Case report: A case of diabetic ketoacidosis following chikungunya virus infection

Chikungunya is a mosquito-borne viral disease that has recently become endemic in the Caribbean, including the island of Puerto Rico. We present the case of a 50-year-old Puerto Rican man who traveled to St. Louis for business and was diagnosed with acute chikungunya virus infection with atypical features causing diabetic ketoacidosis. This case highlights the need to keep tropical infectious diseases on the differential diagnosis in appropriate individuals and the ways in which tropical infectious diseases can masquerade as part of common presentations

Six Sigma, Sustainability, and IT Management: A Research Review and Discussion of Future Directions

Abstract Purpose- Six Sigma is based upon quality improvement by finding the root cause and refining processes to the precision of process outcomes. The purpose of this research was to conduct a systematic literature review (SLR) to explore the Six Sigma techniques and information technology (IT) management concepts to identify the IT management principle\u27s impact on the sustainability of Six Sigma project efforts and identify the gaps that are essential to be addressed through further research. This research also discusses the principles of IT management upon the influence on Six Sigma projects, and subsequent contribution to organizational economic sustainability. An effective IT infrastructure including communication, data warehousing, and software maximizes the organization’s knowledge for management and allowing products and services to be delivered with enhanced quality. Thus, in the absence of that cooperation, Six Sigma projects may be unsustainable. Design/methodology/approach- Literature published on Six Sigma, sustainability, and related IT management was investigated. The peer-reviewed journal articles were retrieved from different management science publishers, including Emerald, Elsevier, Science Direct, and Springer Link by using the search terms: Six Sigma, sustainability, and related IT management and their combinations. A content analysis was also adopted to analyze the relationship of IT management principles, Six Sigma applications, and sustainability in small-medium organizations. Findings- Two major themes were developed from the data analysis and coding process. First: effects of Six Sigma on organizational sustainability. Second: effects of IT principles on organizational sustainability. Keywords- Six Sigma, Sustainability, IT Management, IT Infrastructure, Organizational Sustainabilit

Dialysis enrollment patterns in Guatemala: Evidence of the chronic kidney disease of non-traditional causes epidemic in Mesoamerica

BACKGROUND: In western Nicaragua and El Salvador, chronic kidney disease (CKD) is highly prevalent and generally affects young, male, agricultural (usually sugar cane) workers without the established CKD risk factors. It is yet unknown if the prevalence of this CKD of Non-Traditional causes (CKDnT) extends to the northernmost Central American country, Guatemala. Therefore, we sought to compare dialysis enrollment rates by region, municipality, sex, daily temperature, and agricultural production in Guatemala and assess if there is a similar CKDnT distribution pattern as in Nicaragua and El Salvador. METHODS: The National Center for Chronic Kidney Disease Treatment (Unidad Nacional de Atención al Enfermo Renal Crónico) is the largest provider of dialysis in Guatemala. We used population, Human Development Index, literacy, and agricultural databases to assess the geographic, economic, and educational correlations with the National Center for Chronic Kidney Disease Treatment’s hemodialysis and peritoneal dialysis enrollment database. Enrollment rates (per 100 000) inhabitants were compared by region and mapped for comparison to regional agricultural and daytime temperature data. The distribution of men and women enrolled in dialysis were compared by region using Fisher’s exact tests. Spearman’s rank correlation coefficients were calculated. RESULTS: Dialysis enrollment is higher in the Southwest compared to the rest of the country where enrollees are more likely (p < 0.01) to be male (57.8%) compared to the rest of the country (49.3%). Dialysis enrollment positively correlates with Human Development Index and literacy rates. These correlations are weaker in the agricultural regions (predominantly sugar cane) of Southwest Guatemala. CONCLUSIONS: In Guatemala, CKDnT incidence may have a similar geographic distribution as Nicaragua and El Salvador (higher in the high temperature and sugar cane growing regions). Therefore, it is likely that the CKNnT epidemic extends throughout the Mesoamerican region

Prevalencia de enfermedad renal crónica de causa no tradicional (ERCnT) en pacientes en hemodiálisis de la costa sur de Guatemala

La enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) se presenta frecuentemente en la costa sur de América Central y regiones de Sri Lanka. Poco se sabe de esta patología pero, afecta poblaciones jóvenes, trabajadores de la agroindustria que se exponen al golpe de calor, viven debajo de 200 m.snm, tienden a tener poca proteinuria y no se asocian a factores tradicionales de ERC, además se reconocen otros factores como, deshidratación frecuente, rabdomiolisis, uso de AINES, contexto de pobreza, bajo peso al nacer y malnutrición. Se estableció la prevalencia de pacientes con ERCnT y los factores asociados a través de un estudio descriptivo de corte transversal en donde se entrevistaron 242 pacientes que reciben tratamiento de hemodiálisis en diferentes unidades de la costa sur (Escuintla, Mazatenango y Retalhuleu). Los pacientes fueron clasificados en diabéticos, hipertensos, obesos o si ninguno de esos factores. Se analizó la relación entre pacientes con factores no tradicionales de ERC: ocupación, demográficos, hábitos, altitud y tiempo en llegar a su clínica de diálisis, usando un análisis multivariado de regresión logística. Se encontró que 171 (71%) pacientes no presentaron factores tradicionales de ERC. Aunque la ocupación de agricultor es la más común, únicamente alcanzó significancia estadística la edad &lt;50 años y el tiempo &gt;30 min que tardan en desplazarse a la clínica de diálisis. El uso de AINES y consumo de bebidas carbonatadas fue descrito como frecuente. La prevalencia de ERCNT en pacientes que reciben hemodiálisis en la costa sur de Guatemala es alta. Es el mismo fenómeno reportado en El Salvador y Nicaragua. Queda entonces demostrado que la ERCnT también se presenta en la costa sur de Guatemala

Understanding China’s past and future energy demand: an exergy efficiency and decomposition analysis

There are very few useful work and exergy analysis studies for China, and fewer still that consider how the results inform drivers of past and future energy consumption. This is surprising: China is the world’s largest energy consumer, whilst exergy analysis provides a robust thermodynamic framework for analysing the technical efficiency of energy use. In response, we develop three novel sub-analyses. First we perform a long-term whole economy time-series exergy analysis for China (1971–2010). We find a 10-fold growth in China’s useful work since 1971, which is supplied by a 4-fold increase in primary energy coupled to a 2.5-fold gain in aggregate exergy conversion efficiency to useful work: from 5% to 12.5%. Second, using index decomposition we expose the key driver of efficiency growth as not ‘technological leapfrogging’ but structural change: i.e. increasing reliance on thermodynamically efficient (but very energy intensive) heavy industrial activities. Third, we extend our useful work analysis to estimate China’s future primary energy demand, and find values for 2030 that are significantly above mainstream projections

A New Approach for Heparin Standardization: Combination of Scanning UV Spectroscopy, Nuclear Magnetic Resonance and Principal Component Analysis

The year 2007 was marked by widespread adverse clinical responses to heparin use, leading to a global recall of potentially affected heparin batches in 2008. Several analytical methods have since been developed to detect impurities in heparin preparations; however, many are costly and dependent on instrumentation with only limited accessibility. A method based on a simple UV-scanning assay, combined with principal component analysis (PCA), was developed to detect impurities, such as glycosaminoglycans, other complex polysaccharides and aromatic compounds, in heparin preparations. Results were confirmed by NMR spectroscopy. This approach provides an additional, sensitive tool to determine heparin purity and safety, even when NMR spectroscopy failed, requiring only standard laboratory equipment and computing facilities