Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review.

OBJECTIVES: Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS: We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS: The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION: This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.

A Human-Centered Design Approach to SOVTE Straw Phonation Instruction.

OBJECTIVES: Extensive research has demonstrated that straw/tube phonation exercises produce positive effects on the voice quality of the user. The purpose of this study was to explore pedagogical practices employed by a range of voice professionals when using SOVTEs by applying human-centered design approaches to examine workflow and communication between teachers and students. METHOD/DESIGN: The researchers conducted a series of five participatory role-playing workshop activities at a multi-disciplinary vocology conference that included speech-language pathologists, voice scientists, physicians, singing teachers, acting voice teachers, choral directors, and singers. Volunteers were asked to assume the role of teaching or learning straw phonation exercises. The other participants from each workshop were asked to provide written and verbal feedback regarding the teacher/student dynamics and what they found most important and relevant in terms of best practices for SOVTEs. Expert evaluators subsequently provided similar feedback based on video recordings of the workshops. RESULTS: While there was variability noted in teaching techniques and results, common themes emerged in the analysis. Successful and unsuccessful student and teacher techniques were identified by the workshop participants. Through the video analysis, the research team identified themes in instructional teaching, experiential learning, and straw articulation and mechanics. CONCLUSIONS: The benefits of straw/tube phonation exercises on voice quality have been well-established and are clear. As we continue to refine best practices in SOVTEs and, in particular, straw phonation, involvement of experts in HCD as part of multidisciplinary teams may lead to the eventual design of SOVTE tools that provide greater precision, consistency, and effectiveness both in clinical and pedagogical settings, and aid in the differentiation of SOVTE approaches within the taxonomy of vocal habilitation and rehabilitation techniques.

A Fatal Fungal Infection: Cryptococcus gattii (VGI) Meningitis in Texas.

Cryptococcus gattii is an underrecognized cause of meningitis, especially in nonendemic regions. This report details C gattii disease progression from admission to autopsy in an otherwise healthy 40-year-old male in Texas. It brings awareness to an often unsuspected organism that can cause severe infection requiring early recognition and treatment in immunocompetent individuals.

Examining the status of forest fire emission in 2020 and its connection to COVID-19 incidents in West Coast regions of the United States.

Forest fires impact on soil, water, and biota resources. The current forest fires in the West Coast of the United States (US) profoundly impacted the atmosphere and air quality across the ecosystems and have caused severe environmental and public health burdens. Forest fire led emissions could significantly exacerbate the air pollution level and, therefore, would play a critical role if the same occurs together with any epidemic and pandemic health crisis. Limited research is done so far to examine its impact in connection to the current pandemic. As of October 21, nearly 8.2 million acres of forest area were burned, with more than 25 casualties reported so far. In-situ air pollution data were utilized to examine the effects of the 2020 forest fire on atmosphere and coronavirus (COVID-19) casualties. The spatial-temporal concentrations of particulate matter (PM2.5 and PM10) and Nitrogen Dioxide (NO2) were collected from August 1 to October 30 for 2020 (the fire year) and 2019 (the reference year). Both spatial (Multiscale Geographically Weighted Regression) and non-spatial (Negative Binomial Regression) analyses were performed to assess the adverse effects of fire emission on human health. The in-situ data-led measurements showed that the maximum increases in PM2.5, PM10, and NO2 concentrations (µg/m3) were clustered in the West Coastal fire-prone states during August 1 - October 30, 2020. The average concentration (µg/m3) of particulate matter (PM2.5 and PM10) and NO2 was increased in all the fire states severely affected by forest fires. The average PM2.5 concentrations (µg/m3) over the period were recorded as 7.9, 6.3, 5.5, and 5.2 for California, Colorado, Oregon, and Washington in 2019, increasing up to 24.9, 13.4, 25.0, and 17.0 in 2020. Both spatial and non-spatial regression models exhibited a statistically significant association between fire emission and COVID-19 incidents. Such association has been demonstrated robust and stable by a total of 30 models developed for analyzing the spatial non-stationary and local association. More in-depth research is needed to better understand the complex relationship between forest fire emission and human health.

Examining the effects of green revolution led agricultural expansion on net ecosystem service values in India using multiple valuation approaches.

Ecosystem Services (ESs) are bundles of natural processes and functions that are essential for human well-being, subsistence, and livelihoods. The 'Green Revolution' (GR) has substantial impact on the agricultural landscape and ESs in India. However, the effects of GR on ESs have not been adequately documented and analyzed. This leads to the main hypothesis of this work - 'the incremental trend of ESs in India is mainly prompted by GR led agricultural innovations that took place during 1960 - 1970'. The analysis was carried out through five successive steps. First, the spatiotemporal Ecosystem Service Values (ESVs) in Billion US$ for 1985, 1995, and 2005 were estimated using several value transfer approaches. Second, the sensitivity and elasticity of different ESs to land conversion were carried out using coefficient of sensitivity and coefficient of elasticity. Third, the Geographically Weighted Regression model was performed using five explanatory factors, i.e., total crop area, crop production, crop yield, net irrigated area, and cropping intensity, to explore the cumulative and individual effects of these driving factors on ESVs. Fourth, Multi-Layer Perceptron based Artificial Neural Network was employed to estimate the normalized importance of these explanatory factors. Fifth, simple and multiple linear regression modeling was done to assess the linear associations between the driving factors and the ESs. During the observation periods, cropland, forestland and water bodies contributed to 80%-90% of ESVs, followed by grassland, mangrove, wetland and urban built-up. In all three evaluation years, the highest estimated ESVs among the nine ES categories was provided by water regulation, followed by soil formation and soil-water retention, biodiversity maintenance, waste treatment, climate regulation, and greenhouse gas regulation. Among the five explanatory factors, total crop area, crop production, and net irrigated area showed strong positive associations with ESVs, while cropping intensity exhibited a negative association. Therefore, the study reveals a strong association between GR led agricultural expansion and ESVs in India. This study suggests that there should be an urgent need for formulation of rigorous ecosystem management strategies and policies to preserve ecological integrity and flow of uninterrupted ESs and to sustain human well-being.

Examining the effects of forest fire on terrestrial carbon emission and ecosystem production in India using remote sensing approaches.

Remote sensing techniques are effectively used for measuring the overall loss of terrestrial ecosystem productivity and biodiversity due to forest fires. The current research focuses on assessing the impacts of forest fires on terrestrial ecosystem productivity in India during 2003-2017. Spatiotemporal changes of satellite remote sensing derived burn indices were estimated for both fire and normal years to analyze the association between forest fires and ecosystem productivity. Two Light Use Efficiency (LUE) models were used to quantify the terrestrial Net Primary Productivity (NPP) of the forest ecosystem using the open-source and freely available remotely sensed data. A novel approach (delta NPP/delta burn indices) is developed to quantify the effects of forest fires on terrestrial carbon emission and ecosystem production. During 2003-2017, the forest fire intensity was found to be very high (>2000) across the eastern Himalayan hilly region, which is mostly covered by dense forest and thereby highly susceptible to wildfires. Scattered patches of intense forest fires were also detected in the lower Himalayan and central Indian states. The spatial correlation between the burn indices and NPP were mainly negative (-0.01 to -0.89) for the fire-prone states as compared to the other neighbouring regions. Additionally, the linear approximation between the burn indices and NPP showed a positive relation (0.01 to 0.63), suggesting a moderate to high impact of the forest fires on the ecosystem production and terrestrial carbon emission. The present approach has the potential to quantify the loss of ecosystem productivity due to forest fires.

Safety and Efficacy of Primary Multisession Dose Fractionated Gamma Knife Radiosurgery for Jugular Paragangliomas.

BACKGROUND: While multisession dose fractionated Gamma Knife radiosurgery (DFGKS) is common, its use has never been described for jugular paragangliomas (JP), which are notoriously difficult to treat. OBJECTIVE: To define efficacy, safety, and complication profile of DFGKS in 2 or 3 consecutive sessions for the treatment of a cohort of 10 cases of JP. METHODS: Between 2012 and 2017, 10 patients with JP were treated with DFGKS in 2 or 3 sessions, because it was not safe to treat the lesion in a single session because of the large volume or proximity to organs at risk. The small to medium-sized JP are treated with 16-22 Gy radiation, but the large-volume JP were treated with 23-25 Gy radiation dose. The Leksell G frame was kept in situ during the whole procedure. The tumor volumes on pretreatment and posttreatment imaging were compared, using the Leksell Gamma Plan treatment plan software to assess tumor progression. The patients were regularly evaluated for their clinical outcome with radiologic correlation. RESULTS: The mean radiologic follow-up was 39 months (range, 12-78 months). The mean marginal dose for 3 fractions and 2 fractions was 7.64 Gy at 50% and 11.2 Gy at 50%, respectively. The mean tumor size was 29.9 cm3 (range, 9.95-47.63 cm3) at treatment and 21.9 cm3 (range, 8.83-37.5 cm3) at follow-up (suggestive of 26.7% reduction). Tumor control was achieved in all patients (100%). Of 110 potential neurologic problems (signs/symptoms) evaluated (11 in each patient), 56 (50.9%) were present preoperatively. Of them, 27 (48.2%) improved and 29 (51.8%) stabilized after treatment. There were 2 new-onset neurologic problems (of 110, 1.8%) attributable to treatment (new-onset headache and spinal accessory paresis). No patient had any permanent neurologic deterioration. CONCLUSIONS: DFGKS for large-volume JP leads to acceptable progression-free survival, tumor control rate, and symptomatic improvement. It may be preferred to surgery or fractionated radiotherapy given its better safety, efficacy, and complication profile.

Estimating global ecosystem service values and its response to land surface dynamics during 1995-2015.

Changes in land use due to the industrial revolution, increasing population, ever-increasing desire for economic growth is a global concern. The aforementioned changes can have a significant impact on global and regional ecosystem services which are indispensable for human well-being and their subsistence. This study identifies several approaches (Costanza et al., de Groot et al., and Xie et al.) to estimate the value of global terrestrial ecosystem services. High resolution (300 m) land use products provided by European Space Agency-Climate Change Initiative (ESA-CCI) were used to quantify the global ecosystem service values (ESV) for 1995, 2000, 2005, 2010 and 2015 respectively. The coefficient of elasticity (CE) and coefficient of sensitivity (CS) was calculated to compute the response of ESV's corresponding to land use land cover (LULC) change. The results estimated the mean global ESV's (Trillion US$ year-1) to be 58.97 in 1995 and 57.76 in 2015, indicating a net loss of ESV (1.21 Trillion US$ year-1) during the analysis period (1995-2015) due to depletion of forest cover and wetland/water surface. The overall ESV (Trillion US$ year-1) increased in cropland (4.8 in 1995 to 4.9 in 2015) and urban coverage (0.3 in 1995 to 0.59 in 2015) whereas, it reduced substantially in forests (17.59 in 1995 to 17.42 in 2015), grasslands (9.1 in 1995 to 8.9 in 2015), wetland (22.19 in 1995 to 21.11 in 2015) and water bodies (5.29 in 1995 to 5.27). The forestland, wetland, and water bodies are the highest sensitive eco-regions defined by all valuation methods. The current research provides a way to quantify the overall economic loss or gain due to changes in the past, present, and future land use. This will bridge the gap between economic evaluations of current assets concerning the changes in land use. It will also help planners to provide an in-depth thought to the changes in the overall economic value of a particular land use in future (keeping biodiversity in mind) while validating long-term policies concerning to ecological conservation of a country.

Dose fractionated gamma knife radiosurgery for large arteriovenous malformations on daily or alternate day schedule outside the linear quadratic model: Proof of concept and early results. A substitute to volume fractionation.

BACKGROUND: To evaluate the feasibility, safety and efficacy of dose fractionated gamma knife radiosurgery (DFGKRS) on a daily schedule beyond the linear quadratic (LQ) model, for large volume arteriovenous malformations (AVMs). MATERIAL AND METHODS: Between 2012-16, 14 patients of large AVMs (median volume 26.5 cc) unsuitable for surgery or embolization were treated in 2-3 of DFGKRS sessions. The Leksell G frame was kept in situ during the whole procedure. 86% (n = 12) patients had radiologic evidence of bleed, and 43% (n = 6) had presented with a history of seizures. 57% (n = 8) patients received a daily treatment for 3 days and 43% (n = 6) were on an alternate day (2 fractions) regimen. The marginal dose was split into 2 or 3 fractions of the ideal prescription dose of a single fraction of 23-25 Gy. RESULTS: The median follow up period was 35.6 months (8-57 months). In the three-fraction scheme, the marginal dose ranged from 8.9-11.5 Gy, while in the two-fraction scheme, the marginal dose ranged from 11.3-15 Gy at 50% per fraction. Headache (43%, n = 6) was the most common early postoperative complication, which was controlled with short course steroids. Follow up evaluation of at least three years was achieved in seven patients, who have shown complete nidus obliteration in 43% patients while the obliteration has been in the range of 50-99% in rest of the patients. Overall, there was a 67.8% reduction in the AVM volume at 3 years. Nidus obliteration at 3 years showed a significant rank order correlation with the cumulative prescription dose (p 0.95, P value 0.01), with attainment of near-total (more than 95%) obliteration rates beyond 29 Gy of the cumulative prescription dose. No patient receiving a cumulative prescription dose of less than 31 Gy had any severe adverse reaction. In co-variate adjusted ordinal regression, only the cumulative prescription dose had a significant correlation with common terminology criteria for adverse events (CTCAE) severity (P value 0.04), independent of age, AVM volume, number of fractions and volume of brain receiving atleast 8 Gy of radiation. CONCLUSION: DFGKRS is feasible for large AVMs with a fair nidus obliteration rate and acceptable toxicity. Cumulative prescription dose seems to be the most significant independent predictor for outcome following DFGKRS with 29-30 Gy resulting in a fair nidus obliteration with least adverse events.

Dopamine transporter function differences between male and female CD-1 mice.

It has been reported that male mice are more susceptible to the neurotoxic effects of methamphetamine (MA) upon the nigrostriatal dopaminergic (NSDA) system. Since MA utilizes the dopamine transporter (DAT) to exert its effects, in the present study, we tested for differences in the dynamics of DAT function between male and female mice as an approach to understand some of the bases for this sex difference in MA-induced NSDA neurotoxicity. To accomplish this goal, in Experiment 1, the amount of dopamine (DA) obtained following DA infusion into the superfused striatal tissue fragments of male and female mice was measured while in Experiment 2 responses to the DA uptake blocker, nomifensine (NMF), were assessed in these preparations. The differences obtained to these treatments demonstrate that marked differences in DA transporter activity exist between male and female mice. When combining the DA and DOPAC measures from these two experiments, the data suggest that the female mice show a more active and efficient recovery and vesicular packaging of extracellular DA. These findings have important implications for sex differences in NSDA functions and responses to neurotoxins which enter the neurons via the DAT.