Use of a dual lumen port for automated red cell exchange in adults with sickle cell disease

Red cell exchange (RCE) is a common procedure in adults with sickle cell disease (SCD). Implantable dual lumen Vortex (DLV) ports can be used for RCE in patients with poor peripheral venous access. We performed a retrospective cohort study of RCE procedures performed in adults with SCD. The main objective of the study was to compare the inlet speed, duration of procedures and rate of complications performed through DLV ports to those performed through temporary central venous and peripheral catheters. Twenty‐nine adults with SCD underwent a total of 318 RCE procedures. Twenty adults had DLV ports placed and 218 procedures were performed using DLV ports. Mean length of follow‐up after DLV port placement was 397 ± 263 days. Six DLV ports were removed due to infection and 1 for malfunction after a mean of 171 ± 120 days. Compared to temporary central venous and peripheral catheters, DLV port procedures had a greater rate of procedural complications, a longer duration, and a lower inlet speed (all P < 0.01). When accounting for the maximum allowable inlet speed to avoid citrate toxicity, 40% of DLV port procedures were greater than 10% below maximum speed, compared to 7 and 14% of procedures performed through temporary central venous and peripheral catheters (P < 0.0001). In conclusion, DLV ports can be used for RCE in adults with SCD, albeit with more procedural complications and longer duration. The smaller internal diameter and longer catheter of DLV ports compared to temporary central venous catheters likely accounts for the differences noted. J. Clin. Apheresis 30:353–358, 2015. © 2015 Wiley Periodicals, Inc.     

Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District,Pakistan, 2017-2018: Retrospective Record Review

BackgroundHyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited.ObjectiveTo address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan.MethodsWe reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths.ResultsA total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06).ConclusionsAs this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures.     

Extraintestinal Seeding of Salmonella enterica Serotype Typhi,Pakistan

We evaluated Salmonella enterica serotype Typhi strains isolated from all body sites in Pakistan during 2013–2018. Despite an increase in overall number of localized, extensively drug-resistant Salmonella Typhi in organ infections during 2018, there was no increase in the proportion of such isolates in comparison with non–extensively drug-resistant isolates.     

Chromosomal instability triggers cell death via local signalling through the innate immune receptor Toll

Chromosomal instability (CIN) is a hallmark of cancer and has been implicated in cancer initiation, progression and the development of resistance to traditional cancer therapy. Here we identify a new property of CIN cells, showing that inducing CIN in proliferating Drosophila larval tissue leads to the activation of innate immune signalling in CIN cells. Manipulation of this immune pathway strongly affects the survival of CIN cells, primarily via JNK, which responds to both Toll and TNFα/Eiger. This pathway also activates Mmp1, which recruits hemocytes to the CIN tissue to provide local amplification of the immune response that is needed for effective elimination of CIN cells.     

Misdiagnosis of trigger finger? Flexor seed ganglion masquerading as closed FDS rupture

The authors present the case of a 25-year-old right-handed female warehouse worker who presented to the emergency department complaining of an inability to flex her left index finger and an associated painful lump on the volar surface of her left index finger over the metacarpal–phalangeal joint following a hyperextension injury. Clinical examination suspected a closed flexor digitorum superficialis (FDS) injury; however, on surgical exploration, the FDS tendon to the left index finger was intact. A flexor sheath seed ganglion was identified. This case, although rare, identifies the modality of specialist ultrasound scan (USS) by those with an interest in musculoskeletal radiology to be used in cases where the history is unclear or diagnosis in doubt. Level of Evidence: Level V, diagnostic study.     

An assessment of the quality of care provided to orthognathic surgery patients through a multidisciplinary clinic

The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.     

Carbon nanostructure-reinforced SiCw/Si3N4 composite with enhanced thermal conductivity and mechanical properties

Carbon nanostructures (CNS) as a kind of reinforcement material can remarkably enhance the mechanical and thermal properties of ceramics. This research presents an analysis of the influence of CNS on the thermal conductivity and mechanical properties of SiC_w/Si₃N₄ composites. The SiC_w/Si₃N₄ composites containing various types of CNS e.g. carbon nanofibers (CNF), multi-walled carbon nanotubes (MWCNT) and graphene nano-platelets (GNP) were fabricated by hot-press sintering. XRD analysis confirmed a complete transformation of α-Si₃N₄ to β-Si₃N₄ and microstructural analysis shows a uniform distribution, as well as a pullout and bridging mechanism of CNS. The results revealed that the thermal conductivity and mechanical properties of SiC_w/Si₃N₄ composites increased with the addition of CNS. Maximum values of fracture toughness (9.70 ± 0.8 MPa m^1/2) and flexural strength (765 ± 58 MPa) have been achieved for the MWCNT-containing SiC_w/Si₃N₄ composite, whereas the maximum values of Young''s modulus (250 ± 3.8 GPa) and hardness (27.2 ± 0.9 GPa) have been achieved for the CNF-containing SiC_w/Si₃N₄ composite. Moreover, thermal conductivity also improved with the addition of CNS and reached a maximum value of 110.6 W m⁻¹ K⁻¹ for the CNF-containing SiC_w/Si₃N₄ composite. This work provides a useful approach for the fabrication of high-performance multifunctional composites for emerging engineering applications.

Carbon nanostructures (CNS) as a kind of reinforcement material can remarkably enhance the mechanical and thermal properties of ceramics.