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An 81-year-old male with a history of coronary artery disease, hypertension, paroxysmal atrial fibrillation and chronic kidney disease presents with asymptomatic bradycardia. Examination was notable for an early diastolic heart sound. 12-lead electrocardiogram revealed sinus bradycardia with a markedly prolonged PR interval and second-degree atrioventricular block, type I Mobitz. We review the differential diagnosis of early diastolic heart sounds and present a case of Wenckebach associated with a variable early diastolic sound on physical exam.

Donor-centered education offers students the opportunity to not only acquire visual and tactile experiences for applying anatomical knowledge but also a chance for students to reflect upon fundamental humanistic principles. The exploration of differences in students' viewpoints on body donation and the utilization of body donors in their education remains unexplored across various healthcare professional programs, which has an impact on student learning and experience. This study aimed to qualitatively examine the similarities and differences in student perspectives regarding body donation across three healthcare professional programs. One-page reflections from nursing (n = 37), physical and occupational therapy (n = 49), and medical students (n = 66) regarding their experiences in the anatomy laboratory at McGill University were collected and analyzed using a deductive approach based on themes and sub-themes outlined by Stephens et al. in 2019. Despite differences in their curricula, there were few discrepancies across the programs' reflections suggesting that donor-based learning had similar effects on each user group. Most students across the healthcare professional programs mentioned that their positive laboratory experiences motivated them to donate their bodies, extending the privilege they had to future generations. Nursing students did not reflect upon the notion that working with body donors provided unique learning experiences in the anatomy laboratory. Likewise, physical and occupational therapy (PT/OT) students did not address the importance of maintaining the privacy of body donors by covering certain body parts during lab. These findings show that prosection- and dissection-based exercises encourage reflective practices associated with these of medical ethics, highlighting an important advantage to including donor-based learning in anatomical education.

A long-term regional solar energy assessment improves decision-making processes for the selection of the best solar energy technology and helps understand how to define focused policies and investments. This study presents long-term solar resource monthly maps for Qatar. The availability of solar radiation throughout the country has been mapped here using ground-based measurements and satellite data. The regression-kriging algorithm and its variants are used to calibrate satellite data, through interpolation of ground solar radiation data. Digital surface model data is used as an auxiliary variable to further scale down to 30 m resolution. Long-term monthly maps of daily total solar radiation have been produced which consist of 12 monthly maps for global horizontal irradiance (GHI) and 12 monthly maps for direct normal irradiance (DNI) for each month of the year. A significant improvement of 9.15% and 9.32% in GHI and DNI estimation has been observed after calibration, which brings down the Normalized Root Mean Square Error (NRMSE) to 4% and 11.70% for GHI and DNI respectively as compared to the non-calibrated satellite data estimation.

Case presentationA 77-year-old woman with asthma, hypothyroidism, irritable bowel syndrome, overactive bladder, and multiple rheumatologic conditions was sent from the clinic to the ED for evaluation of hypoxia. In the clinic, she reported dizziness without shortness of breath and was noted to have perioral cyanosis with an oxygen saturation measured by pulse oximetry (Spo2) of 80%. She was given a nonrebreather mask delivering oxygen at 8 L/min, but the Spo2 remained at 77% to 82%. In the ED, the patient reported intermittent shortness of breath, 2 to 3 days of mild left lower extremity swelling, and a brief episode of lightheadedness earlier in the day that had since resolved. She denied fevers/chills, upper respiratory symptoms, and chest pain. She had been referred to the pulmonology clinic 3 years earlier to evaluate mild hypoxia with Spo2 readings in the low 90% range, but pulmonary function testing failed to identify an etiology. There was no history of VTE. Her rheumatologic conditions included osteoarthritis, rheumatoid arthritis, Sjögren's syndrome, and fibromyalgia.

BackgroundKnowledge of the pattern of regression and distribution of residual tumor cells may assist in the selection of candidates for rectum-sparing strategies.ObjectiveTo investigate and identify factors associated with tumor regression pattern and distribution of residual tumor cells.MethodsWe conducted a prospective study of patients with T3/T4 N0/N+ adenocarcinoma of the middle and lower third of the rectum (≤10 cm) treated with radiotherapy (5×5 Gy) followed by 6 cycles of CAPOX chemotherapy. The pattern of tumor regression was classified as fragmented or solid. Microscopic intramural spread was measured. We used a model of distribution of residual tumor cells not yet applied to rectal cancer, defined as follows: type I (luminal), type II (invasive front), type III (concentric), and type IV (random).ResultsForty patients were included with a median age of 66 years; 23 (57.5%) were men. A fragmented pattern was identified in 18 patients (45.0%), and a solid pattern in 22 (55.0%). Microscopic intramural spread was identified in 25 patients (62.5%), extending from 1 to 18 mm (median, 4 mm). There were 14 cases (35.0%) of microscopic intramural spread ≥10 mm. All cases of fragmented regression pattern, except one, showed microscopic intramural spread. Within the fragmented pattern, microscopic intramural spread was 4–8 mm in 4 cases and ≥10 mm in the remaining cases. All cases of microscopic intramural spread ≥ 10 mm were within the fragmented pattern. Regarding the distribution pattern of residual tumor cells, 11 cases (31.5%) were classified as type I, 14 (40.0%) as type II, 10 (28.5%) as type III, and none as type IV. Carcinoembryonic antigen levels >5 ng/mL, downsizing 20 mm, and anatomopathologic lymph node involvement were significantly associated with the occurrence of fragmentation (P

Abstract An 81‐year‐old male with a history of coronary artery disease, hypertension, paroxysmal atrial fibrillation and chronic kidney disease presents with asymptomatic bradycardia. Examination was notable for an early diastolic heart sound. 12‐lead electrocardiogram revealed sinus bradycardia with a markedly prolonged PR interval and second‐degree atrioventricular block, type I Mobitz. We review the differential diagnosis of early diastolic heart sounds and present a case of Wenckebach associated with a variable early diastolic sound on physical exam.

Abstract BackgroundThe etiology of capsular contracture (CC), the most common complication following breast augmentation, remains unclear. Chronic, fibrotic inflammation resulting in excessive fibrosis has been proposed as a potential mechanism. ObjectivesIn this study, we aimed to investigate the relation between biomarkers that are associated with inflammation and fibrosis and the severity of CC. MethodsFifty healthy females were categorized into 3 groups: females with no-to-mild CC (Baker 1-2; nnn ResultsNo significant differences in intracapsular cytokine levels were observed between the Baker 1-2 and the Baker 3-4 groups, as the levels were generally low and, in some cases, almost undetectable. In the blood samples, no significant differences in Gal-1, INF-γ, IL-6, or TNF-α levels were found within the 3 groups. We identified significantly increased levels of INF-β (P ConclusionsThe cytokines assessed in this study did not reflect the degree of CC among females with silicone breast implants. However, 3 females with severe CC, who all had prolonged silicone exposure, showed extremely elevated levels of INF-β in their serum samples. This possible association between prolonged silicone exposure and systemic inflammation in some females should be further investigated. Level of Evidence: 3

Introdução/Objetivos: Relato de caso de linfoma raro, que foi tratado com protocolo nunca utilizado anteriormente para este tipo de neoplasia. Com o sucesso do tratamento, nosso objetivo é colaborar com a comunidade médica, enriquecer a literatura e trazer novas alternativas terapêuticas para os pacientes. Material e métodos: Coleta dos dados clínicos na Unidade de Hematologia do Hospital Meridional e levantamento em prontuário das provas laboratoriais, exames especializados e revisão do tema na literatura. Resultados: Paciente hoje com 73 anos, em maio/2012 teve o diagnóstico de linfoma difuso de grandes células B (LDGCB) IIsB IPI = 2. Recebeu 8 ciclos de R-CHOP + radioterapia, finalizando o tratamento em 21/03/13 com remissão completa da doença. No fim de 2021 suspeitou-se de recidiva do LDGCB. Foi realizada nova biopsia de linfonodo abdominal, porém em 07/02/22 definiu-se o diagnóstico como linfoma de Hodgkin não clássico, subtipo predominância linfocítica nodular (LHPLN), estádio IV. Discussão: Como o LHPLN é o subtipo histológico mais raro do linfoma de Hodgkin (LH), não existe consenso sobre a melhor terapia nos estadios avançados. O protocolo ABVD é comumente aplicado como extrapolação da literatura do LH clássico, contudo, há relatos de que a recidiva com o ABVD é alta, com maior eficácia observada em regimes que contenham agentes alquilantes. A escolha da nova terapia foi um desafio, pois a paciente já havia recebido a dose máxima de antraciclina no tratamento anterior. Além disso também já havia usado agente alquilante e doses adicionais poderiam predispor à mielodisplasia e leucemia mieloide aguda. Por ser idosa e frágil, também não era candidata a transplante de medula óssea. Optamos pelo protocolo R-GemOx (rituximab, gencitabina e oxaliplatina) que, pela nossa revisão da literatura, nunca havia sido utilizado no tratamento de LHPLN, porém tem eficácia comprovada contra linfomas não Hodgkin de células B, com perfil de toxicidade bastante aceitável. Nesse tipo de linfoma, em casos refratários ou recidivados, a taxa de resposta global variou entre 61 a 83% e taxa de resposta completa foi de 44 a 50%, com taxa de sobrevida livre de eventos em 2 anos de 43% e sobrevida global de 66%, respectivamente, sobrevida livre de progressão em 42 meses de 28%, com sobrevida global de 37%. Também demonstrou boa ação no controle do linfoma de Hodgkin clássico com taxa de resposta global de 71% e completa de 38%. Dessa forma, a paciente recebeu 8 ciclos de R-GemOx entre 18/03/22 a 12/08/22 e obteve resposta completa que se mantém até a presente data. Conclusão: A paciente foi tratada com sucesso com protocolo de imunoquimioterapia nunca relatado anteriormente para esse tipo de neoplasia, com resultado animador. Assim, acreditamos que nossa contribuição possa ajudar comunidade médica e outros profissionais ao se depararem com casos semelhantes e servir como hipótese para realização de estudos prospectivos mais robustos que possam definir o melhor tratamento do LHPLN.

Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

BackgroundDuring the first wave of COVID-19 in Amsterdam, the Netherlands, a disproportional number of COVID-19 hospitalizations occurred in individuals with an ethnic minority background and in individuals living in city districts with a lower socioeconomic status (SES). In this study, we assessed whether these disparities continued throughout the second wave, when SARS-CoV-2 testing was available to anyone with symptoms but prior to the availability of COVID-19 vaccination.MethodsSurveillance data on all notified SARS-CoV-2 cases in Amsterdam between 15 June 2020 and 20 January 2021 were matched to municipal registration data to obtain the migration background of cases. Crude and directly age- and sex-standardized rates (DSR) of confirmed cases, hospitalizations, and deaths per 100,000 population were calculated overall, and by city districts, and migration backgrounds. Rate differences (RD) and rate ratios (RR) were calculated to compare DSR between city districts and migration backgrounds. We used multivariable Poisson regression to assess the association of city districts, migration backgrounds, age, and sex with rates of hospitalization.ResultsA total of 53,584 SARS-CoV-2 cases (median age 35 years [IQR = 25–74]) were notified, of whom 1,113 (2.1%) were hospitalized and 297 (0.6%) deceased. DSR of notified infections, hospitalization, and deaths per 100,000 population were higher in lower SES peripheral city districts (South-East/North/New-West) than higher SES central districts (Central/West/South/East), with almost a 2-fold higher hospitalization DSR in peripheral compared to central districts (RR = 1.86, 95%CI = 1.74–1.97). Individuals with a non-European migration background also had a higher COVID-19 burden, particularly with respect to hospitalization rates, with a 4.5-fold higher DSR for individuals with a non-European background compared to ethnic-Dutch (RR 4.51, 95%CI = 4.37–4.65). City districts, migration backgrounds, male gender, and older age were independently associated with COVID-19 hospitalization rates.DiscussionIndividuals with a non-European background and individuals living in city districts with lower SES continued to independently have the highest COVID-19 burden in the second wave of COVID-19 in Amsterdam, the Netherlands.

Previous research has demonstrated that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gains cell entry through the angiotensin-converting enzyme 2 receptor, which is abundantly found throughout the gastrointestinal (GI) tract, resulting in a wide array of GI manifestations of coronavirus disease 2019 (COVID-19). By gaining entry into the intestinal epithelial and stromal cells, SARS-CoV-2 has been observed to cause intestinal inflammation and gut dysbiosis. Alterations in gut microbiota are known to be involved in the pathophysiology of Clostridioides difficile infection (CDI). During the initial stages of the COVID-19 pandemic, rates of CDI were similar to historical data despite the increased use of antibiotics. This may be due to increased emphasis on hygiene and protective equipment and reduced C. difficile testing as diarrhea was presumed to be COVID-19 related. Studies also demonstrated additional risk factors for CDI in COVID-19 patients, including length of hospitalization and new abdominal pain during admission. Although not associated with increased mortality, CDI was associated with increased length of hospital stay among patients admitted with COVID-19. Due to fecal viral shedding and concern of oral–fecal transmission of SARS-CoV-2, increased safety regulations were introduced to fecal microbiota transplantation (FMT) leading to reduced rates of this procedure during the COVID-19 pandemic. FMT for recurrent CDI during the COVID-19 pandemic remained highly effective without any reports of SARS-CoV-2 transmission. In addition, limited data show that FMT may be effective in treating COVID-19 and restoring healthy gut microbiota. The goal of this article is to review the impact that the COVID-19 pandemic has had on hospital-acquired CDI and the utilization of FMT.

La hiperglicemia intrahospitalaria se define como un valor de glucosa >140 mg/dL, este valor puede estar presente en individuos con Diabetes y sin diagnóstico previo de Diabetes o que presentan hiperglicemia durante la hospitalización secundaria a fenómenos de estrés. La Asociación americana de Diabetes (ADA), Asociación Americana de Educadores en Diabetes (AADE) y la Sociedad Europea de Endocrinólogos Clínicos, recomienda mantener las glicemias en hospitalización en rango entre 140 mg/dL, y 180 mg/dL. OBJETIVO: Para este estudio se planteó determinar el efecto de la Hiperglicemia intrahospitalaria sobre la morbimortalidad en pacientes sometidos a cirugía cardiovascular en el Centro Médico Docente la Trinidad (CMDLT), en periodo de enero 2018 hasta agosto 2020. METODOLOGÍA: para el logro de esto se realizó un estudio observacional analítico retrospectivo, donde se recolectaron los datos de 59 pacientes con diagnósticos de hiperglicemia intrahospitalaria sometidos a cirugía cardiovascular con una muestra total de 37 pacientes. RESULTADOS Y CONCLUSIONES: Se observó que existieron mayores complicaciones médicas que quirúrgicas, de estas las más frecuentes fueron injuria renal aguda, fibrilación auricular, y trastorno acido base. Las variables más relacionadas con complicaciones médicas fueron: pacientes con glicemias al ingreso > 180 mg/dl, excursiones glicemias amplias, glicemia al egreso ≥140mg/dl, así mismo se observó que la variabilidad glicémica fue el principal factor de riesgo a considerar para determinar riesgo de morbimortalidad.

BackgroundBreakpoint cluster region-Abelson gene (BCR-ABL) tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of patients with chronic myeloid leukemia (CML). However, concern has arisen about the cardiac safety profile of these drugs.ObjectivesThis study aims to compare long-term risks of adverse cardiovascular and cerebrovascular events (ACE), heart failure or left ventricular ejection fraction (LVEF) < 50%, and venous thromboembolic events (VTE) in patients with CML treated with BCR-ABL TKIs, using data from a large multinational network.MethodsPatients aged ≥ 18 years with CML treated with imatinib, dasatinib, or nilotinib without prior cardiovascular or cerebrovascular disease were included. We used propensity score matching to balance the cohorts. The 5-year cumulative incidences and hazard ratios were calculated.ResultsWe identified 3,722 patients with CML under treatment with imatinib (n = 1,906), dasatinib (n = 1,269), and nilotinib (n = 547). Patients with imatinib compared to dasatinib showed a higher hazard ratio (HR) for ACE (HR 2,13, 95% CI 1.15–3.94, p = 0.016). Patients with imatinib presented a lower HR than nilotinib for ACE (HR 0.50, 95% CI 0.30–0.83, p = 0.0074). In relation to heart failure or LVEF < 50%, patients with imatinib had a higher HR than dasatinib (HR 9.41, 95% CI 1.22–72.17, p = 0.03), but no significant difference was observed between imatinib and nilotinib (HR 0.48, 95% CI 0.215–1.01, p = 0.064).ConclusionIn this retrospective study with a large number of patients with CML, those treated with nilotinib had a higher 5-year ratio of ACE, while patients with dasatinib showed a lower ratio than patients with imatinib. The ratio of heart failure was higher in patients with imatinib than in patients with dasatinib, but not when compared to nilotinib.

As Lebanon faces compound challenges, a looming food security crisis is rapidly approaching, much of which could be attributed to the lack of long-term planning for sustainability in its agricultural sector. The disconnect between decision-makers within the agricultural sector, and other interconnected sectors is exacerbated by the lack of integrative national platforms and methodologies for quantifying the trade-offs associated with possible interventions. This study aims to: (1) identify and quantify the critical interconnections between water, energy, nutrition, and food systems in Lebanon; (2) develop a framework to quantify the trade-offs associated with adopting interventions within current water, energy, and agriculture portfolios and practices; (3) evaluate producers' perceptions toward their willingness to implement proposed changes in crop production, renewable energy, and water reuse. Findings show that investing in locally producing Lebanon's needs of broad beans, lentils, chickpeas, and peas, results in cost savings, increased nutritional value in the locally produced basket, and reduced reliance on foreign markets. In turn, this comes at additional water, energy, land and carbon footprints which needs to be accounted for. Given the uncertainty of future currency conversion rates, it becomes more critical to identify a strategic food basket that could be produced locally to reduce reliance on imports. Conclusions from this study can play a role in informing policymaking and planning in Lebanon, which could be adapted and replicated in other countries in the MENA Region.

Objective: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment. Methods: The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls. Results: Patients with missing molars failed significantly more often in MAS therapy than the controls (p = 0.020). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (p = 0.050). Conclusion: The study could not identify a single reason for MAS failure. [ABSTRACT FROM AUTHOR]

Soiling of photovoltaic (PV) modules is a major issue due to its critical impact on PV performance and reliability, especially in the desert and arid regions such as the state of Qatar. Soiling frequently results in a severe reduction in PV power generation, which drastically affects the economical profitability of the PV plant, and therefore, must be mitigated. The most common way of mitigating PV soiling is surface cleaning. However, the latter could consequently increase the associated operation and maintenance (O&M) cost of the PV site. However, previous studies indicated that even if the best-optimized cleaning schemes are used, the actual global solar-power production can still be reduced by about 4%, which is associated with at least EUR 5 billion in annual revenue losses worldwide. This loss is expected to reach a conservative value of EUR 7 billion in 2023. Accordingly, investigating the interplayed physics phenomena related to the various soiling processes, the site-specific O&M costs, along with a techno-economical assessment of state-of-the-art soiling mitigation strategies (including innovative anti-soiling coating materials) is of paramount importance. The goal of this comprehensive report is to provide the solar community at large, and those focusing on the desert environment in particular, with real field measurements that provide key findings and challenges in addressing soiling research obtained from multiyear testing at the Outdoor Test Facility (OTF) field station, located in the desert environment of the city of Doha, in the state of Qatar.

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Obstructive sleep apnea (OSA) is prevalent in individuals with Osteogenesis imperfecta (OI). To date, no study has investigated treatment of OSA in adult individuals with OI using positive airway pressure (PAP). This observational pilot study examined the adherence of adults with OI to treatment of OSA with PAP therapy, and the evolution of self-experienced sleepiness and depression symptoms before and after treatment. Methods We included 20 patients, with a mean age of 51 years, who represented varying severity of OI and displayed an apnea and hypopnea index ≥ 5 /sleeping hour as recorded by an overnight polysomnography. PAP therapy was proposed to all patients. Epworth Sleepiness Scale (ESS) questionnaire to evaluate daytime sleepiness, and a validated self-rating depression questionnaire to identify possible depression, were completed prior to PAP therapy and repeated after a minimum of one year. The datasets supporting the conclusions of this article are included within the article. Results From the 20 patients, 15 initiated PAP therapy, and two patients later interrupted it. The mean PAP follow-up period was 1230 days. At baseline, an abnormally high ESS score was reported by 29% of the respondents, and an abnormally high number of symptoms suggesting depression by 29%. Follow-up questionnaires were completed by 60% of the patients, of whom 83% were adherent to PAP treatment. ESS score and depression symptoms did not decrease significantly with PAP therapy. Conclusions Patients with OI accepted well PAP therapy and remained compliant. Sleepiness and depression persisted unaltered despite good PAP adherence. These unexpectedly poor improvements in symptoms by PAP therapy may be due to subjective depression symptoms and the complexity of factors underlying persisting sleepiness in OI. Further research is needed to confirm this novel finding.

Summary: Background: In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods: National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings: The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200). Interpretation: The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding: The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.

La hiperglucemia intrahospitalaria se define como un valor de glucosa >140 mg/dL. Si bien esto puede suceder en primer lugar en individuos con diabetes ya conocidos, en segundo lugar, en pacientes sin diagnóstico previo, pero que al momento del ingreso presenta síntomas asociados al diagnóstico de diabetes como pérdida de peso, hiperglicemia, deshidratación, cetosis, y en tercer lugar en aquellos pacientes que presentan hiperglicemia durante la hospitalización secundaria a fenómenos de estrés. La Asociación americana de Diabetes (ADA), Asociación Americana de Educadores en Diabetes (AADE) y la Sociedad Europea de Endocrinólogos Clínicos, recomienda mantener las glicemias en hospitalización en rango entre 140 mg/dL, y 180 mg/dL. Para este estudio se planteó determinar el efecto de la Hiperglicemia intrahospitalaria sobre la morbimortalidad en pacientes sometidos a cirugía cardiovascular en el Centro Médico Docente la Trinidad, en periodo de enero 2018 hasta agosto 2020. Para el logro de esto se realizó un estudio observacional analítico retrospectivo, donde se recolectaron los datos de 59 pacientes con diagnósticos de hiperglicemia intrahospitalaria sometidos a cirugía cardiovascular con una muestra total de 37 pacientes. Se observó que existieron mayores complicaciones médicas que quirúrgicas, de estas las más frecuentes fueron injuria renal aguda, fibrilación auricular, y trastorno acido base, así mismo. Las variables más relacionadas con complicaciones médicas fueron: pacientes con glicemias al ingreso > 180 mg/dl, excursiones glicemias amplias, glicemia al egreso ≥140mg/dl, así mismo se observó que la variabilidad glicémica fue el principal factor de riesgo a considerar para determinar riesgo de morbimortalidad.

Objectives: Hip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting. Methods: Patients aged ≥50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures. Results: There were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P 0.05). Conclusions: When comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity.

Abstract Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

This paper introduce a new way to simulate the effect of changing the length and the band gap of the nanotube on the current of carbon nanotube field effect transistors (CNTFET( by using simulation tools: FETToy, CNTFET lab, CNT bands 2.0, since this simulation were done in different parameters of ZigZag nanotube. We use three simulations tools because each tool provides simulation of parameters that differ from the parameters of other tools, so we can study more parameters that we change which this article is studied. In this paper we studied the effect of changing of ZigZag nanotube length which has a chirality (n,0) on the current of the CNTFET. We have found that the relationship between nanotube length and the current of the CNTFET is an inverse proportional, as the nanotube length increase, the current of CNTFET decrease, and the relation between the band gap of the ZigZag nanotube and current of the CNTFET has been studied too. We have found that this relationship is an inverse proportional, as the band gap increase, the current of CNTFET decrease. Also, we studied the relation between the band gap of the ZigZag nanotube and the average velocity of charges in CNTFET, we found that relationship is an inverse proportional, as the band gap increase, the average velocity of charges of CNTFET decrease.

A growing number of studies suggest that climate may impact the spread of COVID-19. This hypothesis is supported by data from similar viral contagions, such as SARS and the 1918 Flu Pandemic, and corroborated by US influenza data. However, the extent to which climate may affect COVID-19 transmission rates and help modeling COVID-19 risk is still not well understood. This study demonstrates that such an understanding is attainable through the development of regression models that verify how climate contributes to modeling COVID-19 transmission, and the use of feature importance techniques that assess the relative weight of meteorological variables compared to epidemiological, socioeconomic, environmental, and global health factors. The ensuing results show that meteorological factors play a key role in regression models of COVID-19 risk, with ultraviolet radiation (UV) as the main driver. These results are corroborated by statistical correlation analyses and a panel data fixed-effect model confirming that UV radiation coefficients are significantly negatively correlated with COVID-19 transmission rates.

Background Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.Methods OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.Results We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).Conclusion Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)