Imaging findings in a patient with eosinophilic pneumonia (Lvffler's syndrome)

Löffler’s syndrome was initially described as a disorder characterised by transient pulmonary infiltrates accompanied by peripheral blood eosinophilia in asymptomatic or mildly ill patients. Abnormal chest radiographic findings are said to occur in 95% of patients but there are no descriptions of CT findings. There are many causes of this syndrome, but in developing countries the most common presentation remains secondary to the migratory larvae of common intestinal helminths. We present the clinical and radiological features of a boy with clearly defined Löffler's syndrome due to larval migration

Surgical treatment for 'brain compartment syndrome' in children with severe head injury

OBJECTIVES: Traumatic brain injury accounts for a high percentage of deaths in children. Raised intracranial pressure (ICP) due to brain swelling within the closed compartment of the skull leads to death or severe neurological disability if not effectively treated. We report our experience with 12 children who presented with cerebral herniation due to traumatic brain swelling in whom decompressive craniectomy was used as an emergency. DESIGN: Prospective, observational. SETTING: Red Cross Children's Hospital. SUBJECTS: Children with severe traumatic brain injury and cerebral swelling. OUTCOME MEASURES: Computed tomography (CT) scanning, ICP control, clinical outcome. RESULTS: Despite the very poor clinical condition of these children preoperatively, aggressive management of the raised pressure resulted in unexpectedly good outcomes. CONCLUSION: Aggressive surgical measures to decrease ICP in the emergency situation can be of considerable benefit; the key concepts are selection of appropriate patients and early intervention

Medics in southern Queensland: Effects of sowing method, weed control and phosphorus application on plant population and biomass

Declining sown pasture productivity as a result of a tie-up in plant available soil nitrogen is an ongoing constraint to grazing production across the brigalow bioregion of central and southern Queensland. Research suggests that legume establishment offers the most cost effective long-term remediation strategy for improving pasture quality and yield. Within southern Queensland, medics (Medicago spp.) can provide valuable winter contributions to dietary protein and soil nitrogen, however establishment and yields are frequently poor and soil phosphorus often limiting. An experiment was established across two soil types (brigalow clay and poplar box red loam) 70 km north of Goondiwindi, Queensland to investigate the effects of sowing method, weed control and phosphorus fertiliser application on the establishment and yield of a mix of three medic cultivars (Medicago truncatula cv. Jester & cv .Caliph and Medicago orbicularis cv. Bindaroo Gold). On both soil types, plant population and biomass were significantly improved via direct drilling of seed as compared to broadcasting. On the loam, drilling increased average populations by between 519 and 1,900% above those recorded in broadcast treatments and improved biomass by between 144 and 315%. On the clay soil, drilling increased populations by between 339 and 983% above those measured in broadcast treatments. Clay soil drilling showed biomass improvements of between 124 and 1,368%. No significant biomass or legume population treatment effects were observed on the clay soil. No significant treatment effects were observed for yield on the loam soil. This study implies that medic establishment, plant populations and biomass can be greatly improved through the application of seed drilling

Determining the extent of declining pasture productivity with nitrogen fertiliser

Declining productivity of sown pastures due to a reduction in plant available soil nitrogen has typically reduced grass and beef production by 50% since initial land development within the Brigalow bioregion of southern and central Queensland. As this decline continues, it’s estimated it will cost the northern beef industry more than $17 billion over the next 30 years. To assist landholders determine the extent of declining pasture productivity on their own properties, and assess the magnitude of response if more nitrogen is made available, nitrogen fertiliser was applied to approximately 70 replicated and non-replicated sites across southern and central Queensland between 2012 and 2014. Nitrogen (N) fertiliser as Green Urea NV® (Incitec Fertilisers) was broadcast onto existing grass-pastures in the lead up to a forecast rainfall event in summer. A range of rates were applied, from 25 – 200 kg N/ha, and dry matter yields and protein levels were measured. At all sites the grass pasture responded to the added nitrogen, with the magnitude of response dependant on the amount of nitrogen applied. As the production from sown pastures continues to decline, options that improve nitrogen supply and address this decline will be required to improve beef production across the northern region

Determining the extent of declining pasture productivity with nitrogen fertiliser

Declining productivity of sown pastures due to a reduction in plant available soil nitrogen has typically reduced grass and beef production by 50% since initial land development within the Brigalow bioregion of southern and central Queensland. As this decline continues, it’s estimated it will cost the northern beef industry more than $17 billion over the next 30 years. To assist landholders determine the extent of declining pasture productivity on their own properties, and assess the magnitude of response if more nitrogen is made available, nitrogen fertiliser was applied to approximately 70 replicated and non-replicated sites across southern and central Queensland between 2012 and 2014. Nitrogen (N) fertiliser as Green Urea NV® (Incitec Fertilisers) was broadcast onto existing grass-pastures in the lead up to a forecast rainfall event in summer. A range of rates were applied, from 25 – 200 kg N/ha, and dry matter yields and protein levels were measured. At all sites the grass pasture responded to the added nitrogen, with the magnitude of response dependant on the amount of nitrogen applied. As the production from sown pastures continues to decline, options that improve nitrogen supply and address this decline will be required to improve beef production across the northern region

Recording plasticity in neuronal activity in the rodent intrinsic cardiac nervous system using calcium imaging techniques

The intrinsic cardiac nervous system (ICNS) is composed of interconnected clusters of neurons called ganglionated plexi (GP) which play a major role in controlling heart rate and rhythm. The function of these neurons is particularly important due to their involvement in cardiac arrhythmias such as atrial fibrillation (AF), and previous work has shown that plasticity in GP neural networks could underpin aberrant activity patterns that drive AF. As research in this field increases, developing new techniques to visualize the complex interactions and plasticity in this GP network is essential. In this study we have developed a calcium imaging method enabling the simultaneous recording of plasticity in neuronal activity from multiple neurons in intact atrial GP networks. Calcium imaging was performed with Cal-520 AM labeling in aged spontaneously hypertensive rats (SHRs), which display both spontaneous and induced AF, and age-matched Wistar Kyoto (WKY) controls to determine the relationship between chronic hypertension, arrhythmia and GP calcium dynamics. Our data show that SHR GPs have significantly larger calcium responses to cholinergic stimulation compared to WKY controls, as determined by both higher amplitude and longer duration calcium responses. Responses were significantly but not fully blocked by hexamethonium, indicating multiple cholinergic receptor subtypes are involved in the calcium response. Given that SHRs are susceptible to cardiac arrhythmias, our data provide evidence for a potential link between arrhythmia and plasticity in calcium dynamics that occur not only in cardiomyocytes but also in the GP neurons of the heart

Epidemiology and aetiology of community-acquired pneumonia in children: South African Thoracic Society guidelines (part 1)

Background. Pneumonia remains a major cause of morbidity and mortality among South African (SA) children. Improved immunisation regimens, strengthening of HIV programmes, better socioeconomic conditions and new preventive strategies have influenced the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis.Objectives. To summarise current information on childhood community-acquired pneumonia (CAP) epidemiology and aetiology in children as part of the revised South African Thoracic Society guidelines.Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases expert subgroup on epidemiology and aetiology revised the existing SA guidelines.The subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system, and the relevant section underwent peer review.Results. Respiratory viruses, particularly respiratory syncytial virus, are the key pathogens associated with hospitalisation for radiologically confirmed pneumonia in HIV-uninfected children. Opportunistic organisms, including Pneumocystis jirovecii, are important pathogens in HIV-infected infants, while non-typable Haemophilus influenzae and Staphylococcus aureus are important in older HIV-infected children. Co-infections with bacteria or other respiratory viruses are common in hospitalised children. Mycobacterium tuberculosis is common in children hospitalised with CAP in SA.Conclusions. Numerous public health measures, including changes in immunisation schedules and expansion of HIV prevention and treatment programmes, have influenced the epidemiology and aetiology of CAP in SA children. These changes have necessitated a revision of the South African Paediatric CAP guidelines, further sections of which will be published as part of a CME series in SAMJ

Photophysics of cage/guest assemblies : photoinduced electron transfer between a coordination cage containing osmium(II) luminophores, and electron-deficient bound guests in the central cavity

An octanuclear cubic Os4Zn4 coordination cage, containing Os(II) tris-diimine units at four of the eight vertices which are good photoelectron donors from their 3MLCT excited state, performs photoinduced electron transfer to electron-accepting organic guests which bind in the central cavity in water via the hydrophobic effect: the resulting charge-separated states have lifetimes of ca. 200 ps and have been characterized by transient absorption spectroscopy

Prevention of community-acquired pneumonia in children: South African Thoracic Society guidelines (part 4)

Background. More comprehensive immunisation regimens, strengthening of HIV prevention and management programmes and improved socioeconomic conditions have impacted on the epidemiology of paediatric community-acquired pneumonia (CAP) in South Africa (SA).Objectives. To summarise effective preventive strategies to reduce the burden of childhood CAP.Methods. An expert subgroup reviewed existing SA guidelines and new publications focusing on prevention. Published evidence on pneumonia prevention informed the revisions; in the absence of evidence, expert opinion was used. Evidence was graded using the British Thoracic Society (BTS) grading system.Recommendations. General measures for prevention include minimising exposure to tobacco smoke or air pollution, breastfeeding, optimising nutrition, optimising maternal health from pregnancy onwards, adequate antenatal care and improvement in socioeconomic and living conditions. Prevention of viral transmission, including SARS-CoV-2, can be achieved by hand hygiene, environmental decontamination, use of masks and isolation of infected people. Specific preventive measures include vaccines as contained in the Expanded Programme on Immunisation schedule, isoniazid prophylaxis for tuberculosis, co-trimoxazole prophylaxis for HIV-infected infants and children who are immunosuppressed, and timely diagnosis of HIV, as well as antiretroviral therapy (ART) initiation. HIV-infected children treated with ART from early infancy, and HIV-exposed children, have similar immunogenicity and immune responses to most childhood vaccines as HIV-unexposed infants.Validation. These recommendations are based on available published evidence supplemented by the consensus opinion of SA paediatric experts, and are consistent with those in published international guidelines

Diagnosis of community-acquired pneumonia in children: South African Thoracic Society guidelines (part 2)

Background. Accurate diagnosis and attribution of the aetiology of pneumonia are important for measuring the burden of disease, implementing appropriate treatment strategies and developing more effective interventions.Objectives. To produce revised guidelines for the diagnosis of pneumonia in South African (SA) children, encompassing clinical, radiological and aetiological methods.Methods. An expert group was established to review diagnostic evidence and make recommendations for a revised SA guideline. Published evidence was reviewed and graded using the British Thoracic Society grading system.Results. Diagnosis of pneumonia should be considered in a child with acute cough, fast breathing or difficulty breathing. Revised World Health Organization guidelines classify such children into: (i) severe pneumonia; (ii) pneumonia (tachypoea or lower chest indrawing); or (iii) no pneumonia. Malnourished or immunocompromised children with lower chest indrawing should be managed as cases of severe pneumonia. Pulse oximetry should be done, with hospital referral for oxygen saturation <92%. A chest X-ray is indicated in severe pneumonia or when tuberculosis (TB) is suspected. Microbiological investigations are recommended in hospitalised patients or in outbreak settings. Improved aetiological methods show the importance of co-infections. Blood cultures have a low sensitivity (<5%), for diagnosing bacterial pneumonia. Highly sensitive, multiplex tests on upper respiratory samples or sputum detect multiple potential pathogens in most children. However, even in symptomatic children, it may be impossible to distinguish colonising from causative organisms, unless identification of the organism is strongly associated with attribution to causality, e.g. respiratory syncytial virus, Mycobacterium tuberculosis, Bordetella pertussis, influenza, para-influenza or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Investigations for TB should be considered in children with severe pneumonia who have been hospitalised, in a case of a known TB contact, if the tuberculin skin test is positive, if a child is malnourished or has lost weight, and in children living with HIV. Induced sputum may provide a higher yield than upper respiratory sampling for B. pertussis, M. tuberculosis and Pneumocystis jirovecii. Conclusions. Advances in clinical, radiological and aetiological methods have improved the diagnosis of childhood pneumonia