Hantavirus-induced cardiac tamponade: A diagnostic dilemma.

Herein we describe a case of a 60-year-old white male from New York City who was admitted to hospital due to worsening dyspnea. He presented with an acute onset of fever, night sweats, and progressively worsening nonproductive cough and orthopnea over the preceding week. Electrocardiogram findings revealed atrial fibrillation. Manifesting signs of hypoperfusion, a trans-esophageal echocardiography was performed, which demonstrated the presence of a cardiac tamponade. An emergency pericardiocentesis was performed, draining 750 cc of serosanguinous content. Laboratory investigations depicted an inflammatory milieu marked by lymphocytic leukocytosis, cardiac function impairment, and remarkably elevated d-dimer and brain natriuretic peptide levels. Notably, high-sensitivity troponin T remained within normal limits. Comprehensive viral panel assays, including COVID-19, Influenza A + B, Respiratory Syncytial Virus, Hepatitis C, HIV, Cytomegalovirus, Coxsackie A + B, and Herpes Simplex Virus, returned negative results. Furthermore, antinuclear factor and rheumatoid factor titers were negative. Blood and fungal cultures, as well as assessments for Mycobacterium tuberculosis, yielded negative findings. On further history-taking, he reported that he had occupational exposure to rat droppings and urine two weeks ago. Serological analysis demonstrated positive hantavirus IgG and IgM antibodies. Supportive management was initiated. Consequently, the patient was discharged asymptomatic, without pericardial effusion. Evaluation after two weeks revealed no recurrence of symptoms.

Extensively drug-resistant Pseudomonas aeruginosa panophthalmitis from contaminated artificial tears.

Pseudomonas aeruginosa is one of the common gram-negative organisms that cause severe invasive infections in different organ systems. P. aeruginosa has unique intrinsic mechanisms to develop antimicrobial resistance quickly, making it extremely difficult to treat. We report a case of extensively drug-resistant (XDR) P. aeruginosa panophthalmitis due to contaminated artificial tears. This report investigates the role of systemic and intravitreal antimicrobials, summarizes the resistance mechanisms of P. aeruginosa, and provides an overview on cefiderocol, a novel antimicrobial that targets multidrug-resistant (MDR) and XDR Gram-negative pathogens.

The Clinical Value of Methicillin-Resistant Staphylococcus aureus Nasal Screening in the Management of Diabetic Foot Infections.

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) remains an important risk factor for diabetic foot infections (DFIs). We explored herein the clinical value of MRSA-nasal screening in the management of DFIs. In this retrospective case-control study, patients admitted with a DFI between 1/1/2014-6/30/2020 were studied and divided into cases (positive MRSA-nasal screening) and controls (negative MRSA-nasal). We included 171 patients (22 cases and 149 controls). MRSA nasal screening had a negative predictive value (NPV) of 86%. Compared to controls, cases were treated with intravenous vancomycin for a longer duration: (median [IQR], 5[3,11] vs 2[2,6]) days, P = .037). In multivariate analysis, a negative MRSA nasal screening was associated with a 74% decreased risk of AKI (OR = 0.26, 95% CI = 0.07-0.89). MRSA nasal screening in patients admitted with DFI has a high NPV. Obtained early, it can shorten the duration of intravenous vancomycin, consequently preventing AKI.

Erysipelothrix rhusiopathiae endocarditis.

Erysipelothrix rhusiopathiae is a zoonotic gram positive coccobacillus. It is rarely found in humans as an occupational pathogen that mainly infects animal handlers. There are three forms of human infection: localized erysipeloid, diffuse cutaneous form and lastly, bacteremia that could progress to infective endocarditis. We present a case of a 59-year-old male who was found to have E. rhusiopathiae bacteremia that was diagnosed as aortic valve endocarditis with severe aortic regurgitation. The patient was treated with ampicillin-sulbactam then transitioned to six weeks of intravenous ampicillin. This report summarizes a rare organism that causes a serious human infection and discusses its epidemiology, clinical presentation, diagnosis and treatment options.

Secondary encephalocele in an adult leading to subdural empyema.

Brain abscesses are an uncommon but potentially fatal infection. They can spread directly from an adjacent source or hematogenously from a distant source. Encephaloceles represent a rare form of neural tube defects that can potentially be complicated by the development of meningitis or brain abscess. We report a case of a 63-year-old female who presented with bilateral lower extremity weakness and was ultimately found to have a Streptococcus pneumoniae subdural empyema and an associated frontal lobe encephalocele extending through the left frontal sinus. She was treated with surgical drainage, intravenous antimicrobials, and ultimately surgical repair of the encephalocele. This report highlights a unique presentation of brain abscess. Clinicians should be aware of this potential infectious complication of a neural tube defect.

Successful allotransplantation of encapsulated islets in pancreatectomized canines for diabetic management without the use of immunosuppression.

BACKGROUND: Pancreatic islet transplantation has shown great success in the treatment of diabetic patients. However, the required immunosuppressive therapy exposes patients to serious side effects. METHODS: We have designed a novel five-component/three-membrane capsule and encapsulation system to protect the transplanted islet cells from immune system attack while allowing the influx of molecules and nutrients necessary for cell function/survival and efflux of the desired cellular product, specifically insulin, for making recipients healthy. RESULTS: We transplanted encapsulated canine pancreatic islets into the peritoneal cavity of pancreatectomized canines. Transplantation normalized fasting blood glucose levels in nine out of nine dogs for up to 214 days with a single transplantation. Retransplantation was assessed in three animals and encapsulated islets were effective in providing fasting glycemic control after the initial transplantation had run its course. No immunosuppression or anti-inflammatory therapy was used. CONCLUSION: This advancement in transplantation may lead to an alternative approach for islet transplantation treatment for diabetic patients. This approach may also benefit patients suffering from other hormone deficiency diseases including liver disease and Parkinson's disease.

Successful diabetes management without immunosuppressivedrugs in NHP model has been demonstrated. Encapsulation system with taperednanopore conduits achieved normal glycaemia with regulated insulin release.

Encapsulation of living cells offer superior treatment for human hormone deficiency diseases: (i) living cell transplantation without immunosuppressive drug and its accompanying deleterious side effects, (ii) nanopores can regulate cellular products to maintain cell health and functionality, and (iii) transplantation of cells from non-human donors can relieve donor shortage. In this paper, we focus our attention on the treatment of Diabetes [ 6 ]. A hormone deficiency disease affecting a substantial percentage of the world population. Still, the encapsulation model has one major weakness [ 7-14 ]. Polymers are a random network system with large pore size distribution. Polymers membranes have too many larger pores that compromise immunoprotection and too many smaller pores that restrict mass transport. This large pore size distribution could not meet the dichotomous requirements of mass transport and immunoprotection. Despite the dedicated effort of many for more than 50 years with hundreds of millions of dollars of capital investment, encapsulation system performance was found to be wanting [ 15 , 16 ]. The advancement in the treatment of hormone or protein deficiency diseases with the transplantation of living cells stalled.

Investigation of the Influence of ECoG Grid Spatial Density on Decoding Hand Flexion and Extension.

Electrocorticogram (ECoG) has been used as a reliable modality to control a brain machine interface (BMI). Recently, promising results of high-density ECoG have shown that non redundant information can be recorded with finer spatial resolution from the cortical surface. In this study, highdensity ECoG was recorded intraoperatively from two patients during awake brain surgery while performing instructed hand flexion and extension. Event related desynchronization (ERD) were found in the low frequency band (LFB: 8-32 Hz) band while event related synchronization (ERS) were found in the high frequency band (HFB: 60-200 Hz). The classification between hand flexion and extension was performed by using common spatial pattern (CSP) as a feature extraction technique and linear discriminant analysis (LDA) as a classifier. In order to compare the high-density ECoG and normal ECoG in terms of classifying between hand flexion and extension, we simulated a typical clinical ECoG (8 mm spacing) by averaging the neural activity of nearest four channels. The same classification methods were applied on the averaged recordings. In HFB, the classification error rate using simulated ECoG greatly increased and lagged the movement onset compared to the original highdensity ECoG. In LFB, the differences between them were not prominent. These results indicated that high-density ECoG is able to capture non-redundant task-related information from the motor cortex and potentially serves as a better modality to drive a neural prosthetic compared to typical clinical electrodes.

Characterization and Decoding the Spatial Patterns of Hand Extension/Flexion using High-Density ECoG.

During awake brain surgeries, electrocorticogram (ECoG) was recorded using a high density electrode grid from the motor cortex of two subjects while they were asked to execute spontaneous hand extension and flexion. Firstly, we characterized the spatio-spectral patterns of high-density ECoG during the hand movements. In both subjects, we observed event related desynchronization (ERD) in low frequency band (LFB: 8-32 Hz) and event related synchronization (ERS) in high frequency band (HFB: 60-200 Hz) where HFB-ERS was more spatially localized and movement specific compared to LFB-ERD. In particular, improved spatial resolution of high density ECoG revealed HFB-ERS patterns with distinct timing in different anatomical regions. A few channels located anterior to the central sulcus were associated with HFB-ERS which started several hundred milliseconds prior to the movement onset. Several channels were associated with HFB-ERS which started close to the movement onset. Most importantly, only a small number of channels in the motor cortex regions exhibited long duration ERS which lasted while the subjects maintained their hand posture. A common spatial pattern (CSP) algorithm fused with linear discriminant analysis (LDA) was used to distinguish between hand extension and flexion at different time points based on subband features. ECoG data recorded from the channels located either anterior or posterior to the central sulcus were tested separately in classification. For both subjects, using channels located in motor area, HFB yielded almost 100% classification accuracy within 150-250 ms after the movement onset. The classification accuracies obtained from sensory areas were poor compared to motor areas and lagged the movement onset. These results suggest that spatial patterns of motor cortex captured with high-density ECoG in HFB can effectively drive a neural prosthetic to perform hand flexion and extension.

A novel method of monitoring response to islet transplantation: bioluminescent imaging of an NF-kB transgenic mouse model.

BACKGROUND: Transplantation of encapsulated pancreatic islets is a novel therapeutic approach for the treatment of Type 1 diabetes mellitus that has the potential to circumvent both a limited islet supply and immunosuppression. Current methods for scoring the biocompatibility of the alginate-based capsules that sequester Islets of Langerhans include fabrication and implantation into the peritoneal cavity of mice, incubation, retrieval via peritoneal lavage, and observation of the number of cells or cell layers surrounding the capsules. This method allows only one data point to be obtained per animal. We describe a method to measure biocompatibility real time and in situ. This method of monitoring immune response using bioluminescent technology and a nuclear factor-kappa beta (NF-kB) sensitive transgenic mouse model allows many data points to be acquired per animal, reduces the number of animals required to obtain statistically significant immune response data over time, and in turn reduces error associated with animal variability. NF-kB is a transcription factor that coordinates the inflammatory and wound healing cascades by initiating the transcription of cytokines, chemokines, adhesion molecules, and proinflammatory genes. METHODS: Inflammation after the transplantation of five types of capsules was monitored for 6 six weeks after transplantation into the dorsal-cervical fat pad. RESULTS: Bioluminescence over 6-week time period: Capsule group 1.0+/-.00 normalized units, Bead group 1.3+/-.26 normalized units, No coat group .96+/-.48 normalized units, Sham group .96+/-.00 normalized units, Control group .17+/-.11 normalized units. CONCLUSIONS: This imaging modality was able to detect statistically significant differences in NF-kB activity between pre- and postoperative data points per mouse. It was also able to discern an unexpected increase in NF-kB activity due to capsule size instead of capsule wall composition over a 6-week time period.

Local spatial correlation analysis of hand flexion/extension using intraoperative high-density ECoG.

We recorded motor cortical activity using highdensity electrocorticogram (ECoG) from three patients during awake craniotomy. Subjects repeatedly executed hand flexion/extension tasks according to auditory instructions. Clear event-related desynchronization (ERD) in beta band (8-32) Hz and event-related synchronization (ERS) in gamma band (60-200) Hz were observed. High frequency band (HFB: 60-200 Hz) activation was found to be more localized compared to low frequency band (LFB: 8-32 Hz) activation in all subjects. Local spatial correlation maps in LFB and HFB were constructed by computing the correlation between channels. Local spatial correlation dropped more in the ERD/ERS areas consistently in two subjects. The results indicate that ERD/ERS patterns are more spatially uncorrelated and denser ECoG electrode is necessary within these areas to map uncorrelated `sources'. High resolution electrodes might improve both clinical functional mapping and brain machine interface outcomes in the near future.