Concomitant Paratubal Cyst and Isolated Fallopian Tube Torsion Masquerading as Acute Appendicitis in a Pregnant Female.

Abdominal pain in pregnant individuals presents diagnostic challenges, especially when appendicitis is suspected. We report a rare case of a 26-year-old pregnant female with recurrent right lower quadrant (RLQ) abdominal pain initially misdiagnosed as a urinary tract infection. Diagnostic uncertainty led to a magnetic resonance imaging (MRI) scan, which revealed a right adnexal cystic structure and a thickened tubular structure adjacent to the cecal pole, raising concerns of complicated appendicitis. Subsequent diagnostic laparoscopy revealed a right-sided fallopian tube paratubal cyst with 360-degree torsion and associated fallopian tube torsion without the involvement of the ovary. The cyst was successfully excised, and the patient subsequently delivered a healthy baby via emergency lower section caesarean section. Abdominal pain during pregnancy has various causes. Diagnosing appendicitis during pregnancy is challenging due to anatomical and physiological changes. Ultrasound (US) is commonly used but has limited accuracy. Computed tomography (CT) is avoided due to radiation risks, while MRI is increasingly used and shows high diagnostic accuracy or aids in alternative diagnoses. Regardless of the diagnosis, the prompt recognition of intraabdominal pathology is crucial to prevent fetal morbidity. This case highlights the challenges in the accurate diagnosis of abdominal pain during pregnancy and emphasizes the importance of considering alternative pathologies to prevent delays in treatment and complications. Clinicians should consider diagnostic laparoscopy for pregnant patients with equivocal investigations and lower abdominal pain. The differential diagnosis may include both common and rare causes such as concomitant paratubal cyst and isolated fallopian tube torsion (IFTT), emphasizing a high index of suspicion and collaboration with obstetric colleagues to ensure optimal care.

Method for estimating ultraviolet germicidal fluence rates in a hospital room.

BACKGROUND: Upper-room air UV germicidal irradiation (UVGI) is an effective environmental control measure for mitigating the transmission of airborne infections. Many factors influence the efficacy of an upper-room air UVGI system, including the levels and distribution of radiation. The radiation levels experienced by airborne microorganisms can be estimated by measuring the fluence rate, which is the irradiance from all angles that is incident on a small region of space. METHODS: The fluence rate can be estimated by use of a radiometer coupled to a planar detector. Measurements in 4 directions at a single point are taken and summed to estimate the fluence rate at that point. This measurement process is repeated at different sites in the room at a single height. RESULTS: In the upper air of a test room, the UV fluence rate varied at least 3-fold, with the maximum rate occurring in the immediate vicinity of the fixtures containing lamps emitting UV radiation. In the area that would be occupied by the patient and/or healthcare personnel, no significant variation occurred in the UV fluence rate for a designated height. There was no significant statistical difference between measurements obtained by different individuals, by using a different alignment, or during 5 observation periods. Lamp failures were detected on multiple occasions. CONCLUSION: This method is simple, requires no specialized training, and permits regular monitoring of the necessary UV fluence rates needed to sustain the targeted airborne microorganisms' inactivation level. Additionally, this method allowed for the detection of changes in UV fluence rates in the upper air of the simulated hospital room.

Quantum chemical study of the photocoloration reaction in the napthoxazine series.

Ab initio and semiempirical quantum mechanical calculations were performed to study the electronic spectra of spiroxazine photochromic compounds as well as the corresponding photoisomers. Ground-state geometries were optimized based on density functional theory (DFT). Excitation energies of the different forms were calculated using the time-dependent density functional theory (TD-DFT) method. Semiempirical calculations including configuration interactions were performed to detail the mechanism of ring opening in excited states. On the basis of the obtained potential energy profile, a complete mechanism of photocoloration able to clarify some experimental findings is provided. A correlation of the experimental quantum yield of photocoloration with the calculated properties as a function of substituent effects is proposed.

Bioaerosol mass spectrometry for rapid detection of individual airborne Mycobacterium tuberculosis H37Ra particles.

Single-particle laser desorption/ionization time-of-flight mass spectrometry, in the form of bioaerosol mass spectrometry (BAMS), was evaluated as a rapid detector for individual airborne, micron-sized, Mycobacterium tuberculosis H37Ra particles, comprised of a single cell or a small number of clumped cells. The BAMS mass spectral signatures for aerosolized M. tuberculosis H37Ra particles were found to be distinct from M. smegmatis, Bacillus atrophaeus, and B. cereus particles, using a distinct biomarker. This is the first time a potentially unique biomarker was measured in M. tuberculosis H37Ra on a single-cell level. In addition, M. tuberculosis H37Ra and M. smegmatis were aerosolized into a bioaerosol chamber and were sampled and analyzed using BAMS, an aerodynamic particle sizer, a viable Anderson six-stage sampler, and filter cassette samplers that permitted direct counts of cells. In a background-free environment, BAMS was able to sample and detect M. tuberculosis H37Ra at airborne concentrations of >1 M. tuberculosis H37Ra-containing particles/liter of air in 20 min as determined by direct counts of filter cassette-sampled particles, and concentrations of >40 M. tuberculosis H37Ra CFU/liter of air in 1 min as determined by using viable Andersen six-stage samplers. This is a first step toward the development of a rapid, stand-alone airborne M. tuberculosis particle detector for the direct detection of M. tuberculosis bioaerosols generated by an infectious patient. Additional instrumental development is currently under way to make BAMS useful in realistic environmental and respiratory particle backgrounds expected in tuberculosis diagnostic scenarios.

Impact of environmental factors on efficacy of upper-room air ultraviolet germicidal irradiation for inactivating airborne mycobacteria.

This study evaluated the efficacy of an upper-room air ultraviolet germicidal irradiation (UVGI) system for inactivating airborne bacteria, which irradiates the upper part of a room while minimizing radiation exposure to persons in the lower part of the room. A full-scale test room (87 m3), fitted with a UVGI system consisting of 9 louvered wall and ceiling fixtures (504 W all lamps operating) was operated at 24 and 34 degrees C, between 25 and 90% relative humidity, and at three ventilation rates. Mycobacterium parafortuitum cells were aerosolized into the room such that their numbers and physiologic state were comparable both with and without the UVGI system operating. Airborne bacteria were collected in duplicate using liquid impingers and quantified with direct epifluorescent microscopy and standard culturing assay. Performance of the UVGI system degraded significantly when the relative humidity was increased from 50% to 75-90% RH, the horizontal UV fluence rate distribution was skewed to one side compared to being evenly dispersed, and the room air temperature was stratified from hot at the ceiling to cold at the floor. The inactivation rate increased linearly with effective UV fluence rate up to 5 microW cm(-2); an increase in the fluence rate above this level did not yield a proportional increase in inactivation rate.

Photofragmentation study of hexamethyldisiloxane following core ionization and direct double ionization.

X-ray photoelectron spectroscopy and Auger spectroscopy studies of gas-phase hexamethyldisiloxane (HMDSO) are presented. The photodissociation of this molecule is studied using various experimental coincidence techniques. We compare the fragmentation pathways observed after core ionization followed by Auger decay and after valence double photoionization of the molecule. A strongly selective production of the doubly charged tetramethyldisiloxane ion is observed in the low binding-energy regions. Theoretical calculations are carried out to tentatively explain the stability of the produced dication.

Rapid detection and determination of the aerodynamic size range of airborne mycobacteria associated with whirlpools.

Novel environmental air and water mycobacteria sampling and analytical methods are needed to circumvent difficulties associated with the use of culture-based methodologies. To implement this objective, a commercial, clinical, genus DNA amplification method utilizing the polymerase chain reaction (PCR) was interfaced with novel air sampling strategies in the laboratory. Two types of air samplers, a three-piece plastic, disposable filter cassette and an eight-stage micro-orifice uniform deposit impactor (MOUDI), were used in these studies. In both samplers, 37-mm polytetrafluoroethylene (PTFE) filters were used. Use of the MOUDI sampler permitted the capture of airborne mycobacteria in discrete size ranges, an important parameter for relating the airborne mycobacteria cells to potential respirable particles (aerodynamic diameter <10 microm) capable of causing health effects. Analysis of the samples was rapid, requiring only 1-1.5 days, as no microbial culturing or DNA purification was required. This approach was then used to detect suspected mycobacteria contamination associated with pools at a large public facility. PCR was also used to analyze various water samples from these pools. Again, no culturing or sample purification was required. Water samples taken from all ultraviolet light/hydrogen peroxide-treated whirlpools tested positive for the presence of mycobacteria. No mycobacteria were detected in the chlorine-treated pools and the water main supply facility. All air samples collected in the proximity of the indoor whirlpools and the associated changing rooms were strongly positive for airborne mycobacteria. The airborne mycobacteria particles were predominantly collected on MOUDI stages 1-6 representing an aerodynamic size range of 0.5 to 9.9 microm. In conclusion, using this approach permits the rapid detection of mycobacteria contamination as well as the routine monitoring of suspected pools. The approach circumvents problems associated with culture-based methods such as fungal overgrowth on agar plates, and the presence of nonculturable or difficult to culture mycobacteria strains.