Acute Necrotizing Encephalopathy Associated with Coronavirus Disease 2019 in an Infant.

A 5-week-old infant born at term was diagnosed with acute necrotizing encephalopathy associated with severe acute respiratory syndrome coronavirus 2 as evidenced by clinical presentation, neuroimaging, and cerebrospinal fluid studies. Our patient was treated with high-dose intravenous methylprednisolone, tocilizumab, and intravenous immunoglobulin with significant short-term clinical improvement but long-term sequelae.

Carboxymethylcellulose: A hidden culprit in immediate hypersensitivity reactions after triamcinolone injections.

We aim to bring awareness of allergies to excipients such as carboxymethylcellulose as "hidden dangers" that can be easily missed in diagnosis, leading to severe effects on patient health, and falsely limit the drug treatments that a patient can receive.

Ocular involvement in allergic drug reactions.

PURPOSE OF REVIEW: Many systemic medications have been observed to cause ocular toxicity. A subset of these reactions is thought to involve immunomodulation or a hypersensitivity reaction. As new medications are developed, ocular adverse effects are becoming increasingly prevalent. Herein we review immune-mediated drug reactions affecting they eye with special attention to the hypersensitivity mechanisms leading to ocular toxicity. RECENT FINDINGS: Recent work has focused on mechanisms and risk of immune-mediated ocular adverse drug reactions including genetic susceptibility and loss of ocular immune privilege. SUMMARY: Given the consequences of immune-mediated ocular adverse drug reactions, clinicians must be aware of these to facilitate early recognition and management. The prompt involvement of an ophthalmologist for diagnosis and management is often essential to preserve vision and avoid long-term morbidity.

Dupilumab-Associated Sweet Syndrome.

Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is characterized by the abrupt appearance of edematous and erythematous papules, plaques, or nodules on the skin that have a distinct histopathologic appearance. Several subtypes of SS exist, including classic (also referred to as idiopathic) and drug induced. Although multiple medications have been implicated as causative agents, we present a rare case of SS caused by dupilumab, a monoclonal antibody therapy, used in the treatment of severe eosinophilic asthma and other conditions. Clinicians should be aware of this potential adverse reaction, as prompt recognition and treatment are essential.

Primary cutaneous mucormycosis of the abdomen at the site of repeated insulin injections.

A 71-year-old woman with metastatic squamous cell carcinoma of the lung and insulin-dependent type 2 diabetes mellitus presented with a necrotic lesion on her lower abdomen. Further history revealed that this was the site of repeat insulin injections with reuse of the same needles. On investigation, biopsy of the site was positive for broad, aseptate, right-angle branching fungal hyphae consistent with mucormycosis. Studies have shown that insulin needle reuse is a common practice among diabetics for several reasons, including cost and convenience. While the current American Diabetes Association guidelines suggest that this is an acceptable practice among the general population of diabetics, they advise against it in patients who are actively ill or immunocompromised. Discussion about insulin needle reuse should be of utmost importance among providers and their diabetic patients, especially for patients who are immunocompromised.

The suction mechanism of the pipid frog, Pipa pipa (Linnaeus, 1758).

Most suction-feeding, aquatic vertebrates create suction by rapidly enlarging the oral cavity and pharynx. Forceful enlargement of the pharynx is powered by longitudinal muscles that retract skeletal elements of the hyoid, more caudal branchial arches, and, in many fish, the pectoral girdle. This arrangement was thought to characterize all suction-feeding vertebrates. However, it does not exist in the permanently aquatic, tongueless Pipa pipa, an Amazonian frog that can catch fish. Correlating high-speed (250 and 500 fps) video records with anatomical analysis and functional tests shows that fundamental features of tetrapod body design are altered to allow P. pipa to suction-feed. In P. pipa, the hyoid apparatus is not connected to the skull and is enclosed by the pectoral girdle. The major retractor of the hyoid apparatus arises not from the pectoral girdle but from the femur, which lies largely within the soft tissue boundaries of the trunk. Retraction of the hyoid is coupled with expansion of the anterior trunk, which occurs when the hypertrophied ventral pectoral elements are depressed and the urostyle and sacral vertebra are protracted and slide forward on the pelvic girdle, thereby elongating the entire trunk. We suggest that a single, robust pair of muscles adduct the cleithra to depress the ventral pectoral elements with force, while modified tail muscles slide the axial skeleton cranially on the pelvic girdle. Combined hyoid retraction, axial protraction, and pectoral depression expand the buccopharyngeal cavity to a volume potentially equal to that of the entire resting body of the frog. Pipa may be the only tetrapod vertebrate clade that enlarges its entire trunk during suction-feeding.

FHAST: FPGA-Based Acceleration of Bowtie in Hardware.

While the sequencing capability of modern instruments continues to increase exponentially, the computational problem of mapping short sequenced reads to a reference genome still constitutes a bottleneck in the analysis pipeline. A variety of mapping tools (e.g., Bowtie, BWA) is available for general-purpose computer architectures. These tools can take many hours or even days to deliver mapping results, depending on the number of input reads, the size of the reference genome and the number of allowed mismatches or insertion/deletions, making the mapping problem an ideal candidate for hardware acceleration. In this paper, we present FHAST (FPGA hardware accelerated sequence-matching tool), a drop-in replacement for Bowtie that uses a hardware design based on field programmable gate arrays (FPGA). Our architecture masks memory latency by executing multiple concurrent hardware threads accessing memory simultaneously. FHAST is composed by multiple parallel engines to exploit the parallelism available to us on an FPGA. We have implemented and tested FHAST on the Convey HC-1 and later ported on the Convey HC-2ex, taking advantage of the large memory bandwidth available to these systems and the shared memory image between hardware and software. A preliminary version of FHAST running on the Convey HC-1 achieved up to 70x speedup compared to Bowtie (single-threaded). An improved version of FHAST running on the Convey HC-2ex FPGAs achieved up to 12x fold speed gain compared to Bowtie running eight threads on an eight-core conventional architecture, while maintaining almost identical mapping accuracy. FHAST is a drop-in replacement for Bowtie, so it can be incorporated in any analysis pipeline that uses Bowtie (e.g., TopHat).

Low inferior vena caval catheters for hemodynamic and pulmonary function monitoring in pediatric critical care patients.

OBJECTIVE: To assess the value of low inferior vena caval (LIVC) catheters for estimating central venous pressure in pediatric intensive care patients and to assess influences of intra-abdominal pressures and mean airway pressure on these measurements. DESIGN: Prospective cohort of consecutive patients. SETTING: Pediatric intensive care unit. PATIENTS: Thirty patients ranging in age (18, 0-1 yrs; four, 1-3 yrs; four, 3-10 yrs; four, > or =10 yrs). INTERVENTIONS: Interventions included catheterizations via internal jugular, subclavian, and common femoral veins, as well as direct right atrial catheterization during surgery; arterial catheter placement; airway pressure monitoring during mechanical ventilation; indirect intra-abdominal pressure monitoring via bladder catheter pressure readings; and arterial and central venous blood gas analysis. LIVC vein catheters were placed below the origin of the renal veins. MEASUREMENTS AND MAIN RESULTS: LIVC pressure was highly correlated with central venous pressure (n=30, r2=.965, p=.0001). LIVC pressure did not correlate with intra-abdominal pressure (n=18, r2=.000). Mean airway pressure did not correlate with central venous pressure (n=11, r2=.106). The pH of LIVC blood was similar to that of central venous blood (n=18, r2=.941, p=.0001). PCO2 values of inferior vena cava and central venous blood correlated (r2=.945, p=.0001). However, agreement between inferior vena cava and central venous PO2 and oxyhemoglobin saturation was poor (PO2, r2=.066; oxyhemoglobin saturation, r2=.000). CONCLUSIONS: LIVC catheters whose tips lie below the origin of the renal veins predict central venous pressure in pediatric intensive care unit patients. Intra-abdominal pressure and mean airway pressure do not affect this relationship, within the wide range of values for these variables included in this study. Blood samples drawn from femoral venous catheters can be used to monitor acid-base balance and partial pressure of carbon dioxide.