Pre-exposure Prophylaxis Therapy and the Blood-Brain Barrier: Is PrEP Neuroprotective?

Journal of Neuroimmune Pharmacology -     

Recovery of a species of Brugia, probably B. ceylonensis, from the conjunctiva of a patient in Sri Lanka

A species of Brugia, probably B. ceylonensis, was recovered from the conjunctiva of a patient in Sri Lanka for the first time. This infection represents only the second record of Brugia in the human conjunctiva, and is clearly zoonotic, acquired from a dog. Brugia ceylonensis has a distinct head bulb like that of Wuchereria bancrofti and B. malayi. However, the parasite recovered was not W. bancrofti, as specific IFAT and DNA probes gave negative results, and B. malayi is believed to have been eradicated from Sri Lanka several years ago. The presence of a distinct head bulb excludes the possibility that the parasite was B. buckleyi.     

ALS training

Editor—Turley and colleagues¹ have highlighted a well-knownproblem. By completing a 2- or 3-day course on Advanced LifeSupport (ALS), one     

A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning

Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) are potentially lethal plants after ingestion. Poisoning by these plants is a common toxicological emergency in tropical and subtropical parts of the world and intentional self-harm using T. peruviana is prevalent in South Asian countries, especially India and Sri Lanka. All parts of these plants are toxic, and contain a variety of cardiac glycosides including neriifolin, thevetin A, thevetin B, and oleandrin. Ingestion of either oleander results in nausea, vomiting, abdominal pain, diarrhoea, dysrhythmias, and hyperkalemia. In most cases, clinical management of poisoning by either N. oleander or T. peruviana involves administration of activated charcoal and supportive care. Digoxin specific Fab fragments are an effective treatment of acute intoxication by either species. However, where limited economic resources restrict the use of such Fab fragments, treatment of severely poisoned patients is difficult. Data from case reports and clinical studies were reviewed to identify treatments supported by evidence for the management of poisoning by N. oleander and T. peruviana.     

A pilot study of change in fracture risk in patients with acute respiratory distress syndrome

IntroductionAcute skeletal muscle wasting is a major contributor to post critical illness physical impairment. However, the bone response remains uncharacterized. We prospectively investigated the early changes in bone mineral density (BMD) and fracture risk in critical illness.MethodsPatients were prospectively recruited ≤24 hours following intensive care unit (ICU) admission to a university teaching or a community hospital (August 2009 to April 2011). All were aged >18 years and expected to be intubated for >48 hours, spend >7 days in critical care and survive ICU admission. Forty-six patients were studied (55.3% male), with a mean age of 54.4 years (95% confidence interval (CI): 49.1 to 59.6) and an APACHE II score of 23.9 (95% CI: 22.4 to 25.5). Calcaneal dual X-ray absorptiometry (DXA) assessment of BMD was performed on day 1 and 10. Increase in fracture risk was calculated from the change in T-score.ResultsBMD did not change between day 1 and 10 in the cohort overall (0.434 (95% CI: 0.405 to 0.463) versus 0.425 g/cm² (95% CI: 0.399 to 0.450), P = 0.58). Multivariable logistical regression revealed admission corrected calcium (odds ratio (OR): 1.980 (95% CI: 1.089 to 3.609), P = 0.026) and admission PaO₂-to-FiO₂ ratio (OR: 0.916 (95% CI: 0.833 to 0.998), P = 0.044) to be associated with >2% loss of BMD. Patients with acute respiratory distress syndrome had a greater loss in BMD than those without (−2.81% (95% CI: −5.73 to 0.118%), n = 34 versus 2.40% (95% CI: 0.204 to 4.586%), n = 12, P = 0.029). In the 34 patients with acute respiratory distress syndrome, fracture risk increased by 19.4% (95% CI: 13.9 to 25.0%).ConclusionsPatients with acute respiratory distress syndrome demonstrated early and rapid bone demineralisation with associated increase in fracture risk.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0892-y) contains supplementary material, which is available to authorized users.     

The crystallization behavior and the mechanical properties of segmented poly(ether ester) thermoplastic elastomers

The isothermal melt crystallization of three segmented copoly(ether ester)s based on PBT as the hard and PTMO as the soft segments differing in their hard segment content was investigated. The kinetics of crystallization was studied using polarizing microscopy and DSC. Two regimes of crystallization were observed. Spherulitic structures of low crystallinity are formed via predominantly athermal nucleation in regime I at supercoolings ΔT_u < 30°C. Ill-defined aggregations of lamellae grow at ΔT_u > 30°C. The crystallization follows an apparent Avrami-equation; the Avrami-constants cannot be explained in terms of a simple model. The structure of the samples was investigated by SAXS and compared to the structure of samples crystallized by rapid quenching and subsequent annealing. Much higher long spacings are obtained on isothermal crystallization. The long spacing increases with decreasing ΔT_u. It increases at constant ΔT_u with decreasing average hard segment length contrary to the samples crystallized by subsequent annealing of the quenched melt. In this case polymers differing in composition do not differ with regard to the long spacing obtained at constant ΔT_u. The modulus in the Hookean-range as derived from stress-strain curves at T > T_g does not reflect the details of the morphology or chain architecture but it is found to depend logarithmically on the volume fraction of crystallinity in the sample. Data of pure PBT are described by the same relationship.