Hepatitis C Cirrhosis, Hepatitis B Superimposed Infection, and the Emergence of an Acute Portal Vein Thrombosis: A Case Report

Acute portal vein thrombosis (PVT) is a complication of liver cirrhosis. The presence of viral infections such as hepatitis B (HBV) and hepatitis C (HCV) can further increase cirrhotic patients\u27 risk of developing PVT, especially in the rare case when there is superinfection with both HBV and HCV. We present a patient with HCV cirrhosis whose clinical condition was decompensated secondary to the development of superimposed HBV infection, who developed acute PVT during hospitalization. This case offers a unique presentation of acute PVT that developed within several days of hospitalization for decompensated liver disease, as proven by the interval absence of portal venous flow on repeat imaging. Despite the workup on the initial presentation being negative for PVT, reconsideration of differentials after the change in our patient\u27s clinical status led to the diagnosis. Active HBV infection was likely the initial trigger for the patient\u27s cirrhosis decompensation and presentation; the subsequent coagulopathy and alteration in the portal blood flow triggered the development of an acute PVT. The risk for both prothrombotic and antithrombotic complications remains high in patients with cirrhosis, a risk that is vastly increased by the presence of superimposedinfections. The diagnosis of thrombotic complications such as PVT can be challenging, thus stressing the importance of repeat imaging in instances where clinical suspicion remains high despite negative imaging. Anticoagulation should be considered for cirrhotic patients with PVT on an individual basis for both prevention and treatment. Prompt diagnosis, early intervention, and close monitoring of patients with PVT are crucial for improving clinical outcomes. The goal of this report is to illustrate diagnostic challenges that accompany the diagnosis of acute PVT in cirrhosis, as well as discuss therapeutic options for optimal management of this condition

The Achievable Rate of Interweave Cognitive Radio in the Face of Sensing Errors

Cognitive radio (CR) systems are potentially capable of mitigating the spectrum shortage of contemporary wireless systems. In this paper, we provide a brief overview of CR systems and the important research milestones of their evolution, along with their standardization activities, as a result of their research. This is followed by the detailed analysis of the interweave policy-based CR network (CRN) and by a detailed comparison with the family of underlay-based CRNs. In the interweave-based CRN, sensing of the primary user's (PU) spectrum by the secondary user's (SU) has remained a challenge, because the sensing errors prevent us from fulfilling the significant throughput gains that the concept of CR promises. Since missed detection and false alarm errors in real-time spectrum sensing cannot be avoided, based on a new approach, we quantify the achievable rates of the interweave CR by explicitly incorporating the effect of sensing errors. The link between the PU transmitter and the SU transmitter is assumed to be fast fading. Explicitly, the achievable rate degradation imposed by the sensing errors is analyzed for two spectrum sensing techniques, namely, for energy detection and for magnitude squared coherence-based detection. It is demonstrated that when the channel is sparsely occupied by the PU, the reusing techniques that are capable of simultaneously providing low missed detection and false alarm probabilities cause only a minor degradation to the achievable rates. Furthermore, based on the achievable rates derived for underlay CRNs, we compare the interweave CR and the underlay CR paradigms from the perspective of their resilience against spectrum sensing errors. Interestingly, in many practical regimes, the interweave CR paradigm outperforms the underlay CR paradigm in the presence of sensing errors, especially when the SNR at the SU is below 10 dB and when the SNR at the PU is in the range of 10-40 dB. Furthermore, we also provide rules of thumb that identify regimes, where the interweave CR outperforms the underlay CR

Cetacean bycatch in Indian Ocean tuna gillnet fisheries

Pelagic gillnet (driftnet) fisheries account for some 34% of Indian Ocean tuna catches. We combined published results from 10 bycatch sampling programmes (1981−2016) in Australia, Sri Lanka, India and Pakistan to estimate bycatch rates for cetaceans across all Indian Ocean tuna gillnet fisheries. Estimated cetacean bycatch peaked at almost 100 000 ind. yr−1 during 2004−2006, but has declined by over 15% since then, despite an increase in tuna gillnet fishing effort. These fisheries caught an estimated cumulative total of 4.1 million small cetaceans between 1950 and 2018. These bycatch estimates take little or no account of cetaceans caught by gillnet but not landed, of delayed mortality or sub-lethal impacts on cetaceans (especially whales) that escape from gillnets, of mortality associated with ghost nets, of harpoon catches made from gillnetters, or of mortality from other tuna fisheries. Total cetacean mortality from Indian Ocean tuna fisheries may therefore be substantially higher than estimated here. Declining cetacean bycatch rates suggest that such levels of mortality are not sustainable. Indeed, mean small cetacean abundance may currently be 13% of pre-fishery levels. None of these estimates are precise, but they do demonstrate the likely order of magnitude of the issue. Countries with the largest current gillnet catches of tuna, and thus the ones likely to have the largest cetacean bycatch are (in order): Iran, Indonesia, India, Sri Lanka, Pakistan, Oman, Yemen, UAE and Tanzania. These 9 countries together may account for roughly 96% of all cetacean bycatch from tuna gillnet fisheries across the Indian Ocean

Evaluations of the effect of sodium metabisulfite on the stability and dissolution rates of various model drugs from the extended release polyethylene oxide matrices

Purpose: This study examines the effect of sodium metabisulfite (SMB) as an antioxidant on the stability and release of various model drugs namely propranolol HCl, theophylline and zonisamide from the polyethylene oxide (PEO) tablets. The antioxidant was used to minimise degradation and instability of the manufactured tablets when stored at 40°C (55±5 % RH) over 8 weeks. Method: Multiple batches of tablets weighing 240 mg (50% w/w) with a ratio of 1:1 drug: polymer and 1% (w/w) sodium metabisulfite containing different model drugs and various molecular weights of PEO 750 and 303 were produced. Results: The results indicated that the use of sodium metabisulfite marginally assisted in reducing drug release and degradation via oxidation in propranolol HCl tablets containing both PEO 750 and 303. In the case of poorly and semi-soluble drugs (zonisamide and theophylline) the formulations with both PEO showed entirely superimposable phenomenon and different release profiles compared to control samples (matrices without SMB). DSC study demonstrated the modifications of the polymer due to degradation and observed the effect of SMB on the thermal degradation of the PEO matrices. Conclusion: The use of antioxidant has assisted in retaining the stability of the manufactured tablets with different model drugs especially those with the highly soluble drug that are susceptible to rapid degradation. This has been reflected by an extended release profile of various drugs used at various stages of the storage time up to 8 weeks

Population Reference Ranges of Urinary Endogenous Sulfate Steroids Concentrations and Ratios as Complement to the Steroid Profile in Sports Antidoping

The population based Steroid Profile (SP) ratio of testosterone (T) and epitestosterone (E) has been considered as a biomarker approach to detect testosterone abuse in '80s. The contemporary Antidoping Laboratories apply the World Antidoping Agency (WADA) Technical Document (TD) for Endogenous Androgenic Anabolic Steroids (EAAS) in the analysis of SP during their screening. The SP Athlete Biological Passport (ABP) adaptive model uses the concentrations of the total of free and glucuronide conjugated forms of six EAASs concentrations and ratios measured by GC/MS. In the Antidoping Lab Qatar (ADLQ), the routine LC/MS screening method was used to quantitatively estimate the sulfate conjugated EAAS in the same analytical run as for the rest qualitative analytes. Seven sulfate EAAS were quantified for a number of routine antidoping male and female urine samples during screening. Concentrations, statistical parameters and selected ratios for the 6 EAAS, the 6 sulfate EAAS and 29 proposed ratios of concentrations from both EAAS and sulfate EAAS, which potentially used as SP ABP biomarkers, population reference limits and distributions have been estimated after the GC/MSMS analysis for EAAS and LC/Orbitrap/MS analysis for sulfate EAAS

Influence of supramolecular forces on the linear viscoelasticity of gluten

Stress relaxation behavior of hydrated gluten networks was investigated by means of rheometry combined with μ-computed tomography (μ-CT) imaging. Stress relaxation behavior was followed over a wide temperature range (0–70 °C). Modulation of intermolecular bonds was achieved with urea or ascorbic acid in an effort to elucidate the presiding intermolecular interactions over gluten network relaxation. Master curves of viscoelasticity were constructed, and relaxation spectra were computed revealing three relaxation regimes for all samples. Relaxation commences with a well-defined short-time regime where Rouse-like modes dominate, followed by a power law region displaying continuous relaxation concluding in a terminal zone. In the latter zone, poroelastic relaxation due to water migration in the nanoporous structure of the network also contributes to the stress relief in the material. Hydrogen bonding between adjacent protein chains was identified as the determinant force that influences the relaxation of the networks. Changes in intermolecular interactions also resulted in changes in microstructure of the material that was also linked to the relaxation behavior of the networks

Spatio-temporal patterns of pre-eclampsia and eclampsia in relation to drinking water salinity at the district level in Bangladesh from 2016 to 2018

This analysis examines whether salinity in drinking water is associated with pre-eclampsia and eclampsia (PE/E), a leading cause of maternal morbidity and mortality. Bangladesh’s national health information system data were extracted at the district level (n = 64) to assess PE/E rates, and these were overlaid with three environmental measures approximating drinking water salinity, remotely sensed low-elevation coastal zone (LECZ), monthly rainfall data, and electrical conductivity of groundwater (i.e., water salinity). Results from a negative binomial fixed effects model suggest PE/E rates are higher with less rainfall (dry season), lower population density, and that district level rates of PE/E increase with higher groundwater salinity and in the high risk LECZ category closest to the coast. Results suggest that drinking water salinity may be associated with PE/E and that using national health surveillance data can improve understanding of this association. This approach can potentially be leveraged in the future to inform targeted interventions to high risk regions and times

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions

Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction

Background: Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010–2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016. Methods: Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates. Results: The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates. Conclusions: Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis