Angiotensin Converting Enzyme Inhibitor Induced Angioedema (ACEI-AE): Emergency Department Treatments

Angiotensin Converting Enzyme Inhibitor Induced Angioedema (ACEI-AE) is the acute swelling of the upper airway in patients who are currently or were formerly taking Angiotensin Converting Enzyme Inhibitors (ACEIs) for control of primary hypertension. Though emergency department presenting signs and symptoms have overlap with angioedema associated with anaphylaxis, there are key differences, including the absence of urticaria or hypotension and history of ACEI use, that can guide clinicians in identifying the underlying cause of the angioedema and initiate appropriate treatment. Due to its differing pathophysiology, ACEI-AE must be treated uniquely with Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) to reverse airway swelling and avoid necessity for intubation. Other mediations explored but deemed ineffective or of questionable effectiveness in the treatment of ACEI-AE include antihistamines, epinephrine, systemic glucocorticoids, Icatibant, Ecallantide, and C1-Esterase Inhibitors

Viral metagenomic sequencing in the diagnosis of meningoencephalitis: a review of technical advances and diagnostic yield

Introduction Meningoencephalitis patients are often severely impaired and benefit from early etiological diagnosis, though many cases remain without identified cause. Metagenomics as pathogen agnostic approach can result in additional etiological findings; however, the exact diagnostic yield when used as a secondary test remains unknown. Areas covered This review aims to highlight recent advances with regard to wet and dry lab methodologies of metagenomic testing and technical milestones that have been achieved. A selection of procedures currently applied in accredited diagnostic laboratories is described in more detail to illustrate best practices. Furthermore, a meta-analysis was performed to assess the additional diagnostic yield utilizing metagenomic sequencing in meningoencephalitis patients. Finally, the remaining challenges for successful widespread implementation of metagenomic sequencing for the diagnosis of meningoencephalitis are addressed in a future perspective. Expert opinion The last decade has shown major advances in technical possibilities for using mNGS in diagnostic settings including cloud-based analysis. An additional advance may be the current established infrastructure of platforms for bioinformatic analysis of SARS-CoV-2, which may assist to pave the way for global use of clinical metagenomics.Molecular basis of virus replication, viral pathogenesis and antiviral strategie

The hybrid FRP and glass bridge: Research for a material adapted and optimized hybrid pedestrian bridge design

This thesis focuses on the collaboration of two innovative materials - Fibre Reinforced Polymers (FRP) and structural glass – in the design of a (hybrid) footbridge with a 30 meter span. The choice of subject is led by a rising popularity of these materials in bridge design and strengthened by positive recent developments in conceptual small-scale FRP & glass hybrid structures. This research will try to take previous research one step further and will combine the advantages of both materials to reach a structurally efficient bridge design. The research question is as follows: “Can a hybrid pedestrian bridge with a loadbearing structure of FRP and structural glass be designed while making optimal use of the material properties of both materials?”. The design by research process is divided in multiple steps. First of all a theoretical framework is created, with state-of-the-art information about the material properties of glass and FRP. This theoretical framework resulted - via design rules - in several preliminary design variants of which the structurally most efficient, most transparent and safest variant is chosen and subsequently elaborated on. The chosen variant is optimized by using a form-finding and geometric optimization process powered by the Grasshopper plugin Kangaroo and Finite Element software DIANA. The research shows - via its design rules – that a hybrid facetted shell bridge, consisting of glass facets and FRP joints is the most efficient variant. A concave shape is chosen for its “natural” parapet and relatively low share of bending stress in the total stress, while still measuring up to the bridges’ requirements. The concave shape is tessellated with triangular panels due to problems with the – in theory – more efficient hexagonal panels. By shortening the length of connections along each side of a triangular panel, the behavior of hexagonal panels is approximated. Several topologically different triangular tessellation variants have been analyzed using DIANA. The topological variant based on a combination of the equilateral and isosceles triangle proved to result in the lowest stress and deformation values under NEN-based loads and is therefore the most efficient variant. By adding more curvature to the base of the bridge, better shell behavior is achieved, resulting in even lower stress and deformation values. The connection between the panels is made using an FRP embedded sheet, which results in a higher axial stiffness and ultimately also a higher critical load of the bridge. The ideal thickness of this sheet is determined with FEM analysis. A clamped double-pin joint is chosen for its uniformity and adaptability. Finally, an uncertainty analysis is performed to investigate the influence of tolerance related production flaws on stress levels in the joint, which resulted in no issues.Architecture, Urbanism and Building Sciences | Building Technolog

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Viral metagenomic sequencing in the diagnosis of meningoencephalitis: a review of technical advances and diagnostic yield

Meningoencephalitis patients are often severely impaired and benefit from early etiological diagnosis, though many cases remain without identified cause. Metagenomics as pathogen agnostic approach can result in additional etiological findings; however, the exact diagnostic yield when used as a secondary test remains unknown. This review aims to highlight recent advances with regard to wet and dry lab methodologies of metagenomic testing and technical milestones that have been achieved. A selection of procedures currently applied in accredited diagnostic laboratories is described in more detail to illustrate best practices. Furthermore, a meta-analysis was performed to assess the additional diagnostic yield utilizing metagenomic sequencing in meningoencephalitis patients. Finally, the remaining challenges for successful widespread implementation of metagenomic sequencing for the diagnosis of meningoencephalitis are addressed in a future perspective. The last decade has shown major advances in technical possibilities for using mNGS in diagnostic settings including cloud-based analysis. An additional advance may be the current established infrastructure of platforms for bioinformatic analysis of SARS-CoV-2, which may assist to pave the way for global use of clinical metagenomics.</p