Risk of Streptococcus pneumoniae-associated haemolytic uraemic syndrome in industrialised nations: a systematic review of the literature.

BACKGROUND AND AIM: Haemolytic uraemic syndrome (HUS) is a triad of haemolytic anaemia, thrombocytopaenia, and acute kidney injury. It is a leading cause of acute kidney injury in children and has a high rate of long-term sequelae. Streptococcus pneumoniae-associated HUS (SpHUS) is a rare complication from pneumococcal disease. This article aims to systematically review SpHUS following the global introduction of pneumococcal conjugate vaccines (PCVs). MATERIAL AND METHODS: A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane library from 1st January 2000 to 13th April 2022. RESULTS: Thirteen studies were included in this review, involving a total of 7,177 children with HUS, of which 336 cases were associated with Streptococcus pneumoniae. SpHUS accounted for 4.8% of all HUS cases, in which most patients were younger than 24 months old. Nine studies (80.4%, 281) were during the country's PCV era, whereas 4 studies (19.6%, 66) were before the introduction of PCV into the national vaccination programme. Pneumonia was the commonest clinical presentation (77.3%; 75/97), followed by septicaemia (33.0%; 32/97), and meningitis (29.9%; 29/97). Most cases presenting with pneumonia were complicated by empyema or pleural effusion (54.4%, n=49/90). Only 5 studies reported the isolated serotypes, with the most prevalent serotype being 19A (44.4%, n=20/45), followed by serotype 3 (17.8%, n = 8/45) and 7F (6.7%, n = 3/45). Of those reporting fatality, there were 12 deaths with a fatality rate of 9.8% (n = 12/122). CONCLUSION: SpHUS is rare, but commonly presents in children younger than 2 years old. There remains a high risk of long-term complications and relatively high mortality rate even in the era of conjugate vaccines.

Depression in adults post burn injury: a descriptive study conducted in the burn centre of a tertiary care hospital in Karachi.

Burns are a major cause of psychological disability in this modern era. Psychological aspects of burn have been studied throughout the world with vast differences in results. Depression is one of the psychological illnesses that affect the individual post burn injury. Our objective was to determine frequency of depression in burn patients, burn-related factors that may contribute to the development of depression and to assess demographic distribution. Ninety-four patients from the Burns Centre, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital in Karachi were selected according to specific criteria. Duration of study was from September 2017 to February 2018, with 1-40% of burns patients included through non-probability purposive sampling. Data were collected through a questionnaire consisting of consent form, demographic details and burn details. Beck Depression Inventory II was used as a scoring instrument for depression. Standard statistical measures were calculated using SPSS version 22. Out of 94 patients, 58 were male (61.7%) and 36 (38.3%) female. The most common type of burn was thermal, seen in 58 (61.7%) patients. Thirty (31.9%) patients had depression: 15 (16%) had a mild form, eight (8.5%) a moderate form and seven (7.4%) had severe symptoms of depression. Depression in 32% of cases indicates the need for diagnosis in burn-injured patients. Therefore psychiatric rehabilitation is necessary for all cases of burn in order to manage depressive symptoms, whether these symptoms are mild or severe.

À notre époque, les brûlures sont une cause majeure de troubles psychologiques, parmi lesquelles les dépressions. Ils ont été étudiés partout dans le monde, avec des résultats très variables. Cette étude avait pour but la fréquence et la distribution démographique de la dépression chez les brûlés et de mettre en évidence les facteurs contribuant à son développement. Quatre vingt dix neuf patients hospitalisés dans le CTB de l'hôpital civil de Karachi entre septembre 2017 et février 2018 ont été sélectionnés par échantillonnage non probabiliste. Nous avons utilisé un questionnaire comprenant un consentement ainsi que des précisions démographiques et brûlologiques. La dépression a été évaluée selon le Beck Depression Inventory II. Les statistiques ont été calculées avec SSPS 22. Sur 94 patients, 58 (61,7%) étaient des hommes, 36 (38,3%) des femmes. La brûlure était thermique chez 58 (61,7%) patients. Trente (31,9%) patients étaient dépressifs dont 15 (16% des brûlés) avec une forme légère, 8 (8,5%) avec une forme modérée et 7 (7,4%) avec une forme sévère. Cette fréquence nécessite sa recherche chez les brûlés donc un suivi psychiatrique de tous ces patients.

Synthetic polymers as substrates for a DNA-sliding clamp protein.

The clamp protein (gp45) of the DNA polymerase III of the bacteriophage T4 is known to bind to DNA and stay attached to it in order to facilitate the process of DNA copying by the polymerase. As part of a project aimed at developing new biomimetic data-encoding systems we have investigated the binding of gp45 to synthetic polymers, that is, rigid, helical polyisocyanopeptides. Molecular modelling studies suggest that the clamp protein may interact with the latter polymers. Experiments aimed at verifying these interactions are presented and discussed.

PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction.

BACKGROUND: PET/CTA was used to evaluate the effect of cholesterol crystal emboli (CCE) on muscle injury. Cholesterol crystals (CCs) released during plaque rupture travel downstream and lodge in muscle triggering inflammation and tissue injury. METHODS: Thigh muscles in three groups of rabbits (n = 22) were studied after intra-arterial injection of CCs, Group I (n = 10); polystyrene microspheres, Group II (n = 5); or normal saline, Group III (n = 7). After 48 hours, muscle inflammation and injury were measured by fluorodeoxy-glucose uptake using PET/CTA, serum tissue factor (TF), and creatinine phosphokinase (CPK). Macrophages were stained with RAM11 and CCs with Bodipy. RESULTS: SUVmax of thigh muscles was greater for Group I vs Group II and III (0.40 ± 0.16 vs 0.21 ± 0.11, P = .038 and 0.23 ± 0.06, P = .036). CPK levels rose significantly in Group I vs Group II and III (6.7 ± 6.0 vs 0.6 ± 0.4, P = .007 and 0.9 ± 0.4 mg·dL-1, P = .023). No arterial thrombosis was detected by CTA or histology of embolized arteries and TF did not rise significantly. There were extensive macrophage infiltrates surrounding muscle necrosis in Group I only. CONCLUSIONS: Cholesterol crystal emboli triggered muscle inflammation and necrosis with an intact circulation. PET/CTA may help in the early detection of inflammation caused by CCs.

Outpatient Percutaneous Release of Trigger Finger: A Cost Effective and Safe Procedure.

INTRODUCTION: Trigger finger is a common cause of pain and disability of the hand. Percutaneous release results in earlier functional recovery and patient satisfaction. This is a rapid and cost-effective method which saves a surgical procedure and results in better functional outcome. MATERIALS AND METHODS: This is a prospective observational study conducted on fifty-two fingers and thumbs in 52 patients treated from 1st July 2014 till 31st December 2014, in the Orthopaedic Section, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. All the baseline characteristics of the patients, like demographics, symptoms, Quinell's criteria and functional outcome were recorded. The patients were treated at our hospital with trigger finger, managed with percutaneous release using an 18 gauge needle and followed up for a minimum period of three months. The follow-up information included range of motion scoring, patient satisfaction and overall outcome of the procedure in terms of patient acceptance. The data was analyzed to determine the functional outcome at three months. RESULTS: There was complete release of A1 pulleys in 52 out of 52 digits (100%) in the patients undergoing percutaneous release and significant patient satisfaction. No recurrence was observed. CONCLUSION: Percutaneous release of trigger finger with needle was not only associated with excellent functional outcome and recovery in terms of patient satisfaction and range of finger motion three months post-procedure but also was found to be cost effective.

Thermal and dynamic mechanical properties of cellulose nanofibers reinforced epoxy composites.

The current study presents about the effect of cellulose nanofibers (CNFs) filler on the thermal and dynamic mechanical analysis (DMA) of epoxy composites as a function of temperature. In this study hand lay-up method was used to fabricate CNF reinforced Epoxy nanocomposites with CNF loading of 0.5%, 0.75%, and 1% into epoxy resin. The obtained thermal and DMA results illustrates that thermal stability, char content, storage modulus (E'), loss modulus (E") and glass transition temperature (Tg) increases for all CNF/epoxy nanocomposites compared to the pure epoxy. Thermal results revealed that 0.75% offers superior resistance or stability towards heat compared to its counterparts. In addition, 0.75% CNF/epoxy nanocomposites confers highest value of storage modulus as compared to 0.5% and 1% filler loading. Hence, it is concluded that 0.75% CNFs loading is the minimal to enhance both thermal and dynamic mechanical properties of the epoxy composites and can be utilized for advance material applications where thermal stability along with renewability are prime requirements.

Mechanical, morphological and structural properties of cellulose nanofibers reinforced epoxy composites.

Present study, deals about isolation and characterization of cellulose nanofibers (CNFs) from the Northern Bleached Softwood Kraft (NBSK) pulp, fabrication by hand lay-up technique and characterization of fabricated epoxy nanocomposites at different filler loadings (0.5%, 0.75%, 1% by wt.). The effect of CNFs loading on mechanical (tensile, impact and flexural), morphological (scanning electron microscope and transmission electron microscope) and structural (XRD and FTIR) properties of epoxy composites were investigated. FTIR analysis confirms the introduction of CNFs into the epoxy matrix while no considerable change in the crystallinity and diffraction peaks of epoxy composites were observed by the XRD patterns. Additions of CNFs considerably enhance the mechanical properties of epoxy composites but a remarkable improvement is observed for 0.75% CNFs as compared to the rest epoxy nanocomposites. In addition, the electron micrographs revealed the perfect distribution and dispersion of CNFs in the epoxy matrix for the 0.75% CNFs/epoxy nanocomposites, while the existence of voids and agglomerations were observed beyond 0.75% CNFs filler loadings. Overall results analysis clearly revealed that the 0.75% CNFs filler loading is best and effective with respect to rest to enhance the mechanical and structural properties of the epoxy composites.

Extra pontine osmotic demyelination syndrome.

The osmotic demyelination syndrome (ODS) has been identified as a complication of the rapid correction of hyponatremia for decades. However, in recent years, a variety of other medical conditions have been associated with the development of ODS, independent of changes in serum sodium which cause a rapid changes in osmolality of the interstitial (extracellular) compartment of the brain leading to dehydration of energy-depleted cells with subsequent axonal damage that occurs in characteristic areas. Slow correction of the serum sodium concentration and additional administration of corticosteroids seems to be a major prevention step in ODS patients. In the current report we aimed to share a rare case which we observed in our hospital. A 65 year old female admitted as altered sensorium with history of vomiting, diarrhea was managed with intravenous fluids for 2 days at a peripheral health centre. Patient was referred to our centre with encephalopathy, evaluated and found to have hyponatremia and hypokalemia rest of biochemical parameters and septic profile were normal. Patient's electrolyte disturbances were managed as per guidelines but encephalopathy persisted. Supportive treatment was continued and patient was discharged after 2 wks of stay in hospital after gaining full sensorium and neurological functions.

Non-Hyperammonemic valproate encephalopathy.

A 21-year-old male known case of primary hypothyroidism, Seizure disorder sequelae of an old trauma receiving sodium valproate, clobazam and phenobarbitone for control of Generalized tonic clonic seizures reported to neurology OPD with history of altered sensorium and gait unsteadiness for 1 week with history of hike in valproate dose 2 weeks before. On examination he was drowsy. Neurological examination was unremarkable except for gait unsteadiness and ataxia. Patient was admitted and evaluated for acute worsening. All (the) biochemical parameters including complete blood count, liver function tests, kidney function tests, routine urine examination, arterial blood gas analysis, blood and urine culture tests were normal. CSF analysis was also normal. Repeat MRI brain was also done which depicted all old changes with no fresh changes which will account for worsening of his sensorium. EEG was suggestive of diffuse encephalopathy. Thyroid function tests were also normal. Valproate encephalopathy was suspected and Valproate was empirically stopped and he was put on levetiracetam and phenytoin. His sensorium improved rapidly after stoppage of valproate with normalization of EEG. Serum valproate Levels were high with serum ammonia levels were in the normal range. We made the inference of nonhyperammoneamic valproate encephalopathy. This case highlights the existence of non-hyperammonemic valproate induced encephalopathy, suggesting mechanisms other than hyperammonemia responsible for this encephalopathy.

Iatrogenic gastric perforation during laparoscopy presenting on anaesthesia monitor.

Unfortunately, in the era of minimal access surgery, visceral injuries due to laparoscopic port insertion are common. Most such injuries are diagnosed on direct vision through a laparoscope camera. We report a case of iatrogenic gastric perforation during laparoscopy, presenting in an unusual way in the form of a very high carbon dioxide output on the anaesthesia monitor. This atypical presentation should be borne in mind while performing laparoscopy.

CRIM-Negative Pompe Disease Patients with Satisfactory Clinical Outcomes on Enzyme Replacement Therapy.

Pompe disease, especially in its infantile form, is a fatal disease. Most of the patients with this disease synthesize a nonfunctional form of the enzyme alpha glucosidase (GAA), the deficient enzyme in this disease. Patients producing some amount of this protein are labeled as cross-reactive immunologic material (CRIM)-positive. Few of them are unable to synthesize it and are labeled CRIM-negative. The clinical course of the disease has changed with the advent of enzyme replacement therapy (ERT) with recombinant alpha glucosidase enzyme (rhGAA). However, CRIM-negative patients have always been known to have poor outcome on ERT due to the development of anti-rhGAA antibodies in their bodies that neutralizes ERT efficacy. Here, we describe two CRIM-negative siblings on rhGAA ERT with unusually low anti-rhGAA antibody titer and good clinical outcome. Up to our current knowledge, this is the first report that describes such a good response to ERT in CRIM-negative patients.

Periprocedural myocardial infarction in a randomized trial of everolimus-eluting and Paclitaxel-eluting coronary stents: frequency and impact on mortality according to historic versus universal definitions.

BACKGROUND: A consensus definition for periprocedural myocardial infarction (MI) in coronary stent trials has not been established. Differences between a historic definition, based on modified World Health Organization (WHO) criteria, and a proposed universal definition have not been compared in a prospective clinical trial. METHODS AND RESULTS: We randomly assigned 3687 patients with stable coronary artery disease to undergo stenting with either everolimus-eluting stents (2458 patients) or paclitaxel-eluting stents (1229 patients). Serial creatine kinase (CK) and CKMB or troponin measurements were obtained before and after stenting. MI was classified by protocol according to the WHO definition (total CK >2× normal with elevated CKMB) and post hoc according to the Universal/Academic Research Consortium (ARC) definition (CKMB or troponin >3× normal). Protocol MI was determined in 58 (1.6%) and universal/ARC MI in 287 (7.8%) patients within 48 hours post index procedure. There were substantial differences in frequency of universal/ARC MI if only CKMB (5.4%) or troponin (18.7%) data were included for evaluation. Total stent length was a strong predictor of both protocol and universal/ARC MI. Mortality at 2 years was low (2.3%) and was not different for either MI definition. The mortality rates did not increase with elevations of CKMB or troponin to >10× normal. CONCLUSIONS: There was a marked difference in periprocedural MI rates according to protocol or universal/ARC MI definitions. No association was present between periprocedural MI and mortality up to 2 years by either definition. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00307047.