AGGRESSIVE DIURESIS AND SEVERITY-ADJUSTED LENGTH OF HOSPITAL STAY IN ACUTE CONGESTIVE HEART FAILURE PATIENTS

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. \u3e 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in group 1 and 165 in group 2 respectively). The Kaplan-Meier estimate of the median cumulative proportion of patients still hospitalized for the group 1 was 4 days and in group 2 was 5 days (log-rank test; P=0.67). In univariate analysis, Cox PH regression showed unadjusted hazard rate of discharge from hospital was slightly higher in group 1 than group 2 but was statistically non-significant (HR=1.08; P=0.70). In multivariate Cox model analysis, creatinine at the time of admission when greater than 1.6mg/dL (P=0.75), LVEF (P= 0.14), total twenty-four hours dose of intravenous Furosemide given (P=0.98) and interaction between Furosemide dose and Creatinine level (P=0.79) were not significant predictor of hospital discharge. Adjusted hazard rate for discharge from hospital was 12% higher in group 1 than group 2 but still statistically non-significant (HR=1.12; P=0.60). Since the length of hospital stay is similar between two groups, we suggest the goal of diuresis to be less than 2400mL in first twenty-four hours to prevent excessive dehydration

Fungi - an Amalgam of Toxins and Antibiotics: a Mini- Review

Fungi are eukaryotes with many functions. Earlier, fungi were classified in the plant kingdom but were later classified as a separate kingdom due to their unique cell walls. Fungi are heterotrophs like animals and are more closely related to animals. The perception of fungi is inconspicuous due to their small sizes and their ability to grow symbiotically in plants, animals, other fungi, and parasites. Fungi are used for their nutrition, fermentation potential, and bactericidal potential. However, fungi are also toxic due to certain bioactive compounds known as mycotoxins. Candida and Aspergillus are invasive species that contribute to a high percentage of mycoses in oncological and haematological patients. The mortality rate due to invasive aspergillosis and candidiasis is high, at 4% and 2%, respectively. In the agriculture sector, a significant contributor to damage to crops globally is the invasion of filamentous fungi. Fungi invasion destroys over 125 million tons of wheat, rice, soybeans, potatoes, and maize annually. If prevented, 600 million people may be fed. Therefore, it is vital to consider the dual role of fungi, therapeutic, and pathogenic

Penetrating abdominal injuries: management controversies

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries

Impurity Ion Complexation Enhances Carbon Dioxide Reduction Catalysis

Herein, we show that group 11 CO[subscript 2] reduction catalysts are rapidly poisoned by progressive deposition of trace metal ion impurities present in high purity electrolytes. Metal impurity deposition was characterized by XPS and in situ stripping voltammetry and is coincident with loss of catalytic activity and selectivity for CO[subscript 2] reduction, favoring hydrogen evolution on poisoned surfaces. Metal deposition can be suppressed by complexing trace metal ion impurities with ethylenediaminetetraacetic acid or solid-supported iminodiacetate resins. Metal ion complexation allows for reproducible, sustained catalytic activity and selectivity for CO[subscript 2] reduction on Au, Ag, and Cu electrodes. Together, this study establishes the principal mode by which group 11 CO[subscript 2] reduction catalysts are poisoned and lays out a general approach for extending the lifetime of electrocatalysts subject to impurity metal deposition.MIT Energy Initiative (Saudi Aramco, research agreement)United States. Air Force Office of Scientific Research (Award FA9550-15-1-0135)Massachusetts Institute of Technology. Department of Chemistry (Junior Faculty Funds)National Science Foundation (U.S.) (Predoctoral Fellowship)National Science Foundation (U.S.) (MIT MRSEC Program, award number DMR-0819762

Design and Analysis of Even-Positioned Cavity - Based Optical Amplification Device in Dielectric Metasurface

Recently, the development in the field of optical technology is exemplary, specifically relating to the design of the components necessary for optical integrated circuits. This research work investigates optical amplification action in a 2D Photonic Crystals (PhCs) structure with variable radius even-positioned PhC-cavity within its lattice. Twooptical signals are used, first acting as data signals coupled into the optical structure using the phenomenon of the Guided-mode-resonances (GMR) and the second one as a pump signal index-guided into the optical structure. The pump signal is used to amplify the data signal and the PhC-cavity is used for spectral tuning of the device operating in near-infrared (NIR) range. The dielectric structure consists of an optical waveguide packed in between the substrate and a cladding layer. The design and analysis of the proposed device is performed in a Finite-Difference-Time-Domain (FDTD) based open-source software package. The investigated results present optical amplific

Introducing the brain erythropoietin circle to explain adaptive brain hardware upgrade and improved performance

Executive functions, learning, attention, and processing speed are imperative facets of cognitive performance, affected in neuropsychiatric disorders. In clinical studies on different patient groups, recombinant human (rh) erythropoietin (EPO) lastingly improved higher cognition and reduced brain matter loss. Correspondingly, rhEPO treatment of young rodents or EPO receptor (EPOR) overexpression in pyramidal neurons caused remarkable and enduring cognitive improvement, together with enhanced hippocampal long-term potentiation. The ‘brain hardware upgrade’, underlying these observations, includes an EPO induced ~20% increase in pyramidal neurons and oligodendrocytes in cornu ammonis hippocampi in the absence of elevated DNA synthesis. In parallel, EPO reduces microglia numbers and dampens their activity and metabolism as prerequisites for undisturbed EPO-driven differentiation of pre-existing local neuronal precursors. These processes depend on neuronal and microglial EPOR. This novel mechanism of powerful postnatal neurogenesis, outside the classical neurogenic niches, and on-demand delivery of new cells, paralleled by dendritic spine increase, let us hypothesize a physiological procognitive role of hypoxia-induced endogenous EPO in brain, which we imitate by rhEPO treatment. Here we delineate the brain EPO circle as working model explaining adaptive ‘brain hardware upgrade’ and improved performance. In this fundamental regulatory circle, neuronal networks, challenged by motorcognitive tasks, drift into transient ‘functional hypoxia’, thereby triggering neuronal EPO/EPOR expression

Multidrug resistance by microorganisms: a review

Multiple drug resistance (MDR) is the ability of some microorganisms to resist the actions of multiple antimicrobial agents. MDR include those resistant to multiple antibacterial, antifungal, antiviral, and anti-parasitic drugs. Similar activities of some microorganisms to certain chemical (drug) that would normally kill them or limit their growth is called antimicrobial resistance (AMR). Multi drug resistance can be classified as primary resistance, secondary resistance, intrinsic resistance, extensive resistance and clinical resistance. The classes of antibiotics that fall victim of resistance include beta-lactams, glycopeptide, aminoglycosides, sulphonamides, cephalosporins etc. The mode of action of antimicrobial drug includes cell wall synthesis inhibitors, protein synthesis inhibitor, blockage of key metabolic pathways, nucleic acid synthesis inhibitors etc. Bacteria often become resistant and this could be through one of several biochemical mechanisms such as mutation, destruction or inactivation and efflux or genetic transfer of materials between bacteria by several means such as conjugation, transformation and transduction. The mode of action of MDR protozoa occurs through decrease of drug uptake, the export of drugs from the parasite by P-glycoproteins and other traffic ATPases etc. The mode of action of MDR helminths occurs through genetic changes in the drug target, changes in drug transport, drug metabolism etc. The mode of action of antiviral drugs usually target viral DNA polymerase having the reverse transcriptase activity to inhibit the viral replication. The mode of action of MDR fungi occurs as they have learnt to modify the antifungal drug targets or most commonly increase the efflux of the incoming drugs There are various ways to reverse this resistance such as washing hands after seeing each patient, the public should wash raw fruit and vegetables thoroughly to clear off both resistant bacteria and possible antibiotic residues, avoid the misuse of antibiotics, etc

Study of Baryon number transport using model simulations in pppp collisions at LHC Energies

We report on the excitation function of anti-baryon to baryon ratios ($\overline{p}/p$, {\alam /\lam} and {\axi / \xim}) in $pp$ collisions at {\sqrts} = 0.9, 2.76, 7 TeV from DPMJET-III, Pythia~8, EPOS~1.99, and EPOS-LHC model simulations. To study the predictions of these models at {\sqrts} = 13.6 TeV. The anti-baryon to baryon ratios are extremely important for the study of baryon number transport mechanisms. These ratios help determine the carriers of the baryon number and in the extraction of baryon structure information. Even though all models show a good agreement between model simulations and data, the ratios extracted from DPMJET-III model closely describes data at all energies. It is observed that these ratios converge to unity for various model predictions. This convergence also indicates that the anti-baryon to baryon ratios follow the mass hierarchy, such that the hyperon specie containing more strange quarks ({\alam /\lam} and {\axi / \xim}) approaches unity faster than specie containing fewer strange quarks ($\overline{p}/p$). It is also observed that the $\overline{B}/B$ ratio approaches unity more rapidly with the increase in {\sqrts} energy. At lower energies we observe an excess production of baryons over anti-baryons. However, this effect vanishes at higher energies due to the baryon-anti-baryon pair production and the baryon-anti-baryon yield becomes equal. Using model simulations, we additionally compute the asymmetry, (A\equiv\frac{N_{p}-N_{\bar{p}}}N_{p}+N_{\bar{p}}}) for protons. The asymmetry shows a decreasing trend with increase in energy from 0.9 to 7 TeV for all energies. This asymmetry trend is confirmed by model predictions at {\sqrts} = 13.6 TeV which will help to put possible constraints on model calculations at {\sqrts} = 13.6 TeV once the Run-III data for LHC becomes available.Comment: 14 pages, 8 figures, 2 table

Effect of hadronic cascade time on freeze-out properties of Identified Hadrons in Au+Au Collisions at sNN\sqrt{s_{NN}} = 7.7-39 GeV from AMPT Model

We report the transverse momentum $p_T$ spectra of identified hadrons ($\pi^\pm$, $K^\pm$ and $p(\bar p)$) in Au+Au collisions at $\sqrt{s_{NN}}$ = 7.7 - 39 GeV from A Multi Phase Transport Model with string melting effect (AMPT-SM). During this study, a new set of parameters are explored to study the effect of hadronic cascade by varying hadronic cascade time $t_{max}$ = 30 $f$m/$c$ and 0.4 $f$m/$c$. No significant effect of this change is observed in the $p_T$ spectra of light hadrons and the AMPT-SM model reasonably reproduces the experimental data. To investigate the kinetic freeze-out properties the blast wave fit is performed to the $p_T$ spectra and it is found that the blast wave model describes the AMPT-SM simulations well. We additionally observe that the kinetic freeze-out temperature ($T_{kin}$) increases from central to peripheral collisions, which is consistent with the argument of short-lived fireball in peripheral collisions. Whereas the transverse flow velocity, shows a decreasing trend from central to peripheral collisions indicating a more rapid expansion in the central collisions. Both, $T_{kin}$ and show a weak dependence on the collision energy at most energies. We also observe a strong anti-correlation between $T_{kin}$ and $$. The extracted freeze-out parameters from the AMPT-SM simulations agree with the experimental data as opposed to earlier studies that reported some discrepancies. Whereas, no significant effect is found on the freeze-out parameters by varying the $t_{max}$. We also report the $p_T$ spectra of light hadrons and their freeze-out parameters by AMPT-SM simulations at $\sqrt{s_{NN}}$ = 14.5 GeV, where no experimental data is available for comparison. Overall, the set of parameters used in this study well describes the experimental data at BES energies.Comment: 12 pages, 7 figures, 2 table