Subacute Gummy Vitamin Overdose as a Rare Manifestation of Child Neglect.

ABSTRACT: We present a case of a 20-month-old girl who presented to the emergency department with anorexia, progressive weakness, and lethargy who was found to have severe hypercalcemia (20.7 mg/dL) and vitamin D hypervitaminosis. Further questioning revealed that this was secondary to a subacute toxic ingestion of "L'il Critters" calcium and vitamin D3 gummy vitamins that were being administered by the patient's mother multiple times a day for several weeks or even months. This occurred in the setting of child neglect due to the mother's mental illness. The patient required intensive care unit admission and had a prolonged hospital course complicated by hypomagnesemia, hyperphosphatemia, weight loss, and persistent weakness. Her hypercalcemia was initially refractory to standard treatment of intravenous fluids, prednisone, multiple trials of calcitonin, and zoledronic acid. Our patient had the highest calcium level we are aware of in a toddler and is the only case we know of that occurred as a result of a prolonged, intentional exposure in the setting of child neglect and a complex social situation. This case reviews the causes and management of hypercalcemia and vitamin D intoxication. It also highlights the need for a comprehensive social history and exposes the vulnerabilities of children living in homes afflicted by parental depression and severe mental illness.

Mortality events resulting from Australia's catastrophic fires threaten aquatic biota.

The consequences of the 2019-2020 bushfires in Australia were also devastating for the aquatic biota. Following abnormal rainfall events in burnt areas, widespread mortality events including fish and invertebrates were recorded in estuarine and freshwater systems. Such negative impacts on aquatic resources highlight the need to include these ecosystems in bushfire recovery plans. Management should prioritise catchments at higher risks of further negative impacts and research must be conducted to understand the efficacy of actions post-fire.

Duration of the Presence of Infectious Zika Virus in Semen and Serum.

Zika virus (ZIKV) has recently caused a large epidemic in the Americas that is associated with birth defects. Although ZIKV is primarily transmitted by Aedes mosquitoes, ZIKV RNA is detectable in blood and semen of infected individuals for weeks or months, during which sexual and other modes of transmission are possible. However, viral RNA is usually detectable longer than infectious virus is present. We determined the frequency of isolation of infectious virus from semen and serum samples prospectively obtained from a cohort of patients in Puerto Rico. We confirmed isolation of infectious virus on the basis of a tissue culture cytopathic effect, an increase in virus genome copy equivalents (GCE), and positive results of immunofluorescence analysis; virus in infected cells was quantitated by flow cytometry. These criteria confirmed the presence of infectious virus in semen specimens from 8 of 97 patients for up to 38 days after initial detection when virus loads are >1.4 × 106 genome copy equivalents/mL. Two serum isolates were obtained from 296 patients. These findings can help guide important prevention guidelines for persons that may potentially be infectious and transmit ZIKV sexually.

Survival estimates across five life stages of redfin (Perca fluviatilis) exposed to simulated pumped-storage hydropower stressors.

The global prevalence of pumped-storage hydropower (PSH) is expected to grow exponentially as countries transition to renewable energy sources. Compared to conventional hydropower, little is currently known regarding PSH impacts on aquatic biota. This study estimated the survival of five life stages (egg, two larval stages, juvenile and adult) of redfin (European) perch (Perca fluviatilis) following passage through a PSH facility during the pumping phase. This was achieved by simulating the individual stressors expected to occur during passage through a 2000-MW PSH facility using laboratory-simulated (shear strain and extreme compression) and modelling (blade strike, BS) approaches. Our results indicate that redfin could survive the shear, pressure and BS stressors expected within the PSH facility, but impacts varied among life stages. Juvenile survival was >70% across all shear strain rates, while the survival of eggs and larvae declined markedly as strain rate increased. All life stages had high survival when exposed to rapid compression and BS. The high survival of redfin to the stressors tested suggests the PSH facility could facilitate the passage of redfin during the pumping phase from the lower to the higher elevation reservoir. This outcome would be welcomed in situations where the species is native, but could have adverse implications for the conservation of native biota where the species is considered a pest.

Isolation of a highly thermal stable lama single domain antibody specific for Staphylococcus aureus enterotoxin B.

BACKGROUND: Camelids and sharks possess a unique subclass of antibodies comprised of only heavy chains. The antigen binding fragments of these unique antibodies can be cloned and expressed as single domain antibodies (sdAbs). The ability of these small antigen-binding molecules to refold after heating to achieve their original structure, as well as their diminutive size, makes them attractive candidates for diagnostic assays. RESULTS: Here we describe the isolation of an sdAb against Staphyloccocus aureus enterotoxin B (SEB). The clone, A3, was found to have high affinity (Kd = 75 pM) and good specificity for SEB, showing no cross reactivity to related molecules such as Staphylococcal enterotoxin A (SEA), Staphylococcal enterotoxin D (SED), and Shiga toxin. Most remarkably, this anti-SEB sdAb had an extremely high Tm of 85°C and an ability to refold after heating to 95°C. The sharp Tm determined by circular dichroism, was found to contrast with the gradual decrease observed in intrinsic fluorescence. We demonstrated the utility of this sdAb as a capture and detector molecule in Luminex based assays providing limits of detection (LODs) of at least 64 pg/mL. CONCLUSION: The anti-SEB sdAb A3 was found to have a high affinity and an extraordinarily high Tm and could still refold to recover activity after heat denaturation. This combination of heat resilience and strong, specific binding make this sdAb a good candidate for use in antibody-based toxin detection technologies.

Millennial scale persistence of organic carbon bound to iron in Arctic marine sediments.

Burial of organic material in marine sediments represents a dominant natural mechanism of long-term carbon sequestration globally, but critical aspects of this carbon sink remain unresolved. Investigation of surface sediments led to the proposition that on average 10-20% of sedimentary organic carbon is stabilised and physically protected against microbial degradation through binding to reactive metal (e.g. iron and manganese) oxides. Here we examine the long-term efficiency of this rusty carbon sink by analysing the chemical composition of sediments and pore waters from four locations in the Barents Sea. Our findings show that the carbon-iron coupling persists below the uppermost, oxygenated sediment layer over thousands of years. We further propose that authigenic coprecipitation is not the dominant factor of the carbon-iron bounding in these Arctic shelf sediments and that a substantial fraction of the organic carbon is already bound to reactive iron prior deposition on the seafloor.

High prevalence of disability and HIV risk among low socioeconomic status urban adults, 17 U.S. cities.

BACKGROUND: In the United States, approximately 10% of adults 18-64 years are disabled. However, there is scarce literature on the associations between disability and HIV risk. OBJECTIVE: To assess disability prevalence and its associations to health and HIV risk factors among low socioeconomic status (SES) (≤high school education or ≤ poverty guidelines) urban adults. METHODS: We assessed disability prevalence from a cross-sectional sample of low SES urban heterosexually active adults at risk for HIV participating in the 2016 National HIV Behavioral Surveillance (NHBS) and calculated crude and adjusted prevalence ratios and 95% confidence intervals of disability for health and HIV risk behaviors. RESULTS: In the NHBS sample, 39.6% of participants reported any disability. Disability was associated with health care utilization and risk behaviors, even when adjusting for demographics. Participants with disabilities were more likely to have condomless sex with a casual partner and engage in exchange sex. CONCLUSIONS: Low SES urban heterosexually active adults reported high prevalence of disabilities and differences in health, health care utilization, and risk factors. Disability might contribute to sexual risk behaviors that increase the likelihood of HIV infection. Further investigations into the intersection of disability and HIV risk are needed, especially in poor communities often excluded from national assessments.

Predictors and Prevalence of Pain and Its Management in Four Regional Cancer Hospitals in India.

PURPOSE: More than 1 million new occurrences of cancer are diagnosed in India annually. Among patients with cancer, pain is a common and persistent symptom of the disease and its treatment. However, few studies to date have evaluated the prevalence of pain and the adequacy of pain management in Indian hospitals. This cross-sectional study aimed to assess the prevalence and sociodemographic patterns of cancer pain and pain management among a sample of inpatients and newly registered outpatients at four large regional cancer centers in India. METHODS: A sample of 1,600 patients with cancer who were current inpatients or newly registered outpatients were recruited and administered a questionnaire that was based on the Brief Pain Inventory. The survey tool included questions on demographics, medical history, and extent of clinical pain experienced. In addition, a pain management index score was created to link the severity of cancer pain with medication prescribed to treat it. RESULTS: A total of 88% of patients reported pain in the past 7 days, and approximately 60% reported that their worst pain was severe. Several demographic and medical characteristics of the study population predicted severe pain, including the following: lower educational level, outpatient status, and debt incurred as a result of illness. A total of 67% of patients were inadequately treated with analgesics. Inadequate pain management was associated with both treatment hospital and patient type, and patients who reported debt as a result of their illness were more likely to have inadequate pain management. CONCLUSION: A majority of Indian patients with cancer experience significant pain and receive inadequate pain management. Improvement of pain management for Indian patients with cancer is needed urgently.

Multiple factors predict physical performance in people with chronic liver disease.

OBJECTIVE: The aim of this study was to assess whether physical performance correlates with metabolic and inflammatory measures in research subjects with chronic liver disease. DESIGN: This is a prospective, descriptive cohort study correlating performance on a 6-min walk test with cardiorespiratory variables, metabolic measures (glucose [GLU], C-peptide insulin, and lipids), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and the proinflammatory cytokine interleukin-8 (IL-8). RESULTS: This study enrolled 51 subjects (18 women) with chronic liver disease: 41% (n = 21) with nonalcoholic fatty liver disease and 59% (n = 30) with hepatitis C virus. Age, resting heart rate, and fasting GLU correlated significantly with distance walked (P's < 0.05). First quartile "poor performers" (n = 14) and fourth quartile "high performers" (n = 14) showed differences in age, sex, fasting GLU, and IL-8 level (P's < 0.05). Combining the number of abnormal serum values (IL-8, C-peptide insulin, GLU, aspartate aminotransferase, alanine aminotransferase, high-density lipoprotein, triglyceride, and total cholesterol) did not correlate with distance walked (P > 0.90). However, in multiple regression analysis, a model that included sex, age, resting heart rate, IL-8 level, and fasting GLU level explained approximately 39% of the variance in the distance walked during the test. CONCLUSIONS: Older age, female sex, abnormal levels of the proinflammatory cytokine IL-8, abnormalities of GLU metabolism, and high resting heart rate are associated with poor physical performance in subjects with chronic liver disease. Poor physical performance is associated with physiologic, metabolic, and inflammatory abnormalities in subjects with nonalcoholic fatty liver disease and hepatitis C virus.