The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series.

INTRODUCTION: Impaired respiratory and swallow function in patients with intensive care unit-acquired deconditioning, such as associated with massive tissue loss, is not uncommon and can require prolonged rehabilitation. AIM: The aim of the study was to examine the effect of combined inspiratory and expiratory respiratory muscle strength training (RMST) on respiratory and swallow function in two critical care patients with marked deconditioning after massive tissue loss. METHODS: Case 1 was a 19-year-old male patient with 80% body surface area burns; case 2 was a 45-year-old man with group A streptococcus myositis necessitating quadruple amputation. Both required prolonged intensive care and mechanical ventilation. Both received routine intensive pulmonary and swallow rehabilitation before the trial; however, chronic aspiration and poor secretion clearance remained. At 25 and 26 weeks after initial injury, RMST was performed using EMST150 (expiratory) and Threshold IMT (inspiratory) devices, respectively. At baseline and throughout treatment, data collected included peak expiratory flow (PEF), anthropometry measures, aspiration risk (Penetration-Aspiration Scale [PAS]), pharyngeal clearance (Yale Pharyngeal Residue Scale), secretions (New Zealand Secretion Scale [NZSS]), and functional diet (Functional Oral Intake Scale [FOIS]) via endoscopy. RESULTS/DISCUSSION: At baseline, the PEF score of case 1 was 41% (predicted age-height norm) and the PEF score of case 2 was 14%, indicating severe expiratory compromise. Both had extreme energy requirements (3300 kcal/day; 3500 kcal/day). The baseline swallowing scores of case 1 and 2 were as follows: PAS, 8 and 8; Yale, 9 and 10; NZSS, 4 and 7; and FOIS, 1 and 1, respectively, indicating profound dysphagia. At week 3 of 7 of RMST, swallow function improved to allow both to commence oral intake, followed by tracheostomy decannulation. At weeks 10 and 11, full dysphagia resolution was achieved (FOIS = 7; PAS = 1, Yale = 2, NZSS = 0), with PEF at 70% and 48% predicted respectively. Both patients continued RMST, and at discharge from the acute facility, PEF was 84% and 80% predicted respectively. CONCLUSION: The addition of RMST assisted swallow and pulmonary rehabilitation in both cases and was clinically viable to deliver. Controlled validation trials are now required.

Induced thiacloprid insensitivity in honeybees (Apis mellifera L.) is associated with up-regulation of detoxification genes.

Honey bees, Apis mellifera, are markedly less sensitive to neonicotinoid insecticides containing a cyanoimino pharmacophore than to those with a nitroimino group. Although previous work has suggested that this results from enhanced metabolism of the former by detoxification enzymes, the specific enzyme(s) involved remain to be characterized. In this work, a pretreatment of honey bees with a sublethal dose of thiacloprid resulted in induced insensitivity to the same compound immediately following thiacloprid feeding. A longer pretreatment time resulted in no, or increased, sensitivity. Transcriptome profiling, using microarrays, identified a number of genes encoding detoxification enzymes that were over-expressed significantly in insecticide-treated bees compared with untreated controls. These included five P450s, CYP6BE1, CYP305D1, CYP6AS5, CYP315A1, CYP301A1, and a carboxyl/cholinesterase (CCE) CCE8. Four of these P450s were functionally expressed in Escherichia coli and their ability to metabolize thiacloprid examined by liquid chromatography-mass spectrometry (LC-MS) analysis.

COVID-19 presenting with nystagmus. / COVID-19 asociada a nistagmo.

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

[COVID-19 presenting with nystagmus]. / COVID-19 asociada a nistagmo.

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

Congenital disorder of glycosylation type Ia in a Malaysian family: clinical outcome and description of a novel PMM2 mutation.

There are few reports of congenital disorders of glycosylation (CDGs) in the Asian population, although they have been reported worldwide. We identified a Malaysian infant female at 2 days of life with CDG type Ia. The diagnosis was suspected on the basis of inverted nipples and abnormal fat distribution. She had cerebellar hypoplasia and developed coagulopathy, hypothyroidism and severe pericardial effusion and died at 7 months of life. The diagnosis was supported by abnormal serum transferrin isoform pattern that showed elevated levels of the disialotransferrin isoform and trace levels of the asialotransferrin isoform. Enzyme testing of peripheral leukocytes showed decreased level of phosphomannomutase (PMM) activity (0.6 nmol/min per mg protein, normal range 1.6-6.2) and a normal level of phosphomannose isomerase activity (19 nmol/min per mg protein, normal range 12-25), indicating a diagnosis of CDG type Ia. Mutation study of the PMM2 gene showed the patient was heterozygous for both the common p.R141H (c.422T>A) mutation and a novel sequence change in exon 7, c.618C>A. The latter change is predicted to result in the replacement of the highly conserved phenylalanine residue at position 206 with a leucine residue (p.F206L) and occurs in the same codon as the previously reported p.F206S mutation. Analysis of 100 control chromosomes has shown that the p.F206L sequence change is not present, making it highly likely that this change is functionally important. To the best of our knowledge, this is the first report of CDG in the Malay population. Prenatal diagnosis was successfully performed in a subsequent pregnancy for this family.

Displacement imprinted polymer receptor analysis (DIPRA) for chlorophenolic contaminants in drinking water and packaging materials.

The preparation of a molecularly imprinted polymer (MIP) for pentachlorophenol is described together with two alternative reporter derivatives for use in a displacement imprinted polymer receptor analysis (DIPRA) format procedure. In this procedure, alternative reporter molecules were rebound to the synthetic receptor sites and their displacement by the target analyte was employed as the basis of a simple procedure for the measurement of chlorophenols in water and packaging material samples. Water samples were extracted using the standard procedure (EPA 528) and a detection limit of 0.5 microg l(-1) was achieved using the DIPRA detection method, with good agreement between the displacement technique and GC-ECD analysis. A variety of packaging materials, extracted using a buffered detergent solution were also analysed using the DIPRA procedure and showed good agreement with GC results. In addition, investigation of the cross-reactivity of a range of pesticides and materials commonly encountered in environmental analysis indicated the procedure gave good discrimination between pesticides bearing a chlorophenolic moiety and other materials. The procedure is considered highly suitable for use as a rapid field-test method or for incorporation into a test kit device.

COVID-19 asociada a nistagmo / COVID-19 presenting with nystagmus

Presentamos el caso de una mujer de 20años que se encontraba en el norte de Italia cuando se decretó el estado de alarma el 31 de enero de 2020 y volvió a España. A los 15 días de su regreso presentó un cuadro respiratorio de vías altas con fiebre, cefalea y anosmia que fue tratado como una sinusitis y a las 3semanas comenzó con sensación de mareo y un nistagmo horizontal en ambos ojos con componente rotatorio. La exploración otorrinolaringológica y neurológica con resonancia magnética fueron normales. Las pruebas serológicas para COVID-19 dieron un resultado positivo para anticuerpos IgG. En el contexto actual de pandemia, los síntomas y signos en esta paciente asociados a un test serológico IgG positivo nos permite considerar como causa del nistagmo adquirido la infección por SARS-CoV-2 (AU)

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus (AU)

A broad-spectrum cytolytic toxin from Bacillus thuringiensis var. kyushuensis.

Bacillus thuringiensis (Bt) var. kyushuensis synthesizes a mosquitocidal crystalline inclusion containing several proteins ranging from 140 to 14 kDa. We have identified a 25 kDa protein protoxin in this inclusion which is not cytolytic, but when activated proteolytically to 23-22 kDa products is cytolytic to mosquito, lepidopteran and mammalian cells, can release entrapped glucose from liposomes and forms cation-selective channels in a planar lipid bilayer. This broad-spectrum cytolytic toxin is related antigenically to the 23 kDa toxin from Bt var. darmstadiensis strain 73-E10-2, but not to the 25 kDa CytA toxin of Bt var. israelensis. The cytolytic activity of these Bt var. kyushuensis toxins, like that of the latter two toxins, can be neutralized by incubation with liposomes containing phospholipids.

Genetic linkage analysis of epidermolysis bullosa simplex, Köbner type.

Genetic linkage relationships between a range of marker loci and the locus for epidermolysis bullosa simplex (EBS), Köbner type, were examined in a single kindred. A positive lod score of 1.2 at theta = 0.2 was found for Fy. To test the clinical observation that Köbner and Weber-Cockayne types may be the same disease determined by different alleles, published lod scores from definite Weber-Cockayne families were added to those from this study. A lod score of 1.8 was found at theta = 0.2. This value falls to 1.5 at theta = 0.2 when all families other than Ogna type are included. The Köbner variant studied is not closely linked to GPT and is therefore distinct from EBS1 (Ogna type). Linkage analysis is consistent with an hypothesis that Köbner and Weber-Cockayne types are determined by a single locus; however, further evidence is needed before this locus can be designated EBS2 and assigned to chromosome 1.

Characterization of a Bacillus thuringiensis strain which is toxic to the housefly Musca domestica.

A Bacillus thuringiensis isolate has been discovered which is toxic to the common housefly (Musca domestica) as well as other Diptera and Lepidoptera. Crystal delta-endotoxins purified from this isolate killed 50% of Musca larvae at a concentration of 10.2 micrograms/ml, and beta-exotoxin was not detected. Sodium dodecyl polyacrylamide gel electrophoresis of the purified crystals revealed three protein species which were related to CryIA(b), CryIB and CryIIA toxins on the basis of immunoreactivity and amino-terminal sequence determination. Southern blot and DNA restriction analyses suggested that the strain has sequences related to one cryIA(b), one cryIIA, and two cryIIB genes.

The illness experiences of women with fibroids: an exploratory qualitative study.

Previous research suggests that women attending gynaecology clinics experience high rates of psychological distress and psychiatric morbidity. Although the reasons for this are poorly understood, certain conditions appear to cause women particularly high levels of anxiety and depression. This paper reports a qualitative study, using Interpretative Phenomenological Analysis (IPA), to examine the illness experiences of women with the common gynaecological condition of fibroids. The study employs semi-structured interviews, guided by Leventhal's self-regulation model, to explore 18 women's understanding and experiences of having fibroids. Qualitative analysis revealed eight themes drawn into two higher-order themes - 'Managing uncertainty' and 'Struggling between defeat and optimism'. These higher-order themes illustrate the multiplicity of experiences and meanings used by women attempting to understand their condition, treatment options and future health outcomes. The differences in women's illness representations may account for differences in their relative distress levels. The findings indicate the importance of considering an individual's illness representations in order to facilitate the provision of appropriate medical and psychological care to women with fibroids.

Levels of short and medium chain length polychlorinated n-alkanes in environmental samples from selected industrial areas in England and Wales.

Electron capture or negative ion chemical ionisation gas chromatography-mass spectrometry was employed to measure concentrations of short and medium chain length polychlorinated n-alkanes extracted from samples of water, river sediment, benthos, fish, soil, digested sewage and earthworms. Analysis of samples from 20 aquatic and eight agricultural sites indicated that short and medium chain length polychlorinated alkanes were present in the following concentration ranges: sediment < 0.2-65.1 mg/kg dry weight, water < 0.1-1.7 micrograms/l, fish < 0.1-5.2 mg/kg wet weight, benthos < 0.05-0.8 mg/kg wet weight, digested sewage 1.8-93.1 mg/kg dry weight, soil < 0.1 mg/kg dry weight, and earthworms < 0.1-1.7 mg/kg wet weight. It is clear from this study that these compounds are widely distributed in the UK environment, although it is not yet possible to fully assess the risks posed to either wildlife or humans by their continued use. Further study of these compounds is indicated.

Post-mortem changes in the abomasal mucosae of sheep infected with Haemonchus contortus compared with those in uninfected sheep.

Progressive post-mortem changes were observed, with fibre optic endoscopy, in the abomasum of uninfected sheep and sheep infected with H. contortus. Loss of epithelial cells was observed 14 to 16 min after death in the uninfected sheep. The loss exposed the underlying lamina propria. This loss became more widespread as the time after death increased. Epithelial cell loss was observed earlier (as early as 6 min after death) in the infected sheep. Three of the infected sheep also displayed dispersal of alkaline phosphatase activity 30 min after death. The present work shows that post-mortem changes can occur quite quickly in animals, especially infected animals, and emphasizes the importance of rapid removal of tissue from animals after death.

Physiological and microbiological changes in the abomasum of sheep infected with large doses of Haemonchus contortus.

The pH, PO2 and the number of viable bacteria per ml of abomasal fluid were recorded before and after administering large doses of infective larvae of H. contortus to sheep. Highly significant increases were observed in the pH, in numbers of viable bacteria and in the proportion of oxygen-sensitive bacteria in the abomasal fluid during the first 10 to 14 days of infection. At the same time a decrease in the abomasal fluid PO2 was recorded. Subsequently a slow recovery of pH, PO2 and bacterial numbers to pre-infection values ensued. The microbiological and physiological changes occurring in the abomasum of sheep after infection with H. contortus are discussed with reference to these results.

Hypergastrinaemia of sheep infected with Haemonchus contortus.

Radioimmunoassay of plasma gastrin has shown that a hypergastrinaemia occurs in yearling sheep, after infection with 10(6) infective third stage larvae of Haemonchus contortus. Plasma gastrin concentrations began to rise two to four days after infection, that is, at about the same time as, or slightly before, the abomasal pH was observed to increase.

A pneumatic device for attaching wing bands to day-old chicks.

A device for attaching aluminum bands to the wings of day-old chicks is described and illustrated. It is powered with compressed air and utilizes both hand and foot operated controls. Using this device, an operator can apply wing bands without an assistant at rates up to 300 chicks/hour.

A 12-year retrospective audit study of tooth loss in a general dental practice.

OBJECTIVES: To determine the incidence of periodontal disease in a general dental practice, and to evaluate the effectiveness of treatment in preventing tooth loss over a period of 12 years. DESIGN: This was a single centre retrospective analysis. SETTING: A general dental practice in Bournemouth. SUBJECTS AND METHODS: Over a 6-month period from February 1997 to August 1997 records were made of all patients attending at the practice who had presented for dental examination between September 1985 and September 1986. A database was constructed to record the number of teeth present at the beginning of the study, those which at their initial exam had probing depths of between 5 and 6 mm, and those with 7 mm and greater. If teeth were lost, the date of the extraction was recorded. INTERVENTIONS: All patients were treated by conventional dental therapy. MAIN OUTCOME MEASURES: Tooth loss was chosen as the end-point. RESULTS: 13% of the patients presenting initially had periodontal problems, and conventional treatment resulted in very few teeth being lost over the study period. CONCLUSIONS: Periodontal disease affected only a small number of the patients in the general dental practice. Those patients affected responded well to conventional therapy, resulting in very few teeth being lost during the period of study.

Periodontal disease incidence, progression and rate of tooth loss in a general dental practice: the results of a 12-year retrospective analysis of patient's clinical records.

One of the main objectives of a general dental practice is to teach its patients how to reduce their oral bacterial load. In other words, by teaching good oral hygiene habits, it is possible to reduce the number of bacteria and hence the number of species of bacteria present in each patient's mouth. Thus by achieving a high level of oral hygiene, the dental team hope to reduce each patient's future risk of periodontal problems, and dental caries.

Waterborne outbreak of Campylobacter jejuni in Christchurch: the importance of a combined epidemiologic and microbiologic investigation.

Campylobacter is a common cause of gastroenteritis in New Zealand; however, the source of infection usually remains unknown. Reports of two cases of Campylobacter jejuni enteritis at a camp and convention centre near Christchurch were investigated. Through interviews of persons living at or attending the camp, 42 additional cases were identified. Epidemiologic and microbiologic data strongly suggested the water supply as the source of infection. The combined epidemiologic and microbiologic investigation was useful in quickly defining the magnitude and source of the outbreak, allowing for rapid implementation of control measures.

An audit of oral and dental health regimens practised in the management of oropharyngeal cancer.

The purpose of the present study was to find out what preventive care was offered to patients after radiotherapy, particularly if they were dentate. As the mean age of the population increases and the number of people who retain at least some of their teeth into old age also rises, it is likely that more and more people with a diagnosis of oral cancer will be dentate. The incidence of oropharyngeal cancer has also started to increase recently and is affecting more young and dentate people. It is of paramount importance to provide comprehensive management for these patients, not only to remove the disease and reconstruct the defect, but also to provide the patient with the opportunity of experiencing a good quality of life by having a comfortable mouth after treatment. A questionnaire was sent to all senior fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the results analyzed. The results of this survey show that improvements could be made if some simple preventive measures were instigated in the early stages of treatment.