Prolonged Fever, Hepatosplenomegaly, and Pancytopenia in a 46-Year-Old Woman

Liran Levy and colleagues discuss the differential diagnosis, investigation, and management of a 46-year-old woman with fever, weakness, night sweats, and weight loss

SVNR: Spatially-variant Noise Removal with Denoising Diffusion

Denoising diffusion models have recently shown impressive results in generative tasks. By learning powerful priors from huge collections of training images, such models are able to gradually modify complete noise to a clean natural image via a sequence of small denoising steps, seemingly making them well-suited for single image denoising. However, effectively applying denoising diffusion models to removal of realistic noise is more challenging than it may seem, since their formulation is based on additive white Gaussian noise, unlike noise in real-world images. In this work, we present SVNR, a novel formulation of denoising diffusion that assumes a more realistic, spatially-variant noise model. SVNR enables using the noisy input image as the starting point for the denoising diffusion process, in addition to conditioning the process on it. To this end, we adapt the diffusion process to allow each pixel to have its own time embedding, and propose training and inference schemes that support spatially-varying time maps. Our formulation also accounts for the correlation that exists between the condition image and the samples along the modified diffusion process. In our experiments we demonstrate the advantages of our approach over a strong diffusion model baseline, as well as over a state-of-the-art single image denoising method

Exertional heat stroke in a marathon runner with extensive healed deep burns: a case report

Exertional heat illness typically occurs over hours in younger athletic patients or military recruits who exercise at elevated temperatures for a sufficient period of time to cause the rate of heat production to exceed the capacity of the body to dissipate heat. Since the physiological response to exercise includes cutaneous vasodilation and sweating, any limitation of such a response can cause rapid hyperthermia and thus heat stroke. One such condition is extensive burns healed by cicatrisation of the skin where the scar and grafted skin surface do not have functional sweat glands and are unable to lose heat in response to high temperatures. The authors report one unique case of a female marathon runner with exertional heat stroke who had recovered from deep second and third degree burns over approximately 50% of her body a few years ago

Risk factors for heat illness among British soldiers in the hot Collective Training Environment.

BACKGROUND: Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops. OBJECTIVE: To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses. METHODS: An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation). RESULTS: The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation. CONCLUSIONS: Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of 'marginal gains' is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE

Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

BACKGROUND: Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. CASE PRESENTATION: We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II) using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. CONCLUSION: M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods

Humic Substances Enhance Chlorothalonil Phototransformation via Photoreduction and Energy Transfer

ABSTRACT: The photodegradation of chlorothalonil, a polychlorinated aromatic fungicide widely used in agriculture, was investigated under ultraviolet–visible irradiation in the presence and absence of different humic substances that significantly enhance the chlorothalonil phototransformation. On the basis of a kinetic model, an analytical study, the effect of scavengers, the chlorothalonil phosphorescence measurement, and varying irradiation conditions, it was possible to demonstrate that this accelerating effect is due to their capacity to reduce the chlorothalonil triplet state via H-donor reaction and to energy transfer from the triplet humic to ground state chlorothalonil. Energy transfer occurs at wavelengths below 450 nm and accounts for up to 30% of the reaction in deoxygenated medium upon irradiation with polychromatic light (300–450 nm). This process is more important with Elliott humic and fulvic acids and with humic acids extracted from natural carbonaceous material than with Nordic NOM and Pahokee peat humic acids. The obtained results are of high relevance to understanding the processes involved in chlorothalonil phototransformation and the photoreactivity of humic substances. Chlorothalonil is one of the rare molecules shown to react by energy transfer from excited humic substances