Infliximab therapy in combination with examination under anesthesia/seton drainage is a safe and effective short-term treatment for fistulating anal Crohn's disease. Long-term fistula healing rates are low.
Spontaneous rupture of the urinary bladder is a rare occurrence, and when encountered it is a diagnostic challenge. We present an unusual case of urinary bladder rupture in a patient with severe cerebral palsy who initially presented with localized abdominal pain and during admission developed generalized peritonitis caused by bladder rupture. In this case, the patient had none of risk factors associated with urinary bladder.
Biodiesel was synthesized from locally sourced, on-campus, dining facility waste cooking oil and grease by base-catalyzed transesterification with methanol. The components and properties of the biodiesel were characterized by gas chromatography− mass spectrometry (GC−MS), Fourier transform infrared spectroscopy (FT-IR), nuclear magnetic resonance spectroscopy (NMR ( 1 H and 13 C)), inductively coupled plasma-mass spectrometry (ICP−MS), viscometer, and bomb calorimetery. Five major components of fatty acid methyl esters (FAMEs) in the synthesized biodiesel were methyl oleate, methyl linoleate, methyl palmitate, methyl linolenate, and methyl stearate. The 1 H NMR spectra analysis strongly supports the GC−MS results for the percentage of each FAME in the biodiesel. Kinematic viscosity and heat of combustion of the biodiesel were measured, and their values were within optimal ranges recommended by the American Biodiesel Standard (ASTM D6751). The trace elemental composition of the biodiesel determined no significant environmental concerns. The biodiesel was blended with diesel and used to fuel a diesel generator. The combustion exhaust gas was analyzed by FT-IR, and results indicate that the fuel blend underwent complete combustion. Overall results indicate that the biodiesel-diesel fuel blend may be a sustainable, locally sourced alternative fuel for campus diesel utility vehicles.
These observations suggest that intravenous tirilazad at doses of up to 6.0 mg/kg per day for 3 days is well tolerated in this population of predominantly elderly stroke patients. Larger studies with earlier treatment will be needed to demonstrate efficacy.
Objective
The COVID‐19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019–2022.
Methods
This study included consecutive NSTEMI patients from March 14–May 9, 2019–2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia.
Results
This study comprised 250 patients of whom 181 who were admitted during the COVID‐19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door‐to‐angiography time from 29 h in 2019 to 19 h in 2020 [
p
= 0.01] and 20 h in 2021 [
p
= 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [
p
= 0.05] and 54.7% in 2021 [
p
< 0.01]. Median length‐of‐stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [
p
= 0.03]. There was no significant change in outcomes in COVID‐19 cohorts compared to control year.
Conclusions
NSTEMI patients during the first 2 years of the COVID‐19 pandemic were associated with reduced door‐to‐angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.
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