Computed Tomography of the Head Before Lumbar Puncture in Adults With Suspected Meningitis in High-HIV Prevalence Settings.

Background: The role of computed tomography (CT) before lumbar puncture (LP) is unclear, with limited evidence for a causal link between LP and cerebral herniation or for the ability of CT to identify individuals at risk of herniation. The risks of LP delay or deferral are potentially greater in high-HIV prevalence, resource-limited settings; we analyzed data from such a setting to determine the impact of CT on time to LP and treatment, as well as mortality.

Methods: Adults with suspected central nervous system (CNS) infection were enrolled prospectively into the Botswana National Meningitis Survey between 2016 and 2019.

COVID-19-associated pulmonary aspergillosis in mechanically ventilated patients: a prospective, multicentre UK study.

Background: Invasive pulmonary aspergillosis is a complication of severe COVID-19, with regional variation in reported incidence and mortality. We describe the incidence, risk factors and mortality associated with COVID-19-associated pulmonary aspergillosis (CAPA) in a prospective, multicentre UK cohort.

Methods: From March 2020 to March 2021, 266 mechanically ventilated adults with COVID-19 were enrolled across 5 UK hospital intensive care units (ICUs).

Presacral malakoplakia presenting as foot drop: a case report.

Background: Malakoplakia is a rare condition characterized by inflammatory masses with specific histological characteristics. These soft tissue masses can mimic tumors and tend to develop in association with chronic or recurrent infections, typically of the urinary tract. A specific defect in innate immunity has been described.

A rare case of Salmonella Paratyphi C osteomyelitis: A genetic analysis and review of Salmonella osteomyelitis in England.

Salmonella osteomyelitis is rare in patients without sickling hemoglobinopathies. Invasive disease caused by Salmonella Paratyphi C is rarer still with only one case reported in the United Kingdom in the last 15 years. We report a case of relapsing S.

Combination Therapy for HIV-Associated Cryptococcal Meningitis-A Success Story.

Cryptococcal meningitis is the leading cause of adult meningitis in patients with HIV, and accounts for 15% of all HIV-related deaths in sub-Saharan Africa. The mainstay of management is effective antifungal therapy, despite a limited arsenal of antifungal drugs, significant progress has been made developing effective treatment strategies by using combination regimens. The introduction of fluconazole as a safe and effective step-down therapy allowed for shorter courses of more fungicidal agents to be given as induction therapy, with higher doses achieving more rapid CSF sterilisation and improved treatment outcomes.

Identification of immune correlates of fatal outcomes in critically ill COVID-19 patients.

Prior studies have demonstrated that immunologic dysfunction underpins severe illness in COVID-19 patients, but have lacked an in-depth analysis of the immunologic drivers of death in the most critically ill patients. We performed immunophenotyping of viral antigen-specific and unconventional T cell responses, neutralizing antibodies, and serum proteins in critically ill patients with SARS-CoV-2 infection, using influenza infection, SARS-CoV-2-convalescent health care workers, and healthy adults as controls. We identify mucosal-associated invariant T (MAIT) cell activation as an independent and significant predictor of death in COVID-19 (HR = 5.

Prevalence and Sequelae of Cryptococcal Antigenemia in Antiretroviral Therapy-Experienced Populations: An Evaluation of Reflex Cryptococcal Antigen Screening in Botswana.

Background: Evidence to inform cryptococcal antigen (CrAg)-screening guidelines among ART-experienced populations is lacking. We performed a study evaluating the utility of reflex CrAg screening in Gaborone, Botswana.

Methods: CD4 count data were collected from the HIV reference laboratory from 2014-2016.

Causes of Pediatric Meningitis in Botswana: Results From a 16-Year National Meningitis Audit.

Background: Central nervous system infections are an important cause of childhood morbidity and mortality in high HIV-prevalence settings of Africa. We evaluated the epidemiology of pediatric meningitis in Botswana during the rollout of antiretroviral therapy, pneumococcal conjugate vaccine and Haemophilus influenzae type B (HiB) vaccine.

Methods: We performed a cross-sectional study of children (<15 years old) evaluated for meningitis by cerebrospinal fluid (CSF) examination from 2000 to 2015, with complete national records for 2013-2014.

Epidemiology of adult meningitis during antiretroviral therapy scale-up in southern Africa: Results from the Botswana national meningitis survey.

Objectives: Data on meningitis epidemiology in high HIV-prevalence African settings following antiretroviral therapy scale-up are lacking. We described epidemiology of adult meningitis in Botswana over a 16-year period.

Methods: Laboratory records for adults undergoing lumbar puncture (LP) 2000-2015 were collected, with complete national data 2013-2014.

Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study.

Background: CNS infections are a leading cause of HIV-related deaths in sub-Saharan Africa, but causes and outcomes are poorly defined. We aimed to determine mortality and predictors of mortality in adults evaluated for meningitis in Botswana, which has an estimated 23% HIV prevalence among adults.

Methods: In this prevalent cohort study, patient records from 2004-15 were sampled from the Botswana national meningitis survey, a nationwide audit of all cerebrospinal fluid (CSF) laboratory records from patients receiving a lumbar puncture for evaluation of meningitis.

Advanced Human Immunodeficiency Virus Disease in Botswana Following Successful Antiretroviral Therapy Rollout: Incidence of and Temporal Trends in Cryptococcal Meningitis.

Background: Botswana has a well-developed antiretroviral therapy (ART) program that serves as a regional model. With wide ART availability, the burden of advanced human immunodeficiency virus (HIV) and associated opportunistic infections would be expected to decline. We performed a nationwide surveillance study to determine the national incidence of cryptococcal meningitis (CM), and describe characteristics of cases during 2000-2014 and temporal trends at 2 national referral hospitals.

Arthroscopic bursectomy for recalcitrant trochanteric bursitis.

Purpose: The purpose of this prospective study was to evaluate the arthroscopic treatment of trochanteric bursitis in patients who have not responded to nonoperative treatment.

Methods: Thirty patients were enrolled in this study to evaluate the results of arthroscopic bursectomy. Outcomes were assessed by use of a visual analog pain scale, Harris Hip Score, Short Form 36 Health Survey, and additional specific hip function questions.

Anal incontinence in women with and those without pelvic floor disorders.

Objective: To compare the prevalence of anal incontinence and anal sphincter injury in women with pelvic floor disorders (cases) with those in a group of normal control subjects and to evaluate the relationship between sphincter injury and anal incontinence in each group.

Methods: We previously reported the results of a cross-sectional study of 100 women with pelvic floor disorders (> or = stage II pelvic organ prolapse and/or urinary incontinence). In this study, we compared those cases with 90 controls (stage 0 or I pelvic organ prolapse and no urinary incontinence) who completed the Rockwood-Thompson fecal incontinence severity index, in which scoring (0-61) is based on the frequency and type of anal incontinence.

Empirical and theoretical dosimetry in support of whole body radio frequency (RF) exposure in seated human volunteers at 220 MHz.

This study reports the dosimetry performed to support an experiment that measured physiological responses of seated volunteer human subjects exposed to 220 MHz fields. Exposures were performed in an anechoic chamber which was designed to provide uniform fields for frequencies of 100 MHz or greater. A vertical half-wave dipole with a 90 degrees reflector was used to optimize the field at the subject's location.

Anal sphincter injury in women with pelvic floor disorders.

Objective: 1) To estimate the rate of anal incontinence and anal sphincter injury in a group of women with pelvic floor disorders; 2) to evaluate the relationship between anal incontinence and anal sphincter injury as demonstrated by endoanal ultrasonography; 3) to explore any associations between operative vaginal delivery and anal sphincter injury in this population.

Methods: A cohort of 100 women with stage II or greater pelvic organ prolapse and/or urinary incontinence completed the Rockwood-Thompson Fecal Incontinence Severity Index Questionnaire (FISI). Pelvic organ prolapse was recorded using the Pelvic Organ Prolapse Quantification system.

Empirical and theoretical dosimetry in support of whole body resonant RF exposure (100 MHz) in human volunteers.

This study reports the dosimetry performed to support an experiment that measured physiological responses of volunteer human subjects exposed to the resonant frequency for a seated human adult at 100 MHz. Exposures were performed in an anechoic chamber which was designed to provide uniform fields for frequencies of 100 MHz or greater. A half wave dipole with a 90 degrees reflector was used to optimize the field at the subject location.

Inter-species extrapolation of skin heating resulting from millimeter wave irradiation: modeling and experimental results.

This study reports measurements of the skin surface temperature elevations during localized irradiation (94 GHz) of three species: rat (irradiated on lower abdomen), rhesus monkey (posterior forelimb), and human (posterior forearm). Two exposure conditions were examined: prolonged, low power density microwaves (LPM) and short-term, high power density microwaves (HPM). Temperature histories were compared with calculations from a bio-heat transfer model.

Empirical validation of SAR values predicted by FDTD modeling.

Rapid increase in the use of numerical techniques to predict current density or specific absorption rate (SAR) in sophisticated three dimensional anatomical computer models of man and animals has resulted in the need to understand how numerical solutions of the complex electrodynamics equations match with empirical measurements. This aspect is particularly important because different numerical codes and computer models are used in research settings as a guide in designing clinical devices, telecommunication systems, and safety standards. To ensure compliance with safety guidelines during equipment design, manufacturing and maintenance, realistic and accurate models could be used as a bridge between empirical data and actual exposure conditions.

Parametric dependence of SAR on permittivity values in a man model.

The development and widespread use of advanced three-dimensional digital anatomical models to calculate specific absorption rate (SAR) values in biological material has resulted in the need to understand how model parameters (e.g., permittivity value) affect the predicted whole-body and localized SAR values.

Predicted SAR in Sprague-Dawley rat as a function of permittivity values.

Specific absorption rate (SAR) value is dependent on permittivity value. However, variability in the published permittivity values for human and animal tissue and the development of sophisticated 3-dimensional digital anatomical models to predict SAR values has resulted in the need to understand how model parameters (permittivity value) affect the predicted whole body and localized SAR values. In this paper, we establish the partial derivative of whole body SARs and localized SAR values (defined as SAR for individual organs with respect to a change in the permittivity values of all tissue types, as well as for those tissues with the most variable permittivity values.

The routine use of cystoscopy with the Burch procedure.

Objective: We sought to determine the incidence of unsuspected injury to the lower urinary tract as detected by intraoperative cystoscopy when the Burch procedure is performed.

Study Design: We reviewed the records of 181 women who underwent pelvic surgery, which included a Burch retropubic urethropexy for genuine stress urinary incontinence, between Jan 1, 1998, and Dec 31, 1999. All patients underwent intraoperative cystoscopy at the completion of the Burch procedure after the administration of intravenous indigo carmine dye.

Compartment syndrome associated with lithotomy position and intermittent compression stockings.

Background: Compartment syndrome is a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space.

Case: A 43-year-old black woman, para 3, had repair of a recurrent vesicovaginal fistula. She was placed in a low lithotomy position with thigh length sequential compression sleeves.

Variability in EMF permittivity values: implications for SAR calculations.

Digital anatomical models of man and animals are available for use in numerical calculations to predict electromagnetic field (EMF)-induced specific absorption rate (SAR) values. To use these models, permittivity values are assigned to the various tissues for the EMF frequencies of interest. There is, as yet, no consensus on what are the best permittivity data.