Thoracic ultrasonic narration of Covid-19 pneumonia.

Covid-19 (SARS-CoV-2) is a new coronavirus. Since the declaration of a global pandemic, a lot has been learnt about its spread, disease pattern, diagnosis and management. The lungs remain the prime organs to incur serious insult and when lung complications embark, significant morbidity and mortality is observed. Predominantly, patchy and peripheral lung distribution in the Covid-19 pneumonia has been described in the radiology experience and literature. There are a range of imaging modes useable in diagnosis, prognosis, monitoring, and therapy of Covid-19. However, when it comes to the appropriateness and the potential benefits of imaging, resource utilization and infectious risk must be considered. The use of ultrasound during this pandemic has provided us with an alternate imaging modality that is easily performed at the bedside, with real time images available to the clinician. This case highlights the role played by the thoracic ultrasound in the diagnosis and progression of Covid-19 pneumonia.

Author Correction: Metallacyclic actinide catalysts for dinitrogen conversion to ammonia and secondary amines.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Metallacyclic actinide catalysts for dinitrogen conversion to ammonia and secondary amines.

Chemists have spent over a hundred years trying to make ambient temperature/pressure catalytic systems that can convert atmospheric dinitrogen into ammonia or directly into amines. A handful of successful d-block metal catalysts have been developed in recent years, but even binding of dinitrogen to an f-block metal cation is extremely rare. Here we report f-block complexes that can catalyse the reduction and functionalization of molecular dinitrogen, including the catalytic conversion of molecular dinitrogen to a secondary silylamine. Simple bridging ligands assemble two actinide metal cations into narrow dinuclear metallacycles that can trap the diatom while electrons from an externally bound group 1 metal, and protons or silanes, are added, enabling dinitrogen to be functionalized with modest but catalytic yields of six equivalents of secondary silylamine per molecule at ambient temperature and pressure.

A tetranuclear samarium(ii) inverse sandwich from direct reduction of toluene by a samarium(ii) siloxide.

The dinuclear SmII complex, [Sm2L4(dme)] (L = OSi(OtBu)3), is easily obtained from the protonolysis reaction of [Sm{N(SiMe3)2}(thf)2] with HOSi(OtBu)3. This complex reacts slowly with toluene, resulting in the isolation of the triple-decker arene-bridged SmII complex, [{Sm2L3}2(µ-η6:η6-C7H8)], in 44% yield. This reactivity provides the first example of unambiguous arene reduction by an isolated SmII species. In contrast, reduction of [SmL3]2 afforded the inverse sandwich complex, [{KSmL3}2(µ-η6:η6-C7H8)].

Reduction of a Cerium(III) Siloxide Complex To Afford a Quadruple-Decker Arene-Bridged Cerium(II) Sandwich.

Organometallic multi-decker sandwich complexes containing f-elements remain rare, despite their attractive magnetic and electronic properties. The reduction of the CeIII siloxide complex, [KCeL4 ] (1; L=OSi(OtBu)3 ), with excess potassium in a THF/toluene mixture afforded a quadruple-decker arene-bridged complex, [K(2.2.2-crypt)]2 [{(KL3 Ce)(µ-η6 :η6 -C7 H8 )}2 Ce] (3). The structure of 3 features a [Ce(C7 H8 )2 ] sandwich capped by [KL3 Ce] moieties with a linear arrangement of the Ce ions. Structural parameters, UV/Vis/NIR data, and DFT studies indicate the presence of CeII ions involved in δ bonding between the Ce cations and toluene dianions. Complex 3 is a rare lanthanide multi-decker complex and the first containing non-classical divalent lanthanide ions. Moreover, oxidation of 1 by AgOTf (OTf=O3 SCF3 ) yielded the CeIV complex, [CeL4 ] (2), showing that siloxide ligands can stabilize Ce in three oxidation states.

Metathesis of a UV imido complex: a route to a terminal UV sulfide.

Herein, we report the synthesis and characterisation of the first terminal uranium(v) sulfide and a related UV trithiocarbonate complex supported by sterically demanding tris(tert-butoxy)siloxide ligands. The reaction of the potassium-bound UV imido complex, [U(NAd){OSi(OtBu)3}4K] (4), with CS2 led to the isolation of perthiodicarbonate [K(18c6)]2[C2S6] (6), with concomitant formation of the UIV complex, [U{OSi(OtBu)3}4], and S[double bond, length as m-dash]C[double bond, length as m-dash]NAd. In contrast, the reaction of the UV imido complex, [K(2.2.2-cryptand)][U(NAd){OSi(OtBu)3}4] (5), with one or two equivalents of CS2 afforded the trithiocarbonate complex, [K(2.2.2-cryptand)][U(CS3){OSi(OtBu)3}4] (7), which was isolated in 57% yield, with concomitant elimination of the admantyl thiocyanate product, S[double bond, length as m-dash]C[double bond, length as m-dash]NAd. Complex 7 is likely formed by fast nucleophilic addition of a UV terminal sulfide intermediate, resulting from the slow metathesis reaction of the imido complex with CS2, to a second CS2 molecule. The addition of a solution of H2S in thf (1.3 eq.) to 4 afforded the first isolable UV terminal sulfide complex, [K(2.2.2-cryptand)][US{OSi(OtBu)3}4] (8), in 41% yield. Based on DFT calculations, triple-bond character with a strong covalent interaction is suggested for the U-S bond in complex 7.

Outcomes of adjustable strabismus surgery in an Irish University Hospital.

PURPOSE: Strabismus surgery aims to improve binocular vision, reduce diplopia, and enhance cosmesis. Adjustable strabismus procedures have been developed as a means of tackling unpredictability in some post-operative results. The purpose of the study was to compare the effectiveness of adjustable and non-adjustable squint procedures in the treatment of strabismus. METHODS: We analyzed adjustable or non-adjustable squint surgery undergone in our Irish locality by retrospectively studying 27 consecutive patients at Mater Misericordiae University Hospital, Dublin. RESULTS: There was no significant difference (p = 0.519) in the mean post-operative horizontal deviation between the adjustable group (mean = 11.6 PD) and the non-adjustable group (mean = 15.3 PD). We found that adjustable procedures resulted in a trend (p = 0.050) towards a greater mean horizontal effect per muscle (18.9 PD per muscle) than non-adjustable procedures (mean 9.7 PD). We went on to analyze the adjustable group in order to determine the impact on outcome in those patients in whom their adjustable sutures were manipulated postoperatively. Of the 11 patients who underwent adjustable procedures, 6 subsequently had adjustments made as planned and 5 did not require adjustment. Those patients who had their sutures adjusted demonstrated a smaller mean post-operative deviation (8.5 PD) than those patients in whom their suture was not adjusted (mean = 16.3 PD). CONCLUSION: Our study displays a trend that adjustable procedures are more effective in terms of the mean horizontal effect per muscle operated, and is a novel way of reporting effectiveness of strabismus procedures.

Activation of SO2 by [Zn(Cp*)2] and [(Cp*)ZnI-ZnI(Cp*)].

Interesting reactivity was observed in reactions of SO2 with [Zn(Cp*)2] and [(Cp*)ZnI-ZnI(Cp*)]. These reactions proceeded with insertion of SO2 into the Zn-C bonds. Spectacularly, the lability of the C-S bond in the O2SCp* ligands led to the thermal decomposition of [Zn(O2SCp*)2(tmeda)] to afford [Zn2(µ-SO3)(µ-S2O4)(tmeda)2].

Early-Late Heterometallic Complexes of Gold and Zirconium: Photoluminescence and Reactivity.

OH functionalized triarylphosphines were used to assemble zirconocene-based metalloligands with phosphine donor sites in varying positions. These complexes were subsequently treated with different gold precursors to obtain early-late heterometallic compounds in which the metal atoms exhibit different intermetallic distances. All compounds were fully investigated by spectroscopic techniques, photoluminescence measurements and single crystal X-ray diffraction. Quantum chemical calculations were also performed. Some compounds show bright emission even at room temperature with quantum yields of up to 19 % (excitation at 350 nm). Furthermore, the reactivity of dimethyl zirconocene derivatives towards gold complexes was investigated, revealing simultaneous ligand exchange and transmetallation reactions.

Exploring the effect of the Ln(III)/Ln(II) redox potential on C-F activation and on oxidation of some lanthanoid organoamides.

The divalent europium complexes, and (L(Me/Et) = p-HC6F4N(CH2)2NMe2/Et2), have been prepared from redox-transmetallation/protolysis (RTP) reactions between Eu metal, Hg(C6F5)2 and L(Me/Et)H in thf. The complexes exhibit close (C)F-Ln interactions and the amide ligands feature tridentate N,N',F chelation. The complexes are thermally robust but on exposure to light they undergo C-F activation. From exposure of to light, the Eu(III) mixed fluoride/oxide cluster, was isolated, but other well-defined C-F activation products have proven elusive due to the stability of Eu(II). Oxidation of [Ln(L(R))2(thf)2] (Ln = Eu, R = Me; Ln = Yb, R = Et) with I2 afforded the heteroleptic iodo complexes, [Ln(L(R))2I(thf)n] (Ln = Eu, n = 1; Ln = Yb, n = 0), and the homoleptic complexes, [Ln(L(R))3]. The formation of the iodo complexes and the heteroleptic complexes appear to occur by different routes. shows interesting structural differences from reported [Ln(L(Et))3] (Ln = La, Ce, Nd) complexes, and highlights an incomplete shift towards N,N' chelation to the much smaller Yb ion. was prepared from a protolysis reaction between [Sm(CH2C6H4-NMe2-o)3] and L(Me)H. Heating a solution of in toluene at 110 °C for three days did not afford any samarium fluoride complex. An RTP reaction with Sm afforded the heteroleptic samarium complex, , in very low yield. From an attempted protolysis reaction between [Sm(DippForm)2(thf)2] and L(Me)H, the mixed ligand samarium fluoride complex, , was isolated. Overall, the instability of Sm(II) precludes control over the C-F activation reactions.

Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method.

BACKGROUND: The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression. OBJECTIVE: The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position. DESIGN: An interrater and intratester reliability and validity study was conducted. METHODS: Testing was conducted on the same day by 2 physical therapists who were blinded to each other's results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity. RESULTS: For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were <0.9 mm, <2.5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method. LIMITATION: The results of this study are limited to static measurement of the scapula in one plane. CONCLUSION: Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.

Thyroid-like ophthalmopathy in a euthyroid patient receiving Ipilimumab.

A 68-year-old lady with metastatic malignant melanoma was treated with Ipilimumab. She presented to Eye Casualty unable to move her eyes. Physical examination confirmed ophthalmoplegia and identified proptosis bilaterally. Radiological imaging showed bilateral enlargement of all the extra-ocular muscles suggestive of thyroid eye disease. Laboratory investigations found this patient to be euthyroid. A diagnosis of thyroid-like orbitopathy secondary to Ipilimumab therapy was made. Thyroid function tests should be performed for all patients prior to their commencement of Ipilimumab. Thyroid-like eye disease may develop in patients treated with Ipilimumab even if they remain euthyroid.

Predictors of 10-year pancreas allograft survival after simultaneous pancreas and kidney transplantation.

OBJECTIVE: This study aimed to identify the preoperative, perioperative, and postoperative factors affecting 10-year pancreas allograft survival after simultaneous pancreas and kidney (SPK) transplantation. METHODS: Analysis was performed on a prospectively maintained database of 56 SPK transplants consecutively performed between January 1992 and October 2002. The definition cutoff points of specific variables were obtained by the receiver operating characteristic curve and multiple logistic regression analyses that were performed to determine the predictors of pancreas allograft survival after 10 years. RESULTS: In total, 44 (79%) patients had an overall survival of more than 10 years, and the overall 10-year pancreas allograft survival rate was 57% (n = 32/56). The significant predictors for pancreas allograft failure in 10 years and above were kidney allograft failure (P = 0.04), serum creatinine 1 year postoperatively (P = 0.002), and serum hemoglobin A1c (HbA1c) level 2 years postoperatively (P = 0.003). A serum creatinine cutoff value of more than 129 µmol/L at 1 year was 87.5% sensitive and 70% specific for predicting pancreas allograft failure at 10 years. Serum HbA1c of more than 5.6% at 2 years was 85.7% sensitive and 62.5% specific for predicting pancreas allograft failure at 10 years. On multivariate analysis, 129 µmol/L and above of serum creatinine and more than 5.6% of serum HbA1c were the independent predictors of pancreas allograft failure at 10 years. CONCLUSIONS: These findings may provide important information for identifying patients at risk for long-term pancreas allograft failure after SPK transplantation.

Selective arterial embolisation of bilateral angiomyolipomata in a symptomatic pregnant female.

Renal angiomyolipoma (RA) is a rare benign tumour that can expand rapidly during pregnancy due to oestrogen and other hormonal factors. Complications associated with expanding renal angiomyolipomata are spontaneous retroperitoneal haemorrhage secondary to acute rupture and thrombosis of the renal vein or inferior vena cava. MRI is recommended for diagnostic purposes in pregnancy; however, this modality is not always readily available. In the present report, we describe the first case of bilateral selective arterial embolisation for renal angiomyolipomata presenting symptomatically in a previously healthy pregnant female.

Thrombosed prosthetic valve in Ebstein's anomaly: Evaluation with echocardiography and 64-slice cardiac computed tomography.

Ebstein's anomaly (EA) is a rare cardiac congenital malformation with displacement of septal and posterior tricuspid leaflets, resulting in atrialization of the right ventricle. We report a case of EA in which the etiology of a malfunctioning prosthetic tricuspid valve is depicted on cardiac computed tomography to be as a result of thrombus lodged in the valve.

The effects of light lanthanoid elements (La, Ce, Nd) on (Ar)CF-Ln coordination and C-F activation in N,N-dialkyl-N'-2,3,5,6-tetrafluorophenylethane-1,2-diaminate complexes.

A new class of homoleptic organoamido rare earth complexes [Ln(L(Me) or L(Et))(3)] (Ln = La, Ce, Nd; L(Me/Et) = p-HC(6)F(4)N(CH(2))(2)NMe(2)/Et(2)) exhibiting (Ar)CF-Ln interactions has been isolated from redox-transmetallation/protolysis (RTP) reactions between the free metals, Hg(C(6)F(5))(2) and L(Me/Et)H in tetrahydrofuran, together with low yields of [Ln(L(Me))(2)F](3) (Ln = La, Ce) or [Nd(L(Et))(2)F](2) species, resulting from C-F activation reactions. The structures of the homoleptic complexes have eight-coordinate Ln metals with two tridentate (N,N',F) amide ligands including (Ar)CF-Ln bonds and either a bidentate (N,F) ligand (Ln = La, Ce, Nd; L(Et)) or a bidentate (N,N') ligand (Ln = Nd; L(Me)), in an unusual case of linkage variation. All (Ar)CF-Ln bond lengths are shorter than or similar to the corresponding Ln-NMe(2)/Et(2) bond lengths. In [Ln(L(Me))(2)F](3) (Ln = La, Ce) complexes, there is a six-membered ring framework with alternating F and Ln atoms and the metal atoms are eight-coordinate with two tridentate (N,N',F) L(Me) ligands, whilst [Nd(L(Et))(2)F](2) is a fluoride-bridged dimer.

A welfare benefits outreach project to users of community mental health services.

BACKGROUND: Many psychiatric service users are entitled to welfare benefits, but work from the UK and the USA suggests many are either unaware of their entitlements or find the benefits system difficult to access. AIMS: This study has four aims: 1) to assess the extent to which people using a range of community mental health services receive the welfare benefits to which they are entitled; 2) to calculate the impact on income of receiving help from specialist benefits advisors; 3) to ascertain sociodemographic risk factors for under-claiming; and 4) to identify reasons for under-claiming related to the claims system itself, in order to make recommendations for routine practice. METHODS: This report makes use of data collected during a welfare benefit uptake project by Mind in Croydon staff (MF-G, RO, RP). Benefit assessments were offered to a total of 153 people attending any Croydon resource centre (run by the Health Service) other than the pilot site, or day centre (run by Social Services) for people with mental health problems. All those who were identified as under-claiming were offered help pursuing claims through to conclusion. We used quantitative methods to address the first three aims; qualitative methods in the form of case studies were used to address the fourth. RESULTS: One-third (34%) of people seen were getting their correct entitlement and two-thirds (66%) were under-claiming. All those found to be under-claiming who accepted all the help offered (87 out of 99 underclaimants) did gain additional benefits as a result, of a mean annual amount of pound 3079 each. Under-claiming was more frequent in those under 65 years of age, but having had previous advice or having a care manager did not protect against under-claiming. A number of reasons for under-claiming were identified. CONCLUSIONS: For a large and possibly increasing proportion of people using community mental health services, the current benefits system necessitates frequent advice and help by expert advisers to avoid poverty due to underclaiming. The adverse effects on quality of life and mental health may be significant, as are the economic implications of correcting this level of under-claiming.