The deleterious effect of metabolic acidosis on nutritional status of hemodialysis patients

One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3‾ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients. The mean age of the study patients was 55 ± 13.8 years; there were 22 females and six diabetics. The average Kt/V was 1.22 ± 0.16, pH was 7.40 ± 0.15, serum HCO 3‾ was 23.18 ± 2.38 mEq/L, serum albumin was 4.03 ± 0.56 g/dL, nPCR was 1.00 ± 0.16 g/kg/day, post-dialysis body weight was 58.50 ± 11.50 kg and BMI was 23.47 ± 2.70 kg/m 2 . There was a statistically significant direct correlation between serum albumin and BMI (r = 0.415, P = 0.004), and between serum albumin and serum HCO 3 (r = 0.341, P = 0.019). On multiple regression analysis, the predictors of serum albumin were serum HCO3‾ and BMI (direct effect) and nPCR (inverse effect). In 17 patients on MHD with serum HCO3‾ 22 mEq/L (P = 0.046). These data demonstrate that patients on MHD with metabolic acidosis had a lower serum albumin concentration despite adequate dialysis treatment. The inverse effect of nPCR on serum albumin concentration in acidotic MHD patients may be due to hypercatabolism in the setting of metabolic acidosis, leading to deleterious effects on the nutritional status of patients on MHD

Monitoring, sensor data, privacy, and consumer behavior : the case of usage-based automobile insurance

The Internet of Things (IoT)-powered services can deliver incredible monitoring capabilities to businesses and their customers. The IoT continues to evolve and reshape the businesses in different industries by collecting individuals’ sensor-based data. In the insurance industry, Usage-Based Insurance (UBI) is a recent auto insurance innovation that enables insurance companies to collect individual-level driving data, provide feedback on driving performance, and offer individually targeted price discounts based on each consumer’s driving behavior. In this thesis, we study consumer behavior from different perspectives in the presence of UBI program that relies on using consumers’ private data in three independent essays. In the first essay, we examine and estimate the effect of the UBI policy on changing the customers’ driving behavior. By considering a fixed-effect model of drivers, we find that motorists improve their driving behavior, resulting in being safer drivers, providing a meaningful benefit for both the driver and the insurance company. We also find heterogeneous effects across different demographic groups. For example, younger drivers are more likely to adopt UBI and they also improve their UBI performance faster than older drivers. To examine the tradeoffs consumer makes between costs (including privacy) and economic benefits of UBI, we study consumers’ adoption and usage of UBI by developing a dynamic structural model in the second essay. Our results suggest that the costs of being monitored (including privacy concerns) are significant, and they vary across demographic characteristics. Using a natural experiment resulting from a major (exogenous) data breach to examine the effect of changing privacy perception, we also find that the data breach is associated with a decrease in retention rates among currently monitored customers. In the third essay, we evaluate the effect of the UBI policy on changing the insurance coverage choice at the renewal time compared to the initial purchase. The results suggest that the UBI customers are significantly more likely to change their coverage choice than non-UBI customers at the renewal time. We capture price discount and information effects as two major sources of difference between UBI and non-UBI customers that could affect the different pattern of insurance coverage choice.Business, Sauder School ofGraduat

Subacute bacterial endocarditis with vasculitis-like presentation; report of a case and literature review

Infective endocarditis is a diagnostic challenge since it could manifest as a systemic disease mimicking rheumatologic disorders by immunological mechanisms. We introduced a case of infective endocarditis which was a 62-year-old man who presented with weakness, weight loss, myalgia, arthritis, petechiae, hematuria and proteinuria and was admitted by a rheumatologist for evaluation of possible vasculitis

The Effect of Aluminium on Antibacterial Properties and the Content of Some Fatty Acids in Microalgae, Chlorella vulgaris Beijernick, under Heterotrophic and Autotrophic Conditions

Microalgae are a group of organisms, which have a significant potential for industrial applications. These algae contain large amounts of lipids compounds that are beneficial to health, have antibacterial properties, and their extracted oil can be used for biofuel. In this study, microalgae Chlorella vulgaris Beijernick was grown in the culture medium BG-11 containing aluminium (AlCl3) under autotrophic and heterotrophic conditions. In each case, survival and growth, dry weight, internal aluminium content of the sample, antibacterial properties, the content of fatty acids accumulated in the algae and secreted into the culture medium in the logarithmic growth phase were studied. Aluminium significantly increased (P < .05) growth and dry weight in autotrophic treatment compared to the heterotrophic one. Most antibacterial properties were observed in methanol extracts of heterotrophic treatments containing 0.05% glucose. Aluminium also decreased fatty acids accumulation in the algae and increased fatty acids excretion into the culture medium in heterotrophic treatment compared to the autotrophic treatment. Survival of the sample was maintained in heterotrophic conditions and showed growth without lag phase, which is indicative of rapid acclimation of organisms in heterotrophic conditions. It seems that the mentioned characteristics make the single-celled green algae Chlorella vulgaris more efficient in different ways

Successful non-surgical management of bilateral emphysematous pyelonephritis despite adverse prognostic factors; report of a case and review of the literature

Emphysematous pyelonephritis (EPN) is a rare and ominous necrotizing kidney infection mainly involving diabetic patients. While prompt medical therapy with antibiotic and percutaneous catheter drainage is mainstay of management, nephrectomy should remain for unresponsiveness situations with poor prognostic factors. We introduced the clinical course of an old male presented with bilateral EPN which was successfully treated without nephrectomy regardless of various risk factors such as thrombocytopenia, impaired consciousness, and acute renal failure

Investigating Antibiotic Resistance Pattern and Prevalence of Class I, II, III Integron Genes in K. Pneumoniae Isolated from Clinical Samples in Sahrekord, Iran

Background & Objective: Acquiring integron is an important factor in multidrug resistance in the intestinal gram negative microorganisms. The most common integron cassette contains the genes associated with resistance to a wide range of antimicrobial agents. The aim of this study was to determine the prevalence of class 1, 2 and 3 integron genes in Klebsiella pneumoniae strains which was isolated from clinical samples in Shahrekord. Material & Methods: In this study antibiotic resistance pattern of 64 strains of Klebsiella pneumonia isolated from clinical samples in medical diagnostic laboratories in Shahrekord were tested by disk diffusion. In order to determine the prevalence of integrons class 1, 2 and 3 were used as specific primers. Results: After performing antibiogram tests, the most resistant was observed to be ampicillin (90.6%) and the lowest resistance one was imipenem (9.3%). Class 1, 2 and 3 integron were observed in 8 isolates (12/5%), 6 isolates (9/4%) and 10 isolates (15/62%). In 40 isolates were not observed Integron genes. In the statistical analysis by Fisher exact test between class 1 integron and resistance to the ampicillin significant association was observed. Conclusion: Resistance genes are located on the integrons and can be transmitted from one strain to another and disseminate resistance in the hospital or other environments, it is important to identify these types of antibiotic resistance genes twofold has done

Characterizations techniques in the story of the battle “YAZDAH ROKH” Ferdowsi's Shahnameh

Characterization is an important element of fiction. After creating the characters of a story, the storyteller exposes them to the reader in a special way. The story of the Battle of YAZDAH ROKH Ferdowsi's Shahnameh, despite the use of storytelling techniques, especially characterization, has received less attention from scholars in the field than similar stories in the Shahnameh and it justifies the need for more recent research. This study, while quoted from the story of the Battle of Ferdowsi's YAZDAH ROKH, seeks to explore different ways of personalizing the story. In this regard, various methods of characterization in this story have been studied using descriptive and analytical methods and using library data. The results of this study show that in the structure of the story of the Battle of the YAZDAH ROKH, two ways of characterization have been used; characterization division methods based on static and dynamic And characterization methods Based on logically description and dramatic description.  Among these methods, Dramatic description is the most important way to present the characters in this story