Fifty-eight patients with chronic asthma in whom airflow obstruction was relieved by bronchodilator aerosols but not by oral corticosteroids were compared with 58 other chronic asthmatics who responded equally well to both treatments. The two groups were matched for age and sex. The only significant clinical differences between the two groups were that in the "corticosteroidresistant" patients there was a more frequent family history of asthma and a longer duration of symptoms. Resistant patients also had a relatively lower peak expiratory flow rate in the morning than later in the day and a greater degree of bronchial reactivity to methacholine. Such features, however, may not be specific criteria of corticosteroid resistance since they were also observed in untreated asthmatics who subsequently responded well to corticosteroids. The failure of prednisolone to inhibit a monocyte-mediated bronchial reaction may explain why some chronic asthmatics do not respond to corticosteroids.Patients with corticosteroid-resistant asthma should be recognised at an early stage so that regular treatment with oral corticosteroids may be withdrawn. Failure to do this results in needless exposure to the risk of developing serious side effects.

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Fracture stimulation of infield or offset wells in unconventional developments can involve communication between the legacy (parent) wells and newly drilled offset (child) wells. Production from the legacy well results in a decrease in reservoir pressure and stress, which can cause pressure sinks that ultimately lead to fracturing fluid communicating between the child and parent wells. Depending on the reservoir conditions, completing infield wells can result in production losses for the parent well, and in some cases, the parent well might never fully recover its full production potential. One of the current strategies used to minimize offset well completion communication with a parent well is to perform a preemptive protection refracture of the parent well. However, for the majority of these restimulations, the operator does not receive confirmation of refracturing effectiveness—even after production data from the refractured well become available. Under the auspices of the Gas Technology Institute, the Department of Energy helped fund a research project hosted by Laredo Petroleum (the operating company) in the Wolfcamp to better understand, among other things, the relationship between lateral well placement, production interference between laterals, effectiveness of completion sequences, and hydraulic fracture geometry in unconventional reservoirs. Two vertically stacked parent wells that had been producing for approximately 15 months were chosen as the subjects for this study. The two vertically stacked parent wells were landed in the Upper and Middle Wolfcamp formations in the Midland basin of West Texas. The objective of the study was to understand the impact of refracturing these two wells immediately before the stimulation of 11 offset child wells (part of a development program within a production corridor setting) with regard to the reservoir pressures and stresses surrounding both the parent and child wells. Conclusions were drawn based on well treatment and downhole microseismic data, which were acquired during the restimulation of the two parent wells and the completions of the 11 child wells, and data from radioactive (RA) tracers that were pumped during the refractures. Overall, microseismic analysis revealed positive pressure protection effects were achieved during the refracture. Downhole microseismic data for the refractured wells focused on events that occurred both near the wellbores and in the far-field and the time at which they occurred relative to the execution of the restimulation. Results from the first restimulated parent well indicated that less than half of the well was successfully restimulated and, therefore, only a portion of the reservoir between the laterals was repressurized. This resulted in the development of asymmetric fractures in the offset child well in the lower pressure portion of the reservoir, while the section that was repressurized resulted in symmetric fracture development. Using real-time microseismic monitoring during the completion of the parent wells allowed for an immediate review of the acquired microseismic data and on-site adjustments to the pump schedule. As a result, the restimulation of the second parent well appeared to have more effectively repressurized the reservoir and promote the creation of symmetric fractures during the completion of the offset child well that was landed in the same formation (as the second refracture parent well). RA tracer results were in alignment with the microseismic data.

We report on a 60-year-old housewife who presented to the Mycetoma Research Centre (MRC) at the University of Khartoum on the 7 December 2016 with a 30-year history of chest wall eumycetoma due to Madurella mycetomatis. Two months prior to presentation to the MRC, a discharging sinus in the left lateral side of the chest wall was noted by the patient. The discharge was purulent and contained black grains. Just before presentation, air leak from the sinus was noted and she developed general weakness and deterioration. The patient was noncompliant with ketoconazole therapy for eumycetoma and has had 3 previous surgical excisions of her chest wall lesion; the first one was in 1991, the second one was in 1995, and the third excision was done in 2002. However, she ceased treatment and follow up in 2002. The patient has had diabetes mellitus for 14 years and hypertension for 1 year. She has various diabetic microvascular complications, diabetic nephropathy, and diabetic septic foot, leading to left above-knee amputation in 2015, and she later developed right gangrenous middle and fourth toes. Her drug history includes insulin 10/5 units, furosemide 40 mg, aspirin 81 mg, atorvastatin 20 mg, and amlodipine 10 mg per day. She has had multiple hospital admissions and blood transfusions due to chronic kidney disease secondary to diabetic nephropathy. She is a housewife with a low socioeconomic status. A family history of mycetoma was noted; her son has bilateral lower limb eumycetoma. Clinically she looked unwell and pale. She was haemodynamically stable, with a pulse rate of 72 beats per minute, respiratory rate of 20 breaths per minute, and blood pressure of 130/70 mmHg. Her head and neck examinations were unremarkable. A respiratory examination showed no signs of respiratory distress, and the trachea was central, but the movement of the left side of the chest was reduced. A 2 cm in diameter sinus discharging an exudative material with black grains was noted in the midaxillary line of the left chest. The discharge was noted to increase with cough (Fig 1). There was a decrease in air entry and stony dullness on the left side but no added sounds. Other systems were unremarkable. Investigations showed a haemoglobin level of 5.0 g/dl with normal leucocyte count and platelets. Her random blood glucose level was elevated at 324 mg/dl. There was evidence of chronic kidney disease, with urea 94 mg/dl and creatinine 3.2 mg/dl. She was hyponatremic with a serum sodium of 129 mmol/l and a normal K + of 4.6 mmol/l. A liver function test showed an elevated alkaline phosphatase (ALP) of 228 IU/l; otherwise, other enzymes were normal, with aspartate aminotransferase (AST) 6 IU/l and alanine aminotransferase (ALT) 4 IU/l. Total protein was normal at 6.9 g/dl, but a low serum albumin (1.8 g/dl) was noted. C-reactive protein was 11 mg/l, and a viral screening was negative. A urinalysis was positive for PLOS Neglected Tropical Diseases | https://doi.