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.     

A CTAB-mediated antisolvent vapor route to shale-like Cs4PbBr6 microplates showing an eminent photoluminescence

Compared with nanoscale quantum dots (QDs), the large-sized perovskite crystals not only possess better stability but also are convenient for application exploration. Herein, we develop a facile and efficient antisolvent vapor-assisted recrystallization approach for the synthesis of large-sized Cs₄PbBr₆ perovskite crystal microplates. In this method, for the first time, the shale-like Cs₄PbBr₆ microplates with lateral dimensions of hundreds of microns are fabricated by employing cetyltriethylammnonium bromide (CTAB) as a morphology-directing agent. FESEM, TEM, and AFM characterizations indicate that the as-obtained shale-like Cs₄PbBr₆ microplates are actually formed by 6–8 nm thick Cs₄PbBr₆ nanosheets with orientational stacking. Importantly, such highly crystalline Cs₄PbBr₆ microplates with shale-like morphology exhibit a narrow and intense green PL emission with a 59% PL quantum yield. Moreover, the planar structure of shale-like Cs₄PbBr₆ microplates makes it easy to form a preferred orientation on a substrate, which endow them with promising potential in optoelectronic devices such as lighting and displays.

Highly luminescent shale-like Cs₄PbBr₆ microplates with hundreds of microns in lateral dimension and formed by thin nanosheets with orientational stacking.     

Tubular Heart Valves from Decellularized Engineered Tissue

A novel tissue-engineered heart valve (TEHV) was fabricated from a decellularized tissue tube mounted on a frame with three struts, which upon back-pressure cause the tube to collapse into three coapting “leaflets.” The tissue was completely biological, fabricated from ovine fibroblasts dispersed within a fibrin gel, compacted into a circumferentially aligned tube on a mandrel, and matured using a bioreactor system that applied cyclic distension. Following decellularization, the resulting tissue possessed tensile mechanical properties, mechanical anisotropy, and collagen content that were comparable to native pulmonary valve leaflets. When mounted on a custom frame and tested within a pulse duplicator system, the tubular TEHV displayed excellent function under both aortic and pulmonary conditions, with minimal regurgitant fractions and transvalvular pressure gradients at peak systole, as well as well as effective orifice areas exceeding those of current commercially available valve replacements. Short-term fatigue testing of one million cycles with pulmonary pressure gradients was conducted without significant change in mechanical properties and no observable macroscopic tissue deterioration. This study presents an attractive potential alternative to current tissue valve replacements due to its avoidance of chemical fixation and utilization of a tissue conducive to recellularization by host cell infiltration.     

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.