Spontaneous pneumomediastinum is a rare condition in viral pneumonia. However, it can arise spontaneously in COVID-19 patients with no other risk factors. Here we present four cases of spontaneous pneumomediastinum in patients with COVID-19 pneumonia with no other precipitating factors.
A baseline study was carried out to assess the metal concentrations and microbial contamination at selected Lake waters in and around Miri City, East Malaysia. Sixteen surface water samples were collected at specific Lakes in the environs of major settlement areas and recreational centers in Miri City. The Physico-chemical parameters [pH, Electrical Conductivity (EC) and Dissolved Oxygen (DO)], metals (Fe, Mn, Cu, Cd, Ni and Zn) and Escherichia coli (E. coli) were analysed. The concentrations of Fe, Mn and Ni have been found to be above the permissible limits of drinking water quality standards. The metals data have also been used for the calculation of heavy metal pollution index. Higher values of E. coli indicate microbial contamination in the Lake waters.
Gadilam river basin has gained its importance due to the presence of Neyveli Lignite open cast mines and other industrial complexes. It is also due to extensive depressurization of Cuddalore aquifer, and bore wells for New Veeranam Scheme are constructed downstream of the basin. Geochemical indicators of groundwater were used to identify the chemical processes that control hydrogeochemistry. Chemical parameters of groundwater such as pH, electrical conductivity, total dissolved solids, sodium (Na(+)), potassium (K(+)), calcium (Ca(+)), magnesium (Mg(+)), bicarbonate (HCO(-)(3)), sulfate (SO(-)(4)), phosphate (PO(-)(4)), and silica (H(4)SiO(4)) were determined. Interpretation of hydrogeochemical data suggests that leaching of ions followed by weathering and anthropogenic impact controls the chemistry of the groundwater. Isotopic study reveals that recharge from meteoric source in sedimentary terrain and rock-water interaction with significant evaporation prevails in hard rock region.
Revision surgery following failed open reduction for developmental dysplasia of the hip (DDH) is technically demanding. We reviewed 12 patients in our institution that required a revision surgery between January 1994 and December 2003. The aims of this study are to identify the causes of redislocation after the primary open reduction and to determine the clinical and radiological outcome after the revision surgery. The mean age at presentation for DDH was 31 months (range 1-84) and the mean age at primary open reduction surgery was 38 months (range 15-84) and the mean age at revision surgery was 69 months (range 21-180). The mean follow-up period after revision surgery was 20 months (range 3-84). All the revision surgery was performed via an anterior Smith Peterson approach. The most common cause for redislocation was inadequate exposure and failure to release the obstructing soft tissues around the hip. The bony factors for redislocation included failure to perform a femoral shortening and excessive derotation of an anteverted femoral head combined with a Salter osteotomy. Three cases with posterior acetabular wall deficiency needed immobilization of the hip in extension as the hip tended to dislocate in flexion. Six patients had limb length discrepancy ranging from 1 cm to 4 cm and 50% developed avascular necrosis. Only 2 patients were asymptomatic and the majority had a limp and limitation of motion. All were pain free except one. In view of the technically demanding surgery and poor results after revision, the surgeon should recognize the pathology and ensure that the primary procedure achieves a stable and concentric reduction.
A 44-year-old woman was admitted to our hospital with dengue fever. She developed a haematoma in the right arm at the site of a previous arterial line insertion. Due to coexisting thrombocytopenia, the bleeding was severe enough to cause compartment syndrome. An emergency fasciotomy was performed and her limb salvaged. The case illustrates one important potential complication of this common infectious disease.
Uranium is a radioactive element normally present in hexavalent form as U(VI) in solution and elevated levels in drinking water cause health hazards. Representative groundwater samples were collected from different litho-units in this region and were analyzed for total U and major and minor ions. Results indicate that the highest U concentration (113 µg l(-1)) was found in granitic terrains of this region and about 10 % of the samples exceed the permissible limit for drinking water. Among different species of U in aqueous media, carbonate complexes [UO2(CO3)(2)(2-)] are found to be dominant. Groundwater with higher U has higher pCO2 values, indicating weathering by bicarbonate ions resulting in preferential mobilization of U in groundwater. The major minerals uraninite and coffinite were found to be supersaturated and are likely to control the distribution of U in the study area. Nature of U in groundwater, the effects of lithology on hydrochemistry and factors controlling its distribution in hard rock aquifers of Madurai district are highlighted in this paper.
Microbes in groundwater play a key role in determining the drinking water quality of the water. The study aims to interpret the sources of microbes in groundwater and its relationship to geochemistry. The study was carried out by collecting groundwater samples and analyzed to obtain various cations and anions, where HCO3-, Cl- and NO3- found to be higher than permissible limits in few samples. Microbial analysis, like total coliform (TC), total viable counts (TVC), fecal coliforms (FC), Vibrio cholera (V. cholerae) and total Streptococci (T. streptococci) were analyzed, and the observations reveal that most of the samples were found to be above the permissible limits adopted by EU, BIS, WHO and USEPA standards. Correlation analysis shows good correlation between Mg2+-HCO3-, K+-NO3-, TVC- V. cholerae and T. streptococci-FC. Major ions like Mg+, K+, NO3, Ca2+ and PO4 along with TS and FC were identified to control the geochemical and microbial activities in the region. The magnesium hardness in the groundwater is inferred to influence the TVC and V. cholerae. The mixing of effluents from different sources reflected the association of Cl with TC. Population of microbes T. streptococci and FC was mainly associated with Ca and Cl content in groundwater, depicting the role of electron acceptors and donors. The sources of the microbial population were observed with respect to the land use pattern and the spatial distribution of hydrogeochemical factors in the region. The study inferred that highest microbial activity in the observed in the residential areas, cultivated regions and around the landfill sites due to the leaching of sewage water and fertilizers runoff into groundwater. The concentrations of ions and microbes were found to be above the permissible limits of drinking water quality standards. This may lead to the deterioration in the health of particular coastal region.
The presence of radioactive elements in groundwater results in high health risks on surrounding populations. Hence, a study was conducted in central Tamil Nadu, South India, to measure the radon levels in groundwater and determine the associated health risk. The study was conducted along the lithological contact of hard rock and sedimentary formation. The concentrations of uranium (U) varied from 0.28 to 84.65 µg/L, and the radioactivity of radon (Rn) varied from 258 to 7072 Bq/m3 in the collected groundwater samples. The spatial distribution of Rn in the study area showed that higher values were identified along the central and northern regions of the study area. The data also indicate that granitic and gneissic rocks are the major contributors to Rn in groundwater through U-enriched lithological zones. The radon levels in all samples were below the maximum concentration level, prescribed by Environmental Protection Agency. The effective dose levels for ingestion and inhalation were calculated according to parameters introduced by UNSCEAR and were found to be lesser (0.235-6.453 μSvy-1) than the recommended limit. Hence, the regional groundwater in the study area does not pose any health risks to consumers. The spatial distribution of Rn's effective dose level indicates the higher values were mainly in the central and northern portion of the study area consist of gneissic, quarzitic, and granitic rocks. The present study showed that Rn concentrations in groundwater depend on the lithology, structural attributes, the existence of uranium minerals in rocks, and the redox conditions. The results of this study provide information on the spatial distribution of Rn in the groundwater and its potential health risk in central Tamil Nadu, India. It is anticipated that these data will help policymakers to develop plans for management of drinking water resources in the region.
The dynamics of the coastal aquifers are well-expressed by geochemical and isotopic signatures. Coastal regions often exhibit complex groundwater recharge pattern due to the influence of depression in the Bay of Bengal, tidal variations on surface waters, saline water intrusion and agricultural return flows. In this research, groundwater recharge processes occurring in coastal Tamil Nadu, South India were evaluated using major ion chemistry and environmental isotopes. A total of 170 groundwater samples were collected from shallow and deep aquifers during both post-monsoon (POM) and pre-monsoon (PRM) seasons. The isotopic results showed a wide variation in the shallow groundwater, suggesting contribution from multiple recharge sources. But, the deeper groundwater recharge is mainly from precipitation. The northern part of the study area showed more depleted isotopic values, which rapidly changed towards south from -6.8 to -4.4‰. Alternatively, central and southern parts exhibited relatively enriched isotopic content with variation from -0.58 to -2.7‰. Groundwater was discerned to be brackish to saline with chloride content, 600-2060 mgL-1 and δ18O ranging from -5.8 to -4.5‰, suggesting influence of the saline water sources. A minor influence of anthropogenic activities was also observed in the deeper groundwater during PRM, which was confirmed by tritium and Cl- trends. The old groundwater with depleted isotopic content infer recharged by distant sources while modern groundwater with enriched isotopes points to the influence of evaporated recharge.
COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.