Continuous renal replacement therapy for two neonates with hyperammonemia

Objectives: This study aims to assess the feasibility of using hemofiltration for ammonia clearance in low body weight infants with an inborn error of metabolism. Design: A study of two cases. Setting: Quaternary pediatric hospital (Saint Louis Children's Hospital) NICU and PICU. Patients: Infants <6 months of age with an ICD-9 diagnosis of 270.6 (hyperammonemia). Interventions: Continuous renal replacement therapy (CRRT). Measurements and Main Results: We measure serum ammonia levels over time and the rate of ammonia clearance over time. Continuous renal replacement therapy was more effective than scavenger therapy alone (Ammonul™) for rapid removal of ammonia in low weight infants (as low as 2.5 kg). Conclusions: Continuous renal replacement therapy is technically feasible in low weight infants with severe hyperammonemia secondary to an inborn error of metabolism

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Adaptive Strategies Of Men And Women In Zaria, Nigeria: Industrial Workers And Their Wives.

PhDCultural anthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/190425/2/7403744.pd

Attribution of 2022 early-spring heatwave in India and Pakistan to climate change: lessons in assessing vulnerability and preparedness in reducing impacts

In March 2022, large parts over the north Indian plains including the breadbasket region, and southern Pakistan began experiencing prolonged heat, which continued into May. The event was exacerbated due to prevailing dry conditions in the region, resulting in devastating consequences for public health and agriculture. Using event attribution methods, we analyse the role of human-induced climate change in altering the chances of such an event. To capture the extent of the impacts, we choose March–April average of daily maximum temperature over the most affected region in India and Pakistan as the variable. In observations, the 2022 event has a return period of ∼1-in-100 years. For each of the climate models, we then calculate the change in probability and intensity of a 1-in-100 year event between the actual and counterfactual worlds for quantifying the role of climate change. We estimate that human-caused climate change made this heatwave about 1 °C hotter and 30 times more likely in the current, 2022 climate, as compared to the 1.2 °C cooler, pre-industrial climate. Under a future global warming of 2 °C above pre-industrial levels, heatwaves like this are expected to become even more common (2–20 times more likely) and hotter (by 0 °C–1.5 °C) compared to now. Stronger and frequent heat waves in the future will impact vulnerable groups as conditions in some regions exceed limits for human survivability. Therefore, mitigation is essential for avoiding loss of lives and livelihood. Heat Action Plans have proved effective to help reduce heat-related mortality in both countries