bluuebunny/crossref_metadata_2025 huggingface dataset:
MONETARY POLICY AND INCOME DISTRIBUTION IN THE COVID-19 PANDEMIC CRISIS. A EUROPEAN PERSPECTIVE
Authors: Rossi Sergio
Published: October 2022

ABSTRACT
This paper focuses on central banks’ interventions during the COVID-19 pandemic crisis and their impacts on income distribution across Europe, particularly as regards Switzerland and the euro area. The first section offers a survey of the monetary policy tools that have been put into practice to deal with the macroeconomic shock resulting from this pandemic. The second section points out the impact of central banks’ interventions on the whole economic system, before elaborating on the distributive effects of them. The third section suggests an alternative monetary policy stance to reduce the latter effects and to enhance sustainable development for the common good.
 
POLÍTICA MONETARIA Y DISTRIBUCIÓN DEL INGRESO EN LA CRISIS DE LA PANDEMIA COVID-19:
UNA PERSPECTIVA EUROPEA
RESUMEN
El presente artículo analiza las intervenciones de los bancos centrales durante la crisis de la pandemia COVID-19 y sus impactos en la distribución del ingreso en Europa, en particular en lo que concierne a Suiza y el área del euro. Después de la introducción, la segunda parte ofrece una revisión de los instrumentos de política monetaria puestos en práctica para confrontar el choque resultante de esta pandemia. La tercera parte enfatiza el impacto de las intervenciones de los bancos centrales en todo el sistema económico, previo al escrutinio de sus efectos distributivos, y la cuarta sugiere un enfoque alternativo de política monetaria para atenuar estos efectos y para mejorar el desarrollo sustentable de los bienes comunes.
Effects of different inorganic selenium levels in laying quails (Coturnix coturnix Japonica) diets on performance, egg quality, and serum biochemical parameters
Authors: Sarmiento-García Ainhoa , Sevim Behlül , Olgun Osman , Ahmet-Gökmen Seyit
Published: October 2022

Inorganic selenium supplementation in poultry diet has been controversial. It has been linked that the excess and deficiency of this mineral can lead to health problems in these animals. However, this fact is not so evident in quails. In this research 120 female quails (220.6 ± 8.2 g) at 10 weeks of age were allocated to five treatment groups with six replicates of four quails in each. Experimental diets were formed by adding 0, 0.25, 0.50, 0.75 or1.00 mg/kg of inorganic selenium (sodium-selenite) to the diet containing 0.12 mg/kg of selenium. We observed that performance parameters, mortality, egg external, and internal quality of quails were not affected by the supplementation of inorganic selenium to the diet Serum glucose (P = 0.0020) and creatinine (P = 0.0333) levels were affected by inorganic selenium supplementation, but no differences were found for other parameters among those treatments. The addition of 0.50 mg/kg of inorganic selenium to the diet increased serum glucose levels of laying quails compared with the control group. While serum creatinine level was maximized with the addition of 0.25 mg/kg inorganic selenium to the diet, and it was minimized with the addition of 0.50 mg/kg inorganic selenium. Supplementation with inorganic selenium (0 to 1.00 mg/kg) in laying quail diets did not have any adverse effect on performance, mortality, and egg quality during the study. No abnormalities were found in the serum parameters that would lead to the suspicion of metabolic disease in the quails.
Seal Cap Resistivity Structure of Los Humeros Geothermal Field from Direct Current and Transient Electromagnetic Soundings
Authors: Flores Carlos , Avilés Esquivel Thalia , Arango Claudia
Published: October 2022

Los métodos geofísicos dan información importante en la exploración de recursos geotérmicos. En este trabajo buscamos pistas de la presencia de un yacimiento geotérmico conocido (Los Humeros, México) en la estructura somera de la resistividad eléctrica. Interpretamos cerca de 410 sondeos eléctricos verticales (SEV) y 230 sondeos electromagnéticos transitorios (TEM) que dan información de la resistividad eléctrica hasta profundidades de 1 km, alcanzándose en algunos sitios hasta 2 km.La estructura vertical de la resistividad generalmente consiste de una secuencia resistivo-conductor-resistivo. El rasgo más importante es la unidad conductora, conocida como el casquete de arcillas, asociado con arcillas de alteración hidrotermal arriba del yacimiento geotérmico. Esta unidad sufre de un problema de equivalencia, donde no se pueden determinar por separado su resistividad de su espesor. Sin embargo, las temperaturas de los pozos y las arcillas de alteración asociadas ayudan a constreñir este problema. En varias zonas de la unidad resistiva somera encontramos resistividades bajas que podrían representar zonas de recarga donde roca fracturada permite la infiltración de agua meteórica. El casquete de arcillas no solo se presenta sobre el yacimiento, sino que tiene una presencia regional. Sin embargo, sobre el reservorio esta unidad tiene una mayor conductancia y su cima está más somera. Los pocos lugares donde los sondeos eléctricos alcanzaron profundidades del yacimiento con resistividades bien resueltas dan una resistividad media de 118 ohm▪m, sin poder diferenciar estadísticamente las zonas productoras de las no productoras. Esta resistividad está dentro del rango de valores encontrados en otras zonas geotérmicas del mundo.
An IOT Based Low Cost Weather Monitoring System
Authors: Singh Kshitij
Published: October 2022

Abstract: Weather is a phenomenon that describes the present atmospheric conditions like temperature, wind direction, humidity etc. over a geographical location. Weather monitoring involves use of high configuration computer system that require high amount of power and expenditure for installation and maintenance. In the present work we have developed a low cost IoT based system to monitor weather conditions of a location. This system is limited in its geographical radius but its low cost reliable features make it possible to use such a series of systems instead of just one to monitor weather conditions over a large pheriphery.
SISTEMA DE CONTROLE GERENCIAL E CONFIANÇA ENTRE GESTORES E FUNCIONÁRIOS: ESTUDO DE CASO DURANTE A FUSÃO DE EMPRESA NO BRASIL
Authors: Villa Costa Vaz Patricia , Maria dos Santos Bortolocci Espejo Marcia
Published: October 2022

Objetivo: Este estudo tem como objetivo analisar como o pacote de Sistema de Controle Gerencial impacta a percepção de confiança entre gestores e funcionários de uma empresa que passava por processos de mudança de ativos, como fusão.
Método / abordagem: A metodologia adotada é o estudo de caso em uma empresa de telecomunicações do sul do Brasil, com entrevistas semiestruturadas com cinco sujeitos (dois gerentes e três funcionários) e análise do discurso dos dados coletados.
Principais resultados: Como resultados, foi possível identificar os cinco componentes do pacote de Sistema de Controle Gerencial nos relatos dos entrevistados (controles culturais, planejamento, controles cibernéticos, recompensa e compensação e controles administrativos) e sua relação com as três formas de confiança (contratual, comunicativa e baseada em competência). Foi apontado que a transparência nas ações diárias facilita a ocorrência de confiança entre gestores e colaboradores. Além disso, foi analisada a percepção de dois entrevistados algum tempo após a fusão, verificando que as percepções de confiança foram diferentes, de acordo com a proximidade com o processo de fusão.
Contribuições metodológicas / sociais / gerenciais: Este estudo busca contribuir na análise dos componentes do pacote de Sistema de Controle Gerencial e aspectos de confiança, considerando um processo de fusão.
Originalidade / relevância: É relevante analisar o processo de fusão considerando que esta incerteza sobre o futuro da empresa pode promover nos colaboradores resultados indesejáveis, como diminuição da produtividade, falta de comprometimento com as metas e aumento da rotatividade dos funcionários.
TRABALHO E RISCO DE ADOECIMENTO NA PERSPECTIVA DOS AGENTES DE NECROPSIA
Authors: Dos Santos de Freitas Julia Maria , Barra de Oliveira Agostinha Mafalda , De Sousa Juliana Carvalho , Do Vale Aline Francilurdes Nery
Published: October 2022

Objetivo: Compreender a percepção dos custos e danos relacionados ao trabalho dos agentes de necropsia de um Instituto Técnico Científico de Perícia (ITEP), do estado do Rio Grande do Norte (RN).
Método / abordagem: Trata-se de um estudo de caso, qualitativo e descritivo. Entrevistas semiestruturadas foram realizadas com sete agentes de necropsia do ITEP-RN. O roteiro de entrevista foi baseado nas Escalas de Custo Humano no Trabalho (ECHT) e de Avaliação dos Danos Relacionados ao Trabalho (EADRT). Para a análise de dados, utilizou-se a análise de conteúdo de Bardin (2010).
Principais resultados: Identificou-se custos físicos devido ao carregamento de peso, manuseio de equipamentos e cadáveres; e custos emocionais, por lidar com vítimas conhecidas e crianças, sofrimento das famílias e conflitos interpessoais no trabalho. Bem como, danos físicos, como dores e doenças causadas pela exposição a fortes odores; danos sociais, como impaciência para lidar com pessoas e problemas; e danos psicológicos, como ansiedade, depressão e fadiga mental.
Contribuições metodológicas / sociais / gerenciais: Este estudo contribui com a literatura sobre trabalho e risco de adoecimento e socialmente dar visibilidade aos agentes de necropsia. Em nível institucional, fornece um diagnóstico dos riscos à saúde, e subsidia seus gestores nas tomadas de decisões para ações de melhoria do contexto de trabalho desses profissionais.
Originalidade / relevância: O estudo adentrou nas particularidades do contexto laboral dos agentes de necropsia e seus custos e danos relacionados ao trabalho foram considerados e analisados qualitativamente.
Antibiotic Management Practices in Patients with Viral Respiratory Infections
Authors: Serbanescu Claudiu , Irfan Neal , Mertz Dominik , Ahmed Amna
Published: October 2022

ObjectivesTo identify patient characteristics associated with physicians’ decision to continue empiric antibiotics in patients with a lower respiratory tract infection and a positive nasopharyngeal swab (NPS).MethodsA retrospective cohort study of inpatient adults empirically treated with antibiotics and subsequent positive NPS during 2018. We compared patients whose antibiotics were stopped within 48 hours of a positive NPS with those whose antibiotics continued.ResultsEmpiric antibiotics were continued despite confirmation of a viral respiratory infection in 54 (54%) patients. Consolidation on a chest X-ray (odds ratio [OR], 3.6; 95% confidence intervals [CI], 1.5–8.3; P = 0.003) and a respiratory rate of ≥ 22 breaths per minute at the time of diagnosis (OR, 2.4; 95% CI, 1.1–5.4; P =0.03) were associated with continuation of antibiotics.ConclusionAn increased respiratory rate upon diagnosis and consolidation on chest X-ray were associated with the physicians’ decisions to continue empiric antibiotics after diagnosis of a viral infection.
 
Objectifs
Déterminer les caractéristiques des patients associées à la décision des médecins de poursuivre le traitement empirique par antibiotiques chez les patients atteints d’une infection des voies respiratoires inférieures et ayant un résultat positif par écouvillonnage nasopharyngé (ENP).
Méthodologie
Une étude de cohorte rétrospective menée chez des adultes hospitalisés recevant un traitement empirique par antibiotiques et ayant obtenu un résultat positif par ENP a été réalisée au cours de l’année 2018. Nous avons comparé les patients qui ont cessé la prise d’antibiotiques dans les 48 heures suivant un résultat positif par ENP et ceux qui ont poursuivi le traitement par antibiotiques.
Résultats
Le traitement empirique par antibiotiques s’est poursuivi chez 54 patients (54 %) malgré la confirmation d’une infection respiratoire virale. La présence d’une consolidation sur la radiographie pulmonaire (rapport de cotes [RC] de 3,6; intervalle de confiance [IC] à 95 % de 1,5 à 8,3; P = 0,003) et la fréquence respiratoire égale ou supérieure à 22 respirations par minute au moment du diagnostic (RC de 2,4; IC à 95 % de 1,1 à 5,4; P = 0,03) sont associées à la poursuite du traitement par antibiotiques.
Conclusion
Une fréquence respiratoire accélérée au moment du diagnostic et la présence d’une consolidation sur la radiographie pulmonaire sont associées aux décisions des médecins de poursuivre le traitement empirique par antibiotiques après le diagnostic d’une infection virale.
First-Generation H1-Antihistamine Prescribing in Hospitalized Patients
Authors: Lohrenz Sarah , Yatham Kavya , Kassir Sandy , Fong Andrea
Published: October 2022

First-generation H1-antihistamines are commonly utilized in hospital, however, these agents are associated with a number of undesirable adverse effects such as central nervous system (CNS) depression, cardiotoxicity and death in overdose.We performed a retrospective analysis of all first-generation antihistamine prescriptions at the Regina General Hospital over the past year from January 1, 2019 – January 1, 2020. A total of 6,972 prescriptions were written during the study period, 6,692 (96%) of which were for first-generation antihistamines. The largest number of prescriptions for first generation antihistamines was in surgery, followed by internal medicine, and obstetrics and gynecology.Physicians, pharmacists, and nurses in these areas may benefit from education around the potential for serious harm of first-generation antihistamines and the availability of safer alternatives. Additionally, limiting access to first-generation antihistamines in hospital would encourage safer prescribing habits and familiarity with second-generation agents.
RésuméLes antihistaminiques H1 de première génération sont couramment utilisés en milieu hospitalier. Toutefois, ces agents sont associés à un certain nombre d’effets indésirables comme la dépression du système nerveux central (SNC), la cardiotoxicité et le décès causé par une surdose.Nous avons effectué une analyse rétrospective de toutes les ordonnances d’antihistaminiques de première génération délivrées à l’hôpital régional de Régina au cours d’une année, soit du 1er  janvier  2019 au 1er  janvier 2020. Au total, 6972 ordonnances ont été rédigées au cours de la période à l’étude, dont 6692 (96 %) pour des antihistaminiques de première génération. Le plus grand nombre d’ordonnances d’antihistaminiques de première génération ont été rédigées en chirurgie, suivie de la médecine interne et de l’obstétrique et de la gynécologie.Les médecins, les pharmaciens et les infirmières de ces secteurs pourraient tirer profit d’une formation sur le potentiel de dangerosité des antihistaminiques de première génération et sur l’existence de solutions de rechange plus sûres. En outre, le fait de limiter l’accès aux antihistaminiques de première génération en milieu hospitalier favoriserait des habitudes d’ordonnance plus sûres et la familiarisation avec les agents de deuxième génération.
A Case of Autoimmune Polyglandular Syndrome Type 2 Presenting as Dyspnea
Authors: Moshynskyy Anton , Ho Keren-happuch , Caspar-Bell Gudrun
Published: October 2022

We will discuss the case of a 17-year-old male who initially presented to care with shortness of breath on exertion. His symptoms progressed over 7 months to include general weakness, anorexia, and malaise. He presented again to care with tachycardia and hypotension. A combination of dermatological manifestations of autoimmune disease, extensive family history of autoimmune disease, and electrolyte abnormalities prompted a bedside thyroid ultrasound, which led to investigation for thyroid disease. Hormone and antibody testing confirmed the diagnosis of autoimmune polyglandular syndrome type 2 (APS2), and he was successfully treated with levothyroxine, hydrocortisone, and fludrocortisone replacement. We present a case of APS2 in an unusual patient population, with a seldom reported initial manifestation. We will discuss diagnostic clues, investigations, management, and further monitoring of APS2.
ResumeNous aborderons le cas d’un adolescent de 17 ans qui a d’abord consulté pour un essoufflement à l’effort. Ses symptômes ont évolué sur une période de sept mois et comprennent une faiblesse générale, une anorexie et un malaise. Puis, il a consulté de nouveau pour une tachycardie et une hypotension. Une combinaison de signes dermatologiques de maladie auto-immune, d’antécédents familiaux importants de maladie auto-immune et d’anomalies électrolytiques a conduit à la réalisation d’une échographie de la thyroïde au chevet du patient, ce qui a mené à la recherche d’une maladie thyroïdienne. Le dosage des hormones et le dépistage d’anticorps ont confirmé le diagnostic de polyendocrinopathie auto-immune de type 2 (PEA2), et il a été traité avec suc-cès par la lévothyroxine, l’hydrocortisone et la fludrocortisone de remplacement. Nous présentons un cas de PEA2 chez une population de patients inhabituelle, une manifestation initiale y étant rarement rapportée. Nous aborderons les pistes de diagnostic, les examens, la prise en charge et la surveillance accrue de la PEA2.
Insidious Development: Cerebral Mycotic Aneurysm in an Immunocompromised Patient
Authors: Valentini Daniele , Das Debapria , Tran Allen
Published: October 2022

Mycotic aneurysms are microinfections of a cerebral artery occurring secondary to infectious endocarditis or central nervous system infection. They are usually discovered only after rupture, which is often fatal.
RésuméL’anévrisme mycotique est une micro-infection d’une artère cérébrale qui survient à la suite d’une endocardite infectieuse ou d’une infection du système nerveux central. On ne le découvre généralement qu’après sa rupture, qui est souvent mortelle. Mis à part le fait de s’attaquer à la cause sous-jacente, le traitement demeure incertain.
What Internists Should Know about Malnutrition in Hospitalized Patients
Authors: Oleynick Christopher , Chiu Elaine , Pomreinke Haley , Raman Maitreyi
Published: October 2022

There is a high prevalence of malnutrition amongst hospitalized patients in Canada which is associated with poor outcomes including increased length of stay, readmission rates and mortality. Despite its ubiquity, malnutrition is often underdiagnosed and undertreated which is of concern because intervention has been shown to improve many of these outcomes, including mortality. In Canada, an interdisciplinary group called the Canadian Malnutrition Task Force has developed a framework for the screening of, diagnosis and treatment of malnutrition which has been successfully implemented at multiple sites across the country. Despite advancements in the field, many clinicians report feeling unknowledgeable about nutrition management as there is minimal training provided in most medical school and residency curriculums. This is a short review article highlighting the essentials of what we believe internists should know about malnutrition in hospitalized patients.
RésuméParmi les patients hospitalisés au Canada, on constate une forte prévalence de malnutrition qui est associée à de mauvais résultats, notamment une augmentation de la durée d’hospitalisation, du taux de réhospitalisation et de la mortalité. Malgré son omniprésence, la malnutrition est souvent sousdiagnostiquée et partiellement traitée, ce qui est préoccupant, car il a été démontré qu’une intervention pouvait améliorer bon nombre de ces résultats, y compris la mortalité. Au Canada, un groupe interdisciplinaire appelé le Groupe de travail canadien sur la malnutrition a élaboré un cadre pour le dépistage, le diagnostic et le traitement de la malnutrition qui a été mis en œuvre avec succès à plusieurs endroits un peu partout au pays. Malgré les progrès réalisés dans ce domaine, beaucoup de cliniciens estiment manquer de connaissances sur la gestion de la nutrition, car la plupart des curriculums des écoles de médecine et des programmes de résidence ne prévoient qu’une formation minimale dans ce domaine. Ce court article de synthèse met en lumière l’essentiel de ce que nous pensons que les internistes devraient savoir à propos de la malnutrition chez les patients hospitalisés.
HP HEROES: Arielle Berger MD
Authors: Govig (ED) Bert
Published: October 2022

N/A
Barriers to Implementing Internist Recommendations for Perioperative Anticoagulation Management by Surgical Teams
Authors: Flemons Kristin , Bosch Michael , Marcil Gabriel , Kachra Rahim , Zarnke Kelly , Skeith Leslie , Ruzycki Shannon Marie
Published: October 2022

Introduction: In our center, half of all recommendations made by an internist about perioperative anticoagulation management are not followed by surgical team members. We aimed to understand the barriers to implementing perioperative anticoagulation recommendations.Methods: This was a prespecified analysis of interviews with surgical team members about individual- and systems-level drivers of missed perioperative anticoagulation recommendations. Interviews and analysis were guided by the Theoretical Domains Framework and the Consolidation Framework for Implementation Research.Results: We interviewed 16 surgical team members and 2 internists. Surgical team members intentionally did not follow recommendations about perioperative anticoagulation management when they felt that the bleeding risk outweighed the risk of thrombosis. This assessment of risk was driven by emotion and previous experience, even among participants who were familiar with perioperative literature.Conclusions: Development of study outcomes and guideline recommendations for perioperative anticoagulation management should include surgical team members in order to address the acceptability of these recom-mendations and increase adoption.
RésuméIntroduction : Dans notre centre, la moitié des recommandations formulées par un interniste concernant la prise en charge de l’anticoagulation périopératoire ne sont pas suivies par les membres de l’équipe chirurgicale. Nous avons cherché à comprendre les obstacles à l’application des recommandations relatives à l’antico-agulation périopératoire.
Méthodologie : Il s’agit d’une analyse prédéterminée d’entrevues menées auprès des membres de l’équipe chirurgicale au sujet des facteurs individuels et systémiques de l’insuccès des recommandations relatives à l’anticoagulation périopératoire. Les entrevues et l’analyse ont été guidées par le Theoretical Domains Framework et le Consolidation Framework for Implementation Research.Résultats : Nous avons interrogé 16 membres de l’équipe chirurgicale et 2 internistes. Intentionnellement, les membres de l’équipe chirurgicale ne suivent pas les recommandations concernant la prise en charge de l’anti-coagulation périopératoire lorsqu’ils estiment que le risque d’hémorragie l’emporte sur le risque de thrombose. Cette évaluation du risque est dictée par l’émotion et l’expérience antérieure, même parmi les participants qui connaissent bien la documentation du domaine périopératoire.Conclusions : La mise en application des résultats des études et des recommandations formulées par les lignes directrices pour la prise en charge de l’anticoagulation périopératoire devrait comprendre des membres de l’équipe chirurgicale pour aborder l’acceptabilité de ces recommandations et augmenter l’adoption.
The Top Five Papers of 2020 for General Internists
Authors: Huard Gabriel , St-Laurent Olivier
Published: October 2022

The Canadian Society of Internal Medicine (CSIM) held an annual session to present the “Top 5 papers” influencing the practice of general internists. We reviewed major journal publications from January 2020 to November 2020 to come up with approximately 10 articles we considered practice changing trials for general internists. Out of those papers, we decided to present the five we considered were most relevant by addressing frequent pathologies seen in practice, were methodologically well conducted, and had the potential to sustainably modify practice guidelines. The references to the papers that were not retained are presented in the bibliography section for the reader’s interest. This article aims to present those top five papers of 2020, and to review their strengths and limitations. These articles were also discussed at the CSIM Virtual Educational Activity on October 15, 2020 and in the BaladoCritique podcast.
RésuméLa Société canadienne de médecine interne (SCMI) a tenu une séance annuelle pour présenter les « cinq meil-leurs articles » qui influencent la pratique des internistes généralistes. Nous avons examiné les publications des principales revues publiées entre janvier 2020 et novembre 2020 pour en arriver à proposer environ dix articles que nous avons considérés comme des essais pouvant influencer la pratique des internistes généralistes. Parmi ces articles, nous avons décidé d’en présenter cinq qui, selon nous, sont les plus pertinents en abordant des pathologies fréquemment observées dans la pratique, sont bien menés sur le plan de la méthodologie et ont le potentiel de modifier de façon durable les directives de pratique. Les références des articles qui n’ont pas été retenus figurent dans la bibliographie pour l’intérêt du lecteur. Cet article vise à présenter les cinq meilleurs articles de 2020 et à examiner leurs forces et leurs limites. Ces articles ont également fait l’objet de discussions lors de l’activité éducative virtuelle de la SCMI qui s’est tenue le 15 octobre 2020 et dans un épisode du BaladoCritique.
Giant Calcified Left Ventricular Aneurysm with Calcified Thrombus Following Remote Myocardial Infarction
Authors: Deschner Max , Deschner Emilie , Teefy Patrick , Glanz Anthony
Published: October 2022

In this case study, we provide angiographic and computed tomography images demonstrating a large cal-cified left ventricular (LV) aneurysm and associated calcified thrombus—unique, and now rare, sequelae of ST-elevation myocardial infarction (MI) that are rarely seen in the era of percutaneous coronary intervention (PCI). We discuss here the epidemiology, natural history, workup, and recommended management for LV aneurysms and thrombi with reference to clinical guidelines. Our patient’s calcified LV aneurysm and thrombus were discovered at the time of cardiac catheterization undertaken for a 2-month history of stable angina. He suffered an anterior MI 17 years ago and took aspirin only. He remained asymptomatic until presentation. Angiography also demonstrated severe triple-vessel coronary artery disease including left anterior descending artery occlusion. Our patient underwent stenting of the left circumflex and first diagonal and staged PCI to the right coronary artery, which led to functionally complete revascularization.
RésuméDans cette étude de cas, nous présentons des images angiographiques et des coupes tomographiques d’un gros anévrisme calcifié du ventricule gauche (VG) et d’un thrombus calcifié qui y est associé – des séquelles uniques, mais maintenant rares, de l’infarctus du myocarde (IM) avec susdécalage du segment ST qui sont rarement constatées à l’ère de l’intervention coronarienne percutanée (ICP). Nous nous penchons sur l’épidémiologie, l’histoire naturelle, le processus d’évaluation et la prise en charge recommandée des anévrismes et des thrombus du VG en nous appuyant sur les lignes directrices cliniques. L’anévrisme et le thrombus calcifiés du VG de notre patient ont été découverts lors d’un cathétérisme cardiaque effectué pour une angine de poitrine stable depuis deux mois. Il a déjà subi un IM il y a 17 ans et ne prend que des aspirines. Il est demeuré asymptomatique jusqu’à la consultation. L’angiographie montre également la présence d’une coronaropathie tritronculaire grave, dont une occlusion de l’artère descendante antérieure gauche. Notre patient a subi une implantation d’endoprothèses dans l’artère auriculoventriculaire et la première branche diagonale et une ICP différée de l’artère coronaire droite, ce qui a mené à une revascularisation complète fonctionnelle.
A Case of Sturge–Weber Syndrome with Bilateral Leptomeningeal Involvement
Authors: Anvari Sama , Dalmia Shreyash , Patel Ameen
Published: October 2022

A 40-year-old man with a diagnosis of Sturge–Weber Syndrome (SWS) was admitted to hospital with fever and urosepsis. The sequelae of this condition include seizures, intellectual disability, bilateral glaucoma, hypothyroidism, and diffuse port-wine stain. He was also noted to have several pyogenic granulomas and a large capillary malformation of the lower lip, with associated bleeding risk. Clinical images highlight the diagnostic cues and dermatologic manifestations that are associated with SWS. Management of patients with this condition requires multidisciplinary care of the neurologic, endocrine, and vascular complications of SWS, in addition to extensive psychosocial support.
RésuméUn homme de 40 ans ayant reçu un diagnostic de syndrome de Sturge-Weber est admis à l’hôpital en raison d’une pyrexie et d’une urosepsie. Les séquelles de ce syndrome sont l’épilepsie, la déficience intellectuelle, le glaucome bilatéral, l’hypothyroïdie et l’angiome plan diffus. On a également constaté la présence de plusieurs granulomes pyogènes et d’une malformation capillaire importante de la lèvre inférieure qui pose un risque d’hémorragie. Les images cliniques mettent en évidence les indices diagnostiques et les manifestations dermatologiques associés au syndrome de Sturge-Weber. Les patients atteints de cette affection ont besoin d’une prise en charge multidisciplinaire des complications neurologiques, endocriniennes et vasculaires du syndrome de Sturge-Weber, en plus d’un soutien psychosocial important.
Achenbach Syndrome
Authors: Singh Kevin , Ladak Karim , Patel Matthew
Published: October 2022

N/A
Prognostic Value of Inflammatory Markers in Hospitalized COVID-19 Patients
Authors: Raiter Noam , Junek Mats , Rahim Ahmad , Mithoowani Siraj
Published: October 2022

It is unclear whether D-dimer is a disease-specific marker for COVID-19 or part of the general inflammatory response alongside C-reactive protein (CRP) and other acute-phase reactants. We extracted data of patients hos-pitalized with COVID-19 for demographics, comorbidities, biochemical data, and outcomes. Using multivari-able logistic regression, the value of D-dimer in predicting intensive care unit (ICU) admission or mortality was measured. Of 1175 patients, 263 were admitted to the ICU and 226 died. CRP predicted both ICU admission and mortality [Odds ratios (ORs) with 95% confidence interval 1.01 (1.01–1.01) and 1.00 (1.00–1.01), respectively] but D-dimer was not predictive of either outcome [ORs 1.02 (0.97–1.06) and 0.99 (0.93–1.06)]. This suggests D-dimer levels are not independently predictive of COVID-19 severity or mortality. Our results confirm find-ings from smaller cohorts and demonstrate the inflammatory characteristics of COVID in the Canadian context.
RésuméOn ne sait pas exactement si le D-dimère est un marqueur propre à la COVID-19 ou s’il fait partie de la réponse inflammatoire générale au même titre que la protéine C réactive et autres réactifs de phase aiguë. Nous avons extrait les données relatives aux caractéristiques démographiques, aux affections comorbides, aux analyses bio-chimiques et aux issues de patients hospitalisés en raison de la COVID-19. À l’aide d’une régression logistique multivariable, nous avons mesuré l’utilité du D-dimère dans la prédiction de l’admission à l’unité des soins intensifs (USI) ou de la mortalité. Sur 1175 patients, 263 ont été admis à l’USI et 226 sont décédés. La protéine C réactive a permis de prédire l’admission à l’USI (rapport de cotes [RC] = 1,01; intervalle de confiance [IC] à 95 % de 1,01 à 1,01) et la mortalité (RC = 1,00; IC à 95 % de 1,00 à 1,01), mais le D-dimère n’a pas permis de prédire l’une ou l’autre issue (RC = 1,02; IC à 95 % de 0,97 à 1,06 pour l’admission à l’USI et RC = 0,99; IC à 95 % de 0,93 à 1,06 pour la mortalité). D’après ces résultats, les taux de D-dimère ne sont pas des prédicteurs indépendants de la gravité de la COVID-19 ou de la mortalité. Nos résultats confirment les résultats de cohortes plus petites et démontrent les caractéristiques inflammatoires de la COVID-19 dans le contexte canadien.
General Internal Medicine (GIM): do the Puzzle Pieces Portray the Picture? A Continuous Quality Improvement Process for Entrustable Professional Activities (EPAs)
Authors: Halman Samantha , Marcotte Laura , Elizov Michelle , Stroud Lynfa , Karpinski Jolanta , Card Sharon E
Published: October 2022

Defining General Internal Medicine (GIM) has been difficult due to the tension between ensuring flexibility for varied environments and the need for national standards. With the launch of competency-based medical education, the Royal College of Physicians and Surgeons of Canada Specialty Committee in GIM (SCGIM) (national standard-setting body) had the opportunity to explicitly define the discipline via elaboration of the GIM competencies and Entrustable Professional Activities (EPAs). Defining the EPAs is the essence of defining the tasks of the discipline. We describe our SCGIM approach to the continuous review of the theoretical written documentation around EPAs in the “real world environment” in order to continuously refine the EPAs and ensure they are facilitating skill attainment. Major lessons learned (1) centralized feedback with simple reporting and multiple input is best; (2) there is tension between theory (perfect EPAs) and practical implementation; (3) it takes time to see how the EPAs are performing.
RésuméIl a été difficile de définir la médecine interne générale (MIG) en raison de la tension entre la nécessité d’assurer la souplesse pour des environnements variés et le besoin de normes nationales. Grâce au lancement de la formation médicale par compétences, le comité de spécialité en MIG (CSMIG) du Collège royal des médecins et chirurgiens du Canada (organisme national de normalisation) a eu l’occasion de définir explicitement la discipline en élaborant les compétences en MIG et les activités professionnelles confiables (APC). Définir les APC consiste essentiellement à définir les tâches de la discipline. Nous décrivons notre approche du CSMIG de l’examen continu de la documentation théorique écrite concernant les APC « en situation réelle » pour améliorer continuellement les APC et veiller à ce qu’elles facilitent l’acquisition des compétences. Principales leçons apprises : a) la rétroaction centralisée avec des rapports simples et des commentaires multiples convi-ent le mieux; b) il existe une tension entre la théorie (APC parfaites) et l’application dans la pratique; c) il faut du temps avant de constater le rendement des APC.
Thrombocytopenia in the Time of COVID-19
Authors: Shweikialrefaee Bisan , Hershenfeld Samantha , Liederman Zachary
Published: October 2022

The COVID-19 infection and associated treatments, including vaccination, can lead to a multitude of hematologic complications. Both vaccine-induced thrombotic thrombocytopenia (VITT) and immune thrombocytopenia (ITP) are possible causes of thrombocytopenia following an adenoviral vector vaccine. While ITP and VITT share many similarities, they have distinct differences and require specialized treatment. Therefore it is critically important to accurately distinguish between these two vaccine-induced disorders. We report a patient who presented with ITP approximately after 1 week of COVID-19 positive diagnosis and 3 weeks after the first dose of AstraZeneca vaccine.
RésuméL’infection à la COVID-19 et les traitements qui lui sont associés, dont la vaccination, peuvent entraîner une multitude de complications hématologiques. La thrombocytopénie thrombotique induite par le vaccin (TTIV) et la thrombocytopénie immunitaire (TI) sont deux causes de thrombocytopénie qui peuvent appa-raître après avoir reçu un vaccin à vecteur adénoviral. Bien que la TI et la TTIV présentent de nombreuses similitudes, elles ont des différences marquées et exigent un traitement spécialisé. Il est donc d’une importance cruciale de les distinguer avec exactitude. Dans cet article, nous rapportons le cas d’un patient qui a présenté une TI environ une semaine après avoir reçu un diagnostic de la COVID-19 et trois semaines après avoir reçu une première dose du vaccin d’AstraZeneca.
Hepatoprotector Effect of Banana Peel (Musa paradisiaca Sapientum) on Paracetamol Induced Rats
Authors: Pusmarani Jastria , Ifaya Mus , Putri Risky Juliansyah
Published: October 2022

Background: Liver disease is generally still a high prevalence in Indonesia. One of drug-induced liver injury is paracetamol. Banana peel (Musa paradisiaca Sapientum) has flavonoid compounds that could increasing the production of glutathione enzymes in the liver. Objectives: This research aims to determine the activity of banana peel induced by paracetamol. This research is an experimental with pre and post test control group design method. Material and Methods: This research is an experimental with pre and post test control group design method. Group I was given 0.05% Na CMC as negative control, group II was given paracetamol 180 mg/kgBB as induction control group, group III was given banana peel extract at dose 700 mg / kgBB, group IV was given banana peel extract at dose 1400 mg/kgBB, and group V was given banana peel extract at dose 2100 mg/kgBW. Results: The liver damage can be measured by SGOT/SGPT serum levels of rats. SPSS data analysis with Paired sample T test obtained the value of p = 0.003 for SGOT (serum glutamic oxaloacetic transaminase) and p = 0.000 for SGPT. Conclusions: Both SGOT and SGPT values have p <0.05 which indicates that banana peel (Musa paradisiaca Sapientum) methanol extract has hepatoprotector effect on paracetamol-induced rats.
Governance responsibility in Italy to monitor corporate performance
Authors: Giovando Guido
Published: October 2022

The annual financial statement is the document that provides a “snapshot” of the effects of the management operations that have taken place during the fiscal year. The analysis derived from it is a tool that, over the years, is increasingly asserting its importance as a means of communicating, not only with internal shareholders but also with external stakeholders, who need to know the company’s dynamics, its key points, and future effects. In this panorama, corporate governance is playing an increasingly fundamental role, which, through the instruments of control, exercises an important activity to protect not only the shareholders but also all the stakeholders. In Italy, the new corporate discipline is constantly addressing more responsibility to governance by giving them the task of monitoring and bringing out states of corporate crisis promptly. In order for these obligations to be put in place, the Code of Corporate Crisis and Insolvency was introduced, which provides a reporting system. Therefore, the corporate supervisory bodies and the auditor must proceed with the 5 alerts, i.e., verify that the ratios applied to the financial statement analysis do not exceed the thresholds provided as it would imply the presence of imbalances of an asset and financial nature. The proper and functional application of this alert procedure is only possible if governance equips the company with all the appropriate organizational and control arrangements to detect the necessary data in a timely manner in order to be able to analyze them and then take the appropriate corrective actions. In this study, we have analyzed a sample of companies to verify whether the indexes proposed by the National Council of Chartered Accountants and Accounting Experts (Consiglio Nazionale dei Dottori Commercialisti e degli Esperti Contabili, CNDCEC) can provide real help in managing a company’s state of insolvency and are not merely theoretical management of the situation.
Do we really need a new classification for cor triatriatum sinister?
Authors: Alaloola Alhanouf , Alghamdi Rawan , Arafat Amr
Published: October 2022

Current classifications of Cor Triatriatum Sinister (CTS) do not address
the associated heart defects or single ventricle pathology. Therefore,
these classifications are not prognostic classifications and only
describe the anatomy and the pulmonary venous drainage. The proposed
classification considered the associated congenital cardiac lesions and
the single ventricle pathology, therefore, it could have prognostic
value. Future multicenter studies are required to measure the
performance of this classification and its prognostic value in patients
with CTS.
Diagnosis of unicuspid aortic valve after loss of consciousness during cesarean section: a case report
Authors: Yukami Shun , Juri Takashi , Nakajima Asami , Daisuke Tachibana , Takahashi Yosuke , Iwata Shinichi , Yamamoto Akira , Mori Takashi
Published: October 2022

Loss of consciousness during delivery by cesarean section under spinal
anesthesia is a rare but potentially serious complication. We report a
case of a pregnant woman with unicuspid aortic valve, which was
incidentally diagnosed during an aortic valve replacement after
transient loss of consciousness during cesarean section.
Trends in Disparities in COVID Hospitalizations Among Community-Dwelling Residents of Two Counties in Connecticut, Before and After Vaccine Introduction, March 2020 - September 2021
Authors: McWilliams Caroline , Bothwell Laura , Yousey-Hindes Kimberly , Hadler James
Published: October 2022

Background. Prior to the introduction of vaccines, COVID-19
hospitalizations of non-institutionalized persons in Connecticut
disproportionately affected communities of color and individuals of low
socioeconomic status (SES). Whether the magnitude of these disparities
changed 7-9 months after vaccine rollout during the Delta wave is not
well documented. Methods. All initially hospitalized patients with
laboratory-confirmed COVID-19 during July-September 2021, were obtained
from the Connecticut COVID-NET database, including patients’ geocoded
residential addresses. Census tract measures of poverty and crowding
were determined by linking geocoded residential addresses to the
2014-2018 American Community Survey. Age-adjusted incidence and relative
rates of COVID-19 hospitalization were calculated and compared to those
from July-December 2020. Vaccination levels by age and race/ethnicity at
the beginning and end of the study period were obtained from
Connecticut’s COVID vaccine registry and age-adjusted average values
were determined. Results. There were 708 COVID-19 hospitalizations among
community residents of the two counties, July-September 2021.
Age-adjusted incidence was highest among non-Hispanic Blacks and
Hispanic/Latinx compared to non-Hispanic Whites ((RR 4.10 (95% CI
3.41-4.94) and 3.47 (95% CI 2.89-4.16)). While RR decreased
significantly among Hispanic/Latinx and among the lowest SES groups, it
increased among non-Hispanic Blacks (from RR 3.1 (95% CI 2.83-3.32) to
RR 4.10). Average age-adjusted vaccination rates among those
>12 years were lowest among non-Hispanic Blacks compared to
Hispanic/Latinx and non-Hispanic Whites (50.6% vs 64.7% and 66.6%).
Conclusions. While racial/ethnic and SES disparities in COVID-19
hospitalization have mostly decreased over time, disparities among
non-Hispanic Blacks increased, possibly due to differences in
vaccination rates.
GERMLINE GENOMIC FINDINGS IN CHILDREN AND YOUNG ADULTS WITH MELANOCYTIC TUMORS
Authors: Nagel Margaret , Perrino Melissa R. , Nuccio Regina , Blake Alise , Harrison Lynn , Nichols Kim , Pappo Alberto
Published: October 2022

In this retrospective study, we examined the prevalence and spectrum of
germline variants in cancer predisposition genes in 38 children and
young adults with melanocytic lesions who underwent germline genetic
testing at St. Jude Children’s Research Hospital. Diagnoses included
malignant melanoma (n=19; 50%), spitzoid melanoma (n=14; 37%), and
uveal melanoma (n=5; 13%). Five patients (13%) harbored
pathogenic variants: one with bi-allelic PMS2, and one each with
heterozygous 17q21.31 deletion, TP53,BRIP1, and
ATM pathogenic In this convenience
cohort, 13% of children and young adults with melanoma who underwent
germline testing harbored an underlying cancer predisposition syndrome.
Closed-form algebraic expressions for monoprotic weak acid dissolutions
Authors: Arango Carlos A. , Pomeo Anthony Joseph Caicedo , Morales Juan C.
Published: October 2022

Closed-form algebraic expressions for the pH of ideal weak acid and weak
acid buffer solutions (and their titration with a strong base) were
obtained and analyzed with the aid of computer algebra systems. These
expressions are used to evaluate, without the use of numerical
approximations, the precision and accuracy of different approximations
commonly employed to calculate the pH. The closed-form expression for
the pH of a buffer solution is used to obtain an analytical expression
for the pH stability when a strong base is added. Finally, it is shown
that the pH expressions for all the systems under study can be obtained
from an unique closed-form expression in terms of an effective weak acid
constant and an effective acid concentration.
Covariance matrix estimation via bilinear shrinkage regularization
Authors: Zhang Bin , Yuan Shoucheng
Published: October 2022

The problem of estimating a covariance matrix plays crucial in
signal processing and other related fields. This paper proposes a novel
bilinear shrinkage estimation by simultaneously regularizing the sample
mean and the SCM via the linear shrinkage technique. Through a one-one
mapping of the weight parameters, the bilinear shrinkage estimation can
be expressed as a generalization version of the well-known linear
shrinkage estimation. Available covariance matrix estimators are
developed by parametric and nonparametric methods for different target
matrices. In our numerical simulations, the bilinear shrinkage
estimators can reach lower Frobenius losses compared with the existing
linear shrinkage estimators. Moreover, the proposed covariance matrix
estimators can work well in application to large array signal
processing.
Methylprednisolone use in children with severe pneumonia caused by SARS-CoV-2
Authors: Demir Osman Oguz , ozsurekci yasemin , Aykac Kubra , Ilbay Sare , Kesici Selman , Karakaya Jale , Ceyhan Mehmet , Cengiz Ali Bülent
Published: October 2022

Objective: This study aimed to evaluate the effectiveness and optimal
use of corticosteroids in children with severe coronavirus disease 2019
(COVID-19) pneumonia. Methods: We conducted a retrospective study and
included patients (aged<18 years) with severe COVID-19
pneumonia and/or acute respiratory distress syndrome (ARDS) who received
standard doses (2–4 mg/kg/day) and high doses (>250
mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid
treatments with a propensity score and patient survival. Results:
Fifty-nine patients were included: 61% were male, the median age was 8
(interquartile range [IQR], 2–15) years. The overall survival was
84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and
92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p =
0.67). The demographic, clinical, and laboratory data didn’t differ
significantly after propensity score matching, apart from bradycardia,
which was a prominent feature of the high-dose group. The clinical and
radiological response rates on Day 7 were higher and the need for
invasive mechanical ventilation (IMV) was lower in the high-dose group.
Conclusion: Pulse MPZ treatment seems to result in better clinical and
radiological responses, with less need for IMV, although the mortality
rate doesn’t differ between standard and high-dose regimens of MPZ.