Case Report: A Great Mimicker of Neoplasm: Pulmonary Cryptococcosis in an Immunocompetent Host After High-Altitude Descent.

Cryptococcus exposure in certain global regions is common and yet virulence in the immunocompetent host remains rare. Radiological findings of pulmonary cryptococcosis may include nonspecific lung nodules or masses indistinguishable from lung cancer or pulmonary tuberculosis. We present a case of an immunocompetent diabetic female who presented with progressively worsening pleuritic chest pain and cough with travel between Tibet and New York 2 months earlier. Chest imaging demonstrated a large lobulated mass, acid-fast bacillus smears were negative, and our patient underwent pulmonary biopsy, which grew rare budding yeast later confirmed by mucicarmine staining as Cryptococcus. Our patient was successfully treated with fluconazole therapy. We hypothesize that the high altitude of Tibet may allow for clinical latency followed by symptomatic reactivation on descent. A raised index of suspicion for pulmonary cryptococcosis with careful attention to travel history is expected to facilitate timely diagnosis.

Multifunctional nanoparticles in stem cell therapy for cellular treating of kidney and liver diseases.

The review gives an overview of the mechanisms of internalization and distribution of nanoparticles in stem cells this is achieved via providing analysis of the methods used in exploring the migration routes of stem cells, and their reciprocity. In addition, exploring microenvironment target in the body, and tracking the fate of exogenously transplanted stem cells by using innovative and non-invasive techniques will also be discussed. Such techniques like magnetic resonance imaging (MRI), multimodality tracking, optical imaging, and nuclear medicine imaging, which were designed to follow up stem cell migration. This review will explain the various distinctive strategies to enhance homing of labeled stem cells with nanoparticles into damaged hepatic and renal tissues, this purpose was obtained by inducing a specific gene into stem cells, various chemokines, and applying an external magnetic field. Also, this work illustrates how to improve nanoparticles uptake by using transfection agents or covalently binding an exogenous protein (i.e., Human immunodeficiency virus-Tat protein) or conjugating a receptor-specific monoclonal antibody or make modifications to iron coat. It contains stem cell labeling methods such as extracellular labeling and internalization approaches. Ultimately, our review indicates trails of researchers in nanoparticles utilization in stem cell therapy in both kidney and liver diseases.

A method for determining exercise oscillatory ventilation in heart failure: Prognostic value and practical implications.

BACKGROUND: Exercise oscillatory ventilation (EOV) has been shown to be a powerful prognostic marker in chronic heart failure (CHF). However, EOV is poorly defined, its measurement lacks standardization and it is underutilized in clinical practice. The purpose of this pilot study was to investigate the prognostic value of a modified definition of EOV in patients with CHF. METHODS: Eighty-nine CHF patients (56.5±8.4years) (64% NYHA class III-IV) underwent cardiopulmonary exercise testing. EOV was defined as meeting all the following criteria: (1) ≥3 consecutive cyclic fluctuations of ventilation during exercise; (2) average amplitude over 3 ventilatory oscillations ≥5L; and (3) an average length of three oscillatory cycles 40s to 140s. Adverse cardiac events were tracked during 28±19months follow up. Cox proportional hazard analysis was used to determine the association between cardiac events and EOV. RESULTS: Forty-eight patients (54%) met all three criteria and were determined to have EOV. These patients exhibited significantly increased risk for adverse cardiac events [hazard ratio=2.2, 95% CI (1.2 to 4.1), p=0.011] compared to patients without EOV. After adjusting for age and established prognostic covariates (peak VO2 and VE/VCO2 slope), the modified EOV definition was the only significant variable in the multivariate model [hazard ratio=2.0, 95% CI (1.1 to 3.7), p=0.035]. CONCLUSIONS: The proposed method for determining EOV was independently associated with increased risk for adverse cardiac events in CHF patients. While larger prospective studies are needed, this definition provides a relatively simple and more objective characterization of EOV, suggesting its potential application in clinical practice.

Prevalence and Predictors of Use of Home Sphygmomanometers Among Hypertensive Patients.

OBJECTIVE: Few studies have looked at the predictors of use of home sphygmomanometers among hypertensive patients in low-income countries such as Pakistan. Considering the importance of home blood pressure monitoring (HBPM), cross-sectional study was conducted to evaluate the prevalence and predictors of the usage of all kinds of HBPM devices. METHOD: This study was conducted in Karachi during the time period of January-February 2017. Adult patients previously diagnosed with hypertension visiting tertiary care hospitals were selected for the study. Interviews from the individuals were conducted after verbal consent using a pre-coded questionnaire. The data was analyzed using Statistical Package for the Social Sciences v. 23.0 (SPSS, IBM Corporation, NY, USA). Chi-squared test was applied as the primary statistical test. RESULTS: More than half of the participants used a home sphygmomanometer (n=250, 61.7%). The age, level of education, family history of hypertension, compliance to drugs and blood pressure (BP) monitoring, few times a month at clinics were significant determinants of HBPM (P values < 0.001). It was found that more individuals owned a digital sphygmomanometer (n=128, 51.3%) as compared to a manual type (n=122, 48.8%). Moreover, avoiding BP measurement in a noisy environment was the most common precaution taken (n=117, 46.8%). CONCLUSION: The study showed that around 40% of the hypertensive individuals did not own a sphygmomanometer and less than 25% performed HBPM regularly. General awareness by healthcare professionals can be a possible factor which can increase HBPM.