Acute Drop Research Articles

Rectus Abdominis Sheath Hematoma Following Cesarean Section: A Case Series

This case series describes two patients who underwent Cesarean section complicated by a rectus abdominis sheath hematoma that did not immediately resolve following exploratory laparotomy. One of the patients required an additional procedure by interventional radiology. Both patients had similar presentations. Both were noted to have symptomatic anemia on postoperative day 1 with an acute drop in hemoglobin. This was accompanied by severe abdominal pain and distension on physical exam. Computerized tomography (CT) abdomen/pelvis demonstrated evidence of active bleeding within the anterior abdominal wall musculature. Due to increasing concern for intrabdominal hemorrhage in the setting of an acute abdominal exam, the decision was made to proceed with an exploratory laparotomy. A substantial amount of blood was evacuated from the abdomen with greater than 1500 cc of estimated blood loss in both cases. A Jackson-Pratt drain was placed and had increased output immediately postoperatively. Both patients received blood products. One developed a consumptive coagulopathy. Interventional Radiology was consulted following exploratory laparotomy to consider intravascular embolization of the inferior epigastric arteries, which was eventually performed in one of the cases. The patients were discharged on hospital day 5 in good condition. Rectus abdominis sheath hematomas are a rare complication that can lead to significant postpartum hemorrhage. Prompt recognition and management is vital to avoid significant morbidity and mortality. Algorithms exist to guide treatment and standardize patient care. Despite using sound clinical judgment in line with existing algorithms, both patients had delayed resolution of their bleeding following initial management, requiring additional intervention.

Increased heart rate fragmentation in those with Williams-Beuren syndrome suggests nonautonomic mechanistic contributors to sudden death risk.

Williams-Beuren syndrome (WBS) is a rare genetic condition caused by a chromosomal microdeletion at 7q11.23. It is a multisystem disorder characterized by distinct facies, intellectual disability, and supravalvar aortic stenosis (SVAS). Those with WBS are at increased risk of sudden death, but mechanisms underlying this remain poorly understood. We recently demonstrated autonomic abnormalities in those with WBS that are associated with increased susceptibility to arrhythmia and sudden cardiac death (SCD). A recently introduced method for heart rate variability (HRV) analysis called "heart rate fragmentation" (HRF) correlates with adverse cardiovascular events (CVEs) and death in studies where heart rate variability (HRV) failed to identify high-risk subjects. Some argue that HRF quantifies nonautonomic cardiovascular modulators. We, therefore, sought to apply HRF analysis to a WBS cohort to determine 1) if those with WBS show differences in HRF compared with healthy controls and 2) if HRF helps characterize HRV abnormalities in those with WBS. Similar to studies of those with coronary artery disease (CAD) and atherosclerosis, we found significantly higher HRF (4 out of 7 metrics) in those with WBS compared with healthy controls. Multivariable analyses showed a weak-to-moderate association between HRF and HRV, suggesting that HRF may reflect HRV characteristics not fully captured by traditional HRV metrics (autonomic markers). We also introduce a new metric inspired by HRF methodology, significant acute rate drop (SARD), which may detect vagal activity more directly. HRF and SARD may improve on traditional HRV measures to identify those at greatest risk for SCD both in those with WBS and in other populations.NEW & NOTEWORTHY This work is the first to apply heart rate fragmentation analyses to individuals with Williams syndrome and posits that the heart rate fragmentation parameter W3 may enable detection and investigation of phenomena underlying the proarrhythmic short-long-short RR interval sequences paradigm known to precede ventricular fibrillation and ventricular tachycardia. It also forwards a novel method for quantifying sinus arrhythmia and sinus pauses that likely correlate with parasympathetic activity.

Leveraging deep learning for detecting red blood cell morphological changes in blood films from children with severe malaria anaemia.

In sub-Saharan Africa, acute-onset severe malaria anaemia (SMA) is a critical challenge, particularly affecting children under five. The acute drop in haematocrit in SMA is thought to be driven by an increased phagocytotic pathological process in the spleen, leading to the presence of distinct red blood cells (RBCs) with altered morphological characteristics. We hypothesized that these RBCs could be detected systematically and at scale in peripheral blood films (PBFs) by harnessing the capabilities of deep learning models. Assessment of PBFs by a microscopist does not scale for this task and is subject to variability. Here we introduce a deep learning model, leveraging a weakly supervised Multiple Instance Learning framework, to Identify SMA (MILISMA) through the presence of morphologically changed RBCs. MILISMA achieved a classification accuracy of 83% (receiver operating characteristic area under the curve [AUC] of 87%; precision-recall AUC of 76%). More importantly, MILISMA's capabilities extend to identifying statistically significant morphological distinctions (p < 0.01) in RBCs descriptors. Our findings are enriched by visual analyses, which underscore the unique morphological features of SMA-affected RBCs when compared to non-SMA cells. This model aided detection and characterization of RBC alterations could enhance the understanding of SMA's pathology and refine SMA diagnostic and prognostic evaluation processes at scale.

THE EFFECTS OF ACUTE AND CHRONIC HYPOXIC PLYOMETRIC EXERCISE ON POST ACTIVATION POTENTIATION

INTRODUCTION In the literature, only acute effects of exercise, mostly combined with plyometrics or blood flow restriction (BFR), have been examined on post-activation-potentiation (PAP). Although systemic and local hypoxia have some similar effects, we found only one study (Ramos-Campo et al., 2020) reporting a PAP effect with systemic hypoxia. There is no study investigating chronic effects, and there is also no study examining acute and chronic effects of exercise together, not only in hypoxia but also in normoxia. The aim of this study is to examine the acute and chronic effects of plyometric exercise in hypoxia on PAP, and to test differences between high and low hypoxia. METHOD Nineteen team-sports athletes undertook 8-week drop-jump (DJ) training in Low-Hypoxia (LH, n=8), Normoxia (N, n=6), and High-Hypoxia (HH, n=5) using a hypoxicator set using a biofeedback system to sustain a SpO2 of 90%, 97-100%, and 80%, respectively. PAP assessments were applied under both normoxia and hypoxia on different days. Two DJ trials from 40-cm height were obtained as baseline measurements, and then 7.5 min passive rest was given under each group’s hypoxia level. Following 1x5 DJs for pre-test, and 1x8 DJs for post-test as PAP protocol, DJ tests were applied at 2nd and 4th min. RESULTS RM-ANOVA, to assess acute effect, showed a significant conditionxtest interaction (F=3.40, p=0.044), and only under normoxia condition DJ-height was significantly higher at 2nd (31.7cm) and 4th min (31.6cm) than baseline (30.1cm)(p&amp;lt;0.05). For chronic effect, mixed-ANOVA represented a significant groupxtest interaction (F=2.70, p=0.048). Only HH significantly increased DJ-height from baseline (30.0cm) to 2nd (31.9cm) and 4th min (32.9cm) (p&amp;lt;0.05). CONCLUSION We conclude that while acute hypoxia drop jump exercise may damage net balance between potentiation and fatigue which occurred after conditioning activity, high hypoxia drop jump training may affect this balance in favour of potentiation without any condition difference.

Does Neighborhood Socioeconomic Status Alter Memory Change Associated with a Cancer Diagnosis? Preliminary Evidence from the US Health and Retirement Study.

Neighborhood disadvantage has been linked to cognitive impairment, but little is known about the effect of neighborhood disadvantage on long-term cancer-related memory decline. Incident cancer diagnosis and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial interviews in the US Health and Retirement Study (N = 13,293, 1998-2016). Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index, categorized into tertiles (T1: least disadvantaged-T3: most disadvantaged). Linear mixed-effects models estimated the standardized memory trajectories in participants with or without cancer, by neighborhood disadvantage. Living in more disadvantaged neighborhoods was associated with worse mean memory function and steeper memory declines, regardless of cancer status. An incident cancer diagnosis was associated with an acute memory drop for those living in least disadvantaged neighborhoods but not more disadvantaged neighborhoods [T1: -0.05, 95% confidence interval (CI): -0.08, -0.01; T3: -0.13, 95% CI: -0.06, 0.03]. Cancer survivors in the least disadvantaged neighborhoods had a slight memory advantage in the years prior to diagnosis (T1: 0.09, 95% CI: 0.04, 0.13) and after diagnosis (T1: 0.07, 95% CI: 0.01, 0.13). An incident cancer diagnosis among those living in the least disadvantaged neighborhoods was associated with an acute memory drop at the time of diagnosis and a long-term memory advantage before and after diagnosis compared with cancer-free individuals in similar neighborhoods. These findings could inform interventions to promote cancer survivor's long-term aging. Future studies should investigate the social and biological pathways through which neighborhood socioeconomic status could influence cancer-related memory changes.

A randomised controlled trial to compare the efficacy, safety, and tolerability of low dose, short course primaquine in adults with uncomplicated P. vivax malaria in two hospitals in India

BackgroundPlasmodium vivax remains a major challenge for malaria control and elimination due to its ability to cause relapsing illness. To prevent relapses the Indian National Center for Vector Borne Diseases Control (NCVBDC) recommends treatment with primaquine at a dose of 0.25 mg/kg/day provided over 14 days. Shorter treatment courses may improve adherence and treatment effectiveness.MethodsThis is a hospital-based, randomised, controlled, open-label trial in two centres in India. Patients above the age of 16 years, with uncomplicated vivax malaria, G6PD activity of ≥ 30% of the adjusted male median (AMM) and haemoglobin levels ≥ 8 g/dL will be recruited into the study and randomised in a 1:1 ratio to receive standard schizonticidal treatment plus 7-day primaquine at 0.50 mg/kg/day or standard care with schizonticidal treatment plus 14-day primaquine at 0.25 mg/kg/day. Patients will be followed up for 6 months. The primary endpoint is the incidence risk of any P. vivax parasitaemia at 6 months. Safety outcomes include the incidence risk of severe anaemia (haemoglobin < 8 g/dL), the risk of blood transfusion, a > 25% fall in haemoglobin and an acute drop in haemoglobin of > 5 g/dL during primaquine treatment.DiscussionThis study will evaluate the efficacy and safety of a 7-day primaquine regimen compared to the standard 14-day regimen in India. Results from this trial are likely to directly inform national treatment guidelines.Trial registrationTrial is registered on CTRI portal, Registration No: CTRI/2022/12/048283.

Falls in oxygen saturations accompany electrographic seizures in term neonates: an observational study

BackgroundEffective seizure detection is important however, clinical signs of seizure activity may be subtle in neonates. This study aimed to systematically investigate SpO2 and respiratory pattern changes associated with EEG seizures in term-born neonates.MethodAn observational study in term neonates at risk of seizures admitted to a single tertiary level neonatal intensive care unit. Synchronised high-resolution physiological data (ECG, pulse oximetry, respiration) and EEG/amplitude-integrated EEG (aEEG) monitoring were recorded. Sections of traces with evidence of clear EEG seizure activity were compared with physiological data recorded at the same time.Results22/44 (50%) neonates who had aEEG monitoring were noted to have electrographic seizures. Physiologic download measurements were available for 11 of these neonates. In nine of these, an acute drop in oxygen saturation (SpO2) of at least 5% was noted in at least one seizure. Accompanying apnoeas were noted in three neonates.ConclusionAcute decreases in SpO2 were seen in term neonates associated with seizures and these were not always accompanied by an apnoeic episode. Physiologic download in association with EEG monitoring may assist in improving seizure detection. Unexplained drops in SpO2 could indicate further investigation for possible seizures in at-risk neonates.ImpactA decrease in blood oxygen saturation (SpO2) associated with EEG seizures can occur in term infants with HIE or perinatal stroke.Drops in SpO2 associated with EEG seizures in term infants with HIE or stroke may occur in the absence of apnoeas.Unexplained acute falls in SpO2 in sick neonates may suggest possible seizures.Drops in SpO2 associated with seizures in term infants can occur over less than 3 minutes.Physiological monitoring alongside EEG monitoring could help to improve seizure detection.

A155 METASTATIC EPITHELIOID ANGIOSARCOMA AND RECURRENT GASTROINTESTINAL BLEEDING: A CASE REPORT

Abstract Background Angiosarcomas are aggressive tumors of the vascular endothelium that represent less than 3% of all sarcomas. Epithelioid angiosarcomas are a distinct subtype, and in exceedingly rare circumstances can involve the gastrointestinal tract leading to significant bleeding. Aims Report a case of metastatic epithelioid angiosarcoma as a cause of recurrent gastrointestinal bleeding and the utility of endoscopy in obtaining a diagnosis. Methods A retrospective case report. Results A 71 year old female with a history of type two diabetes and coronary artery disease presented to a peripheral hospital with a two week history of fatigue, abdominal pain, and intermittent fevers for which she was diagnosed with pyelonephritis. Computed tomography (CT) scan of the abdomen/pelvis was unremarkable on admission. Her stay was complicated by cardiac ischemia prompting the initiation of dual antiplatelet therapy and anticoagulation. After a few days she developed melena and an acute hemoglobin drop requiring red blood cell (RBC) transfusion. Gastroscopy revealed a few superficial erosions in the stomach and duodenum. She went on to develop hypercalcemia prompting a repeat CT abdomen/pelvis which showed multiple lytic bone lesions, innumerable small lung nodules, and areas of hypoattenuation in the liver. Contrast enhanced MRI abdomen was performed to better assess the liver, showing a geographic area of signal abnormality without mass like features. The patient was transferred to a tertiary centre for ongoing work-up and management. Shortly after arrival, a bone biopsy from a lytic lesion of the iliac crest was taken. Initial histopathology was inconclusive for malignancy. During this time, she had ongoing melena and need for intermittent RBC transfusions. Enteroscopy revealed multiple centrally ulcerated, hemorrhagic, erythematous/purpuric lesions throughout the stomach and proximal small bowel (Figure 1a). A duodenal lesion with fresh clot was clipped and multiple biopsies were taken from the stomach and duodenum. Histopathology from a gastric biopsy confirmed the diagnosis of epithelioid angiosarcoma (Figure 1b). PET scan revealed uptake in bone, lungs, and liver. The patient received 1 cycle of palliative chemoradiation, however this was discontinued due to frailty. Overt bleeding and intermittent RBC transfusions continued. The patient was transferred to full comfort care and died within 4 months of initial presentation to hospital. Conclusions Epithelioid angiosarcoma involving the gastrointestinal tract should be considered as a cause for upper gastrointestinal bleeding. Our case highlights the endoscopic characteristics and the importance of endoscopic biopsy in obtaining a histopathologic diagnosis. Figure 1a. Enteroscopy showing metastatic angiosarcoma to the stomach and small bowel. A. Gastroesophageal junction; B. Cardia and fundus; C. Duodenal bulb; D. Second portion of duodenum. Figure 1b. Metastatic epithelioid angiosarcoma to the stomach. A-B. Low and medium power H&amp;E; C. Cytokeratin AE1/3; D. Ber-EP4; E. CD31; F. ERG. Funding Agencies None

The impact of volcanism on Scandinavian climate and human societies during the Holocene: Insights into the Fimbulwinter eruptions (536/540 AD)

Recent paleoclimatic research has revealed that volcanic events around 536–540 AD caused severe, short-term global cooling. For this same period, archeological research from various regions evidences significant cultural transformation. However, there is still a lack of understanding of how human societies responded and adapted to extreme climate variability and new circumstances. This study focuses on the effects of the 536/540 AD volcanic event in four Scandinavian regions by exploring the shift in demographic and land use intensity before, during, and after this abrupt climate cooling. To achieve this, we performed climate simulations with and without volcanic eruptions using a dynamically downscaled climate model (iLOVECLIM) at a high resolution (0.25° or ~25 km). We integrated the findings with a comprehensive collection of radiocarbon dates from excavated archeological sites across various Scandinavian regions. Our Earth System Model simulates pronounced cooling (maximum ensemble mean −1.1°C), an abrupt reduction in precipitation, and a particularly acute drop in growing degree days (GDD0) after the volcanic event, which can be used to infer likely impacts on agricultural productivity. When compared to the archeological record, we see considerable regional diversity in the societal response to this sudden environmental event. As a result, this study provides a more comprehensive insight into the demographic chronology of Scandinavia and a deeper understanding of the land-use practices its societies depended on during the 536/540 AD event. Our results suggest that this abrupt climate anomaly amplified a social change already in progress.

Pushing-in single-sex schools for enrichment of both enrolment and gender equity in STEM careers

BackgroundQuality education has been emphasized by the world Sustainable Development Goal 4 (SDG4) of the 17 goals the world set to achieve by 2030. According to the twenty-first century skills, quality education obliges to equip learners to compete in the twenty-first century job market. In addition to enriching enrolment in science, technology, engineering and mathematics (STEM), leveraging of gender equity is indispensable.ObjectivesThis study revealed and processed data to guide education policy maker’s decisions that could ensure quality education. Thus, the study shall lead to shape educational practices leading to achieve SDG4 timelines.MethodologyThe authors studied results of the Certificate of Secondary Education Examination (CSEE) of 52 coeducations and six single-sex secondary schools in Mbeya city. Out of 52 co-education secondary schools, the researchers selected the best six secondary schools in performance and compared those to the six single-sex secondary schools.ResultsThe study revealed that, the six single-sex schools outperformed co-education schools. In addition, single-sex schools were richer of girls’ enrolment than coeducation schools in STEM education. Although, coeducation schools leveraged gender equity in STEM performance, but there was an acute drop of number of number of girls in coeducation schools.ConclusionThis study calls for awareness and seek for more insights into the acute girl’s school dropouts in best-performing coeducation schools, review of educational policies so that the world achieves SDG4 by 2030. Therefore, the study wide-opens that though challenged by many, single-sex schools are decent and remains an addition to achieve the SDG4.

Bacillus paralicheniformis 809 and Bacillus subtilis 810 support in vitro intestinal integrity under hydrogen peroxide and deoxynivalenol challenges.

We designed and conducted two in vitro experiments to evaluate the effects of two Bacillus spp. probiotics on gut barrier integrity using the transepithelial electrical resistance (TEER) assay under two different challenge models. In Exp. 1, intestinal epithelial cells received or not (CON) B. paralicheniformis 809 (BLI) or B. subtilis 810 (BSU) at a rate of 1 × 108 colony forming units (CFU)/transwell. Two hours after treatment application (CON, BLI, or BSU), 5mM of the reactive oxygen species hydrogen peroxide, mimicking mucosal oxidative stress, was added alone (HYP) or with each of the Bacillus spp. (HYP + BLI or HYP + BSU). In Exp. 2, cells were assigned to the same treatments as in Exp. 1 (CON, BLI, and BSU), or mycotoxin deoxynivalenol (DON), which was added alone or in combination with BLI or BSU, resulting in another two treatments (DON + BLI and DON + BSU). Transepithelial electrical resistance was measured for 14h postchallenge. In Exp. 1, a treatment × hour interaction was observed for TEER (P < 0.0001). Adding BLI and BSU resulted in greater TEER values vs. CON for most of the experimental period (P < 0.02), whereas HYP reduced mean TEER and area under the curve (AUC), while increasing the amount of sugar that translocated through the monolayer cells (P < 0.001). A treatment × hour interaction was also observed in Exp. 2 (P < 0.0001), as DON led to an immediate and acute drop in TEER that lasted until the end of the experimental period (P < 0.0001). Both BLI and BSU alleviated the DON-induced damaging effects on the integrity of intestinal epithelial cells, whereas both Bacillus spp. alleviated the damage caused by DON alone and the proportion of sugar that translocated through the monolayer cells was not different between CON and DON + BLI (P = 0.14) and DON + BLI and DON + BSU (P = 0.62). In summary, both Bacillus spp. strains (B. paralicheniformis 809 and B. subtilis 810) were able to counteract the damaging effects of the challenge agents, hydrogen peroxide and deoxynivalenol, on gut barrier integrity.

Hypoglycemic Encephalopathy – A Case Report and Review of the Literature

Glucose is an essential carbohydrate for brain function. Even a short-lasted acute drop in its levels can result in cerebral dysfunction and even death. Early treatment of and decreasing duration of hypoglycemia episodes increases life expectancy and improves the level of consciousness. Furthermore, pharmacological symptoms’ management should be continued for at least 2 weeks after hospital admission aiming to preserve the integrity of brain function and the wider well-being of patients.

Pathogenesis of Cluster 1 Duck Tembusu Virus in Ducks Reveals the Impact of Viral Genotype on Pathogenicity and Disease Severity

Duck Tembusu virus (DTMUV), an emerging avian pathogenic flavivirus, causes severe neurological disorders and acute egg drop syndrome in ducks. Currently, several clusters of DTMUV, including clusters 1, 2, and 3, have been identified and caused outbreaks in Asia. However, most of the DTMUV pathogenesis evaluation has mainly focused on cluster 2, while limited information is available on the pathogenesis of other DTMUV clusters, particularly cluster 1. In this study, the pathogenesis of a cluster 1 DTMUV was investigated in Cherry Valley ducks and compared to our previously reported cluster 2.1 DTMUV. Our results demonstrated that cluster 1 DTMUV was generally less pathogenic than cluster 2.1 DTMUV in ducks as evidenced by slower body weight loss, lower morbidity and mortality rates, and milder pathological changes. Concordantly, delayed viremia, reduced viral loads in blood and tissues, and shorter shedding period with lower viral loads were also observed in cluster 1 DTMUV inoculated ducks compared with those reported in cluster 2.1 DTMUV. In addition, we also found that cluster 1 DTMUV exhibited significant antigenic difference compared to cluster 2.1 DTMUV. Altogether, our findings suggest distinct pathogenicity and antigenicity between cluster 1 and 2.1 DTMUVs in ducks, highlighting the potential association between DTMUV genotype and pathogenicity/disease severity. This study enhances our understanding of DTMUV pathogenesis in ducks and provides useful information for the design and development of effective DTMUV vaccines.

Splenic Sequestration in Febrile Pediatric Sickle Cell Disease Patients

Introduction: Acute splenic sequestration is a rare complication of pediatric sickle cell disease (SCD). Acute splenic sequestration crisis (ASSC) is characterized by an acute decrease in hemoglobin and is associated with an increased risk for hypovolemic shock, often requiring blood transfusion during acute episodes and splenectomy to prevent recurrent episodes. Recent studies have also shown that chronic splenomegaly and resultant anemia (described as chronic or subacute sequestration) with potential benefit of splenectomy. However, non-life-threatening splenic sequestration in febrile, hospitalized children with SCD is a frequent occurrence that has not been well-described in current literature. Aim: To estimate the change in WBC, Hemoglobin, platelet count from inpatient and outpatient baseline to lowest recorded value (LRV) for each febrile hospitalization in sickle-cell disease patients while controlling for hydroxyurea use and patient age. Methods: A retrospective chart review was performed on febrile, hospitalized children with a diagnosis of SCD who presented to a tertiary care hospital from 2018-2021. Data including the magnitude of fever, presence of splenomegaly and trends in laboratory parameters such as complete blood count, and chemistries were recorded. Demographics, hydroxyurea use, transfusions and sickle cell phenotype were also recorded. For our primary outcome we estimated the change in Hgb, platelets, and WBC count from inpatient (first day of hospitalization) and outpatient (most recent outpatient values) baselines to the lowest recorded value (LRV) for each hospital encounter. We employed mixed models to account for within-subject correlation and adjusted for hydroxyurea use and categorized patient age. The beta coefficient and corresponding 95% confidence interval (CI) were reported for the model intercept and predictors. Results: Sixty-six unique patients (ages 0-17) accounted for a total of 117 hospital encounters. There was a statistically significant drop in WBC per microliter (-5.40, 95% CI: -6.89 - [-3.91]) , Hgb g/dL (-0.95, 95% CI : -1.25 - [-0.66]), and platelets per microliter (-60.95, 95% CI : -83.18 - [-38.71]) from the inpatient baseline to the LRV. There was a statistically significant drop in estimated Hgb g/dL (-1.83, 95% CI : -2.23 - [-1.42]) and platelets per microliter (-130.50, CI: -169.59 - [-91.41]) from outpatient baseline to the LRV. Hospital encounters with hydroxyurea had a significantly greater drop in estimated platelets per microliter from inpatient baseline to LRV (-54.43 CI : -93.64 - [-15.22]) but significantly greater increase in estimated Hgb g/dL from inpatient baseline to the LRV (1.11 CI : 0.45 - 1.78) compared to hospital encounters without hydroxyurea. Hospital encounters over the age of 8 were associated with a significantly greater decrease in HGB g/dL (-0.59 CI : -1.04 - [-0.14]) from inpatient baseline to the LRV compared to hospital encounters under the age of 8. Conclusion: Our study demonstrated features consistent with acute, non-life-threatening splenic sequestration in febrile pediatric SCD patients, as evidenced by a statistically significant drop in platelets, Hgb, and WBC count from the inpatient baseline. The largest acute drop was observed in platelets, which presents the strongest argument for sequestration, as drops in Hgb may be explained by rehydration or hyperhemolysis, and changes in WBC count may be related to infection. Hydroxyurea use may delay auto-infarction of the spleen, thus predisposing to splenic sequestration at an age later than classically associated with sequestration. The preservation of splenic function probably explains greater decrease in platelet count for patients on hydroxyurea. Our study has treatment implications: children with SCD experiencing non-life-threatening acute splenic sequestration recover spontaneously without the need for blood transfusion in many cases, thus avoiding long-term complications such as RBC alloimmunization or iron overload. Also, as the drop in WBC, hemoglobin, and platelets are not due to myelosuppression, they should not lead to modification of hydroxyurea therapy. Splenectomy should be reserved for the most severe and life-threatening episodes of sequestration. Further research may assist in correlating sickle cell phenotype and history of blood transfusion with the magnitude of sequestration in this population.

Association of Periprocedural Haemoglobin Reduction and Myocardial Injury in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

Background: Patients undergoing percutaneous coronary intervention are at risk of different complications such as periprocedural bleeding and acute hemoglobin reduction that can lead to myocardial injury. Blood loss through the catheter during the procedure and through puncture site haematoma causes periprocedural acute haemoglobin drop. Objectives: To find out the association between acute haemoglobin reduction and myocardial injury after PCI in patients with unstable angina. Methods: This prospective observational study was conducted at the National Institute of Cardiovascular Diseases (NICVD) for one year of time. A total of 130 patients were enrolled based on inclusion and exclusion criteria during the study period. Haemoglobin and troponin-I were measured before and after PCI within 24 to 48 hours of the procedure. On the basis of post-procedural acute haemoglobin level, the study population was categorized into two groups: Group I patients with normal haemoglobin levels and Group II patients with significant acute haemoglobin reduction (≥ 1 gm/dl). Results: A total of 24 patients developed a periprocedural myocardial injury, among them 17 (70.8%) were in the reduced haemoglobin group and 7 (29.2%) in the normal haemoglobin group. Elevation of troponin I after PCI was higher in group II than in group I patients with a statistically significant difference. Multivariate logistic regression analysis showed that haemoglobin reduction was an independent predictor of PMI (OR 1.94; 95% CI, 1.241-8.684; p = 0.01). Conclusion: Periprocedural haemoglobin reduction in patients with unstable angina was associated with myocardial injury after percutaneous coronary intervention (PCI).

Dynamic response of a dual-opposed free-piston Stirling generator

As a type of distributed power generation device, free-piston Stirling generator (FPSG) is characterised by compactness, high efficiency, and long life. This work devotes to exploring the dynamic response of a low-vibration dual-opposed FPSG by employing the newly-developed time-domain acoustic-electrical analogy (TDAEA) method. Transient evolutions of self-sustained oscillations are first exhibited, which contains the start-up and steady stages. An exploration on steady-state performance is then conducted, which shows the maximum thermal-to-electric efficiency of 46.6% with an electric power of 3.92 kW, implying its enormous potential in distributed power generation for low-vibration applications due to its dual-opposed configuration. Dynamic response with jump in external load and gradual variation in heating temperature are subsequently investigated in detail. The results indicate that an acute drop in electric resistance leads to an oscillation attenuation, particularly, a short circuit results in an emergency shutdown. With the heating temperature declining gradually, the oscillation attenuates and even stops. Based on these results, some general operating regulation principles for FPSGs are further concluded to avoid the cylinder striking as well as frequent start and stop. This study gives a deeper understanding on the dynamic characteristics of FPSGs, as well as broadens the usage of the TDAEA method.

A Case Report of Bilateral Foot Drop in a Young Girl

Acute unilateral foot drop is a well-known entity, but bilateral foot drop in progressive fashion is rare. In particular, slow-progressing bilateral foot drop occurs with various metabolic causes, as in anorexia nervosa, hypothyroid myopathy, Crohn’s disease, and post-electroconvulsive therapy. Parasagittal intracranial and spinal pathologies and cauda equine may also cause progressive bilateral foot drop. This case is presented with bilateral foot drop due to common peroneal nerve entrapment.

Molecular characterization of the HMTp210 gene of Avibacterium paragallinarum and the proposition of a new genotyping method as alternative for classical serotyping

ABSTRACT Avibacterium paragallinarum (A. paragallinarum) is the aetiological agent of infectious coryza (IC) in chickens and characterized by acute respiratory distress and severe drop in egg production. Vaccination is important in the control of IC outbreaks and the efficacy of vaccination is dependent on A. paragallinarum serovars included in the vaccine. Classical serotyping of A. paragallinarum is laborious and hampered by poor availability of antigens and antisera. The haemagglutinin, important in classical serotyping, is encoded by the HMTp210 gene. HMTp210 gene analysis has been shown to have potential as alternative to classical serotyping. The aim of the present study was to further investigate the potential of sequence analyses of partial region 1 of the HMTp210 gene, the HMTp210 hypervariable region and the concatenated sequences of both fragments. For this analysis, 123 HMTp210 gene sequences (field isolates, A. paragallinarum serovar reference strains and vaccine strains) were included. Evaluation of serovar references and vaccine strains revealed a need for critical evaluation, especially within Page serovar B and C. Phylogenetic analysis of HMTp210 region 1 resulted in a separation of Page serovar A, B and C strains. Analysis of the HMTp210 HVR alone was not sufficient to discriminate all nine different Kume serovar references. The concatenated sequences of HMTp210 region 1 and HMTp210 HVR resulted in 14 clusters with a high correlation with Page serovar and with the nine currently known Kume serovars and is therefore proposed as a novel genotyping method that could be used as an alternative for classical serotyping of A. paragallinarum.

Evaluation and Management of Idiopathic Unilateral Foot Drop.

In this study, our purpose is to evaluate patients who were followed by acute developing single-sided foot drop and improving with conservative management or spontaneously. Between 2019 and 2020, 10 patients were evaluated for a unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of foot drop without any etiological cause. Patients were followed for a period of 18 months. All patients were evaluated for acute foot drop of the affected extremity by utilizing the following diagnostic modalities, EMG, MRI lumbar spine, MRI knee, peripheral MRI neurography and non-contrast brain MRI. Each patient was evaluated for a history of Covid-19 infection over the past year. Patients with any identified cause were excluded. Initial evaluation of muscle strength in all patients revealed 0/5 by the MRC muscle testing grading scale. (1) In 2 patients, the muscle strength was 3/5 at the 6th month, and in the other 8 patients 4/5 at the 6th month. The muscle strength of all patients improved as 5/5 in 1 year. Six of the patients were dispensed an AFO device and nine patient's performed physical therapy. Evaluation of EMG results identified significant neuropathy at the level of the common peroneal at the fibular head in all patients. In comparison with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa; 50% reduction in sensory amplitude, and motor conduction slowing of >10 m/s was present. Evaluation of knee MRI revealed, no masses, edema, or anatomical variations at the level of the fibular head. In patients diagnosed with unilateral acute foot drop without an etiological cause, one should keep in mind that spontaneous resolution of this condition can occur within one year period.

Acute Physiological Effects of Drop Set on IGF and GH in the Quadriceps Femoris Among Males in Kakamega County, Kenya

Background: Resistance training (RT) for muscle growth (hypertrophy training – HT) theoretically optimizes the mechanical tension placed on the working muscle, which may be key to activating hypertrophic mechanisms. After prolonged HT, specialized weightlifting techniques like drop set training (DS) – or lifting progressively reduced loads without recovery – may help overcome plateaus in strength and re-stimulate hypertrophy, but physiological evidence to potentially support this hypothesis or the efficacy of implementing an acute drop set protocol in comparison to maintaining a standard hypertrophy training program is lacking. Objective: This objective of this study was to assess the levels of plasma growth hormone, and IGF during drop set and concentric exercises. Methods: The study used a randomized controlled, counterbalanced, repeated measures design. A repeated measures design was used to minimize the inter-individual variability of the hypertrophic response to resistance training. Thirty young males participated in a randomized, counterbalanced, within-subjects design, a DS protocol (4 sets, 4 loads/set, 75-30% 1RM, minimal recovery between loads, 3-minute recovery intervals between sets) and, separated by at least 7 days, a HT protocol (4 sets, 75% 1RM, 3-minute recovery intervals between sets). Data was analyzed using a 2 (Training Type: DS, HT, levels of quadriceps muscle hypertrophy) ´ 2 (Time: pre-exercise, post-exercise) repeated measures ANOVA to test the differences in concentrations of IGF-1 and GH during DS and HT at the specified time points. Results: The study found that there was a significant difference in IGF 1 levels before and after the exercise for both groups (Drop set and concentric exercise), with a p-value of .007. The interaction effect between the within-subjects factor (IGF 1 pre and post) and group was also significant. The results showed that there was a significant difference in GH levels before and after the exercise for both groups (Drop set and concentric exercise), with a p-value of &lt; .001. For the Drop set group, GH pre was also significantly lower than GH post. It can be concluded that both the drop set and concentric exercise techniques have an impact on the levels of IGF 1, and GH in the quadriceps femoris. The study recommends that physical trainers and fitness professionals should consider using the Drop set exercise technique in their training programs for clients who are looking to improve their performance.