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This study aims to examine the potential of natural clay mineral from the southern part of Saudi Arabia as an effective adsorbent material for the removal of heavy metal ions of cadmium (Cd) and nickel (Ni) from aqueous solutions. The SEM analysis showed that clay particles had mixed shapes such as elongated rod-like and rectangular shape having rough corners with larger particles of 2-8 µm in size and smaller particles in the sub-micron size range. X-ray diffraction data revealed that clay particles had a good crystalline structure and composed of a mixture of various minerals including feldspar, illite, quartz, calcite, and gypsum. The BET surface area was found to be 35 ± 1 m²/g and the average pore size and pore volume of 6.5 ± 0.5 nm and 5.7e-02 cc/g, respectively. The X-ray fluorescence analysis of clay showed main compounds of SiO2 (47.33%), Al2O3 (18.14%), Fe2O3 (15.89%) with many others such as CaO, MgO, TiO2, and K2O in minor quantities. It was found that 1.2 g of clay removed up to 99.5% of Ni and 97.5% of Cd from 40 ppm aqueous solutions. The metal removal efficiencies were increased from around 95% up to 99% by increasing the pH of aqueous solutions from 4 to 11. The adsorption of Ni and Cd ions on Saudi clay was relatively fast, and up to 97% of ions were removed from solution within 45 min. The SEM-EDX and BET analysis for recycled clays further confirmed that the metal ions were removed from water through adsorption onto the clay. The experimental data fitted well with Langmuir and Freundlich isotherms. The maximum adsorption capacity of clay for Cd and Ni from isotherms was found to be 3.3 and 2.7 mg/g respectively. The findings of this study confirm the potential role of Saudi natural clay in wastewater treatment processes as a cheap, environment-friendly and safe natural adsorbent material. [ABSTRACT FROM AUTHOR]

In this short communication the solution of a steady state model of a sextuple evaporator system used in a paper industry has been presented. With the help of the residual values of model equations (a set of 12 nonlinear algebraic equations) it has been shown that the presently obtained results are superior to the previously published results. The importance of the number of significant digits in calculation are also briefly discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the applicability of a short-course regimen of antibiotics for managing catheter-associated urinary tract infection (CA-UTI) in patients with spinal cord injury (SCI). Design: Randomized, controlled, noninferiority trial. Setting: Medical center. Participants: Patients with SCI who had CA-UTI (N=61). Interventions: Patients were randomized to receive either a 5-day regimen of antibiotics after catheter exchange (experimental group) or a 10-day regimen of antibiotics with catheter retention (control group). Noninferiority was prespecified with a margin of 10%. Main Outcome Measure: Clinical cure at the end of therapy. Results: Of the 61 patients enrolled in this study, 6 patients were excluded because of bacteremia or absence of urinary symptoms. All patients (100%) achieved clinical cure at the end of therapy. The rates of microbiologic response were 82.1% in the experimental group and 88.9% in the control group (upper boundary 95% confidence interval (CI) for difference, 26%). The rates of resolution of pyuria were 89.3% in the experimental group and 88.9% in the control group (upper boundary 95% CI for difference, 16%). Patients in the experimental group had higher rates of CA-UTI recurrence than the control group. The rates of new CA-UTI, diarrhea, and Clostridium difficile colitis were similar in the 2 treatment arms. Conclusions: The primary endpoint of the study was met, indicating that the 5-day regimen with catheter exchange was noninferior to the 10-day regimen with catheter retention on the basis of clinical cure. Criteria for noninferiority on the basis of microbiologic response and resolution of pyuria were not met. [Copyright &y& Elsevier]

Abstract: We have found in vitro that a biofilm of benign Escherichia coli 83972 interferes with urinary catheter colonization by pathogens, and in human studies E. coli 83972–coated urinary catheters are associated with lower rates of catheter-associated urinary tract infections. We hypothesized that modifying surfaces to present mannose ligands for the type 1 fimbriae of E. coli would promote formation of dense E. coli 83972 biofilms, thereby interfering with surface colonization by Enterococcus faecalis, a common uropathogen. We covalently immobilized mannose on silicon substrates by attaching amino-terminated mannose derivative to carboxylic acid–terminated monolayers via amidation. Fluorescence microscopy showed that E. coli 83972 adherence to mannose-modified surfaces increased 4.4-fold compared to unmodified silicon surfaces. Pre-exposing mannose-modified surfaces to E. coli 83972 established a protective biofilm that reduced E. faecalis adherence by 83-fold. Mannose-fimbrial interactions were essential for the improved E. coli 83927 adherence and interference effects. From the Clinical Editor: Recurrent urinary tract infections remain major adverse events associated with catheter use. The authors report that modifying catheter surface to present mannose ligands for the type 1 fimbriae of benign Escherichia coli 83972 promotes formation of dense E. coli biofilms, which 100-fold reduces urinary catheter colonization of uropathogens. Future application of this technology is expected to result in substantial UTI risk reduction in catheter users. [Copyright &y& Elsevier]

Summary: Infectious diarrhea is a common occurrence in the immunosuppressed population. We present a 43-year-old individual with large-volume stool output Norovirus acute gastroenteritis in the setting of relapsed refractory acute myelogenous leukemia, hematopoietic stem cell transplantation, and biopsy-proven cutaneous and pulmonary graft-versus-host disease. Therapeutic options such as intravenous immunoglobulin or reduction of immunosuppressants were not a feasible choice. A prompt clinical cure was achieved with nitazoxanide, a broad-spectrum antimicrobial agent. Nitazoxanide may be a safe therapeutic alternative, in which a reduction in immunosuppression may not be a viable option. [Copyright &y& Elsevier]

Summary: Objective: Positive end-expiratory pressure (PEEP) has been viewed as an essential component of mechanical ventilation in acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). However, clinical trials have not yet convincingly demonstrated that high PEEP levels improve survival. The object of this study was to test a priori hypotheses that a small but clinically important mortality benefit of high PEEP did exist, especially in patients with greater overall severity of illness and differences in PEEP protocols might have affected the study results. Methods: Meta-analysis of randomized controlled trials comparing high versus low PEEP in ARDS/ALI. Studies were identified by search of MEDLINE (1950–2008) and other sources. Measurements and main results: Five studies including 2447 patients were identified. A pooled analysis showed a significant reduction in hospital mortality in favor of high PEEP (RR=0.89; 95% CI, 0.80–0.99; p =0.03). However, significant statistical and clinical heterogeneities such as differences in disease severity and ventilator protocols were found. The differences in PEEP protocols were not associated with differences in mortality rates. A logistic analysis suggested that the beneficial effect of high PEEP was greater in patients with higher ICU severity scores. Conclusions: The statistical and clinical heterogeneities make proper interpretation of the results difficult. However, a small, but significant mortality benefit of high PEEP may exist. In addition, our analysis suggests the effects of high PEEP are greater in patients with higher ICU severity scores. [Copyright &y& Elsevier]

Abstract: In the present work, a general case of gas absorption with first order irreversible chemical reaction in a liquid film, for laminar flow over a solid wall, has been analyzed theoretically. First order chemical reaction between the diffused solute and the wall is also considered. Laplace transform followed by power series method has been applied to solve the governing equations. Thereafter, the obtained analytical solution of the developed general model has been successfully verified by an explicit numerical scheme. The general model has also been reduced to six simplified cases, tackled by previous workers and an excellent agreement in the solutions is observed. Moreover, the results are validated by the experimental data available in the literature. The obtained concentration profiles in both the phases have been used to find the absorption rates and enhancement factor. Further, the effect of various parameters on concentration profile of solute, enhancement factor and eigen-values have been analyzed. Existence of positive eigen-values for the counter-current absorption is also described which was not pointed out by any of the previous researchers. It is concluded that in a co-current system, for Hatta number greater than 7 approximately, the variation in enhancement factor follows a linear trend on a log–log plot and that there is no effect of rate constants for higher values of Hatta number. It is further shown that the reaction at solid wall has appreciable effect on the absorption rate. [Copyright &y& Elsevier]

GNE (bifunctional UDP-N-acetylglucosamine 2-epimerase/ N-acetylmannosamine kinase) is a distal myopathy due to a mutation in the GNE gene on chromosome 9. Distal lower limb weakness (foot drop) progressing to proximal LL weakness with relative sparing of the quadriceps muscle is a characteristic feature. Cardiorespiratory involvement is rare. We aimed to describe patients with GNE myopathy in an inherited neuromuscular cohort in Northern India. All participants were suspected to be affected by a genetic muscle disorder and were recruited by the MRC-funded International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) study. All participants gave informed consent and underwent clinical assessment, nerve conduction studies (NCS), electromyography (EMG), and serum creatine kinase (CK) measurements. Genetic testing included single gene testing, singleton WES of probands and Sanger confirmation of affected relatives. Virtual diagnostic panels were applied to exome data, and ACMG criteria were applied to classify identified variants. 47 probands and 8 affected relatives were included in the analysis. Singleton WES results are available for 44 probands, of which 41 are solved or likely solved. Four probands have either a single hit in the GNE gene or a biopsy showed rimmed vacuoles. WES results are awaited in 3 probands. Male: Female ratio was 20:27. Median age of onset was 25 years, and the median age of diagnosis was 28 years. Family history was present in 10 probands, and consanguinity was present in 3 probands. Clinical features included distal lower limb weakness, distal UL weakness, proximal lower limb weakness, and proximal UL weakness. Relative quadriceps sparing was present in (75%). The first presenting symptom was distal LL weakness in 60% and proximal LL weakness in 40%. Most were ambulant, but four were wheelchair dependent. Mildly elevated CK (median 365 U/L) and myopathic changes in EMG were present in all patients. Muscle biopsy was done in 18 patients, and rimmed vacuoles were seen in 6 patients. The most common variants detected were c.2179G>A (p.Val727Met), seen in 19 probands, followed by c.2086G>A (p.Val696Met), in 15 probands. We describe the clinical and genetic spectrum of GNE myopathy patients in the ICGNMD cohort of inherited neuromuscular disorders from Northern India. The study confirms the presence of common GNE variants in the South Asian population and underlines the importance of population-specific filtering for variants with a high carrier frequency. [ABSTRACT FROM AUTHOR]

ADSSL1 myopathies were initially reported from Korea, with distal weakness progressing to proximal muscles and histological features of nemaline myopathy. A Japanese cohort was reported to show proximodistal distribution. Indian patients with ADSSL1 myopathy have been reported with proximal weakness as the presenting symptom. We aimed to characterize four cases of adenylosuccinate synthetase-like 1 (ADSSL1) myopathy in a neuromuscular cohort in Northern India. All participants were suspected to be affected by a genetic muscle disorder and were recruited by the MRC-funded International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD). All participants gave informed consent and underwent clinical assessment, nerve conduction studies (NCS), electromyography (EMG), and serum creatine kinase (CK) measurements. Genetic testing included single gene testing, singleton WES of probands and Sanger confirmation of affected relatives. Virtual diagnostic panels were applied to exome data, and ACMG criteria were applied to classify identified variants. We analysed four probands as solved/likely solved for ADSSL1 myopathy. The age of onset was in the second decade (14 and 18 yrs) in two patients, third decade (22 yrs) and from birth (delayed motor milestones) in the other two patients, respectively (range: birth- 22 yrs). Male:female ratio was 3:1. The mean disease duration was 13 years, ranging from 4 to 21 years. All patients were ambulant. The mean serum CK level was 852 IU/L (113-1244 IU/L). The clinical features included proximal muscle weakness, distal weakness, facial weakness and ptosis. Muscle biopsy was not done in any patient. Three of the four probands had the homozygous c.781G>A (p.Asp261Asn) variant, and 1 had a homozygous c.910G>A (p.Asp304Asn) variant in exon 8 of the ADSS1 gene. We describe 4 cases of ADSSL1 myopathy in a neuromuscular cohort in Northern India, including the youngest ever reported proband. [ABSTRACT FROM AUTHOR]

Limb girdle muscular dystrophy (LGMD) is a group of inherited muscular dystrophies which predominantly affects proximal muscles. Patients achieve independent walking at some point, have elevated creatine kinase (CK) levels, dystrophic changes in muscle histology, and degenerative changes in muscle imaging. Dystrophinopathies like Becker muscular dystrophy (BMD) and manifesting carriers are common differential diagnosis. We aimed to identify the spectrum of LGMD using single gene testing and whole exome sequencing (WES) in a genetically uncharacterised cohort with limb girdle weakness. All participants with clinically-suspected LGMD were recruited to the MRC-funded International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) cohort. All participants gave informed consent. All patients underwent clinical assessment, nerve conduction studies (NCS), electromyography (EMG), and serum CK measurement. Genetic testing included MLPA for DMD gene deletions and duplications, singleton WES of probands and Sanger confirmation of affected relatives. Virtual diagnostic panels were applied to exome data and ACMG criteria were applied to classify variants. 373 probands and 87 affected relatives were included in the analysis. DMD-MLPA was performed in 174 probands and identified 110 patients with BMD (63%). Undiagnosed LGMD cases (263 probands) were planned for singleton WES. WES results were available for 229 probands, of which 135 (59%) were solved or likely solved. 94 probands were unsolved or with single hits in recessive genes requiring further evaluation. WES results are awaited in 34 probands. Among the solved cases, 55 probands had LGMD-R2 (DYSF), 42 probands had LGMD-R1 (CAPN3), 18 probands had sarcoglycanopathy (LGMD R5 (SGCG)-7, LGMD R3 (SGCA)-6, LGMD R6 (SGCD)-1, LGMD R4 (SGCB)–4), 7 probands had collagen 6 related dystrophies, 3 probands had LGMD-R9 (FKRP), 2 probands had LGMD-R19 (GMPPB) and one proband each for LGMD-R7 (Telethonin), LGMD-R8 (TRIM32), LGMD-R11 (POMT1), LGMD-R23 (LAMA2), LGMD-D3 (HNRNPDL) and LGMD-R17 (PLEC). We describe the genetic characterisation of a cohort of patients with limb girdle weakness from India. [ABSTRACT FROM AUTHOR]