Spectrum of critical illness in undocumented border crossers. The Arizona-Mexico border experience.

RATIONALE: Approximately 150-250 migrants die each year while attempting to cross the border from Mexico to the Southwest United States. Many border crossers survive the journey, but some develop life-threatening medical complications. Such complications have been subject to little formal analysis. OBJECTIVES: We sought to determine the causes of critical illness in this population and to analyze the hospital course and outcomes of these patients. METHODS: We retrospectively identified border crossers admitted to the intensive care units (ICUs) of two major teaching hospitals in southern Arizona. We recorded admitting diagnoses, severity of illness, length of stay, resource use, discharge diagnoses, and mortality. RESULTS: Our investigation identified 55 admissions to adult ICUs between January 1, 2010 and December 31, 2012. The median age of patients was 27 years. The median hospital length of stay was 7 days, with a median ICU length of stay of 3 days. The median temperature on arrival to the emergency department was 36.8°C. The most common admission diagnoses included trauma (40), rhabdomyolysis (27), acute liver injury (25), dehydration (24), acute kidney injury (19), and encephalopathy (17). Thirteen patients presented with respiratory failure, six patients with severe sepsis, and two with septic shock. A total of 19 patients required ventilator support during their hospital stay, and 30 required at least one surgical intervention. One patient required renal replacement therapy. The median Acute Physiology and Chronic Health Evaluation II score was 6. All but one patient survived to discharge from the hospital. CONCLUSIONS: Border crossers are a unique population of young individuals exposed to high temperatures and extreme conditions. Our review of border crosser admissions showed that most patients demonstrated signs of dehydration and leukocytosis, despite a normal median temperature. The median ICU stay was short, despite a high number of patients requiring ventilator support and surgical intervention. Only one death occurred in this cohort.

An early-branching microbialite cyanobacterium forms intracellular carbonates.

Cyanobacteria have affected major geochemical cycles (carbon, nitrogen, and oxygen) on Earth for billions of years. In particular, they have played a major role in the formation of calcium carbonates (i.e., calcification), which has been considered to be an extracellular process. We identified a cyanobacterium in modern microbialites in Lake Alchichica (Mexico) that forms intracellular amorphous calcium-magnesium-strontium-barium carbonate inclusions about 270 nanometers in average diameter, revealing an unexplored pathway for calcification. Phylogenetic analyses place this cyanobacterium within the deeply divergent order Gloeobacterales. The chemical composition and structure of the intracellular precipitates suggest some level of cellular control on the biomineralization process. This discovery expands the diversity of organisms capable of forming amorphous calcium carbonates.

Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy.

OBJECTIVE: To identify clinical characteristics predicting death among inpatients who are infected with or exposed to human immunodeficiency virus (HIV) during a period of pediatric antiretroviral therapy scale-up in sub-Saharan Africa. STUDY DESIGN: Retrospective review of medical records from every child with HIV infection (n = 834) or exposure (n = 351) identified by routine inpatient testing in Kamuzu Central Hospital, Lilongwe, Malawi, September 2007 through December 2008. RESULTS: The inpatient mortality rate was high among children with HIV infection (16.6%) and exposure (13.4%). Clinically diagnosed Pneumocystis pneumonia or very severe pneumonia independently predicted death in inpatients with HIV infection (OR 14; 95% CI 8.2 to 23) or exposure (OR 21; CI 8.4 to 50). Severe acute malnutrition independently predicted death in children who are HIV infected (OR 2.2; CI 1.7 to 3.9) or exposed (OR 5.1; CI 2.3 to 11). Other independent predictors of death were septicemia, Kaposi sarcoma, meningitis, and esophageal candidiasis for children infected with HIV, and meningitis and severe anemia for inpatients exposed to HIV. CONCLUSIONS: Severe respiratory tract infections and malnutrition are both highly prevalent and strongly associated with death among hospitalized children who are HIV infected or exposed. Novel programmatic and therapeutic strategies are urgently needed to reduce the high mortality rate among inpatients with HIV infection and HIV exposure in African pediatric hospitals.

First Report of Septoria Leaf Spot of Pistachio in New Mexico.

In September of 2008, a Septoria sp., the causal agent of Septoria leaf spot of pistachio (Pistacia vera L.) was isolated from leaf lesions in an orchard in southern New Mexico. Tree fruit and nut crops including pistachios are becoming an increasingly important part of New Mexico's agricultural industry with total cash receipts of $103 million in 2007 (3). This preliminary positive for Septoria prompted a survey of pistachio-growing counties in the state. The surveyed orchards accounted for approximately 30% of the pistachio acreage in New Mexico. Results indicated that all five pistachio-growing counties had orchards infected with a Septoria sp. Isolates of Septoria from leaf lesions were identified as Septoria pistaciarum Caracc. based on the following symptoms and morphological characteristics of the fungus: leaf lesions were usually circular, 0.5 to 3 mm in diameter, and contained many pycnidia per lesion; pycnidia were dark, ostiolate, and measured 101 to 255 × 69 to 133 µm; and conidia were hyaline, filiform, contained 3 to 9 septa, and measured 3 to 4 × 60 to 149 µm. Most orchards were only mildly affected. In severe cases, hundreds of leaf lesions were present on diseased leaves; large sections of the leaves turned tan and some trees defoliated prematurely. This widespread occurrence of Septoria leaf spot in New Mexico in 2008 suggests that the disease had already been present in the state for several years. A higher average rainfall in the summer of 2008 provided excellent conditions for disease development. Because of the high amounts of inoculum currently present in New Mexico orchards, Septoria leaf spot may emerge as a recurring disease problem for pistachio producers. This disease was first reported in the United States in Texas in 1971 and was also reported in Arizona in 1989 (1,2,4). To our knowledge, this is the first report of Septoria leaf spot of pistachio in New Mexico. References: (1) A. Chitzandis. Ann. Inst. Phytopathol. Benaki 10:29, 1956. (2) J. L. Maas et al. Plant Dis. Rep. 55:72, 1971. (3) New Mexico Agricultural Statistics, Department of Agriculture, 2007. (4) D. J. Young and T. Michailides. Plant Dis. 73:775, 1989.

Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children.

OBJECTIVES: To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits. STUDY DESIGN: Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression. RESULTS: Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm3 in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes. CONCLUSIONS: Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.

The antihypertensive effects of the Jamaican Cho-Cho (Sechium edule).

The experiments reported in this study constitute a preliminary investigation into the possible hypotensive effect of the Jamaican Cho-Cho (Sechium edule). Experiments were conducted in a random and blind fashion on two sub species of Sechium edule. Both the pulp and the peel were examined for hypotensive activity. Water-soluble extracts were prepared from these components of the fruit and injected into anaesthetised rats. Various cardiovascular parameters were measured including heart rate, mean arterial pressure (MAP) and several ECG intervals. We report that all extracts tested produced a fall in blood pressure with little change in ECG intervals. Extract B produced the least change in heart rate with a fall in MAP of approximately 23 mmHg. Changes in heart rate with all extracts appeared to be minimal as an ED25 value could only be determined for extract A, and ED10 values could not be evaluated for extracts C and D. The mechanism(s) by which these extracts produce their hypotensive effects could not be determined in these preliminary experiments. However, it appears not to involve direct effects on cardiac tissue. This conclusion is based on the finding that it took a minimum of 10 to 15 seconds for the hypotensive action to manifest post bolus. Future experiments will be aimed at delineating the mechanism(s) involved in decreasing MAP.

The antihypertensive effects of the Jamaican Cho-Cho (Sechium edule)

The experiments reported in this study constitute a preliminary investigation into the possible hypotensive effect of the Jamaican Cho-Cho (Sechium edule). Experiments were conducted in a random and blind fashion on two sub species of Sechium edule. Both the pulp and the peel were examined for hypotensive activity. Water-soluble extracts were prepared from these components of the fruit and injected into anaesthetised rats. Various cardiovascular parameters were measured including heart rate, mean arterial pressure (MAP) and several ECG intervals. We report that all extracts tested produced a fall in blood pressure with little change in ECG intervals. Extract B produced the least change in heart rate with a fall in MAP of approximately 23 mmHg. Changes in heart rate with all extracts appeared to be minimal as an ED25 value could only be determined for extract A, and ED10 values could not be evaluated for extracts C and D. The mechanism(s) by which these extracts produce their hypotensive effects could not be determined in these preliminary experiments. However, it appears not to involve direct effects on cardiac tissue. This conclusion is based on the finding that it took a minimum of 10 to 15 seconds for the hypotensive action to manifest post bolus. Future experiments will be aimed at delineating the mechanism(s) involved in decreasing MAP.(Au)

Reduction of contact factors in sickle cell disease.

Surface-mediated reactions of clotting were compared in 21 black children with homozygous sickle cell disease, 12 age-matched controls, and 15 adults. Both the coagulant and antigen titers of Hageman factor (factor XII) were decreased in asymptomatic patients compared with those in the control groups. These findings were associated with slight but significant reductions in the plasma titers of prekallikrein and high molecular weight kininogen. A further decrease from the initially low titers of these contact factors was observed during vaso-occlusive crises. Additionally, we observed a disparate relationship between Hageman factor coagulant activity and its antigen titers. These data provide evidence for reduction of the contact factors in patients with homozygous sickle cell disease.

Examination of a teacher from El Salvador.

On Oct 19, 1983, a medical examination was carried out on a 30-year-old man, a teacher, from El Salvador, who alleged that he had been arrested and tortured eighteen months previously. An interpreter was present and medical photographs were taken at the time of the examination.

The clinical evaluation of a patient-administered SnF2-ZrSiO4 prophylactyic paste in children. 1. results after one year in the Virgin Islands

A total of 279 children living in the nonfluoride area in the Virgin Islands used the SnF2-ZrSiO4 prophylaxis paste which they administered to themselves under the direction and supervision of a dentist. After one year there was a 41 percent reduction in new DMF teeth and a 64 percent reduction in new DMF surfaces. It is suggested that this technique be used for producing an anticariogenic effect in school-age children on a mass treatment basis (Summary)