Drugs account for 1–2% of all cases of pancreatitis. A 58-year-old man was prescribed atorvastatin 10 mg for 6 months for hyperlipidemia. He developed acute abdominal pain and vomiting with epigastric tenderness. Serum lipase and CT scan of the patient suggested the presence of acute pancreatitis. The patient was hospitalized; atorvastatin was stopped and treated symptomatically. He recovered completely within 10 days of drug withdrawal. The causality of the adverse drug reaction according to Naranjo and WHO-UMC Scale was probable. The exact mechanism of pancreatitis due to atorvastatin is not known. It may be a class effect of HMG CoA reductase inhibitors as it had been reported with other statins too. The definite causal relationship is difficult to establish, as rechallenge with the suspected drug was not done due to ethical consideration.
Understanding the out‐of‐plane behavior of unreinforced masonry walls is crucial in seismic assessment of existing buildings. Here, the dynamic response of a vertical spanning strip wall, connected to a flexible diaphragm at the top, is investigated. Despite the simplicity of the model, two rocking rigid bodies elastically restrained at the top, the dynamic response is highly nonlinear. This behavior is due to different phenomena: when in motion the system may assume different configurations, with the transition between them due either to impacts or crack opening caused by ground acceleration. An analytical model capable to capture the complex dynamic response of the system is implemented. The equations of motion are first derived, using variational methods, then the events that the system can undergo during motion are studied. Finally, in order to show the potential of the model, some numerical exemplifications are presented applying an earthquake record and a sine pulse to the system.
Diabetes mellitus (DM) is a pandemic disease and an important cardiovascular (CV) risk factor. The atherogenic dyslipidemia in diabetes (ADD) is characterized by high serum triglycerides, high small dense LDL levels, low HDL levels and postprandial lipemia. Insulin resistance is a primary cause for ADD. Though statins are highly effective for CVD prevention in DM but a significant residual CV risk remains even after optimal statin therapy. Fibrates, niacin and omega-3 fatty acids are used in addition to statin for treatment of ADD (specifically hypertriglyceridemia). All these drugs have some limitations and they are far from being ideal companions of statins. Many newer drugs are in pipeline for management of ADD. Dual PPAR α/γ agonists are in most advanced stage of clinical development and they have a rational approach as they control blood glucose levels (by reducing insulin resistance, a primary factor for ADD) in addition to modulating ADD. Availability of dual PPAR α/γ agnosits and other drugs for ADD management may improve CV outcomes and decrease morbidity and mortality in diabetic patients in future.
We present a case of bacteremia by an unsual, instrinsically multidrug resistant organism, Chryseobacterium indologenes in a 59 year old gentleman with squamous cell carcinoma of lung with multiple metastasis. Despite of treating as per sensitivity report after isolating Chryseobacterium indologenes , patient could not be survived. The pathogenicity and predictability of the organism towards antibiotics, both in vivo and in vitro needs further research. How to cite this article Bhagawati G, Bhardwaj A et al . Bacteremia by Chryseobacterium Indologenes in a Patient with Lung Cancer: A Clinical and Microbiological Investigation. Indian J Crit Care Med 2019;23(3):157-159.
Past earthquakes have shown the high vulnerability of existing masonry buildings, particularly to out-of-plane local collapse mechanisms. Out-of-plane response is one of the most debated topics in the last decades, because of its complex nature as for geometrical nonlinearity, energy damping, record sensitivity. In this work is considered a monolithic wall, resting on a foundation, restrained by a flexible diaphragm. The wall rocks around two base pivots and has one degree of freedom. Its thickness is explicitly accounted for, and the diaphragm is modelled as a linear-elastic spring and a concentrated mass. The non-linear equation of motion is presented, within a lagrangian approach. The energy dissipation is associated to the impact of the wall against the foundation. The effect of size of the wall, diaphragm stiffness and mass are evaluated through parametric analyses. Neglecting the diaphragm mass, the results can be interpreted also as related to a wall restrained at the top by tie-rods.
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