Influence of asphaltene inhibitors on asphaltene deposition in the porous media

351-355This article deals with organic asphaltene deposition in the reservoir rock, for crude oil having high asphaltene content and high apparent viscosity. The crude oil is characterized using thermal analysis through the thermogravimetric method. Crude oil is blended with heptane and flooded through the formation core at 55°C and 200-1200 psi pressure. With the rise in flow pressure, asphaltene precipitation became more significant with about four hundred times fall in the initial flow rate (flow rate at 200 psi) of crude oil at 1200 psi pressure. Phthalic acid and turpentine oil are used as asphaltene inhibitors for this crude oil. These asphaltene inhibitors are easy to procure, required less dosage for asphaltene dissolution and are relatively less toxic as compared to the other organic solvents used frequently as asphaltene inhibitor in oil industries. The asphaltene inhibitors are injected into the crude oil and flowed through the pores of the core. It is found that the crude oil treated with phthalic acid resulted in 88.23% increment its flow rate as compared to the turpentine oil, suggesting significant organic asphaltene dissolution in the formation rock

The adverse effect profile of oral azathioprine in pediatric atopic dermatitis, and recommendations for monitoring

Background Azathioprine is efficacious in the treatment of severe childhood atopic dermatitis; however, robust data on adverse effects in this population are lacking. Objective We sought to assess adverse effects of azathioprine treatment in a pediatric atopic dermatitis cohort, and make recommendations for monitoring based on these data

Liver abscess caused by Serratia grimesii in an immunocompetent patient

In tropical and subtropical countries, the most common cause of liver abscess is Entamoeba histolytica. However, pyogenic infections are common due to bacteria like Kleibsella pneumonia followed by Escherichchia coli and enterococcus species. The possibility of atypical organisms should be considered especially with recurrent liver abscess. We report a case of recurrent liver abscess caused by Serratia grimesii in an immunocopetent individual. Early isolation of the organism along with drug susceptibility testing would make a marked difference in improving the management of the patient and associated prognosis

A rare case of progressive disseminated histoplasmosis with bone marrow involvement in an immunocompetent patient

Histoplasmosis is a rare entity in India and very few cases have been reported from eastern region of India like West Bengal and rarely cases from southern India as well. We hereby report a case of progressive disseminated histoplasmosis (PDH) from a non-endemic region of India (Eastern Utter Pradesh) and that too in an immunocompetent individual.

A case of rocky mountain spotted fever without eschar as a cause of pyrexia with multiple organ failure

Rocky mountain spotted fever (RMSF) is a rickettsia disease frequently reported from North America and Europe and transmitted by tick bite. This disease is very rare in India and other parts of South East Asia. Fever with rash and thrombocytopenia are the hallmark clinical presentations of viral hemorrhagic fever but other diseases like malaria, typhoid, Leptospira and rickettsia diseases should also be considered in differential diagnosis. Knowledge of geographical distribution, evidence of exposure to the vector and a high degree of clinical suspicion of rickettsia diseases are very important for early differentiation from other diseases to prevent lethal complications and institute initial treatment. We report a rare case of rocky mountain spotted fever (RMSF) from New Delhi, which was confirmed by specific indirect immunofluorescence assay (IIF).

<i>Pseudomonas aeruginosa</i> in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance

ObjectiveTo determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa.MethodsThis was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.ResultsP. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.ConclusionAntibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade

High antibiotic resistance and mortality with <i>Acinetobacter</i> species in a tertiary hospital, Nepal

SettingNepal Mediciti Hospital, Bhainsepati, Lalitpur, Nepal.ObjectivesTo determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019.DesignThis was a hospital laboratory-based, cross-sectional study.ResultsAcinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%).ConclusionA significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases

Angiogenic gene expression and vascular density are reflected in ultrasonographic features of synovitis in early Rheumatoid Arthritis: an observational study.

INTRODUCTION: Neovascularization contributes to the development of sustained synovial inflammation in the early stages of Rheumatoid Arthritis. Ultrasound (US) provides an indirect method of assessing synovial blood flow and has been shown to correlate with clinical disease activity in patients with Rheumatoid Arthritis. This study examines the relationship of US determined synovitis with synovial vascularity, angiogenic/lymphangiogenic factors and cellular mediators of inflammation in a cohort of patients with early Rheumatoid Arthritis (RA) patients prior to therapeutic intervention with disease modifying therapy or corticosteroids. METHODS: An ultrasound guided synovial biopsy of the supra-patella pouch was performed in 12 patients with early RA prior to treatment. Clinical, US and biochemical assessments were undertaken prior to the procedure. Ultrasound images and histological samples were obtained from the supra-patella pouch. Histological samples were stained for Factor VIII and a-SMA (a-smooth muscle actin). Using digital imaging analysis a vascular area score was recorded. QT-PCR (quantitative-PCR) of samples provided quantification of angiogenic and lymphangiogenic gene expression and immunohistochemistry stained tissue was scored for macrophage, T cell and B cell infiltration using an existing semi-quantitative score. RESULTS: Power Doppler showed a good correlation with histological vascular area (Spearman r--0.73) and angiogenic factors such as vascular endothelial growth factor-A (VEGF-A), Angiopoietin 2 and Tie-2. In addition, lymphangiogenic factors such as VEGF-C and VEGF-R3 correlated well with US assessment of synovitis. A significant correlation was also found between power Doppler and synovial thickness, pro-inflammatory cytokines and sub-lining macrophage infiltrate. Within the supra-patella pouch there was no significant difference in US findings, gene expression or inflammatory cell infiltrate between any regions of synovium biopsied. CONCLUSION: Ultrasound assessment of synovial tissue faithfully reflects synovial vascularity. Both grey scale and power Doppler synovitis in early RA patients correlate with a pro-angiogenic and lymphangiogenic gene expression profile. In early RA both grey scale and power Doppler synovitis are associated with a pro-inflammatory cellular and cytokine profile providing considerable validity in its use as an objective assessment of synovial inflammation in clinical practice

A Pauci-Immune Synovial Pathotype Predicts Inadequate Response to TNF alpha-Blockade in Rheumatoid Arthritis Patients

Objectives: To assess whether the histopathological features of the synovium before starting treatment with the TNFi certolizumab-pegol could predict clinical outcome and examine the modulation of histopathology by treatment. Methods: Thirty-seven RA patients fulfilling UK NICE guidelines for biologic therapy were enrolled at Barts Health NHS trust and underwent synovial sampling of an actively inflamed joint using ultrasound-guided needle biopsy before commencing certolizumab-pegol and after 12-weeks. At 12-weeks, patients were categorized as responders if they had a DAS28 fall >1.2. A minimum of 6 samples was collected for histological analysis. Based on H&E and immunohistochemistry (IHC) staining for CD3 (T cells), CD20 (B cells), CD138 (plasma cells), and CD68 (macrophages) patients were categorized into three distinct synovial pathotypes (lympho-myeloid, diffuse-myeloid, and pauci-immune). Results: At baseline, as per inclusion criteria, DAS28 mean was 6.4 \ub1 0.9. 94.6% of the synovial tissue was retrieved from the wrist or a metacarpophalangeal joint. Histological pathotypes were distributed as follows: 58% lympho-myeloid, 19.4% diffuse-myeloid, and 22.6% pauci-immune. Patients with a pauci-immune pathotype had lower levels of CRP but higher VAS fatigue compared to lympho- and diffuse-myeloid. Based on DAS28 fall >1.2, 67.6% of patients were deemed as responders and 32.4% as non-responders. However, by categorizing patients according to the baseline synovial pathotype, we demonstrated that a significantly higher number of patients with a lympho-myeloid and diffuse-myeloid pathotype in comparison with pauci-immune pathotype [83.3% (15/18), 83.3 % (5/6) vs. 28.6% (2/7), p = 0.022) achieved clinical response to certolizumab-pegol. Furthermore, we observed a significantly higher level of post-treatment tender joint count and VAS scores for pain, fatigue and global health in pauci-immune in comparison with lympho- and diffuse-myeloid patients but no differences in the number of swollen joints, ESR and CRP. Finally, we confirmed a significant fall in the number of CD68+ sublining macrophages post-treatment in responders and a correlation between the reduction in the CD20+ B-cells score and the improvement in the DAS28 at 12-weeks. Conclusions: The analysis of the synovial histopathology may be a helpful tool to identify among clinically indistinguishable patients those with lower probability of response to TNF\u3b1-blockade

Report of Second Meeting for the Purpose of Obtaining the Views of the Three Affiliated Tribes of the Fort Berthold Reservation on the Lieu Lands Offered by the Secretary of War, 1946

Report of the second meeting held in the office of Assistant Secretary of the Interior C. Girard Davidson for the purpose of obtaining the views of the Three Affiliated Tribes of the Fort Berthold Reservation of the lieu lands offered by the Secretary of War. Includes a list of attendees and a transcript of the meeting discussing the Three Affiliated Tribes\u27 rejection of the offer of lieu lands made by the Secretary of Interior and Department of War to the Fort Berthold Reservation. See also: Report of Meeting for the Purpose of Obtaining the Views of the Three Affiliated Tribes of the Fort Berthold Reservation on the Lieu Lands Offered by the Secretary of War, 1946https://commons.und.edu/langer-papers/1147/thumbnail.jp