Dipolar Interaction and Magneto-Viscoelasticity in Nanomagnetic Fluid

We investigate the effect of dilution on dipolar interaction with linear and non-linear rheological properties of kerosene based magnetic fluid. The steady-state behavior demonstrate a shear thinning behavior and corroborated with a power law, (η = c γ ˙ n + η∞) exponent, n ≤ 1. The shear-induced-breakup (separation) of nanoparticles and the yielding behavior has been explained by Bingham model. Moreover, the magnetoviscous effect showed an initial increase at low shear rate and decrease at higher shear rate. Further, specific viscosity (ηF)-versus-Mason number (Mn) shows a perfect scaling at lower Mn (≤10-4) confirming negligible thermal and colloidal forces. Whereas, at higher Mn (≥10-3) deviation from collapse indicates the dominance of Brownian forces acting on nanofluids. The magnetic field dependent elastic (G') and viscous (G″) modulus reveal a crossover from viscoelastic-to-viscous behavior of nanofluid at critical concentration. Finally, we compare viscoelastic results with De Gans diagonal scaling theory to correlate the functional dependence of storage and loss modules with different particle volume concentration.

Controlling a possible outbreak of Candida auris infection: lessons learnt from multiple interventions

BACKGROUND

Multidrug-resistant Candida auris infection has been reported from five continents in recent years. The prevalence of C. auris invasive infection has been estimated at 5.3% for intensive-care-acquired candidaemia in India. The transmission of the organism between the patients and from environment to patients is rapid.

AIM

To understand the intra-hospital dynamics of C. auris transmission and to determine the possible interventions to prevent its spread.

METHODS

Surveillance of intensive care units was carried out to assess patient colonization, environmental contamination and hand carriage of the yeast among healthcare workers. Interventions including chlorhexidine washing of patients and decontamination of environmental surfaces with stabilized hydrogen peroxide disinfectant (Ecoshield) were undertaken. We further evaluated the effectiveness of frequently used disinfectants in the hospital against C. auris on various inanimate surfaces, and its persistence on hospital fabrics.

FINDINGS

Three cases of C. auris bloodstream infection were detected over a period of three months. Many patients admitted at the same time, in the same area, were colonized by C. auris. Surveillance detected C. auris contamination of environmental surfaces and hands of healthcare workers. Interventions such as chlorhexidine washing and appropriate use of disinfectants could eradicate C. auris from patients and hospital environment.

CONCLUSION

The frequently used disinfectants in our hospital and current hand hygiene practices were efficient against C. auris if proper contact time and procedures were followed. Evaluation of possible persistence of C. auris on dry fabrics showed that they can persist for up to seven days.

Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome

BACKGROUND

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterized by unexplained persistent fatigue, commonly accompanied by cognitive dysfunction, sleeping disturbances, orthostatic intolerance, fever, lymphadenopathy, and irritable bowel syndrome (IBS). The extent to which the gastrointestinal microbiome and peripheral inflammation are associated with ME/CFS remains unclear. We pursued rigorous clinical characterization, fecal bacterial metagenomics, and plasma immune molecule analyses in 50 ME/CFS patients and 50 healthy controls frequency-matched for age, sex, race/ethnicity, geographic site, and season of sampling.

RESULTS

Topological analysis revealed associations between IBS co-morbidity, body mass index, fecal bacterial composition, and bacterial metabolic pathways but not plasma immune molecules. IBS co-morbidity was the strongest driving factor in the separation of topological networks based on bacterial profiles and metabolic pathways. Predictive selection models based on bacterial profiles supported findings from topological analyses indicating that ME/CFS subgroups, defined by IBS status, could be distinguished from control subjects with high predictive accuracy. Bacterial taxa predictive of ME/CFS patients with IBS were distinct from taxa associated with ME/CFS patients without IBS. Increased abundance of unclassified Alistipes and decreased Faecalibacterium emerged as the top biomarkers of ME/CFS with IBS; while increased unclassified Bacteroides abundance and decreased Bacteroides vulgatus were the top biomarkers of ME/CFS without IBS. Despite findings of differences in bacterial taxa and metabolic pathways defining ME/CFS subgroups, decreased metabolic pathways associated with unsaturated fatty acid biosynthesis and increased atrazine degradation pathways were independent of IBS co-morbidity. Increased vitamin B6 biosynthesis/salvage and pyrimidine ribonucleoside degradation were the top metabolic pathways in ME/CFS without IBS as well as in the total ME/CFS cohort. In ME/CFS subgroups, symptom severity measures including pain, fatigue, and reduced motivation were correlated with the abundance of distinct bacterial taxa and metabolic pathways.

CONCLUSIONS

Independent of IBS, ME/CFS is associated with dysbiosis and distinct bacterial metabolic disturbances that may influence disease severity. However, our findings indicate that dysbiotic features that are uniquely ME/CFS-associated may be masked by disturbances arising from the high prevalence of IBS co-morbidity in ME/CFS. These insights may enable more accurate diagnosis and lead to insights that inform the development of specific therapeutic strategies in ME/CFS subgroups.

End-tidal sevoflurane concentration for ProSeal(TM) versus Classic(TM) laryngeal mask airway insertion in unpremedicated anaesthetised adult females

The optimal end-tidal sevoflurane concentration for successful ProSealTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus ClassicTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. Forty-four unpremedicated American Society of Anesthesiologists physical status I and II women with cervical carcinoma (aged 30 to 60 years), scheduled for intracavity caesium implantation under general anaesthesia with a laryngeal mask airway (LMA) were included in the study. The participants were randomised to one of the two groups, to receive either a PLMA or CLMA. After anaesthetic induction with sevoflurane, a predetermined end-tidal sevoflurane concentration (starting at 2.5%) was sustained for 10 minutes before LMA insertion was attempted. End-tidal sevoflurane concentration was increased/decreased (step-size 0.25%) using Dixon and Massey's up-and-down method for the next patient based on the previous patient's response. Placement without clenching, movement, coughing or biting within one minute was considered successful insertion. The end-tidal sevoflurane concentration required for successful LMA insertion in fifty percent of anaesthetised adults was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. The end-tidal sevoflurane concentration (95% confidence interval) required for successful PLMA insertion in 50% of anaesthetised adults (3.15% [3.12% to 3.18%]) was significantly higher than that for CLMA insertion (2.71% [2.66% to 2.76%], P<0.001). These findings suggest that deeper anaesthesia is required for placement of a PLMA in comparison to a CLMA.

Efficacy and safety of surfactant replacement therapy for preterm neonates with respiratory distress syndrome in low- and middle-income countries: a systematic review

Surfactant replacement therapy (SRT) has been shown to reduce mortality and air leaks in preterm neonates from high-income countries (HICs). The safety and efficacy of SRT in low- and middle- income countries (LMICs) have not been systematically evaluated. The major objectives of this review were to assess the (1) efficacy and safety, and (2) feasibility and cost effectiveness of SRT in LMIC settings. We searched the following databases-MEDLINE, CENTRAL, CINAHL, EMBASE and WHOLIS using the search terms 'surfactant' OR 'pulmonary surfactant'. Both experimental and observational studies that enrolled preterm neonates with or at-risk of respiratory distress syndrome (RDS) and required surfactant (animal-derived or synthetic) were included. A total of 38 relevant studies were found; almost all were from level-3 neonatal units. Pooled analysis of two randomized controlled trials (RCTs) and 22 observational studies showed a significant reduction in mortality at the last available time point in neonates who received SRT (relative risk (RR) 0.67; 95% confidence interval (CI) 0.57 to 0.79). There was also a significant reduction in the risk of air leaks (five studies; RR 0.51; 0.29 to 0.90). One RCT and twelve observational studies reported the risk of bronchopulmonary dysplasia (BPD) with contrasting results; while the RCT and most before-after/cohort studies showed a significant reduction or no effect, the majority of the case-control studies demonstrated significantly higher odds of receiving SRT in neonates who developed BPD. Two studies-one RCT and one observational-found no difference in the proportion of neonates developing pulmonary hemorrhage, while another observational study reported a higher incidence in those receiving SRT. The failure rate of the intubate-surfactant-extubate (InSurE) technique requiring mechanical ventilation or referral varied from 34 to 45% in four case-series. No study reported on the cost effectiveness of SRT. Available evidence suggests that SRT is effective, safe and feasible in level-3 neonatal units and has the potential to reduce neonatal mortality and air leaks in low-resource settings as well. However, there is a need to generate more evidence on the cost effectiveness of SRT and its effect on BPD in LMIC settings.

Patterns of IgE sensitization in house dust mite-allergic patients: implications for allergen immunotherapy

BACKGROUND

Understanding patterns of IgE sensitization in Dermatophagoides-allergic patients living in various geographical areas is necessary to design a product suitable for worldwide allergen immunotherapy (AIT).

METHODS

Using a HIFI Allergy customized microarray assay, IgEs specific for 12 purified allergens from Dermatophagoides pteronyssinus or D. farinae were assessed in sera from 1302 house dust mite (HDM)-allergic patients living in various areas. Comprehensive mass spectrometric (MS) analyses were conducted to characterize HDM extracts, as well as purified bodies and feces.

RESULTS

Patterns of IgE reactivity to HDM allergens are comparable in all cohorts of patients analyzed, encompassing adults and 5- to 17-year-old children, as well as American, Canadian, European, and Japanese patients. Overall, >70% and >80% of HDM-allergic patients are sensitized to group 1 and group 2 allergens, respectively, from D. pteronyssinus and/or D. farinae species. Furthermore, 20-47% of patients also have IgEs to allergens from groups 4, 5, 7, 13, 15, 21, and 23. All patients have IgEs to allergens present in mite bodies and feces. MS-based analyses confirmed the presence of mite allergens recorded by IUIS in D. pteronyssinus and D. farinae extracts, with groups 2, 8, 10, 11, 14, and 20 prominent in bodies and groups 1, 6, 18, and 23 well represented in feces.

CONCLUSIONS

Mite-specific AIT should rely upon a mixture of D. pteronyssinus and D. farinae extracts, manufactured from both feces and bodies. Such a combination is appropriate to treat children and adult Dermatophagoides-allergic patients from Asia, Europe, and North America.

Evaluation of two socket healing procedures with and without mesenchymal stem cells: A comparative study

Aims and Objectives:

Successful preservation of the edentulous ridge after extraction may eliminate or reduce the need for ridge augmentation procedures. It is proved that grafting of fresh extraction sockets with bone grafts promotes ridge preservation. An objective method of maintaining height and width of alveolar ridge using mesenchymal stem cells (MSCs) seeded on collagen membrane was implemented in this study.

Methodology:

Ten bilaterally symmetrical extraction sockets scheduled for extraction were selected for this study. Involved teeth were extracted atraumatically and the sockets were curetted. MSCs seeded on collagen membrane were placed in the extracted socket on one side. On the other side, only collagen membrane was placed inside the socket. Both the sockets were closed primarily with nonresorbable sutures. Buccolingual and mesiodistal widths of the ridges at three different levels (2 mm below cementoenamel junction [CEJ], 5 mm below CEJ, and 8 mm below CEJ) were assessed immediately after extraction and postoperatively at 3 and 6 months.

Results:

There was statistically significant observation in maintaining the alveolar ridge width in the grafted site when compared to the nongrafted site.

Conclusion:

Socket healing procedure using MSCs and collagen membrane was successful in maintaining width of alveolar socket.

Enhanced magnetic properties in ordered oriented ferrofibres

We report the fabrication of oriented nano-ferrofibres using a typical electrospinning process in the absence of an applied magnetic field to assist alignment.

Molecular Survey of Zoonotic Agents in Rodents and Other Small Mammals in Croatia

Croatia is a focus for many rodent-borne zoonosis. Here, we report a survey of 242 rodents and small mammals, including 43 Myodes glareolus, 131 Apodemus flavicollis, 53 Apodemus agrarius, three Apodemus sylvaticus, six Sorex araneus, four Microtus arvalis, one Microtus agrestis, and one Muscardinus avellanarius, collected at eight sites in Croatia over an 8-year period. Multiplex MassTag polymerase chain reaction (PCR) was used for detection of Borrelia, Rickettsia, Bartonella, Babesia, Ehrlichia, Anaplasma, Francisella tularensis, and Coxiella burnetii. Individual PCR assays were used for detection of Leptospira, lymphocytic choriomeningitis virus, orthopoxviruses, flaviviruses, hantaviruses, and Toxoplasma gondii. Of the rodents, 52 (21.5%) were infected with Leptospira, 9 (3.7%) with Borrelia miyamotoi, 5 (2%) with Borrelia afzelii, 29 (12.0%) with Bartonella, 8 (3.3%) with Babesia microti, 2 (0.8%) with Ehrlichia, 4 (1.7%) with Anaplasma, 2 (0.8%) with F. tularensis, 43 (17.8%) with hantaviruses, and 1 (0.4%) with an orthopoxvirus. Other agents were not detected. Multiple infections were found in 32 rodents (13.2%): dual infections in 26 rodents (10.7%), triple infections in four rodents (2.9%), and quadruple infections in two rodents (0.8%). Our findings indicate that rodents in Croatia harbor a wide range of bacteria and viruses that are pathogenic to humans.

Management of bilateral microspherophakia with secondary angle closure glaucoma

BACKGROUND

Microspherophakia is characterized by lenticular myopia, late development of lens dislocation, shallow anterior chamber and angle-closure glaucoma. If it is associated with angle closure glaucoma, the management can be challenging.

OBJECTIVE

To report the management of a case of bilateral secondary angle closure glaucoma with isolated microspherophakia and right subluxated lens in a middle aged lady.

CASE

A 47-year-old female presented with bilateral secondary angle closure glaucoma with isolated microspherophakia, right subluxated lens and left operated trabeculectomy. The patient`s best corrected log mar visual acuity improved from 1.0 to 0.2 and intraocular pressure (IOP) decreased from 24.9mm of Hg to lower teens following lensectomy with scleral fixation of posterior chamber intraocular lens in the right eye. The left eye IOP remained in mid teens without medication in two year follow up.

CONCLUSION

This case demonstrates that microspherophakia should be ruled out even in middle aged patients presenting as angle closure glaucoma. The possibility of thickened cornea must be kept in mind requiring an IOP correction. Lensectomy with scleral fixation of posterior chamber IOL provides a satisfactory recovery of visual acuity and IOP control. Though in this patient, the lens was held in position by posterior synechiae in the left eye, future stability of zonules needs to be monitored.

Brunner's gland hamartoma of the duodenum

Brunner's gland hamartoma (BGH) is a rare benign tumour of the duodenum. We present a case of duodenal obstruction caused by a BGH, which required surgical resection after a failed attempt at endoscopic removal.

Non-random patterns in viral diversity

It is currently unclear whether changes in viral communities will ever be predictable. Here we investigate whether viral communities in wildlife are inherently structured (inferring predictability) by looking at whether communities are assembled through deterministic (often predictable) or stochastic (not predictable) processes. We sample macaque faeces across nine sites in Bangladesh and use consensus PCR and sequencing to discover 184 viruses from 14 viral families. We then use network modelling and statistical null-hypothesis testing to show the presence of non-random deterministic patterns at different scales, between sites and within individuals. We show that the effects of determinism are not absolute however, as stochastic patterns are also observed. In showing that determinism is an important process in viral community assembly we conclude that it should be possible to forecast changes to some portion of a viral community, however there will always be some portion for which prediction will be unlikely.