Abstract. Objective: Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate-surfactant herbicide (GlySH) intoxication has been encountered with increasing frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. Methods: This was a retrospective study of 131 GlySH-intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were abstracted, looking for predictors of mortality. Results: The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean Ϯ SEM time to death was 2.8 Ϯ 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x-ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. Conclusions: In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance. Key words: glyphosate; surfactant; herbicide; intoxication; aspiration; pneumonitis. ACADEMIC EMER-GENCY MEDICINE 2000; 7:906-910 H ERBICIDES containing glyphosate, an alternative to paraquat, have recently been used with increasing frequency in suicide attempts throughout Asia. 1-5 Ingestion of a large amount of this chemical may place patients at risk for a toxic syndrome that includes gastrointestinal irritation, hepatic and renal dysfunction, cardiovascular instability, and pulmonary insufficiency. 2-6 Although glyphosate-surfactant herbicide (GlySH) is considered to be only slightly toxic in rats, ingestion of a substantial volume of GlySH has been reported to be associated with toxicity and death in humans. 4,5 A number of reports have described the clinical course and outcomes following ingestion;From the Departments of Emergency Medicine (HLL, KWC, CHC, LMT) and Internal Medicine (JJH), National Cheng Kung University Hospital, Tainan, Taiwan. Received July 7, 1999; revisions received October 29, 1999, and January 24, 2000; accepted February 21, 2000. Address for correspondence and reprints: Kuan-Wen Chen...

The current study aims at investigating and identifying the ionospheric effects of the geomagnetic storm that occurred during 17–19 March 2015. Incidentally, with SYM‐H hitting a minimum of −232 nT, this was the strongest storm of the current solar cycle 24. The study investigates how the storm has affected the equatorial, low‐latitude, and midlatitude ionosphere in the American and the European sectors using available ground‐based ionosonde and GPS TEC (total electron content) data. The possible effects of prompt electric field penetration is observed in both sectors during the main phase of the storm. In the American sector, the coexistence of both positive and negative ionospheric storm phases are observed at low latitudes and midlatitudes to high latitudes, respectively. The positive storm phase is mainly due to the prompt penetration electric fields. The negative storm phase in the midlatitude region is a combined effect of disturbance dynamo electric fields, the equatorward shift of the midlatitude density trough, and the equatorward compression of the plasmapause in combination with chemical compositional changes. Strong negative ionospheric storm phase is observed in both ionosonde and TEC observations during the recovery phase which also shows a strong hemispherical asymmetry. Additionally, the variation of equatorial ionization anomaly as seen through the SWARM constellation plasma measurements across different longitudes has been discussed. We, also, take a look at the performance of the IRI Real‐Time Assimilative Mapping during this storm as an ionospheric space weather tool.

[1] Observations of energetic electrons (10 -300 keV) by NOAA/POES and DMSP satellites at heights <1000 km during the period from 1999 to 2010 allowed finding abnormal intense fluxes of~10 6 -10 7 cm À2 s À1 sr À1 for quasi-trapped electrons appearing within the forbidden zone of low latitudes over the African, Indo-China, and Pacific regions. Extreme fluxes appeared often in the early morning and persisted for several hours during the maximum and recovery phase of geomagnetic storms. We analyzed nine storm time events when extreme electron fluxes first appeared in the Eastern Hemisphere, then drifted further eastward toward the South-Atlantic Anomaly. Using the electron spectra, we estimated the possible ionization effect produced by quasi-trapped electrons in the topside ionosphere. The estimated ionization was found to be large enough to satisfy observed storm time increases in the ionospheric total electron content (TEC) determined for the same spatial and temporal ranges from global ionospheric maps. Additionally, extreme fluxes of quasi-trapped electrons were accompanied by the significant elevation of the low-latitude F-layer obtained from COSMIC/FORMOSAT-3 radio occultation measurements. We suggest that the storm time ExB drift of energetic electrons from the inner radiation belt is an important driver of positive ionospheric storms within low-latitude and equatorial regions.

-activating factor-acetylhydrolase A379V (exon 11) gene polymorphism is an independent and functional risk factor for premature myocardial infarction. J Thromb Haemost 2006; 4: 1023-8.Summary. Background: Oxidation of low density lipoproteins is an initial step of atherogenesis that generates pro-inflammatory phospholipids, including platelet-activating factor (PAF). PAF is degraded by PAF-acetylhydrolase (PAF-AH), which has been postulated to be a risk factor for myocardial infarction (MI). The role of PAF-AH for the onset of premature MI is unclear. Methods: Polymorphisms located in putatively functional regions were investigated in a cohort of patients having premature MI onset prior to 46 years of age (n ¼ 200) and a sex-age-matched control group (n ¼ 200). The activity of PAF-AH and coronary angiograms were evaluated for the severity of coronary atherosclerosis. Results: The V allele of A379V (exon 11) polymorphism on PAF-AH gene was more frequent in patients with premature MI (P ¼ 0.001). This V allele polymorphism was also associated with a lower activity of plasma PAF-AH and a more complex coronary atherosclerosis (p Trends <0.05). Multiple logistic regression analysis showed that this polymorphism was an independent risk factor (Odds Ratio [OR] 1.66, 95% CI 1.14.1 to 5.80, P ¼ 0.008) as well as smoking (OR 3.72, 95% CI 1.77 to 9.28, P ¼ 0.001), diabetes mellitus (OR 2.25, 95% CI 1.40 to 5.32, P ¼ 0.007) and hypertension (OR 1.88, 95% CI 1.25 to 5.36, P ¼ 0.003) for the onset of premature MI. Conclusion: We conclude that a functional and significant association between the A379V polymorphism on exon 11 of PAF-AH gene and premature MI exists in this Taiwanese population. This polymorphism is significantly associated with the PAF-AH activity and the severity of coronary atherosclerosis.

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This study was conducted to investigate the association between ompK36 variants and international high-risk clones in Klebsiella pneumoniae. Fifty-nine sequence types (STs) divided into four ompK36 allele groups (groups A to D) were identified among 185 K. pneumoniae isolates. The major high-risk clones (29 ST11, 13 ST15, 7 ST37 and 1 ST147 isolates) were assigned to group A, while 6 STs (15 ST23, 2 ST65, 3 ST86, 1 ST163, 1 ST373 and 2 ST375 isolates) associated with pyogenic liver abscess were assigned to group C. The genotyping assay developed in this study may be useful for screening of epidemic STs.

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