Bone marrow infection with Mycobacterium fortuitum in a diabetic patient

Incidence and prevalence of Mycobacterium fortuitum infection vary greatly by location and death is very rare except in disseminated disease in immunocompromised individuals. We present what we believe is the first case of bone marrow infection with Mycobacterium fortuitum in an HIV negative patient. Bone marrow examination revealed presence of numerous acid fast bacilli which were confirmed as Mycobacterium fortuitum on culture and by molecular analysis. Patient was managed successfully with amikacin and ciprofloxacin.     

Ventilator Y-Piece Pressure Compared with Intratracheal Airway Pressure in Healthy Intubated Children

Objective. Compare airway pressure measurements at the ventilator Y-piece of the breathing circuit (P _Y ) to intratracheal pressure measured at the distal end (P _T ) of the endotracheal tube (ETT) during mechanical ventilation and spontaneous breathing of intubated children. Methods. Thirty children (age range 29 days to 5 years) receiving general anesthesia were intubated with an ETT incorporating a lumen embedded in its sidewall that opened at the distal end to measure P _T . Peak inflation pressure (PIP) was measured at P _Y and P _T during positive pressure ventilation. Just before extubation, all measurements were repeated and imposed resistive work of breathing (WOBi) was calculated at both sites while breathing spontaneously. Results. Average PIP was approximately 25% greater at P _Y (19.7 ± 3.4 cm H₂O) vs. P _T (15.0 ± 2.9 cm H₂O), p < 0.01. During spontaneous inhalation P _T was 59% lower ({bond}8.5 ± 4.0 cm H₂O) vs. P _Y ({bond}3.5 ± 2.0 cm H₂O), p < 0.01. WOBi measured at P _Y (0.10 ± 0.02 Joule/L) was 86% less than WOBi measured at P _T (0.70 ± 0.40 Joule/L), p < 0.01. Conclusions. In healthy children P _Y significantly overestimates PIP in the trachea during positive pressure ventilation and underestimates the intratracheal airway pressure during spontaneous inhalation. During positive pressure ventilation P _T better assesses the pressure generated in the airways and lungs compared to P _Y because P _T also includes the difference in airway pressure across the ETT tube due to resistance. During spontaneous inhalation, P _T reflects the series resistance of the ETT and ventilator circuit, while P _Y reflects only the resistance of the ventilator circuit, accounting for the smaller decreases in pressure. Additionally, P _Y underestimates the total WOBi load on the respiratory muscles. Thus, P _T is a more accurate reflection of pulmonary airway pressures than P _Y and suggests that it should be incorporated into ventilator systems to more accurately trigger the ventilator and to reduce work of breathing.     

Novel adhesive glove device (AGD) for active compression-decompression (ACD) CPR results in improved carotid blood flow and coronary perfusion pressure in piglet model of cardiac arrest

Objective

ACD-CPR improves coronary and cerebral perfusion. We developed an adhesive glove device (AGD) and hypothesized that ACD-CPR using an AGD provides better chest decompression resulting in improved carotid blood flow as compared to standard (S)-CPR.

Design

Prospective, randomized and controlled animal study.

Methods

Sixteen anesthetized and ventilated piglets were randomized after 3 min of untreated VF to receive either S-CPR or AGD-ACD-CPR by a PALS certified single rescuer with compressions of 100 min⁻¹ and C:V ratio of 30:2. AGD consisted of a modified leather glove exposing the fingers and thumb. A wide Velcro patch was sewn to the palmer aspect of the glove and the counter Velcro patch was adhered to the pig's chest wall. Carotid blood flow was measured using ultrasound. Data (mean ± SD) was analyzed using one way ANOVA and unpaired t-test; p-value ≤ 0.05 was considered statistically significant.

Results

Right atrial pressure (mm Hg) during the decompression phase was lower during AGD-ACD-CPR (−3.32 ± 2.0) when compared to S-CPR (0.86 ± 1.8, p = 0.0007). Mean carotid blood flow was 53.2 ± 27.1 (% of baseline blood flow in ml/min) in AGD vs. 19.1 ± 12.5% in S-CPR, p = 0.006. Coronary perfusion pressure (CPP, mm Hg) was 29.9 ± 5.8 in AGD vs. 22.7 ± 6.9 in S-CPR, p = 0.04. There was no significant difference in time to ROSC and number of epinephrine doses.

Conclusion

Active chest decompression during CPR using this simple and inexpensive adhesive glove device resulted in significantly better carotid blood flow during the first 2 min of CPR.     

Removal of Pb(ii) and Cd(ii) from wastewater using arginine cross-linked chitosan–carboxymethyl cellulose beads as green adsorbent

A one pot approach has been explored to synthesize crosslinked beads from chitosan (CS) and carboxymethyl cellulose (CM) using arginine (ag) as a crosslinker. The synthesized beads were characterized by FTIR, SEM, EDX, XRD, TGA and XPS analysis. The results showed that CS and CM were crosslinked successfully and the obtained material (beads) was analyzed for adsorption of Cd(ii) and Pb(ii) by using batch adsorption experiments; parameters such as temperature, contact time, pH and initial ion concentration were studied. Different kinetic and thermodynamic models were used to check the best fit of the adsorption data. The results revealed that the kinetics data of the adsorption of Pb(ii) and Cd(ii) ions shows the best fit with the pseudo second order model whereas the thermodynamics data shows the best fit with the Langmuir isotherm with maximum adsorption capacities of 182.5 mg g⁻¹ and 168.5 mg g⁻¹ for Pb(ii) ions Cd(ii) ions, respectively. For the recovery and the regeneration after the one use of the beads, several adsorption–desorption cycles were carried out to check the reusability and recovery of both the metal ion and the adsorbent without the loss of maximum adsorption efficiency.

Remediation of Pb(ii) and Cd(ii) containing wastewater by arginine crosslinked chitosan/carboxymethyl cellulose beads.     

The clinical, cardiac, renal, arterial and neurohormonal effects of omapatrilat, a vasopeptidase inhibitor, in patients with chronic heart failure

OBJECTIVES: We sought to examine the effects of long-term vasopeptidase inhibition in patients with heart failure. BACKGROUND: The long-term effects of omapatrilat, an agent that inhibits both neutral endopeptidase and angiotensin-converting enzyme, on clinical status, neurohormonal indexes and left ventricular function in patients with chronic heart failure (CHF) have not been previously documented. METHODS: Forty-eight patients in New York Heart Association functional class II or III, with left ventricular ejection fraction (LVEF)< or =40% and in sinus rhythm were randomized to a dose-ranging pilot study of omapatrilat for 12 weeks. Measurements were performed at baseline and 12 weeks. RESULTS: There was an improvement in functional status, as reported by the patient (p<0.001) and physician (p<0.001) at 12 weeks. Dose-dependent improvements in LVEF (p<0.001) and LV end-systolic wall stress (sigma) (p<0.05) were seen, together with a reduction in systolic blood pressure (p<0.05). There was evidence of a natriuretic effect (p<0.001), and total blood volume decreased (p<0.05). Omapatrilat induced an increase in postdose plasma atrial natriuretic peptide levels (p<0.01) in the high dose groups, with a reduction in predose plasma brain natriuretic peptide (p<0.001) and epinephrine (p<0.01) levels after 12 weeks of therapy. Omapatrilat was well tolerated. CONCLUSIONS: The sustained hemodynamic, neurohumoral and renal effects of omapatrilat, together with improved functional status, suggest that vasopeptidase inhibition has potential as a new therapeutic modality for the treatment of CHF.