Occurrence, distribution and composition of microplastics in the sediments of South Andaman beaches.

Herein, we report the prevalence of microplastics in the South Andaman beaches, India. The average microplastic abundance of the eight stations covered along the South Andaman beach was found to be 414.35 ± 87.4 particles per kilogram of beach sediment. Among the stations sampled, Kodiyaghat was found with highest microplastic abundance of 973.3 ± 76.59 particles per kilogram of beach sediment and Burmanullah recorded the lowest number of 161.7 ± 32.51. Microplastic particles of different types, size, color and shape were present in all the eight stations sampled. From the Raman spectral analysis, thirteen different types of polymers were identified. The microplastic pollution may be attributed to improper solid waste management, tourism activities and maritime activities. The present study will help in understanding the prevalence, source and pathway of microplastic particles and their affiliated risk to the fragile marine ecosystem.

Blastomycosis in northwestern Ontario, 2004 to 2014.

Blastomycosis is an invasive fungal disease caused by Blastomyces dermatitidis and the recently discovered Blastomyces gilchristii. The medical charts of 64 patients with confirmed cases of blastomycosis in northwestern Ontario during a 10-year period (2004 to 2014) were retrospectively reviewed. The number of patients diagnosed with blastomycosis in Ontario was observed to have increased substantially compared with before 1990, when blastomycosis was removed from the list of reportable diseases. Aboriginals were observed to be disproportionately represented in the patient population. Of the patients whose smoking status was known, 71.4% had a history of smoking. 59.4% of patients had underlying comorbidities and a higher comorbidity rate was observed among Aboriginal patients. The case-fatality rate from direct complications of blastomycosis disease was calculated to be 20.3%; this case-fatality rate is the highest ever to be reported in Canada and more than double that of previously published Canadian studies. The clinical characteristics of 64 patients diagnosed with blastomycosis are summarized.

La blastomycose est une maladie fongique invasive causée par la Blastomyces dermatitidis et le Blastomyces gilchristii, récemment découvert. Les chercheurs ont réalisé une analyse rétrospective des dossiers médicaux des 64 patients atteints d'une blastomycose confirmée au nord-ouest de l'Ontario, déclarés sur une période de dix ans (2004 à 2014). Le nombre de patients ayant un diagnostic de blastomycose en Ontario avait considérablement augmenté par rapport à celui d'avant 1990, lorsque la blastomycose a été retirée de la liste de médicaments à déclaration obligatoire. Le nombre d'Autochtones représenté au sein de la population de patients était disproportionné. Chez les patients dont on connaissait le statut de fumeur, 71,4 % avaient des antécédents de tabagisme, 59,4 % présentaient des comorbidités sousjacentes, et le taux de comorbidités était plus élevé chez les patients autochtones. Le taux de mortalité causé par les complications directes de la blastomycose s'élevait à 20,3 %. C'est le taux le plus élevé jamais déclaré au Canada, soit plus de deux fois celui signalé auparavant dans les études canadiennes. Les caractéristiques cliniques des 64 patients atteints d'une blastomycose diagnostiquée sont résumées.

Extracorporeal membrane oxygenation for blastomycosis-related acute respiratory distress syndrome: a case series.

PURPOSE: Blastomyces dermatitidis is a dimorphic fungus endemic to North America capable of causing fatal respiratory failure. Acute respiratory distress syndrome (ARDS) complicates up to 10% of pulmonary blastomycosis in hospitalized patients and carries a mortality of 50-90%. This report describes the clinical course of four consecutive patients with blastomycosis-related ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO) during 2009-2014. CLINICAL FEATURES: Four adults were referred from northwestern Ontario, Canada with progressive respiratory illnesses. All patients developed diffuse bilateral opacities on chest radiography and required mechanical ventilation within 6-72 hr. Patients satisfied Berlin criteria for severe ARDS with trough PaO2/F i O2 ratios of 44-61 on positive end-expiratory pressure of 12-24 cm H2O. Wet mount microscopy from respiratory samples showed broad-based yeast consistent with B.dermatitidis. Despite lung protective ventilation strategies with maximal F i O2 (patients A-D), neuromuscular blockade (patients A-D), inhaled nitric oxide (patients A and D), and prone positioning (patient D), progressive hypoxemia resulted in initiation of venovenous ECMO by hours 24-90 of mechanical ventilation with subsequent de-escalation of ventilatory support. In all four cases, ECMO decannulation was performed (7-23 days), mechanical ventilation was withdrawn (18-52 days), and the patients survived to hospital discharge (31-87 days). CONCLUSION: This report describes the successful application of ECMO as rescue therapy in aid of four patients with refractory blastomycosis-associated ARDS. In addition to early appropriate antimicrobial therapy, transfer to an institution experienced with ECMO should be considered when caring for patients from endemic areas with rapidly progressive respiratory failure.

Prolonged use of intravenous lipid emulsion in a severe tricyclic antidepressant overdose.

INTRODUCTION: Intravenous lipid emulsion (ILE) resuscitation is now frequently being used for severe overdoses due to lipophilic drugs. However, the optimal dose, duration, and safety are still unclear. CASE REPORT: A patient with refractory cardiovascular collapse following an amitriptyline overdose was treated with ILE with initial improvement. Instability recurred after ILE discontinuation and lipid therapy was restarted, but high-dose treatment was complicated by severe lipemia. A low-dose infusion was instead used, and the patient did not experience further toxicity despite amitriptyline levels in the toxic range for 21 days. He survived to discharge without long-term sequelae. DISCUSSION: A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose.