Predictors of the development of myocarditis or acute renal failure in patients with leptospirosis: An observational study

<p>Abstract</p> <p>Background</p> <p>Leptospirosis has a varied clinical presentation with complications like myocarditis and acute renal failure. There are many predictors of severity and mortality including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore recognizing the early predictors of the complications of leptospirosis is important in patient management. This study was aimed at determining the clinical and laboratory predictors of myocarditis or acute renal failure.</p> <p>Methods</p> <p>This was a prospective descriptive study carried out in the Teaching Hospital, Kandy, from 1st July 2007 to 31st July 2008. Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory measures done on admission were recorded. Patients were observed for the development of acute renal failure or myocarditis. Chi-square statistics, Fisher's exact test and Mann-Whitney <it>U </it>test were used to compare patients with and without complications. A logistic regression model was used to select final predictor variables.</p> <p>Results</p> <p>Sixty two confirmed leptospirosis patients were included in the study. Seven patients (11.3%) developed acute renal failure and five (8.1%) developed myocarditis while three (4.8%) had both acute renal failure and myocarditis. Conjunctival suffusion - 40 (64.5%), muscle tenderness - 28 (45.1%), oliguria - 20 (32.2%), jaundice - 12 (19.3%), hepatomegaly - 10 (16.1%), arrhythmias (irregular radial pulse) - 8 (12.9%), chest pain - 6 (9.7%), bleeding - 5 (8.1%), and shortness of breath (SOB) 4 (6.4%) were the common clinical features present among the patients. Out of these, only oliguria {odds ratio (OR) = 4.14 and 95% confidence interval (CI) 1.003-17.261}, jaundice (OR = 5.13 and 95% CI 1.149-28.003), and arrhythmias (OR = 5.774 and 95% CI 1.001-34.692), were predictors of myocarditis or acute renal failure and none of the laboratory measures could predict the two complications.</p> <p>Conclusions</p> <p>This study shows that out of clinical and laboratory variables, only oliguria, jaundice and arrhythmia are strong predictors of development of acute renal failure or myocarditis in patients with leptospirosis presented to Teaching Hospital of Kandy, Sri Lanka.</p

The PHENIX Experiment at RHIC

The physics emphases of the PHENIX collaboration and the design and current status of the PHENIX detector are discussed. The plan of the collaboration for making the most effective use of the available luminosity in the first years of RHIC operation is also presented.Comment: 5 pages, 1 figure. Further details of the PHENIX physics program available at http://www.rhic.bnl.gov/phenix

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

High specific-energy lead-acid batteries through organic metals

A novel room-temperature route to corrosion protect lead-coated plastic grids with an organic metal, namely, polyaniline, for producing commercial-grade high specific-energy 12 V/45 Ah lead-acid batteries is reported. The specific energy of these lead-acid batteries is found to be ca. 45 Wh/kg as against about 30 Wh/kg for conventional lead-acid batteries. It is believed that the study reported here will open up a new realm of possibilities for lead-acid battery development, and will contribute directly towards lowering the cost of both battery materials and manufacturing

High Specific-Energy Lead-Acid Batteries Through Organic Metals

A novel room-temperature route to corrosion protect lead-coated plastic grids with an organic metal, namely, polyaniline, for producing commercial-grade high specific-energy 12 V/45 Ah lead-acid batteries is reported. The specific energy of these lead-acid batteries is found to be ca. 45 Wh/kg as against about 30 Wh/kg for conventional lead-acid batteries. It is believed that the study reported here will open up a new realm of possibilities for lead-acid battery development, and will contribute directly towards lowering the cost of both battery materials and manufacturing

Water productivity improvements in Indian Agriculture: potentials, constraints and prospects

In International Water Management Institute (IWMI). Strategic Analyses of the National River Linking Project (NRLP) of India Series 5. Proceedings of the Second National Workshop on Strategic Issues in Indian Irrigation, New Delhi, India, 8-9 April 2009. Colombo, Sri Lanka: International Water Management Institute (IWMI)

New single-source precursor for bismuth sulfide and its use as low-cost counter electrode material for dye-sensitized solar cells

One new homoleptic Bi(dtc)(3)] (1) (dtc = 4-hydroxypiperdine dithiocarbamate) has been synthesized and characterized by microanalysis, IR, UV-Vis, H-1 and C-13 spectroscopy and X-ray crystallography. The photoluminescence spectrum for the compound in DMSO solution was recorded. The crystal structure of 1 displayed distorted octahedral geometry around the Bi(III) center bonded through sulfur atoms of the dithiocarbamate ligands. TGA indicates that the compound decomposes to a Bi and Bi-S phase system. The Bi and Bi-S obtained from decomposition of the compound have been characterized by pXRD, EDAX and SEM. Solvothermal decomposition of 1 in the absence and presence of two different capping agents yielded three morphologically different Bi2S3 systems which were deployed as counter-electrode in dye-sensitized solar cells (DSSCs). (C) 2015 Elsevier B.V. All rights reserved

Benchmarking Performance in Retail Chains: An Integrated Approach

Standardizing performance expectations across different outlets within a chain, differing in their individual features, their consumers, and the nature of competition they face, can be an onerous task. We develop an integrated, nonlinear, block group-level market share model of store expectations that draws upon the existing trade area as well as store performance literatures. By incorporating and normalizing a large number of external and internal factors impacting performance, we are able to offer a means for the retailer to determine equitable standards. The model is estimated using a variation of the maximum-likelihood estimation, on a data set fashioned from several sources and aggregated at the block group and store levels. Finally, we propose a set of indices that allows us to evaluate relative performances of stores and regions given the competitive environments they face. We find that a block group-level model offers a better fit, as well as significantly richer implications, than a traditional store-level model. Results show that a significant number of stores operate well below their expected levels, an insight not obvious from the raw numbers used to report store statistics to upper management.retailing, store performance, benchmarking, econometric models