COVID-19: mobilising CT as a frontline management tool

As the COVID-19 pandemic has spread across the globe, questions have arisen about the approach healthcare systems should adopt in order to optimally manage patient influx. With a focus on the impact of COVID-19 on the NHS, we describe the frontline experience of a severely affected hospital in close proximity to London. We highlight a protocol-driven approach, incorporating the use of CT in the rapid triage, assessment and cohorting of patients, in an environment where there was a lack of readily available, onsite RT-PCR testing facilities. Furthermore, the effects of the protocol on the effective streamlining of patient flow within the hospital are discussed, as are the resultant improvements in clinical management decisions within the acute care service. This model may help other healthcare systems in managing this pandemic whilst assessing their own needs and resources.     

Acute kidney injury due to tubular intraluminal monoclonal light chain crystals mimicking acute pyelonephritis

Tubular intraluminal inflammatory cells may be seen in kidney biopsies of patients with pyelonephritis, cell-mediated transplant rejection, autoimmune tubulointerstitial nephritis, allergic reactions, or in association with monoclonal light chain casts. When casts in a native kidney are primarily composed of granulocytes, the cause is most commonly acute pyelonephritis due to an ascending bacterial urinary tract infection. We report a 57-year-old man with acute kidney injury and an intense intraluminal neutrophil response to monoclonal lambda light chain crystal containing casts.     

Investigating a crow die-off in January–February 2011 during the introduction of a new clade of highly pathogenic avian influenza virus H5N1 into Bangladesh

We investigated unusual crow mortality in Bangladesh during January-February 2011 at two sites. Crows of two species, Corvus splendens and C. macrorhynchos, were found sick and dead during the outbreaks. In selected crow roosts, morbidity was ~1 % and mortality was ~4 % during the investigation. Highly pathogenic avian influenza virus H5N1 clade 2.3.2.1 was isolated from dead crows. All isolates were closely related to A/duck/India/02CA10/2011 (H5N1) with 99.8 % and A/crow/Bangladesh/11rs1984-15/2011 (H5N1) virus with 99 % nucleotide sequence identity in their HA genes. The phylogenetic cluster of Bangladesh viruses suggested a common ancestor with viruses found in poultry from India, Myanmar and Nepal. Histopathological changes and immunohistochemistry staining in brain, pancreas, liver, heart, kidney, bursa of Fabricius, rectum, and cloaca were consistent with influenza virus infection. Through our limited investigation in domesticated birds near the crow roosts, we did not identify any samples that tested positive for influenza virus A/H5N1. However, environmental samples collected from live-bird markets near an outbreak site during the month of the outbreaks tested very weakly positive for influenza virus A/H5N1 in clade 2.3.2.1-specific rRT-PCR. Continuation of surveillance in wild and domestic birds may identify evolution of new avian influenza virus and associated public-health risks.     

Influence of α-thalassemia trait on spleen function in sickle cell anemia patients with high HbF

Spleen function was studied in a group of 20 Kuwaiti SS patients (aged 2–12 years), using ^99mTc-labeled tin colloid scintigraphy. They were screened for the α-thalassemia determinants which are prevalent in the Arabian Peninsula [-α (3.7 kb) deletion, α2-globin gene polyadenylation signal (AATAAA → AATAAG) mutation, and 5′ IVS-I splice junction pentanucleotide (GAGGTGAGG → GAGG) deletion] with a combination of polymerase chain reaction and allele-specific oligonucleotide (ASO) hybridization techniques. The patients were divided into three groups depending on the result of their colloid uptake. Group I consisted of 7 patients (35.0%) with normally visualized spleens, Group II consisted of 5 (25.0%) with partial visualization, and in Group III there were 8 (40.0%) in whom the spleen was not visualized at all. The significant distinguishing features among those in Groups I and III were mean corpuscular volumes (MCVs) of 74.1 ± 5.1 and 90.1 ± 6.6 fl (P < 0.0001) and mean corpuscular hemoglobins (MCHs) of 22.4 ± 2.7 and 27.5 ± 4.0 pg (P < 0.05), respectively. The overall frequency of α-thalassemia determinants in the study was 35.0%; however, the frequencies in Groups I, II, and III were 57.1, 30.0, and 18.8%, respectively. α-Thalassemia trait, therefore, appears to be associated with normal splenic function in these patients. © 1996 Wiley-Liss, Inc.     

Chemical synthesis of Nd2Fe14B/Fe–Co nanocomposite with high magnetic energy product

Nd₂Fe₁₄B is one of the most popular permanent magnets (PMs) possessing the best energy product (BH)_max among the common PM materials. However, exchange-coupled nanocomposite magnets fabricated by embedding nanostructures of soft-phase magnetic materials into a hard-phase magnetic matrix manifest higher remanence and a higher energy product. Here we present the fabrication of exchange coupled Nd₂Fe₁₄B/Fe–Co magnetic nanocomposites using gel-combustion and diffusion–reduction processes. Pre-fabricated CoFe₂O₄ nanoparticles (NPs) of ∼5 nm diameter were incorporated into a Nd–Fe–B oxide matrix during its synthesis by gel-combustion. The obtained mixed oxide was further processed with oxidative annealing at 800 °C for 2 h and reductive annealing at 900 °C for 2 h to form a Nd₂Fe₁₄B/Fe–Co nanocomposite. Nanocomposites with different mol% of soft-phase were prepared and characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM) and physical property measurement system (PPMS) to study their crystalline phase, morphology and magnetic behavior. Addition of 7.7 mol% of soft-phase was found to be optimum, producing a coercivity (H_c) of 5.6 kOe and remanence (M_r) of 54 emu g⁻¹ in the nanocomposite.

Nd₂Fe₁₄B is one of the most popular permanent magnets (PMs) possessing the best energy product (BH)_max among the common PM materials.     

A Conserved Tryptophan in the Envelope Cytoplasmic Tail Regulates HIV-1 Assembly and Spread

The HIV-1 envelope (Env) is an essential determinant of viral infectivity, tropism and spread between T cells. Lentiviral Env contain an unusually long 150 amino acid cytoplasmic tail (EnvCT), but the function of the EnvCT and many conserved domains within it remain largely uncharacterised. Here, we identified a highly conserved tryptophan motif at position 757 (W757) in the LLP-2 alpha helix of the EnvCT as a key determinant for HIV-1 replication and spread between T cells. Alanine substitution at this position potently inhibited HIV-1 cell–cell spread (the dominant mode of HIV-1 dissemination) by preventing recruitment of Env and Gag to sites of cell–cell contact, inhibiting virological synapse (VS) formation and spreading infection. Single-molecule tracking and super-resolution imaging showed that mutation of W757 dysregulates Env diffusion in the plasma membrane and increases Env mobility. Further analysis of Env function revealed that W757 is also required for Env fusion and infectivity, which together with reduced VS formation, result in a potent defect in viral spread. Notably, W757 lies within a region of the EnvCT recently shown to act as a supporting baseplate for Env. Our data support a model in which W757 plays a key role in regulating Env biology, modulating its temporal and spatial recruitment to virus assembly sites and regulating the inherent fusogenicity of the Env ectodomain, thereby supporting efficient HIV-1 replication and spread.     

Thoracic surgery in United Arab Emirates

The United Arab Emirates (UAE) has undergone a significant change in its population and economy in the last decades and in parallel its healthcare system has evolved rapidly to provide advanced, innovative and world-leading care. At the forefront of this revolution in healthcare is the development of a multidisciplinary multimodality thoracic service provision, offered at quaternary referral hospitals amalgamating academics, training, research and innovation. Previously, thoracic service care was limited to single providers at various public and private hospitals, usually performing lower complexity cases. Most complex thoracic cases were repatriated outside the UAE. This practice was replaced with the opening of Cleveland Clinic Abu Dhabi (CCAD), in 2015, which created a multidisciplinary thoracic program. This included the start of a mini-invasive surgical and lung transplantation program. Since that time other public and private hospitals have emerged providing care in a similar model. The impact of these programs has been a decreased transfer of patients abroad for treatment. Under the umbrella of the Emirates Thoracic Society (ETS) a platform for greater collaboration aimed at improving patient care, potential research and physician education has been created. Direct links have been established with world-leading Thoracic surgery and Respiratory Medicine Centers facilitating this development and offering support and guidance. This article charts these changes in thoracic care in the recent past, present, and delineates plans for the future in the UAE.     

Review of the prevalence,diagnostics, and containment measures of the current mpox outbreak

Monkeypox(mpox), is a disease from the Poxviridae family that can cause several serious medical issues. This mini-review sought to analyze the existing literature regarding the current mpox outbreak with a focus on the prevalence, diagnostics, and containment measures. Mpox cases have been reported to World Health Organization(WHO) from 85 Member States in all six WHO regions during the period of January 1, 2022, through August 3, 2022. Standardized or optimized guidelines for the clinical care ...