Mycoplasma pneumoniae Associated Acute Transverse Myelitis: An Atypical Clinical Presentation in an Adolescent Child.

We report an atypical case of a 15-year-old pediatric patient diagnosed with Mycoplasma pneumoniae associated acute transverse myelitis (ATM). The patient had no prodromal or pulmonary symptoms that are commonly associated with mycoplasma infection. Yet, the patient exhibited acute bilateral lower extremity paralysis, paresthesia, decreased sensation at the level of T11 and below, bowel and bladder dysfunction, and thrombocytopenia. Magnetic resonance imaging of the spinal cord revealed transverse myelitis from T10 to the end of the conus medullaris. The patient showed only slow clinical improvement despite therapy consisting of azithromycin, high-dose intravenous methylprednisolone, intravenous immunoglobulin, and plasmapheresis. This report calls attention to the importance of early identification of mycoplasma as an underlying cause of ATM and the potential consequences of delayed detection and treatment: more severe neurologic complications, prolonged hospitalization, and unfavorable clinical outcomes.

Serum Procalcitonin Level Is Associated with Positive Blood Cultures, In-hospital Mortality, and Septic Shock in Emergency Department Sepsis Patients.

This study examines the accuracy of initial and subsequent serum procalcitonin (PCT) levels in predicting positive blood cultures, in-hospital mortality, and development of septic shock in emergency department (ED) patients with severe sepsis. This study includes all patients who presented to our ED with an admission diagnosis of severe sepsis over a period of nine months. The median initial PCT was 0.58 ng/mL, interquartile range (IQR) 0.16-5.39. The median subsequent serum PCT was 2.1 ng/mL, with an IQR of 0.3-11.1. The PCT trend over the initial three hours increased in 67% of the study population. Blood cultures were positive in 38% of the cohort. The median maximum PCT in those with a negative blood culture was 1.06 ng/mL compared to 4.19 ng/mL in those with a positive blood culture (p=0.0116). Serum PCT levels >2.0 ng/mL display significant correlation with positive blood cultures, in-hospital mortality, and development of septic shock and as such may serve as a biomarker for more serious infections.

Quick Sepsis-related Organ Failure Assessment Versus Systemic Inflammatory Response Syndrome Criteria for Predicting Organ Dysfunction and Mortality.

The International Consensus Definition for Sepsis and Septic Shock Task Force has recently developed new methods to determine whether a patient is at risk for end organ failure after he has been suspected to have sepsis. One of the newest measures developed is a quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), and it is used to identify patients who are at risk of sepsis outside the intensive care unit. The systemic inflammatory response syndrome (SIRS) score has previously been the standard for determining a patient's sepsis risk and prognosis for future mortality. With the development of these new tools, it is imperative to compare qSOFA to SIRS in order to determine which method is best and under which circumstances. We conclude that according to evidence currently available, qSOFA has limited use for patients in the intensive care unit at the time of evaluation for predicting mortality and organ dysfunction. Furthermore, qSOFA outranks SIRS for patients in the emergency department except for SIRS delivering positive results more quickly.

"Insensitive" to touch: fabric-supported lubricant-swollen polymeric films for omniphobic personal protective gear.

The use of personal protective gear made from omniphobic materials that easily shed drops of all sizes could provide enhanced protection from direct exposure to most liquid-phase biological and chemical hazards and facilitate the postexposure decontamination of the gear. In recent literature, lubricated nanostructured fabrics are seen as attractive candidates for personal protective gear due to their omniphobic and self-healing characteristics. However, the ability of these lubricated fabrics to shed low surface tension liquids after physical contact with other objects in the surrounding, which is critical in demanding healthcare and military field operations, has not been investigated. In this work, we investigate the depletion of oil from lubricated fabrics in contact with highly absorbing porous media and the resulting changes in the wetting characteristics of the fabrics by representative low and high surface tension liquids. In particular, we quantify the loss of the lubricant and the dynamic contact angles of water and ethanol on lubricated fabrics upon repeated pressurized contact with highly absorbent cellulose-fiber wipes at different time intervals. We demonstrate that, in contrast to hydrophobic nanoparticle coated microfibers, fabrics encapsulated within a polymer that swells with the lubricant retain the majority of the oil and are capable of repelling high as well as low surface tension liquids even upon multiple contacts with the highly absorbing wipes. The fabric supported lubricant-swollen polymeric films introduced here, therefore, could provide durable and easy to decontaminate protection against hazardous biological and chemical liquids.

Snake co-occurrence patterns are best explained by habitat and hypothesized effects of interspecific interactions.

Snakes often occur in species-rich assemblages, and sympatry is thought to be facilitated primarily by low diet overlap, not interspecific interactions. We selected, a priori, three species pairs consisting of species that are morphologically and taxonomically similar and may therefore be likely to engage in interspecific, consumptive competition. We then examined a large-scale database of snake detection/nondetection data and used occupancy modelling to determine whether these species occur together more or less frequently than expected by chance while accounting for variation in detection probability among species and incorporating important habitat categories in the models. For some snakes, we obtained evidence that the probabilities that habitat patches are used are influenced by the presence of potentially competing congeneric species. Specifically, timber rattlesnakes (Crotalus horridus) were less likely than expected by chance to use areas that also contained eastern diamond-backed rattlesnakes (Crotalus adamanteus) when the proportion of evergreen forest was relatively high. Otherwise, they occurred together more often than expected by chance. Complex relationships were revealed between habitat use, detection probabilities and occupancy probabilities of North American racers (Coluber constrictor) and coachwhips (Coluber flagellum) that indicated the probability of competitive exclusion increased with increasing area of grassland habitat, although there was some model uncertainty. Cornsnakes (Pantherophis guttatus or Pantherophis slowinskii) and ratsnakes (Pantherophis alleghaniensis, Pantherophis spiloides, or Pantherophis obsoletus) exhibited differences in habitat selection, but we obtained no evidence that patterns of use for this species pair were influenced by current interspecific interactions. Overall, our results are consistent with the hypothesis that competitive interactions influence snake assemblage composition; the strength of these effects was affected by landscape-scale habitat features. Furthermore, we suggest that current interspecific interactions may influence snake occupancy, challenging the paradigm that contemporary patterns of snake co-occurrence are largely a function of diet partitioning that arose over evolutionary time.

Landscape-level influences of terrestrial snake occupancy within the southeastern United States.

Habitat loss and degradation are thought to be the primary drivers of species extirpations, but for many species we have little information regarding specific habitats that influence occupancy. Snakes are of conservation concern throughout North America, but effective management and conservation are hindered by a lack of basic natural history information and the small number of large-scale studies designed to assess general population trends. To address this information gap, we compiled detection/nondetection data for 13 large terrestrial species from 449 traps located across the southeastern United States, and we characterized the land cover surrounding each trap at multiple spatial scales (250-, 500-, and 1000-m buffers). We used occupancy modeling, while accounting for heterogeneity in detection probability, to identify habitat variables that were influential in determining the presence of a particular species. We evaluated 12 competing models for each species, representing various hypotheses pertaining to important habitat features for terrestrial snakes. Overall, considerable interspecific variation existed in important habitat variables and relevant spatial scales. For example, kingsnakes (Lampropeltis getula) were negatively associated with evergreen forests, whereas Louisiana pinesnake (Pituophis ruthveni) occupancy increased with increasing coverage of this forest type. Some species were positively associated with grassland and scrub/shrub (e.g., Slowinski's cornsnake, Elaphe slowinskii) whereas others, (e.g., copperhead, Agkistrodon contortrix, and eastern diamond-backed rattlesnake, Crotalus adamanteus) were positively associated with forested habitats. Although the species that we studied may persist in varied landscapes other than those we identified as important, our data were collected in relatively undeveloped areas. Thus, our findings may be relevant when generating conservation plans or restoration goals. Maintaining or restoring landscapes that are most consistent with the ancestral habitat preferences of terrestrial snake assemblages will require a diverse habitat matrix over large spatial scales.

Length of Acute-Care Hospitalization in Alzheimer's Disease.

The authors conducted a retrospective study of acute-care hospitalization over a 2-year period for patients diagnosed with Alzheimer's disease (AD). These patients were compared to an age- and gender-matched group of non-AD patients. AD patients had fewer admissions and fewer comorbid medical diagnoses, but had a significantly longer total length of hospital stay. Possible explanations for the increased length of stay and suggestions for further research are discussed.