Discrepancies in Chest X-Ray among Patients with Tuberculous Cervical Lymphadenitis

Abstract Tuberculous cervical lymphadenitis is not an uncommon entity when it comes to otolaryngology practice and that too in Bangladesh. In tuberculous cervical lymphadenitis the bacilli may reach the neck nodes from the lungs as well, through circulation. This study was done in the department of ENT and Head Neck Surgery, Dhaka Medical College Hospital, Dhaka, from January 2012 to January 2013 and was designed to find out chest x-ray abnormalities in apparently chest asymptomatic confirmed tuberculous cervical lymphadenitis without associate disease. The diagnosis of tuberculous cervical lymphadenitis was confirmed by fine needle aspiration cytology (FNAC) and/or smear for acid-fast bacillus, and chest x-ray (PA view) was done in all confirmed cases (n=183). (13%) and abnormal chest x-ray in 51 cases (27.87%). Pulmonary infiltration, the commonest radiological finding was detected in 32 cases (17.49%), hilar enlargement in 17 cases (9.29%), right paratracheal opacity in 2 (1.09%), obliteration of costophrenic angles in 3 cases (1.64%) and miliary mottling in one case (0.55%). Upper zonal predominance of lung parenchymal infiltrations was noted in 12.57% and right lung involvement in 16.39%. Single zone was affected in 9.84% cases and multiple zones were involved in 7.65% cases. We observed right hilar enlargement in 6.56%, left hilar lymphadenopathy in 4.37% and bilateral hilar lymphadenopathy in 2.73% cases. We concluded that routine chest x-ray PA view should be done in all tuberculous lymphadenitis before categorization and starting of treatment

RANTES/CCL5 and risk for coronary events: Results from the MONICA/KORA Augsburg case-cohort, Athero-express and CARDIoGRAM studies

Background: The chemokine RANTES (regulated on activation, normal T-cell expressed and secreted)/CCL5 is involved in the pathogenesis of cardiovascular disease in mice, whereas less is known in humans. We hypothesised that its relevance for atherosclerosis should be reflected by associations between CCL5 gene variants, RANTES serum concentrations and protein levels in atherosclerotic plaques and risk for coronary events. Methods and Findings: We conducted a case-cohort study within the population-based MONICA/KORA Augsburg studies. Baseline RANTES serum levels were measured in 363 individuals with incident coronary events and 1,908 non-cases (mean follow-up: 10.2±

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Age-sex dimorphisms in the estimation of median lethal dose (LD50) of lead diacetate in rabbits using up-and-down procedure (Arithmetic method)

Lead had been known to be toxic since pre-antiquity. It causes neurodevelopmental, cardiovascular and renal pathologies. Other toxicological studies of lead (Pb) salts are studied in laboratory animals such as rat, mice, hamsters, rabbits and monkeys; however, there is paucity of information on the median lethal dose (LD50) of Pb salts in rabbits especially when used as a model for molecular studies of Pb toxicity. In view of this, oral LD50 of lead (Pb) diacetate [Pb(CH3COO)2] was determined in both young (6 weeks old, weighing 0.40 ± 0.03 kg) and adult (34 weeks old, weighing 1.63 ± 0.10 kg), male and female New Zealand White (NZW) rabbits (Oryctolagus cuniculus) using the revised arithmetic method of Up-and-Down Procedure (UDP). The estimated LD50 of Pb diacetate in young male and female NZW rabbits was 1214.20 ± 275.80 and 1214.20 ± 275.80 mg/kg body weight respectively. Also, the LD50 of the adult male and female rabbits was 1503.30 ± 342.90 and 1792.50 ± 354.40 mg/kg body weight respectively. Similarities in the estimated LD50 of the young rabbits could be attributed to poorly developed xenobiotic metabolic processes. Sex-dimorphism in the toxicity of Pb diacetate was observed in the adult animals, where the male animals were found to be more sensitive to the toxicant than the female. Hence, Pb diacetate is moderately toxic in NZW Rabbits according to “Gosselin, Smith and Hodge scale” of toxicity rating.Keywords: Arithmetic mean, Dimorphism, Dose, Lead, Rabbits, Sex, Toxicit

Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements

The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, to have a baseline for comparison with abnormal movements. Dynamic ultrasound images of both wrists of 10 asymptomatic volunteers were obtained during wrist maximal flexion, extension and ulnar deviation. To simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared with the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p<0.01). There were significant differences in median nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p's<0.001). The mean amplitudes of median nerve motion in wrist flexion with finger extension (2.36±0.79 normalized units [NU]), wrist flexion with finger flexion (2.46±0.84 NU) and wrist ulnar deviation with finger extension (2.86±0.51 NU) were higher than those in finger flexion (0.82±0.33 NU), wrist extension with finger extension (0.77±0.46 NU) and wrist extension with finger flexion (0.81±0.58 NU) (p<0.0001). In the normal carpal tunnel, wrist flexion and ulnar deviation could induce significant transverse displacement and deformation of the median nerve

Altered median nerve deformation and transverse displacement during wrist movement in patients with carpal tunnel syndrome

Rationale and Objectives: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Strong pinch or grip with wrist flexion has been considered a risk factor for CTS. Studying median nerve displacement during wrist movements may provide useful information about median nerve kinematic changes in patients with CTS. The purpose of this study was to evaluate the deformability and mobility of the median nerve in patients with CTS compared to healthy subjects. Materials and Methods: Dynamic ultrasound images were obtained in 20 affected wrists of 13 patients with CTS. Results were compared to complementary data obtained from both wrists of 10 healthy subjects reported in a previous study. Shape and position of initial and final median nerve were measured and analyzed for six defined wrist movements. The deformation ratios for each movement were defined as the median nerve area, perimeter, and circularity of the final position normalized by respective values assessed in the initial position. The median nerve displacement vector and magnitude were also calculated. Results: The deformation ratio for circularity was significantly less in patients with CTS compared to healthy subjects during wrist flexion (P<.05). The mean vector of median nerve displacement during wrist flexion was significantly different between patients with CTS and healthy subjects (P<.05). The displacement magnitude of the median nerve was found to be less in patients with CTS compared to healthy subjects during most movements, with the exception of wrist extension with fingers extended. Conclusions: Patients with CTS differ from normal subjects with regard to mobility and deformability of the median nerve

The effect of tendon excursion velocity on longitudinal median nerve displacement: Differences between carpal tunnel syndrome patients and controls

The subsynovial connective tissue (SSCT) is a viscoelastic structure connecting the median nerve (MN) and the flexor tendons in the carpal tunnel. Increased strain rates increases stiffness in viscoelastic tissues, and thereby its capacity to transfer shear load. Therefore, tendon excursion velocity may impact the MN displacement. In carpal tunnel syndrome (CTS) the SSCT is fibrotic and may be ruptured, and this may affect MN motion. In this study, ultrasonography was performed on 14 wrists of healthy controls and 25 wrists of CTS patients during controlled finger motions performed at three different velocities. Longitudinal MN and tendon excursion were assessed using a custom speckle tracking algorithm and compared across the three different velocities. CTS patients exhibited significantly less MN motion than controls (p ≤ 0.002). While in general, MN displacement increased with increasing tendon excursion velocity (p ≤ 0.031). These findings are consistent with current knowledge of SSCT mechanics in CTS, in which in some patients the fibrotic SSCT appears to have ruptured from the tendon surface