Matrix-Independent Surface-Enhanced Raman Scattering Detection of Uranyl Using Electrospun Amidoximated Polyacrylonitrile Mats and Gold Nanostars.

Reproducible detection of uranyl, an important biological and environmental contaminant, from complex matrixes by surface-enhanced Raman scattering (SERS) is successfully achieved using amidoximated-polyacrylonitrile (AO-PAN) mats and carboxylated gold (Au) nanostars. SERS detection of small molecules from a sample mixture is traditionally limited by nonspecific adsorption of nontarget species to the metal nanostructures and subsequent variations in both the vibrational frequencies and intensities. Herein, this challenge is overcome using AO-PAN mats to extract uranyl from matrixes ranging in complexity including HEPES buffer, Ca(NO3)2 and NaHCO3 solutions, and synthetic urine. Subsequently, Au nanostars functionalized with carboxyl-terminated alkanethiols are used to enhance the uranyl signal. The detected SERS signals scale with uranyl uptake as confirmed using liquid scintillation counting. SERS vibrational frequencies of uranyl on both hydrated and lyophilized polymer mats are largely independent of sample matrix, indicating less complexity in the uranyl species bound to the surface of the mats vs in solution. These results suggest that matrix effects, which commonly limit the use of SERS for complex sample analysis, are minimized for uranyl detection. The presented synergistic approach for isolating uranyl from complex sample matrixes and enhancing the signal using SERS is promising for real-world sample detection and eliminates the need of radioactive tracers and extensive sample pretreatment steps.

A Case of Painless Subacute Thyroiditis Presenting as Fever of Unknown Origin.

Subacute thyroiditis (SAT) is characterized by severe pain in the anterior aspect of the neck and tenderness is present during the thyroid gland's palpation. It is commonly caused by viruses including mumps, measles, rubella, coxsackievirus, influenza, and Epstein-Barr virus (EBV). Painless subacute thyroiditis is rare and can present as a fever of unknown origin (FUO). Our case reports an unusual case of SAT as our patient did not have any neck pain. Laboratory investigations show low thyroid-stimulating hormone (TSH), poor or no uptake of radioactive iodine by the thyroid, and elevated erythrocyte sedimentation rate (ESR). Clinicians should be aware that painless SAT can present as a fever of unknown origin.

An Unusual Case of the "Terrible Triad" in a Transgender Woman.

With the increasing use of sodium-glucose cotransporter-2 inhibitors for type 2 diabetes and heart failure, clinicians need to understand how to treat euglycemic diabetic ketoacidosis (DKA), which is a potential side effect of the medication. The disease triad of euglycemic ketoacidosis, acute pancreatitis, and hypertriglyceridemia (HTG) has complex pathogenesis, and often the trigger of the triad is unknown. Here, we present an unusual case of euglycemic DKA in a transitioning transgender woman on canagliflozin who was treated with 10% dextrose and insulin infusions and apheresis. What makes our case unique is an added layer of complexity with her use of estrogen supplements contributing to HTG and gallstone formation, which could have set off the disease triad.

Comparison of Johnson's Method with Hadlock's Method for Estimation of Fetal Weight in Term Pregnancies.

BACKGROUND: Fetal weight estimation is of utmost need to determine the course of labour and complications for its management. This study intents to compare the fetal weight determined through Johnson's method and Hadlock's method with actual birth weight in term pregnancies. METHODS: This is an observational study carried out over a period of six months in Kirtipur Hospital among 200 samples of term, singleton pregnancy with cephalic presentation using convenience sampling technique. RESULTS: The mean maternal age was 25.9±4.3 years whereas mean gestational age was 39.1 weeks. Less than half (49.1%) of the babies' weight ranged between 3.0 - 3.5 kgs. The mean error of estimated weight by Johnson's method was less compared to Hadlock's method 185.1±191.1 grams and 355.8±225.7 grams respectively. It was also observed that estimation of fetal weight by Johnson's method was closer to the actual birth weight than by Hadlock's method. CONCLUSIONS: Johnson's method requires some basic skills and knowledge with flexibility to apply as and where needed beyond the health facilities irrespective of the availability of the equipment. Furthermore, it was also observed to be slightly more specific in its estimation of birth weight among the term pregnancies compared to Hadlock's method. Hence, it should be promoted widely among the clinicians. However, Hadlock's method is equally important for detection of anomalies and high-risk factors coupled with confirmation of the estimation made through Johnson's method.