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To compare cardiopulmonary variables and blood gas analytes in guinea pigs (Cavia porcellus) during anesthesia with and without abdominal carbon dioxide (COProspective experimental trial.A total of six intact female Hartley guinea pigs.A crossover study with sequence randomization for IAP and intubation status was used. The animals were sedated with intramuscular midazolam (1.5 mg kgIntubated guinea pigs had significantly higher pH and lower partial pressure of COAlthough the oral anatomy of guinea pigs makes endotracheal intubation difficult, capnoperitoneum during anesthesia induces marked hypercapnia in the absence of mechanical ventilation. An IAP of 4 mmHg should be further evaluated for laparoscopic procedures in guinea pigs because hypercapnia may be less severe than with 6 mmHg.

There is a lack of current, multi-institutional data regarding hospital outcomes of infants with interrupted aortic arch (IAA). We analyzed the Pediatric Health Information System database to identify infants with IAA who underwent repair during 2004 to 2019. We classified patients as simple or complex based on associated heart defects. We evaluated factors associated with hospital mortality and complications related to 22q11.2 deletion syndrome (22q11.2del) using mixed logistic regression, accounting for hospital clustering. In 1,283 infants included (904 simple, 379 complex), mortality was higher in the complex group (11.7% vs 4.4%, p0.001). Factors associated with mortality in the simple group were low birth weight (adjusted risk ratio [aRR] 3.77, 95% confidence interval [95% CI] 1.83 to 7.77), non-22q11.2del genetic conditions (aRR 6.44, 95% CI 1.73 to 23.96), and gastrointestinal anomalies (aRR 8.47, 95% CI 3.12 to 22.95), whereas surgery between 2012 and 2015 (aRR 0.36, 95% CI 0.13 to 0.99) was protective. In the complex group, factors associated with mortality were male (aRR 2.32, 95% CI 1.10 to 4.24) and central nervous system anomalies (aRR 3.73, 95% CI 1.62 to 8.59). Compared with their nonsyndromic counterparts, infants with simple IAA and 22q11.2del were at higher risk of sepsis (aRR 1.63, 95% CI 1.02 to 2.39) and gastrostomy tube placement (aRR 3.18, 95% CI 2.13 to 4.74), and infants with complex IAA and 22q11.2del were at higher risk of gastrostomy tube placement (aRR 2.42, 95% CI 1.20 to 4.88). In conclusion, presence of complex cardiac lesions is associated with increased mortality after IAA repair. The co-occurrence of extracardiac congenital anomalies and non-22q11.2del genetic conditions elevates mortality risk. Presence of 22q11.2del is associated with hospital complications.

With the increasing frequency of rabbits as veterinary patients, the expectation for high-quality, intensive veterinary care, and resultantly an understanding of anesthesia has been increasing. Sedation and general anesthesia are commonly required for many routine and emergency procedures in rabbits, and this results in the need for a strong awareness of anesthetic principles, knowledge of limitations of anesthesia, and maintenance of high standards of anesthesia.

Astrocytes play crucial roles in brain homeostasis and are regulatory elements of neuronal and synaptic physiology. Astrocytic alterations have been found in Major Depressive Disorder (MDD) patients; however, the consequences of astrocyte Ca2+ signaling in MDD are poorly understood. Here, we found that corticosterone-treated mice (Cort-mice) showed altered astrocytic Ca2+ dynamics in mPFC both in resting conditions and during social interactions, in line with altered mice behavior. Additionally, Cort-mice displayed reduced serotonin (5-HT)-mediated Ca2+ signaling in mPFC astrocytes, and aberrant 5-HT-driven synaptic plasticity in layer 2/3 mPFC neurons. Downregulation of astrocyte Ca2+ signaling in naïve animals mimicked the synaptic deficits found in Cort-mice. Remarkably, boosting astrocyte Ca2+ signaling with Gq-DREADDS restored mood and cognitive deficits in Cort-mice to control levels. This study highlights the important role of astrocyte Ca2+ signaling for homeostatic control of brain circuits and behavior, but also reveals its potential therapeutic value for depressive-like states.

Knowledge of genetic determinism and evolutionary dynamics mediating host-pathogen interactions is essential to manage fungal plant diseases. However, the genetic architecture of fungal pathogenicity remains poorly understood, and studies often focus on large-effect effector genes triggering strong, qualitative resistance. It is not clear how this translates to predominately quantitative pathogens. Here, we used theZymoseptoria tritici-wheat model to elucidate the genetic architecture of quantitative pathogenicity and mechanisms mediating host adaptation.Z. triticiis a globally occurring pathogen that causes severe yield losses on wheat. We perform whole-genome sequencing of 103 isolates and quantified pathogenicity traits on 12 cultivars harbouring different resistance genes. We perform a multi-host GWAS and identified 58 candidate genes associated with pathogenicity, of which nineteen are highly expressed and/or differentially expressedin planta. Two of these had large effects and three were shared in more than one cultivar, suggesting thatZ. triticipathogenicity is predominantly quantitative and host-specific. Analysis of genetic diversity revealed that sequence polymorphism is the main evolutionary process mediating differences in quantitative pathogenicity, a process that is likely facilitated by genetic recombination and transposable elements dynamics. We found signatures of positive diversifying selection in ∼68% of the candidate genes acting on specific amino acid substitutions, likely responsible for evasion of host recognition. Finally, we used functional approaches to confirm the role of an effector-like gene and a methyltransferase in quantitative pathogenicity. This study highlights the complex genetic architecture of quantitative pathogenicity, extensive diversifying selection and plausible mechanisms facilitating pathogen adaptation.

Due to the increase of mental health problems in college students, examining how bicultural stress may impact mental health is crucial. The purpose of the present study was to examine the relations between bicultural stress and depression, anxiety, and stress among college students. Additionally, race, Hispanic identification, and time of immigration were assessed to examine if they were significant moderators to the relationship between bicultural stress and mental health problems. A sample of 58 college students from the same Hispanic Serving Institute (HSI) in southern California completed measures assessing bicultural stress, anxiety, stress, depression, and a demographic questionnaire, including questions concerning race, ethnicity, and family immigration history. The results of the study showed that bicultural stress had a positive relation with anxiety, stress, and depression. Additionally, race moderated the relation between bicultural stress and anxiety where the bicultural stress of the minority racial group was more strongly related to higher levels of anxiety than the majority racial group. Time of immigration and Hispanic identification did not moderate the relation between bicultural stress and depression, anxiety, and stress. The results highlight the implication that it is necessary to transition college students to multicultural environments. HSIs could be beneficial as they can seek to mitigate the negative effects of bicultural stress.

Introduction: The World Health Organization declared, in January 2020, an outbreak of COVID-19 caused by SARS-CoV-2. Among the most common symptoms of COVID-19 are fever, cough, tiredness, ageusia and anosmia, with breathing difficulties being considered the serious effects. Several studies have shown that patients recovered from COVID-19 may continue to present sensory losses as well as other changes related to the central nervous system, constituting the post-covid syndrome. Objective: To analyze and evaluate in the literature the prevalence and impact of sensory dysfunctions caused by COVID-19 on the population's quality of life. Method: This is an integrative literature review, carried out in November 2021, in the SciELO, LILACS and PubMed databases, selecting articles published in Portuguese, in the years 2020 to 2021. The descriptors were: Ageusia, Anosmia , COVID-19, Quality of Life and Population, identifying similarities between studies that answered the guiding question: “What are the impacts of sensory losses caused by COVID-19 on quality of life?”. Results: Eighteen scientific articles that met the inclusion criteria were found and evaluated. According to the research carried out, it can be seen that cognitive and sensory changes have become much more common after COVID-19, mainly due to the loss of neurons caused by the disease. Conclusions: It is concluded that sensory losses related to SARS-CoV-2 infection have a significant biopsychosocial impact, with repercussions at a personal, social and even professional level. it is noted that these events can lead to changes in health-related quality of life, and it is extremely important to analyze the consequences of these losses.

The concurrent timing of the COVID-19 pandemic and the seasonal occurrence of influenza, makes it especially important to analyze the possible effect of the influenza vaccine on the risk of contracting COVID-19, or in reducing the complications caused by both diseases, especially in vulnerable populations. There is very little scientific information on the possible protective role of the influenza vaccine against the risk of contracting COVID-19, particularly in groups at high-risk of influenza complications. Reducing the risk of contracting COVID-19 in high-risk patients (those with a higher risk of infection, complications, and death) is essential to improve public well-being and to reduce hospital pressure and the collapse of primary health centers. Apart from overlapping in time, COVID-19 and flu share common aspects of transmission, so that measures to protect against flu might be effective in reducing the risk of contracting COVID-19.In this study, we conclude that the risk of contracting COVID-19 is reduced if patients are vaccinated against flu, but the reduction is small (0.22%) and therefore not clinically important. When this reduction is analysed based on the risk factor suffered by the patient, statistically significant differences have been obtained for patients with cardiovascular problems, diabetics, chronic lung and chronic kidney, in all four cases the reduction in the risk of contagion does not reach 1%.It is worth highlighting the behaviour that is completely different from the rest of the data for institutionalized patients. The data for these patients does not suggest a reduction in the risk of contagion for patients vaccinated against the flu, but rather the opposite, a significant increase of 6%.Socioeconomic conditions, as measured by the MEDEA deprivation index, explain increases in the risk of contracting COVID-19, and awareness campaigns should be increased to boost vaccination programs.

Os corpos d'água costumam sofrer eutrofização como resultado do excesso de nutrientes, e isso impulsionou a necessidade de desenvolvimento de tecnologias para auxiliar e manter a qualidade da água. Os sistemas Algal Turf Scrubber (ATS) são alternativas para a preservação e monitoramento das condições da água, bem como proporcionar sustentabilidade ambiental e financeira ao longo do tempo. Com base nisso, objetivamos estudar o potencial de desenvolvimento de um biofilme em um sistema piloto de ATS instalado em um lago durante o período de outono/inverno. Para isso, monitoramos alguns parâmetros da água, avaliamos o rendimento de biomassa e identificamos as microalgas no perifíton. As estações selecionadas e as condições ambientais complicaram o desenvolvimento do biofilme. Apesar disso, obtivemos um rendimento de biomassa de 4,67 g m-2 d-1 e sua composição de lipídios foram de 10%, em que os ácidos graxos em maior abundância foram o ácido palmítico e oleico. Através de estudos morfológicos e taxonômicos, quatro gêneros de microalgas foram identificados: Chlorella; Desmodesmus; Pedriastrum e Spirogyra. Acreditamos que analisando em outras estações e variações das condições ambientais poderia levar a um maior desenvolvimento do perifíton e, consequentemente, a melhores tratamentos para massas de água eutrofizadas.

Objective To evaluate staining of nerve branches after the injection of different volumes during ultrasound-guided transversus abdominis plane (TAP) block in dog cadavers. Study design Prospective randomized study. Animals A total of 15 frozen/thawed adult dog cadavers. Methods Hemiabdomens were randomly allocated to one of four groups. In groups G0.3, G0.6 and G1.0, ropivacaine–methylene blue solution (0.3, 0.6 and 1.0 mL kg–1 in seven, eight and eight hemiabdomens, respectively) was injected at the midpoint between the iliac crest and the last rib at the height of the shoulder. In group G0.3×2 (seven hemiabdomens), two injections (0.3 mL kg–1) were performed, caudal to the last rib and cranial to the iliac crest at the same height. Total time for injection was recorded; after 30 minutes, cadavers were dissected and spread of dye was evaluated. Results Accuracy of injection site was 80% and injection time was 71 (48–120) seconds for all groups together. Craniocaudal spread was 6.4 ± 1.6, 9.1 ± 2.6, 11.4 ± 2.3 and 11.2 ± 3.8 cm for G0.3, G0.6, G1.0 and G0.3×2, respectively [G0.3 to G0.3×2 (p = 0.044) and G1.0 (p = 0.034)]. There was no difference in dorsoventral spread among groups. Number of ventral nerve branches stained was 3 (2–4), 3 (2–4), 3 (3–4) and 3 (2–4) for G0.3, G0.6, G1.0 and G0.3×2, respectively, including nerve branches from twelfth thoracic to third lumbar (L3) in different proportions among groups. Conclusions and clinical relevance Results suggest that a single-injection TAP block, using 0.3 mL kg–1, stains comparable number of nerve branches as higher volumes or two-point injection. Despite the volume or technique, consistent staining of the innervation of the caudal abdomen (L1–L3) was observed. Additional cadaveric studies are necessary to identify the optimal technique for complete abdominal wall staining.

La pandemia de COVID-19 ha generado impactos a nivel mundial en la salud pública, la economía, el transporte, las comunicaciones, el trabajo, la tecnología y la vida cotidiana. De igual forma, las instalaciones radiactivas se vieron afectadas en su operación, lo que ocasionó la toma de decisiones relacionadas con la seguridad tecnológica y seguridad física. Se realizó un estudio exploratorio tipo encuesta para conocer las percepciones del impacto de la pandemia de COVID-19 en las instalaciones radiactivas de Colombia, excluyendo las operadas por el Servicio Geológico Colombiano. Se encontró que la pandemia ocasionó el cese de operación del 43,2 % de las instalaciones encuestadas, el 26,4 % reportó sobrecostos, el 4,8 % desvinculó trabajadores ocupacionalmente expuestos y el 0,8 % ha contemplado la posibilidad de clausurar la instalación. La investigación evidenció el potencial de los desarrollos tecnológicos para la supervisión remota de las instalaciones, así como, la importancia de intercambiar experiencias y lecciones aprendidas durante la pandemia para facilitar la toma de decisiones.

Introdução: A Organização Mundial de Saúde declarou, em janeiro de 2020, um surto de COVID-19 causado pelo SARS-CoV-2, o que constituía uma emergência de saúde pública mundial. Pesquisadores do mundo todo entraram em uma batalha contra a falta de informações existentes sobre o vírus. Dentre os sintomas mais comuns da COVID-19, encontram-se febre, tosse, cansaço, ageusia (perda de paladar) e anosmia (perda do olfato), sendo considerados os efeitos graves as dificuldades respiratórias. Vários estudos têm demonstrado que pacientes recuperados da COVID-19 podem continuar a apresentar perdas sensoriais bem como outras alterações relacionadas ao sistema nervoso central, por exemplo a perda de memória e falta de concentração, constituindo a síndrome pós-covid. Acredita-se que o SARS-CoV-2 é capaz de promover danos neuronais. Objetivo: Analisar a prevalência e o impacto das disfunções sensoriais causadas pelo COVID-19 na qualidade de vida da população. Método: Trata-se de uma revisão integrativa da literatura, realizada em novembro de 2021, nas bases de dados SciELO, LILACS e Pubmed, selecionando-se 5 artigos, sendo todos publicados no ano de 2020 e 2021 e na língua portuguesa. Os descritores utilizados durante a pesquisa bibliográfica foram: Ageusia, Anosmia, COVID-19, Qualidade de Vida e População, identificando semelhanças entre aquelas pesquisas que respondiam à pergunta norteadora: Quais são os impactos das perdas sensoriais causadas pelo COVID-19 na qualidade de vida? Resultados: De acordo com a pesquisa realizada, pode-se observar que as alterações cognitivas e sensoriais bem como o aumento de casos de doenças neuropsiquiátricas se tornaram muito mais comuns após o COVID-19, principalmente devido à perda de neurônios causada pela doença, mesmo após a plena recuperação da infecção causada pelo SARS-CoV-2. Do ponto de vista neurológico observamos um intenso acometimento do sistema nervoso central e do sistema nervoso periférico, tendo como relatos de danos mais comuns a anosmia e a ageusia, podendo chegar a consequências mais severas como por exemplo, a doença de Parkinson e a Esclerose Múltipla. Relacionado às perdas sensoriais (paladar e olfato), os estudos indicam que esses acometimentos podem remeter a dois mecanismos principais, o bloqueio inflamatório das fendas olfatórias e/ou o comprometimento do neuroepitélio olfatório. Podem-se destacar como agravantes, os pacientes que já tinham alguma doença de base ou que foram submetidos a cuidados intensivos, além de outros fatores existentes como ansiedade, estresse, sobrecarga no ambiente doméstico ou de trabalho, diminuição ao acesso à saúde e sedentarismo. Conclusões: Os órgãos dos sentidos humanos são estruturas anatômica e fisiologicamente complexas e extremamente importantes para a manutenção dos processos vitais dos seres vivos. Observa-se que as perdas sensoriais relacionadas à infecção do SARS-CoV-2 apresentam significativo impacto biopsicossocial, repercutindo a nível pessoal, social e até mesmo profissional. Desta forma, nota-se que estes eventos podem acarretar alterações na qualidade de vida relacionada à saúde, sendo de extrema importância analisar as consequências biopsicossociais dessas perdas bem como buscar maneiras não apenas de combater os sintomas da doença durante sua fase ativa, mas também minimizar suas possíveis sequelas, visando a manutenção da qualidade de vida e a promoção de saúde da população.

Os ví­rus representam causa comum de doença infecciosa adquirida em ambientes interiores, pois são facilmente transmitidos, especialmente em ambientes lotados e mal ventilados. Recentemente, o mundo vem passando pela pandemia da Sí­ndrome Respiratória Aguda Grave do Coronaví­rus 2 (SARS-CoV-2). Esse estudo objetivou verificar na literatura internacional o risco de transmissão do ví­rus por aerossóis em ambientes climatizados, como hospitais, aeronaves e navios de cruzeiro. Tratou-se de revisão integrativa da literatura. A questão norteadora desta revisão foi: O Coronaví­rus pode se propagar pelo ar interior de ambientes climatizados como hospitais, aeronaves e navios e representar risco de transmissão para os usuários desses ambientes? A literatura pesquisada revelou que os aerossóis virais podem comprometer a qualidade do ar de ambientes interiores e facilitar a transmissão da SARS-CoV-2. Portanto, mais pesquisas devem ser realizadas no sentido de corroborar esses achados e também são necessárias medidas urgentes para melhorar a limpeza e higienização desses ambientes, além da verificação da renovação e filtragem do ar interior em salas de isolamento em hospitais, aeronaves e navios de cruzeiro.

El test ECCO_Senior se diseñó para evaluar la comprensión de oraciones en adultos mayores. Es una prueba corta y de fácil aplicación, que se ha empleado en distintos estudios previos. En el estudio participaron 670 personas, de 50 a 85 años de edad, que cumplían criterios de inclusión relativos al estatus cognitivo general, el estado de ánimo y porcentaje mínimo de aciertos en el test. Además de los test de cribado (MEC y GDS-15) y un cuestionario socio-demográfico, se aplicó a todos los participantes el test ECCO_Senior con el que se pueden obtener distintos índices (generales y específicos). Además de comprobar si existen diferencias entre los grupos según la edad y el nivel educativo, se evaluaron las propiedades psicométricas del test, incluyendo evidencias de validez en las que se probó la bondad de ajuste de tres modelos estructurales que sirven para identificar los índices que explican un mayor porcentaje de la varianza del constructo (comprensión de oraciones). Se ofrecen normas interpretativas del test por edad y nivel de estudios en los Apéndices. Los resultados indican que el test permite evaluar la comprensión de oraciones con una fiabilidad adecuada y es sensible a las dificultades que puede experimentar un adulto al realizar esta tarea. Los tres modelos muestran un buen ajuste y permiten concluir que las oraciones no ajustadas al orden sintáctico canónico y los distractores léxicos (si se considera el tipo de ítem) serían los mejores indicadores en términos del porcentaje de la varianza del constructo que explican., The ECCO_Senior test was designed to assess sentence comprehension in older adults. It is a short test and easy to apply, which has been used in different previous studies. The study involved 670 people, 50 to 85 years of age, who met inclusion criteria related to general cognitive status, mood and minimum percentage of performance in the test. In addition to the screening tests (MEC and GDS-15) and a socio-demographic questionnaire, the ECCO_Senior test was applied to all participants with which different indices (general and specific) can be obtained. In addition to checking if there are differences between the groups according to age and educational level, we evaluated the psychometric properties of the test, evidences of validity included, thus we tested the goodness of fit of three structural models that serve to identify the indices that explain a greater percentage of the variance of the construct (comprehension of sentences). Interpretive norms of the test are offered by age and level of studies in the Appendices. The results indicate that the test allows to evaluate sentence comprehension with adequate reliability and it is sensitive to the difficulties that an adult may experience when performing this task. The three models show a good fit and allow us to conclude that the sentences not adjusted to the canonical syntactic order and lexical foils (if the type of item is considered) would be the best indexes in terms of the percentage of construct’s variance they explain.

Objective To determine the effects of midazolam on the minimum anesthetic concentration (MAC) reduction of end-tidal isoflurane concentration (F e′ Iso) measured using an electrical stimulus in Quaker parrots (Myiopsitta monachus). Study design Randomized crossover experimental study. Animals A group of six adult Quaker parrots, weighing 98–124 g. Methods Birds were anesthetized with isoflurane in oxygen delivered by mask, then tracheally intubated and mechanically ventilated. Three treatments were applied with a 4 day interval between anesthetic events. Each anesthetized bird was administered midazolam (1 mg kg−1; treatment MID1), midazolam (2 mg kg−1; treatment MID2) or electrolyte solution (control) intramuscularly. The treatments were administered using a replicated Latin square design and the observers were blinded. Based on a pilot bird, the starting F e′ Iso was 1.8%. After equilibration for 10 minutes, a supramaximal stimulus was delivered using an electrical current (20 V and 50 Hz for 10 ms) and birds were observed for non-reflex movement. The F e′ Iso was titrated by 0.1% until a crossover event was observed. The MAC was estimated using logistic regression. Results The MAC of isoflurane (MACISO) was estimated at 2.52% [95% confidence interval (CI), 2.19–2.85] with a range of 1.85–2.65%. MACISO in MID1 was 2.04% (95% CI, 1.71–2.37) and in MID2 was 1.81% (95% CI, 1.48–2.14); reductions in MACISO from control of 19% (p = 0.001) and 28% (p Conclusions Midazolam (1–2 mg kg−1) intramuscularly resulted in a significant isoflurane-sparing effect in response to a noxious stimulus in Quaker parrots without observable adverse effects. Clinical relevance Midazolam can be used as part of a balanced anesthetic approach using isoflurane in Quaker parrots, and potentially in other psittacine species.

A 4-y-old, female mixed-breed dog was presented to the Ontario Veterinary College for further evaluation of multiple pulmonary and hepatic masses, intrathoracic lymphadenitis, and recent development of a pyogranulomatous pleural effusion. Along with other comprehensive tests, a thoracic lymph node biopsy was performed, and

Objetivo: Identificar as formas de intervenções espirituais durante o cuidar de enfermagem e os benefí­cios da espiritualidade para os pacientes. Método: Revisão integrativa da literatura, realizada nas bases de dados LILACS e SciELO, utilizando os descritores: espiritualidade e enfermagem, no perí­odo de 2008 a 2018. Resultados: Foram encontrados 410 estudos, sendo que após análise, adequação ao tema da revisão e exclusão de duplicatas, selecionou-se 31. As intervenções espirituais realizadas pelos enfermeiros junto aos doentes em sofrimento incluí­ram comunicação verbal e não verbal. Dentre as dificuldades encontradas pelos enfermeiros para prestar o cuidado espiritual destacaram-se falta de tempo, falta de conhecimento e desconforto ao abordar essa temática. Para o paciente, o cuidado espiritual resultou em melhor enfretamento da doença, calma, paz interior, alí­vio da dor, diminuição da ansiedade e sintomas depressivos. Conclusão: O cuidado espiritual ao paciente é de suma importância para uma assistência integral.

Objetivo: Analisar o uso das metodologias ativas de aprendizagem na formação de Enfermagem. Método: Trata-se de uma revisão sistemática, realizada nas fontes de busca LILACS, SciELO, PubMed, BDENF e CINAHL, no perí­odo de 2007 a 2018. A questão norteadora desta revisão sistemática foi: Quais são os impactos da utilização das metodologias ativas na formação dos profissionais de enfermagem? Resultados: Foram identificados 548 artigos, mas, selecionados 62 artigos que se adequaram í temática estudada. As metodologias ativas abordadas nos trabalhos foram: problematização, aprendizagem baseada em equipe, software ou programa computacional, caso clí­nico, diário de bordo, portfólio reflexivo e simulação. Conclusões: A maioria dos trabalhos estudados identificou as tentativas da enfermagem para adotar concepções pedagógicas inovadoras em suas práticas de ensino e assistência. As metodologias ativas utilizados na formação da Enfermagem tornaram os profissionais mais independentes, preparados para trabalhar em equipe e envolvidos com a realidade social.

13 Pàg., Natural infections frequently involve several co-infecting pathogen strains. These mixed infections can affect the extent of the infection, the transmission success of the pathogen and the eventual epidemic outcome. To date, few studies have investigated how mixed infections affect transmission between hosts. Zymoseptoria tritici is a highly diverse wheat pathogen in which multiple strains often coexist in the same lesion. Here we demonstrate that the most competitive strains often exclude their competitors during serial passages of mixed infections. The outcome of the competition depended on both the host genotype and the genotypes of the competing pathogen strains. Differences in virulence among the strains were not associated with competitive advantages during transmission, while differences in reproductive potential had a strong effect on strain competitive ability. Overall, our findings suggest that host specialization is determined mainly by the ability to successfully transmit offspring to new hosts during mixed infections., This project was supported by the ETH research grant ETH-23 15-2 to A.S.-V. and B.A.M. and by Ministerio de Ciencia e Innovación research grant RYC2018-025530-I to A.S.-V.

People that consumed treated water from Dourado Lake, Santa Cruz do Sul, RS, Brazil perceived alterations in its taste and odor. Based on this, we focused our study on the monitoring of 2-MIB and GSM in samples collected from Dourado Lake, using solid-phase microextraction (SPME) coupled to gas chromatography/mass spectrometry (GC/MS). The monitoring was done by performing exploratory evaluations at several points on the lake during the summers of 2017 and 2018 and in all seasons of 2019, considering points of water in an inlet and an outlet of the lake. At the inlet point, the average concentration of GSM was 7.56 ± 1.94 ng L-1 and that of 2-MIB was 33.09 ± 6.89 ng L-1. However, for the outlet point, the average concentrations of GSM and 2-MIB were 10.62 ± 2.51 ng L-1 and 28.72 ± 10.47 ng L-1, respectively. In all cases, the presence of GSM and 2-MIB was perceptible by the people consuming the water (during all seasons), showing the need for correct management of water resources. People that consumed treated water from Dourado Lake, Santa Cruz do Sul, RS, Brazil, perceived alterations in its taste and odor. Based on this, it was studied the monitoring of 2-mthylisoborneol (2-MIB) and geosmin (GSM) in samples collected from Dourado Lake, using solid-phase microextraction (SPME) coupled to gas chromatography/mass spectrometry (GC/MS). The monitoring was done by performing exploratory evaluations at several points on the lake during the summers of 2017 and 2018 and in all seasons of 2019, considering points of water in an inflow and an outflow of the lake. At the inlet point, the average concentration of GSM was 7.56 ± 1.94 ng L-1 and that of 2-MIB was 33.09 ± 6.89 ng L-1. However, for the outlet point, the average concentrations of GSM and 2-MIB were 10.62 ± 2.51 ng L-1 and 28.72 ± 10.47 ng L-1, respectively. In all cases, the presence of GSM and 2-MIB was perceptible by the people consuming the water(during all seasons), showing the need for correct management of water resources.

RNA binding motif 20 (RBM20) cardiomyopathy has been detected in approximately 3% of populations afflicted with dilated cardiomyopathy (DCM). It is well conceived that RBM20 cardiomyopathy is provoked by titin isoform switching in combination with resting Ca2+ leaking. In this study, we characterized the cardiac function in Rbm20 knockout (KO) rats at 3‐, 6‐, 9‐, and 12‐months of age and examined the effect of the ryanodine receptor stabilizer S107 on resting intracellular levels and cardiomyocyte contractile properties. Our results revealed that even though Rbm20 depletion promoted expression of larger titin isoform and reduced myocardial stiffness in young rats (3 months of age), the established DCM phenotype required more time to embellish. S107 restored elevated intracellular Ca2+ to normal levels and ameliorated cardiomyocyte contractile properties in isolated cardiomyocytes from 6‐month‐old Rbm20 KO rats. However, S107 failed to preserve cardiac homeostasis in Rbm20 KO rats at 12 months of age, unexpectedly, likely due to the existence of multiple pathogenic mechanisms. Taken together, our data suggest the therapeutic promises of S107 in the management of RBM20 cardiomyopathy., Loss of Rbm20 results in reduced myocardial stiffness at younger age and overt RBM20 cardiomyopathy at older age in rats. The RyR2 stabilizer S107 improves contractility properties by restoring the elevated resting intracellular Ca2+ level in Rbm20‐depleted cardiomyocytes. S107 could be a component of a therapeutic option for RBM20 cardiomyopathy.

Objetivo: Analisar a produção cientí­fica nacional e internacional acerca da utilização da laserterapia pelo enfermeiro notratamento de lesões cutâneas e orais. Métodos: Tratou-se de uma revisão integrativa realizada nas bases de dados SciELO, Lilacs,Pubmed e Bdenf, nos últimos sete anos, utilizando os seguintes descritores: laser, feridas, lesões por pressão, mucosite oral, fissuras mamáriase enfermagem. Resultados: Não foram localizados artigos cientí­ficos nas bases de dados pesquisadas, utilizando os descritoreslaser, mucosite oral, fissuras mamárias e enfermagem. Foram localizados 83 artigos cientí­ficos e, selecionados 4, que se adequaram í temática laserterapia, feridas, lesões por pressão e enfermagem. Conclusão: Embora o Conselho Federal de Enfermagem tenha aprovadoa utilização da laserterpia para tratamento de lesões cutâneas e orais, enfatiza- se a necessidade dos enfermeiros se capacitaremem laserterapia, visando ao tratamento de lesões, pois o laser de baixa potência representa um tratamento promissor para acelerar oreparo tecidual.

Le luxe est associe a l’exces mais aussi a la beaute et au plaisir. Il eveille souvent des reactions a la fois favorables et defavorables parmi les consommateurs, en particulier chez les jeunes ou millennials. Cette categorie de la population, generalement negligee dans les etudes sur le luxe, represente pourtant un levier potentiel de croissance pour les marques de luxe. Par ailleurs, ce segment represente l’avenir dans le sens ou il sera au cœur du marche du luxe des adultes de demain. Les enjeux sont donc importants. Ce segment des millennials pourrait en effet eprouver des sentiments d’ambivalence face a la decision d’acheter des produits de luxe et cela pourrait influencer son intention de faire des achats et de les reporter. L’impact de l’ambivalence sur ces variables est mal connu dans la litterature en marketing. En effet, les etudes sur les attitudes envers les produits et marques de luxe utilisent des echelles qui mesurent les attitudes favorables ou defavorables mais qui ne permettent pas aux consommateurs d’exprimer leur ambivalence. Afin d’expliquer comment l’ambivalence influe sur la decision d’acheter des produits de luxe, nous avons mene une enquete par questionnaire aupres de 143 etudiants francais. Les resultats montrent que l’ambivalence a un double effet sur les intentions de ce nouveau segment de consommateurs : elle attenue l’intention d’achat par le biais de l’attitude, et favorise le report d’achat par le biais de la recherche d’informations.

Fil: Sánchez Ruiz, Andrea. Pontificia Universidad Católica Argentina; Argentina Resumen: Cabría pensar que en el ámbito familiar la hospitalidad supone hacer del propio hogar una morada a quien adviene de fuera, desconocido o forastero y es recibido para augurar un fecundo «nosotros». Sin embargo, a lo largo de la trayectoria familiar, no solo reconocemos en el hijo o la hija que llega, recién nacido o ya crecido, indefenso, necesitado, un tú a quien hospedar amorosamente sino también a quien va ir siendo con el paso de los años. Y ese ser que va siendo, en su entera libertad, también habrá de ser hospedado más de una vez si se muestra, por momentos, como un extraño a quien abrir las puertas para seguir siendo «nosotros» siendo cada uno, cada una, sí mismo. En estas páginas, a partir de la experiencia de hospedarse/hospedarnos en familia, haré foco en la situación que se plantea cuando un niño o una niña se manifiesta como transgénero. No abordaré una temática. No estudiaré un objeto: la transe- xualidad. No abriré juicios morales. La complejidad de la situación demanda una reflexión teológica y antropológica que no será en esta ocasión más que un balbuceo, preguntas que nos interpelen a pensar cómo Dios se revela en tales circunstancias, cuál es su Rostro en sus rostros, qué antropología podemos imaginar para incluir identidades que desbordan los límites de lo conocido y aprendido. Siguiendo a Rita Segato, plantearé brevemente mi abordaje como una «antropología por demanda», para ofrecer las lentes desde donde podré enfocar la experiencia de vida narrada por los papás y las mamás que han recorrido este camino con sus hijos e hijas. En un segundo momento aclararé algunos conceptos básicos que nos permitan una comprensión más amplia de lo que iremos reflexionando. Finalmente, la llamada insistente del Evangelio, que en palabras de Francisco nos interpelan a aceptar y promover, «el desafío de la hospitalidad, la cultura del encuentro», nos ofrecerá el camino para un abordaje teológico y antropológico en proceso y, por tanto, inacabado. Abstract: It is easy to think that within the family nucleus hospitality means offering our own home to any stranger and welcome him to a future «we». However, through- out our family history, the daughter or son who is coming, whether a newborn or a grown up, is a person to lovingly took care of and host over the years. This free human being will be also taken in several times if he/she shows himself/herself as a stranger to other people with whom later become a «we». Throughout these pages, based on the experience of living as a family, I will con- centrate on the situation that arises when a child identifies himself/herself as transgender. I will not address one topic. I will not study an object: transsexuality. I will not introduce moral judgments. The complexity of the situation requests a theological and anthropological debate but in this case it will only be a summary to leave space to questions about how God reveals himself in this situations, to see his face in our face and to image an anthropology in which we can include the different identities beyond the scope of what we already know. Following Rita Segato, I will briefly present my own approach about «anthropolo- gy by demand», to shine a light on the life experience narrated by the parents that have come a long way with their children. Secondly, I will clarify some basic con- cepts for a broader understanding. Finally, the constant call of the Gospel, as ex- pressed by Francisco when he talks about accepting and supporting «the challenge of hospitality, culture and gather ing» will leads us the way towards the ongoing theological and anthropological approach, which is still unfinished.

Scalp electrode impedance measurements recorded by wired and wireless electroencephalography (EEG) machines in 7 healthy dogs were compared. Eight recordings resulted in 80 impedance readings from subdermal wire electrodes (locations F7/F8, F3/F4, T3/T4, C3/C4, Fz, and Cz). Impedance values were measured first from the wired and then the wireless EEG machine. Wireless impedance measurements were higher than the wired EEG machine in 79/80 readings (P ≤ 0.05), being on average 2.83 kΩ [P ≤ 0.05, 95% confidence interval (CI): 2.51 to 3.14, SD = 1.42] higher. Impedances from the wired machine ranged between < 0.5 and 9 kΩ (mean = 3.09, median = 2.00, SD = 2.15), whereas impedances from the wireless machine ranged between 2.69 and 6.07 kΩ (mean = 5.92, median = 5.05, SD = 2.59). Despite these differences in impedance measurements, both machines measured similar impedance patterns. The wireless EEG machine’s impedance measurements, therefore, should be acceptable for veterinary clinical settings.

Presented by: Javier Padilla-Cabello (jpadillacabello@gmail.com) Introduction A 67-year-old male patient, smoker of more than a pack a day since childhood, presented to the emergency department with a right cervical tumor and dysphagia of twoweeks' evolution. On examination, cervical palpation revealed an adenopathy in the right area IIa of about 5 cm in diameter, stony and adherent to deep planes. Fibrolaryngoscopy showed a lesion on the right laryngeal surface of the epiglottis and a leukoplakia in the right lateral glossoepiglottic fold. Therefore, it was decided to perform transoral laryngeal microsurgery to take biopsies and request CT for extension study. Materials and Methods The samples taken in the operating room and the CT scan showed that it was an epidermoid carcinoma of the supraglottis stage cT1N2BM0. It was decided to perform a right hemiepiglottectomy with extension to the right lateral glossoepiglottic fold by transoral laser surgery together with bilateral functional cervical emptying. The patient required a tracheotomy due to an episode of severe post-surgical laryngeal edema and the cannula had to be maintained, together with a gastrostomy, because the patient subsequently developed dysphagia with aspiration of secretions and food. Results Histopathological analysis showed that it was a combined tumor: on the one hand a poorly differentiated epiglottic neuroendocrine carcinoma (NEC) (CK-20 +, S100 +, Ki67 90%) with cervical metastasis and on the other hand a supraglottic squamous cell carcinoma in the right glossoepiglottic fold with one cervical metastasis (pT1N1). The case was presented to the oncology committee and it was decided to complete treatment with chemoradiotherapy. Chemotherapy was administered with a reduced dose of carboplatin (AUC = 3) and etoposide. Despite treatment, local cervical tumor progression was observed in the control CT scan and the patient finally died a few weeks later due to COVID19. Conclusions NEC of the larynx are very rare and aggressive, so an accurate histopathologic diagnosis is essential for early treatment. Their most frequent location is the supraglottis and the clinical presentation of the patient is a mild odynophagia or a cervical mass. Very few associated cases of synchronous laryngeal squamous cell carcinoma have been described. Treatment of NEC is based on chemoradiotherapy with a survival rate of less than 5% at 5 years.

The effects of feeding frequency on postprandial response of circulating appetite-regulating hormones, insulin, glucose and amino acids, and on physical activity, energy expenditure, and respiratory quotient were studied in healthy adult cats. Two experiments were designed as a 2 x 3 replicated incomplete Latin square design. Eight cats, with an average body weight (BW) of 4.34 kg ± 0.04 and body condition score (BCS) of 5.4 ± 1.4 (9 point scale), were fed isocaloric amounts of a commercial adult maintenance canned cat food either once (0800 h) or four times daily (0800 h, 1130 h, 1500 h, 1830 h). Study 1 consisted of three 21-d periods. On day 14, two fasted and 11 postprandial blood samples were collected over 24 hours to measure plasma concentrations of ghrelin, GLP-1, GIP, leptin, PYY, insulin and amino acids, and whole blood glucose. Physical activity was monitored from day 15 to 21 of each period. In Study 2 indirect calorimetry was performed on the last day of each period. Body weight was measured weekly and feed intake recorded daily in both experiments. No effect of feeding regimen on BW was detected. Cats eating four times daily had lesser plasma concentrations of GIP and GLP-1 (P0.1). Cats fed once daily had a greater postprandial plasma amino acid response, and greater plasma ghrelin and insulin concentrations (P

Se aplicó la metodología análisis probabilístico de seguridad para la cuantificación del riesgo radiológico asociado a la operación del irradiador del fabricante HopeWell modelo G-100 en el Laboratorio Secundario de Calibración Dosimétrica del Servicio Geológico Colombiano. El irradiador cuenta con una fuente radiactiva de 60Co con actividad nominal de 185 TBq, considerada una fuente extremadamente peligrosa para las personas, según el Organismo Internacional de Energía Atómica. El análisis contempló la identificación de los sucesos iniciadores mediante la metodología de diagramas lógicos maestros, la determinación de las secuencias accidentales y su frecuencia mediante árboles de fallo y la estimación de la magnitud de la consecuencia de cada secuencia accidental en función de la probabilidad de causar la muerte de un individuo asociada al escenario de exposición planteado. El riesgo cuantificado fue de 1,6 x 10–5 por año para una exposición mortal, que es inferior a la restricción establecida de 1,44 x 10–4 por año. Finalmente, se encontró que las disposiciones de protección y seguridad más críticas son las relacionas con la capacitación sobre el significado de las señales de advertencia del inicio de las secuencias de último hombre afuera (LMO, por su sigla en inglés) y de inicio de irradiación, seguidas por estas señales de advertencia.

This dissertation addresses the phenomenon of complex failure in the context of rotating mechanical systems. Specifically, complex failure refers to the irreversible alterations of the load distribution, leading to a heterogeneous degradation of system components. In general complex failures cannot be attributed to a single component damage nor the operational environment alone. Rather these emerge as a combination of factors that undermine system functionality altogether. Complex failures stretch the modelling possibilities from a physics and an empirical perspective to a system-wide scale, limiting the accuracy of their assessment. This dissertation offers a framework for the study of complex failures. This framework elaborates from the theory of material degradation and extends to the changes in load distribution among system components. Such changes are understood to obey to fundamentally different principles than those used in the design. The framework is guided according to four main elements: the mechanisms and dynamics of complex failures, and the methods and instruments necessary to the assessment of the corresponding failure behaviour. The principles of failure behaviour and the functional approach to vibration monitoring are illustrated in two mechanical sub-systems: roller bearings and rotor blade systems. The rolling bearing case is developed through a comparative study of three different systems displaying bearing damage, a lab set-up, a wind turbine generator and a train axle box, for which a comparison of different types of damage and operational environment is performed. The rotor blade case is developed through a representing the operational excitations and boundary conditions of a rotating blade. Finally, a design framework for vibration monitoring systems in accordance with the monitoring needs for complex failure is presented.

O objetivo deste trabalho foi simular e avaliar com o código RELAP5 o acidente base de projeto de perda de refrigerante primário devido a uma ruptura média na linha de surto do pressurizador da usina nuclear Angra 2. Este acidente foi uma quebra do tipo guilhotina ou seja 100% da tubulação e representa uma ruptura de 437 cm². Nesta análise, verificou-se que as lógicas de atuação do Sistema de Proteção do Reator (SPR) e do Sistema de Resfriamento de Emergência do Núcleo (SREN) de Angra 2, utilizadas nesta simulação, funcionaram corretamente, mantendo a integridade do núcleo com as temperaturas do núcleo em níveis aceitáveis durante todo o evento. Os resultados obtidos foram satisfatórios, quando comparados com os apresentados no Relatório Final de Análise de Segurança de Angra 2 (FSAR/A2).

BACKGROUND Our case report demonstrates acute onset of diplopia due to Isolated Sixth Nerve Palsy (ISNP) secondary to uncontrolled T2DM, presenting as an ophthalmoplegia. The most frequent one, is ISNP with an incidence of 11.3/100.000 1. Vasculopathic ISNP is associated with atherosclerosis in patients older than 50 years 1. CASE PRESENTATION A 63 year-old male with history of T2DM, HTN, HL, came for evaluation of acute onset double vision 3 days prior. He noted diplopia while attempting to park his car; he saw that tracking to the left with his eyes would elicit double vision. Denied recent travel, trauma, headache or dizziness. He was awake and alert, BP 200/110mmHg, BMI 33. No pathologic murmur. He had PERRLA bilaterally but impaired lateral rectus muscle movement on the left side. Otherwise, EOMI on the right side. No facial asymmetry or ptosis. Overall, findings positive for ISNP. BMP only remarkable for a glucose of 297, HA1c was 10.0. Head CT was negative for any acute intracranial abnormality. Orbital MRI did not show acute infarction or masses. Patient was admitted for acute diplopia due to ISNP. Differential diagnoses were neoplasm, migraine, MS and diabetic neuropathy. Based on the aforementioned data, we suggested that T2DM was the probable cause. Counseling on improving glycemic control was given. Unfortunately, patient was lost to follow up. DISCUSSION ISNP remains an elusive entity; atherosclerotic risk factors such as DM, HTN, HL, hyperhomocysteinemia 2 or viral infections 3 have been reported in association. This type of palsy seems to be more frequent in children and can be recurrent in nature. In adults, the most likely cause of ISNP seems to be ischemic mononeuropathy or more aggressive etiologies such as temporal arteritis 4. Inconclusive images prove even a higher diagnostic challenge 3. Of note, we found a case demonstrating evidence for Eicosapentaenoic Acid in the improvement of ISNP with recovery in as shortly as 8 weeks. The basis of this treatment lies in the recovery of endothelial function focusing on the anti-platelet and anti-inflammatory effects of the drug2,4. REFERENCES (1). Elder, Christopher, et al. “Isolated abducens nerve palsy: update on evaluation and diagnosis.” Current neurology and neuroscience reports 16.8 (2016): 69. (2). Takenouchi, Yasuhiro, et al. “Eicosapentaenoic acid ethyl ester improves endothelial dysfunction in type 2 diabetic mice.” Lipids in health and disease 17.1 (2018): 118. (3). Azarmina, Mohsen, and Hossein Azarmina. “The six syndromes of the sixth cranial nerve.” Journal of ophthalmic & vision research 8.2 (2013): 160. (4). Yanai, Hidekatsu, and Mariko Hakoshima. “Eicosapentaenoic Acid for Diabetic Abducens Nerve Palsy.” Journal of Endocrinology and Metabolism 7.4 (2017): 131–132.

BACKGROUND We are reporting a case of a Hispanic female who presented with a pericardial effusion as a complication of hypothyroidism, untreated due to lack of medical care, which demonstrates health disparities in chronic diseases. CLINICAL CASE The patient is a 48 year-old Hispanic female with PMHx of hypothyroidism, non-compliant with medical therapy, who presented to the ED with fatigue and dyspnea. Despite progressively worsening symptoms for the past 4 months, she had refused to be seen by a physician because she was uninsured. Her physical exam was notable for generalized pallor and bradycardia, with otherwise normal cardiopulmonary exam. Her initial laboratory data showed hemoglobin of 5.5 g/dl. CXR demonstrated an enlarged cardiac silhouette, which on CT was found to represent a large pericardial effusion. On admission her laboratory data demonstrated low ferritin, TSH of 94 mIU/L and T4 of 1.4 mcg/dl. m. Cortisol was 9 mcg/dl at 11 am. Repeat hemoglobin post-transfusion was 9 g/dl The patient was started on IV levothyroxine and hydrocortisone. Echocardiogram showed a large posterior wall pericardial effusion without evidence of RV strain. Pericardiocentesis was attempted but was unsuccessful because of difficult access to the fluid location. She was discharged on levothyroxine 88mcg QD and recommended to follow up with endocrinology and cardiology as an outpatient. It is well known that the United States spends a disproportionate amount of money in healthcare in comparison to developing countries (1). Underinvestment in social services and high prices set by pharmaceutical companies are likely contributing factors (1). Unfortunately, the resulting outcomes do not necessarily reflect the spending. Minorities are well known to have a higher morbidity and mortality as well as to present more frequently with dramatic manifestations of chronic diseases. This can often be attributed to a lack of access to medical care and poor follow up. Our patient was diagnosed with pericardial effusion as a complication of untreated hypothyroidism, a condition that is underdiagnosed despite a high incidence (3-37%). This pericardial effusion was initially concerning due to its large volume. The fact that she was hemodynamically stable reflects its chronicity, but it could have led to a fatal complication if she continued without appropriate therapy for a longer period of time. CONCLUSION A case such as this should make us question what more we can do to improve healthcare outcomes for minorities in the USA. REFERENCES (1). Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. “Health care spending in the United States and other high-income countries.” Jama 319.10 (2018): 1024-1039.

Background: Rhabdomyolysis is a potential life threatening condition defined as injury of the skeletal muscle, which results in the release of intracellular contents into the circulation. This muscle injury is often associated with the development of myoglobinuria, electrolyte abnormalities, and often ARF; it can be caused by diverse mechanisms including drugs and toxins. We present a case of rhabdomyolysis complicated by hypercalcemia and ARF in a patient with a history of polysubstance abuse after using intravenous heroin. Case: A 28 y/o male with h/o polysubstance comes to the ED with c/o fatigue, nausea, vomiting and decreased urine output for about 5 days; patient acknowledged using heroin and afterwards he developed weakness and tenderness in upper and lower extremities. Additionally he admitted cocaine and marijuana abuse. On physical exam vital signs were unremarkable and he had some mild tenderness to palpation mostly of the quadriceps bilaterally. Laboratory data was significant for acute kidney injury (cr 11.33 mg/dl, n: 0.7–1.5 mg/dl) and CPK 171920 u/l (n: 22–269 u/l). He received 2 L of NS in the ED and was started on NS at 100cc/hour. He underwent hemodialysis on day 2; initially he was treated for hypocalcemia with calcium and vitamin D supplementation until day 11 were hypercalcemia (calcium 12.7 mg/dl, n: 8.7–10.3 mg/dl; ionized calcium 1.7 mmol/l, n: 1.12–1.32) was noted; this was associated with concomitant suppression of PTH (5 pg/ml, n: 10–65 pg/ml). He remained asymptomatic from calcium abnormalities during his hospitalization, his urine output recovered progressively, hemodialysis was discontinued on day 13. Upon discharge was recommended to f/u with nephrology. Discussion: Various neurological and neuromuscular complications of heroin abuse have been described; one of these is rhabdomyolysis; its pathophysiology in heroin abuse is thought to be multifactorial; including acidosis, hypoxia, muscle compression and adulterants found in heroin. Narcotics may also have direct cell toxicity and alter membrane transport. Usually upon initial presentation hypocalcemia is one of the most common electrolyte imbalances seen with rhabdomyolysis. The proposed mechanism is precipitation of serum calcium salts in necrotic muscle. This may be followed by hypercalcemia during the diuretic phase of ARF which appears to be a relatively unusual complication associated with the presence of severe muscle damage due to metastatic calcium salts that are liberated from the necrotic muscle and the return to the serum. Conclusion: This case report highlights the importance of recognizing potential electrolyte imbalances in patients with rhabdomyolysis; it appears, that concomitant rhabdomyolysis and ARF are needed for a patient to develop hypercalcemia. Serum calcium should always be routinely measured and the appropriate treatment should be implemented to improve outcomes.

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are one of the newest classes of antihyperglycemic medications now available for the treatment of type 2 diabetes (1). Clinical guidelines recommend this type of medication as one of various possible approaches for pharmacological therapy after failure of or intolerance to metformin (1). SGLT2 inhibitors are the first class of medications that act on the kidneys to optimize glycemic control; they prevent the reabsorption of glucose in the proximal renal tubules by targeting the action of the protein SGLT2 (2). As glucose is excreted through the urine, plasma glucose levels fall, leading to an improvement in glycemia (1). The most common adverse side effects attributed to SGLT2 inhibitors are genital and urinary infections. Because of osmotic diuresis induced by the glucosuria resulting from SGLT2 inhibition, volume depletion is also a possibility (3). Recently, episodes of diabetic ketoacidosis (DKA) have been identified as a rare side effect (2). As a consequence of the glucosuria induced by SGLT2 inhibition, the majority of reported DKA episodes have been associated with a mild to moderate increased glycemia (4). R.F., a 44-year-old man with a history of type 2 diabetes, presented to the hospital emergency department with complaints of malaise, fatigue, heartburn, and decreased exercise capacity. He had been taking the dipeptidyl peptidase 4 inhibitor sitagliptin 100 mg, the SGLT2 inhibitor empagliflozin 25 mg, and metformin 1,000 mg twice daily for the past 2 years. He said his symptoms started 4 days earlier. The only change he could identify in his lifestyle was that he had switched to a ketogenic diet and was restricting carbohydrates, which he had been doing for 7 days before coming to the hospital. R.F.’s heart rate was 120 bpm, his blood pressure was 120/80 mmHg, and his temperature was 97.8°F. On physical …

Objective To characterize the cardiovascular effects of increasing dosages of norepinephrine (NE) in healthy isoflurane-anesthetized rabbits. Study design Prospective experimental study. Animals A total of nine female ovariohysterectomized New Zealand White rabbits weighing 3.4 ± 0.2 kg (mean ± standard deviation). Methods Rabbits were premedicated intramuscularly with buprenorphine (0.05 mg kg–1) and midazolam (0.5 mg kg–1). Anesthesia was induced with intravenous propofol and maintained with a 1.1 × minimum alveolar concentration of isoflurane for this species to induce hypotension. Rabbits were administered NE infusions at three doses: low, 0.1 μg kg–1 minute–1; medium, 0.5 μg kg–1 minute–1; and high doses, 1 μg kg–1 minute–1 for 10 minutes each in that order. Cardiovascular variables including heart rate (HR), cardiac output (CO) by lithium dilution technique and systolic (SAP), mean (MAP) and diastolic (DAP) invasive arterial blood pressures measured in the auricular artery were recorded at baseline, 10 minutes after the start of the infusion of each NE treatment and 10 minutes after NE was discontinued. A linear mixed model and a type III anova with Tukey’s post hoc comparison was performed (p Results Significant increases in SAP (28% and 90%), MAP (27% and 90%) and DAP (33% and 97%) were measured with medium and high dose treatments, respectively (p Conclusions and clinical relevance The infusion of NE at 0.5–1.0 μg kg–1 minute–1 is a potentially effective treatment for hypotension in healthy isoflurane-anesthetized New Zealand White rabbits.