Critical aortic stenosis (AS) is very severe narrowing at aortic valve in newborns, causing left ventricular outflow tract obstruction (LVOTO). It is lethal if not treated soon after birth.
Nipah virus is a newly discovered paramyxovirus transmitted directly from pigs to humans. During a large encephalitis outbreak in Malaysia and Singapore in 1998-9, most patients presented acutely. A 12 year old child is described who developed encephalitis 4 months after exposure to the virus. She was diagnosed by a new indirect IgG enzyme linked immunosorbent assay (ELISA), which is also described. The late presentation and IgG subclass responses had similarities to subacute sclerosing panencephalitis. Nipah virus should be considered in patients with encephalitis even months after their possible exposure.
In recent years, ozone pollution in China has been shown to increase in frequency and persistence despite the concentrations of fine particulate matter (PM2.5) decreasing steadily. Open crop straw burning (OCSB) activities are extensive in China and emit large amounts of trace gases during a short period that could lead to elevated ozone concentrations. This study addresses the impacts of OCSB emissions on ground-level ozone concentration and the associated health impact in China. Total VOCs and NOx emissions from OCSB in 2018 were 798.8 Gg and 80.6 Gg, respectively, with high emissions in Northeast China (31.7%) and North China (23.7%). Based on simulations conducted for 2018, OCSB emissions are estimated to contribute up to 0.95 µg/m3 increase in annual averaged maximum daily 8-hour (MDA8) ozone and up to 1.35 µg/m3 for the ozone season average. The significant impact of OCSB emissions on ozone is mainly characterized by localized and episodic (e.g., daily) changes in ozone concentration, up to 20 µg/m3 in North China and Yangtze River Delta region and even more in Northeast China during the burning season. With the implementation of straw burning bans, VOCs and NOx emissions from OCSB dropped substantially by 46.9%, particularly over YRD (76%) and North China (60%). Consequently, reduced OCSB emissions result in an overall decrease in annual averaged MDA8 ozone, and reductions in monthly MDA8 ozone could be over 10 µg/m3 in North China. The number of avoided premature death due to reduced OCSB emissions (considering both PM2.5 and ozone) is estimated to be 6120 (95% Confidence Interval: 5320-6800), with most health benefits gained over east and central China. Our results illustrate the effectiveness of straw burning bans in reducing ozone concentrations at annual and national scales and the substantial ozone impacts from OCSB events at localized and episodic scales.
A phylogenetic analysis of VP1 and VP4 nucleotide sequences of 52 recent CVA16 strains demonstrated two distinct CVA16 genogroups, A and B, with the prototype strain being the only member of genogroup A. CVA16 G-10, the prototype strain, showed a nucleotide difference of 27.7-30.2% and 19.9-25.2% in VP1 and VP4, respectively, in relation to other CVA16 strains, which formed two separate lineages in genogroup B with nucleotide variation of less than 13.4% and less than 16.3% in VP1 and VP4, respectively. Lineage 1 strains circulating before 2000 were later displaced by lineage 2 strains.
Melioidosis is a potentially fatal disease caused by the saprophytic bacterium Burkholderia pseudomallei. Resistance to gentamicin is generally a hallmark of B. pseudomallei, and gentamicin is a selective agent in media used for diagnosis of melioidosis. In this study, we determined the prevalence and mechanism of gentamicin susceptibility found in B. pseudomallei isolates from Sarawak, Malaysian Borneo. We performed multilocus sequence typing and antibiotic susceptibility testing on 44 B. pseudomallei clinical isolates from melioidosis patients in Sarawak district hospitals. Whole-genome sequencing was used to identify the mechanism of gentamicin susceptibility. A novel allelic-specific PCR was designed to differentiate gentamicin-sensitive isolates from wild-type B. pseudomallei. A reversion assay was performed to confirm the involvement of this mechanism in gentamicin susceptibility. A substantial proportion (86%) of B. pseudomallei clinical isolates in Sarawak, Malaysian Borneo, were found to be susceptible to the aminoglycoside gentamicin, a rare occurrence in other regions where B. pseudomallei is endemic. Gentamicin sensitivity was restricted to genetically related strains belonging to sequence type 881 or its single-locus variant, sequence type 997. Whole-genome sequencing identified a novel nonsynonymous mutation within amrB, encoding an essential component of the AmrAB-OprA multidrug efflux pump. We confirmed the role of this mutation in conferring aminoglycoside and macrolide sensitivity by reversion of this mutation to the wild-type sequence. Our study demonstrates that alternative B. pseudomallei selective media without gentamicin are needed for accurate melioidosis laboratory diagnosis in Sarawak. This finding may also have implications for environmental sampling of other locations to test for B. pseudomallei endemicity.