Torsades de pointes in SARS-CoV-2 (COVID-19) pneumonia: medicine reconciliation and careful monitoring of QTc interval may help prevent cardiac complications.

Hydroxychloroquine has been widely prescribed to treat patients with COVID-19 pneumonia. A 73-year-0ld woman with COVID-19 pneumonia was treated with dexamethasone and hydroxychloroquine. Her home medications, citalopram and donepezil, were continued. The ECG prior to starting hydroxychloroquine showed normal sinus rhythm with prolonged corrected QT (QTc) of 497 ms, due to citalopram and donepezil therapy. Repeat ECG on days 3 and 4 of hydroxychloroquine therapy showed significantly prolonged QTc of 557 ms and 538 ms, respectively, despite normal serum electrolytes. All QT-prolonging medications including hydroxychloroquine were discontinued on day 4; however, she suffered a transient torsades de pointes lasting for about 15 s, which resolved before any intervention. QTc improved to 477 ms, after discontinuation of QT-prolonging medications. The patient had QTc prolongation and torsades de pointes due to therapy with multiple QT-prolonging medications. Medicine reconciliation and careful monitoring of QTc may help prevent cardiac complications in patients with COVID-19 treated with hydroxychloroquine.

Conversion of agricultural waste into stable biocrude using spinel oxide catalysts.

Biomass, the feedstock for biocrude and ultimately renewable diesel is a low energy density feedstock. The transport of this feedstock over long distance has been proven to be a major burden on the commercialisation of biorefining. Therefore, it has been generally accepted that biomass should be upgraded to biocrude (a relatively high energy density liquid) in close proximity to the biomass sources. The biocrude liquid would then be transported to a biorefinery. Biocrude contains large amounts of oxygen (generally up to 38 wt%) that is removed from the crude in the refining process. In this study, we have synthesised a range of spinel oxide based catalysts to remove oxygen from the biocrude during the catalytic fast pyrolysis. The activity of spinel oxide (MgB2O4 where B = Fe, Al, Cr, Ga, La, Y, In) catalysts were screened for the pyrolysis reaction. While all the tested spinel oxides deoxygenated the pyrolysis vapour, MgCr2O4 was found to be effective in terms of oxygen removal efficiency relative to the quantity of bio oil produced.

Impact of Inappropriate Antibiotic Therapy in Vancomycin-Resistant Enterococcus Bacteremia.

BACKGROUND: Vancomycin-resistant Enterococcus (VRE) bacteremia has significant morbidity and mortality. Empiric antibiotic regimens for treating patients with risk factors for multidrug-resistant organisms may not have medications directed at treating VRE. STUDY QUESTION: To evaluate the impact of antibiotic therapy (and other risk factors) on mortality in VRE bacteremia. STUDY DESIGN: We identified 146 patients with VRE bacteremia, admitted at our institution over an 11 years period (2004-2014). All inpatients with an initial positive VRE blood culture were included only once in the analysis. Eighteen patients were excluded from the study because of inability to retrieve medical information regarding one or more important study variables. The retrospectively collected data from electronic medical records of 128 patients were analyzed. RESULTS: The inpatient, 30-day, and 1-year mortality rates from VRE bacteremia were 23%, 31%, and 59%, respectively. Only 19% patients were discharged home. Inappropriate antibiotics were prescribed in 19% patients. Appropriate antibiotics were prescribed in 81% patients (62% daptomycin and 37% linezolid); however, only 58% patients received appropriate antibiotics within 24 hours of the reported positive blood cultures. The 30-day and 1-year mortality rates for patients treated with inappropriate antibiotics were 54% and 67% compared with 26% and 50%, respectively, for those treated with appropriate antibiotics. The median survival rate for patients treated with inappropriate antibiotics was 1 month (95% confidence interval: 0.0-1.0) compared with 11 months (95% confidence interval: 4.0-13.0) for those treated with appropriate antibiotics. The advanced patient age (median age 75 years vs. 63 years) was a significant risk factor for inappropriate antibiotic therapy (P value = 0.02). The multivariate Cox regression model revealed inappropriate antibiotic therapy (P value = 0.003), septic shock (P value = 0.0004), albumin (P value = 0.04), and dementia (P value = 0.003) to be associated with 30-day mortality. CONCLUSIONS: Our study highlights the detrimental effect of inappropriate antibiotic therapy and other risk factors on morbidity and mortality associated with VRE bacteremia.

Application of structural equation modelling to develop a conceptual model for smallholder's credit access: The mediation of agility and innovativeness in organic food value chain finance.

Developing a conceptual model is vital for small-scale organic farmer's credit access to sustain the livelihoods. However, smallholders continually face severe problems in getting finance that lead to reduce investment and in turn, challenges the livelihoods. Therefore, the aim of the present study was to establish and empirically test a theoretical model to explore how agility and innovativeness in organic food value chain finance are achieved through ITI, TRST, CG, ICT, and IS, and how these, in turn, can accelerate financial flow in the value chain and enhance competitiveness. The present study used a survey method and collected data from small-scale farmers, traders, and financial institutions. The model and hypothesis are tested using data obtained from 331 respondents through partial least square structure equation modeling techniques. We argue that development of theoretical model show potential to increase creditworthiness of smallholders and overcome uncertainties that impede traditional value chain credit arrangement. Thus, the present study could provide new ways to integrate the value chain partners, through information and communication technology and governance arrangements in the organic food value chain financing. This study demonstrates that the mediations of innovativeness and agility significantly affect the development of new financial products to make agile the financial flow, which in turn positively influences value chain competitiveness. Significant judgments are required for trustworthy relations among the value chain partners to positively harness innovative product development for swifter value chain finance. Therefore, this theoretical model should not be regarded as a quick solution, but a process of testing, error, and learning by doing so.

Standardizing education in interventional pulmonology in the midst of technological change.

Interventional pulmonology (IP) is a maturing subspecialty of pulmonary medicine. The robust innovation in technology demands standardization in IP training with both disease and technology driven training. Simulation based training should be considered a part of IP training as seen in other procedural and surgical subspecialties. Procedure volume is a component of training; however, this does not guarantee or translate into competency for learners. Basic competency skills can be assessed using standardized well validated assessment tools designed for various IP procedures including flexible bronchoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA), rigid bronchoscopy and chest tube placement; however, further work is needed to validate tools in all procedures as new technologies are introduced beyond fellowship training. Currently there are at least 39 IP fellowship programs in the United States (US) and Canada which has led to improved training by accreditation of programs who meet rigorous requirements of standardized curriculum and procedural volume. The challenge is to be innovative in how we teach globally with intention and how to best integrate new evolving technology training for those not only during fellowship training but also beyond fellowship training.

Nanostructured NiMoS2/Carbon Catalysts for Syngas Conversion to Higher Alcohols.

Syngas conversion to higher alcohols remains a very attractive alternative due to the abundance of syngas feedstock, such as renewable carbon and waste-carbon resources. Catalysts suitable for syngas conversion still show low selectivity to alcohols. In this article, we present nanostructured NiMoS2 and CoMoS2 catalysts supported on activated carbon pellets and design strategies to improve its selectivity towards higher alcohols. Activated carbon pellets were treated with concentrated HNO3 to enlarge porous channels and enable better dispersion of NiMoS2 and CoMoS2. These treatment steps lead to a formation of nanostructured NiMoS2 and CoMoS2 catalysts and promoted higher selectivity to ethanol, propanol and butanol. BET surface area of 532 m² g-1 was obtained for NiMoS2/Carbon catalysts from the nitrogen physisorption analysis. In catalytic tests, the highest CO conversion (39.1%) was achieved by the NiMoS2/Carbon, whereas the CoMoS2/Carbon showed the highest alcohol selectivity (74.4%). CoMoS2 catalysts supported on activated carbon pellets proved to be highly active towards undesired by-product "filamentous carbon."

Acute fibrinous organising pneumonia presenting as a cavitary lung lesion and treatment response to azithromycin.

Acute fibrinous organising pneumonia is distinct from the classic diffuse alveolar damage, organising pneumonia and eosinophilic pneumonia. A 52-year-old woman presented with fever, productive cough, night sweats and left-sided pleuritic chest pain for a week. Physical examination was significant only for decreased breath sounds in the left infraclavicular area laterally. Imaging studies revealed a peripheral thick-walled left upper lobe cavitary lesion, left lower lobe consolidation and an enlarged subcarinal lymph node. She was treated with doxycycline for 10 days without improvement. Pertinent laboratory tests, microbiologic workup and fibre-optic bronchoscopy were non-diagnostic and a CT-guided left upper lobe lung biopsy revealed acute fibrinous organising pneumonia. She was treated with azithromycin with complete resolution of symptoms. To our knowledge, this is the first reported case of acute fibrinous organising pneumonia presenting as a cavitary lung lesion and the first with treatment response to azithromycin.

Massive hemoptysis: an unusual presentation of papillary thyroid carcinoma due to tracheal invasion.

A 67-year-man presented to the emergency department with massive hemoptysis, coughing up about 250 mL frank blood in 2-3 hours. Physical examination was significant for tachycardia, tachypnea and blood around the mouth. A CT of the chest did not reveal any aetiology of hemoptysis. Flexible fiberoptic bronchoscopy was remarkable for an actively oozing 1×1 cm sessile subglottic polyp on the anterior tracheal wall. CT neck revealed a 2.5×2.4 cm pretracheal soft tissue mass, bulging into the subglottic trachea. Fine needle aspiration confirmed papillary thyroid carcinoma with BRAF mutation. The patient underwent radical resection and surgical pathology confirmed a 2.5 cm papillary thyroid carcinoma with extensive extra-thyroid extension into the tracheal mucosa. Invasion of the trachea and surrounding structures like larynx and oesophagus is not usual for papillary thyroid carcinoma and may be associated with aggressive cancer behaviour and relatively poor outcome and prognosis.