Drug reaction with eosinophilia and systemic symptoms is a quite unusual condition related to drug reaction. A case report of sulfasalazine-induced liver failure is described. The patient was submitted to liver transplantation. Liver transplantation is an option when DRESS is associated with acute liver failure, but the prognosis remains poor.
The new corona virus has become a global health concern.Voice has the potential to provide an easily obtained, non-invasive way to monitor physiological changes throughout the body. For health care providers with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS and MERS, as well as sepsis and ARDS, the application of acoustical voice analysis should serve as a foundation for optimized supportive care to ensure the best possible chance for survival.
Cardiac computed tomography (CT) is increasingly used to plan transcatheter structural heart interventions, however, intra-operative guidance relies on trans-esophageal echocardiography (TEE) and fluoroscopy. This study sought to develop the methods of stepwise CT multi-planar reconstruction manipulation to mimic TEE thus bridging the gap between preoperative planning and intra-operative guidance tools. This CT manipulation successfully reproduces similar configurations as TEE views in mid-esophageal left ventricle (LV) views, transgastric LV 2-chamber views for mitral apparatus, and other miscellaneous views. Stepwise cardiac CT manipulation to mimic TEE is the final piece of the puzzle in the mental co-registration of these three crucial imaging modalities. With it, we are enabled to foresee the TEE images and fluoroscopy projections in a preoperative rehearsal thus improving the intra-operative accuracy of interventions.
Ortner's syndrome is a really rare complication that manifest by hoarseness of voice. It is usually due to left recurrent laryngeal nerve compression. Cardiac causes of Ortner's syndrome are rarely encountered and it is usually due to left atrial enlargement as a complication of valvular lesions affecting mitral valve but other rare causes include ascending aortic aneurysm or pulmonary artery aneurysm. Hereby, we present the 3rd case in the literature to report Ortner's syndrome due to pulmonary artery aneurysm in a 38-year old female patient with previous history of bilharziasis.
His bundle pacing (HBP) offers physiologic pacing by placing the pacing lead directly to the His bundle. We present a case in which a HBP lead, implanted at the fragile membranous septum, resulted in a persistent restrictive peri-membranous ventricular septal defect (VSD). This complication of HBP has not been reported before but brings new insights in the discussion regarding the optimal position of a pacing lead in the ventricular septum. The fragility of the membranous septum and low rate of spontaneous closure of membranous VSD, might favor lead placement in the muscular septum when aiming for physiologic pacing.
Theories attempting to explain species coexistence in plant communities have argued in favor of species’ capacities to occupy a multidimensional niche with spatial, temporal and biotic axes. We used the concept of hydrological niche segregation to learn how ecological niches are structured both spatially and temporally and whether small scale humidity gradients between adjacent niches are the main factor explaining water partitioning among tree species in a highly water-limited semiarid forest ecosystem. By combining geophysical methods, isotopic ecology, plant ecophysiology and anatomical measurements, we show how coexisting pine and oak species share, use and temporally switch between diverse spatially distinct niches by employing a set of functionally coupled plant traits in response to changing environmental signals. We identified four geospatial niches that turned into nine, when considering the temporal dynamics of the wetting/drying cycles in the substrate and the particular plant species adaptations to garner, transfer, store and use water. Under water scarcity, pine and oak exhibited water use segregation from different niches, yet under maximum drought when oak trees crossed physiological thresholds, niche overlap occurred. The identification of niches and mechanistic understanding of when and how species use them will help unify theories of plant coexistence and competition.
Aim Kelp forests worldwide are important marine ecosystems that foster high primary to secondary productivity and multiple ecosystem services. These ecosystems are increasingly under threat from extreme storms, changing ocean temperatures, harvesting, and greater herbivore pressure at regional and global scales, necessitating urgent documentation of their historical to present day distributions. Species range shifts to higher latitudes have already been documented in some species that dominate subtidal habitats within Europe. Very little is known about kelp forest ecosystems in Ireland, where rocky coastlines are dominated by Laminaria hyperborea. In order to rectify this substantial knowledge gap, we compiled historical records from an array of sources to present historical distribution, kelp and kelp forest recording effort over time, and present rational for the monitoring of kelp habitats to better understand ecosystem resilience. Location Ireland (Northern Ireland and Éire). Methods Herbaria, literature from the Linnaean society dating back to late 1700s, journal articles, government reports, and online databases were scoured for information on L. hyperborea. Information about kelp ecosystems was solicited from dive clubs and citizen science groups that are active along Ireland’s coastlines. Results Data were used to create distribution maps, analyse methodology and technology used to record L. hyperborea presence and kelp ecosystems within Ireland. We discuss the recent surge in studies on Irish kelp ecosystems and fauna associated with kelp ecosystems that may be used as indicators of ecosystem health and suggest methodologies for continued monitoring. Main Conclusions While there has been a steady increase in recording effort of the dominant subtidal kelp forest species, L. hyperborea, only recently have studies begun to address other important eco-evolutionary processes at work in kelp forests including connectivity among kelp populations in Ireland. Further monitoring, using suggested methodologies, is required to better understand the resilience of kelp ecosystems in Ireland.
The COVID-19 outbreak is a global pandemic with rapid community spread. Patients with multi-morbidities are particularly vulnerable during this time. The number of cases soared in early February 2020, and Singapore declared escalation of the Disease Outbreak Response System Condition (DORSCON) level to Orange. Multiple measures have been taken to combat the spread of this highly contagious infection. Despite our medical manpower being diverted to the wards, our hospital aims to maintain nearly full operations at the clinic, balancing against concern about the spread of the virus and exposing healthcare workers to potential risks. We describe the measures taken in a tertiary hospital in Singapore to mitigate the risk of infection in the outpatient setting while ensuring that continuing clinical care of patients with chronic diseases is not compromised.
There is a vast number of biomaterials ranging from drug-eluting stents, coated implants, drug delivery devices and artificial organs, among others, that have been developed in recent years. However, translation of many of these biomaterials to clinic is often plagued by biocompatibility challenges. This review focuses on strategies implemented in some of the recently developed biomaterials -- particularly for soft and hard tissue regeneration, organ manufacturing and disease remediation -- to overcome potential foreign body response to the incorporation of the biomaterials in the host.
Starting from December 2019 the novel SARS-Cov-2 has spread all over the world, being recognized as the causing agent of COVID-19. Since nowadays no specific drug therapies neither vaccines are available for the treatment of COVID-19, drug repositioning may offer a strategy to efficiently control the clinical course of the disease and the spread of the outbreak. In this paper we aim to describe the main pharmacological properties, including data on mechanism of action, safety concerns and drug-drug interactions, of drugs currently administered in patients with COVID-19, focusing on antivirals and drugs with immune-modulatory and/or anti-inflammatory properties. Where available, data from clinical trials involving patients with COVID-19 were reported. A large number of clinical studies have been registered worldwide and several drugs were repurposed to face the new health emergency of COVID-19. For many of these drugs, including lopinavir/ritonavir, remdesivir, favipiravir, chloroquine and tocilizumab, clinical evidence from literature and real life settings support their favorable efficacy and safety profile in improving patients’ clinical conditions. Even though drug repurposing is necessary, it requires caution. Indeed, too many drugs that are currently tested in patients with COVID-19 have peculiar safety profiles. While waiting for the results of clinical studies demonstrating the efficacy of drugs able to reduce symptoms and complications of COVID-19, the best therapeutic path to pursue is the development of an effective vaccine able to prevent this infection.
The mechanisms by which herbivores induce plant defenses are well studied. However, how specialized herbivores suppress plant resistance is still poorly understood. Here, we discovered a rice (Oryza sativa) leucine-rich repeat receptor-like kinase, OsLRR-RLK2, which is induced upon attack by gravid females of a specialist piercing-sucking herbivore, the brown planthopper (BPH, Nilaparvata lugens). Silencing OsLRR-RLK2 decreases the constitutive activity of mitogen-activated protein kinase (OsMPK6) and alters BPH-induced transcript levels of several defense-related WRKY transcription factors. Moreover, silencing OsLRR-RLK2 reduces BPH-induction of jasmonic acid and ethylene but promotes the biosynthesis of both elicited salicylic acid and H2O2; silencing also enhances the production of volatiles emitted from rice plants infested with gravid BPH females. These changes decrease BPH preference and performance in the glasshouse and the field. Our study identifies OsLRR-RLK2 as a major susceptibility factor of rice against BPH. It is likely to be employed by BPH to suppress host plant defenses for its own benefit via signaling crosstalk and/or changing the plant’s defense-related signaling profile.
Introduction: Silent cerebral events (SCEs) are related to the potential thromboembolic risk in atrial fibrillation (AF) ablation. Peri-procedural uninterrupted oral anticoagulation (OAC) reportedly reduced the risk of SCEs, but the incidence still remains. Methods and Results: AF patients undergoing catheter ablation were eligible. All patients took non-vitamin K antagonist oral anticoagulants (NOACs, n=248) or vitamin K antagonist (VKA, n=37) for peri-procedural OAC (>4 weeks) without interruption during the procedure. Brain magnetic resonance imaging was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. SCEs were detected in 66 patients (23.1%, SCE[+]) but were not detected in 219 patients (SCE[-]). Average age was higher in SCE[+] than in SCE[-] (66±10 years vs. 62±12 years, p<0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, serum NT-ProBNP levels, left-atrial dimension (LAD), and spontaneous echo contrast prevalence in transesophageal echocardiography significantly increased in SCE[+] vs. SCE[-]. SCE[+] had lower baseline activated clotting time (ACT) before heparin injection and longer time to reach optimal ACT (>300 sec) than SCE [-] (146±27 sec vs. 156±29 sec and 44±30 sec vs. 35±25 sec, p<0.05, respectively). In multivariate analysis, LAD, baseline ACT, and time to reach the optimal ACT were predictors for SCEs. The average values of the ACT parameters were significantly different among NOACs/VKA. Conclusion: LAD and intra-procedural ACT kinetics significantly affect SCEs during AF ablation. Different anticoagulants have different impacts on ACT during the procedure, which should be considered when estimating the risk of SCEs.
How soil quality and microbial communities change in conjunction with stand age in plantations is poorly understood. Here, we evaluated soil quality by using an integrated soil quality index (SQI) and traced the paralleled shifts in fungal community composition by high-throughput sequencing in a chronosequence of Chinese fir (Cunninghamia lanceolata) plantations (stand age of 3, 16, 25, 32, >80 years). Soil properties showed pronounced changes with stand age in the top 0-5 cm. The most prominent increase from 3 to >80-year-old stand was for soil organic carbon (SOC, by 2.1-times), total nitrogen (TN, 1.9-times) and available phosphorus (AP, 2.2-times). SQI increased logarithmically with stand age, with sharper change seen in the 0-5 cm layer than in the 5-15 cm layer. Mycorrhizal fungi increased in abundance initially in younger stands, but then they were gradually replaced by saprotrophic fungi in older stands due to the increase in litter input, which sustains saprotrophs. The positive correlation between saprotrophic fungi and the key soil quality indicators, such as TN, AP and NH4+, showed that higher soil quality was tightly linked with the enrichment of decomposers. Mycorrhizal taxa, such as orders Sebacinales, Thelephorales and Russulales, were positively correlated with acid phosphatase mobilizing P from organic matter. This suggests that the establishment of mycorrhizal fungi sustains tree productivity in younger stands under low soil quality. We conclude that the increase in soil quality throughout the development of Chinese fir plantations is closely linked with the observed transition of fungal communities from mycorrhizae to saprotrophs.