A massive hemorrhagic pleural effusion does not exclude the diagnosis of tuberculosis: a case report

We report a case of an immunocompetent 18-year-old man with a massive hemorrhagic, exudative, lymphocytic pleural effusion. Blind transthoracic pleural biopsy showed granuloma formation, while the pleural fluid culture was positive for Mycobacterium tuberculosis, confirming the diagnosis of primary tuberculous pleuritis. A massive hemorrhagic pleural effusion is extremely rare in tuberculosis, but tuberculosis is a very protean disease and should always be included in the differential diagnosis of pleural effusion

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Breakdown of kaolin concentration in different organs and analysis of complications following its infusion into the pleura

Background: there are no many reports, which have already described the efficacy of intrapleural in­fusion of Kaolin to induce an effective pleurodesis. Objective: The main aim of this experimental study was to recognize the rapidity of the Kaolin particles absorption and systemic distribution after the intrapleural installation and the promoted side effects in the mean time of 7 days. Materials and Methods: Thirty male rabbits among 40 ones, were assignied to receive Kaolin slurry through an intrapleural catheter placed in a right mini thoracotomy. They were randomly divided in 4 groups: A B C and D in relation with the euthanassion time after Kaolin installation in 7, in 24 and D in 7 days respectively. Samples of both lungs, heart, aorta, paratracheal lymph nodes, chest wall, diaphragm, liver, spleen kidneys and brain were obtained and examined in optic polarized light microscopy in order to identify particles of Kaolin and histologic lesions. Results: Kaolin crystals were found in the most of the examined organs. There was rapid and progressive increase deposition of the Kaolin particles on the organs. The amount of Kaolin was statistically different in the organs in relation to the time of death. The only tissue reaction due to the Kaolin deposition was on the lung parenchyma and was similar to the damages of Adult Respiratory Distress Syndrome (ARDS). Conclusions: This report suggest that there is a rapid absorption of Kaolin particles and progressive deposition of them in the organs, after it's intrapleural administration in rabbits, in the mean time of 7 days. The only reaction due to Kaolin deposition regards the lung tissue. Further studies are required to assess the Kaolin absorption and systemic distribution with the side effects.Ο σκοπός της παρούσης ερεύνης ήταν να μελετηθεί η απορρόφηση των σωματιδίων Καολίνης, μετά την έγχυση τους στην υπεζωκοτική κοιλότητα, η μεταφορά τους στα διάφορα όργανα και η διερεύνηση πιθανών ιστολογικών αλλοιώσεων που προκαλούνται στους ιστούς από την εναπόθεση των σωματιδίων Καολίνης. Υλικό - Μέθοδος: Σε 30 κόνικλους (40 συνολικά με την ομάδα των μαρτύρων) έγινε ενδοϋ­πεζωκοτική έγχυση Καολίνης μέσου μικρής θωρακοτομής. Τα πειραματόζωα κατάνεμήθηκαν σε 4 ισάριθμες ομάδες Α, Β, Γ, και Δ και θανατώθηκαν 7 ώρες και 7 ημέρες αντίστοιχα μετά την ενδοϋπεζωκοτική έγχυση ποσότητας Καολίνης 25mg/kg βάρους που είχε διαλυθεί σε 20ml φυσιολογικού ορού. Μετά την θανάτωση των πειραματόζωων αφαιρέθηκαν από αυτά: αμφότεροι οι πνεύμονες, η καρδιά, μέρος της αορτής, λεμφαδένες υπό το αορτικό τόξο, παρατραχειακοί λεμφαδένες, κυτταρολιπώδης ιστός του άνω και κάτω μεσοθωρακίου, μέρος του θωρακικού τοιχώματος, του διαφράγματος, του ήπατος, του σπληνός, αμφότεροι οι νεφροί και του εγκεφάλου. Δείγματα από αυτά τα όργανα εξετάστηκαν με κοινό οπτικό μικροσκόπιο και με μικροσκόπιο πολωμένου φωτός, με σκοπό την ανίχνευση των σωματιδίων Καολίνης στους ιστούς καθώς και των αλλοιώσεων που ενδεχομένως προκαλούσαν σε αυτούς. Αποτελέσματα: Από την επεξεργασία των ευρημάτων διαπιστώθηκε προοδευτικά αυξανόμενη ποσότητα σωματιδίων Καολίνης στους περισσότερους ιστούς από την στιγμή της ενδοϋ­πεζωκοτικής εγχύσεως. Το γεγονός αυτό αντανακλά την ταχεία απορρόφηση και κατανομή των σωματιδίων Καολίνης στους ιστούς δεδομένου ότι βρέθηκαν κρύσταλλοι Καολίνης σε όργανα σε διάστημα 7 ωρών μετά την έγχυση. Η μόνη παρενέργεια - ιστολογική αλλοίωση που καταγράφηκε από την εναπόθεση Καολίνης στους ιστούς ήταν στο πνευμονικό παρέγχυμα. Η φλεγμονώδης αντίδραση ήταν παρόμοια με αυτή που περιγράφεται στο Σύνδρομο Αναπνευστικής Δυσχέρειας του Ενήλικος (ARDS). Το μέγεθος της αντιδράσεως διαφοροποιήθηκε στο διάστημα των 7 ημερών. Το γεγονός αυτό συνδυάζεται με την κλινική εξέλιξη του ανωτέρου συνδρόμου. Συμπεράσματα: Από τη μελέτη αποδείχθηκε ταχεία απορρόφηση και προοδευτική εναπόθεση Καολίνης στους ιστούς, μετά από ενδοϋπεζωκοτική έγχυση με σκοπό την πλευρόδεση. Χαρακτηριστικές ήταν οι ιστολογικές αλλοιώσεις στο πνευμονικό παρέγχυμα ως αποτέλεσμα της κατανομής των κρυστάλλων Καολίνης. Κρίνεται αναγκαία η συνέχιση της έρευνας, παράλληλα με μετρήσεις κλινικών και εργαστηριακών παραμέτρων, έτσι ώστε να μελετηθεί η αντίδραση των ιστών στην Καολίνη πέραν των 7 ημερών και ταυτόχρονα να ερμηνευθεί η παθογένεια των ιστολογικών αλλοιώσεων στον πνεύμονα.

Loop Scheduling for Multithreaded Processors

Abstrac

Optimization Method on the Tuning, Sound Quality, and Ergonomics of the Ancient Guitar Using a DSP-FEM Simulation

The key parameters musicians consider when they evaluate the quality of a musical instrument are its tuning (reproducing a musical scale), sound quality, and ergonomics. Musical instrument makers, even up to this day, primarily base their practice on empirical knowledge and costly physical experimentation. A computational model that combines all the aforementioned key parameters is presented to predict the building details of an instrument. The simulation of the instrument is introduced to a multi-objective optimizer to calculate its optimal set of geometrical and material features, considering the importance of the three key parameters. For a string musical instrument this approach is based on a hybrid model of Digital Signal Processing simulating the vibrating string and of Finite Elements Method simulating the effect of the body. The simulation technique has been validated by building an ancient guitar and comparing its recordings with its analogous digital model. The proposed method can be put into practice to investigate the building details of any instrument by introducing the relevant simulation and the objective’s function parameters. This work is expected to provide a powerful tool for the musical instrument makers towards a more efficient design of a bespoke instrument

The Role of Angiotensin Receptor Blockers in the Personalized Management of Diabetic Neuropathy

Neuropathy is a frequent complication of diabetes mellitus (DM) and is associated with the increased risk ofamputation and vascular events. Tight glycemic control is an important component inthe prevention of diabetic neuropathy. However, accumulating data suggest that angiotensin receptor blockers (ARBs) might also be useful in this setting. We discuss the findings of both experimental and clinical studies that evaluated the effects of ARBs on indices of diabetic neuropathy. We also review the implicated mechanisms of the neuroprotective actions of these agents. Overall, it appears that ARBs might be a helpful tool for preventing and delaying the progression of diabetic neuropathy, but more data are needed to clarify their role in the management of this overlooked complication of DM