PENGARUH CAMPURAN ABU AMPAS KAYU PADA TANAH DESA COT SEUNONG DENGAN PENGUJIAN CALIFORNIA BEARING RATIO

Tanah yang tersedia di alam sering tidak dapat langsung digunakan karena secara alamiah tanah memiliki sifat-sifat fisis dan mekanis tertentu yang terbatas. Oleh karena itu diperlukan penelitian tentang tanah untuk mengetahui sifat-sifatnya dengan teliti sehingga dapat menyesuaikan dengan kebutuhan konstruksi sehingga menjamin stabilitas suatu konstruksi. Penelitian ini bertujuan untuk mengetahui pengaruh penambahan abu ampas kayu yang digunakan sebagai bahan stabilisasi terhadap nilai CBR (California Bearing Ratio). Tanah yang digunakan dalam penelitian ini berasal dari Desa Cot Seunong Kecamatan Montasik Kabupaten Aceh Besar. Abu ampas kayu yang diperoleh diambil dari sisa-sisa limbah perabot pembuatan kayu yang berada di daerah Desa Kajhu Aceh Besar. Tanah tersebut menurut klasifikasi AASHTO tergolong A-7-6 (tanah berlempung). Menurut USCS tanah Desa Cot Seunong termasuk golongan tanah lempung tak organik dengan plastisitas tinggi yang disimbolkan CH (Clay High) dengan indeks plastisitasnya adalah 33,69%. Persentase penambahan abu ampas kayu yaitu 0%, 5%, 10%, 15% dan 20% terhadap berat kering tanah. Hasil pengujian Standart Proctor tanpa campuran didapat nilai OMC (Optimim Moisture Content) 23,60% dengan berat isi kering maksimum (?dmax) 1,595 gr/cm3. Hasil pengujian CBR memperlihatkan bahwa nilai CBR pada persentase 0% sebesar 1,67%, pada persentase 5% sebesar 2,45%, pada persentase 10% sebesar 2,62%, pada persentase 15% sebesar 2,73%, dan pada persentase 20% sebesar 3,03%. Nilai CBR tertinggi terdapat pada persentase 20% dengan nilai CBR 3,03%, dengan demikian penggunaan abu ampas kayu pada tanah lempung Desa Cot Seunong sangat efektif karena semakin banyak campuran abu ampas kayu yang mengisi pori-pori kosong pada tanah, sehingga tanah menjadi padat dan dapat meningkatkan daya dukung tanah menjadi lebih baik.Banda Ace

Minor mutations in HIV protease at baseline and appearance of primary mutation 90M in patients for whom their first protease-inhibitor ntiretroviral regimens failed

The association between minor mutations in human immunodeficiency virus (HIV) protease at baseline and development of common primary mutation 90M at virological failure (conferring some resistance to all protease inhibitors [PIs]) was evaluated in 93 previously drug-naive patients experiencing failure of their first PI-based antiretroviral regimens. In logistic regression analysis, the probability of accumulating a new 90M mutation at virological failure was associated with the presence at baseline of minor mutation 36I (naturally occurring in ∼25% of HIV clade B and in >80% of HIV non-clade-B viruses) (adjusted odds ratio, 13.5 [95% confidence interval, 1.89–95.6]; P=.009) and, possibly, of 10I/V. This suggests a potential role for the presence of 36I at baseline in predicting the appearance of 90M at virological failure

Ceftolozane/Tazobactam for Treatment of Severe ESBL-Producing Enterobacterales Infections: A Multicenter Nationwide Clinical Experience (CEFTABUSE II Study)

Background. Few data are reported in the literature about the outcome of patients with severe extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) infections treated with ceftolozane/tazobactam (C/T), in empiric or definitive therapy.Methods. A multicenter retrospective study was performed in Italy (June 2016-June 2019). Successful clinical outcome was defined as complete resolution of clinical signs/symptoms related to ESBL-E infection and lack of microbiological evidence of infection. The primary end point was to identify predictors of clinical failure of C/T therapy.Results. C/T treatment was documented in 153 patients: pneumonia was the most common diagnosis (n = 46, 30%), followed by 34 cases of complicated urinary tract infections (22.2%). Septic shock was observed in 42 (27.5%) patients. C/T was used as empiric therapy in 46 (30%) patients and as monotherapy in 127 (83%) patients. Favorable clinical outcome was observed in 128 (83.7%) patients; 25 patients were considered to have failed C/T therapy. Overall, 30-day mortality was reported for 15 (9.8%) patients. At multivariate analysis, Charlson comorbidity index >4 (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.9-3.5; P = .02), septic shock (OR, 6.2; 95% CI, 3.8-7.9; P < .001), and continuous renal replacement therapy (OR, 3.1; 95% CI, 1.9-5.3; P = .001) were independently associated with clinical failure, whereas empiric therapy displaying in vitro activity (OR, 0.12; 95% CI, 0.01-0.34; P < .001) and adequate source control of infection (OR, 0.42; 95% CI, 0.14-0.55; P < .001) were associated with clinical success.Conclusions. Data show that C/T could be a valid option in empiric and/or targeted therapy in patients with severe infections caused by ESBL-producing Enterobacterales. Clinicians should be aware of the risk of clinical failure with standard-dose C/T therapy in septic patients receiving CRRT

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

TDM-guided therapy with daptomycin and meropenem in a morbidly obese, critically ill patient

OBJECTIVE: To describe a case of severe cellulitis, successfully treated with high-dose daptomycin plus continuous infusion meropenem, in a patient with morbid obesity and renal failure, in whom drug exposure over time was optimized by means of real-time therapeutic drug monitoring (TDM). CASE SUMMARY: A 63-year-old man with morbid obesity (body mass index 81.6 kg/m\ub2) and renal failure was admitted to the emergency department because of severe cellulitis. The patient had an admission Laboratory Risk Indicator for Necrotizing Fasciitis score of 9, and broad-spectrum antimicrobial therapy with daptomycin and meropenem was started. Because of rapidly changing renal function, dosage adjustments were guided by an intensive program of TDM (daptomycin ranging from 1200 mg every 48 hours over 30 minutes to 1200 mg every 36 hours over 30 minutes; meropenem ranging from 0.25 g every 8 hours over 6 hours to 500 mg every 4 hours by continuous infusion). Clinical response was observed within 72 hours. However, a sudden increase of serum creatine kinase (SCK) raised questions about the need for discontinuation of daptomycin. The drug concentrations were not toxic; therefore, we decided to continue therapy. Significant clinical improvement, with SCK normalization, was observed within a few days. Antimicrobial therapy was switched on day 29 to amoxicillin/clavulanate plus levofloxacin, and then discontinued at discharge on day 53. DISCUSSION: High-dose daptomycin plus continuous infusion meropenem may ensure adequate empiric antimicrobial coverage in patients with possible early necrotizing fasciitis. However, in patients with morbid obesity and changing renal function, significant challenges may arise because of the hydrophilic nature of these drugs and the inaccuracy of standard methods of estimating renal function. CONCLUSIONS: Real-time TDM may represent an invaluable approach in optimizing drug exposure with high-dose daptomycin plus continuous infusion meropenem in patients with severe cellulitis, morbid obesity, and changing renal function

Management of vertebral osteomyelitis in an 8-year period: the UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis)

vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians, because of its insidious and indolent course which make diagnosis difficult

Secondary Mutations in the Protease Region of Human Immunodeficiency Virus and Virologic Failure in Drug‐Naive Patients Treated with Protease Inhibitor–Based Therapy

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