The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients

The impact of serum concentrations of vancomycin is a controversial topic. Results: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624–0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. Discussion: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. Conclusion: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used.

Tips and Tricks in surgical reduction of the posterior column of AO/OTA C3 pilon fractures

Background Accurate posterior column reduction remains a challenging and controversial topic in the management of complex pilon fractures (AO/OTA C3). We aim to report the outcomes of surgical treatment for 22 AO/OTA C3 pilon fracture cases between January 2015 and May 2017 and highlight some traps and tips. Methods Three patients underwent two-stage early plating on the posterior column through a posterolateral approach. The remaining 19 patients were treated with two-stage delayed plating on the posterior column: 11 patients were treated with a posterolateral approach, five patients with a modified posteromedial approach, and three patients with a single anterior approach. The reduction of the posterior column was evaluated according to the Burwell-Charnley’s radiographic criteria, and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores. Results Posterior column malreduction occurred in five cases, including in one case that was re-adjusted immediately and in another case that was re-adjusted during a two-staged delayed operation. According to Burwell-Charnley’s criteria, the satisfactory rate of fracture reduction was 81.8%. After 1 year, the mean AOFAS score was 81.9 (81.9 ± 9.9); the outcome was excellent in three (20.0%), good in nine (60.0%), and fair in three (20.0%). Excellent or good outcomes were noted in 12 patients (80.0%). Conclusions The combined anterior and posterior approach is suggested in the second stage of plating so that the posterior column fragments can be re-adjusted intraoperatively, if necessary. Following these procedures, satisfactory reduction and recovery of good ankle function can be anticipated.

Verstaatlichung und Entschädigung in Österreich

Umfassende Aufarbeitung des österreichischen Enteignungsrechts anhand der Causa Bleckmann Die Verstaatlichung von Unternehmen spielte in der Zweiten Republik eine bedeutende Rolle. In den Jahren 1946 und 1947 wurden zahlreiche Großbetriebe, unter anderem die Schoeller-Bleckmann Stahlwerke AG, per Gesetz verstaatlicht - und ab 1993 wieder privatisiert. Damit ging ein denkwürdiges Kapitel österreichischer Industriegeschichte zu Ende. Die Brisanz dieses kontroversen Themas hierzulande besteht aber fort. Stets ist es dabei um Geld, Macht und Einfluss gegangen. Und auch heute - 75 Jahre später - ist die Aufarbeitung der Verstaatlichung in Österreich noch nicht abgeschlossen. Welche juristische Dimension damit verbunden ist, beleuchtet die vorliegende Monografie. The nationalization of enterprises played an important role in the Austrian 2nd Republic. In the years 1946 and 1947 numerous large enterprises, Schoeller-Bleckman Stahlwerke AG among others were nationalized per law - and from 1993 again privatized. With it ended a memorable chapter of Austrian industry. The explosive force of this controversial topic in Austria continues until today. It has always been about money, power and influence. Until today – 75 years later – the reappraisal of nationalization in Austria has still not been closed. Which juridical dimension is linked therewith is highlighted in the submitted monography.

Bed rails in an internal medicine clinical setting: a medico-legal analysis based on a systemic review of available literature

The use of restraints and, specifically, bed rails embody a controversial topic. Bedrails are commonly considered to be a protective device; however, they may be used as a form of restraint, and they may lead to severe injuries. Often restraints are used despite the lack of indication and prescription, without complete informed consent and without adequate reporting in medical records. Due to these reasons, restraints may lead to lawsuits. We present two cases where the use of physical restraints was complicated by health consequences, leading to litigation and medico-legal evaluation of medical and/or nurse liability.

Mission Possible: Intercultural Communication and the Quest for Finding Shared Meaning

The source of objective meaning is a controversial topic. For most of human history, religion had a monopoly on meaning, truth, and values. But from the nineteenth century onwards and with relativism gaining more popularity, this began to change, leaving most people divided into two main camps: those who believe in the existence of objective meaning and truth and those who maintain that such concepts simply do not exist. The resulting impossibility of finding shared meaning is very problematic, especially when it comes to intercultural communication. In fact, to speak of communication is to speak of common meaning. In this paper, I attempt to provide a definition for intercultural communication, explore the issue of shared meaning, and propose a culture-free approach to the latter—one that is based on reverting to an axiomatic understanding of the notion of meaning. My aim is to conclude that the failure of both dogmatism and relativism to sustain intercultural communication should not be interpreted pessimistically. Quite the opposite, it should be viewed as an opportunity to investigate other promising alternatives, mainly Sam Harris’s science of morality.

Propaganda and Radicalization: The Case of Daesh in Iran

The process of becoming radicalized and joining extremist groups like Daesh, in countries with a Shi’a majority, such as Iran, is a controversial topic that has not received sufficient attention in the literature. This study examines Daesh’s media content in Farsi and seeks to provide an analysis of Daesh’s main messages, which have the primary objective of profoundly impacting their target audiences in Iran. This study collected data from 16 Iranian members of Daesh to discover how they were radicalized and why they decided to join Daesh. This study seeks to understand whether the media and Daesh’s propaganda are indeed the key reasons behind the radicalization of Daesh’s Iranian members and the creation of others’ perception of their mindsets against Iran and its Shi’a population, and to discover other possible factors that play a role in the radicalization process. While Daesh media and messages hold salience in relation to the Daeshization of some, studying such complex socio-political issues is rooted in an amalgamation of different personal, social, political, economic, and cultural push and pull factors. Such phenomena cannot, therefore, be reduced to only one of the mentioned elements.

RPL3L-containing ribosomes modulate mitochondrial activity in the mammalian heart

ABSTRACTThe existence of naturally occurring ribosome heterogeneity is now a well-acknowledged phenomenon. However, whether this heterogeneity leads to functionally diverse ‘specialized ribosomes’ is still a controversial topic. Here, we explore the biological function of RPL3L, a ribosomal protein (RP) paralog of RPL3 that is exclusively expressed in muscle and heart tissues, by generating a viable homozygous Rpl3l knockout mouse strain. We identify a rescue mechanism in which, upon Rpl3l depletion, RPL3 becomes upregulated, yielding RPL3-containing ribosomes instead of RPL3L-containing ribosomes that are typically found in cardiomyocytes. Using both ribosome profiling (Ribo-Seq) and a novel orthogonal approach consisting of ribosome pulldown coupled to nanopore sequencing (Nano-TRAP), we find that RPL3L neither modulated translational efficiency nor ribosome affinity towards a specific subset of transcripts. By contrast, we show that depletion of RPL3L leads to increased ribosome-mitochondria interactions in cardiomyocytes, which is accompanied by a significant increase in ATP levels, potentially as a result of mitochondrial activity fine-tuning. Our results demonstrate that the existence of tissue-specific RP paralogs does not necessarily lead to enhanced translation of specific transcripts or modulation of translational output. Instead, we reveal a complex cellular scenario in which RPL3L modulates the expression of RPL3, which in turn affects ribosomal subcellular localization and, ultimately, mitochondrial activity.

Population Growth and Economic Development: Theoretical Arguments and Empirical Findings— A Survey of Literature

The relationship between population growth and economic development has remained a controversial topic since the time of Malthus. Opinion among the scholars on this issue is sharply divided. This article examines the theoretical arguments about the likely consequences—positive or negative—of higher population growth on economic development and looks at the empirical findings on the issue based on the survey of literature in the field. The article traces the historical profile of demographic change in the developed and the developing countries over the last two centuries and analyses the factors behind them with particular reference to China and India. The implications of the findings for population control policy are also examined. There is a growing realisation of the fact that fertility decline is dependent upon socio-economic development. There is a general consensus among demographers that policies for fertility reduction should stress voluntary decisions on the part of the individuals concerned rather than compulsion and should be conceived in the context of a much wider programme for social, economic, and political development. The positive and negative incentives in this situation have a limited role to play in this context.

The Concept of Harm Reduction from Tobacco: Past, Present, Future

The concept of tobacco harm reduction (THR) is a speculative and controversial topic in the context of the international battle against the use of all types of tobacco. This concept involves providing tobacco users who are unable or unwilling to quit smoking or using other types of tobacco (snuff, chewing), with modified risk tobacco product (MRTP) for continued use. Skepticism about THR is huge and is associated with the negative experience of tobacco companies to produce cigarettes with a low content of tobacco tar/nicotine, which should have had significantly lower health risks than conventional cigarettes. Paradoxically, such an experience served as a springboard to an increase in the number of tobacco products that potentially have the properties of MRTP. Moreover, some members of the anti-smoking coalition, including WHO, consider the transition of tobacco smokers to MRTP as a strategy with great potential. However, the European Group of Experts believes that the MRTP strategy does not work and will lead to another generation of young people getting used to tobacco. In this article, we have critically analyzed the history of the past and present of tobacco products, myths and contradictions around them. We have tried to evaluate the modern concept of S THR as objectively as possible, which has a high potential for a real reduction in the number of deaths associated with smoking.

Knowledge, Attitude, and Awareness about Nitrous Oxide Inhalation Sedation among Dental Practitioners of Gujarat, India

Introduction: Conscious sedation is a safe and effective method of anxiolysis. However, the use of conscious sedation in pediatric dental patients is a controversial topic as it involves the intersection of dentistry and medicine. Among the many questions that could be asked, it is necessary to find out what dental practitioners think about the use of sedatives in their routine pediatric dental practice. Therefore, the above survey was conducted aiming to evaluate the perceptions of dentists on the use of Conscious Sedation in pediatric dental practice in Vadodara city, Gujarat. Methods: Questionnaires were sent electronically to Indian Dental Association (IDA) members of Vadodara at the time of the study. The contact details of these dental practitioners were obtained from the IDA members list. Details on personal status, use of, and training in, conscious sedation techniques were sought via the questionnaires to find the knowledge, attitude, and awareness towards the use of Conscious Sedation in pediatric dental practice. Results: The questionnaire was sent to IDA members in Vadodara city, Gujarat. 64.37% (150 dentists) responded to the questionnaire. 48% were female practitioners and 52% were male practitioners. 78.5% were in favor of using conscious sedation as a behavior management technique in pediatric dental practice, irrespective of their qualification or years of experience. Maximum knowledge about conscious sedation was obtained through the curriculum. Conclusion: It can be concluded that the dentists of Vadodara city, Gujarat state developed a positive attitude towards the use of conscious sedation, however, complained of a lack of training to the subject.