Comparative analysis of organophosphorus versus carbamate pesticide poisoning: a case study.

Organophosphorus poisoning is a critical condition that can cause central nervous system depression, respiratory failure, and death early on. As its clinical manifestations closely resemble those of carbamate pesticide poisoning, the aim of this case study is to present a case of misdiagnosis, initially identifying carbofuran poisoning as organophosphate in a patient suspect of a heatstroke. We also present a case of intentional self-poisoning with organophosphate dichlorvos to underline the likelihood of pesticide poisoning in patients exhibiting acute cholinergic symptoms when the ingested substance is not known. In such cases, empirical treatment with atropine and oxime can be started pending timely differential diagnosis to adjust treatment as necessary.

Suicide and Suicide Risk in Adolescents.

Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.

The association between higher cardiac troponin levels and the development of left ventricular diastolic dysfunction in septic patients with diabetes mellitus.

This study was designed to retrospectively analyze the relationship between the levels of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) and the development of left ventricular diastolic dysfunction (LVDD) in septic patients with diabetes mellitus. Furthermore, the predictive value of cTnT and cTnI in the LVDD development in those patients was investigated. The clinical information of 159 septic patients with diabetes mellitus treated in the intensive care unit of Affiliated Hospital of Chengde Medical University from June 2016 to January 2023 were retrospectively analyzed. These patients were separated into LVDD group (LVFP > 15 mmHg) and non-LVDD group (LVFP ≤ 15 mmHg) based on left ventricular filling pressure (LVFP). The differences in clinical data, echocardiographic parameters, as well as cTnT and cTnI levels between the LVDD and non-LVDD groups were compared. The relationship between the cTnT and cTnI levels and the echocardiographic parameters was studied using Pearson correlation analysis. Logistic regression analysis was conducted to explore the factors that influenced the LVDD development in septic patients with diabetes. Receiver operator characteristic (ROC) curves were created to evaluate the predictive value of cTnT and cTnI levels for the LVDD development in septic patients with diabetes. Totally 159 septic patients with diabetes were included in this study, with 97 patients in the LVDD group and 62 in the non-LVDD group. Compared with the non-LVDD group, patients in the LVDD group had much lower left ventricular (LV) early diastolic peak inflow velocity (E), LV advanced diastolic peak inflow velocity (A), E/A, and early diastolic mitral annular velocity (Em) while significantly higher E/Em. The LVDD group showed much higher levels of cTnI and cTnT than the non-LVDD group (P < 0.05). Significant positive correlation between log10cTnI level and E/Em ratio (r = 0.425, P < 0.001) was revealed by the Pearson correlation analysis. Multivariate analysis showed that E/A, E/Em, cTnI and cTnT were independent risk factors for the LVDD development in septic patients with diabetes (P < 0.05). As for ROC curve results, the area under the curve (AUC) of cTnT to predict the development of LVDD in septic patients with diabetes was 0.849 (95% CI 0.788-0.910, P < 0.001); the AUC of cTnI was 0.742 (95% CI 0.666-0.817, P < 0.001). Both cTnT and cTnI are independent risk factors and have predictive value for the LVDD development in septic patients with diabetes mellitus.

Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia.

Legionella is an aerobic, gram-negative, intracellular pathogen and is an important cause of community-acquired pneumonia. Legionella pneumophila is the most common causative agent of Legionella pneumonia. Clinical diagnosis of Legionella pneumonia is challenging due to the lack of specific clinical manifestations and the low positive rates of conventional pathogen detection methods. In this study, we report a case of a patient with chronic myeloid leukemia who developed rigors and high fever after chemotherapy and immunotherapy. Chest computed tomography revealed consolidation in the left lower lobe of the lung and ground-glass opacities in both lower lobes. Multiple blood cultures showed Escherichia coli, Staphylococcus aureus, Bacillus licheniformis, and positive results in the ß-D-glucan test (G test). The patient was treated with various sensitive antimicrobial agents, including meropenem plus fluconazole, meropenem plus carpofungin, and vancomycin. Unfortunately, the patient's condition gradually worsened and eventually resulted in death. On the following day of death, metagenomic next-generation sequencing (mNGS) of 1whole blood revealed L. pneumophila pneumonia with concurrent bloodstream infection (blood mNGS reads 114,302). These findings suggest that when conventional empirical antimicrobial therapy proves ineffective for critically ill patients with pneumonia, the possibility of combined Legionella infection must be considered, and mNGS can provide a diagnostic tool in such cases.

Integration of Substance Use Disorder Treatment Into a Traditional Community Mental Health Treatment System.

In response to the opioid crisis, Catholic Charities of Baltimore sought to integrate substance use disorder treatment into their outpatient community mental health clinics. The agency developed a systematic practice improvement strategy that included a competency-based curriculum and supervision plan for psychiatric providers and therapists. Psychiatric providers developed competency with medications used to treat substance use disorders, and therapists developed competency in therapeutic modalities to treat substance use disorders, all of which were gradually integrated into outpatient clinics. This column demonstrates that integration of substance use disorder treatment into outpatient community mental health care is feasible and beneficial.

Distributed Acoustic Sensing Based on Coherent Microwave Photonics Interferometry.

A microwave photonics method has been developed for measuring distributed acoustic signals. This method uses microwave-modulated low coherence light as a probe to interrogate distributed in-fiber interferometers, which are used to measure acoustic-induced strain. By sweeping the microwave frequency at a constant rate, the acoustic signals are encoded into the complex microwave spectrum. The microwave spectrum is transformed into the joint time-frequency domain and further processed to obtain the distributed acoustic signals. The method is first evaluated using an intrinsic Fabry Perot interferometer (IFPI). Acoustic signals of frequency up to 15.6 kHz were detected. The method was further demonstrated using an array of in-fiber weak reflectors and an external Michelson interferometer. Two piezoceramic cylinders (PCCs) driven at frequencies of 1700 Hz and 3430 Hz were used as acoustic sources. The experiment results show that the sensing system can locate multiple acoustic sources. The system resolves 20 nε when the spatial resolution is 5 cm. The recovered acoustic signals match the excitation signals in frequency, amplitude, and phase, indicating an excellent potential for distributed acoustic sensing (DAS).

Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults.

Pediatricians are often the first physicians to encounter adolescents and young adults presenting with psychotic symptoms. Although pediatricians would ideally be able to refer these patients immediately into psychiatric care, the shortage of child and adolescent psychiatry services may sometimes require pediatricians to make an initial assessment or continue care after recommendations are made by a specialist. Knowing how to identify and further evaluate these symptoms in pediatric patients and how to collaborate with and refer to specialty care is critical in helping to minimize the duration of untreated psychosis and to optimize outcomes. Because not all patients presenting with psychotic-like symptoms will convert to a psychotic disorder, pediatricians should avoid prematurely assigning a diagnosis when possible. Other contributing factors, such as co-occurring substance abuse or trauma, should also be considered. This clinical report describes psychotic and psychotic-like symptoms in the pediatric age group as well as etiology, risk factors, and recommendations for pediatricians, who may be among the first health care providers to identify youth at risk.

Microwave-photonic low-coherence interferometry for dark zone free distributed optical fiber sensing.

A microwave-photonic low-coherence interferometry (MPLCI) system is proposed for fully distributed optical fiber sensing. Assisted by an unbalanced Michelson interferometer, a low-coherence laser source is used to interrogate cascaded Fabry-Perot interferometers along with an optical fiber for a dark zone free (or spatially continuous) distributed measurement. By combining the advantages of microwaves and photonics, the MPLCI system can synergistically achieve high sensitivity and high spatial resolution. Our tests have confirmed a strain resolution of 95 nε at the spatial resolution of 10 cm.

Fabrication and characterization of femtosecond laser induced microwave frequency photonic fiber grating.

We proposed and fabricated a microwave-frequency photonic fiber grating (MPFG) by femtosecond laser micromachining on optical fibers. Illuminated by low coherent light source, the MPFG can be interrogated using proposed microwave photonic system to show the resonant peaks in microwave frequency domain. We studied the working principle and characteristics of this device. After that, we discussed the influence of fiber type, apodization and light source coherence lengths on this device. The device can also respond to ambient temperature change like fiber optic sensors.

Information integrated glass module fabricated by integrated additive and subtractive manufacturing.

In this Letter, we report a novel integrated additive and subtractive manufacturing (IASM) method to fabricate an information integrated glass module. After a certain number of glass layers are 3D printed and sintered by direct ${{\rm CO}_2}$CO2 laser irradiation, a microchannel will be fabricated on top of the printed glass by integrated picosecond laser, for intrinsic Fabry-Perot interferometer (IFPI) optical fiber sensor embedment. Then, the glass 3D printing process continues for the realization of bonding between optical fiber and printed glass. Temperature sensing up to 1000°C was demonstrated using the fabricated information integrated module. In addition, the long-term stability of the glass module at 1000°C was conducted. Enhanced sensor structure robustness and harsh temperature sensing capability make this glass module attractive for harsh environment structural health monitoring.

Coherence-length-gated distributed optical fiber sensing based on microwave-photonic interferometry.

This paper presents a new optical fiber distributed sensing concept based on coherent microwave-photonics interferometry (CMPI), which uses a microwave modulated coherent light source to interrogate cascaded interferometers for distributed measurement. By scanning the microwave frequencies, the complex microwave spectrum is obtained and converted to time domain signals at known locations by complex Fourier transform. The amplitudes of these time domain pulses are a function of the optical path differences (OPDs) of the distributed interferometers. Cascaded fiber Fabry-Perot interferometers (FPIs) fabricated by femtosecond laser micromachining were used to demonstrate the concept. The experimental results indicated that the strain measurement resolution can be better than 0.6 µÎµ using a FPI with a cavity length of 1.5 cm. Further improvement of the strain resolution to the nε level is achievable by increasing the cavity length of the FPI to over 1m. The tradeoff between the sensitivity and dynamic range was also analyzed in detail. To minimize the optical power instability (either from the light source or the fiber loss) induced errors, a single reflector was added in front of an individual FPI as an optical power reference for the purpose of compensation.

Microwave-assisted frequency domain measurement of fiber-loop ring-down system.

A new frequency domain measurement method for a fiber-loop ring-down system is proposed in this Letter. Compared to traditional time domain measurement, this method uses a microwave modulated continuous wave (CW) laser as a light source, making full use of the duty cycle to achieve enhanced measurement efficiency. By measuring the amplitude modulation over a frequency span, this technique can be used to determine the ring-down time in the frequency domain, which will then be used to calculate the loss in the ring.

Microwave interrogated large core fused silica fiber Michelson interferometer for strain sensing.

A Michelson-type large core optical fiber sensor has been developed, which is designed based on the optical carrier-based microwave interferometry technique, and fabricated by using two pieces of 200-µm diameter fused silica core fiber as two arms of the Michelson interferometer. The interference fringe pattern caused by the optical path difference of the two arms is interrogated in the microwave domain, where the fringe visibility of 40 dB has easily been obtained. The strain sensing at both room temperature and high temperatures has been demonstrated by using such a sensor. Experimental results show that this sensor has a linear response to the applied strain, and also has relatively low temperature-strain cross talk. The dopant-free quality of the fused silica fiber provides high possibility for the sensor to have promising strain sensing performance in a high temperature environment.

Psychosocial functioning, familiality, and psychiatric comorbidity in bipolar youth with and without psychotic features.

OBJECTIVE: Few studies have examined the correlates of psychosis in children and adolescents with bipolar disorder (BPD). We examined psychiatric comorbidity, familiality, and psychosocial functioning in multiple domains in BPD children and adolescents with and without psychotic features. METHOD: As part of 2 ongoing family-based studies of children and adolescents with DSM-IV-defined BPD, we compared youth and their families with psychotic symptoms (BPD+P) and without psychotic symptoms (BPD-P). All youth and family members were assessed using indirect and direct structured psychiatric interviews (Kiddie Schedule for Affective Disorders-Epidemiologic Version and DSM-IV Structured Clinical Interview) in a blinded manner. One study was conducted from January 2000 through December 2004, and the other study was conducted from February 1997 through September 2006. RESULTS: Of the 226 youth with BPD, 33% manifested psychotic symptoms, as defined by the presence of hallucinations or delusions. We found that BPD+P youth had a greater number of BPD episodes (P < .01), more psychiatric hospitalizations (P < .01), and significantly higher rates of psychiatric comorbidity compared to BPD-P youth (all P values < .05). Additionally, a higher percentage of BPD+P youth had a family history of psychosis (P = .01). There was a lower processing speed (P = .03) and lower arithmetic scaled score (P = .04) in BPD+P youth, but no other meaningful differences in cognitive variables were identified between the 2 BPD groups. Psychosis in BPD was also associated with decreased family cohesion (P = .04) and poorer overall global functioning (P < .01). CONCLUSIONS: In children and adolescents with BPD, those who manifest psychotic features have higher rates of comorbid psychopathology, family history of psychosis, and poorer overall functioning in multiple domains than BPD children without psychosis. Future studies should examine neuroimaging correlates, medication response, and longitudinal course of children and adolescents with BPD who manifest psychosis as part of their clinical picture.

The diagnosis and treatment of attention deficit-hyperactivity disorder in children and adolescents with cystic fibrosis: a retrospective study.

BACKGROUND: There has been minimal study of the impact of attention deficit-hyperactivity disorder (ADHD) in cystic fibrosis (CF) or other chronic illness. OBJECTIVE: To examine patterns of ADHD diagnosis and treatment in CF. METHOD: Retrospective chart review of all pediatric patients in the Massachusetts General Hospital (MGH) CF Program referred from 8/05-12/08 for outpatient child psychiatric consultation and diagnosed with ADHD. The medication trial resulting in the best improvement in ADHD symptoms with the most tolerable side effects was designated the Best Regimen for each patient. RESULTS: Of the 188 patients aged 5-18 followed in the MGH CF Program during this time, 18 (9.6%) were referred to the liaison psychiatrist and diagnosed with ADHD. Eleven (61%) had CF treatment non-adherence as a presenting problem. Psychopharmacologic treatment of ADHD was attempted in 13 of the 18 cases. In eight cases the Best Regimen achieved a Clinical Global Impression improvement rating of much or very much improved. In three cases, the Best Regimen consisted of stimulant monotherapy; two consisted of nonstimulant monotherapy; two used a combination of two nonstimulants; and one used a combination of a stimulant and a nonstimulant. CONCLUSION: ADHD is common and treatable in pediatric patients with CF. Stimulants, nonstimulants, and combination therapies are viable treatment options. The presence of ADHD or other psychiatric disorders should be considered when behavior is interfering with adherence to medical care. Further research is needed into the prevalence and treatment of ADHD in CF and its impact on medical adherence and outcomes.

[A clinical analysis of 22 cases of Pneumocystis pneumonia in acquired immunodeficiency syndrome].

OBJECTIVE: To investigate the clinical characteristics, therapeutical approaches and outcome of Pneumocystis pneumonia (PCP) in patients with AIDS. METHODS: The clinical data of 22 PCP patients with AIDS who were treated in Peking Union Medical College Hospital from January 1992 to October 2004 were analyzed, including the routes of HIV infection, clinical profiles, immunological status, chest radiological characteristics, therapeutic managements and outcome. RESULTS: (1) Of the 22 PCP patients, 16 were male and 6 female. The average age was (35.0 +/- 9.4) years old. The majority of patients got HIV infection through blood transfusion (54.5%) and sexual transmission (27.3%). (2) The common clinical presentations were fever (21/22), progressive exertional dyspnea (20/22), cough (16/22), sputum (12/22) and weight loss (18/22). 68.2% (15/22) of the patients had normal or mild coarse breath sounds on auscultation. 14 patients had an PaO(2) less than 60 mm Hg (1 mm Hg = 0.133 kPa). (3) All the 22 PCP cases were in their late stage of AIDS. For the 20 patients who had an immunological test, the peripheral CD(4)(+) T lymphocyte count was ranging from 3 x 10(6)/L to 148 x 10(6)/L and 90% of the cases had a CD(4)(+) T cell count less than 100 x 10(6)/L, 95% of the cases had a CD(4)(+)/CD(8)(+) ratio less than 0.20; (4) The most common abnormal chest radiological findings were bilateral diffuse interstitial infiltrations (19/22) and patchy shadows (14/22); (5) All patients were given trimethoprim-sulfamethoxazole (SMZco) and 86.4% of the patients were treated with corticosteroids concomitantly. Of the 22 PCP patients, 13 recovered, 5 gave up after knowing their definite diagnosis, 4 died. Comparing with the recovery patients, the 4 patients who died of PCP had much lesser CD(4)(+) T cell count (P = 0.07). CONCLUSIONS: Most PCP occurred in patients who were in their late stage of AIDS and with a CD(4)(+) T cell count below 100 x 10(6)/L. For these reasons, we suggest that whenever encountering a young patient presenting with fever, dyspnea, hypoxia, loss of weight, the possibility of PCP complicating AIDS should be considered, especially when chest radiological study revealed interstitial infiltration or patchy shadows. If HIV was confirmed to be positive, the combined therapy of SMZco and corticosteroids should be started immediately.

[The diagnostic value of polymerase chain reaction for the detection of Pneumocystis carinii DNA from induced sputum samples].

OBJECTIVES: To evaluate the diagnostic value of PCR for detection of Pneumocystis carinii DNA from induced sputum samples. METHODS: P. carinii cysts or trophozoites were detected in induced sputa by Giemsa stain or Gomori Methenamine silver (GMS) stain. A fragment of the Pneumocystis carinii mitochondrial large-subunit rRNA gene was amplified from sputum samples using a one-step PCR method with mt-rRNA primers. RESULTS: In this study, sputum samples from 16 patients with a clinical diagnosis of Pneumocystis carinii pneumonia (PCP) and 20 patients with other respiratory infections were first tested by cytochemical staining. Pneumocystis carinii was detected in 8 and 0 sputum samples from the two groups, respectively. The sensitivity and specificity of cytochemical stain were 50% and 100%. With the one-step mt-rRNA-PCR method, Pneumocystis carinii DNA was detected in 14 and 0 sputum samples from 16 PCP patients and 20 non-PCP patients. The sensitivity and specificity of mt-rRNA-PCR was 88% and 100%, respectively. CONCLUSIONS: The specificity of both Giemsa and GMS staining of induced sputum samples is high and the methods are simple, but the sensitivity is low. The sensitivity of PCR for P. carinii DNA from induced sputum samples is significantly higher than cytochemical stains, and the method is highly specific when used in the clinical diagnosis of PCP.

Modulation of astrocyte inducible nitric oxide synthase and cytokine expression by interferon beta is associated with induction and inhibition of interferon gamma-activated sequence binding activity.

Although interferon (IFN)-beta is firmly established as a therapeutic agent for multiple sclerosis, information regarding its role in astrocyte cytokine production is limited. In primary cultures of human astrocytes, we determined the effects of IFN-beta on astrocyte cytokine [tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6] and inducible nitric oxide synthase (iNOS) expression by ribonuclease protection assay and ELISA. We found that IFN-beta inhibited astrocyte cytokine/iNOS induced by IL-1 plus IFN-gamma, but in the absence of IFN-gamma, IFN-beta enhanced IL-1-induced cytokine/iNOS expression. Electrophoretic mobility shift analysis (EMSA) demonstrated that IFN-gamma induced sustained IFN-gamma-activated sequence (GAS) binding, while IFN-beta induced transient GAS binding. When used together, IFN-beta inhibited IFN-gamma-induced GAS binding activity. Nuclear factor-kappa B (NF-kappaB) activation was not altered by either IFNs, whereas IFN stimulated response element (ISRE) was only activated by IFN-beta and not IFN-gamma. These results suggest that IFN-beta can both mimic and antagonize the effect of IFN-gamma by modulating induction of nuclear GAS binding activity. Our results demonstrating differential regulation of astrocyte cytokine/iNOS induction by IFN-beta are novel and have implications for inflammatory diseases of the human CNS.

[Clinical characteristics and diagnosis of Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS)].

OBJECTIVE: To explore the clinical characteristics and the diagnostic methods for PCP in patients with AIDS. METHODS: Twelve cases of AIDS associated PCP confirmed by sputum polymerase chain reaction (PCR) were analyzed. RESULTS: Tuberculosis was found in 4 cases and pneumonia in 1 case of PCP. Sputum PCR was positive in all the 12 cases, of them blood PCR was positive in 9, Gomori methenamine silver stain (GMS) positive in 5 and Giemsa stain positive in 6 cases. The CD(4)(+) lymphocyte count was (5 approximately 155) x 10(6)/L, with a mean of (51 +/- 48) x 10(6)/L; the number of CD(4)(+) cells less than 100 x 10(6)/L in 10 cases (83%) with 9 cases (75%) less than 50 x 10(6)/L. The CD(4)(+)/CD(8)(+) ratio was 0.01 approximately 0.29. CONCLUSIONS: PCP was common in patients with advanced AIDS and often co-infected with other opportunistic infections such as tuberculosis. A diagnosis of PCP should be considered if sputum PCR is positive and typical clinical manifestations are present in patients with AIDS.