Diabetic Muscle Infarction (Myonecrosis): Underdiagnosed or Underreported?

Diabetic muscle infarction is a rare complication of diabetes. It is seen more in Type 1 DM than Type 2 DM, but in both it is associated with longer duration of diabetes, poor glycemic control with or without microvascular complications. We present a case report of a 47 year diabetic male, who presented with sudden onset of painful swelling of the left thigh muscles (vastus group). The patient had microvascular complications of diabetes. Apart for mild elevation of CPK and LDH other investigations were normal. MRI findings of left thigh showed T2 hyperintensities in the involved muscles which established the diagnosis. Muscle biopsy revealed necrosis of the muscle fibres, presence of inflammatory cell infiltrates and hyalinization of the blood vessels with luminal narrowing which is characteristic of diabetic muscle infarction. The patient was treated with immobilization, analgesics and adequate blood sugar control. This case highlights the rarity of finding vascular changes as well as the poor prognosis and the occurrence of fatal complications in near future.

Green synthesis of gold nanoparticles and its application for the trace level determination of painter's colic

The green synthesis of metal nanoparticles is found to be more attractive in various disciplines, including in analytical chemistry for heavy metal ion sensing.

Green synthesized silver nanoparticles decorated on reduced graphene oxide for enhanced electrochemical sensing of nitrobenzene in waste water samples

In the present work, an electrochemical sensor for nitrobenzene has been developed based on a green synthesized silver nanoparticle (AgNP) decorated reduced graphene oxide (RGO) modified glassy carbon electrode (GCE).

Green synthesis of gold nanoparticles for trace level detection of a hazardous pollutant (nitrobenzene) causing Methemoglobinaemia

The present study involves a green synthesis of gold nanoparticles (Au-NPs) using Acacia nilotica twig bark extract at room temperature and trace level detection of one of the hazardous materials, viz. nitrobenzene (NB) that causes Methemoglobinaemia. The synthesis protocol demonstrates that the bioreduction of chloroauric acid leads to the formation of Au-NPs within 10min, suggesting a higher reaction rate than any other chemical methods involved. The obtained Au-NPs have been characterized by UV-vis spectroscopy, X-ray diffraction, transmission electron microscopy, Energy-Dispersive X-ray Spectroscopy and Fourier Transform Infrared Spectroscopy. The electrochemical detection of NB has been investigated at the green synthesized Au-NPs modified glassy carbon electrode by using differential pulse voltammetry (DPV). The Au-NPs modified electrode exhibits excellent reduction ability toward NB compared to unmodified electrode. The developed NB sensor at Au-NPs modified electrode displays a wide linear response from 0.1 to 600μM with high sensitivity of 1.01μAμM(-1)cm(-2) and low limit of detection of 0.016μM. The modified electrode shows exceptional selectivity in the presence of ions, phenolic and biologically coactive compounds. In addition, the Au-NPs modified electrode exhibits an outstanding recovery results toward NB in various real water samples.

Production of extremely alkaliphilic, halotolerent, detergent, and thermostable mannanase by the free and immobilized cells of Bacillus halodurans PPKS-2. Purification and characterization

The alkaliphilic Bacillus halodurans strain PPKS-2 was shown to produce extracellular extreme alkaliphilic, halotolerent, detergent, and thermostable mannanase activity. The cultural conditions for the maximum enzyme production were optimized with respect to pH, temperature, NaCl, and inexpensive agro wastes as substrates. Mannanase production was enhanced more than 4-fold in the presence of 1 % defatted copra meal and 0.5 % peptone or feather hydrolysate at pH 11 and 40 °C. Mannanase was purified to 10.3-fold with 34.6 % yield by ion exchange and gel filtration chromatography methods. Its molecular mass was estimated to be 22 kDa by SDS-PAGE. The mannanase had maximal activity at pH 11 and 70 °C. This enzyme was active over a broad range of NaCl (0-16 %) and thermostable retaining 100 % of the original activity at 70 °C for 3 h. Immobilization of whole cells proved to be effective for continuous production of mannanase. Since the strain PPKS-2 grows on cheaper agro wastes such as defatted copra meal, corn husk, jowar bagasse, and wheat bran, these can be exploited for mannanase production on an industrial scale.

Low adherence of Kuwaiti adults to fruit and vegetable dietary guidelines

The study aimed to assess the adherence of Kuwaiti adults to dietary guidelines for daily fruit and vegetable intake. Data were compiled from national cross-sectional studies from 2006 to 2008 including 9350 adults. Demographic data, frequency of fruit and vegetable consumption and anthropometric and lifestyle indicators were collected. Approximately 11% of people reported consuming 5 or more fruits and vegetables daily with a mean consumption of 3.04 times per day. Consumption increased with age and body mass index but decreased with smoking and non-exercising. Minimal change in compliance with 5-per-day fruit and vegetable consumption was observed between 2006 and 2008. However, the average daily consumption of total vegetables and green salads decreased and of total fruits, fruit juices and cooked and fried potatoes increased. The low frequency of fruit and vegetable consumption among Kuwaiti adults indicates the need to adopt more healthy eating patterns to control chronic diseases.

A dedicated cone-beam CT system for musculoskeletal extremities imaging: design, optimization, and initial performance characterization

PURPOSE

This paper reports on the design and initial imaging performance of a dedicated cone-beam CT (CBCT) system for musculoskeletal (MSK) extremities. The system complements conventional CT and MR and offers a variety of potential clinical and logistical advantages that are likely to be of benefit to diagnosis, treatment planning, and assessment of therapy response in MSK radiology, orthopaedic surgery, and rheumatology.

METHODS

The scanner design incorporated a host of clinical requirements (e.g., ability to scan the weight-bearing knee in a natural stance) and was guided by theoretical and experimental analysis of image quality and dose. Such criteria identified the following basic scanner components and system configuration: a flat-panel detector (FPD, Varian 3030+, 0.194 mm pixels); and a low-power, fixed anode x-ray source with 0.5 mm focal spot (SourceRay XRS-125-7K-P, 0.875 kW) mounted on a retractable C-arm allowing for two scanning orientations with the capability for side entry, viz. a standing configuration for imaging of weight-bearing lower extremities and a sitting configuration for imaging of tensioned upper extremity and unloaded lower extremity. Theoretical modeling employed cascaded systems analysis of modulation transfer function (MTF) and detective quantum efficiency (DQE) computed as a function of system geometry, kVp and filtration, dose, source power, etc. Physical experimentation utilized an imaging bench simulating the scanner geometry for verification of theoretical results and investigation of other factors, such as antiscatter grid selection and 3D image quality in phantom and cadaver, including qualitative comparison to conventional CT.

RESULTS

Theoretical modeling and benchtop experimentation confirmed the basic suitability of the FPD and x-ray source mentioned above. Clinical requirements combined with analysis of MTF and DQE yielded the following system geometry: a -55 cm source-to-detector distance; 1.3 magnification; a 20 cm diameter bore (20 x 20 x 20 cm3 field of view); total acquisition arc of -240 degrees. The system MTF declines to 50% at -1.3 mm(-1) and to 10% at -2.7 mm(-1), consistent with sub-millimeter spatial resolution. Analysis of DQE suggested a nominal technique of 90 kVp (+0.3 mm Cu added filtration) to provide high imaging performance from -500 projections at less than -0.5 kW power, implying -6.4 mGy (0.064 mSv) for low-dose protocols and -15 mGy (0.15 mSv) for high-quality protocols. The experimental studies show improved image uniformity and contrast-to-noise ratio (without increase in dose) through incorporation of a custom 10:1 GR antiscatter grid. Cadaver images demonstrate exquisite bone detail, visualization of articular morphology, and soft-tissue visibility comparable to diagnostic CT (10-20 HU contrast resolution).

CONCLUSIONS

The results indicate that the proposed system will deliver volumetric images of the extremities with soft-tissue contrast resolution comparable to diagnostic CT and improved spatial resolution at potentially reduced dose. Cascaded systems analysis provided a useful basis for system design and optimization without costly repeated experimentation. A combined process of design specification, image quality analysis, clinical feedback, and revision yielded a prototype that is now awaiting clinical pilot studies. Potential advantages of the proposed system include reduced space and cost, imaging of load-bearing extremities, and combined volumetric imaging with real-time fluoroscopy and digital radiography.

Task-based modeling and optimization of a cone-beam CT scanner for musculoskeletal imaging

PURPOSE

This work applies a cascaded systems model for cone-beam CT imaging performance to the design and optimization of a system for musculoskeletal extremity imaging. The model provides a quantitative guide to the selection of system geometry, source and detector components, acquisition techniques, and reconstruction parameters.

METHODS

The model is based on cascaded systems analysis of the 3D noise-power spectrum (NPS) and noise-equivalent quanta (NEQ) combined with factors of system geometry (magnification, focal spot size, and scatter-to-primary ratio) and anatomical background clutter. The model was extended to task-based analysis of detectability index (d') for tasks ranging in contrast and frequency content, and d' was computed as a function of system magnification, detector pixel size, focal spot size, kVp, dose, electronic noise, voxel size, and reconstruction filter to examine trade-offs and optima among such factors in multivariate analysis. The model was tested quantitatively versus the measured NPS and qualitatively in cadaver images as a function of kVp, dose, pixel size, and reconstruction filter under conditions corresponding to the proposed scanner.

RESULTS

The analysis quantified trade-offs among factors of spatial resolution, noise, and dose. System magnification (M) was a critical design parameter with strong effect on spatial resolution, dose, and x-ray scatter, and a fairly robust optimum was identified at M ∼ 1.3 for the imaging tasks considered. The results suggested kVp selection in the range of ∼65-90 kVp, the lower end (65 kVp) maximizing subject contrast and the upper end maximizing NEQ (90 kVp). The analysis quantified fairly intuitive results-e.g., ∼0.1-0.2 mm pixel size (and a sharp reconstruction filter) optimal for high-frequency tasks (bone detail) compared to ∼0.4 mm pixel size (and a smooth reconstruction filter) for low-frequency (soft-tissue) tasks. This result suggests a specific protocol for 1 × 1 (full-resolution) projection data acquisition followed by full-resolution reconstruction with a sharp filter for high-frequency tasks along with 2 × 2 binning reconstruction with a smooth filter for low-frequency tasks. The analysis guided selection of specific source and detector components implemented on the proposed scanner. The analysis also quantified the potential benefits and points of diminishing return in focal spot size, reduced electronic noise, finer detector pixels, and low-dose limits of detectability. Theoretical results agreed quantitatively with the measured NPS and qualitatively with evaluation of cadaver images by a musculoskeletal radiologist.

CONCLUSIONS

A fairly comprehensive model for 3D imaging performance in cone-beam CT combines factors of quantum noise, system geometry, anatomical background, and imaging task. The analysis provided a valuable, quantitative guide to design, optimization, and technique selection for a musculoskeletal extremities imaging system under development.

Observation on integron carriage among clinical isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamases

PURPOSE

Klebsiella pneumoniae is considered an important pathogen causing nosocomial and community-acquired infections and is often associated with the production of extended-spectrum beta-lactamases (ESBL) belonging to SHV and CTX-M families, which are frequently described as a part of complex integrons, facilitate their horizontal transfer to other related as well as unrelated microbes. The present study was undertaken to investigate the occurrence and characterization of integrons among K pneumoniae isolates producing ESBL in a tertiary referral hospital.

MATERIALS AND METHODS

A total of 136 clinical isolates of K pneumoniae were investigated for the presence of ESBL. Their ESBL genes were characterized by multiplex polymerase chain reaction (PCR). Integrase gene PCR was performed to detect the presence of integron. The isolates were further typed by random amplification of polymorphic DNA (RAPD).

RESULT

Out of 136 K pneumoniae isolates, 63 (46%) were confirmed to be ESBL producers. SHV (68%) and CTX-M (67%) ESBL genes were the most common in our study. Of the 63 ESBL-positive isolates, 58 (92%) strains carried integrons; 52 strains (82%) carried only class 1 integron, whereas 6 (9%) isolates harboured both class 2 integrons and the class 1 gene. However, in ESBL negatives, only 29 (40%) strains were positive for class 1 integron and none for class 2 integron.

CONCLUSION

The presence of class 2 integron amongst ESBL-producing K pneumoniae is being described for the first time in this part of the world. The findings of this study strongly suggest that integrons have a role in the dissemination of ESBL-mediated resistance among the nosocomial isolates of K pneumonia.