RESUMO
Background: Blood culture-negative endocarditis (BCNE) is a diagnostic challenge, therefore our objective was to pinpoint high-risk cohorts for BCNE. Methods: The study included adult patients with definite endocarditis. Data were collected via the Infectious Diseases International Research Initiative (ID-IRI). The study analysing one of the largest case series ever reported was conducted across 41 centers in 13 countries. We analysed the database to determine the predictors of BCNE using univariate and logistic regression analyses. Results: Blood cultures were negative in 101 (11.65 %) of 867 patients. We disclosed that as patients age, the likelihood of a negative blood culture significantly decreases (OR 0.975, 95 % CI 0.963-0.987, p < 0.001). Additionally, factors such as rheumatic heart disease (OR 2.036, 95 % CI 0.970-4.276, p = 0.049), aortic stenosis (OR 3.066, 95 % CI 1.564-6.010, p = 0.001), mitral regurgitation (OR 1.693, 95 % CI 1.012-2.833, p = 0.045), and prosthetic valves (OR 2.539, 95 % CI 1.599-4.031, p < 0.001) are associated with higher likelihoods of negative blood cultures. Our model can predict whether a patient falls into the culture-negative or culture-positive groups with a threshold of 0.104 (AUC±SE = 0.707 ± 0.027). The final model demonstrates a sensitivity of 70.3 % and a specificity of 57.0 %. Conclusion: Caution should be exercised when diagnosing endocarditis in patients with concurrent cardiac disorders, particularly in younger cases.
RESUMO
Discovering new applications for discarded materials, such as leather waste (LW), has proven to be an effective approach to an ecofriendly and sustainable production. The manufacture of halogen-free flame retardant LW containing thermoplastic polyurethane (TPU)-based samples containing an organic phosphinate (OP)-based flame retardant additive would represent an advance in this area. The effects of LW and OP levels on the thermal, flame retardant, and tensile properties of the samples using thermal gravimetric analysis (TGA), limiting oxygen index (LOI), vertical UL-94 (UL-94 V), mass loss calorimetry, and tensile tests have been assessed. OP is highly effective in LW-filled TPU. The highest UL-94 V rating of V0, LOI value of 31.4%, the lowest peak heat release rate (93 ± 3 kW/m2), and total heat evolved (49 ± 2 MJ/m2) values are obtained with the use of 20 wt % OP. OP is primarily promoted through the creation of a compact intumescent residue structure in the condensed phase. LW exhibits an adjuvant effect by producing nonflammable gases in the gas phase and raising the residual yield in the condensed phase. The most remarkable effect of the LW presence is observed in fire performance index (FPI) and fire growth rate (FIGRA) values. The highest FPI value of 0.49 sm2/kW and the lowest FIGRA value of 0.91 kW/m2s are observed with the use of 20 wt % LW.