Steroid-induced Strongyloidiasis with Cholestasis Post-COVID-19 Pneumonia

The use of immunosuppressive agents has recently been raised during the COVID-19 pandemic to manage the COVID-19-induced systemic inflammatory response and improve mortality. This widespread use of steroids and other immunomodulators for severe COVID-19 diseases might pose a potential risk of reactivation of latent diseases and the emergence of opportunistic infections such as strongyloidiasis. We report a case of strongyloidiasis with cholestasis in a middle-aged man; who was otherwise healthy and had no history of recent travel, developed three weeks after a prolonged course of steroids for the management of severe COVID-19 pneumonia. The patient was managed with a combination of albendazole and ivermectin. A high index of suspicion of strongyloidiasis in symptomatic patients post immunosuppressant therapy for severe COVID-19 is required to prevent unfavorable outcomes. In selected high-risk patients, post prolonged steroid therapy for COVID-19 pneumonia screening for strongyloidiasis and ivermectin empirical treatment might be considered even in non-endemic areas

Changes in Scomberotoxin (Histamine) and Volatile Amine (TVB-N) Formation in Longtail Tuna (Thunnus tonggol) Stored at Different Temperatures

Changes in histamine and volatile amine (TVB-N) formation was studied in longtail tuna (Thunnus tonggol) captured in the Sea of Oman and stored at different temperatures. Based on sensory analysis, longtail tuna maintained shelf life for 1, 4, 15 and 300 days at 0, 8, 25 and -18 oC, respectively. Histamine and TVB-N increased with time, but the rate of change varied with storage temperature. Histamine formation was suppressed significantly at lower than the FDA limit of 5 mg/100 g at 0 and -18 oC but not at 8 or 25 oC. TVB-N did not reflect the quality index at 0 or 8 oC even though the samples were rejected by sensory evaluation. No correlation was observed between histamine and TVB-N values except at 25 oC and assessment of TVB-N was not sufficient for estimating the degree of histamine-related health hazard. Poor correlation was found between sensory score and pooled TVB-N value compared to histamine, and the correlation was closer at 8 and 25 oC than at the lower temperatures

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Interface Layers Detection in Oil Field Tanks: A Critical Review

An emulsion layer is a mixture of two or more liquids in which one of them the dispersed phase, is present as droplets of microscopic size, distributed throughout the other, called continuous phase. The existence of such layer between oil and water is due to the crude properties, and contaminants such as asphaltenes and resins. A measurement system to determine the boundaries of this emulsion in a modern oil production field is necessary to extract the pure single phase liquids [1, 2, 3]. This would for instance reduce the usage of expensive two phase flow meters and avoid the installation of additional tank separators along the upstream oil pipeline. In addition, this would help collecting accurate daily oil production statistics from each oil station. One widely deployed solution consists to inject chemical substances to completely eliminate the emulsion layer and leave only a crisp oilwater interface which can then be detected relatively much more easier. However, this approach is costly, not environmental friendly, and leads to a significant increase of the retention time in the separator. This book chapter provides a survey on electronic-basedtechniques which are capable to measure the high and low boundaries of the emulsion layer in real-time. It then describes in more details a new ultrasonic-based device along with the experimental results it could provide. Document type: Part of book or chapter of boo

Changing Elemental Uptake of Roots and Leaves from Plants Grown on a Soil Variably Polluted by Crude Oil

International audienceA radish species was grown in a sandy loamy soil either unpolluted or polluted by increasing concentrations of crude oil added to watering solutions during one month under controlled laboratory conditions. This procedure was set to evaluate the impact of oil pollution of the substrate on the elemental uptake by plants. In summary, the increasing pollution by crude oil to the soil has not a univocal impact: the changing elemental contents in the roots and leaves of the cultivated radishes are never single trended with the amount of oil pollution, showing in turn that they are not provided by the spilled oil. The most significant elemental increase occurs in the leaves of the radishes grown in the soil polluted by 10 ml of oil and in the roots of those grown in the soil polluted by 4 ml of oil. In the detail, the significant effects of the oil pollution induce in the leaves: (1) similar behaviors for Ca, K, P, Mg, Fe and Al; (2) the highest impact on Ca, K, P, Mg and Al at the intermediate 10-ml pollution; (3) the highest uptake at the high side of pollution for Fe, Mn, Zn, Ni, Co, Cr and Pb; and (4) no significant impact on the uptake of the REEs. Oil pollution on the plant roots impacts: (1) an increased Ca, Fe, Al and Si uptake, often only in the case of the highest pollution, while P's uptake decreases; (2) an increase of the microbial population by a factor of about 2.5 at low pollution and a dramatic decrease at higher pollution; (3) an uptake of REEs only at the highest degree of pollution by a specific increase of the light REEs. The translocation roots-to-leaves indicates a decrease of Ca to the leaves when oil pollution increases, while remaining state for K and P with a slight decrease when pollution is at its maximum. The total biomass increases in the soil at low levels of pollution, decreases at intermediate levels and remains the same at high levels of pollution. The increase of most of elements at low level of oil supply is correlated with an increase in microorganism density, which suggests that availability of elements in soil can be attributed to an increase in organic activity, which has been stimulated by the oil pollution

COVID-19 and Pulmonary Mycobacterium Tuberculosis Coinfection

The Coronavirus disease-2019 (COVID-19) outbreak was classified as a global pandemic by the World Health Organization on 11 March 2020. It is caused by the novel severe acute respiratory syndrome coronavirus 2. The virus affects mainly the human respiratory system. Mycobacterium tuberculosis (TB) is another respiratory infection known to affect humans and may share joint clinical presentations and risk factors with COVID-19 infection. Therefore, clinicians must have a high index of suspicion that the two infections might coexist so that there is no delay in diagnosis and starting the appropriate treatment. There are few case reports about TB and COVID-19 coinfection. The first case report ever was from China and there have been a few others around the world. Here, we report two cases of coexisting COVID-19 and newly diagnosed pulmonary TB infection in Oman

White Coat Hypertension and Masked Hypertension Among Omani Patients Attending a Tertiary Hospital for Ambulatory Blood Pressure Monitoring

Objectives: Our study aimed to estimate the rate of white coat hypertension (WCH) and effect, and masked hypertension in patients attending a tertiary care hospital for 24 hour ambulatory blood pressure monitoring (24-h ABPM). Methods: A total of 231 adult patients were referred to the Department of Clinical Physiology at Sultan Qaboos University Hospital, Muscat, for ABPM, between January 2010 and June 2012. The following data were gathered and analyzed: demographic data, clinic blood pressure (BP) measurements, and 24-h BP profile from ABPM. Thirty-two patients were excluded and the final analysis included 199 patients. Results: There were 105 (52.8%) women and 94 (47.2%) men studied. The mean age of patients was 46±15 years and most patients were overweight with a mean BMI of 29.6±5kg/m2. Around half of patients (53.8%) were on one or more antihypertensive medications. WCH was found in 10.6% and white coat effect was found in 16% of patients. The majority of patients (57%) with WCH were aged 40 years or above. Masked hypertension was present in 6% of patients and masked uncontrolled hypertension in 8.5% of patients. Conclusions: Our study showed that WCH and effect, and masked hypertension are common in hypertensive patients. Identifying these patients will have an impact on their management. However, the results of the study should be interpreted within the context of its limitations. Prospective randomized community and hospital-based studies should be conducted to estimate the true prevalence in the general population as well as in hypertensive patients

Changes in Scomberotoxin (Histamine) and Volatile Amine (TVB-N) Formation in Longtail Tuna (Thunnus tonggol) Stored at Different Temperatures

Changes in histamine and volatile amine (TVB-N) formation was studied in longtail tuna (Thunnus tonggol) captured in the Sea of Oman and stored at different temperatures. Based on sensory analysis, longtail tuna maintained shelf life for 1, 4, 15 and 300 days at 0, 8, 25 and -18 oC, respectively. Histamine and TVB-N increased with time, but the rate of change varied with storage temperature. Histamine formation was suppressed significantly at lower than the FDA limit of 5 mg/100 g at 0 and -18 oC but not at 8 or 25 oC. TVB-N did not reflect the quality index at 0 or 8 oC even though the samples were rejected by sensory evaluation. No correlation was observed between histamine and TVB-N values except at 25 oC and assessment of TVB-N was not sufficient for estimating the degree of histamine-related health hazard. Poor correlation was found between sensory score and pooled TVB-N value compared to histamine, and the correlation was closer at 8 and 25 oC than at the lower temperatures