Rhinocerebral mucormycosis treated with 32 gram liposomal amphotericin B and incomplete surgery: a case report

BACKGROUND: Mucormycosis (or zygomycosis) is the term for infection caused by fungi of the order Mucorales. Mucoraceae may produce severe disease in susceptible individuals, notably patients with diabetes and leukemia. Rhinocerebral mucormycosis most commonly manifests itself in the setting of poorly controlled diabetes, especially with ketoacidosis. CASE PRESENTATION: A 31-year-old diabetic man presented to the outpatient clinic with the following signs and symptoms: headache, periorbital pain, swelling and loss of vision in the right eye. On physical examination his right eye was red and swollen. There was periorbital cellulitis and the conjunctiva was edematous. KOH preparation of purulent discharge showed broad, ribbonlike, aseptate hyphae when examined under a fluorescence microscope. Cranial MRI showed involvement of the right orbit, thrombosis in cavernous sinus and infiltrates at ethmoid and maxillary sinuses. Mucormycosis was diagnosed based on these findings. Amphotericin B (AmBisome(®); 2 mg/kg.d) was initiated after the test doses. Right orbitectomy and right partial maxillectomy were performed; the lesions in ethmoid and maxillary sinuses were removed. The duration of the liposomal amphotericin B therapy was approximately 6 months and the total dose of liposomal amphotericin B used was 32 grams. Liposomal amphotericin B therapy was stopped six months later and oral fluconazole was started. CONCLUSIONS: Although a total surgical debridement of the lesions could not be performed, it is remarkable that regression of the disease could be achieved with medical therapy alone

Halo Excitation of 6^6He in Inelastic and Charge-Exchange Reactions

Four-body distorted wave theory appropriate for nucleon-nucleus reactions leading to 3-body continuum excitations of two-neutron Borromean halo nuclei is developed. The peculiarities of the halo bound state and 3-body continuum are fully taken into account by using the method of hyperspherical harmonics. The procedure is applied for A=6 test-bench nuclei; thus we report detailed studies of inclusive cross sections for inelastic $^6$He(p,p')$^6$He$^*$ and charge-exchange $^6$Li(n,p)$^6$He$^*$ reactions at nucleon energy 50 MeV. The theoretical low-energy spectra exhibit two resonance-like structures. The first (narrow) is the excitation of the well-known $2^+$ three-body resonance. The second (broad) bump is a composition of overlapping soft modes of multipolarities $1^-, 2^+, 1^+, 0^+$ whose relative weights depend on transferred momentum and reaction type. Inelastic scattering is the most selective tool for studying the soft dipole excitation mode.Comment: Submitted to Phys. Rev. C., 11 figures using eps

Perfil sorológico dos anticorpos colostrais para Neospora caninum em bezerros livres da infecção

Neospora caninum is considered the main cause of bovine abortion worldwide. The correct laboratorial diagnose is very important to identify the infected animals and to apply control measure. The objetive of this study was to show the persistence period of colostral antibodies in calves. Eight newborn Holstein Friesan calves, males, were selected from N. caninum soronegative dams. Pre-colostral blood samples were collected of these calves and all of them were seronegative to N. caninum. They were fed with two liters of pooled colostrum from seropositive cows within two hours after birth. Blood samples were collected and tested weekly until the animals turned negative. Serum samples were tested for antibodies to N. caninum using indirect fluorescence antibody test at 1:50; 1: 100 and 1:200 dilutions. Antibodies were not detected from three out of eight calves and they were excluded from the study. The remaining 5 calves seroconverted in all dilutions at the fifth day after colostrums ingestion. At 1:50 dilution, one calf remained positive for 21 weeks, two for 20 weeks and one for 13 weeks. At 1:100, one calf was positive for 15 weeks and the remaining 4 calves for 13 weeks. At 1:200, each calf was positive for 1, 7, 12, 12 and 13 weeks, respectively. These results demonstrate that the colostral antibody to N. caninum may persist until 21 weeks after birth in calves and it's very important to exclud the calves at the first month of age in the seroprevalence studies to avoid the false-positive results.Neospora caninum é considerado a principal causa de aborto bovino mundial. O diagnóstico laboratorial correto é muito importante para identificar os animais infectados e para aplicar medidas de controle. O objetivo deste trabalho foi mostrar o declínio de anticorpos colostral em bezerros. Este estudo empregou oito bezerros holandeses, recém-nascidos, machos, descendentes de vacas soronegativas para N caninum. Amostra de sangue pré-colostral foram colhidas destes bezerros e todos estavam soronegativos pra N. caninum. Estes bezerros foram alimentados com dois litros de um pool de colostro de vacas soropositivas dentro de duas horas após o nascimento. Amostras de sangue dos bezerros foram colhidas semanalmente até os animais soroconverterem negativo. As amostras foram testadas para anticorpos de N. caninum usando teste de imunofluorescência indireta nos títulos de 1:50; 1: 100 e 1:200. Os resultados mostraram que 3 dos 8 bezerros não soroconverteram e foram excluídos do estudo. Os restantes cinco bezerros soroconverteram em todos os títulos no quinto dia após a inoculação. No título 1:50, um bezerro permaneceu positivo por 21 semanas, dois por 20 semanas e um por 13 semanas. No título 1:100, um bezerro foi positivo por 15 semanas e o restante quatro bezerros por 13 semanas. No título 1:200, cada bezerro foi positivo por 1; 7; 12; 12 e 13 semanas, respectivamente. Estes resultados demonstram que o anticorpo colostral para N. caninum pode permanecer até 21 semanas após o nascimento nos bezerros e é muito importante excluir os bezerros até quatro meses de idade nos estudos de soroprevalência para impedir os resultados falso-positivos

Lindblad master equation approach to superconductivity in open quantum systems

We consider an open quantum Fermi-system which consists of a single degenerate level with pairing interactions embedded into a superconducting bath. The time evolution of the reduced density matrix for the system is given by Linblad master equation, where the dissipators describe exchange of Bogoliubov quasiparticles with the bath. We obtain fixed points of the time evolution equation for the covariance matrix and study their stability by analyzing full dynamics of the order parameter.Comment: 7 pages, 2 pdf figure

Design of experiments to study the impact of process parameters on droplet size and development of non-invasive imaging techniques in tablet coating

Atomisation of an aqueous solution for tablet film coating is a complex process with multiple factors determining droplet formation and properties. The importance of droplet size for an efficient process and a high quality final product has been noted in the literature, with smaller droplets reported to produce smoother, more homogenous coatings whilst simultaneously avoiding the risk of damage through over-wetting of the tablet core. In this work the effect of droplet size on tablet film coat characteristics was investigated using X-ray microcomputed tomography (XμCT) and confocal laser scanning microscopy (CLSM). A quality by design approach utilising design of experiments (DOE) was used to optimise the conditions necessary for production of droplets at a small (20 μm) and large (70 μm) droplet size. Droplet size distribution was measured using real-time laser diffraction and the volume median diameter taken as a response. DOE yielded information on the relationship three critical process parameters: pump rate, atomisation pressure and coating-polymer concentration, had upon droplet size. The model generated was robust, scoring highly for model fit (R2 = 0.977), predictability (Q2 = 0.837), validity and reproducibility. Modelling confirmed that all parameters had either a linear or quadratic effect on droplet size and revealed an interaction between pump rate and atomisation pressure. Fluidised bed coating of tablet cores was performed with either small or large droplets followed by CLSM and XμCT imaging. Addition of commonly used contrast materials to the coating solution improved visualisation of the coating by XμCT, showing the coat as a discrete section of the overall tablet. Imaging provided qualitative and quantitative evidence revealing that smaller droplets formed thinner, more uniform and less porous film coats

Rhabdomyolysis in Community Acquired Bacterial Sepsis – A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES:Rhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort. DESIGN, SETTING, PARTICIPANTS #ENTITYSTARTX00026; MEASUREMENTS:Retrospective cohort study of adult patients with community acquired bacterial sepsis complicated by rhabdomyolysis from March 2003--August 2008. Rhabdomyolysis was defined as serum creatine kinase >2000 IU/L. The study population was divided into group-I (sepsis with gram positive pathogens), group-II (sepsis with gram negative pathogens) and group-III (culture negative sepsis). RESULTS:103 patients (group I -15, group II- 34 and group III- 54) formed the study cohort. Mean age was 55 years and two-third had diabetes. Mean creatine kinase was 7114 IU/L and mean serum creatinine on admission was 2.4 mg/dl. Causative pathogen of sepsis was identified in 47.5%. Gram negative pathogens were more frequently (33%) associated with rhabdomyolysis than gram positive pathogens (14.5%). Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia. Mortality was 59%. CONCLUSIONS:Gram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens. Rhabdomyolysis in patients with sepsis is multifactorial and is associated with high mortality