What’s that Beeping Sound? Case Report

Abstract Title: What’s that Beeping Sound? A Case Report Ellie Balakhanlou, Medical Doctor - Medical Resident, Virginia Commonwealth University School of Medicine (Role: Presenting Author) Olivier Rolin, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author) Eugenio Monasterio, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author) Disclosure: None. Setting: Outpatient pediatric clinic Patient: A 21 year old female with spastic quadriplegic cerebral palsy (CP) with an intrathecal baclofen (ITB) pump Case Description: The patient presented with concerns of intermittent beeping sounds from her pump. She does not endorse any new weakness or spasticity. She notes the sound alarms for 10 minutes with long periods of silence. Assessment: Neurological exam was unremarkable except for sustained clonus on the right foot, which was not present at usual baseline. Interrogation of her Medtronic SynchroMed™ II showed it was replaced 3 months prior with a low reservoir alarm date in 6 months. The reservoir volume was 16.7 mL and no recent alerts were recorded. Abdominal x-ray was unremarkable for discontinuity or kinking of the pump catheter. Pump was programmed to deliver a 20-mcg bolus over 5 minutes. On reassessment in one hour, she was found to have decreased muscle tone and resolved clonus. Discussion: Given benign X-ray findings and the response to the bolus, we concluded that pump was functioning appropriately and the catheter was in continuity. We discussed our case with a representative from Medtronic who suggested the alarm may be coming from her recently explanted pump, which the patient had indeed kept. The patient was then discharged back home where she found her explanted pump alarming on her night table. Conclusion: ITB administration is a useful and well-established treatment of severe spasticity. The pump alarm alerts when pump volume is below the programmed low reservoir alarm volume or if it needs to be replaced. We report a case in which the patient mistakenly associated her removed pump alarm with her current implanted pump. This case demonstrates the importance of educating patients regarding the different alarm sounds, reasons why the pump may alarm, and disabling explanted pumps (if kept)

Substrate orientation effects on nanoelectrode lithography : ReaxFF molecular dynamics and experimental study

The crystallographic orientation of the substrate is an essential parameter in the kinetic mechanism for the oxidation process. Hence, the choice of substrate surface orientation is crucial in nanofabrication industries. In the present work, we have studied qualitatively the influence of substrate orientation in nanoelectrode lithography using ReaxFF reactive molecular dynamics simulation. We have investigated the oxidation processes on (100), (110) and (111) orientation surfaces of silicon at different electric field intensities. The simulation results show the thickness of the oxide film and the initial oxygen diffusion rate follow an order of (100) > (110) > (111) at lower electric field intensities. It also confirms that surfaces with higher surface energy are more reactive at lower electric field intensity. Crossovers occurred at a higher electric field intensity (7 V nm -1) under which the thickness of the oxide film yields an order of T(110) > T(100) > T(111). These types of anomalous characteristics have previously been observed for thermal oxidation of silicon surfaces. Experimental results show different orders for the (100) and (111) substrate, while (110) remains the largest for the oxide thickness. A good correlation has been found between the oxide growth and the orientation-dependent parameters where the oxide growth is proportional to the areal density of the surfaces. The oxide growth also follows the relative order of the activation energies, which could be another controlling factor for the oxide growth. Less activation energy of the surface allows more oxide growth and vice versa. However, the differences between simulation and experimental results probably relate to the empirical potential as well as different time and spatial scales of the process

Genetic counseling in the context of Bangladesh : current scenario, challenges, and a framework for genetic service implementation

With the advancements in genetics and genomics in the twenty-first century, genetic services have become an integral part of medical practices in high-income and upper-middle-income countries. However, people living in low and lower-middle-income countries (LICs and LIMCs), including Bangladesh, are rather underprivileged in receiving genetic services. Consequently, genetic disorders are emerging as a significant public health concern in these countries. Lack of expertise, high expense, the dearth of epidemiological data, insufficiently updated medical education system, poor infrastructure, and the absence of comprehensive health policies are the main factors causing people living in these countries not having access to genetic services. In this article, the authors took benefit from their professional experience of practicing medical genetics in the area and reviewed existing literature to provide their opinions. Particularly, it reviews the current knowledge of genetic disorders' burden and their causative factors in Bangladesh. It focuses on why providing genetic services is challenging in the context of the country's cultural and religious sentiment. Finally, it proposes a physician-academician collaborative framework within the existing facility that aims to tackle the challenges. Such a framework could also be useful for other LICs and LMICs to address the challenges associated with providing genetic services

ReaxFF molecular dynamics simulation study of nanoelectrode lithography oxidation process on silicon (100) surface

The nanoelectrode lithography has been strengthened in recent years as one of the most promising methods due to its high reproducibility, low cost and ability to manufacture nano-sized structures. In this work, the mechanism and the parametric influence in nanoelectrode lithography have been studied qualitatively in atomic scale using ReaxFF MD simulation. This approach was originally developed by van Duin and co-workers to investigate hydrocarbon chemistry. We have investigated the water adsorption and dissociation processes on Si (100) surface as well as the characteristics (structure, chemical composition, morphology, charge distribution, etc.) of the oxide growth. The simulation results show two forms of adsorption of water molecules: molecular adsorption and dissociative adsorption. After breaking the adsorbed hydroxyls, the oxygen atoms insert into the substrate to form the Si−O−Si bonds so as to make the surface oxidized. The influence of the electric field intensity (1.5 – 7 V/nm) and the relative humidity (20 – 90%) on the oxidation process have also been discussed. Nevertheless, the results obtained from the simulations have been compared qualitatively with the experimental results and they show in good agreements. Variable charge molecular dynamics allowed us to characterize the nanoelectrode lithography process from an atomistic point of view

Chikungunya outbreak in Bangladesh (2017) : clinical and hematological findings

Introduction: A massive outbreak of chikungunya virus (CHIKV) occurred in Bangladesh during the period of April-September 2017, and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological, and long-term aspects of this outbreak. Methods: A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven laboratory-confirmed CHIKV cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 chikungunya patients was monitored for post-infection effects for 12 months. Results: Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that irrespective of age and sex groups, CHIKV patients had a decreased level of hemoglobin (n = 64, p < 0.01) and elevated erythrocyte sedimentation rate (n = 131, p < 0.01). Besides, a significant portion of the patients represented abnormal values for RBC (n = 38, p = 0.0005) and WBC (n = 63, p < 0.01) counts. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain, and memory problems were the most significant aftereffects, which had an impact on the daily activities of patients. Conclusions: This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of CHIKV in Bangladesh as well as its chronic outcomes till the 12(th) month. It provides insights into the natural history of this disease, which may help to improve the management of CHIKV patients. Author summary: The clinical profile, epidemiology, and the economic impacts during the acute phase of chikungunya infection have been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are infrequent. In this study, we analyzed the clinical and hematological features of 187 chikungunya patients in the acute phase of the infection. Also, we monitored a smaller group of 48 patients until 12 months to study its post-infection consequences. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that CHIKV infection features a significantly reduced hemoglobin and remarkably elevated erythrocyte sedimentation rate. Besides, RBC and WBC counts, especially in children and females, were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had a moderate to severe impact on the daily activities of the respondents. This study provides insights into the clinical and hematological aspects of chikungunya infection during the acute phase as well as describes an account for its chronic outcomes, which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improve patient management

Chikungunya outbreak in Bangladesh (2017) : clinical and hematological findings

A massive outbreak of Chikungunya occurred in Bangladesh during the period of April-September, 2017 and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological and long-term aspects of this outbreak. A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven clinically proven Chikungunya cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 Chikungunya patients was monitored for post-infection effects for 12 months. Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that, irrespective of age groups, hemoglobin level significantly decreased and erythrocyte sedimentation rate remarkably increased in Chikungunya confirmed patients. However, the majority of the patients had a normal range of whole WBC and platelet counts; RBC counts for mid aged (40 – 60 years) and senior (61+ years) patients (especially in the females) were beyond the reference values. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain and memory problems were the most significant aftereffects, which had an impact on daily activities of patients. This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of Chikungunya in Bangladesh as well as its chronic outcomes till the 12th month. It provides insights into the natural history of this disease which may help to improve management of the Chikungunya patients.Author summeryThe clinical profile, epidemiology and the economic impacts during the acute phase of Chikungunya infection has been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are very limited. In this study, a dataset of 187 clinically proven chikungunya patients were analyzed for the clinical and hematological features at acute phase of the infection. Additionally, the long-term consequences till month 12 after the infection were studied for a smaller group of 48 patients. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that, hemoglobin levels of the patients were significantly reduced and erythrocyte sedimentation rate increased remarkably. Also, RBC counts for mid-aged and older patients were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had moderate to severe impact on daily activities of the respondents. This study provides insights into the clinical and hematological aspects of Chikungunya infection during the acute phase as well as describes an account for its chronic outcomes which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improved patient management

Seeing two faces together: preference formation in humans and rhesus macaques

Humans, great apes and old world monkeys show selective attention to faces depending on conspecificity, familiarity, and social status supporting the view that primates share similar face processing mechanisms. Although many studies have been done on face scanning strategy in monkeys and humans, the mechanisms influencing viewing preference have received little attention. To determine how face categories influence viewing preference in humans and rhesus macaques (Macaca mulatta), we performed two eye-tracking experiments using a visual preference task whereby pairs of faces from different species were presented simultaneously. The results indicated that viewing time was significantly influenced by the pairing of the face categories. Humans showed a strong bias towards an own-race face in an Asian–Caucasian condition. Rhesus macaques directed more attention towards non-human primate faces when they were paired with human faces, regardless of the species. When rhesus faces were paired with faces from Barbary macaques (Macaca sylvanus) or chimpanzees (Pan troglodytes), the novel species’ faces attracted more attention. These results indicate that monkeys’ viewing preferences, as assessed by a visual preference task, are modulated by several factors, species and dominance being the most influential

Dermanyssus gallinae in layer farms in Kosovo: a high risk for salmonella prevalence

Background The poultry red mite (PRM), Dermanyssus gallinae (D.g.) is a serious ectoparasitic pest of poultry and potential pathogen vector. The prevalence of D. g. and the prevalence of Salmonella spp. within mites on infested laying poultry farms were investigated in Kosovo. Findings In total, 14 populated layer farms located in the Southern Kosovo were assessed for D. g. presence. Another two farms in this region were investigated 6 months after depopulation. Investigated flocks were all maintained in cages, a common housing system in Kosovo. A total of eight farms were found to be infested with D. g. (50%) at varying levels, including the two depopulated farms. The detection of Salmonella spp. from D. g. was carried out using PCR. Out of the eight layer farms infested with D. g., Salmonella spp. was present in mites on three farms (37.5%). Conclusions This study confirms the high prevalence of D. g. in layer flocks in Kosovo and demonstrates the link between this mite and the presence of Salmonella spp. on infested farms

The complete mitochondrial genome of the foodborne parasitic pathogen Cyclospora cayetanensis

Cyclospora cayetanensis is a human-specific coccidian parasite responsible for several food and water-related outbreaks around the world, including the most recent ones involving over 900 persons in 2013 and 2014 outbreaks in the USA. Multicopy organellar DNA such as mitochondrion genomes have been particularly informative for detection and genetic traceback analysis in other parasites. We sequenced the C. cayetanensis genomic DNA obtained from stool samples from patients infected with Cyclospora in Nepal using the Illumina MiSeq platform. By bioinformatically filtering out the metagenomic reads of non-coccidian origin sequences and concentrating the reads by targeted alignment, we were able to obtain contigs containing Eimeria-like mitochondrial, apicoplastic and some chromosomal genomic fragments. A mitochondrial genomic sequence was assembled and confirmed by cloning and sequencing targeted PCR products amplified from Cyclospora DNA using primers based on our draft assembly sequence. The results show that the C. cayetanensis mitochondrion genome is 6274 bp in length, with 33% GC content, and likely exists in concatemeric arrays as in Eimeria mitochondrial genomes. Phylogenetic analysis of the C. cayetanensis mitochondrial genome places this organism in a tight cluster with Eimeria species. The mitochondrial genome of C. cayetanensis contains three protein coding genes, cytochrome (cytb), cytochrome C oxidase subunit 1 (cox1), and cytochrome C oxidase subunit 3 (cox3), in addition to 14 large subunit (LSU) and nine small subunit (SSU) fragmented rRNA genes