Remote ultrasound diagnostics disrupting traditional military frontline healthcare delivery.

Accurate and reliable diagnostic capability is essential in deployed healthcare to aid decision-making and mitigate risk. This is important for both the patient and the deployed healthcare system, especially when considering the prioritisation of scarce aeromedical evacuation assets and frontline resources. Novel ultrasound tele-guidance technology presents a valuable diagnostic solution for remotely deployed military clinicians. This report discusses the first use of a consultant radiologist guiding a clinician, untrained in ultrasound, to perform an ultrasound scan via a live tele-guidance feed in the deployed environment using the Butterfly iQ+ tele-guidance system. Distance scanning provided a diagnostic quality report when compared with locally performed imaging to improve patient care and maintain operational output. This example demonstrates feasibility of remote point-of-care imaging systems in provision of location-agnostic high-quality diagnostic capability. Future opportunities to develop care pathways using bedside tele-diagnostics will democratise access, drive efficiency and improve patient care experience and outcomes.

Positive Retrospective SARS-CoV-2 Testing in a Case of Acute Respiratory Distress Syndrome of Unknown Etiology.

In order to elucidate the cause of acute respiratory distress syndrome of unknown etiology in a pre-pandemic patient, molecular techniques were used for detection of SARS-CoV-2. We used a SARS-CoV-2 nucleocapsid protein immunofluorescence stain to retrospectively identify an individual with diffuse alveolar damage on autopsy histology who had negative respiratory virus panel results in February, 2020, in Birmingham, Alabama. In situ hybridization for SARS-CoV-2 RNA revealed evidence of widespread multiorgan SARS-CoV-2 infection. This death antecedes the first reported death of a State of Alabama resident diagnosed with SARS-CoV-2 by 26 days.

Phylogenetic placement of Cibicidoides wuellerstorfi (Schwager, 1866) from methane seeps and non-seep habitats on the Pacific margin.

Benthic foraminifera are among the most abundant groups found in deep-sea habitats, including methane seep environments. Unlike many groups, no endemic foraminiferal species have been reported from methane seeps, and to our knowledge, genetic data are currently sparse for Pacific deep-sea foraminifera. In an effort to understand the relationships between seep and non-seep populations of the deep-sea foraminifera Cibicidoides wuellerstorfi, a common paleo-indicator species, specimens from methane seeps in the Pacific were analyzed and compared to one another for genetic similarities of small subunit rDNA (SSU rDNA) sequences. Pacific Ocean C. wuellerstorfi were also compared to those collected from other localities around the world (based on 18S gene available on Genbank, e.g., Schweizer et al., 2009). Results from this study revealed that C. wuellerstorfi living in seeps near Costa Rica and Hydrate Ridge are genetically similar to one another at the species level. Individuals collected from the same location that display opposite coiling directions (dextral and sinstral) had no species level genetic differences. Comparisons of specimens with genetic information available from Genbank (SSU rDNA) showed that Pacific individuals, collected for this study, are genetically similar to those previously analyzed from the North Atlantic and Antarctic. These observations provide strong evidence for the true cosmopolitan nature of C. wuellerstorfi and highlight the importance of understanding how these microscopic organisms are able to maintain sufficient genetic exchange to remain within the same species between seep and non-seep habitats and over global distances.

Persistency of Pseudomonas aeruginosa in sputum cultures and clinical outcomes in adult patients with cystic fibrosis.

Our objective was to describe the natural history of infection with transmissible and unique strains of P. aeruginosa (PA) in adult CF patients and to determine if clearance of PA from sputum was associated with an improvement in clinical status. This was a 3-year prospective cohort study of adult patients with CF. Sputum was collected at baseline and annually. Rate of decline of FEV1, BMI, exacerbation rate, and time to death or transplant were compared between patients who cleared PA versus those in whom PA was persistent. A total of 373 patients were included in the study, 75% were infected with PA at baseline; 24% were infected with transmissible strains and 51% with unique strains. Patients infected with unique strains were more likely to clear PA from their sputum over 3 years compared to those infected with transmissible strains (19% vs 10%, P=0.05). Declines in FEV1 and rates of pulmonary exacerbations, deaths, or lung transplants were not different between patients who cleared PA compared to those who remained persistently infected. No clinical benefit was identified in patients who cleared PA from sputum compared to those who remained persistently infected.

Colostrogenesis: mass transfer of immunoglobulin G1 into colostrum.

Bovine IgG(1) is thought to be specifically transported by a process of transcytosis across the mammary epithelial cells during colostrogenesis. Mammary IgG(1) appearance in cow colostrum has typically been reported as a concentration and shows IgG(1) concentration to be extremely variable because of animal variation, colostrum milking time, and water dilution effects. To identify animal IgG(1) transfer capacity and separate it from the other effects, our objective was to determine first colostrum IgG(1) total mass. We collected 214 samples of totally milked first colostrum with recorded colostrum weights from 11 Pennsylvania dairy farms that participated in Pennsylvania Dairy Herd Improvement Association, analyzed colostrum for IgG(1) by ELISA, and calculated total IgG(1) mass. Median and mean concentrations of IgG(1) were 29.4 mg/mL and 37.5+/-30.2 mg/mL, respectively, with a range of 9 to 166 mg/mL. However, total mass of IgG(1) had a median of 209.1g, mean of 291.6+/-315.8 g, and a range of 14 to 2,223 g. Colostrum IgG(1) concentration showed no relationship with colostrum volume, but IgG(1) mass had a positive relationship with volume. Colostrum IgG(1) mass was related to IgG(1) concentration (R(2)=0.58). Using DHIA records for 196 animals, we established milk production for these animals to a 15-d equivalent. An established milk secretion relationship to mammary parenchyma tissue (secretory tissue) was calculated and showed no relationship of IgG(1) mass with mammary parenchyma tissue. In addition, we show that approximately 10% of the sampled animals had IgG(1) mass greater than 1 standard deviation above the mean (high mass transfer) and represented all parities tested (1-7). Whereas first-lactation animals showed less overall calculated parenchyma tissue when compared with other parities, approximately 10% of the first-lactation group animals were capable of high mass transfer, with one transporting 2,029 g into first colostrum. Concentration variance of IgG(1) can be attributed to water inclusion, whereas mass transfer provides a clear indication of animal IgG(1) transfer capacity. The specific mechanism of bovine mammary IgG(1) transfer is not clear, but secretory tissue mass does not explain the variation observed. We hypothesize that the animal variation is attributable to endocrine regulation or genetic variation of the transporter(s).

Infecciones por levaduras: agentes causales y su resistencia a antifúngicos en pacientes pediátricos hospitalizados y en adultos HIV positivos / Yeast infections: etiologic agents and antifungal resistance in hospitalized pediatric patients and in HIV positive adult patients

Se realizó un estudio retrospectivo de las candidiasis en pacientes pediátricos hospitalizados y en adultos HIV positivos provenientes de 5 instituciones de la ciudad de Bunnos Aires, ciudad de La Plata y partidos del conurbano bonaerense, durante el período 1993-1995. Se determinó la frecuencia de aparición de las especies de levaduras y su perfil de sensibilidad a los antifúngicos de uso sistémico con el objeto de obtener datos actualizados de esta patología. Candida albicans fue el agente etiológico en el 87 o/o de los 214 pacientes adultos HIV positivos con candidiasis orofaríngeas estudiados y en el 50 o/o de los 209 pacientes pediátricos hospitalizados. En este último grupo el 28 o/o de estas infecciones se debió a Candida parapsilosis y el 18 o/o a Candida tropicalis, mientras que sólo el 2 y el 4 o/o de las candidiasis orales fueron causadas por estos microorganismos. La recuperación de Candida krusei y Candida glabrata, especies intrínsecamente resistentes a los azoles, se vio incrementada en la población expuesta al tratamiento con fluconazol. En ambos grupos se observó un bajo número de levaduras resistentes a la anfotericina B, en cambio para las drogas azólicas se detectó un mayor porcentaje de aislamientos resistentes, en especial al fluconazol: 13 o/o en los pacientes pediátricos y 34 o/o en los pacientes HIV positivos (AU)

Infecciones por levaduras: agentes causales y su resistencia a antifúngicos en pacientes pediátricos hospitalizados y en adultos HIV positivos / Yeast infections: etiologic agents and antifungal resistance in hospitalized pediatric patients and in HIV positive adult patients

Se realizó un estudio retrospectivo de las candidiasis en pacientes pediátricos hospitalizados y en adultos HIV positivos provenientes de 5 instituciones de la ciudad de Bunnos Aires, ciudad de La Plata y partidos del conurbano bonaerense, durante el período 1993-1995. Se determinó la frecuencia de aparición de las especies de levaduras y su perfil de sensibilidad a los antifúngicos de uso sistémico con el objeto de obtener datos actualizados de esta patología. Candida albicans fue el agente etiológico en el 87 o/o de los 214 pacientes adultos HIV positivos con candidiasis orofaríngeas estudiados y en el 50 o/o de los 209 pacientes pediátricos hospitalizados. En este último grupo el 28 o/o de estas infecciones se debió a Candida parapsilosis y el 18 o/o a Candida tropicalis, mientras que sólo el 2 y el 4 o/o de las candidiasis orales fueron causadas por estos microorganismos. La recuperación de Candida krusei y Candida glabrata, especies intrínsecamente resistentes a los azoles, se vio incrementada en la población expuesta al tratamiento con fluconazol. En ambos grupos se observó un bajo número de levaduras resistentes a la anfotericina B, en cambio para las drogas azólicas se detectó un mayor porcentaje de aislamientos resistentes, en especial al fluconazol: 13 o/o en los pacientes pediátricos y 34 o/o en los pacientes HIV positivos

[Yeast infections: causative agents and their antifungal resistance in hospitalized pediatric patients and HIV-positive adults]. / Infecciones por levaduras: agentes causales y su resistencia a antifúngicos en pacientes pediátricos hospitalizados y en adultos HIV positivos.

Candidiasis has increased its frequency over the last decade, particularly among hospitalized patients where it is accompanied with high rates of mortality, and in patients with AIDS who are predisposed to oropharyngeal or esophageal candidiasis. The aim of this study was to determine the frequency of appearance of different yeast species and the resistance profile to current antifungal drugs in hospitalized pediatric patients and adult HIV patients from 5 institutions of Buenos Aires City and suburbs, and La Plata City, during the period 1993-1995, in order to obtain local and updated information. Candida albicans was the etiologic agent recovered in 87% of the 214 HIV positive patients with oropharyngeal candidosis, and in 50% of the 209 hospitalized pediatric patients. In the latter group 28% of these infections were due to Candida parapsilosis and 18% to Candida tropicalis, but only 2% and 4% of oral candidosis were caused by these organisms. Detection of Malassezia furfur and Hansenula anomala, responsible of systemic infections, and Trichosporon beigelii, isolated from a burn patient, were considered remarkable since these organisms appear to be emerging pathogens. Azole resistant species as Candida krusei and C. glabrata were mostly recovered from HIV positive patients, exposed to fluconazole treatment. A very low number of amfotericin B "resistant" yeasts (n = 9) were observed in both groups. However, resistance to azole drugs, particularly to fluconazole, was found in pediatric patients (13%) and in HIV infected adults (34%).