Acute Generalized Exanthematous Pustulosis Associated with Diltiazem

Acute generalized exanthematous pustulosis (AGEP) usually presents with the acute appearance of oedematous and erythematous lesions, on which multiple sterile pustules appear, associated with fever. Almost 90% of cases are associated with drugs, with antibiotics (penicillins and macrolides) being the most frequent causative agents. We describe a 36-year-old female patient, which started diltiazem 120mg/day for hypertension. After 6 days of therapy, multiple erythematous and oedematous lesions appeared, with associated multiple small non-follicular pustules. Oral corticosteroids were started, with progressive and complete improvement. Patch-tests were performed, which revealed positivity for diltiazem. Although a rare entity, AGEP must be considered in cases of acute eruptions with disseminated pustules and fever. The use of patch tests in this disease may be useful as positive reactions are frequent

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation.

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console

The development of path integration: combining estimations of distance and heading

Efficient daily navigation is underpinned by path integration, the mechanism by which we use self-movement information to update our position in space. This process is well-understood in adulthood, but there has been relatively little study of path integration in childhood, leading to an underrepresentation in accounts of navigational development. Previous research has shown that calculation of distance and heading both tend to be less accurate in children as they are in adults, although there have been no studies of the combined calculation of distance and heading that typifies naturalistic path integration. In the present study 5-year-olds and 7-year-olds took part in a triangle-completion task, where they were required to return to the startpoint of a multi-element path using only idiothetic information. Performance was compared to a sample of adult participants, who were found to be more accurate than children on measures of landing error, heading error, and distance error. 7-year-olds were significantly more accurate than 5-year-olds on measures of landing error and heading error, although the difference between groups was much smaller for distance error. All measures were reliably correlated with age, demonstrating a clear development of path integration abilities within the age range tested. Taken together, these data make a strong case for the inclusion of path integration within developmental models of spatial navigational processing

An innovative thermal protective clothing system for firefighters

Nowadays, despite the evolution of personal protective equipment (PPE), the number of firefighters injured and burned during fire extinguishing operations is still very high, leading in some cases to loss of life. Therefore, the research and development of new solutions to minimize firefighters' heat load and skin burns, with consecutive improvements of commercial firefighters' suits, is of extreme importance. The integration of phase change materials (PCMs) in a protective clothing system has been used to significantly reduce the incoming heat flux from the fire environment. This study consists in the development of a protective clothing system composed by a vest, specially designed to protect the torso (back, chest and abdomen) with a layer of PCM pouches, to be worn over a fire-resistant jacket - selection and design based on numerical models' predictions. Therefore, several mockups were made, varying the number of PCM pouches and their distribution in the vest, allowing the creation of air ducts to increase the breathability of the vest. The most promising solutions are being evaluated in a real controlled environment, at a Portuguese National School of Firefighters (ENB) simulation site, using a fire manikin and thermocouples to monitor vest temperature during heat and flame exposure, and consequently to verify PCMs influence in heat protection. Results regarding the development of a PCM vest will be presented, focusing on the integration of PCM pouches and the thermal performance of the most promising solutions

Periodontitis and Systemic Markers of Neurodegeneration. A case-control study

Aim: To investigate whether periodontitis is associated with amyloid beta (Aβ) peptides and whether systemic inflammation could act as a potential mediator of this link. Materials and Methods: A case–control study was designed including 75 patients with periodontitis (cases) and 75 age‐balanced and gender‐matched participants without periodontitis (controls). Full‐mouth periodontal evaluation was performed in all participants. Demographic, clinical and behaviour data were also recorded. Fasting blood samples were collected, and serum levels of interleukin 6 (IL‐6), high‐sensitivity C‐reactive protein (hs‐CRP), Aβ1‐40 and Aβ1‐42 were determined. Results: Cases showed higher levels of IL‐6 (8.7 ± 3.2 vs. 4.8 ± 0.5 pg/ml), hs‐CRP (3.3 ± 1.2 vs. 0.9 ± 0.7 mg/L), Aβ1‐40 (37.3 ± 6.0 vs. 30.3 ± 1.8 pg/ml) and Aβ1‐42 (54.5 ± 10.6 vs. 36.5 ± 10.0 pg/ml) when compared to controls (all p < .001). Diagnosis of periodontitis was statistically significantly associated with circulating Aβ1‐40 (urn:x-wiley:03036979:media:jcpe13267:jcpe13267-math-0001 = 6.9, 95% CI: 5.4–8.3; p < .001) and Aβ1‐42 (urn:x-wiley:03036979:media:jcpe13267:jcpe13267-math-0002 = 17.8, 95% CI: 14.4–21.3; p < .001). Mediation analysis confirmed hs‐CRP and IL‐6 as mediators of this association. Conclusions: Periodontitis is associated with increased peripheral levels of Aβ. This finding could be explained by enhanced systemic inflammation that can be seen in patients with periodontitis

Smart firefighters PPE: Impact of phase change materials

Considering the high level of heat and flame exposure firefighters encounter while performing their work activities, personal protective equipment (PPE) is of the utmost importance to enhance their safety. Phase change materials (PCMs) are known as advanced materials able to absorb high amounts of thermal energy, with the potential to increase the thermal performance of protective clothing. In this work, a PCM-vest was developed for the first time, and its thermal performance was evaluated. A three-stage approach was followed: (1) at a small scale in the laboratory, the effect of different encapsulated PCMs on a multilayer assembly performance was evaluated; (2) in the laboratory, the essential requirements of heat and flame tests were assessed; and (3) in a simulated urban fire, the thermal performance of three different PCM-vests (different textiles and designs) was studied. As the main conclusions, the PCMs significantly affected the heating rate of the multilayer assembly, particularly when a PCM with higher latent heat was used. In some cases, the heat transfer index (HTI) doubled by comparison with the sample without PCMs. As a drawback and as expected, the cooling time was increased. The PCM-vest sample ensured the requirements of the heat and flame tests. Through this study, the positive impact of using PCMs to enhance the heat protection of conventional PPE can be highlighted

Trend analysis of imported malaria in London; observational study 2000 to 2014.

BACKGROUND: We describe trends of malaria in London (2000-2014) in order to identify preventive opportunities and we estimated the cost of malaria admissions (2009/2010-2014/2015). METHODS: We identified all cases of malaria, resident in London, reported to the reference laboratory and obtained hospital admissions from Hospital Episode Statistics. RESULTS: The rate of malaria decreased (19.4[2001]-9.1[2014] per 100,000). Males were over-represented (62%). Cases in older age groups increased overtime. The rate was highest amongst people of Black African ethnicity followed by Indian, Pakistani, Bangladeshi ethnicities combined (103.3 and 5.5 per 100,000, respectively). The primary reason for travel was visiting friends and relatives (VFR) in their country of origin (69%), mostly sub-Saharan Africa (92%). The proportion of cases in VFRs increased (32%[2000]-50%[2014]) and those taking chemoprophylaxis decreased (36%[2000]-14%[2014]). The overall case fatality rate was 0.3%. We estimated the average healthcare cost of malaria admissions to be just over £1 million per year. CONCLUSION: Our study highlighted that people of Black African ethnicity, travelling to sub-Saharan Africa to visit friends and relatives in their country of origin remain the most affected with also a decline in chemoprophylaxis use. Malaria awareness should focus on this group in order to have the biggest impact but may require new approaches