37 human participants were included with control and test groups and the average radiation dose was 27.50 ± 2.91 mSv. γ-H2AX foci assay in the collected blood samples was performed to assess the DSBs, and excreted guanine species in urine were analyzed by a competitive ELISA method. We observed a significant increase of DNA damage that correlated well with the increasing dose (p-value 0.009) and body weight (p-value 0.05). In the test group, excreted guanine species in urine sample significantly increased (from 24.29 ± 5.82 to 33.66 ± 7.20 mg/mmol creatinine). A minimum (r2 = 0.0488) correlation was observed between DSBs formation and excreted guanine species. A significant difference of DNA damage and 8-OHdG formation was seen in the test group compared to controls. Larger population studies are needed to confirm these observations, describe the fine-scale timing of changes in the biomarker levels after exposure, and further clarify any potential risks to patients from PET/CT procedures.

Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children

BACKGROUND

Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps.

METHODS

We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata.

RESULTS

Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03).

CONCLUSIONS

Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.

The Effect of Vitamin C on Apoptosis and Bax/Bcl-2 Proteins Ratio in Peripheral Blood Lymphocytes of Patients during Cardiac Interventional Procedures

Background:

There is a close relationship between the effects of free radicals and apoptosis, and vitamin C is known as a potent scavenger of free radicals.

Objective:

The aim of this study was to evaluate the effect of vitamin C against the radiation-induced apoptosis and the ratio of Bax/Bcl-2 proteins in peripheral blood lymphocytes in patients undergoing cardiac procedures in vivo condition.

Material and Methods:

In this clinical intervention study, blood samples from 6 patients in the first group were taken to assess the effect of radiation on the apoptosis and Bax/Bcl-2 proteins ratio, and 5 patients as the second group to evaluate the effect of vitamin C on the apoptosis and Bax/Bcl-2 proteins ratio before and 24 hours after the examination. Flow cytometry was used to analyze the apoptosis and ELISA method to assess Bax and Bcl-2 proteins amount.

Results:

In the second group receiving 25 mg/kg vitamin C and a mean skin dose of 1001 mGy in the chest area, there was no significant difference (P <0.05) in the percentage of early apoptosis in 24 hours after the examination than before it. This significant increase in the percentage of apoptosis in the first group (385.6 mGy) was associated with a significant increase in the Bax/Bcl-2 ratio (P <0.05), while in the second group, it was not associated with a significant decrease in the Bax/Bcl-2 ratio in 24 hours after the examination than before it.

Conclusion:

Our results suggest that vitamin C may modulate Bax and Bcl-2 proteins expression, in maintaining peripheral blood lymphocytes in patients undergoing cardiology in radiation-induced apoptosis.

18F-FDG-induced DNA damage, chromosomal aberrations, and toxicity in V79 lung fibroblast cells

¹⁸F-FDG PET/CT imaging is used in the diagnosis of diseases, including cancers. The principal photons used for imaging are 511 ke V gamma photons resulting from positron annihilation. The absorbed dose varies among body organs, depending on administered radioactivity and biological clearance. We have attempted to evaluate DNA double-strand breaks (DSB) and toxicity induced in V79 lung fibroblast cells in vitro by ¹⁸F-FDG, at doses which might result from PET procedures. Cells were irradiated by ¹⁸F-FDG at doses (14.51 and 26.86 mGy), comparable to absorbed doses received by critical organs during PET procedures. The biological endpoints measured were formation of γ-H2AX foci, mitochondrial stress, chromosomal aberrations, and cell cycle perturbation. Irradiation induced DSB (γH2AX assay), mitochondrial depolarization, and both chromosome and chromatid types of aberrations. At higher radiation doses, increased aneuploidy and reduced mitotic activity were also seen. Thus, significant biological effects were observed at the doses delivered by the ¹⁸F-FDG exposure and the effects increased with dose.