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Introduction: Stokes-Adams syndrome characterizes a primary mechanism of syncope stemming from cardiac origins, resulting from disruptions in cardiac rhythm. These rhythm disturbances can manifest as either a fast or slow heart rate, presenting as either regular or irregular patterns. Case Report: A three-year-old patient was admitted to the hospital due to experiencing myoclonus, gaze fixation and fever. These symptoms were preceded by episodes of vomiting. Upon admission, the family reported that the child had experienced self-limited generalized tonic-clonic seizures lasting 3-4 minutes. The child's grandfather, who has medical experience, likened the convulsions to a myocardial infarction. Following the convulsive episode, the patient's status reveals pupils of equal size and preserved photomotor reflex. Initially, the diagnosis of generalized febrile convulsions might be considered, but upon examination, additional changes were identified. The clinical examination shows rhythmic heart sounds, a low ventricular rate of 48 beats per minute, a systolic murmur at the mitral valve, warm extremities and a congested pharynx. The electrocardiogram indicates a third-degree atrioventricular block along with severe bradycardia and a prolonged QT interval (QTc = 0.50second). The cardiac ultrasound shows the ejection fraction of the left ventricle measuring 55% and no abnormalities in the cardiac structure are found. The treatment administered included a 1000 ml intravenous infusion of glucose and electrolytes per 24 hours, 40 ml of 15% mannitol, cortisone hemisuccinate and 0.5 ml per day of intramuscular phenobarbital 10%. The patient's condition showed improvement with no recurrence of syncopal episodes. Bradycardia persisted at 46 beats per minute with a slight tendency to increase upon mobilization. The electrocardiogram continues to exhibit the same changes during hospitalization. Discussions : In this case, initially, bradycardia was linked with acute cerebral edema following a seizure, a connection that might have postponed the pacemaker implantation procedure. Given the potential severity of the case, the patient is promptly referred for pacemaker implantation. In children, third-degree atrioventricular block can stem from congenital or acquired type. In the absence of congenital heart defects, the congenital type is often associated with neonatal lupus erythematosus. Other causes include cardiomyopathies, Lyme carditis, acute rheumatic fever or myocarditis. Conclusions: Severe bradycardia, third-degree atrioventricular block type and long QT intervals led to the interpretation of the convulsive crisis as cardiac syncope. A potential congenital origin is suspected. Additionally, the parents noted reduced and irregular heart sounds since infancy. Neither parent has a known history of heart disease. [ABSTRACT FROM AUTHOR]

The paper presents the results of several studies concerning urban landscape (types and evolutive tendencies) for various Romanian tourist cities. The study outlines that the natural and architectural urban tourist resource is generated by different urban landscape elements, not only the main tourist resource itself. One of the conclusions of the survey is that the landscape is one of the most important existent resources, but despite that is the most transformed element due to urban development pressures, especially within the existent urban landscape frame. In accordance with present development trends, the study outlines the main features that can characterise a landscape at urban level and the transformations that affected Romanian tourist destinations in the latest years. A very important aspect of urban landscape is its complexity - being in the same time society's living environment, a cultural, historical and economical context and further development matrix - spatially expressed at territorial level. The paper wants to formulate the main development principles that should be included in urban development policies in order to preserve the main landscape and architectural features of these tourist towns. Due to the urban explosion of the latest centuries, new landscapes appeared, reflecting the new technologies and new social needs - like large communication infrastructures, intermodal nodes, industrial landscapes or media landscapes - belonging of the consumer society. We are dealing with a succession of landscapes - overlapped morphological and spatial structures - which reflects different relations between society and its living environment, creating contemporary contexts. [ABSTRACT FROM AUTHOR]

This paper considers the cultural reflection of William Blake's literary madness in the shaping of the identitary image of "Howl"'s Beats, with the word beat interpreted as meaning beatifically mad. I underline the effect of this type of madness upon the hipsters who inspired and became inspirational trough Allen Ginsberg's groundbreaking American poem and the latter's portrayal of madness as both a consequence of social stigma and a source of prophetic self-confidence. [ABSTRACT FROM AUTHOR]

The shadowy realms of William Blake's Urizen (The Book of Urizen) and Allen Ginsberg's Moloch (Howl) entail a conceptual reversal between life and death via 'sleep' imagery. The Biblical association of 'sleep' with 'death' is overturned in the prophetic poems of both Blake and Ginsberg towards a Gnostic and Hermetic perspective upon existence, according to which earthly life is led in forgetfulness and ignorance in relation to the true nature of reality. Consequently life becomes more akin to death. Since William Blake describes the universal man, Albion, as being asleep and Allen Ginsberg's lyrical self is depicted being asleep as well, earthly life takes the shape of a mere shadow, a dream, an imitation of true or divine reality, rooted in a shadowy sleep of death that awaits awakening. This lack of awareness over which Urizen and Moloch (as parts of the human psyche) rule breeds aggression, cruelty and destructive urges so vicious that they can only take shelter underneath the 'shadow' of the mind or what Jung conceptualized to be the darkest corner of the unconscious. Last, but not least, the same obscurity of the mind can be interpreted through the lens of the alchemical process known as Nigredo, which is the necessary blackening step in the process of purification. [ABSTRACT FROM AUTHOR]

A total of 47 patients were on propofol, 39 (83%) patients were successfully weaned off propofol (55.3%) or had a decrease in infusion rate (25.7%). B Introduction: b The use of ketamine as a sedative agent has increased dramatically in patients who are mechanically ventilated (MV) due to COVID-19 in intensive care units (ICU). At the start of ketamine, 74 patients were on fentanyl, 27 (36.5%) of those patients were successfully weaned off fentanyl (10.8%) or had a decrease in infusion rate (25.7%). [Extracted from the article]

B Introduction: b Tocilizumab has been used for treatment of COVID-19 in hospitalized patients who require supplementation oxygen. All patients had received dexamethasone and remdesivir per standard hospital protocols and antibiotics for superimposed bacterial pneumonia in patients with infiltrates concerning for concomitant bacterial picture. 2 of the 7 patients underwent caesarean delivery for maternal hypoxia, both in the setting of severe COVID-19 infection. [Extracted from the article]

B Conclusions: b All patients who received high-dose insulin infusion for hypertriglyceridemia-induced acute pancreatitis had reduction in their triglyceride levels after starting insulin infusion with 74% of patients reaching a goal triglyceride level less than 500. All patients admitted to the medical intensive care unit from September 1st, 2018 to September 30th, 2021 who received high-dose insulin drip for hypertriglyceridemia-induced acute pancreatitis will be eligible for inclusion. Future studies comparing insulin and insulin in addition to plasmapheresis are needed to further analyze optimal treatment for hypertriglyceridemia induced pancreatitis. [Extracted from the article]

Typical for the last decades economical and social processes at metropolitan level induce new models of spatial organization characterized by extensive urban development. These extensive processes configure various components of the cultural landscape in different ways. Such development modifies the rural, agricultural and industrial landscapes and generates new landscape typologies modeled by interaction between urban and rural space. Diverse approaches of urban development have modified the territorial structure and also the way in which the territory visually and dynamically responds to external factors by transforming the main cultural features. In such a context, preservation of common agricultural landscape as a part of cultural landscape is becoming an important issue for the local development policies. [ABSTRACT FROM AUTHOR]

The sustainable development and the regional approach bring good results for in the economical, social and environmental areas of interest and at the level of all the regions. Tourism is an activity that can be managed to achieve these two concepts for obtaining the best for the local goals and by reuniting the effort s of all the regions, can bring a national development. The implementation of specific measures can increase the number of tourists and can respond to the demands of the eco tourists. This work presents the case of the regional development of the South Muntenia region. [ABSTRACT FROM AUTHOR]

Currently, the interest is no longer just hading to the economic benefits but also to the environmental ones, which ensures a clean world and in which the future is attractive. One element that shows this interest is taking measures for economic and environmental outcomes across sectors. An example is the tourism sector in the South Muntenia region. [ABSTRACT FROM AUTHOR]

The present paper examines the funding situation from which has benefited our country before and during the post-accession period to the European Union, ensured from community sources, from the governmental area or generated through the partnership between the world states and Romania. These funds may be the solution for the implementation of the projects for improving the quality of the natural and human environment, urban and rural areas, targeting the development of human resource and the economic environment in each area. They can support the development of localities and those activities that enhance the economic national growth, but they also contain right items at the same time for the regional sustainable development. The case study presented below being that of the South Muntenia development region of Romania. [ABSTRACT FROM AUTHOR]

Tourism is a special activity in the economic sector that refers to a required service. The contribution of this activity generates development, which can be regional and national. This development is ensured by the financed projects from the sector. The case study refers to the South Muntenia region. [ABSTRACT FROM AUTHOR]

The Natura 2000 network is a European network of protected natural areas comprising a representative sample of wild species and natural habitats of Community interest. Since 1992, the European Union has promoted as the main nature conservation tool the development of the Natura 2000 network of protected areas, targeting both EU and candidate countries. The establishment of the Natura 2000 network is based on two European Union directives, the Habitats Directive and the Birds Directive, which regulates the way of selecting and designating sites and protecting them, and Member States have the right to regulate the practical implementation and implementation of the provisions of Directives at national level. Natura 2000 site ROSCI263 Valea Ierii, with an area of 6,194 ha, is a protected area of average size in our country and, at the same time, one of the largest wild areas in the Apuseni Mountains. Administratively, the protected natural area is entirely on the territory of Cluj County. Valea Ierii was declared a protected natural area of Community importance with landscape value through Decision 147/1994 of the Cluj County Council. The following habitats have been identified within the site: natural grasslands, deciduous forests, coniferous forests, mixed forests, transition forests. [ABSTRACT FROM AUTHOR]

Traumatic injury is a major cause of morbidity and mortality in pediatric patients. Hemorrhage is a known but treatable component of these outcomes. Evidence exists that major trauma patients are at high risk for hypocalcemia but the rate of pediatric occurrence is not documented. The purpose of this study was to determine the incidence of hypocalcemia in pediatric trauma patients, as well as to investigate any correlation between hypocalcemia and the need for transfusion and operative intervention. After IRB approval a retrospective analysis was conducted of all pediatric trauma patients seen in our Adult Level One, Pediatric Level Two trauma center. Significance testing for mortality was performed using Pearson's χ 2 test. For the remaining numeric variables, association was determined one-way analysis of variance (when comparing all classes) or Welch's two-sample t-test (when comparing subsets based on calcium or mortality). In any event, significance was determined using α=0.05. A total of 2,928 patients were identified, 1623 were excluded, primarily due to incomplete data. Patients were predominantly male following blunt trauma. Initial calcium levels were 8.73 mg/dL, 95% CI [4-10.9] and 8.97 mg/dL, 95% CI [6.42-13.1] when correcting for albumin levels. Acute declines were noted when comparing initial and corrected serum calcium levels in patients requiring transfusion (7.99 mg/dL and 8.72 mg/dL) and operative intervention (8.54 mg/dL and 8.91 mg/dL). 456 (34.9%) patients required operative intervention, 138 (10.6%) required transfusion and 29 (2.2%) required massive transfusion. Patients in our cohort arrived with calcium values on the low end of normal, with a trend towards hypocalcemia if operative intervention or blood transfusion was required. This has been previously associated with increased mortality. Patients requiring operative intervention and transfusion are at increased risk for hypocalcemia and recognition of this potential is key for improved outcomes., Competing Interests: None., (IJBT Copyright © 2021.)