Babesiosis as a Cause of Atraumatic Splenic Injury: Two Case Reports and a Review of Literature.

We present two cases of Babesia-induced splenic injury at a single institution. In the late summer, two patients presented with left-sided abdominal pain radiating to the shoulder. They were both found to have hemolytic anemia, thrombocytopenia, and acute splenic infarction on imaging. Blood smears showed intracellular ring forms consistent with Babesia spp. and low parasitemia (<1%). Diagnosis was confirmed by PCR for Babesia microti. Both patients improved with azithromycin and atovaquone, without blood products or surgical intervention. Several weeks following treatment, repeat blood smears revealed no parasites. Splenic infarct and hemorrhage have been previously reported as rare complications of babesiosis. However, given the steady rise in Babesia microti cases in the USA, even these rare complications will become more prevalent. We review both the diagnosis and management of Babesia-induced splenic complications, which can be challenging in patients with low-level parasitemia. Clinicians should consider babesiosis as a cause of atraumatic splenic injury.

Electrospun probiotics: an alternative for encapsulation.

Electrospinning has emerged as a potential method to fabricate nonwoven nanofibers. It has application in different fields of biomedicine as it has potential to carry antimicrobial and bioactive agents. The present investigation was conducted to optimize the process conditions and determine the viability of probiotics after being electrospun in fibers. Poly(vinyl alcohol) (PVA) was utilized as electrospun material because it possesses generally recognized as safe (GRAS) status and in dry form it acts as a high oxygen barrier and has high water solubility. This characteristic allows the easy recovery of the bacteria from electrospun fibers. The viability tests, carried out at three different temperatures (room temperature, 4°C and -20°C) showed Bifidobacterium animalis subsp. Lactis Bb12 (probiotic 1) and combination of Streptococcus thermophilus (TH-4®), Lactobacillus paracasei 431® and Bb-12 (probiotic 2) within the electrospun PVOH fibers remained viable after 1 week at room temperature and refrigeration temperature. The nanofibers containing probiotics prepared with 9% poly venyl alcohol showed homogenous, uniform, bead-free and smooth texture. Probiotic 1 demonstrated growth as 1.85×108, 1.57×108 and 1.71×108 before, 0 hour and after 1 week of encapsulation. While probiotic 2 exhibited a growth of 2.1×108 before electrospinning, 1.3 ×108 at 0 hour and 1.97×108 after one week of electrospinning. There was no change in CFU/mL count and remained 108 CFU/mL. The encapsulation efficiency was 84.07% and 85.73% at 0 and one week, respectively, for Probiotic 1, while probitic 2 showed 90.09% and 93.59 % encapsulation efficiency before and after one week, respectively. Considering the prolonged viability of nanofibers containing probiotics noted at room temperature, this technology can be implemented for prolonged viability of probiotics.

Pneumomediastinum from a severe asthma attack.

Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

Emerging SARS-CoV-2 variants of concern evade humoral immune responses from infection and vaccination.

Emerging SARS-CoV-2 variants pose a threat to human immunity induced by natural infection and vaccination. We assessed the recognition of three variants of concern (B.1.1.7, B.1.351 and P.1) in cohorts of COVID-19 patients ranging in disease severity (n = 69) and recipients of the Pfizer/BioNTech vaccine (n = 50). Spike binding and neutralization against all three VOC was substantially reduced in the majority of samples, with the largest 4-7-fold reduction in neutralization being observed against B.1.351. While hospitalized COVID-19 patients and vaccinees maintained sufficient neutralizing titers against all three VOC, 39% of non-hospitalized patients did not neutralize B.1.351. Moreover, monoclonal neutralizing antibodies (NAbs) show sharp reductions in their binding kinetics and neutralizing potential to B.1.351 and P.1, but not to B.1.1.7. These data have implications for the degree to which pre-existing immunity can protect against subsequent infection with VOC and informs policy makers of susceptibility to globally circulating SARS-CoV-2 VOC.

Epidemiology of cleft lip and cleft palate in Pakistan.

Clinical and epidemiologic studies of defined geographic populations can serve as a means of establishing data important for the diagnosis, treatment, and counseling of patients with cleft lip and cleft palate. Several descriptive epidemiologic studies have been carried out in many countries worldwide; however, no such study has ever been performed in Pakistan. Population-based data on the incidence of cleft lip and palate were obtained from birth registry information in northern Pakistan. A total of 117 cases from 61,156 live births reported were identified. The incidence for cleft lip and/or cleft palate was 1.91 per 1000 births (one per 523 births). Cleft lip alone (42 percent) was noted more frequently than isolated cleft palate (24 percent) and combined cleft lip and palate deformities (34 percent). Boys were more commonly affected by cleft lip and cleft lip with cleft palate, whereas girls predominated in the isolated cleft palate cases. Consanguineous marriages were observed in 32 percent of parents versus 18 percent in matched controls. Only 32 percent of cleft mothers received formal prenatal counseling, monthly examinations, and regular laboratory testing during the entirety of the pregnancy. Nutritional and vitamin supplements were given to only 28 percent of mothers of cleft children versus 59 percent in matched controls. Descriptive statistics were used to assess pertinent risk factors associated with cleft lip and palate. The acquisition of incidence and associated data has generated baseline information on the magnitude of cleft lip and cleft palate in Pakistan. It is hoped that this information can be used for appropriate resource use, cleft lip and cleft palate prevention programs, and counseling programs with Pakistan-specific data.