Posterior Reversible Leucoencephalopathy Syndrome: Case Series, Comments, and Diagnostic Dilemma.

PURPOSE OF REVIEW: To report a series of patients with clinical and radiological features suggestive of posterior reversible encephalopathy syndrome (PRES) related to diverse etiologies emphasizing its pathophysiological basis. RECENT FINDINGS: Posterior reversible encephalopathy syndrome (PRES) may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation. Typical imaging findings include posterior-circulation predominant vasogenic edema. Although there are many well-documented diseases associated with PRES, the exact pathophysiologic mechanism has yet to be fully elucidated. Generally accepted theories revolve around disruption of the blood-brain barrier secondary to elevated intracranial pressures or endothelial injury induced by ischemia from a vasoconstrictive response to rising blood pressure or toxins/cytokines. While clinical and radiographic reversibility is common, long-standing morbidity and mortality can occur in severe forms. In patients with malignant forms of PRES, aggressive care has markedly reduced mortality and improved functional outcomes. Various factors that have been associated with poor outcome include altered sensorium, hypertensive etiology, hyperglycemia, longer time to control the causative factor, elevated C reactive protein, coagulopathy, extensive cerebral edema, and hemorrhage on imaging. Reversible cerebral vasoconstriction syndromes (RCVS) and primary angiitis of the central nervous system (PACNS) are invariably considered in the differential diagnosis of new cerebral arteriopathies. Recurrent thunderclap headache (TCH), and single TCH combined with either normal neuroimaging, border zone infarcts, or vasogenic edema, have 100% positive predictive value for diagnosing RCVS or RCVS-spectrum disorders. Diagnosis of PRES in some circumstances can be challenging and structural imaging may not be sufficient to distinguish it from other differential diagnostic considerations like ADEM. Advanced imaging techniques, such as MR spectroscopy or positron emission tomography (PET) can provide additional information to determine the diagnosis. Such techniques are more useful to understand the underlying vasculopathic changes in PRES and may answer some of the unresolved controversies in pathophysiology of this complex disease. Eight patients with PRES resulting from different etiologies varying from pre-eclampsia/eclampsia, post-partum headache with seizures, neuropsychiatric systemic lupus erythematosus, snake bite, Dengue fever with encephalopathy, alcoholic liver cirrhosis with hepatic encephalopathy, and lastly reversible cerebral vasoconstriction syndrome (RCVS). Additionally, a diagnostic dilemma between PRES and acute disseminated encephalomyelitis (ADEM) was notable in one patient. Some of these patients did not have or only very transiently had arterial hypertension. PRES may underlie the clinical conundrum of headache, confusion, altered sensorium, seizures, and visual impairment. PRES need not necessarily be always associated with high blood pressure. Imaging findings may also be variable. Both clinicians and radiologists need to familiarize themselves with such variabilities.

Assessment of organic shrimp farming sustainability from economic and environmental viewpoints in Bangladesh.

The study assessed the economic, environmental and sustainability issues of organic shrimp farming in Bangladesh. Following stratified random sampling technique, 60 farmers were interviewed from several villages of Assasuni upazila under Satkhira district. The study revealed that productivity of organic shrimp per hectare was 383 pound and benefit cost ratio was 1.91 which meant that organic shrimp farming was highly profitable. Educational level of household head, gher size and knowledge on organic shrimp production had positive and significant influence in adopting organic shrimp production by the farmers. Cause-effect-mitigation analysis pointed out that organic shrimp farming could mitigate the adverse effects on environment caused by traditional shrimp farming. Appropriate climate and environment for organic shrimp culture was found as major strength and comparative profitability than traditional shrimp production was found as major opportunity of organic shrimp production. The study confirmed sustainability of organic shrimp production from the standpoint of consuming energy, protecting environment, economic feasibility and social/political equity. The study recommends that farmers should be trained to follow the work instructions and principles of organic shrimp production and the application of good management practices (GMPs) should be ensured for reducing the disease outbreak risk.

Embedding Fe(0) electrocoagulation in a biologically active As(III) oxidising filter bed.

Long-term consumption of groundwater containing elevated levels of arsenic (As) can have severe health consequences, including cancer. To effectively remove As, conventional treatment technologies require expensive chemical oxidants to oxidise neutral arsenite (As(III)) in groundwater to negatively charged arsenate (As(V)), which is more easily removed. Rapid sand filter beds used in conventional aeration-filtration to treat anaerobic groundwater can naturally oxidise As(III) through biological processes but require an additional step to remove the generated As(V), adding complexity and cost. This study introduces a novel approach where As(V), produced through biological As(III) oxidation in a sand filter, is effectively removed within the same filter by embedding and operating an iron electrocoagulation (FeEC) system inside the filter. Operating FeEC within the biological filter achieved higher As(III) removal (81 %) compared to operating FeEC in the filter supernatant (67 %). This performance was similar to an analogous embedded-FeEC system treating As(V)-contaminated water (85 %), confirming the benefits of incorporating FeEC in a biological bed for comparable As(III) and As(V) removal. However, operating FeEC in the sand matrix consumed more energy (14 Wh/m3) compared to FeEC operated in a water matrix (7 Wh/m3). The efficiency of As removal increased and energy requirements decreased in such embedded-FeEC systems by deep-bed infiltration of Fe(III)-precipitates, which can be controlled by adjusting flow rate and pH. This study is one of the first to demonstrate the feasibility of embedding FeEC systems in sand filters for groundwater arsenic removal. Such systems capitalise on biological As(III) oxidation in aeration-filtration, effectively eliminating As(V) within the same setup without the need for chemicals or major modifications.

Heterolytic tide-dominated sedimentary facies and depositional environment: An Example from the Boka Bil formation, Sitapahar anticline, Bangladesh.

The Baraichari Shale Formation, which is equivalent to the Boka Bil Formation, is well exposed within the Neogene sequence of the Sitapahar Anticline in the Chittagong-Tripura Fold Belt, Bengal Basin, Bangladesh. Regardless of its importance in hydrocarbon accumulation, a comprehensive facies analysis is essential to understand and explain the heterogeneity within different depositional architectural elements. The purpose of this work is to delineate the lithofacies characteristics, depositional environment heterogeneities and propose a generic depositional model for the Middle to Late Miocene shallow marine sediments of the formation. The sedimentary facies were investigated at three outcrops along the Kaptai-Chandraghona road cut sections of the Sitapahar anticline. The formation is composed of dark to bluish-gray shale, silty shale, yellowish brown siltstone, and gray to yellowish brown fine-to medium-grained sandstone. Eight distinct sedimentary facies have been identified and were categorized into three facies associations: subtidal or estuarine, mixed flats with tidal creeks, and tidal mud flats. The subtidal facies, predominant in the middle member, consists of fine to medium-grained ripple cross-stratified sandstone-siltstone, herringbone cross-stratified sandstone, and trough cross-stratified sandstone, indicating sub-tidal channel deposition. Mixed flats with tidal creeks exhibit heterolithic facies, suggesting energy level changes in intertidal to sub-tidal zones influenced by tidal currents. Tidal mud flats are predominantly laminated shale/mudstone and lenticular laminated sandstone-siltstone, reflecting deposition during tide transitions in the intertidal zone. Fining upward cycles within the formation indicate progressive progradation or changes in inner tidal flats conditions during regressive periods. These depositional settings serve as analogs for equivalent subsurface reservoirs and contribute to the construction of reservoir models with greater accuracy.

Groundwater-native Fe(II) oxidation prior to aeration with H2O2 to enhance As(III) removal.

Groundwater contaminated with arsenic (As) must be treated prior to drinking, as human exposure to As at toxic levels can cause various diseases including cancer. Conventional aeration-filtration applied to anaerobic arsenite (As(III)) contaminated groundwater can remove As(III) by co-oxidizing native iron (Fe(II)) and As(III) with oxygen (O2). However, the As(III) removal efficiency of conventional aeration can be low, in part, because of incomplete As(III) oxidation to readily-sorbed arsenate (As(V)). In this work, we investigated a new approach to enhance As(III) co-removal with native Fe(II) by the anaerobic addition of hydrogen peroxide (H2O2) prior to aeration. Experiments were performed to co-oxidize Fe(II) and As(III) with H2O2 (anaerobically), O2 (aerobically), and by sequentially adding of H2O2 and O2. Aqueous As(III) and As(V) measurements after the reaction were coupled with solid-phase speciation by Fe and As K-edge X-ray absorption spectroscopy (XAS). We found that complete anaerobic oxidation of 100 µM Fe(II) with 100 µM H2O2 resulted in co-removal of 95% of 7 µM As(III) compared to 44% with 8.0-9.0 mg/L dissolved O2. Furthermore, we found that with 100 µM Fe(II), the initial Fe(II):H2O2 ratio was a critical parameter to remove 7 µM As(III) to below the 10 µg/L (0.13 µM) WHO guideline, where ratios of 1:4 (mol:mol) Fe(II):H2O2 led to As(III) removal matching that of 7 µM As(V). The improved As(III) removal with H2O2 was found to occur partly because of the well-established enhanced efficiency of As(III) oxidation in Fe(II)+H2O2 systems relatively to Fe(II)+O2 systems. However, the XAS results unambiguously demonstrated that a large factor in the improved As(III) removal was also due to a systematic decrease in crystallinity, and thus increase in specific surface area, of the generated Fe(III) (oxyhydr)oxides from lepidocrocite in the Fe(II)+O2 system to poorly-ordered Fe(III) precipitates in the Fe(II)+H2O2 system. The combined roles of H2O2 (enhanced As(III) oxidation and structural modification) can be easily overlooked when only aqueous species are measured, but this dual impact must be considered for accurate predictions of As removal in groundwater treatment.

Integrating biological As(III) oxidation with Fe(0) electrocoagulation for arsenic removal from groundwater.

Arsenic (As) is a toxic element present in many (ground)water sources in the world. Most conventional As removal techniques require pre-oxidation of the neutral arsenite (As(III)) species to the negatively charged arsenate (As(V)) oxyanion to optimize As removal and minimize chemical use. In this work, a novel, continuous-flow As removal system was developed that combines biological As(III) oxidation by bacteria with Fe electrocoagulation (EC), an Fe(0)-based electrochemical technology that generates reactive Fe(III) precipitates to bind As. The bio-integrated FeEC system (bio-FeEC) showed effective oxidation and removal of 150 µg/L As(III), without the need of chemicals. To remove As to below the WHO guideline of 10 µg/L, 10 times lower charge dosage was required for the bio-FeEC system compared to conventional FeEC. This lower Fe dosage requirement reduced sludge production and energy consumption. The As(III) oxidizing biomass was found to consist of bacteria belonging to Comamonadaceae, Rhodobacteraceae and Acidovorax, which are capable of oxidizing As(III) and are common in drinking water biofilms. Characterization of the As-laden Fe solids by X-ray absorption spectroscopy indicated that both bio-FeEC and conventional FeEC produced solids consistent with a mixture of lepidocrocite and 2-line ferrihydrite. Arsenic bound to the solids was dominantly As(V), but a slightly higher fraction of As(V) was detected in the bio-FeEC solids compared to the conventional FeEC.

Is stroke increasing in India--preventive measures that need to be implemented.

Stroke is the third commonest cause of mortality after heart disease and cancer. It is generally the disease of the aged. Prevalence rates of stroke very from one study to another. However, there has been a definite increase in the prevalence and incidence of stroke disorder in India over the last 30 years. Diabetes, smoking, hyperlipidaemia, hypertension are some of the risk factors found in stroke. To curb the rising trend of stroke in India, the two principal risk factors ie, hypertension and diabetes mellitus need to be strictly brought under control. The change in dietary habit to reduce intake of solid fat and complete cessation of smoking and chewing tobacco need also to be encouraged. Public awareness campaigns and health educations are most important part to combat increasing trend of stroke.