A case of atypical Kawasaki disease with giant coronary artery aneurysm containing thrombus

Kawasaki disease (KD) is an acute febrile, systemic vasculitic syndrome of unknown etiology, occurring primarily in children younger than 5 years of age. Administration of IVIG within the first 10 days after onset of fever in combination with high dose aspirin reduces the risk of coronary artery damage in KD. Though rare, giant aneurysms of the coronary arteries may develop in untreated cases and prove extremely challenging to manage. A 9-month-old Caucasian boy presented to our paediatric emergency department with a 4-week history of intermittent pyrexia and irritability. Typical mucocutaneous signs of Kawasaki Disease were absent upon presentation. A trans-thoracic echocardiogram identified a giant aneurysm of the left anterior descending artery with thrombus formation in-situ and the child was managed with intravenous immunoglobulin, steroids, high dose aspirin therapy and later warfarinisation. Cardiovascular sequelae of Kawasaki disease include giant coronary artery aneurysms with thrombosis. Enlargement of a coronary aneurysm after the acute phase of Kawasaki disease is uncommon and the outcome of interventional approaches poorly studied.peer-reviewe

Native roadside perennial grasses persist a decade after planting in the Sacramento Valley

Restoring native grassland along roadsides can provide a relatively low-maintenance, drought-tolerant and stable perennial vegetative cover with reduced weed growth, as opposed to the high-maintenance invasive annual cover (requiring intensive mowing and herbicide treatments) that dominates most Sacramento Valley roadsides. A survey of long-established roadside native-grass plantings in Yolo County showed that once established and protected from disturbance, such plantings can persist with minimal maintenance for more than a decade, retaining a high proportion of native species. The survey also showed that each species of native perennial grass displays a microhabitat preference for particular roadside topographic positions, and that native perennial grass cover is negatively affected by disturbance

Influenza vaccination survey in Maltese healthcare workers in the COVID-19 era

Introduction: Seasonal influenza globally infects 5%-15% annually, with a total of 3-5 million cases of severe illness and ≤500,000 deaths. Hospital-acquired influenza has a particularly high mortality, and healthcare workers are frequently the source of these infections. This study was carried out to ascertain last year’s influenza vaccination uptake in Malta’s government sector healthcare workers, and estimate the likely vaccine uptake rate in the coming winter season when COVID-19 is expected to be prevalent. --- Methods: A short, anonymous questionnaire was sent via the sector’s standard email services (open 30/06-17/072020). --- Results: There were a total of 735 (7.6%) responses from a total workforce of 9,681. The proportion of Maltese healthcare workers who did not take the vaccine last year but who are likely to take the vaccine this winter halved from 41% to 21%. Doctors had the highest baseline uptake (23% refused vaccination in 2019) and the highest likely uptake next winter (6% likely to refuse vaccination in 2020). Analysis by age showed a likely increase in vaccine uptake with increasing age across almost all age brackets. --- Discussion: Influenza vaccination is advantageous and incurs a trivial burden. Clinicians, legislators and ethicists are increasingly aware of this aspect of healthcare, and increasingly mandate compulsory seasonal influenza vaccination for healthcare workers, where vaccine refusal can be taken to equate to maleficent practice. Education with regard to the low risk of side effects may increase voluntary uptake. Institutions are also responsible for ensuring employee vaccination, and this is even more the case for next winter in the setting of the potential co-circulation of novel COVID-19 with influenza.peer-reviewe

Flux of organic carbon in a riverine mangrove wetland in the Florida Coastal Everglades

Short-term (daily) and seasonal variations in concentration and flux of dissolved organic carbon (DOC) were examined over 15 tidal cycles in a riverine mangrove wetland along Shark River, Florida in 2003. Due to the influence of seasonal rainfall and wind patterns on Shark River’s hydrology, samplings were made to include wet, dry and transitional (Norte) seasons. We used a flume extending from a tidal creek to a basin forest to measure vertical (vegetated soil/water column) and horizontal (mangrove forest/tidal creek) flux of DOC. We found significant (p \u3c 0.05) variations in surface water temperature, salinity, conductivity, pH and mean concentration of DOC with season. Water temperature and salinity followed seasonal patterns of air temperature and rainfall, while mean DOC concentration was highest during the dry season (May), followed by the wet (October) and ‘Norte’ (December) seasons. This pattern of DOC concentration may be due to a combination of litter production and inundation pattern of the wetland. In contrast to daily (between tides) variation in DOC flux between the mangrove forest and tidal creek, daily variations of mean water quality were not significant. However, within-tide variation of DOC flux, dissolved oxygen content and salinity was observed. This indicated that the length of inundation and water source (freshwater vs. saltwater) variation across tidal cycles influenced water quality and DOC flux in the water column. Net DOC export was measured in October and December, suggesting the mangrove forest was a source of DOC to the adjacent tidal creek during these periods. Net annual export of DOC from the fringe mangrove to both the tidal creek and basin mangrove forest was 56 g C m−2 year−1. The seasonal pattern in our flux results indicates that DOC flux from this mangrove forest may be governed by both freshwater discharge and tidal range

Patterns of nutrient exchange in a riverine mangrove forest in the Shark River Estuary, Florida, USA

This study aimed to evaluate tidal and seasonal variations in concentrations and fluxes of nitrogen (NH4 +, NO2+NO3, total nitrogen) and phosphorus (soluble reactive phosphorus, total phosphorus) in a riverine mangrove forest using the flume technique during the dry (May, December 2003) and rainy (October 2003) seasons in the Shark River Estuary, Florida. Tidal water temperatures during the sampling period were on average 29.4 (± 0.4) oC in May and October declining to 20 oC (± 4) in December. Salinity values remained constant in May (28 ± 0.12 PSU), whereas salinity in October and December ranged from 6‒21 PSU and 9‒25 PSU, respectively. Nitrate + nitrite (N+N) and NH4+ concentrations ranged from 0.0 to 3.5 μM and from 0 to 4.8 μM throughout the study period, respectively. Mean TN concentrations in October and December were 39 (±0.8) μM and 37 (±1.5) μM, respectively. SRP and N+N concentrations in the flume increased with higher frequency in flooding tides. TP concentrations ranged between 0.2‒2.9 μM with higher concentrations in the dry season than in the rainy season. Mean concentrations were \u3c1. 5 μM during the sampling period in October (0.75 ± 0.02) and December (0.76 ± 0.01), and were relatively constant in both upstream and downstream locations of the flume. Water residence time in the flume (25 m2) was relatively short for any nutrient exchange to occur between the water column and the forest floor. However, the distinct seasonality in nutrient concentrations in the flume and adjacent tidal creek indicate that the Gulf of Mexico is the main source of SRP and N+N into the mangrove forest

Using an Improved Phagocytosis Assay to Evaluate the Effect of HIV on Specific Antibodies to Pregnancy-Associated Malaria

Background: Pregnant women residing in malaria endemic areas are highly susceptible to Plasmodium falciparum malaria, particularly during their first pregnancy, resulting in low birth weight babies and maternal anaemia. This susceptibility is associated with placental sequestration of parasitised red blood cells expressing pregnancy-specific variant surface antigens. Acquisition of antibodies against these variant surface antigens may protect women and their offspring. Functions of such antibodies may include prevention of placental sequestration or opsonisation of parasitised cells for phagocytic clearance. Methodology/Findings: Here we report the development and optimisation of a new high-throughput flow cytometry-based phagocytosis assay using undifferentiated Thp-1 cells to quantitate the amount of opsonizing antibody in patient sera, and apply this assay to measure the impact of HIV on the levels of antibodies to a pregnancy malaria-associated parasite line in a cohort of Malawian primigravid women. The assay showed high reproducibility, with inter-experimental correlation of r2 = 0.99. In primigravid women, concurrent malaria infection was associated with significantly increased antibodies, whereas HIV decreased the ability to acquire opsonising antibodies (Mann-Whitney ranksum: p = 0.013). This decrease was correlated with HIV-induced immunosuppression, with women with less than 350×106 CD4+ T- cells/L having less opsonising antibodies (coef: −11.95,P = 0.002). Levels of antibodies were not associated with protection from low birth weight or anaemia. Conclusions/Significance: This flow cytometry-based phagocytosis assay proved to be efficient and accurate for the measurement of Fc-receptor mediated phagocytosis-inducing antibodies in large cohorts. HIV was found to affect mainly the acquisition of antibodies to pregnancy-specific malaria in primigravidae. Further studies of the relationship between opsonising antibodies to malaria in pregnancy and HIV are indicated.Ricardo Ataíde, Wina Hasang, Danny W. Wilson, James G. Beeson, Victor Mwapasa, Malcolm E. Molyneux, Steven R. Meshnick, Stephen J. Rogerso

Maternal–Fetal Microtransfusions and HIV-1 Mother-to-Child Transmission in Malawi

Background: Between 25% and 35% of infants born to HIV-infected mothers become HIV-1 infected. One potential route of mother-to-child transmission (MTCT) could be through a breakdown in the placental barrier (i.e., maternal–fetal microtransfusions). Methods and Findings: Placental alkaline phosphatase (PLAP) is a 130-kD maternal enzyme that cannot cross the intact placental barrier. We measured PLAP activity in umbilical vein serum as an indicator of maternal–fetal microtransfusion, and related this to the risk of HIV-1 MTCT. A case-cohort study was conducted of 149 women randomly selected from a cohort of HIV-1-infected pregnant Malawians; these women served as a reference group for 36 cases of in utero MTCT and 43 cases of intrapartum (IP) MTCT. Cord PLAP activity was measured with an immunocatalytic assay. Infant HIV status was determined by real-time PCR. The association between cord PLAP activity and HIV-1 MTCT was measured with logistic regression using generalized estimating equations. Among vaginal deliveries, PLAP was associated with IP MTCT (risk ratio, 2.25 per $log_{10}$ ng/ml PLAP; 95% confidence interval, 0.95–5.32) but not in utero MTCT. In a multivariable model adjusted for HIV-1 RNA load, chorioamnionitis, and self-reported fever, the risk of IP MTCT almost tripled for every $log_{10}$ increase in cord PLAP activity (risk ratio, 2.87; 95% confidence interval, 1.05–7.83). Conclusion: These results suggest that during vaginal deliveries, placental microtransfusions are a risk factor for IP HIV-1 MTCT. Future studies are needed to identify factors that increase the risk for microtransfusions in order to prevent IP HIV-1 MTCT

Removing Orbital Debris with Lasers

Orbital debris in low Earth orbit (LEO) are now sufficiently dense that the use of LEO space is threatened by runaway collisional cascading. A problem predicted more than thirty years ago, the threat from debris larger than about 1 cm demands serious attention. A promising proposed solution uses a high power pulsed laser system on the Earth to make plasma jets on the objects, slowing them slightly, and causing them to re-enter and burn up in the atmosphere. In this paper, we reassess this approach in light of recent advances in low-cost, light-weight modular design for large mirrors, calculations of laser-induced orbit changes and in design of repetitive, multi-kilojoule lasers, that build on inertial fusion research. These advances now suggest that laser orbital debris removal (LODR) is the most cost-effective way to mitigate the debris problem. No other solutions have been proposed that address the whole problem of large and small debris. A LODR system will have multiple uses beyond debris removal. International cooperation will be essential for building and operating such a system.Comment: 37 pages, 15 figures, in preparation for submission to Advances in Space Researc