Patient outcomes following transfer between intensive care units during the COVID-19 pandemic.

Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID-19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter-hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra-hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 h pre-transfer, immediately post-transfer and 24 h post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO2 /FI O2 ratio: from median (IQR [range]) 25.1 (17.8-33.7 [12.1-78.0]) kPa 6 h pre-transfer to 19.5 (14.6-28.9 [9.8-52.0]) kPa immediately post-transfer (p < 0.05). However, this had resolved at 24 h post-transfer: 25.4 (16.2-32.9 [9.4-51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO2 /FI O2 ratio. We also found no meaningful difference in pH; PaCO2 ;, base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic.

Hypothalamic hamartoma with precocious puberty: a case report.

Hypothalamic hamartoma (HH) is one of the most important causes of central precocious puberty in male children. Hamartomas are malformations composed of ectopic gonadotropic hormone (GnRH) neurons which secrete pulsatile gonadotropin releasing hormone. They are generally observed in children under 3 years. A case of 11/3 year-old male child presented with premature development of secondary sexual characters i.e., growth of pubic and axillary hair, enlargement of penis and acne over the face for the last 5 months. On physical examination, his height was 1.02 m and his weight 18kg, enlarged penile length of which 58mm; testicles were enlarged in size right one measuring 32X25mm and the left 30X23mm. His hematological and other biochemical investigations revealed no abnormality. Plain radiographic examination revealed radiological bone age of about 8-9 years. Endocrinological findings were as follows: Follicle stimulating hormone (FSH): 1.5mIU/ml, Luteinizing hormone (LH): 9.1mIU/ml, Testosterone: 701ng/dl (Testosterone level less than 30ng/dl in prepubertal age). Thyroid function tests were normal. Patient showed no adrenal pathology on ultrasound and his testicular parenchyma was homogeneous echotexture with the size of 30X22X16mm on the right (volume 5.4ml) and 30X20X15mm on the left (volume 4.6ml). With above physical & endocrinological findings and age of the child, it was suspected as a case of central precocious puberty. Subsequently MR imaging of the brain done & showed an oval non-enhancing pedunculated hypothalamic mass arising from the tubercinereum that was iso to hypointense to brain parenchyma on T1 - and intermediate signal on T2-weighted images, 20X10X10mm in diameter, extending into suprasellar cistern. During follow up after 06 months of starting conservative medication with gonadotropin-releasing hormone (GnRH) analog (Leuprolide acetate), his progression of puberty has been arrested and the testosterone level 18ng/dl, which is normal for his age.

Changes in the levels of factor VIII and von Willebrand factor in the puerperium.

To determine changes in Factor VIII (FVIII) and von Willebrand Factor (VWF) in the first 3 days of the puerperium. A prospective study assessing FVIII clotting activity, VWF activity and antigen levels in 95 women (with singleton uncomplicated pregnancies) during labour and on days 1, 2 and 3 of the puerperium. There were no significant differences in FVIII, VWF:Ag and VWF:CB on days 1 and 2 of the puerperium compared with levels during labour. There was a significant decrease in VWF:Ag (P = 0.009) and VWF:CB (P = 0.04) on day 3. Age, ethnicity, duration of labour and mode of delivery did not have any significant effect on the changes in FVIII and VWF levels. The pregnancy induced increase in FVIII and VWF is maintained in the first 48 h after delivery. VWF levels start to decline on day 3 postdelivery.

The outcome of endometrial ablation in women with inherited bleeding disorders.

There are currently limited data on the use of endometrial ablation in the treatment of heavy menstrual bleeding (HMB) in women with inherited bleeding disorders (IBDs). A retrospective review of prospectively collected data was performed. Twelve women with IBDs who had received endometrial ablation for the treatment of HMB were identified and their records reviewed. Details of their menstrual history; quality of life (QOL) and amount of menstrual blood loss [as assessed by pictorial blood-loss assessment chart (PBAC) and haemoglobin (Hb) concentration] pre and post-ablation were collected. Twelve women were included. The median duration of follow-up post-ablation was 32 months (range, 6-76). The median duration of menstruation decreased from 11 to 0 days after treatment (P = 0.004). Median PBAC scores decreased from 1208 preop to 0 post-ablation (P = 0.002).The median Hb concentrations (10.5-13.1 g dL(-1)) and QOL scores (median, 17-54) improved significantly after endometrial ablation (P < 0.01). Endometrial ablation appears to be a safe and effective long-term treatment for HMB in women with IDBs. It significantly decreases menstrual blood loss and improves QOL.

Management of pregnancy, labour and delivery in women with inherited bleeding disorders.

Pregnancy, labour and delivery present intrinsic haemostatic challenges to women with and carriers of bleeding disorders and their offspring. Deficiency of fibrinogen and factor XIII are associated with miscarriage, placental abruption and foetal loss. The risk of antenatal complications including antepartum haemorrhage is unknown in women with other bleeding disorders. There is a significant risk of postpartum haemorrhage (primary and secondary) in women with all types of bleeding disorders. This can be serious and life threatening in those with severe defects such as Bernard Soulier syndrome and Glanzmann's thrombasthenia. Three to four percent of infants with haemophilia experience cranial bleeding that occurs during labour and delivery. The safest method of delivery for affected babies remains controversial. However, the rate of planned Caesarean section is increasing among known carriers of haemophilia. If vaginal delivery is planned, prolonged labour and difficult delivery especially vacuum extraction are associated with the highest risk of cranial bleeding and should be avoided. The optimal management of pregnancy in women with inherited bleeding disorders requires a multidisciplinary approach and advanced individualized management plan taking into consideration obstetric and bleeding risk factors. Women with mild or moderate bleeding disorders can be managed at their local maternity unit in close collaboration with a tertiary centre. However, those with severe or rare disorders or carrying an affected infant should be managed in a tertiary centre with an onsite Haemophilia centre.

Synthesis, characterisation, activities, cell uptake and DNA binding of a trinuclear complex: [[trans-PtCl(NH3)]2mu-[trans-Pd(NH3)(2-hydroxypyridine)-(H2)N(CH2)6NH2)2]Cl4.

The trinuclear complex: [[trans-PtCl(NH3)](2)mu-[trans-Pd(NH(3))(2-hydroxypyridine)-(H(2)N(CH(2))(6)NH(2))(2)]Cl(4) (code named CH25) has been synthesized and characterized. The activity of the compound against human ovarian cancer cell lines: A2780, A2780 cisR and A2780 ZD0473R, cell up take, level of binding with DNA and nature of its interaction with pBR322 plasmid DNA have been determined. The compound is found to exhibit significant anticancer activity against the cell lines-about 45 times as active as cisplatin against A2780 cell line, about 76 times as active as cisplatin against A2780(cisR) cell line and about seven times as active as cisplatin against A2780cell line. The higher activity of CH25 suggests that the compound is able to overcome multiple mechanisms of resistance operating in A2780(cisR) and A2780(ZD0473R) cell lines. The compound is believed to form a range of interstrand GG adducts with duplex DNA that induces global changes in the DNA conformation, unlike cisplatin and ZD0473 [also known as AMD473 and JM473: cis-(2-methylpyridine)(ammine)dichloroplatinum(II)] that form mainly intrastrand adducts that induces a local kink in a DNA strand. The increasing prevention of BamH1 digestion of form I and form II pBR322 plasmid DNA with the increase in concentration of the compound is believed to be due to interstrand binding that brings about global changes in DNA conformation.

Quantitative and morphological characteristics of the human corneal endothelium in relation to age, gender, and ethnicity in cataract populations of South Asia.

PURPOSE: To describe the differences of corneal endothelial cell densities, cell size variability and cell hexagonality in cataract populations of south Asia between sexes and ethnic groups. METHODS: 1,235 eyes of 1,235 male and female patients 40-75 years of age with senile cataract were examined with non contact specular microscopy with semi-automated analysis technique. The cell data of the study population was analyzed in relation to age, sex, and ethnic groups. Mean arithmetic differences and the coefficient of variation of repeated observations were calculated to estimate precision of the technique utilized. The main outcome measures were corneal endothelial cell density, cell size variability and cell hexagonality. RESULTS: The mean corneal endothelial cell density was 2,720 cells/mm2, mean cell size variability was 37.8% and percent cell hexagonality 40%. We found statistical significant difference between the three ethnic populations in all the corneal endothelial cell measurements (p<0.0001). Females had a 2.9% greater cell density than males (p = 0.0001). There was no significant difference in mean cell density according to age. Variability of cell size, however, increased with age (p<0.001). These findings were consistent across the three ethnic groups. CONCLUSIONS: In a total sample of 1,235 eyes distributed evenly in three cataract patient populations of south Asia, we found statistically significant differences of corneal endothelial cell densities of cell size variability and cell hexagonality between sexes and ethnic groups.

Interaction between NiCl2, and nucleobases, nucleosides and nucleotides.

The interaction between NiCl, and nucleobases, nucleosides and nucleotides has been studied by UV-Vis difference spectrophotometry, graphite furnace atomic absorption spectrophotometry, IR spectroscopy and high pressure liquid chromatography using the technique of continuous variation. The proposed structures of the complexes formed were optimised and their electronic and vibrational spectra generated using the molecular modelling program HyperChem 5. Ni2+ reacts with guanine, 2'-dGMP, GMP, adenine and AMP to form 1:1 complexes Ni(Guanine)(H2O)5, Ni(2'-dGMP)(H2O)5, Ni(GMP)(H2O)5, Ni(Adenine)(H2O)5, and Ni(AMP)(H2O)5 respectively. In these complexes, Ni2+ is believed to be bonded to the N7 atom of adenine and guanine.

The South Asian cataract management study: complications, vision outcomes, and corneal endothelial cell loss in a randomized multicenter clinical trial comparing intracapsular cataract extraction with and without anterior chamber intraocular lens implantation.

OBJECTIVE: To determine clinical outcomes of primary intracapsular cataract surgery with and without implantation of anterior chamber lenses. DESIGN: A multicenter randomized clinical trial. PARTICIPANTS: One thousand two hundred twenty-nine male and female patients 40-75 years of age with senile cataract. METHODS: Study patients were recruited from screening eye camps and outpatient clinics. Randomization to the two treatment groups was performed after screening for predetermined inclusion and exclusion criteria. Demographics, visual acuity, intraocular pressures, and corneal endothelial cell data were recorded before surgery and at 6 weeks, 12 months, and 24 months after surgery. Monitoring of the study was secured by a standardized image documentation procedure on all patients using the IMAGEnet digital imaging system. Analysis of corneal endothelial cell images was performed with the Cell Soft software (Topcon Corporation, Japan). MAIN OUTCOME MEASURES: Visual acuity and central corneal endothelial cell loss. RESULTS: The patients were randomized to intraocular lens (IOL; n = 616) and no IOL (n = 613) implantation. Surgical complications were reported in 177 (14.4%) patients (IOL = 14.8%; no IOL = 14.0%). The most frequent complication observed was vitreous loss which occurred in 10.3% of eyes (IOL = 11.2%; no IOL = 9.5%). At the final examination (2 years after surgery), 88% of the operated eyes had a best corrected vision of 6/18 or better (IOL = 88.8%; no IOL = 86.6%). Analysis of corneal endothelial cell data showed a small but significantly greater cell loss 6 weeks after surgery in eyes with IOL compared with those without IOL, but no overall difference was found between the treatment groups in the long term follow-up. CONCLUSIONS: The findings indicate that there is a rationale for the use of anterior chamber intraocular lenses in primary intracapsular cataract surgery.

In vitro assessment of the effect of halogenated hydrocarbons: chloroform, dichloromethane, and dibromoethane on embryonic development of the rat.

Halogenated hydrocarbons are widely used in industry, the laboratory, and in the home. In the present study three of these solvents--chloroform, dichloromethane, and dibromoethane--were examined for embryotoxic/teratogenic potential using rat embryo culture. The results showed that each of the solvents had a concentration-dependent embryotoxic effect on the developing rat embryo in vitro. The effect and no-effect concentrations (expressed in mumol/ml culture medium), respectively, for each of the halogenated hydrocarbons tested were: dibromoethane--0.33, < 0.18; chloroform--2.06, 1.05; dichloromethane--6.54, 3.46. The levels of chloroform and dichloromethane found to be embryotoxic in the present study were compared to reported blood levels attained following controlled human exposure. In the industrial situation, if the current exposure levels are adhered to, chloroform and dichloromethane appear to have little potential for reproductive toxicity in the human. Fatal or near fatal solvent levels would be required in the mother for the embryotoxic level to be reached. For dibromoethane, there are no reports following controlled human exposure presumably due to its carcinogenicity. In an attempt to elucidate the mechanism of embryotoxicity, histological studies were performed after exposure of rat embryos to an embryotoxic level of each of the halogenated hydrocarbons studied, for increasing time periods up to the standard 40-hour culture. Marked cell death in the neuroepithelium of the developing neural tube was a prominent feature in all embryos exposed to an embryotoxic level of these solvents for periods of 16 hours of longer.

An alkenol and C-methylated flavones from Callistemon lanceolatus leaves.

Callistemon lanceolatus leaves after extraction with a combination of organic solvents have afforded 3-methyltetradec-2-en-7-ol and the rare C-methylated flavones: 5-hydroxy-7,4'-dimethoxy-6,8-dimethylflavone and 5-hydroxy-7,4'-dimethoxy-6-methylflavone. Structures have been established by spectroscopic methods. Isolation of C-methylated flavones from C. lanceolatus supported the view that they are characteristic to Myrtaceae.

Prevalence of Helicobacter pylori in asymptomatic population--a pilot serological study in Bangladesh.

Epidemiological reports reveal that H. pylori is distributed among all population in the world. The present cross-sectional study was undertaken to see the H. pylori seroprevalence rates among the asymptomatic adults, as yet reportedly no such data available in Bangladesh. Serum samples were collected from 181 consecutive subjects who attended at the health check-up centre of Bangladesh Institute of Diabeties, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, during the period of August to November 1995 for medical check up. The mean age of these subjects was 30.33 years (range 20-44 yrs). Incidentally all were male and belonged to average socioeconomic class. H. pylori specific IgG antibody level was assayed by an enzyme immunoassay kit ElAgen (Clone system). Among the 181 subjects, 166 (92%) had H. pylori specific antibodies and 15 (8%) were seronegative. No significant difference (p < 0.90) in seroprevalence rates was observed among different age groups. However, the results of higher seroprevalence rates of H. pylori infection in these asymptomatic adult population of Bangladesh are consistent with that of Africa and India.

Drug sensitivity pattern of E. coli causing urinary tract infection in diabetic and non-diabetic patients.

Escherichia coli was isolated from 65 urine samples out of 300 specimens collected from diabetic and non-diabetic patients with urinary tract infections. All isolates were screened for susceptibility to commonly used antibiotics. No remarkable difference in sensitivity pattern was observed between the E. coli isolates from diabetic and non-diabetic out-patients. However, the isolates from hospitalized diabetic patients showed a clear difference in sensitivity; E. coli from this group was more resistant to commonly used antibiotics compared with those from non-hospitalized diabetic and non-diabetic patients.

In vitro assessment of the effect of methanol and the metabolite, formic acid, on embryonic development of the rat.

Inhalation studies in rats have indicated that methanol is embryotoxic at levels that are only mildly maternally toxic. In the present study, the embryotoxicity of methanol and its metabolite, formic acid, was evaluated using rat embryo culture. The results showed that both methanol and formic acid have a concentration-dependent embryotoxic effect on the developing rat embryo in vitro. The no-effect concentration of methanol was 211.7 mumol/ml culture medium, while embryotoxicity was observed at 286.5 mumol/ml. The no-effect concentration of formic acid was 3.74 mumol/ml, while a concentration of 18.66 mumol/ml was associated with severe embryotoxicity. When embryos were grown in sera containing 18.66 mumol sodium formate/ml or in sera adjusted with hydrochloric acid to pH values similar to those achieved with formic acid, the results indicated that both low pH and formate contributed to the observed embryotoxicity of formic acid. When the level of methanol found to be embryotoxic in the present study is compared to blood levels in the human following controlled industrial exposure there appears to be a large margin of safety. However, plasma methanol levels are only one aspect of methanol toxicity in the human. Of greater significance is the formate level and the associated acidosis. However, it appears that embryotoxicity due to low pH or high formate levels would only occur after very severe methanol intoxication. Based on these in vitro studies, current industrial safety limits would appear to provide protection for the developing embryo.

In vitro assessment of individual and interactive effects of aromatic hydrocarbons on embryonic development of the rat.

There have been reports of disruption of embryonic development following exposure of pregnant women to aromatic hydrocarbons. In the present study, the embryotoxicity of toluene, xylene, benzene, styrene, and its metabolite, styrene oxide, was evaluated using the in vitro culture of postimplantation rat embryos. Possible interactions between toluene, xylene, and benzene were also studied using mixtures of these solvents. The results of the study showed that toluene, xylene, benzene, and styrene all have a concentration-dependent embryotoxic effect on the developing rat embryo in vitro. Styrene was embryotoxic at a lower concentration (1.00 mumol/mL) than benzene (1.56 mumol/mL), toluene (2.25 mumol/mL), or xylene (1.89 mumol/mL). The metabolite of styrene, styrene oxide, was embryotoxic at a concentration (0.038 mumol/mL). more than 20 times less than the parent compound. There was no evidence of a synergistic interaction between toluene, xylene, and benzene in causing embryotoxicity; the solvents interacted in an additive manner. The embryos were exposed to the solvents for 40 h of the organogenic period. When the levels of solvents found to be embryotoxic in the present study are compared to blood levels in the human following industrial exposure or solvent abuse, it appears unlikely that the threshold blood levels for embryotoxicity would be exceeded in the workplace. However, the possibility that exposure to solvents earlier or later or throughout the entire organogenic period might result in a different conclusion cannot be excluded.

Changes in serum amino acid concentrations during prolonged endurance running.

Eight endurance trained distance runners (5 male and 3 female) ran on a treadmill at 60% of their VO2max for 3 h. Blood samples (about 12 ml) were taken immediately prior to the exercise, and thereafter every 30 min during and at the end of exercise. Urinary urea excretion was determined for the day of exercise, and for a control day a week after the exercise. Blood samples were analyzed for glucose, free fatty acids, urea and free amino acids concentrations. As the exercise was continued, there was a gradual decrease in the concentrations in serum of alanine and proline such that the concentrations of both the amino acids were significantly less at the end of exercise than the resting values (p < 0.01). These changes appeared to be highly correlated (r = 0.981, p < 0.05). The serum glucose concentration increased significantly (p < 0.05) after 30 min of exercise, remained significantly elevated until 150 min of exercise and then decreased to reach the resting value at the completion of the exercise. Serum free fatty acid (FFA) concentration was significantly higher at the end of exercise compared to the resting value. The increase in serum FFA concentration and the decreases in the concentrations in serum of alanine and proline were also found to be highly correlated (alanine versus FFA: r = -0.986, p < 0.05; proline versus FFA: r = -0.961, p < 0.05). The total urinary urea excretion (332 +/- 43 mmol versus 424 +/- 46 mmol) and urine volume (978 +/- 187 ml versus 1,480 +/- 245 ml) were less on the day fo exercise than on the control day. The decrease in urine volume was found to be significant (p < 0.05).

Acute lower respiratory tract infections in hospitalized patients with diarrhea in Dhaka, Bangladesh.

This study focused on 401 children less than 5 years old who were hospitalized with acute lower respiratory tract infection (ALRI) and diarrhea in Dhaka, Bangladesh, and who were investigated for the presence of both bacterial and viral respiratory tract pathogens as well as for selected diarrheal pathogens. The most common manifestations of ALRI were pneumonia (374 cases), bronchiolitis (12 cases), and tracheobronchitis (11 cases). The majority (77%) of the illnesses were in children less than 2 years of age, and 88% of the children were malnourished. A respiratory tract pathogen was identified in 30% of the patients, and a diarrheal pathogen was identified in 34%. The overall case-fatality rate in children with ALRI and diarrhea was 8%. The case-fatality rate was 14% in children with bacterial pneumonia and diarrhea, 3% in those with viral pneumonia and diarrhea, and 14% in malnourished children with shigellosis and ALRI. The most common respiratory tract pathogens were respiratory syncytial virus, Streptococcus pneumoniae, influenza viruses, and Haemophilus influenzae type b.