Through bond energy transfer (TBET)-operated fluoride ion sensing via spirolactam ring opening of a coumarin–fluorescein bichromophoric dyad

The detection of fluoride ions in a competitive environment often poses several challenges. In this work, we have designed and synthesized a coumarin functionalized fluorescein dyad (R3) which represents an ideal through bond energy transfer (TBET) fluorophore with the coumarin unit as donor and fluorescein unit as acceptor. The bichromophoric dyad demonstrates the detection of fluoride ions in the parts per billion (ppb) concentration level (22.8 ppb) with high selectivity via a TBET emission signal at 548 nm with a diagnostic bright yellow colour fluorescence output. Based on UV-visible, fluorescence, ¹H NMR and DFT studies, it is shown that the fluoride ion induces the opening of the spirolactam ring of the fluorescein moiety and provides a π-conjugation link between the donor and acceptor units enabling a TBET phenomenon with a larger pseudo-Stokes shift of 172 nm. To the best of our knowledge, this is the first report where the fluoride ion is detected via a TBET signal between the coumarin and fluorescein units in a bichromophoric dyad.

A coumarin–fluorescein based bichromophoric dyad detects fluoride ions in parts per billion concentration level via a TBET emission signal at 548 nm with a diagnostic bright yellow fluorescence.     

Tuberculosis in infants less than 3 months of age

The clinical and radiological features in 38 infants less than 3 months of age with tuberculosis proved by culture are described and may aid early diagnosis of this often fatal condition. Respiratory symptoms, cough in 33 (87%) and tachypnoea in 31 (82%), were the commonest presenting symptoms. Twenty five infants (66%) had hepatomegaly and 20 (53%) splenomegaly. Mantoux testing gave an induration of > 15 mm in three of 17 (18%) infants. In a further five a Tine test gave confluent response. Chest radiography in 27 infants showed miliary tuberculosis in seven (26%) and hilar or paratracheal adenopathy in 14 (52%) and 10 (37%) respectively. Compression of either the bronchi or trachea or both was noted in 15 (56%). Detection of this complication was aided by high kilovolt radiographs. A culture of Mycobacterium tuberculosis was obtained from gastric aspirate in 35 (92%) infants, but positive cultures were also obtained from cerebrospinal fluid, tracheal or bronchial aspirate and liver and lymph node biopsy. Of 30 mothers evaluated seven (23) had previously unsuspected pulmonary tuberculosis.     

Retrieving physiotherapy patient records in selected health care facilities in South Africa – is record keeping compromised?

Purpose:?The purpose of this study was to evaluate the process and feasibility of retrieving patient records in a variety of physiotherapy care settings in the Gauteng province in the Republic of South Africa.

Methods:?Thirteen public and private health care facilities providing physiotherapy services were studied. Multiple methods of data collection (facility walk-through observation aided by a researcher designed checklist, in-depth interviews and attempting to retrieve physiotherapy records) were employed to evaluate the process of retrieving physiotherapy patient records, determine physiotherapy record retrieval rates and to determine the factors that were influencing record retrieval.

Results:?The process of retrieving physiotherapy records was arduous and multi-faceted, with some health care facilities allowing patients to take their records home. A final retrieval rate of 46% (36.3%?–?100%) was obtained. An odds ratio calculation revealed that it was 13.09 (CI: 8.99?–?19.13; p?<?0.001) times more possible to retrieve records of patients treated in private physiotherapy care settings (87.4% retrieval rate) than in public sector physiotherapy care settings (34.67% retrieval rate).

Conclusions:?This study concludes that the process of retrieving physiotherapy records was arduous and lacked uniformity in public sector hospitals. Further a low physiotherapy record retrieval rate was obtained.     

Angioplasty and stenting of the superior mesenteric artery in acute mesenteric ischaemia

Acute mesenteric ischaemia is a challenging diagnostic problem with a very high mortality. Traditionally, laparotomy is required for definitive management. We describe a successful case of angioplasty and stenting of the superior mesenteric artery in a surgically unfit patient. We recommend that stenting be considered only in situations where the diagnosis has been made prior to bowel infarction, and if the patient poses a poor operative risk.     

Minocycline-induced cutaneous hyperpigmentation: confocal laser scanning microscope analysis

BACKGROUND: Minocycline has a characteristic yellow-green fluorescent emission. This fluorescence has been previously demonstrated only in type 1 minocycline-induced skin hyperpigmentation. OBJECTIVE: To investigate whether the fluorescence can be detected in other types of minocycline-induced cutaneous hyperpigmentation, and to study the possible mechanisms. METHODS: Biopsies of pigmented and nonpigmented skin from 3 patients with different types of skin hyperpigmentation induced by minocycline were analysed by light microscopy and Confocal Laser Scanning Microscope (CLSM). RESULTS: A yellow-green fluorescence was observed in the hyperpigmented skin of two patients with type 2, and one patient with type 4 minocycline-induced cutaneous hyperpigmentation. No fluorescence was detected in the non-pigmented skin. CONCLUSION: Minocycline can possibly serve as a fluorescent probe in the diagnosis of all types of minocycline-induced cutaneous hyperpigmentation.     

Ganciclovir Treatment for Cytomegalovirus Infection in Immunocompromised Patients With Renal Disease

The safety and efficacy of a 10-day course of ganciclovir therapywas assessed in 17 consecutive patients with proven cytomegalovirusinfection. The patients were receiving immunosuppressive therapyfor a variety of non-malignant renal conditions, including renaltransplantation (seven patients), small vessel vasculitis (sixpatients), systemic lupus erythematosus (three patients) andGoodpasture's disease (one patient). Fifteen patients were pyrexialat the time of their cytomegalovirus infection. Twelve patientshad pneumonitis manifesting as a pulmonary parenchymal infiltrateor a reduction in gas transfer. Fourteen patients had a significantlymphopenia (lymphocyte count <1x10⁹/l), nine were leucopenic(white cell count <3.5xtimes 10⁹/l) and nine had abnormalliver biochemistry. One patient had an infection of the ileumand one an infection of the larynx. All these disease manifestationsresponded completely to a single course of ganciclovir therapy.There were no clinical relapses and no side effects were observed. Ganciclovir is a safe and effective therapy when administeredearly in the course of cytomegalovirus infection in immunosuppressedpatients with renal impairment.     

Anti-Jka, -C, and -E in a single patient, initially demonstrable only by the manual hexadimethrine bromide (Polybrene) test, with incompatibilities confirmed by 51Cr-labeled red cell studies

Published reports have confirmed the superior sensitivity of the manual hexadimethrine bromide (Polybrene) test (MPT) for demonstrating many alloantibodies in vitro; however, the clinical significance of alloantibodies demonstrable exclusively by MPT has not been shown conclusively. A patient with macroglobulinemia experienced chills, fever, hemoglobinemia, and hemoglobinuria following the transfusion of 1 unit of red cells (RBCs) shown to be compatible by the low-ionic-strength antiglobulin (LIS-AG) method. Serologic investigation was negative. Intravascular hemolysis occurred with a second "compatible" unit. Serologic studies were again negative by LIS-AG and ficin-AG methods, but revealed anti-Jka by MPT. Both donors were Jk(a+b-), and 51Cr studies of the second donor's RBCs revealed a t1/2 of less than 30 minutes, with marked intravascular hemolysis. A LIS-AG-compatible Jk(a-) unit was transfused uneventfully, but with no rise in hematocrit. MPT next revealed anti-C; subsequent 51Cr studies with the Jk(a-), Cc donor's RBCs showed a 51Cr t1/2 of 100 minutes with slight intravascular lysis. Four transfusions of Jk(a-), C- blood were uneventful, but 5 days later the patient's hemoglobin declined. The following day, anti-E was demonstrable exclusively by MPT. 51Cr-labeled Jk(a-), C-, E- RBCs had normal 24-hour survival. The patient's hemoglobin rose to 11 g per dl following transfusions of Jk(a-), C-, E- RBCs, and he was discharged. In vitro studies employing the patient's purified IgM paraprotein revealed no interference with alloantibody binding or detection.     

儿童输注少白细胞血制品前使用扑热息痛或苯海拉明的研究

儿科血液病或癌症病人常因血小板减少及贫血而需要输血。输血可能导致不良反应的发生,包括那些少见但却潜在威胁病人生命的一些输血反应,如ABO血型不合的溶血反应、输血相关性脓毒血症、循环超负荷和输血相关急性肺损伤等。非溶血性发热反应和过敏反应是较常见的两种输血反应,它们通常不会造成严重的临床后果,或降低输血疗效。过去非溶血性发热反应发生率高达30%。而使用少白细胞血液制品(包括单采血小板)后,其发生率仅有0.03%~2.18%,过敏反应的发生率则小于1%。发热反应发生率高的原因可能是病人输注手工混合血小板及未经去白细胞处理的…     

Initial Experience with a New Technique of Binding Pancreaticogastrostomy: A Prospective Study

Aim

To study postoperative complications in patients undergoing binding pancreaticogastrostomy (PG) following pancreaticoduodenectomy (PD) in a tertiary hospital in India.

Methods

A prospective study was conducted of patients undergoing binding PG following PD over a 2-year period. The demographic and preoperative laboratory data of the patients, the type of procedure, complications, hospital mortality, duration of hospital stay, and postoperative interventional procedures or reoperations were recorded and examined for associations. Statistical analysis was performed using Stata 9.0 (College Station, Texas, USA).

Results

Over 2 years, 47 patients, 29 men and 18 women, mean age 55.4 ± 11.6 years, who underwent binding PG following PD were included in the study. Postoperative complications were recorded in 23 patients and there were 2 deaths in the first 30 days following surgery. The most frequent complication was delayed gastric emptying (DGE), observed in 11 patients (23%), with a mean duration of 13.5 ± 2.6 days. Post-operative pancreatic leak, which was detected in 3 patients (6%), did not appear to be influenced by the pancreatic duct diameter or the softness of the pancreas, which are known independent factors responsible for pancreatic leak.

Conclusion

The technique of binding PG is simple, safe, easy to perform, and less traumatic to the pancreatic stump, with fewer complications, and it can be performed without significant adverse outcome, irrespective of pancreatic stump texture or pancreatic duct diameter.

     

Deformation of swollen erythrocytes provides a model of sickling- induced leak pathways, including a novel bromide-sensitive component

Deoxygenation-induced red blood cell (RBC) sickling probably activates multiple cation leak pathways. In an attempt to model this, we examined the net passive K efflux ("K leak") from normal and sickle RBCs undergoing elliptical deformation in hypotonic media (200 mOsmol/L). This hypotonic deformation activates two deformation-dependent K leak pathways that are not detectable during the balanced leak (Kefflux = Nainflux) resulting from deformation of RBCs in isotonic medium. These are (1) a calcium-dependent leak component and (2) a novel leak pathway that is inhibited by substitution of bromide (but not sulfamate) for chloride, which converts the unbalanced K leak (Kefflux > Nainflux) of hypotonic deformation to a residual balanced leak. This dramatic effect of hypotonic deformation is reversible, is detected in both normal and sickle RBCs, and is inhibited significantly by 4,4'-diisothiocyano-2,2'- stilbene disulfonate. Remarkably, bromide also inhibits by 55% the K leak resulting from authentic deoxygenation-induced RBC sickling and, thereby, blunts the imbalance of accompanying monovalent cation leaks. The unique effect of bromide is not readily explainable on the basis of known behaviors of known ion leak/transport pathways. The mechanical threshold for triggering K leak during hypotonic deformation is at applied shear stress of 164 dyne/cm2, a value similar to the abnormal susceptibility we previously found for oxygenated sickle RBCs during isotonic deformation. These data suggest that membrane stretch accompanying hypotonic deformation activates the same multiple leak pathways that contribute to net K leak during authentic RBC sickling, including a previously unknown bromide-sensitive leak.