Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic. Results from the MIMIC Study (A Multi-centre cohort study evaluating the role of Inflammatory Markers in patients presenting with acute ureteric Colic)

Objectives There is conflicting data on the role of white blood cell count (WBC) and other inflammatory markers in spontaneous stone passage in patients with acute ureteric colic. The aim of the study was to assess the relationship of WBC and other routinely collected inflammatory and clinical markers including stone size, stone position and Medically Expulsive Therapy use (MET) with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic. Subjects and Methods Multi‐centre retrospective cohort study coordinated by the British Urology Researchers in Surgical Training (BURST) Research Collaborative at 71 secondary care hospitals across 4 countries (United Kingdom, Republic of Ireland, Australia and New Zealand). 4170 patients presented with acute ureteric colic and a computer tomography confirmed single ureteric stone. Our primary outcome measure was SSP as defined by the absence of need for intervention to assist stone passage. Multivariable mixed effects logistic regression was used to explore the relationship between key patient factors and SSP. Results 2518 patients were discharged with conservative management and had further follow up with a SSP rate of 74% (n = 1874/2518). Sepsis after discharge with conservative management was reported in 0.6% (n = 16/2518). On multivariable analysis neither WBC, Neutrophils or CRP were seen to predict SSP, with an adjusted OR of 0.97 [95% CI 0.91 to 1.04, p = 0.38], 1.06 [95% CI 0.99 to 1.13, p = 0.1] and 1.00 [95% CI 0.99 to 1.00, p = 0.17], respectively. Medical expulsive therapy (MET) also did not predict SSP [adjusted OR 1.11 [95% CI 0.76 to 1.61]). However, stone size and stone position were significant predictors. SSP for stones 7mm. For stones in the upper ureter the SSP rate was 52% [95% CI 48 to 56], middle ureter was 70% [95% CI 64 to 76], and lower ureter was 83% [95% CI 81 to 85]. Conclusion In contrast to the previously published literature, we found that in patients with acute ureteric colic who are discharged with initial conservative management, neither WBC, Neutrophil count or CRP help determine the likelihood of spontaneous stone passage. We also found no overall benefit from the use of MET. Stone size and position are important predictors and our findings represent the most comprehensive stone passage rates for each mm increase in stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study

Background Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae. Methods The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis. Findings Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades. Interpretation Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Corrosion inhibition of mild steel in HCl solution by Tinidazole

Tinidazole, a pharmaceutical compound has been investigated with reference to the inhibition of mild steel acidic corrosion in 1 molar HCl by means of weight loss and electrochemical measurements. The outcomes attained at 30°C revealed that the Tinidazole had obtained 90% inhibition efficiency at 400 ppm concentration. These results explain that the inhibition process occurs by means of adsorption. The inhibitor molecules adsorb on the surface of the metal, following Langmuir's adsorption isotherm. Potentiodynamic polarization measurements established that Tinidazole is an inhibitor of a mixed type. An appropriate equivalent electric circuit for modeling and the analysis of impedance data to give a better explanation of the process of corrosion inhibition have been proposed

Corrosion inhibition of mild steel in HCl solution by Tinidazole

Tinidazole, a pharmaceutical compound has been investigated with reference to the inhibition of mild steel acidic corrosion in 1 molar HCl by means of weight loss and electrochemical measurements. The outcomes attained at 30°C revealed that the Tinidazole had obtained 90% inhibition efficiency at 400 ppm concentration. These results explain that the inhibition process occurs by means of adsorption. The inhibitor molecules adsorb on the surface of the metal, following Langmuir's adsorption isotherm. Potentiodynamic polarization measurements established that Tinidazole is an inhibitor of a mixed type. An appropriate equivalent electric circuit for modeling and the analysis of impedance data to give a better explanation of the process of corrosion inhibition have been proposed

Multi-Agent Event Recognition By Preservation Of Spatiotemporal Relationships Between Probabilistic Models

We present a new method for multi-agent activity analysis and recognition that uses low level motion features and exploits the inherent structure and recurrence of motion present in multi-agent activity scenarios. Our representation is inspired by the need to circumvent the difficult problem of tracking in multi-agent scenarios and the observation that for many visual multi-agent recognition tasks, the spatiotemporal description of events irrespective of agent identity is sufficient for activity classification. We begin by learning generative models describing motion induced by individual actors or groups, which are considered to be agents. These models are Gaussian mixture distributions learned by linking clusters of optical flow to obtain contiguous regions of locally coherent motion. These possibly overlapping regions or segments, known as motion patterns are then used to analyze a scene by estimating their spatial and temporal relationships. The geometric transformations between two patterns are obtained by iteratively warping one pattern onto another, whereas the temporal relationships are obtained from their relative times of occurrence within videos. These motion segments and their spatio-temporal relationships are represented as a graph, where the nodes are the statistical distributions, and the edges have geometric transformations between motion patterns transformed to Lie space, as their attributes. Two activity instances are then compared by estimating the cost of attributed inexact graph matching. We demonstrate the application of our framework in the analysis of American football plays, a typical multi-agent activity. The performance analysis of our method shows that it is feasible and easily generalizable. © Published by Elsevier B.V