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Background To evaluate the association of thyroid hormones changes, including increased reverse triiodothyronine (rT3) level, with critically ill clinical patients´ mortality. Patients and methods This study analyzed the observational data prospectively collected over 8 months (2018) in an adult intensive care unit (ICU) in Brasilia, Brazil. All consecutive ICU-admitted clinical patients were included. Thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), free triiodothyronine (fT3), rT3, and thyroid-stimulating hormone (TSH) were collected within 48 hours of ICU admission. Patients with hypothyroidism or hyperthyroidism who were previously diagnosed were excluded. Results Of 353 included patients, age was 68.5 ± 19.0 years, sequential organ failure assessment (SOFA) score was 3.3 ± 2.9, and Acute Physiology and Chronic Health Evaluation II (APACHE II) was 17.1 ± 7.9. ICU mortality was 17.6% (n = 62). Non-survivor patients had a higher incidence of increased rT3 (69.3 vs 59.2%, p = 0.042), lower incidence of low T4 (4.8 vs 9.7%, p = 0.045), and increased age (75.2 ± 16.3 years vs 67.1 ± 19.3 years, p = 0.001), SOFA (3.0 ± 0.4 vs 2.8 ± 2.6, p

This research aims to determine the causes of land-use conflicts and formulate a participatory conflict resolution model of the Forest Management Unit (KPH) of Kulawi. Through interviews with respondents using the purposive sampling method. The study included the community around the forest area, local government, KPH, Department of Agriculture, BPDAS-HL, and local government. Data analysis was stakeholder's and land use conflict by using problem trees analysis. The study results show that the battle occurred not only because of the community's factor of accessing the area illegally but also because the KPH has not performed its function correctly. Some factors cause enforcement's failure, such as lack of understanding of the area and community empowerment. Some alternative solutions desired by the community: (1) The government through related agencies should supervise forest areas, (2) Clear boundaries between community-owned land, villages, and forest areas, (3) Community empowerment by utilizing potential forest product resources and (4) Granting management rights to community's forest claimed by the community. There are two models of conflict resolution to be offered. First, the KPH needs the collaboration of parties to resolve land-use conflicts. Second, community involvement as the main subject is significant in every stage of conflict resolution. The KPH supports improving community capacity related to competence in conflict resolution is indispensable.

This study sought to explore the leadership of principals as educational administrators based on their natural attributes. The excellence in the actions of principals as educational administrators will serve as the determining factor for the success of a school across nine fields listed in the Malaysian School Principals Competency Standards. This success is mainly driven by the natural attributes of principals’ leadership in influencing the processes and behaviour of teachers in the delivery of education. This study also explores leadership issues and problems that are still of current interest. Principals’ competency levels in executing leadership still show that teachers are constrained by numerous flaws particularly in the teaching and learning in schools. Such conditions are often mirrored in schools with poor leadership display by Principals who are bent on putting off planned educational programmes. This qualitative study was done as a single case study. Qualitative data obtained via interviews with 10 informants in school formed the research case. The interviews were semi-structured and were analysed manually using category classification. The interviews explained the natural attributes reflected via Principals’ leadership orientation to answer the issues in this study. The findings of this study shall serve as additional elements in the process of selecting and placing Principals, as well as be developed as a guide for educational administrators desiring effective and quality leadership orientation for managing and administrating schools in Sabah. This study is of importance as it contributes additional knowledge in the fields of education and human resource for the benefit of other researchers.

Despite successful and timely revascularization of the infarct-related artery, myocardial tissue remains underperfused in some patients. This condition is known as the no-reflow phenomenon, which is associated with a worse prognosis. The first part of the systematic review on no-reflow focuses on description of the no-reflow pathogenesis and predictors. This phenomenon has a complicated, multifactorial pathogenesis, including distal embolization, ischemic injury, reperfusion injury, and a component of individual predisposition. Meanwhile, this phenomenon undergoes spontaneous regression in some patients. Several studies have demonstrated the role of definite biomarkers and clinical indexes as risk predictors for no-reflow. The significance of each pathogenetic component of no-reflow is suggested to be different in different patients, which may warrant an individualized approach in the treatment.

Objectives: Breast cancer is the most frequent cancer in women worldwide and it accounts for 27% of all cancer cases among women in India. This study aims to assess the awareness of the patients regarding the breast cancer and also to check their knowledge toward the symptoms of breast cancer as well as the breast self-examination process. This study also determines the attitude of patients regarding the breast cancer and breast self-examination. Methods: A prospective educational study was done using a pre-designed questionnaire on 523 patients in a tertiary care teaching hospital for a period of 6 months. All women greater than 20 years admitted in the Department of General Medicine and General Surgery in-patient female ward of SVRRGGH were included in the study. Results: Out of 523 women, a greater proportion respondents 515 (98%) had poor knowledge of breast cancer. Two hundred and eighty-one (53%) show positive attitude while 225 (43%) show neutral attitude and 17 (4%) show negative attitude toward breast cancer. Only 18 (0.3%) know how to perform breast self-examination while the remaining patients have never performed the breast self-examination. Two hundred and one (38%) have agreed to consult a doctor if they found any lumps in the breast whereas the remaining did not respond. After the counseling session with patients, their knowledge regarding the above problems related to breast cancer has significantly increased. Conclusion: Majority of the participants had poor knowledge of breast cancer as well as low level of practice of breast cancer screening procedures. However, patients do have a positive attitude toward the breast cancer which can help to detect the cancer in early stages. Hence, a greater focus on providing breast cancer education programs can create awareness among women in respect to screening programs which, in turn, can decrease the risk of death due to its late discovery.

Background: Fractures of the proximal femur of the hip are relatively common injuries in adults. Several epidemiological studies show that the incidence of fractures of the proximal femur is increasing. Dissatisfaction with use of a sliding hip screw in unstable fracture patterns led to the development of intramedullary hip screw devices. This design offers potential advantages like more efficient load transfer, decrease tensile strength on the implant, controlled fracture impaction, reduces amount of sliding and therefore limits limb shortening and deformity. Objectives: assess the clinical and functional outcome post operatively and during follow ups in proximal femur fractures by using Proximal Femur Nail. Methods: This is a prospective study of 30 cases of fresh intertrochanteric and subtrochantric fractures admitted to a tertiary care center. Cases were taken according to inclusion and exclusion criteria. Results were evaluated by fracture union on X ray and Harris hip score and descriptive statistics were used to analyze the data. Results: In our series of 30 cases there were 23 males and 7 females, most of the patients were between 41 to 60 years. Mean age of 57.7 years, of cases were admitted due to slip and fall and with predominance of right side. About 50% showed excellent and 50% showed good functional outcome in intertrochanteric and intertrochanteric fractures respectively as per Harris Hip scoring system (Modified). Conclusion: From this study, we consider that Proximal Femoral Nail as a reliable implant for the treatment of intertrochanteric and subtrochantric fractures. This implant also gives very good functional outcome in intertrochanteric and subtrochantric fractures.

Objective: To determine the views of urology trainees regarding training checkpoints/waypoints, and challenges to achieving a Certificate of Completion of Training (CCT). Methods: A novel survey was devised and distributed to evaluate urology trainee perceptions of the challenges in achieving the current CCT requirements as well as their views on the ST4 waypoint, indicative numbers (INs), workplace-based assessments (WBAs) and critical condition case-based discussions. Results: Of 347 trainees, 59 (17.0%) returned completed surveys from 13 of 19 training regions. The most significant challenges in achieving CCT as perceived by all trainees were, from highest to lowest: publication requirements, paediatric urology experience, achieving FRCS (Urol), INs and WBAs. All questions relating to ST4 waypoints were answered positively by a majority of respondents. Conclusions: The findings of this survey suggest that trainees will approve of the forthcoming changes in training assessment and outcomes embedded within the 2021 curriculum. The ST5 checkpoint, in particular, is an opportunity to better match trainees and placements and will underpin successful ‘phasing’ of training. A future study will inform the success of ‘embedding’ the 2021 curriculum and subsequently play a crucial part in the continuous improvement of urological training. Level of evidence: Not applicable for this multicentre audit.

PurposeThe halal industry has been growing in recent years, seeing an increasing demand for halal products from both Muslim and non-Muslim consumers and acknowledging that halal is a universal concept accepted by both Muslim and non-Muslim societies. Service-related providers, such as logistics, could influence the demand for halal products by consumers. This paper aims to investigate the factors that influence consumers' willingness to pay (WTP) for halal logistics among young non-Muslim adults.Design/methodology/approachA set of survey questions were distributed to young non-Muslim adults and 280 questionnaires were analysed.FindingsThe results indicate that three independent variables had a direct relationship and significant influence on the WTP for halal logistics among non-Muslim consumers. These variables are concern on halal, knowledge about halal and perception of halal logistics. Meanwhile, the awareness of halal logistics significantly influenced the consumers' WTP for halal logistics, provided that it was mediated by the perception of halal logistics.Originality/valueGiven the gap in research on halal logistics and WTP, this paper presents a consolidated examination of this subject, particularly the WTP of young non-Muslim adults. Furthermore, by including the perception of halal logistics as a mediator, this study leverages the halal logistics knowledge to a new level, thus deepening the understanding of this topic and contributing additional knowledge. This study also presents some opportunities for future empirical research.

This research explores the understanding of national food heritage based on age ranges (30-35 and > 36 years old). 676 respondents in Klang Valley areas with the appropriate age group and knowledgeable about food heritage are surveyed on a self-completed questionnaire. The correlation of national food heritage differences in terms of preservation, image, identity and sustainabledeterminants (p

This study aims to examine the simultaneous and partial influence of tangibles (X1), reliability (X2), responsiveness (X3), assurance (X4), and empathy (X5) on customer satisfaction (Y) in Garuda Airlines agent in Palu City. The type of research is descriptive-causal. Sampling technique is purposive sampling method. The results show that the dimensions of service quality consisting of physical evidence, empathy, reliability, responsiveness, and assurance simultaneously have a significant influence on customer satisfaction of buying tickets at Garuda Airline service agents. Partially, all the dimension of service quality have significant influence on the customer satisfaction of buying tickets at The Garuda airline service agent in Palu City. Penelitian ini bertujuan untuk mengetahui pengaruh secara serempak dan parsial dari tangibles (X1), reliability (X2), responsiveness (X3), assurance (X4), empathy (X5) terhadap kepuasan konsumen (Y) yang melakukan pembelian tiket pada agen jasa maskapai PT.Garuda Airlines di Kota Palu. Jenis penelitian ini yaitu jenis penelitian deskriptif kausal. Teknik penarikan sampel menggunakan metode purposive sampling Hasil penelitian menunjukkan bahwa dimensi kualitas layanan yang terdiri dari Bukti Fisik, Empati, Kehandalan, Daya Tanggap, dan Jaminan secara serempak berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines. Dimensi Bukti Fisik berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines. Dimensi Empati berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines. Dimensi Kehandalan berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines. Dimensi Daya Tanggap berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines. Dimensi Jaminan berpengaruh signifikan terhadap kepuasan konsumen membeli tiket pada agen jasa maskapai penerbangan PT. Garuda Airlines.

Food can be used as markers for the identity of an individual or society regardless of the geographical, social and political differences separating the populations on one nation. It is a contested medium that establishes national boundaries and identities. The study aims to examine national food heritage awareness in the Klang Valley area based on age. The study involved 676 respondents using a self-completed questionnaire survey. Purposive sampling is being used in selecting the sample based on age, which required respondents to be 30 years old or older and have knowledge of heritage food. Statistic analysis such as frequency and cross-tabulation on age category (30-35 and >36 years old). Results revealed that there is only one common definition agreed by both age category (p>0.05) which is the traditional food are considered as food heritage. Both age using electronic media to gather information regarding on gazette National Food Heritage (p>0.05). However, on the knowledge on the authority responsible on gazette National Food Heritage respondent with adult age ( > 36 years old ) are more knowledgeable than younger adult (30-35 years old) (p36 years old) than young adult (30-35 years old). Respondent chooses the main criteria 'traditional value' which showed significant differences (p

The agricultural and livestock research, education, and extension are important components for increasing production and meeting the demands of the growing population with sustainability. In this context, knowledge or information is very critical for improving the production under the present extension delivery system in India. Several studies have highlighted emerging ICTs which have the potential to reach the mass population at a limited time despite traditional media. One such emerging ICT is Social Media, which is utilized by most of the stakeholders, including farmers around the globe. Hence, for documenting its application for livestock information needs among the livestock farmers, an ex-post-facto exploratory study was conducted in Southern Karnataka using 108 purposively selected farmers, which comprised of 36 farmers each belonging to dairy, poultry and sheep and goat husbandry with pre-tested structured interview schedule. Majority of the farmers in each category were aware about social media and possessed social media accounts with highest number of WhatsApp accounts being possessed by the farmers. Social media was utilized for obtaining information about latest livestock production and management practices in all the categories. From these findings, it could be elucidated that the respondents predominantly perceived that social media had higher benefits in attaining livestock related information and adoption of digital knowledge into practice.

Smallholder potato producers in Jeldu district produce potato for both home consumption and market. Adoption of improved varieties is suggested to improve and diversify farmers’ household income. This study intents to identify factors determining adoption and intensity of adoption of improved potato varieties in Jeldu district of West Shewa zone, Oromia region, Ethiopia. Both primary and secondary data were used. The primary data were collected from 140 sample households’ selected using two-stage random sampling techniques. Descriptive statics and double hurdle econometric model were used to analyze the data. Results indicate that sex of the household head, access to extension services, livestock ownership and farmers’ perception about the technology positively and significantly determined adoption of improved varieties in the district. In contrast, distance from the nearest market affected adoption of improved potato varieties negatively and significantly. Intensity of adoption is measured by the area of land allocated for improved potato varieties by farmers. The truncated result identified improved varieties yield perception, family size, livestock ownership and membership to agricultural cooperative influenced intensity of improved potato varieties adoption positively and significantly. Strengthening extension services to enhance farmers’ awareness about improved potato varieties infrastructure development, family planning, asset ownership and facilitating membership to cooperatives are recommended. Int. J. Agril. Res. Innov. Tech. 9(2): 15-22, December 2019

BACKGROUND: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS:15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING: None.

OBJECTIVES The aim of this study is to develop a Machine Learning (ML) algorithm for an automatic classification of fetal occiput position at transperineal ultrasound (TPU) during the second stage of labor. METHODS Prospective cohort study including singleton term pregnancies (> 37 weeks of gestation) in the second stage of labor, with the fetus in cephalic presentation. Transabdominal ultrasound was preliminarily performed to assess the actual fetal occiput position, which was labeled as occiput anterior (OA) or non-occiput anterior (non-OA). Subsequently, for each case, one sonographic image of the fetal head was acquired on the axial plane using TPU and archived on a cloud for remote analysis. Using the transabdominal sonographic diagnosis as the gold standard, a ML algorithm based on a pattern recognition feed-forward neural network was trained on the transperineal images to discriminate between OA and non-OA cases. In the training phase the model tuned its parameters in order to approximate correctly the training data - i.e., the training dataset - in order to correctly assess the fetal head position, by exploiting geometric, morphological and intensity-based features of the images. In the testing phase, the diagnostic performance of the algorithm was evaluated on unlabeled data, which represented the testing dataset. On this group the ability of the ML algorithm to differentiate the OA from the non-OA fetal positions was assessed in terms of diagnostic accuracy. The F1 -score and Precision-Recall Area Under the Curve (PR-AUC) were also calculated to assess the algorithm's performance. The Cohen's kappa (k) was finally added to evaluate the agreement between the algorithm and the gold standard. RESULTS Over a period of 24 months, 1219 women in the second stage of labor were enrolled. They were classified as OA (n=801 or 65.7%) or non-OA (n=418 or 34.3%) on the basis of transabdominal ultrasound. From both the sub-groups (OA and non-OA), 70% of the patients were randomly assigned to the training dataset (824 patients) while the remaining 30% (395 patients) were used as testing dataset. On the latter group the ML based algorithm yielded a correct classification of the fetal occiput position in 90.6% of cases (357 out of 395), including 224 out of 246 OA (91.0%) and of 133 out of 149 non-OA images (89.3%). Moreover, for the evaluation the algorithm's performance we found a F1 -score=88.7% and PR-AUC=85.4%. The algorithm showed a balanced performance in the recognition of both anterior and non-anterior occiput positions. Eventually, the robustness of the proposed algorithm was confirmed by a high agreement with the gold standard method (k = 0.81; p

Background Despite a modest association between tobacco smoking and breast cancer risk reported by recent epidemiological studies, it is still equivocal whether smoking is causally related to breast cancer risk. Methods We applied Mendelian randomisation (MR) to evaluate a potential causal effect of cigarette smoking on breast cancer risk. Both individual-level data as well as summary statistics for 164 single-nucleotide polymorphisms (SNPs) reported in genome-wide association studies of lifetime smoking index (LSI) or cigarette per day (CPD) were used to obtain MR effect estimates. Data from 108,420 invasive breast cancer cases and 87,681 controls were used for the LSI analysis and for the CPD analysis conducted among ever-smokers from 26,147 cancer cases and 26,072 controls. Sensitivity analyses were conducted to address pleiotropy. Results Genetically predicted LSI was associated with increased breast cancer risk (OR 1.18 per SD, 95% CI: 1.07–1.30, P = 0.11 × 10–2), but there was no evidence of association for genetically predicted CPD (OR 1.02, 95% CI: 0.78–1.19, P = 0.85). The sensitivity analyses yielded similar results and showed no strong evidence of pleiotropic effect. Conclusion Our MR study provides supportive evidence for a potential causal association with breast cancer risk for lifetime smoking exposure but not cigarettes per day among smokers.

Objetivo: Caracterizar o perfil epidemiológico das internações por Linfoma Não Hodgkin em crianças no estado do Pará nos últimos 5 anos. Material e métodos: Estudo ecológico que utilizou dados referentes às internações por Linfoma Não Hodgkin (LNH) em crianças no estado do Pará, no período de 2016 a 2020, disponíveis na base de dados do Departamento de Informática do Sistema Único de Saúde (DATASUS). Analisou-se a epidemiologia dessas internações abordando as variáveis ano de internação, distribuição por região de saúde, faixa etária, sexo e número de óbitos. Resultados: Foram notificadas 352 internações por Linfoma Não Hodgkin em crianças no Pará. Quanto aos anos com maior número de internações, encontram-se 2018 (33,23%) e 2019 (25,28%). Em relação à distribuição por Região de Saúde, a região Metropolitana I foi a que mais se destacou, com 82,67% dos casos, seguida do Baixo Amazonas (16,47%), e, por fim, Carajás, Araguaia e Xingu, cada uma com apenas uma notificação. Tratando-se da faixa etária, obteve-se que 49,71% dos indivíduos possuíam idade entre 5 e 9 anos; 32,1% entre 10 e 14 anos; 17,33% entre 1 e 4 anos; 1,07% eram menores de 1 ano. No que tange ao sexo da população, 73,58% eram do sexo masculino, enquanto 26,42% eram do sexo feminino. Por fim, observou-se 14 óbitos por essa causa. Discussão: O LNH é uma neoplasia hematológica com importante incidência mundial, que é influenciado por fatores extrínsecos como a infecção por Epstein Bar, e intrínsecos, como a genética; e ao analisar a distribuição das internações por LNH no Pará, a região metropolitana possui o maior índice, o que reflete a maior possibilidade de diagnóstico devido à concentração dos centros de referência em oncologia e tecnologias em saúde nessa. Ao estudar a faixa etária, nota-se a concordância com a literatura internacional, visto a diminuta taxa encontrada em crianças menores de 1 ano, e a mais importante entre 5 e 9 anos. Ao se avaliar a variável sexo, os achados são equivalentes à literatura existente, uma vez que a predominância patológica é masculina. A mortalidade por essa doença se explica, a partir da literatura, pelo diagnóstico e estadiamento tardio, visto que a busca por assistência à saúde normalmente ocorre de 30 a 50 dias após o início dos sinais e sintomas, podendo alcançar 365 em estudos. Conclusão: Dessa forma, percebe-se que, no período estudado, essa neoplasia hematológica acometeu de forma mais significativa crianças do sexo masculino entre 5 e 9 anos de idade e indivíduos da região Metropolitana I. Além disso, vale ressaltar que a busca por atendimento precoce ajuda a evitar os óbitos, assim como deve ser sempre investigado os sinais e sintomas devido a dificuldade de diagnóstico e os impactos no sistema que o LNH causa.

A leucemia mieloide aguda (LMA) e o segundo tipo de leucemia mais comum em criancas e adolescentes, sendo necessarios, protocolos quimioterapicos mieloablativos que podem gerar complicacoes desafiadoras a equipe multidisciplinar. Paciente do sexo masculino, 13 anos, diagnosticado com LMA recidivada, em fase de condicionamento para transplante de celulas-tronco hematopoieticas (TCTH), submetido a quimioterapia com citarabina e idarrubicina. Internou por neutropenia febril, pancitopenia severa (hemoglobina: 6,7g/dl; hematocrito: 19%; leucocitos totais: 50/mm3; neutrofilos e segmentados: 500/mm3; eosinofilos, linfocitos tipicos e monocitos: 0/mm3; e plaquetas: 15.000/mm3) e tosse associada a dor toracica. Queixou-se de ardencia em mucosa jugal bilateral e palato duro. Exame intraoral revelou leucoedema em borda de lingua bilateral, edema e eritema generalizado em trigono retromolar direito, palato duro e mole, ulceras de leito eritematoso e halo esbranquicado em gengiva marginal palatina de 2°molar superior direito, 2°pre-molar e 2°molar esquerdo, caracterizando Mucosite oral tratada com Laserterapia de baixa potencia (Therapy XT - DMC®; potencia - 100mW; comprimento de onda - 660nm; energia total - 2J) e cuidados especificos. Alem disso apresentou abaulamento osseo em regiao posterior de maxila e mandibula direito. Prescrito meropenem, vancomicina, anfotericina B e bochecho com clorexidina 0,12% sem alcool a cada 6 horas, porem novo ciclo de quimioterapia foi adiado por nao haver recuperacao medular. Paciente evoluiu com prostracao, febre alta persistente, surgimento de tecido necrotico e osso exposto em regiao lingual de mandibula posterior, associados a mobilidade dentaria, dor intensa e assimetria facial decorrente de edema de rapida evolucao. Tomografia computadorizada de feixe conico revelou area de destruicao ossea sugestiva de sequestro envolvendo os dentes primeiro e segundo molar inferior direito. As hipoteses diagnosticas foram de infiltracao leucemica ou infeccao oportunista invasiva. Para a recuperacao medular, foi prescrito filgrastim por 3 dias, possibilitando maior seguranca na realizacao do procedimento cirurgico odontologico. Realizou-se coleta do tecido clinicamente alterado e extracao dos dentes envolvidos na lesao. Exame histopatologico revelou processo inflamatorio linfoplasmocitario com exsudato neutrofilico e areas de necrose com presenca de pseudomonas aeruginosa e de numerosas hifas espessas, com diagnostico final de necrose ossea associada a infeccao oportunista invasiva. Pos-operatorio de 2 meses ocorreu de forma satisfatoria, sem dor e melhora da condicao geral, porem com novo sequestro osseo em boca sem sinais de infeccao clinica. O fragmento removido revelou no exame histopatologico trabeculas osseas irregulares, com sistemas harvesianos e osteoplastos vazios, biofilme microbiano na superficie e colonias bacterianas com diagnostico final de osso necrotico. Nova TCFC revelou reabsorcao ossea horizontal na regiao operada, preenchimento do alveolo dentario por tecido osseo e ausencia de sequestro osseo. O paciente apresentou-se apto para realizacao do TCTH, porem veio a obito apos 13 meses por nova recidiva da LMA. A Equipe interdisciplinar e imprescindivel para identificacao, controle e tratamento de infeccoes que possam colocar a vida do paciente em risco, alem de auxiliar na melhora da qualidade de vida.

Objetivo: Comparar o perfil imunológico de indivíduos positivos e negativos para IgG anti-SARS-CoV-2. Métodos: Amostras de soro (n = 7.837) de doadores de sangue da Fundação Hemominas, coletadas no período de março a dezembro de 2020, foram testadas por quimioluminescência para IgG anti-SARS-CoV-2. As amostras positivas foram separadas em quatro grupos considerando-se os intervalos interquartis do index de anticorpos detectados no teste sorológico. Amostras positivas e negativas foram utilizadas na dosagem de citocinas (IL-2, IL-4, IL-6, IL-10, TNF, IFN-gama e IL-17A) e quimiocinas (CXCL8, CCL5, CXCL9, CCL2 e CXCL10). Resultados: Dos doadores testados, 441 (5,6%) foram positivos para IgG anti-SARS-CoV-2 com mediana de index de 3,65 (IQR 2,43-5,40). As concentrações séricas (ng/mL) de IL-10 (mediana, 0,51; IQR, 0,18-0,86; p < 0,0001), TNF (mediana, 0,65; IQR, 0,00-0,77; p = 0,0279) e IFN-gama (mediana, 0,36; IQR, 0,00-0,88; p < 0,0001) foram significativamente maiores em doadores de sangue positivos para IgG anti-SARS-CoV-2. As concentrações séricas (ng/mL) de CXCL8 (mediana, 13,60; IQR, 5,98-28,04; p = 0,0013), CCL5 (mediana, 4.017,00; IQR, 2.674,00-4.736,00; p < 0,0001), CXCL9 (mediana, 33,08; IQR, 17,88-54,14; p < 0,0001), CCL2 (mediana, 40,39; IQR, 23,38-61,52; p = 0,0068) e CXCL10 (mediana, 111,70; IQR, 56,98-178,00; p < 0,0001) foram significativamente maiores em doadores de sangue positivos para IgG anti-SARS-CoV-2. Análises de correlação revelaram que todas as citocinas (exceto IL-4, IL-6 e IL-17A) têm correlação negativa significativa com o index de IgG anti-SARS-CoV-2, mas com coeficiente de Spearman (r) menores que 0,5. Todas as quimiocinas testadas tiveram correlação negativa significativa, com destaque para CCL5 (r = -0,79), CXCL9 (r = -0,57) e CXCL10 (r = -0,51). Discussão: A análise do perfil imunológico de indivíduos positivos e negativos evidenciou que a produção de IgG anti-SARS-CoV-2 depende de uma resposta imune inata caracterizada pela alta concentração sérica de quimiocinas e de uma resposta pró-inflamatória potencializada por TNF e IFN-gama e regulada por IL-10. Os resultados evidenciam ainda que a produção de mais anticorpos contra o vírus depende de uma síntese controlada de citocinas e quimiocinas, indicando que menores níveis destes biomarcadores estão relacionados à maior produção de IgG anti-SARS-CoV-2. Conclusão: Os resultados deste estudo evidenciaram que um perfil imune pró-inflamatório associado a biomarcadores de resposta imune inata é importante para o desenvolvimento de anticorpos IgG anti-SARS-CoV-2. Suporte financeiro: Fundação HEMOMINAS, CNPq.

Objetivos Verificar o impacto da pandemia da doenca causada pelo SARS-CoV-2, tambem conhecida como COVID-19, no comparecimento de doadores de sangue e na coleta de sangue na Fundacao Hemominas (FH). Metodos Foi realizado um estudo transversal no periodo de janeiro a junho de 2020. Os dados obtidos foram comparados a uma serie historica de 2016 a 2019. As variaveis analisadas foram: numero de comparecimento total de doadores e numero de coletas de sangue. Resultados A analise evidenciou reducao no numero de candidatos a doacao de sangue, nas coletas de sangue e na producao de hemocomponentes na FH a partir de marco de 2020, mes em que foi notificado o primeiro caso de COVID-19 em Minas Gerais. Os resultados mostraram que as unidades integrantes da rede FH foram afetados de forma distinta pela pandemia. Houve reducao media geral em torno de 17% no comparecimento de doadores de sangue e na coleta de hemocomponentes no periodo de marco a junho. Dados globais apontaram abril como mes de maior reducao na quantidade de doadores e de coletas com quedas de 9,11% e 19,22%, respectivamente, em comparacao ao mesmo periodo da serie historica 2016-2019. Nos meses de maio e junho observou-se ligeira recuperacao desses parâmetros, o que refletiu na maior producao de hemocomponentes. A taxa de retorno dos doadores de sangue aumentou em todos os meses analisados em 2020 quando comparada as medias dos anos anteriores. Discussao A manutencao da producao de hemocomponentes durante a pandemia de COVID-19 tem sido um desafio em diferentes lugares do mundo, como Italia, Ira, China, Estados Unidos e Brasil, que, no primeiro semestre de 2020, se tornou o segundo pais com o maior numero de casos relatados de COVID-19. No presente estudo, o unico indicador que apresentou aumento para todos os meses de 2020 em relacao a media dos anos anteriores foi a taxa de retorno de doadores de sangue, causado pela adocao de medidas de recrutamento ativo de doadores de repeticao. A FH implantou um plano de contingencia (funcionamento em horarios alternativos; envio de mensagens para confirmacao de comparecimento; aumento do recrutamento hospitalar; campanhas nas midias alertando sobre a queda nos estoques e reforcando a seguridade dos locais de doacao) que permitiu melhorar a gestao hemoterapica. Medidas semelhantes foram usadas pelo Hemocentro de Campinas, Sao Paulo, resultando em um aumento medio de 14% no numero de doacoes semanais em relacao ao periodo pre-pandemico. A queda nas doacoes de sangue nao implicou indisponibilidade de sangue devido ao adiamento de cirurgias eletivas, monitoramento de estoques e efetividade no uso de hemocomponentes. O numero de transfusoes executadas em 2020 foi menor em relacao a serie historica em todos os meses avaliados, com a maior queda ocorrendo em maio (23,8%). Conclusao A reducao da doacao de sangue durante o periodo pandemico foi significativa, apesar das medidas adotadas. O recrutamento de doadores de retorno foi uma medida importante a para diminuir o efeito da pandemia nos estoques de sangue. As pandemias emergentes sao um desafio para os Hemocentros, que devem estar aptos para adotar medidas emergenciais que mitiguem o impacto no comparecimento de doadores e na producao de hemocomponentes. A atuacao em rede de unidades cooperativas e uma estrategia dos Hemocentros para superar esses desafios.

Objetivos: Analisar a relação da contagem de blastos em sangue periférico (CBP) com o tempo cumulativo de antibioticoterapia em pacientes com leucemia aguda (LA). Material e métodos: A presente produção foi elaborada a partir de um estudo transversal retrospectivo, dos anos 2010 a 2012 com casos de leucemias agudas em serviço público terciário em Fortaleza, CE. Os dados foram coletados de prontuários, e compilados para análise bioestatística. Resultados: Foram coletados 21 prontuários, sendo 57,1% (12) destes de pacientes diagnosticados com leucemia mieloide aguda (LMA) e 42,9% (9) com leucemia linfoide aguda (LLA). Nos registros analisados, a porcentagem de blastos periféricos variou de 0 a 91%, com mediana de 32%. Tendo sido definida, como variável dependente, o tempo em dias cumulativos de uso de antibiótico (DCA), ao realizar-se a análise de regressão linear multivariada (RLMV), verificou-se que a contagem de blastos no sangue periférico ao diagnóstico relacionou-se com o aumento do DCA, juntamente com idade, hemoglobina, leucócitos, contagem absoluta de neutrófilos, plaquetas, alanina transferase, aspartato transferase albumina, lactato desidrogenase, neutropenias febris, concentrado de hemácias e concentrado de plaquetas (CP). Entre essas variáveis, tiveram significância clínica (R2 > 0,5) e estatística (p-valor < 0,05) contagem de blastos no sangue periférico ao diagnóstico e o número de CP utilizados. Ademais, na RLMV utilizando somente esses parâmetros, obtiveram significância estatística o CP (p-valor = 0,016) e a contagem de blastos periféricos (p-valor = 0,039), mas não significância clínica (R2 = 0,34). Discussão: Com base nos resultados desse estudo, constatou-se que nenhuma das variáveis estudadas conseguiu prever, adequadamente, o comportamento do DCA de forma isolada. Contudo, a CBP acima de 50% esteve associada positivamente com o aumento do DCA. Em um estudo realizado em população pediátrica com LA, demonstrou-se que o aumento da carga tumoral, considerado no estudo como o aumento do LDH, esteve associado ao pior desfecho, especialmente com o aumento de chance de eventos infecciosos. A influência positiva no valor do DCA pela carga de blastos no sangue periférico pode ser um marcador desse efeito na população avaliada no nosso estudo. Conclusão: Desse modo, é possível concluir que a porcentagem de blastos periféricos obteve significância estatística, juntamente com outras variáveis hematológicas, mas sem relevância isoladamente. Nesse sentido, é possível delinear uma relação desse dado inicial com futuras complicações no tratamento. Devido ao número reduzido de casos, é necessária uma maior quantidade de dados e estudos para se obter uma melhor análise dessas variáveis.

Objetivos: Comparar níveis de citocinas e quimiocinas entre indivíduos infectados com SARS-CoV-2 com COVID-19 grave ou com a forma assintomática da infecção, a fim de avaliar quais destes marcadores biológicos de resposta inflamatória são indicadores de gravidade da infecção viral. Métodos: Foram analisados dados clínicos de 48 pacientes com COVID-19 hospitalizados no Hospital Eduardo de Menezes (FHEMIG, MG) no período de 07 de julho a 21 de novembro de 2020, que necessitaram ou não de assistência em terapia intensiva (grupos UTI e sem UTI, respectivamente). Foi feita a quantificação dos níveis de citocinas (IL-2, IL-4, IL-6, IL-10, TNF, IFN-, IL-17A) e quimiocinas (CCL2, CCL5, CXCL8, CXCL9 e CXCL10) do plasma de 14 pacientes UTI e 17 pacientes sem UTI que tinham COVID-19 grave no momento da coleta da amostra, além de 24 doadores de sangue da Fundação Hemominas com infecção ativa pelo SARS-CoV-2 (RT-PCR positiva) que eram assintomáticos no momento da coleta da amostra. Resultados: A análise clínica dos pacientes UTI (n = 19) em comparação àqueles que não usaram UTI (n = 29) não mostrou diferença estatística quanto à frequência de comorbidades e de sinais e sintomas para COVID-19 na admissão hospitalar. A comorbidade mais comum foi hipertensão (62,5%), seguida por diabetes (37,5%) e obesidade (22,9%). Tosse, dispneia, febre, fatiga e mialgia foram os sinais e sintomas mais prevalentes de COVID-19 em ambos os grupos. Entretanto, os pacientes UTI desenvolveram doença grave ou crítica que requereu um período de hospitalização em média duas vezes mais longo que o grupo sem UTI (p < 0,001). O conjunto dos pacientes com COVID-19 mostrou níveis significativamente mais altos de IL6, IL10 e CCL5 que os doadores assintomáticos. Na comparação dos grupos dos pacientes houve diferença significativa apenas para IFN, com níveis mais elevados nos pacientes UTI. Discussão: Apesar do grupo de pacientes UTI apresentarem quadro de COVID-19 mais grave que os pacientes sem UTI, a frequência de sinais e sintomas da doença e de comorbidades não foi significativamente diferente entre os grupos. A evolução da COVID-19 de assintomática para grave e crítica tem sido associada com intensa resposta inflamatória, o que está de acordo com maiores níveis de IL6, IL10 e CCL5 observados nos pacientes em comparação aos doadores assintomáticos. Nível de IFN pode ser especial indicador de gravidade da doença. Conclusão: Marcadores biológicos, como citocinas e quimiocinas, podem ser melhores preditores de evolução da COVID-19 que sinais clínicos e sintomas. Suporte financeiro: Fundação Hemominas e SES/MG.

The severe acute respiratory coronavirus 2 (COVID-19) pandemic impacts the health of women at reproductive age in different ways, starting from pregnancy planning to post-delivery. This narrative review summarises the challenges to obstetric practice posed by the severe acute respiratory coronavirus 2 (COVID-19) pandemic. In this paper, we highlight the impacts of COVID-19 to obstetric practice globally and the efforts taken to address these challenges. Further study is critical to investigate the effects of COVID-19 on pregnancy, the outcome of COVID-19 positive pregnant women, and the safety of vaccination during pregnancy and breastfeeding.

Vitiligo is one of the dermatomes affecting the melanocytes resulting in their destruction and subsequent patchy depigmentation of the skin. It is postulated to occur due to an autoimmune problem. Despite being a disease with limited systemic involvement and lack of mortality, it has a severe psychological impact. It may have a powerfully negative effect on a patient's quality of life. The relationship between vitiligo and pregnancy is not widely acknowledged. It may be associated with adverse pregnancy outcomes such as recurrent miscarriage, prematurity, intrauterine growth retardation and pre-eclampsia. Herein, this review describes the disease's adverse effects on pregnancy outcomes and the influence of pregnancy itself on the clinical evolution and prognosis of vitiligo., Highlights • Vitiligo may be associated with adverse pregnancy outcomes such as recurrent miscarriage, prematurity and pre-eclampsia. • In this review, a comprehensive literature search has been taken to outline the disease’s adverse effects on pregnancy. • This review also includes a literature search on the effects of pregnancy on the clinical progress of vitiligo.

Background Aerobic exercise can increase oxidative stress, but it can produce the necessary stimulus for physiological adaptation of exercise. However, the effects of intensity and duration of exercise on oxidative stress status are unclear. This study aimed to compare the effects of exercise intensity (I) and duration (D) on the oxidative stress [malondialdehyde (MDA)], and the responses of the antioxidant enzymes [catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD), antioxidant enzymes ratio (AE)] among sedentary adults. Methods In a randomized crossover design, 25 sedentary adults, performed nine cycling exercise sessions with a constant load of 50%, 60% and 70% VO2peak for 10-, 20- and 30- minutes duration. Plasma MDA, CAT, GPx and SOD activity were measured before exercise (baseline) and immediately after each session (post). Results The interaction effect of intensity and duration was significant for percentage changes of MDA (FIxD=3.59, df=4, pIxD =3.38, df=2.146, pI =54.24, df=2, pD=8.62, df=2, pI =14.24, df=1.619, pD = 5.96, df=1.347, pD =11.82, df=1.166, pI =5.58, df=1.289, pD =11.63, df=1.201, pI =3.035, df=1.32, p>0.05) is exercise duration. Conclusions These findings suggest that exercise intensity was an essential factor of acute oxidative stress and antioxidant enzyme responses compared with the duration of exercise.

In general, decision makers tend to respond to problems rather than prevent them. In political science, this process of responsive governance is associated with complex dynamics such as availability cascades and punctuated equilibrium. However, most authors treat problems as one-time events, like oil spills or political scandals. Here, we use an agent based model loosely based on the Lake Erie watershed to explore how responsive governance evolves along with an on-going but noisy environmental problem: harmful microbial blooms. This conceptual model features a two-level decision process based on Jones and Baumgartner (2005). Meta-agents representing the individual level of analysis “perceive” blooms either directly via observation if they are near a bloom or indirectly through the media. As a meta-agent observes more blooms, their concern increases until it crosses an action threshold, at which point they use simple cost-benefit analysis to select from a range of options. One of these options is to send a signal to their policy agent, which aggregates these political signals based on a range of assumptions and then decides on actions in much the same way as the metapopulations themselves. We examine two major scenarios, one in which there is a single policy maker managing the entire region (e.g. the national government) and one where there are 5 policy makers, each separately regulating a demographically and geographically distinct region. Although the model is relatively simple, it lets us explore how variability in risk perception and responsive governance shape the functioning of the entire coupled human and natural system, including biophysical feedbacks., Complexity, Governance & Networks, Vol 5, No 1 (2019): Adaptive Governance of Coupled Social-Ecological Systems

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), the plasma fibrinogen level is associated with a decline in lung function and exacerbation of COPD. High blood eosinophil count is also associated with exacerbation of COPD in some studies but not others.OBJECTIVE: To investigate the associations between clinical phenotypes and plasma fibrinogen levels and blood eosinophil counts in patients with COPD.METHODS: Outpatients with COPD, in whom plasma fibrinogen level and blood eosinophil count were measured at least once simultaneously, were analysed retrospectively. Patients were classified into four groups, based on plasma fibrinogen level (threshold, 350 mg/dl) and blood eosinophil percentage (threshold, 2%). Clinical characteristics, comorbidities, laboratory data, COPD severity and exacerbations were compared in the four groups.RESULTS: Of 370 patients with COPD, the group with both high fibrinogen levels and eosinophil counts had more severe airflow limitation, more comorbidities and higher COPD severity indexes than the groups with low plasma fibrinogen. The annual rates of severe (0.29/year) and total (0.42/year) exacerbations were significantly higher in patients with both high fibrinogen and eosinophils than in the other three groups.CONCLUSION: Plasma fibrinogen levels and blood eosinophil counts may predict the clinical phenotype and frequency of exacerbations of COPD.

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking., peer-reviewed

Background: Medical robots are increasingly used for a variety of applications in healthcare. Robots have mainly been used to support surgical procedures, and for a variety of assistive uses in dementia and elderly care. To date, there has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care. Aim: The objective of this article is to examine the possible future impact of medical robotics on palliative, supportive care and end-of-life care. Specifically, we will discuss the strengths, weaknesses, opportunities and threats (SWOT) of this technology. Methods: A SWOT analysis to understand the strengths, weaknesses, opportunities and threats of robotic technology in palliative and supportive care. Results: The opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. However, there are a number of technical, societal, economic and ethical factors which need to be considered to ensure meaningful use of this technology in palliative care. Conclusion: Robotics could have a number of potential applications in palliative, supportive and end-of-life care. Future work should evaluate the health-related, economic, societal and ethical implications of using this technology. There is a need for collaborative research to establish use-cases and inform policy, to ensure the appropriate use (or non-use) of robots for people with serious illness.

Aim:to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect.Materials and methods.Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9.Results.At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume – from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W.Conclusion.Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

Background COVID-19 disease often requires invasive ventilatory support. Trans-laryngeal intubation of the trachea may cause laryngeal injury, possibly compounded by coronavirus infection. Fibreoptic Endoscopic Evaluation of Swallowing (FEES) provides anatomical and functional assessment of the larynx, guiding multidisciplinary management. Our aims were to observe the nature of laryngeal abnormalities in patients with COVID-19 following prolonged trans-laryngeal intubation and tracheostomy, and to describe their impact on functional laryngeal outcomes, such as tracheostomy weaning. Methods A retrospective observational cohort analysis was undertaken between March and December 2020, at a UK tertiary hospital. The Speech and Language Therapy team assessed patients recovering from COVID-19 with voice/swallowing problems identified following trans-laryngeal intubation or tracheostomy using FEES. Laryngeal pathology, treatments, and outcomes relating to tracheostomy and oral feeding were noted. Results Twenty-five FEES performed on 16 patients identified a median of 3 (IQR 2–4) laryngeal abnormalities, with 63% considered clinically significant. Most common pathologies were: oedema (n = 12, 75%); abnormal movement (n = 12, 75%); atypical lesions (n = 11, 69%); and erythema (n = 6, 38%). FEES influenced management: identifying silent aspiration (88% of patients who aspirated (n = 8)), airway patency issues impacting tracheostomy weaning (n = 8, 50%), targeted dysphagia therapy (n = 7, 44%); ENT referral (n = 6, 38%) and reflux management (n = 5, 31%). Conclusions FEES is beneficial in identifying occult pathologies and guiding management for laryngeal recovery. In our cohort, the incidence of laryngeal pathology was higher than a non-COVID-19 cohort with similar characteristics. We recommend multidisciplinary investigation and management of patients recovering from COVID-19 who required prolonged trans-laryngeal intubation and/or tracheostomy to optimise laryngeal recovery.

Objectives The absence of high-level evidence about treatment approaches in tinnitus has eluded the clinical community from arriving at the consensus to date. This could be partially attributable to a limited number of trials. The objective of the present scoping review was to check updates in existing knowledge about tinnitus management and provide recommendations for further research and practice. Design Scoping review with Population, Concept, and Context (PCC) framework. Review question(s) for our study were: Is there any knowledge update from the published evidence on the treatment of tinnitus after the scoping review on tinnitus by Makar S et al. 2017? Are there any therapies existing that do not focus on habituation but target the root cause of tinnitus? Which pharmacological interventions are used in the treatment of tinnitus? Methods The database of our literature search included PubMed, Joanna Briggs Evidence synthesis, Cochrane Library, Scopus, and Google Scholar. We included full-text original articles (randomized controlled trials (RCTs), systematic reviews (SLRs), or meta-analyses) published in the English language between 2010-2021. We included only studies that included interventions to treat patients without any focus on the patient’s habituation or natural adaptation. We excluded reviews, case studies, observational studies, and anecdotal evidence. Patient and Public Involvement Being a secondary data-based analysis, our study did not directly involve any patient. Results Of 20 included records, 11 SLRs and nine RCTs were found. Non-pharmacological interventions included transcranial magnetic-(TMS) (four studies) and direct current stimulation (tDCS) (three studies), vagus nerve stimulation (VNS) (one study), and hearing aid or combined amplification and sound generator (two studies); however, despite causing moderate improvement in tinnitus severity, neither of these interventions reached statistical significance. Pharmacological interventions included AM-101(two studies), anticonvulsants (one study), and antidepressants (one study) with insufficient strength to establish the efficacy of either. Also, a specific extract of the Ginkgo Biloba (EGb 761®) plant demonstrated a reduction in tinnitus severity (1 study). No studies included actionable insights on the quality of life (QoL) outcomes. Conclusions Despite the lack of actionable evidence for tDCS and rTMS like therapies, their curative potential cannot be overlooked. Hence, it is recommended to conduct large-scale trials on similar interventions. Also, aspects like patient-reported outcomes (PROs) in tinnitus. Protocol registration The protocol was registered in the open science framework registry (OSF) (registration DOI:10.17605/OSF.IO/R8D39)

Background: Striae Distansae (SD) are a disfiguring dermal condition, characterized by linear bands of atrophic skin, occurring at sites of dermal damage caused by stretching. They affect adolescents and more than 70% of pregnant females due to stretching of the skin. Aims: To evaluate and to compare the efficacy of 1, 064 nm Long Pulsed Nd: YAG laser and Fractional CO2 laser in the management of SD. Patients/Methods: Thirty female patients with bilateral symmetrical SD were treated with Fractional CO2 laser on one side and long-pulsed Nd: YAG laser on the other side. All patients received 3 sessions at 3 weeks interval. Global Aesthetic improvement scale (GAIS) and was used to evaluate improvement 3 months post treatment. Four mm punch biopsies were taken from each side before treatment and 3 months after the last session to measure epidermal and collagen thickness. Findings: More significant clinical improvement was noted with the Nd:YAG laser than Fractional CO2 laser. Both GAIS and satisfaction score were significantly higher in the Nd:YAG laser treated side epidermal and collagen thickness were evidently increased in the Nd: YAG laser treated lesions than those treated by Fractional CO2 laser with no significant difference. Conclusions: Long pulsed Nd-YAG laser is clinically more effective than the Fractional CO2 laser in treating SD without serious side effects, although there was no significant difference between them histopathologically.

Renewable sources of energy, including wind and solar power, can sustainably provide electricity for end-users. However, a high penetration of renewables presents operational challenges in the power system because the renewable power generation is uncertain and changes the net load profile to a "duck-curve". This paper investigates unit commitment scenarios in 2025 that arise from the new energy policy of Taiwan; in 2025, all nuclear power plants will have been decommissioned and pumped storage units will be changed to regulate the power generation from renewables. Due to the intermittence and uncertainty of renewable energy, unit commitment that is determined using the CPLEX optimizer is studied using the point-estimation method to obtain a stochastic solution. Results of simulations of the summer and winter scenarios for the Taiwan power system in 2025 with ten pumped storage units, 183 combined cycle generators, 16 coal-fired generators and 23 power purchase agreement-based generators will reveal the impact of this new energy policy on unit commitment.

We have developed an Object Segmentation, Counter and Analysis Resource (OSCAR) that is designed specifically to quantify densely packed biological samples with reduced signal-to-background ratio. OSCAR uses as input three dimensional images reconstructed from confocal 2D sections stained with dies such as nuclear marker and immunofluorescence labeling against specific antibodies to distinguish the cell types of interest. Taking advantage of a combination of arithmetic, geometric and statistical algorithms, OSCAR is able to reconstruct the objects in the 3D space bypassing segmentation errors due to the typical reduced signal to noise ration of biological tissues imaged in toto. When applied to the zebrafish developing retina, OSCAR is able to locate and identify the fate of each nuclei as a cycling progenitor or a terminally differentiated cell, providing a quantitative characterization of the dynamics of the developing vertebrate retina in space and time with unprecedented accuracy.

Background Adalimumab is used to treat ulcerative colitis, but additional effectiveness and safety data are needed. Patients and methods This retrospective study considered adults with ulcerative colitis treated with adalimumab at 19 hospitals. Clinical data were collected from the start of treatment, after 2, 6 and 12 months, and at the last visit. Outcome measures of effectiveness were treatment duration, reasons for discontinuation and colectomy. Results We studied 381 patients treated with adalimumab for a median of 12.1 months. Disease activity at the start of treatment was moderate to severe in 262 cases (68.8%) and endoscopic activity was moderate to severe in 339 cases (89.0%). At week 8, clinical responses were observed in 177 cases (46.5%) and clinical remission in 136 cases (35.7%). At 12 months, remission was observed in 128 cases (33.6%). Overall, 44 patients required colectomy, and 170 patients (44.6%) were still taking adalimumab when data were collected. Variables associated with adalimumab discontinuation were concomitant steroid treatment, severe clinical-endoscopic activity at baseline, need for adalimumab intensification and drug-related adverse events. Variables associated with colectomy were concomitant steroid treatment and high baseline C-reactive protein. Conclusion Adalimumab is safe and effective for the treatment of ulcerative colitis.

The authors have requested that this preprint be removed from Research Square.

Chest radiograph (CXR) is the most common imaging performed for both inpatients and outpatients. With advances in medicine and technology, newer devices/prosthesis are being used in the treatment of cardiothoracic conditions. Some of these are common while others are seen only in a handful of cases, especially in patients being treated or referred from tertiary care centers. It is important to know about these devices, their functionality, and radiographic appearances. Many of these devices also help us in understanding the clinical condition of the patient, as some are only used in unstable patients. Newer methods of life support are now available in intensive care units and these also can be seen on CXRs. In this review, we present various iatrogenic devices that we come across on a CXR and highlight important features to determine their correct placement and potential complications. The review looks at cardiac temporary and permanent pacing devices, cardiac interventional devices used to treat congenital heart disease, newer cardiac monitoring devices, and unusual surgical devices that one may come across on a CXR. We also suggest a stepwise algorithm to assess these devices on a CXR.

Purpose: CanAssist Breast (CAB) has been validated retrospectively for assessing risk of recurrence and thereby usefulness of chemotherapy in HR+/HER2- breast cancer. The objective of this study is to assess the agreement between physician’s treatment plan and CAB risk stratification and evaluate whether CAB results aid in the physician’s treatment decision.Methods: The data on the physician’s treatment plan before and after the CAB test was collected prospectively between 2016 and 2021 in 249 patients. Changes in treatment recommendations and compliance with CAB reports were analyzed. Results: Based on conventional clinicopathological features physicians planned to treat 46% of patients with endocrine therapy (ET) (low-risk-LR)), 24% with chemoendocrine therapy (CET) (high-risk-HR)) and in 30% physicians were uncertain of prescribing chemotherapy (intermediate-risk-IR)) before CAB testing. The correlation between clinical risk assessment and CAB risk stratification (k=0.2 (0.05-0.35) was nonsignificant. CAB classified 64% as LR, which was 18% (9.3-25, P=0.0001) higher compared to clinical LR. In the clinical IR category, CAB risk proportions were 55:45 (LR: HR). We observed a substantial shift in treatment recommendation from CET to ET in 54% (40.75- 66.84, PP

Background The emergency of COVID-19, along with the current difficulties in responding to the high demand for vaccines, requests to the scientific community to find alternative treatments based on reuse of drugs as a strategy to prevent the progression of the disease in patients infected with SARS COV 2. This study aims to evaluate the use of ivermectin in mild-stage patients to increase outpatient discharge and prevent the progression to moderate or severe stages of the disease.Methods Cluster Randomised Trials in outpatients care, n = 254. The subjects were divided into experimental (EG: n = 110) and control groups (CG: n = 144). The EG received ivermectin orally 4 tablets of 6 mg = 24 mg every 7 days for 4 weeks. All participants were diagnosed by positive RT-PCR for COVID-19 and were evaluated by clinical examination, at the beginning and the end of protocol. Data analyzed using proportion, bivariate and logistic regression. P-value was considered significant at the p Findings Both groups were similar in age, sex, and comorbidities (EG: median age = 40·0, range: 18·0–75·0, 42·11% Female; CG: median age = 36, range: 18·0–71·0, 57·89% Female). A significant reduction in the percentage of participants with symptoms (PPS) was observed in the EG and CG when the clinical evaluation of symptoms was performed from 5th to 9th (p = 0·0005). When the clinical evaluation was performed from 10th to 14th day there was no significant difference. A higher proportion of outpatient discharge was observed in EG (98·2%) vs. CG (86·1%) (p-Value = 0·0007). EG showed 8 times more chance of receiving discharge than CG (8·71 CI = [1·99, 38·12]; p = 0·004). The treatment effect with ivermectin to obtain discharge from outpatient care was analyzed by the logistic regression. Then, the chance to obtain outpatient discharge was independent of variables sex, age, and comorbidities.Interpretation Treatment with ivermectin in outpatients care with mild disease of COVID-19 managed to slightly reduce PPS. Also, this treatment improved the clinical state to obtain outpatient discharge, even in the presence of comorbidities. The treatment with ivermectin could significantly prevent the evolution to serious stages since the EG did not present any patient with referral to critical hospitalization.