Rituximab induced pulmonary edema managed with extracorporeal life support

Though rare, rituximab has been reported to induce severe pulmonary edema. We describe the first report of ECLS utilization for this indication. A 31-year-old female with severe thrombotic thrombocytopenic purpura developed florid pulmonary edema after rituximab infusion. Despite advanced ventilatory settings, she developed severe respiratory acidosis and remained hypoxemic with a significant vasopressor requirement. Since her pulmonary insult was likely transient, ECLS was considered. Due to combined cardiorespiratory failure, she received support with peripheral venoarterial ECLS. During her ECLS course, she received daily plasmapheresis and high dose steroids. Her pulmonary function recovered and she was decannulated after 8 days. She was discharged after 23 days without residual sequelae

Developing a Community-led Music Intervention to Support Antenatal Mental Health in The Gambia

Stress, anxiety and depression in pregnancy affect not only the mother but can also have long-term adverse effects on her child. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries (HICs). It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression in pregnancy. Using a mixed-methods approach, this thesis aims to investigate how a community-led music intervention can be developed and implemented within The Gambia to help reduce symptoms of antenatal common mental disorders (CMDs). The first study summarises findings from 14 focus group discussions with a variety of stakeholders (health workers, musicians and pregnant women). A pictorial representation presents the three main contributing factors to mental distress symptoms: economic, social, and spiritual. The next study finds that two existing self-report tools, the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20), can be used in The Gambia to measure antenatal CMD symptoms. A different distribution of scores is found, with the SRQ-20, which has more somatic items, giving higher scores. Differences in factor structures of the EPDS in a Gambian versus UK context shows potential differences in the expression of CMD symptoms between the two cultures. The final study demonstrates that a community health intervention through musical engagement (CHIME) can be co-developed and is feasible to administer within a Gambian context. Results also suggest a beneficial effect of CHIME compared to standard care and a potential greater reduction in symptoms in participants with higher levels of CMD symptoms. This thesis is the first to highlight the potential of music interventions to support women’s perinatal mental health care in a LMIC context

Assessment of Intracranial Arterial Stenosis with Multidetector Row CT Angiography: A Postprocessing Techniques Comparison

BACKGROUND AND PURPOSE: It was demonstrated the some patients with stroke have intracranial stenosis of 50% or greater and the identification of intracranial arterial stenosis is extremely important in order to plan a correct therapeutical approach. The aim of this study was to assess the image quality and intertechnique agreement of various postprocessing methods in the detection of intracranial arterial stenosis. MATERIAL AND METHODS: Eighty-five patients who were studied by using a multidetector row CT scanner were retrospectively analyzed. A total of 2040 segments were examined in the 85 subjects. Intracranial vasculature was assessed by using MPR, CPR, MIP, and VR techniques. Two radiologists reviewed the CT images independently. Cohen weighted κ statistic was applied to calculate interobserver agreement and for image accuracy for each reconstruction method. Sensitivity, specificity, PPV, and NPV were also calculated by using the consensus read as the reference. RESULTS: Two hundred fifteen (10.5%) stenosed artery segments were identified by the observers in consensus. The best intermethod κ values between observers 1 and 2 were obtained by VR and MIP (κ values of 0.878 and 0.861, respectively), whereas MPR provided the lowest value (κ value of 0.282). VR showed a sensitivity for detecting stenosed segments of 88.8% and 91.6% for observers 1 and 2, respectively. The highest positive predictive value was also obtained by VR at 95% and 99% for observers 1 and 2, respectively. Image accuracy obtained by using VR was the highest among all reconstruction methods in both observers (185/255 and 177/255 for observers 1 and 2, respectively). CONCLUSIONS: The results of our study suggest that VR and MIP techniques provide the best interobserver and intertechnique concordance in the analysis of intravascular cranial stenosis

Average up/down, strange and charm quark masses with Nf=2 twisted mass lattice QCD

We present a high precision lattice calculation of the average up/down, strange and charm quark masses performed with Nf=2 twisted mass Wilson fermions. The analysis includes data at four values of the lattice spacing and pion masses as low as ~270 MeV, allowing for accurate continuum limit and chiral extrapolation. The strange and charm masses are extracted by using several methods, based on different observables: the kaon and the eta_s meson for the strange quark and the D, D_s and eta_c mesons for the charm. The quark mass renormalization is carried out non-perturbatively using the RI-MOM method. The results for the quark masses in the MSbar scheme read: m_ud(2 GeV)= 3.6(2) MeV, m_s(2 GeV)=95(6) MeV and m_c(m_c)=1.28(4) GeV. We also obtain the ratios m_s/m_ud=27.3(9) and m_c/m_s=12.0(3).Comment: 20 pages, 5 figures. Typos corrected in eqs. (15)-(17). Version published in Phys. Rev.

Quark masses with Nf=2 twisted mass lattice QCD

We present the results of the recent high precision lattice calculation of the average up/down, strange and charm quark masses performed by ETMC with Nf=2 twisted mass Wilson fermions. The analysis includes data at four values of the lattice spacing and pion masses as low as ~270 MeV, allowing for accurate continuum limit and chiral extrapolation. The strange and charm masses are extracted by using several methods, based on different observables: the kaon and the eta_s meson for the strange quark and the D, D_s and eta_c mesons for the charm. The quark mass renormalization is carried out non-perturbatively using the RI-MOM method. The results for the quark masses in the MSbar scheme read: m_ud(2 GeV)= 3.6(2) MeV, m_s(2 GeV)=95(6) MeV and m_c(m_c)=1.28(4) GeV. We have also obtained the ratios m_s/m_ud=27.3(9) and m_c/m_s=12.0(3). Moreover, we provide the updated result for the bottom quark mass, m_b(m_b)=4.3(2) GeV, obtained using the method presented in 0909.3187 [hep-lat].Comment: 7 pages, 7 figures, talk given at the XXVIII International Symposium on Lattice Field Theory (Lattice 2010), June 14-19 2010, Villasimius, Ital

K^0-\bar{K}^0 mixing in the Standard Model from Nf=2+1+1 Twisted Mass Lattice QCD

We present preliminary results at {\beta} = 1.95 (a = 0.077 fm) on the first unquenched N_f=2+1+1 lattice computation of the B_K parameter which controls the neutral kaon oscillations in the Standard Model. Using N_f=2+1+1 maximally twisted sea quarks and Osterwalder-Seiler valence quarks we achieve O(a) improvement and a continuum-like renormalization pattern for the four-fermion operator. Our results are extrapolated/interpolated to the physical light/strange quark mass but not yet to the continuum limit. The computation of the relevant renormalization constants is performed non perturbatively in the RI'-MOM scheme using dedicated simulations with N_f=4 degenerate sea quark flavours produced by the ETM collaboration. We get B_K^{RGI} (a = 0.077) = 0.747(18), which when compared to our previous unquenched N_f=2 determination and most of the existing results, suggests a rather weak B_K^{RGI} dependence on the number of dynamical flavours. We are at the moment analysing lattice data at two additional {\beta} values which will allow us to perform an extrapolation to the continuum limit.Comment: 7 pages, 8 figures, Proceedings of Lattice 2011, XXIX International Symposium on Lattice Field Theory, Squaw Valley, Lake Tahoe, Californi

CT attenuation analysis of carotid intraplaque hemorrhage

Background and Purpose: Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage. MATERIALS AND METHODS: This retrospective study included 91 patients (67 men; median age, 657 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013. Histopathologic analysis was performed for the tissue characterization and identification of intraplaque hemorrhage. Two observers assessed the plaque's attenuation values by using an ROI (≤1 and ≥2 mm2). Receiver operating characteristic curve, Mann-Whitney, and Wilcoxon analyses were performed. RESULTS: A total of 169 slices were assessed (59 intraplaque hemorrhage, 63 lipid-rich necrotic core, and 47 fibrous); the average values of the intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue were 17.475 Hounsfield units (HU) and 18.407 HU, 39.476 HU and 48.048 HU, and 91.66 HU and 93.128 HU, respectively, before and after the administration of contrast medium. The Mann-Whitney test showed a statistically significant difference of HU values both in basal and after the administration of contrast material phase. Receiver operating characteristic analysis showed a statistical association between intraplaque hemorrhage and low HU values, and a threshold of 25 HU demonstrated the presence of intraplaque hemorrhage with a sensitivity and specificity of 93.22% and 92.73%, respectively. The Wilcoxon test showed that the attenuation of the plaque before and after administration of contrast material is different (intraplaque hemorrhage, lipid-rich necrotic core, and fibrous tissue had P values of .006, .0001, and .018, respectively). CONCLUSIONS: The results of this preliminary study suggest that CT can be used to identify the presence of intraplaque hemorrhage according to the attenuation. A threshold of 25 HU in the volume acquired after the administration of contrast medium is associated with an optimal sensitivity and specificity. Special care should be given to the correct identification of the ROI