Evaluating mild traumatic brain injury in adults: an emergency physician’s dilemma

Background: Mild traumatic brain injury (MTBI) is a common presentation in emergency departments across the globe. A controversy about the policy of evaluating them with CT scan and hospital admission or discharge and for these patients. This study is directed towards correlation of clinical profile with CT brain findings of the patients to predict the possibility of an intracranial lesion and need for early neurosurgical intervention.Methods: This prospective observational study was carried out in the Emergency Department (ED) of a tertiary care government medical college and hospital. All patients aged more than 12 years presenting to the ED with mild traumatic brain injury (MTBI) within 24 hours of injury in whom NCCT head (trauma protocol) was done during the Study. Descriptive and analytical statistics were applied. Multiple logistic regression analysis was used to identify factors related to different outcomes.Results: 178 patients with MTBI were enrolled in the study among which intracranial injuries were found by CT scan in 28 patients (15.7%). Odds of finding intracranial injuries were highest with the presence of post-traumatic vomiting, post traumatic amnesia (PTA), pre-existing alcohol use disorder, GCS≤14, focal neurological deficit and clinical signs of basal skull fracture. 2.8% patients required urgent neurosurgical intervention.Conclusions: Presence of post-traumatic vomiting, PTA, alcohol use disorder, GCS≤14, focal neurodeficit and signs of basal skull fracture in a MTBI patient should be considered as high-risk factors for significant intracranial injuries. 

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

Eros is a novel transmembrane protein that controls the phagocyte respiratory burst and is essential for innate immunity

The phagocyte respiratory burst is crucial for innate immunity. The transfer of electrons to oxygen is mediated by a membrane-bound heterodimer, comprising gp91$\textit{phox}$ and p22$\textit{phox}$ subunits. Deficiency of either subunit leads to severe immunodeficiency. We describe Eros (essential for reactive oxygen species), a protein encoded by the previously undefined mouse gene $\textit{bc017643}$, and show that it is essential for host defense via the phagocyte NAPDH oxidase. Eros is required for expression of the NADPH oxidase components, gp91$\textit{phox}$ and p22$\textit{phox}$. Consequently, $\textit{Eros}$-deficient mice quickly succumb to infection. $\textit{Eros}$ also contributes to the formation of neutrophil extracellular traps (NETS) and impacts on the immune response to melanoma metastases. $\textit{Eros}$ is an ortholog of the plant protein Ycf4, which is necessary for expression of proteins of the photosynthetic photosystem 1 complex, itself also an NADPH oxio-reductase. We thus describe the key role of the previously uncharacterized protein Eros in host defense.D.C. Thomas was funded by a Wellcome Trust/CIMR Next Generation Fellowship, a National Institute for Health Research (NIHR) Clinical Lectureship, and a Starter Grant for Clinical Lecturers (Academy of Medical Sciences). K.G.C. Smith was funded by funded by the Medical Research Council (program grant MR/L019027) and is a Wellcome Investigator and a NIHR Senior Investigator. S. Clare and G. Dougan were funded by the Wellcome Trust (grant 098051). The Cambridge Institute for Medical Research is in receipt of a Wellcome Trust Strategic Award (079895). J.C.L is funded by a Wellcome Intermediate Clinical Fellowship 105920/2/14/2

Formation of Stable Cruciform Assembly of Gold Nanoparticles from Cannabis indica Leaves

Gold nanoparticles have been increasingly used in several electronic, material fabrication, and biomedical applications. Several methods have been reported to prepare gold nanoparticles of various shapes and sizes with different photophysical properties. Although useful to prepare gold nanoparticles, most of the methods are not stable enough, which leads to the degradation of the nanoparticles, if they are stored at room temperatures (up to 30 °C) for a few days. In this paper, we report a novel and environmentally friendly method to synthesize self-assembled gold nanoparticles in cruciform shapes by using leaf extract of Cannabis indica as a reducing agent without the aid of any polymers or additional chemicals. The nanoparticles are found to be stable for more than a month (45 days) when stored at room temperature (up to 30 °C). They were able to form stable conjugates with bovine α-lactalbumin protein that may possess anti-cancerous properties

Formation of Stable Cruciform Assembly of Gold Nanoparticles from <i>Cannabis indica</i> Leaves

Gold nanoparticles have been increasingly used in several electronic, material fabrication, and biomedical applications. Several methods have been reported to prepare gold nanoparticles of various shapes and sizes with different photophysical properties. Although useful to prepare gold nanoparticles, most of the methods are not stable enough, which leads to the degradation of the nanoparticles, if they are stored at room temperatures (up to 30 °C) for a few days. In this paper, we report a novel and environmentally friendly method to synthesize self-assembled gold nanoparticles in cruciform shapes by using leaf extract of Cannabis indica as a reducing agent without the aid of any polymers or additional chemicals. The nanoparticles are found to be stable for more than a month (45 days) when stored at room temperature (up to 30 °C). They were able to form stable conjugates with bovine α-lactalbumin protein that may possess anti-cancerous properties