Spontaneous Bacterial Peritonitis Because of Actinomyces.

Actinomycosis is a rare chronic granulomatous disease that manifests with nonspecific symptoms of abdominal pain, anorexia, and weight loss. The disparity in the presentation of this condition presents a tremendous diagnostic challenge. There are few reports of Actinomyces species causing spontaneous bacterial peritonitis without previous localized masses or abscesses have been published. We provide a case of spontaneous bacterial peritonitis secondary to Actinomyces species in a 46-year-old woman with uterine fibroids and a lack of preceding abscess. Although rare, spontaneous bacterial peritonitis because of Actinomyces should be considered in differential in female patients without pre-existing liver disease presenting with spontaneous bacterial peritonitis.

Combined effect of silica fume and fly ash as cementitious material on strength characteristics, embodied carbon, and cost of autoclave aerated concrete.

Aerated concrete (AAC) or lightweight concrete is primarily used for non-load bearing structures in construction work. Generally, it is produced with cement as a main binding ingredient, and the production of cement is blamed to contribute 7 to 8% of CO2 emission in the environment. In addition, the dumping of industrial wastes is also a great environmental concern. This research is an attempt to produce low-cost and sustainable aerated concrete utilizing silica fume and fly ash as partial substitution to cement without compromising the fundamental properties of aerated concrete. The current study was divided into two phases: in the first phase, the silica fume was substituted up to 20% with a variation of 5% in each mix. In the second phase, the fly ash was replaced with cement in three variations, i.e., 10%, 20%, and 30% containing an optimum proportion of silica fume obtained in phase 1. The aluminum powder was added at 0.4% by weight of binder to introduce aeration in concrete. Before testing, samples of aerated concrete were cured with steam in an autoclaving machine for 9 h at a pressure and temperature of 1.5 bars and 127 °C respectively and oven-dried at a temperature of 105 °C for 24 h after steam curing. From the experimental results, the highest compressive and split tensile strength of AAC was recorded when 15% of the cement was replaced with silica fume and 30% of the cement was replaced with fly ash combined. At this proportion the least density was also recorded which showed the lightweight of AAC without compromising the strength characteristics. In addition, the reduction of 42.64% and 32.4% of embodied carbon and cost was observed respectively.

Assessing the sustainability and cost-effectiveness of concrete incorporating various fineness of eggshell powder as supplementary cementitious material.

The eggshell powder (ESP) has been used as a partial cement replacement to reduce the cement content in concrete production. According to recent estimates, cement production contributes to 7% of global Carbon Dioxide (CO2) gas emissions. However, most of the studies so far have focused on the mechanical strength aspect of the concrete incorporating ESP; however, there is a lack of information on the influence of ESP on the sustainability of concrete in terms of embodied carbon and eco-strength efficiency. Therefore, this study aims at determining the influence of ESP on the sustainability and cost of an M40 grade concrete when different fineness ESP (50 µm and 100 µm) is utilized as partial cement replacement. The sustainability was assessed in terms of embodied carbon and eco-strength efficiency, while the cost-effectiveness was determined in terms of the overall cost of concrete and cost to produce unit compressive strength. It was observed that the control M40 concrete mix achieved a total embodied carbon of 482.88 kgCO2/m3. With 5 to 15% ESP of 100 µm fineness, the total embodied carbon was successfully reduced, ranging from 3.86 to 11.60%. While 5 to 15% of 50 µm fineness, the reduction ranged from 3.69 to 11.10%. The 50 µm fineness ESP exhibited slightly lower eco-strength efficiency compared to 100 µm fineness ESP; however, both achieved relatively higher eco-strength efficiency. In terms of cost, the inclusion of ESP resulted in a significant reduction in overall cost and was cheaper to produce 1 MPa compressive strength.

Compaction Characteristics and Permeability of Expansive Shale Stabilized with Locally Produced Waste Materials.

Waste is available in an abundant form and goes to landfill without any use, creating threats to the environment. Recent and past studies have used different types of waste to stabilize soil and reduce environmental impacts. However, there is a lack of studies on the combined use of marble dust, rice-husk ash, and saw dust in expansive shale soil. The current study tries to overcome such a gap in the literature, studying the effect of marble dust, rice-husk ash, and saw dust on expansive shale's compaction characteristics and permeability properties. According to unified soil classification and the AAHTO classification system, the geotechnical properties of natural soil are classified as clay of high plasticity (CH) and A-7-5. Several tests are performed in the laboratory to investigate the compaction characteristics and permeability properties of expansive shale. Moreover, permeability apparatus is used to investigate the permeability properties of soil. In addition, due to the accuracy of the apparatus, the conventional apparatus has been partly modified. The experimental results show that the addition of waste to the soil has significantly improved soil stabilization, increasing permeability and decreasing plasticity indexes. In addition, there is a gradual decrease in the dry density of soil and an increase in the permeability of stabilized soil. Based on the outcomes of the current study, it claims and concludes that these waste materials can be used as soil stabilizers or modifiers, instead of being dumped in landfill, which will provide a green, friendly, and sustainable environment. The current study recommends that future researchers use various wastes in the concrete and soil to improve their compaction and mechanical properties.

Investigating Optimum Conditions for Developing Pozzolanic Ashes from Organic Wastes as Cement Replacing Materials.

This research was performed to investigate the optimum conditions for developing pozzolanic ashes from organic wastes to be used as cement replacement materials. The organic wastes explored in the research are rice husk ash (RHA), wheat straw ash (WSA), and cow dung (CDA). When the organic waste is turned into ash, it develops a pozzolanic character due to the presence of silica. However, the presence of reactive silica and its pozzolanic reactivity depends on the calcination temperature, duration, and grinding. In this research, the organic wastes were calcined at three different calcination temperatures (300 °C, 400 °C, and 800 °C) for 2, 4, 6, and 8 h duration. The obtained ashes were ground for 30 min and replaced by 20% with cement. The samples containing ashes were tested for compressive strength, X-ray diffractometry (XRD), weight loss, and strength activity index (SAI). It was observed that the RHA calcinated at 600 °C for 2 h showed better strength. However, in the case of WSA and CDA, the most favorable calcination condition in terms of strength development was obtained at 600 °C for 6 h duration. The highest SAI was achieved for the mortar samples containing CDA calcinated at 600 °C for 6 h duration (CDA600-6H). The other two ashes (RHA and WSA) did not qualify as pozzolan according to the ASTM C618 classification. This was due to the presence of silica in crystalline form and lower surface area of the ash material. In this research, the ash was ground only for 30 min after calcination which did not contribute to an increase in the specific surface area and thus the pozzolanic activity. The materials ground for the higher duration are recommended for higher SAI.

Effect of silica fume and fly ash as cementitious material on hardened properties and embodied carbon of roller compacted concrete.

The production of cement releases an enormous amount of CO2 into the environment. Besides, industrial wastes like silica fume and fly ash need effective utilization to reduce their impacts on the environment. This research aims to explore the influence of silica fume (SF) and fly ash (FA) individually and combine them as binary cementitious material (BCM) on the hardened properties and embodied carbon of roller compacted concrete (RCC). A total of ten mixes were prepared with 1:2:4 mix ratio at the different water-cement ratios to keep the zero slump of roller compacted concrete. However, the replacement proportions for SF were 5%-15%, and FA were 5%-15% by the weight of cement individually and combine in roller compacted concrete for determining the hardened properties and embodied carbon. In this regard, several numbers of concrete specimens (cubes and cylinders) were cast and cured for 7 and 28 days correspondingly. It was observed that the compressive strength of RCC is boosted by 33.6 MPa and 30.6 MPa while using 10% of cement replaced with SF and FA individually at 28 days, respectively. Similarly, the splitting tensile strength of RCC is enhanced by 3.5 MPa at 10% cement replaced with SF and FA on 28 days, respectively. The compressive and splitting tensile strength of RCC is increased by 34.2 MPa and 3.8 MPa at SF7.5FA7.5 as BCM after 28 days consistently. In addition, the water absorption of RCC decreased while using SF and FA as cementitious material individually and together at 28 days. Besides, the embodied carbon of RCC decreased with increasing the replacement level of SF and FA by the mass of cement individually and combined.

Combined effect of coconut shell and sugarcane bagasse ashes on the workability, mechanical properties and embodied carbon of concrete.

This experimental research was conducted to study the combined effect of agricultural by-product wastes on the properties of concrete. The coconut shell ash (CSA) was utilized to substitute cement content ranging from 0 to 20% by weight of total binder and sugarcane bagasse ash (SCBA) to substitute fine aggregates (FA) ranging from 0 to 40% by weight of total FA. In this regard, a total of 300 concrete specimens (cylinders and cubes) were prepared using 1:1.5:3 mix proportions with a 0.52 water-binder ratio. The study investigated the workability, density, permeability, and mechanical properties in terms of compressive and splitting tensile strengths. Additionally, the total embodied carbon for all mix proportions was calculated. It was observed that with an increase in CSA and SCBA contents, the workability, density, and permeability reduced significantly. Due to CSA and SCBA being pozzolanic materials, a gain in compressive and splitting tensile strengths was observed for certain concrete mixes, after which the strength decreased. The increase in embodied carbon of SCBA increased the total embodied carbon of concrete; however, it can be said that C15S40 which consists of 15% CSA and 40% SCBA is the optimum mix that achieved 28.75 MPa and 3.05 MPa compressive and tensile strength, respectively, a reduction of 4% total embodied carbon.

Determining the Risk of Spontaneous Bacterial Peritonitis due to increase use of Proton Pump Inhibitors among cirrhotic patients with ascites.

OBJECTIVES: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites. METHODS: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm3 (cases) and non-SBP with PMN count < 250 neutrophils/mm3 (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0. RESULTS: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05). CONCLUSIONS: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users.

Effect of local metakaolin developed from natural material soorh and coal bottom ash on fresh, hardened properties and embodied carbon of self-compacting concrete.

The carbon dioxide emissions from Portland cement production have increased significantly, and Portland cement is the main binder used in self-compacting concrete, so there is an urgent need to find environmentally friendly materials as alternative resources. In most developing countries, the availability of huge amounts of agricultural waste has paved the way for studying how these materials can be processed into self-compacting concrete as binders and aggregate compositions. Therefore, this experimental program was carried out to study the properties of self-compacting concrete (SCC) made with local metakaolin and coal bottom ash separately and combined. Total 25 mixes were prepared with four mixes as 5, 10, 15, and 20% replacement of cement with metakaolin; four mixes as 10, 20, 30, and 40% of coal bottom ash as partial replacement of fine aggregates separately; and 16 mixes prepared combined with metakaolin and coal bottom ash. The fresh properties were explored by slump flow, T50 flow, V-funnel, L-box, and J-ring sieve segregation test. Moreover, the hardened properties of concrete were performed for compressive, splitting tensile and flexural strength and permeability of SCC mixtures. Fresh concrete test results show that even if no viscosity modifier is required, satisfactory fresh concrete properties of SCC can be obtained by replacing the fine aggregate with coal bottom ash content. At 15% replacement of cement with local metakaolin is optimum and gave better results as compared to control SCC. At 30% replacement of fine aggregate is optimum and gave better results as compared to control SCC. In the combined mix, 10% replacement of cement with metakaolin combined with 30% replacement of fine aggregate with coal bottom ash is optimum and gave better results as compared to control SCC.

Investigating embodied carbon, mechanical properties, and durability of high-performance concrete using ternary and quaternary blends of metakaolin, nano-silica, and fly ash.

Research for alternative binders has become a necessity due to cement's embodied carbon, climate change, and depletion of natural resources. These binders could potentially reduce our reliance on cement as the sole binder for concrete while simultaneously enhancing the functional characteristics of concrete. Theoretically, the use of finer particles in the cement matrix densifies the pore structure of concrete and results in improved properties. To validate this hypothesis, current research was designed to investigate how the value-added benefits of nano-silica (NS) and metakaolin (MK) in fly ash (FA)-blended cement affect the mechanical and durability characteristics of concrete when used as ternary and quaternary blends. Additionally, the cost-benefit analysis and environmental impact assessment were conducted. It was observed that the synergy of MK and NS used in FA-blended cement had a greater impact on enhancing the functional characteristics of concrete, while 10% MK as ordinary Portland cement (OPC) replacement and 1% NS as an additive in FA-blended OPC concrete was the optimum combination which achieved 94-MPa compressive strength at the age of 91 days and showed more than 25% increment in the flexural and splitting tensile strengths compared to the control mix (MS00). The ultrasonic pulse velocity and dynamic modulus of elasticity were significantly improved, while a significant reduction in chloride migration of 50% was observed. In terms of environmental impact, MS100 (30% FA and 10% MK) exhibited the least embodied CO2 emissions of 319.89 kgCO2/m3, while the highest eco-strength efficiency of 0.268 MPa/kgCO2·m-3 with respect to 28-day compressive strength was exhibited by MS101. In terms of cost-benefit, MS00 was determined the cheapest, while the addition of MK and NS increased the cost. The lowest cost of producing 1 MPa was exhibited by MS01 with a merely 0.04-$/MPa/m3 reduction compared to MS00.

Laurence-Moon-Bardet-Biedl Syndrome: A Rare Case With a Literature Review.

Laurence-Moon-Bardet-Biedl syndrome (LMBBS), a rare autosomal recessive genetic disorder, results from consanguineous marriage. It is a congenital ciliopathy manifesting with primary and secondary characteristics. Primary clinical features include rod and cone dystrophy, polydactyly, central obesity, genital abnormalities, and mental retardation, often presenting as poor schooling skills. Secondary clinical features include developmental delay, speech deficit, brachydactyly/syndactyly, dental defects, ataxia, olfactory deficit, diabetes mellitus (DM), and congenital heart disease. Herein, we report a case of a 15-year-old male with clinical manifestations of LMBBS, namely learning disabilities, night blindness, hypogonadism, polydactyly, polysyndactyly, and obesity. Physicians must be familiar with this syndrome, for which an early diagnosis, multidisciplinary approach, and regular follow-ups can profoundly diminish morbidity and mortality in LMBBS patients.

Resolution of syphilis-related rapidly progressive glomerulonephritis with penicillin therapy: Case report
.

Renal manifestations of syphilis are variable, with membranous nephropathy being the most commonly described lesion. Rapidly progressive glomerulonephritis (RPGN) is rare and there is only one case report in the literature describing syphilis-associated crescentic glomerulonephritis. We report a rare case of RPGN secondary to latent syphilis, which resolved with penicillin treatment in the absence of immunosuppressive therapy. A 28-year-old Black male with a history of HIV was evaluated for severe acute kidney injury, nephrotic-range proteinuria, and active urine sediment. Serologies for glomerulonephritis were negative. Rapid plasma reagin and treponema pallidum particle agglutination assay were reactive, confirming syphilis diagnosis. Kidney biopsy revealed focal and segmental necrotizing and crescentic lesion. Patient received weekly benzathine penicillin (PCN) for 3 weeks, and renal function improved to baseline. This dramatic improvement happened with PCN alone, a finding which has not been previously reported. We recommend that syphilis be considered in the differential diagnosis of all patients with proteinuria or suspected glomerulonephritis.

Diagnostic Accuracy of the SLU AMSAD Scale for Depression in Older Adults Without Dementia.

OBJECTIVES: To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale-15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults. DESIGN: Cross-sectional. SETTING: Outpatient geriatric psychiatry clinic. PARTICIPANTS: Fifty older adults (aged ≥65 years) without dementia. MEASUREMENTS: GDS-15, MADRS, SLU AMSAD, and DSM-5 criteria for major depressive disorder were administered. RESULTS: Total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD correlated significantly with the DMS-5 criteria for major depressive disorder (MDD) [area under the curve (AUC) ≥ 0.93, sensitivity = 0.93, and specificity ≥ 0.80]. Optimal cutoffs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. When score results were categorized according to their known cutoffs for mild, moderate, and severe depression, AUC values were again high (range = 0.82-0.89), with adequate levels of sensitivity (0.87-0.93) and specificity (0.71-0.86), distinguishing no or mild depression from moderate or severe depression in relation to the DSM-5 diagnostic criteria for MDD. CONCLUSIONS AND IMPLICATIONS: Strong diagnostic accuracy was shown for the 3 scales. The SLU AMSAD performed as well as the GDS-15 and slightly better than the MADRS. The superiority of the SLU AMSAD is supported by the fact that it encompasses only 5 simply worded, simply scaled items to be used in busy clinical settings.

Recurrent Pyroglutamic Acidosis Related to Therapeutic Acetaminophen.

Pyroglutamic acid, an intermediate in glutathione metabolism, can lead to elevated anion gap metabolic acidosis as rare complication of acetaminophen therapy in adults. Acquired pyroglutamic acidosis has been observed primarily in settings associated with glutathione deficiency. Risk factors for glutathione deficiency include critical illness, chronic liver or kidney disease, advanced age, female gender, alcohol abuse, malnutrition, pregnancy, antiepileptic drugs, and chronic acetaminophen use. Diagnosis of pyroglutamic acidosis requires both the exclusion of common etiologies of increased anion gap metabolic acidosis and a high index of suspicion. Treatment involves discontinuation of acetaminophen, supportive care, and addressing risk factors for glutathione deficiency. The current report describes an ambulatory patient with multiple risk factors for glutathione deficiency, who developed recurrent pyroglutamic acidosis due to acetaminophen use with therapeutic blood levels of acetaminophen.

Severe Hyperthyroidism Masquerading as Acute Bulbar Weakness.

The stroke occurs in nearly 800,000 patients per year in the United States with significant morbidity if not treated and managed in a time sensitive manner. Acute bulbar weakness can be a common presenting manifestation of acute stroke and transient ischemic attack. However, up to 30% of the patients presenting with symptoms concerning for stroke could be displaying a disease process that mimics the stroke. These disorders include hypoglycemia, seizures, complicated migraines, and endocrinopathies such as thyroid disease. If neuroimaging fails to show evidence of an acute infarct, these stroke mimics should be considered. When acute bulbar weakness occurs in the setting of severe hyperthyroidism, the treatment of this process can result in rapid improvement of symptoms.

A Rare Case of Transient Proximal Renal Tubular Acidosis in Pregnancy.

Renal tubular acidosis (RTA) is a disorder that has improper function of renal acid-base regulation and is rarely encountered during pregnancy. Currently, there is no clear evidence on management and outcomes in patients with this condition. We report a case of a previously healthy 23-year-old female at 30 weeks of gestation who presented with proximal RTA and had spontaneous resolution of the condition shortly after delivery.