We posit that international business and the emergence and spread of communicable diseases are intrinsically connected. To support our arguments, we first start with a historical timeline that traces the connections between international business and communicable diseases back to the sixth century. Second, following the epidemiology of communicable diseases, we identify two crucial transitions related to international business the emergence of epidemics within a host country and the shift from epidemics to global pandemics. Third, we highlight international business contextual factors (host country regulatory quality, urbanization, trade barriers, global migration) and multinationals’ activities (foreign direct investment, corporate political activity, global supply chain management, international travel) that could accelerate each transition. Finally, building on public health insights, we suggest research implications for business scholars on how to integrate human health challenges into their studies and practical implications for global managers on how to help prevent the emergence and spread of communicable diseases.Inhalational injury to the upper and lower airway occurs due to thermal or chemical irritation causing airway edema, capillary leak, mucin, and fibrin debris forming clots and soot. The use of unfractionated heparin (UFH) nebulization was found to be effective by dissolving airway clots. We report a case of inhalational burn injury where UFH nebulization led to a better outcome. A healthy male was trapped in a residential room during a fire in the building. He sustained facial, neck, upper chest, and left upper extremity burns accounting for 25% of body surface area. He was intubated at the site and started on supportive care. In the surgical intensive care unit, bronchoscopy showed severe tracheobronchial burn injury; a thorough lavage was done, started on UFH and N-acetylcysteine nebulization (NAC). The patient improved, and his trachea was extubated on day 6. In our patient, unfractionated heparin nebulization was beneficial as the patient was extubated early without landing to acute respiratory distress syndrome.Bronchoesophageal fistula (BEF) is a rare condition caused by a fistulous connection between the bronchus and the esophagus. BEF can be acquired or congenital; congenital BEFs are rarely encountered in adults. Acquired BEF can be due to either a benign or a malignant process. Acquired BEF due to primary lung cancer is a life-threatening and usually a terminal complication. Unlike tracheoesophageal fistula, this condition is much rarer. Patients usually present with symptoms related to recurrent aspiration. Barium esophagogram is the initial diagnostic modality of choice. Treatment is primarily palliative. We are presenting a case of a bronchoesophageal fistula caused by non-small cell lung cancer that was successfully treated with concurrent chemoradiation therapy.Tuberculosis bacilli can enter the human body through the respiratory system, digestive system, or skin and mucous membranes, with the respiratory tract representing the primary point of entry. Once inside the body, tuberculosis bacilli can enter the bloodstream and attack other organs, including the lymphatic system. One manifestation associated with lymphatic tuberculosis infiltration is the presence of large hilar and mediastinal lymph nodes, which are common in children and classified as primary tuberculosis. A diagnosis of primary tuberculosis in adults is often overlooked by doctors due to its low frequency. When a single enlarged mediastinal lymph node is observed, most doctors suspect other causes, especially malignancy. Determining the correct diagnosis for enlarged hilar and mediastinal lymph nodes can be difficult because diagnostic interventions in this area are challenging to perform. We report a clinical case of primary lymph node tuberculosis in an adult, confirmed by endobronchial ultrasound-guided transbronchial needle aspiration. We aim to provide doctors with a more comprehensive approach for diagnosing this disease.Denervation pseudohypertrophy is an uncommon cause of limb swelling, which may be overlooked. It is an important diagnosis to arrive at, as it instructs the search for an underlying cause which may itself require intervention. We present the case of a 32-year-old male rugby player with a 2-year history of left calf swelling and intermittent pain and tightness. He described a previous history of 2 left sided lumbar micro-discectomy surgeries. There was no tenderness or sensory deficit on examination. MRI of the left calf revealed muscular enlargement, with fat interspersed between the muscle fibers, in keeping with pseudohypertrophy. This has a number of causes, in this cause attributed to lumbar radiculopathy. This case highlights a rare but important cause of limb swelling which should be considered in the workup of a unilateral swollen limb.Spontaneous pneumomediastinum is a rare condition that mostly affects young men and generally follows a benign and self-limiting course. In contrast to secondary pneumomediastinum, which is caused by trauma, iatrogenic intervention or esophageal perforation, spontaneous pneumomediastinum is triggered by violent coughing, excessive vomiting, strenuous physical exercise or Valsalva maneuver. It results from an abrupt increase in intrathoracic pressure leading to alveolar rupture and air leak along the tracheobronchial tree into the mediastinal cavity. Extended spontaneous pneumomediastinum goes along with subcutaneous emphysema of the chest, neck or head. We present a case of a healthy young man who developed pneumomediastinum and profound subcutaneous emphysema with onset during masturbation. Since there is no literature on spontaneous pneumomediastinum associated with autoerotic experiences, we consider our case an unusual presentation of this entity.The fetal variant of the posterior cerebral artery (fPCA) conserves a major blood flow from the anterior to the posterior cerebral circulation via a strong persistent caudal portion of the embryonic internal carotid artery. We present two cases where endovascular treatment in acute ischemic stroke was complicated by this flow diversion. Though direct thrombectomy of the fPCA using a stent retriever was feasible and successful in both cases outcome remained unfavourable due to a continuous redirection of embolic material into the posterior circulation. Knowledge of flow dynamics in a fPCA is important for endovascular treatment in acute ischemic stroke.Attention to the implications of common needle stick injuries has focused heavily on the risk of cross-infection from blood-borne pathogens. An additional risk to the nuclear medicine healthcare worker is that of subcutaneous radioactive contamination from radiopharmaceuticals. This case report provides a rare opportunity to examine the clinical and operator causes of one such event during the dispensing of 99mTc-Tetrofosmin. Contamination monitoring, scintigraphic imaging, and quantification of effective radiation dose provide the level of risk to the operator from the subcutaneous radioactive contamination. Findings demonstrated a very low dose to operator and no deterministic radiobiological effects. Delayed imaging demonstrated negligible biological clearance from the injury site. Implications of the findings for clinical practice are discussed, highlighting the need for a careful and calm approach to radiopharmacy activities.Struma ovarii is categorised as a monodermal type of mature teratoma and consists primarily of thyroid tissue. It is an uncommon ovarian tumor, with non-specific clinical, and imaging findings. The majority of struma ovarii are benign and are typically associated with mature cystic teratomas. A small proportion of struma ovarii may undergo malignant transformation, with papillary carcinoma the most common type of malignancy. The criteria used to identify a malignant change in struma ovarii are identical to those used to evaluate the thyroid gland. Nevertheless, due to the rarity of struma ovarii, imaging diagnostic criteria, and subsequent management are not clearly defined. This case report describes a 41-year-old female patient who presented with rapid abdominal enlargement over a period of 1 month, accompanied by elevation of the tumor marker CA-125. Based on these clinically findings, ovarian cancer was suspected. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathology results revealed a malignant struma ovarii.

Over 10-years of whole-genome sequencing (WGS) of

in Birmingham presents an opportunity to explore epidemiological trends and risk factors for transmission in new detail.

Between 1st January 2009 and 15th June 2019, we obtained the first WGS isolate from every patient resident in a postcode district covered by Birmingham’s centralised tuberculosis service. Data on patients’ sex, country of birth, social risk-factors, anatomical locus of disease, and strain lineage were collected. Poisson harmonic regression was used to assess seasonal variation in case load and a mixed-effects multivariable Cox proportionate hazards model was used to assess risk factors for a future case arising in clusters defined by a 5 single nucleotide polymorphism (SNP) threshold, and by 12 SNPs in a sensitivity analysis.

511/1653 (31%) patients were genomically clustered with another. A seasonal variation in diagnoses was observed, peaking in spring, but only among clustered cases. Risk-factors for a future clustered case included UK-birth (aHR=2·03 (95%CI 1·35-3·04),

<0·001), infectious (pulmonary/laryngeal/miliary) tuberculosis (aHR=3·08 (95%CI 1·98-4·78),

<0·001), and

lineage 3 (aHR=1·91 (95%CI 1·03-3·56),

=0·041) and 4 (aHR=2·27 (95%CI 1·21-4·26),

=0·011), vs. lineage 1. Similar results pertained to 12 SNP clusters, for which social risk-factors were also significant (aHR 1·72 (95%CI 1·02-2·93),

=0·044). There was marked heterogeneity in transmission patterns between postcode districts.

There is seasonal variation in the diagnosis of genomically clustered, but not non-clustered, cases. Risk factors for clustering include UK-birth, infectious forms of tuberculosis, and infection with lineage 3 or 4.

Wellcome Trust, MRC, UKHSA.

Wellcome Trust, MRC, UKHSA.Drug resistance is always a challenge in conquering breast cancer clinically. Recognition of drug resistance and enhancing the sensitivity of the tumor to chemotherapy is urgent. Herein, a dual-responsive multi-function „Matryoshka” nanosystem is designed, it activates in the tumor microenvironment, decomposes layer by layer, and release gene and drug in sequence. The cell is re-educated by NgBR siRNA first to regain the chemosensitivity through regulating the Akt pathway and inhibit ERα activation, then the drugs loaded in the core are controlled released to killing cells. Carbonized polymer dots are loaded into the nanosystem as an efficient bioimaging probe, due to the GE11 modification, the nanosystem can be a seeker to recognize and evaluate drug-resistance tumors by photoacoustic imaging. In the tumor-bearing mouse, the novel nanosystem firstly enhances the sensitivity to chemotherapy by knockdown NgBR, inducing a much higher reduction in NgBR up to 52.09%, then effectively inhibiting tumor growth by chemotherapy, tumor growth in nude mouse was inhibited by 70.