Point-of-care lung ultrasound for the detection of pulmonary manifestations of malaria and sepsis: An observational study.

INTRODUCTION: Patients with severe malaria or sepsis are at risk of developing life-threatening acute respiratory distress syndrome (ARDS). The objective of this study was to evaluate point-of-care lung ultrasound as a novel tool to determine the prevalence and early signs of ARDS in a resource-limited setting among patients with severe malaria or sepsis. MATERIALS AND METHODS: Serial point-of-care lung ultrasound studies were performed on four consecutive days in a planned sub study of an observational cohort of patients with malaria or sepsis in Bangladesh. We quantified aeration patterns across 12 lung regions. ARDS was defined according to the Kigali Modification of the Berlin Definition. RESULTS: Of 102 patients enrolled, 71 had sepsis and 31 had malaria. Normal lung ultrasound findings were observed in 44 patients on enrolment and associated with 7% case fatality. ARDS was detected in 10 patients on enrolment and associated with 90% case fatality. All patients with ARDS had sepsis, 4 had underlying pneumonia. Two patients developing ARDS during hospitalisation already had reduced aeration patterns on enrolment. The SpO2/FiO2 ratio combined with the number of regions with reduced aeration was a strong prognosticator for mortality in patients with sepsis (AUROC 91.5% (95% Confidence Interval: 84.6%-98.4%)). CONCLUSIONS: This study demonstrates the potential usefulness of point-of-care lung ultrasound to detect lung abnormalities in patients with malaria or sepsis in a resource-constrained hospital setting. LUS was highly feasible and allowed to accurately identify patients at risk of death in a resource limited setting.

Spatial distribution and contamination assessment of six heavy metals in soils and their transfer into mature tobacco plants in Kushtia District, Bangladesh.

Although the tobacco production and consumption rate in Bangladesh is very high and a substantial portion of premature deaths is caused by tobacco smoking, the status of heavy metals in tobacco plants has not yet determined. This study, therefore, investigated the concentrations of Cu, Ni, Cd, Pb, Cr, and Zn in tobacco plants and their surrounding agricultural soils in Kushtia District, Bangladesh. The geochemical maps showed a similar spatial distribution pattern of the analyzed metals and identified Shempur, Kharara, Taragunia, and Shantidanga as metal hot spots. Geoanalytical indexes were applied to assess the extent of soil contamination, and the results depicted that the soils of Shempur, Kharara, Taragunia, and Shantidanga were moderately contaminated where Cd contributed the most to contamination degree (C d) in spite of its relative low content. However, other five areas in Kushtia District were suggested as uncontaminated according to both C d and pollution load index (PLI). The hazard quotient (HQ) and hazard index (HI) showed no possible indication of human health risks via ingestion of agricultural soils. This study also determined that human activities such as excess application of commercial fertilizers, animal manures, and metal-based pesticides were the sources of Cu, Ni, Cd, and Cr enrichment in soils and that the metals into tobacco plants were transported from the soils. The present study conclusively suggested that regulation of improper use of agrochemicals and continuous monitoring of heavy metals in tobacco plants are needed to reduce the tobacco-related detrimental health problems in Bangladesh.

Intranasal meningoencephalocoele-a rare childhood condition.

Congenital or acquired intranasal meningocoele or meningoencephalocoele is a rare condition ever reported in world literature. We report a case of intranasal meningoencephalocoele in which a 10 month old male child presented with left sided progressive nasal obstruction, nasal mass and reluctant to feed. On examination slight broadening of the bridge of the nose with obliteration of left nasomaxillary fold, mucoid discharge and a pinkish, polypoidal, non tender, non pulsatile mass with prominent blood vessels on the surface occupying almost 3/4(th) of the nasal cavity was observed. On probing it appeared to be attached to roof of left nasal cavity. Computed tomography revealed a hypodense area in the nasal cavity but there was no bony defect in the skull base. Peroperatively on aspiration of nasal cystic mass revealed free flow of clear fluid which was biochemically CSF. A one stage, Lynch Howarth approach, correctional procedure was performed. We present here a discussion of findings and surgical treatment. Early diagnosis and referral are of paramount importance, because failure to identify this leads to fatal outcome if surgery performed.

Platelet C4d is associated with acute ischemic stroke and stroke severity.

BACKGROUND AND PURPOSE: Platelets bearing complement C4d were recently reported to be 99% specific for a diagnosis of systemic lupus erythematosus (SLE) and associated with neuropsychiatric lupus. We compared the prevalence of platelet C4d and investigated the clinical associations of platelet C4d in patients with acute ischemic stroke. METHODS: We recruited 80 patients hospitalized for acute ischemic stroke. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIH-SS). Infarct volume was determined by MRI. Platelet C4d was measured by flow cytometry. RESULTS: Mean age was 57.9 years (range: 24.6 to 86.8 years), 58% were male, and 91% were white. Eight patients (10%) with acute ischemic stroke were platelet C4d-positive, which was significantly higher in prevalence compared to healthy controls (0%, P<0.0001) and non-SLE patients with immune/inflammatory disease (2%, P=0.004). The median NIH-SS score and infarct volume for acute stroke patients were 6 (interquartile range [IQR]: 2 to 13) and 3.4 cc (IQR: 1.1 to 16.6), respectively. Platelet C4d-positive patients were more likely to have a severe stroke compared to those with negative platelet C4d (NIH-SS median: 17.5 versus 5, P=0.003). Positive platelet C4d was independently associated with stroke severity (P=0.03) after controlling for age, anticardiolipin antibody (aCL) status, and total anterior circulation of stroke involvement, and also with infarct volume (P=0.005) after controlling for age, aCL status, and old stroke by MRI. CONCLUSIONS: Platelet C4d is associated with severe acute ischemic stroke. Platelet C4d may be a biomarker as well as pathogenic clue that links cerebrovascular inflammation and thrombosis.

Reduction of nickel and uranium toxicity and enhanced trichloroethylene degradation to Burkholderia vietnamiensis PR1301 with hydroxyapatite amendment.

The use of hydroxyapatite (HA) to sequester metals at mixed waste sites may reduce metal toxicity and facilitate microbial degradation of cocontaminant organics. The constitutive trichloroethylene (TCE) degrader, Burkholderia vietnamiensis PR1301, grew at 34.1 and 1.7 mM Ni at pH 5 and 7, respectively, with 0.01 g mL(-1) HA compared to 17 and 0.85 mM Ni without HA. PR1 grew at 4.2 mM U at pH 5 and 7 with 0.01 g mL(-1) HA compared to 1.1 mM U without HA. A similar decrease in the toxicity of Ni and U in combination was observed with HA. The ability of PR1 to degrade TCE at 0.85, 1.7, and 3.4 mM Ni and at 0.42 and 1.1 mM U was examined. The presence of TCE resulted in a decreased tolerance of PR1 to Ni and U; however, HA facilitated TCE degradation in the presence of Ni and U, effectively doubling the metal concentrations at which TCE degradation proceeded. These studies suggest that metal sequestration via HA amendments may offer a feasible approach to reducing metal toxicity to microorganisms at mixed waste sites, thereby enhancing the degradation of cocontaminant organics.

Inflammation-susceptible Lewis rats show less sensitivity than resistant Fischer rats in the formalin inflammatory pain test and with repeated thermal testing.

Comparisons between Lewis and Fischer inbred strains of rats are used frequently to study the effect of inherent differences in function of the hypothalamic-pituitary-adrenal axis on pain-relevant traits, including differential susceptibility to chronic inflammatory disease and differential responsiveness to analgesic drugs. Increasing use of genetic models including transgenic knockout mice and inbred strains of rodents has raised our awareness of, and the importance of, thorough characterization (or phenotyping) of the strains of rodents being compared. Furthermore, genetic variability in analgesic sensitivity is correlated with, and may be caused by, genetically determined baseline sensitivity. Thus in this study, baseline inflammatory and thermal nociceptive sensitivities were measured in awake male and female Lewis and Fischer rats to examine whether the results could explain relevant strain differences reported in the literature. The effect of maternal separation was also examined and no effect was found on nociceptive sensitivity, corticosterone responses, or the development of adjuvant-induced arthritis, a model of rheumatoid arthritis. Lewis rats and female rats were more sensitive to thermal nociception in the tail withdrawal test (mean of 3 trials) than Fischer rats and male rats, respectively. Unexpectedly, the more inflammation-susceptible Lewis rats were less sensitive in the formalin inflammatory nociception test, and showed a significant decrease in sensitivity with repeated thermal nociceptive testing, whereas Fischer rats did not. These results affect the interpretation of previously observed results. Further study of the underlying mechanisms and the relevance to differential susceptibility to chronic inflammation is warranted.