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Prune belly syndrome (PBS) results in a total lack of abdominal musculature. Abdominal muscles have an important function during inspiration and expiration. This puts the patient at risk for respiratory complications since they have a very limited ability to cough up secretions. Patients in an intensive care unit (ICU) with PBS who receive mechanical ventilation are at even greater risk for respiratory complications. We review the function of the abdominal muscles in breathing and delineate why they are important in the ICU. We include an illustrative case of a long-term ventilated patient with PBS and offer respiratory management options. [ABSTRACT FROM AUTHOR]

HVAC engineers are challenged to design air distribution systems with optimal performance while satisfying a long list of requirements, including maintaining the desired indoor air quality, thermal and acoustical comfort, minimizing energy usage, and life-cycle cost. One major part of the air distribution system is the ductwork system. The pressure drops in the ductwork system are vital to consider while designing it. Within this regard, fittings generate substantial pressure losses in the ductwork system. They frequently dominate the pressure drop in the ductwork system. Therefore, having the appropriate fitting design in the system is important to achieve a superior ventilation system. Due to the considerable impact of fittings on the pressure drop in the ductwork system, many associated studies have been conducted. Some of these studies intend to optimize the shape of the fittings to reduce their generated pressure drops. Other studies are devoted to accurately estimating the pressure drop generated from the fitting, as the current estimations using analytical equations can lead to deviations in estimating the pressure drop. However, efficiently sizing the fittings has not received enough consideration in the current design methods. To be more specific, the existing methods do not adequately account for sizing the fittings at an early design stage, which may result in an inefficient ventilation system. Therefore, a review is conducted in this paper to investigate how the existing design methods consider sizing their fittings and establish why considering them at an early design stage results in better-performing designs. • Fittings sizing is overlooked in the current ductwork design methods. • Considering fittings at an early design stage can reduce the fan energy use. • Considering fittings at an early design stage can achieve balanced ductwork designs. • Decreasing the ductwork sizes does not necessarily increase the fan energy usage. [ABSTRACT FROM AUTHOR]

In young infants, the triad consisting of acute encephalopathy, retinal hemorrhages, and a subdural hematoma is a nonspecific finding. It has traumatic and non-traumatic etiologies. The triad may be found among a vast spectrum of natural diseases. Optic nerve sheath hemorrhage in infants is typically detected at autopsy. It is a nonspecific finding that can be found in traumatic and non-traumatic etiologies. Neither the triad nor the ONSH are pathognomonic for an abusive head injury. Opposite to the triad, the spectrum of non-traumatic etiologies of ONSH is limited. In infants ONSH rarely occurs in spontaneous subarachnoidal hemorrhage or in infectious conditions. Our results show that the clinical significance of the optic nerve sheath hemorrhage in the forensic work-up of fatal cases of alleged abusive head injury is its limited differential diagnosis. Only after careful differential diagnosis ONSH may contribute to the diagnosis of AHT. However, the main limitation of our study is the sampling bias, as the eyes are usually removed when abusive head trauma is suspected. [ABSTRACT FROM AUTHOR]

Abstract: Spontaneous spinal epidural hematomas (SSEH) are a rare cause of spinal cord compression in childhood and especially in infancy. We reviewed the literature and describe a case of an 8-month-old boy with a large spontaneous cervico-thoracic epidural hematoma. With this review we want to detail the importance of early investigation, diagnosis and treatment in infants with SSEH. In our case the infant presented with irritability and crying and an ascending paralysis within four days. Magnetic resonance imaging (MRI) of the spine demonstrated an extensive epidural hematoma between C5 and L1, serious medullar compression and secondary cervical and thoracic medullar edema and hydromyelia. An emergency laminectomy was performed with evacuation of a well organized hematoma. There was a partial recuperation of the neurologic symptoms. Based on the scarce literature which only concerns seven case reports, SSEH is a rare cause of spinal compression in infancy. The presentation is often not specific and neurological symptoms are often lacking in the beginning. However early diagnosis with MRI and prompt neurosurgical intervention are important to improve outcome. [Copyright &y& Elsevier]

Abstract: Cranberries belong to a group of evergreen dwarf shrubs or trailing vines in the genus Vaccinium subgenus Oxycoccus. Traditionally they grow in acidic bogs throughout the cooler parts of the world; when cultivated are grown on low trailing vines in great sandy bogs. The research focuses on the study of vitamin C changes in Latvia grown wild (Vaccinium oxycoccus L.) and cultivated (Vaccinium macrocarpon Ait.) cranberries during convective and microwave vacuum drying. Latvian wild cranberries and cultivated cranberry varieties ‘Early Black’, ‘Ben Lear’, ‘Stevens’, ‘Bergman’ and ‘Pilgrim’ from Kurzeme region harvested in 2010 were used for experiments. Mechanical and thermal pre-treatment of fresh berries was applied for better water evaporation in drying process. During experiments the berries were dried: in a convective air dryer by controlled hot air stream circulation velocity of 1.2 m s-1 at temperature +50±2°C. The berries were placed on the perforated sieve (diameter 0.185 m, diameter of holes – 0.002 m); the moisture content of dried berries was 9.0±0.1%. Following quality parameters were analysed during experiments: moisture content (oven-drying method) and vitamin C content (LVS EN 14130:2003). Experimentally it was ascertained that drying time of berries by various drying methods mainly depends on the pre-treatment manner. During the drying process moisture content of cranberries decreased from on average 86.94% to 9.00%, about ∼10.00 times. Vitamin C is the least stable of all vitamins and it can be easily degraded during processing and storage. The most harmful factors to vitamin C content are the presence of oxygen, prolonged heating in the air ambiance and exposure to light. The initial content of vitamin C in wild and cultivated fresh cranberries was differing, which mainly depends on varieties’ individuality. Current research proved that vitamin C content loss in cranberries processed by microwave vacuum drying method comparing with drying in convective cabinet type dryer was smaller. [Copyright &y& Elsevier]

Abstract: Cocaine abuse, a growing social problem, is currently estimated from population surveys, consumer interviews and crime statistics. A new approach based on the analysis of cocaine (COC) and metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME), in water samples was applied to 28 rivers and 37 waste water treatment plants in Belgium using solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry. While EME was undetectable, COC and BE were detectable with concentrations ranging from <1 to 753ng/L and <1 to 2258ng/L, respectively. BE concentrations were employed to calculate the local amount of abused cocaine. The highest values (up to 1.8g/day cocaine per 1000 inhabitants) were found in large cities and during weekends. The estimation of cocaine abuse through water analysis can be executed on regular basis without cooperation of patients. It also gives clear geographical information, while prevention campaigns can easily be implemented and evaluated. [Copyright &y& Elsevier]

Abstract: Streptococcus pneumoniae is a common cause of bacterial meningitis, frequently leading to death or severe neurological impairment. We report an exceptional case of a 7-month-old child with meningoencephalitis caused by S. pneumoniae. Peculiar, widespread and unique signal abnormalities were found on magnetic resonance imaging (MRI) with extensive central nervous white matter injury as well as evidence of thrombosis of the lateral transverse sinus. These changes were observed very early in the course of the illness, presumably reflecting widespread cytotoxic edema, vasculitis and acute demyelination. These lesions occurred despite appropriate antibiotic and anti-inflammatory (glucocorticoid) therapy started very early in the course of the disease. Such diffuse white matter lesions in the early course of (pediatric) cases of S. pneumoniae meningoencephalitis have not been reported previously. [Copyright &y& Elsevier]

Background Herpes simplex virus (HSV) is occasionally detected in the lower respiratory tract of patients in intensive care, but its clinical importance in such situations remains unclear. We did a prospective cohort study to define the prevalence, origin, risk factors, and clinical relevance of HSV in the respiratory tract of patients undergoing critical care.Methods We tested 764 patients admitted to intensive care for the presence of HSV in the respiratory tract, and assessed statistical relations between this virus and clinical variables.Findings HSV was detected by oropharyngeal swab in the upper respiratory tract of 169 (22%) of 764 patients, within 10 days of admission for 150 (89%) of these individuals. The virus was isolated in 58 (16%) of 361 patients whose lower respiratory tract was sampled. The presence of HSV in the throat was a risk factor for development of HSV infections in the lower respiratory tract (p<0·001). HSV was isolated most frequently in patients with severe disease. HSV in the throat was associated with acute respiratory distress syndrome (p<0·001) and with increased length of stay in intensive care (p<0·001).Interpretation Our data suggest that HSV reactivation or infection of the upper respiratory tract is frequent among patients in intensive care, and is a risk factor for development of lower respiratory tract infection with this virus, possibly by means of aspiration. [Copyright &y& Elsevier]

Despite advances in perioperative management, thoracic surgery remains a high-risk procedure for many patients. A systematic review of cardiac complications after thoracic surgery is presented. Most reviews about noncardiac thoracic surgery discuss postoperative analgesic regimens and pulmonary complications. In the present review, we also discuss atrial fibrillation as the most frequently encountered cardiac side effect. An evidence-based approach to other complications, such as myocardial ischemia, pulmonary edema, embolism, and shunt, is described. Furthermore, we offer recommendations for daily practice. [Copyright &y& Elsevier]

The phytochemical profile and positive health effects of the fruits and by-products of domesticated Malus domestica Borkh. apple cultivars have been extensively investigated. The present study was designed to evaluate the hydrophilic composition and antioxidant activity of the compounds recovered from wild apple Malus spp. by-products. The phytochemical analysis of the 30 and 96% ethanolic extracts using LC-DAD-ESI-MS/MS has led to the detection and isolation of 25 hydrophilic compounds. Amongst the polyphenols, chlorogenic acid, B-type procyanidins, and phloretin-2-glucoside dominated. The results of HPLC-DPPH• radical scavenging showed that the major contributors to the antioxidant activity of wild apple by-products were found to be cyanidin-glucoside, luteolin-glucoside, and B-type (−)-epicatechin, which showed the lowest EC 50 values of 0.65, 0.70, and 0.80, respectively. The abundance of vitamin C, including ascorbic and dehydroascorbic acids was confirmed using UHPLC-QqQ-MS/MS technique. The results showed that the wild apple by-products have the potential to be used in the production of natural antioxidants. Using a common solid-liquid extraction technique, 100 kg of press cake yielded 200 g of procyanidins, 100 g of chlorogenic acid, 87 g of phloridzin and 60 g of vitamin C, compounds that could potentially be used for the production of lipid oxidation inhibitors and agents with antimicrobial activities as medicines and food additives. Image 1 [ABSTRACT FROM AUTHOR]

Th yrotoxicosis is a life-threatening disorder when encountered after a major surgical procedure. Plasma exchange is an occasionally reported alternative treatment to thyroidectomy, iodine ablative therapy, or the administration of thyreostatic drugs. We used plasmapheresis as a lifesaving treatment in a patient with thyrotoxicosis, as encountered after a left-sleeve pneumonectomy, in whom many classic therapies either failed or were not retained. [Copyright &y& Elsevier]

Abstract: A seven-month-old baby was admitted to a hospital emergency department after collapsing suddenly while staying with his nanny. The baby displayed classic symptoms of shaken baby syndrome, including subdural haemorrhage, cytotoxic cerebral oedema, and bilateral retinal hemorrhages. Child protection services were informed, but both the parents and the nanny denied any involvement. In the subsequent weeks, the baby developed three other episodes of new subdural bleeding and a medico-legal investigation was started into the origin of the repeated subdural bleeding. Eventually, platelet aggregation tests and electron microscopy diagnosed a delta-storage pool disease; that is, a haemostatic disorder involving dense granules of the platelets. Initial minor blunt trauma may have resulted in subdural bleeding, while subsequent retinal haemorrhage could have been facilitated by the underlying haemostatic disorder. Delta-storage pool disease should be considered as a possible mimic of abusive head trauma similar to other rare conditions such as Menkes disease and type 1 glutaric aciduria. [Copyright &y& Elsevier]

This study evaluated retrospectively the efficacy of treatment with cefepime vs. a carbapenem, in combination with amikacin or ciprofloxacin, for seriously-ill patients infected with ESBL-producing Enterobacter aerogenes who were admitted to an intensive care unit. Forty-four episodes of infection were investigated in 43 patients: 21 treated with cefepime; 23 with a carbapenem. The two treatment groups did not differ statistically in terms of age, APACHE II scores, and infection sites, but the average duration of antibiotic exposure was significantly shorter in the cefepime group (8.5 days vs. 11.4 days; p 0.04). Clinical improvement was seen in 62% of patients receiving cefepime vs. 70% of patients receiving a carbapenem (p 0.59). Bacteriological eradication was achieved in 14% of patients receiving cefepime vs. 22% of patients receiving a carbapenem (p 0.76). The 30-day mortality rates related to infection were 33% in the cefepime group and 26% in the carbapenem group (p 0.44). Thus, outcome parameters did not differ significantly between the two groups. Nevertheless, a statistically significant increase in failure to eradicate ESBL-producing E. aerogenes was observed as the MICs of cefepime rose (p 0.017). Pulsed-field gel electrophoresis revealed three distinct clones, but one predominant clone harbouring the blaTEM-24 gene was associated with most (42/44) of the episodes of infection. It was concluded that cefepime may be an alternative agent for therapy of severe infections caused by TEM-24 ESBL-producing E. aerogenes, although further studies are required to confirm these observations. [ABSTRACT FROM AUTHOR]

sasX is a colonization-virulence factor that potentially underlies the success of methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 239 in Asia. We aimed to study the spread of sasX and the population structure of MRSA in two geographically distinct regions, Europe and India. MRSA (n = 128) from screening and clinical samples from tertiary care patients in 12 European countries (n = 119), and from India (n = 9) were multilocus-sequence-typed and screened for sasX and its carrier φSPβ-like prophage by PCR. Whole genome sequencing was performed on sasX -harbouring strains from India (n = 5) and Europe (n = 2) and on a selection non-harbouring sasX (n = 36) (2 × 150 bp, Miseq, Illumina). Reads were mapped to the ST239 reference strain, TW20. sasX and sesI , a sasX homologue native to Staphylococcus epidermidis , were detected in five of the nine Indian MRSA belonging to ST239 and to other sequence types of CC8. In contrast, sasX was restricted to two ST239 strains in Europe. The intact sasX and sesI carrier φSPβ-like prophages were ∼80 kb and ∼118 kb, and integrated in the yeeE gene. We identified 'novel' ST239 clades in India and Serbia that showed significant differences in base substitution frequencies (0.130 and 0.007, respectively, Tamura–Nei model) (p <0.05). Our data highlight dissemination of sasX to non-ST239 sequence types of CC8. Detection of the S. epidermidis -associated sesI in MRSA provided unquestionable evidence of transfer between the two species. Stark differences in evolutionary rates between the novel Indian and Serbian ST239 clades identified here might be due to inherent clade characteristics or influenced by other environmental differences such as antibiotic use. [ABSTRACT FROM AUTHOR]