bluuebunny/crossref_metadata_2025 huggingface dataset:
Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak
Authors: Coppadoro Andrea , Benini Annalisa , Fruscio Robert , Verga Luisa , Mazzola Paolo , Bellelli Giuseppe , Carbone Marco , Mulinacci Giacomo , Soria Alessandro , Noè Beatrice , Beck Eduardo , Di Sciacca Riccardo , Ippolito Davide , Citerio Giuseppe , Valsecchi Maria Grazia , Biondi Andrea , Pesci Alberto , Bonfanti Paolo , Gaudesi Davide , Bellani Giacomo , Foti Giuseppe
Published: February 2021

Background

Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).

Methods

In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death.

Results

A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22–32] to 24 [20–29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3–9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.

Conclusions

Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.

Trial Registration: NCT04424992
Patients in intensive care unit for COVID-19 pneumonia: the lung ultrasound patterns at admission and discharge. An observational pilot study
Authors: Persona Paolo , Valeri Ilaria , Zarantonello Francesco , Forin Edoardo , Sella Nicolò , Andreatta Giulio , Correale Christelle , Serra Eugenio , Boscolo Annalisa , Volpicelli Giovanni , Navalesi Paolo
Published: February 2021

Background

During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease.

Methods

We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern.

Results

Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17).

Conclusions

LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.
Perceived barriers and facilitators to uptake of non-traditional roles by pharmacists in Saudi Arabia and implications for COVID-19 pandemic and beyond: a qualitative study using Theoretical Domain Framework
Authors: Mohammed Eeman , Khanal Saval , Jalal Zahraa , Cheema Ejaz , Abutaleb Mohammed H. , Paudyal Vibhu
Published: February 2021

Background

The COVID-19 pandemic has further strengthened the need for pharmacists to uptake non-traditional roles. Pharmacy practice in Saudi Arabia is emerging in recent years with greater policy emphasis on pharmacists taking new clinical roles. This study aimed to explore the experiences, perceptions and barriers of Saudi pharmacists about their uptake of non-traditional roles using Theoretical Domains Framework (TDF).

Methods

A qualitative semi-structured study using face-to-face or telephone interviews were conducted. Eligible participants included qualified pharmacists from Saudi Arabia. Interviews focused on pharmacist’s perceptions, current opportunities and key challenges towards the uptake of non-traditional roles. Interviews were audiotaped and transcribed verbatim. Results were analysed through the framework analysis method and were later mapped with respective domains of TDF.

Results

A total of 14 pharmacists completed the interview (9 females and 5 males). Participants showed an overall positive attitude towards the uptake of non-traditional roles. Participants felt that there was wider support available for pharmacists at the policy level to uptake non-traditional roles. However, a need for greater recognition of roles by other healthcare professionals and patients were identified. Participants alluded to reluctance of some physicians to take on board the suggestions from a pharmacist. Key barriers to uptake of non-traditional roles were related to environmental context and resources domain of TDF. For example, participants discussed the need for even further practical experiences during their undergraduate degree to become ready to adopt non-traditional roles in clinical practice.

Conclusions

Participants of this theoretically informed qualitative study showed an overall positive attitude towards the way pharmacy practice is progressing in Saudi Arabia and their uptake of non-traditional roles. However, there is a need to improve interdisciplinary working, patient awareness of pharmacist competencies and their educational preparedness in furthering their uptake of non-traditional roles. Addressing such barriers and promoting uptake of novel roles by pharmacists is imperative in the context of emerging COVID-19 and future pandemics.
Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: a pilot randomized controlled trial
Authors: Horth Dillon , Sanh William , Moisiuk Peter , O’Hare Turlough , Shargall Yaron , Finley Christian , Hanna Waël , Agzarian John , Forero Mauricio , Davis Kim , Vanniyasingam Thuva , Thabane Lehana , Shanthanna Harsha
Published: February 2021

Background

The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade.

Methods

This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal, body mass index >40 kg/m2, contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines, known allergy to local anesthetics, language or comprehension barriers, procedures with a higher chance of open surgery, and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary).

Results

Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects.

Conclusions

A fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions.

Trial registration

Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017.
Risk of malignancy long after acute coronary syndrome in selected urban and rural areas and comparison with smoking risk: the ABC-7* study on Heart Disease
Authors: Berton Giuseppe , Mahmoud Heba T. , Palmieri Rosa , Cavuto Fiorella , Cordiano Rocco , Lorenzon Elisabetta , Bagato Francesco
Published: February 2021

Background

Increased cancer risk has been reported in patients with acute coronary syndrome (ACS).

Objectives

To investigate geographic differences in risk malignancy long after ACS.

Methods

We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient’s residency was classified into three urban and three nearby rural areas.

Results

All (except for 3) patients completed the follow-up (22 years or death) and 54 % were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17 % and 24 % (p = 0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95 % confidence interval [CI] 1.7–7.1; p = 0.001), with little change from north to south provinces (OR 1.5;95 % CI 1.0-2.2; p = 0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95 % CI 1.2–3.5; p = 0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95 % CI 1.5–6.2; p = 0.02), but not among provinces (HR 1.3;95 % CI 1.0–2.0; p = 0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95 % CI 1.3–3.5; p = 0.002), even with a fully adjusted model.

Conclusions

The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.
Remimazolam for a patient with myotonic dystrophy type 1 who underwent endoscopic retrograde cholangiopancreatography under general anesthesia: a case report
Authors: Fukuda Masakazu , Tachibana Shunsuke , Nishihara Noriaki , Yamakage Michiaki
Published: February 2021

Background

Remimazolam is a benzodiazepine receptor agonist with an ultra-short-acting anesthetic effect. We used remimazolam for anesthesia in a patient with myotonic dystrophy type 1 who underwent endoscopic retrograde cholangiopancreatography (ERCP).

Case presentation

A 58-year-old woman received ERCP under general anesthesia. She had impaired respiratory function due to myotonic dystrophy type I and was at a risk of respiratory complications after anesthesia. General anesthesia was induced with remimazolam 12 mg/kg/h, remifentanil 0.1 μg/kg/min and rocuronium 15 mg, followed by tracheal intubation and maintained with remimazolam 0.8−1.0 mg/kg/h. At the end of anesthesia, we injected sugammadex 150 mg and flumazenil 0.2 mg, allowing smooth and clear emergence from anesthesia. She was discharged from the hospital without any respiratory problems on postoperative day 5.

Conclusions

Remimazolam was safe to use for general anesthesia in a patient with myotonic dystrophy type 1 undergoing ERCP.
Translation and psychometric evaluation of the Swedish versions of the Nuss Questionnaire modified for Adults and the Single Step Questionnaire
Authors: Norlander Louise , Karlsson Jan , Anderzén-Carlsson Agneta , Vidlund Mårten , Dreifaldt Mats , Andreasson Jesper , Sundqvist Ann-Sofie
Published: February 2021

Background

Pectus excavatum (PE) is the most common congenital chest wall deformity. Most individuals with PE suffer from psychosocial problems, with low self-esteem and poor body image. Correctional surgery for PE is available, the most widely used is the Nuss procedure. The Nuss procedure has previously been reported to improve self-esteem, body image and health-related quality of life (HRQoL). To assess HRQoL among individuals with PE, the Nuss Questionnaire modified for Adults (NQ-mA) and Single Step Questionnaire (SSQ) has been developed. The aim of the current study was to translate and culturally adapt NQ-mA and SSQ to fit a Swedish context, and to evaluate the psychometric properties, and validate the culturally adapted versions.

Methods

Individuals who had undergone the Nuss procedure for pectus excavatum were invited to participate in a multicentre study with cross-sectional design. HRQoL was assessed by NQ-mA, SSQ and RAND-36. Psychometric properties for NQ-mA and SSQ were evaluated by content validity index and construct validity (exploratory factor analysis, confirmatory factor analysis, and inter-scale correlations). Known-groups validity, as well as floor and ceiling effects, were evaluated. Internal consistency reliability was examined using Cronbach’s alpha.

Results

In total 236 individuals participated in the study. Content validity index for NQ-mA showed satisfactory results, except for two items. Factor analysis for NQ-mA suggested a two-factor model, with exclusion of two items. Subscales correlated adequately with RAND-36’s domains. Known-groups validity for NQ-mA demonstrated high sensitivity for between-group differences. Ceiling effects were present in several items. Cronbach’s alpha for NQ-mA was .89. Confirmatory factor analysis for SSQ resulted in a three-factor model, with exclusion of five items. However, this model was shown to be unstable through further exploratory factor analysis testing, and no further psychometric tests were conducted for SSQ.

Conclusion

The 10-item Swedish version of NQ-mA was shown to be valid for research and clinical assessment of HRQoL in individuals with pectus excavatum. The Swedish version of SSQ requires revision of items before further validation can be performed.
Opportunities and challenges of entomopathogenic nematodes as biocontrol agents in their tripartite interactions
Authors: Askary Tarique H. , Abd-Elgawad Mahfouz M. M.
Published: February 2021

Background

The complex including entomopathogenic nematodes (EPNs) of the genera Steinernema and Heterorhabditis and their mutualistic partner, i.e., Xenorhabdus and Photorhabdus bacteria, respectively possesses many attributes of ideal biological control agents against numerous insect pests as a third partner. Despite authenic opportunities for their practical use as biocontrol agents globally, they are challenged by major impediments especially their cost and reliability.

Main body

This review article presents major attributes of EPNs to familiarize growers and stakeholders with their careful application. As relatively high EPN costs and frequently low efficacy are still hindering them from reaching broader biopesticide markets, this is to review the latest findings on EPN strain/species enhancement, improvement of production, formulation and application technology, and achieving biological control of insects from the standpoint of facing these challenges. The conditions and practices that affected the use of EPNs for integrated pest management (IPM) are identified. Besides, efforts have been made to address such practices in various ways that grasp their effective approaches, identify research priority areas, and allow refined techniques. Additionally, sampling factors responsible for obtaining more EPN isolates with differential pathogenicity and better adaptation to control specific pest(s) are discussed.

Conclusion

Specific improvements of EPN production, formulation, and application technology are reviewed which may help in their broader use. Other diverse factors that optimize EPNs to constitute a cost-effective, value-added approach to IPM are also demonstrated.
Dysnatremia is a Predictor for Morbidity and Mortality in Hospitalized Patients with COVID-19
Authors: Tzoulis Ploutarchos , Waung Julian A , Bagkeris Emmanouil , Hussein Ziad , Biddanda Aiyappa , Cousins John , Dewsnip Alice , Falayi Kanoyin , McCaughran Will , Mullins Chloe , Naeem Ammara , Nwokolo Muna , Quah Helen , Bitat Syed , Deyab Eithar , Ponnampalam Swarupini , Bouloux Pierre-Marc , Montgomery Hugh , Baldeweg Stephanie E
Published: February 2021

Context

Dysnatremia is an independent predictor of mortality in patients with bacterial pneumonia. There is paucity of data about the incidence and prognostic impact of abnormal sodium concentration in patients with coronavirus disease 2019 (COVID-19).

Objective

This work aimed to examine the association of serum sodium during hospitalization with key clinical outcomes, including mortality, need for advanced respiratory support and acute kidney injury (AKI), and to explore the role of serum sodium as a marker of inflammatory response in COVID-19.

Methods

This retrospective longitudinal cohort study, including all adult patients who presented with COVID-19 to 2 hospitals in London over an 8-week period, evaluated the association of dysnatremia (serum sodium < 135 or > 145 mmol/L, hyponatremia, and hypernatremia, respectively) at several time points with inpatient mortality, need for advanced ventilatory support, and AKI.

Results

The study included 488 patients (median age, 68 years). At presentation, 24.6% of patients were hyponatremic, mainly due to hypovolemia, and 5.3% hypernatremic. Hypernatremia 2 days after admission and exposure to hypernatremia at any time point during hospitalization were associated with a 2.34-fold (95% CI, 1.08-5.05; P = .0014) and 3.05-fold (95% CI, 1.69-5.49; P < .0001) increased risk of death, respectively, compared to normonatremia. Hyponatremia at admission was linked with a 2.18-fold increase in the likelihood of needing ventilatory support (95% CI, 1.34-3.45, P = .0011). Hyponatremia was not a risk factor for in-hospital mortality, except for the subgroup of patients with hypovolemic hyponatremia. Sodium values were not associated with the risk for AKI and length of hospital stay.

Conclusion

Abnormal sodium levels during hospitalization are risk factors for poor prognosis, with hypernatremia and hyponatremia being associated with a greater risk of death and respiratory failure, respectively. Serum sodium values could be used for risk stratification in patients with COVID-19.
Subclinical Hypothyroidism Represents Visceral Adipose Indices, Especially in Women With Cardiovascular Risk
Authors: Tsou Meng-Ting
Published: February 2021

Context

From previous studies, decreased thermogenesis and metabolic rate in the patients with overt and subclinical hypothyroidism lead to an increase in visceral adipose tissue (VAT) incidence, and which was associated with cardiovascular diseases. In this paper, we want to explore the relationship between various forms of VAT [pericardial (PCF), and thoracic periaortic adipose tissue (TAT)] and obesity indices [body shape index (ABSI), and body roundness index (BRI), Chinese visceral adiposity index (CVAI)] with subclinical hypothyroidism by gender.

Objective

This study aims to evaluate region-specific cardiovascular (CV) fat tissue (pericardial fat [PCF] and thoracic periaortic fat [TAT) and noninvasive visceral adipose indices (a body shape index [ABSI], body roundness index [BRI]), and Chinese visceral adiposity index [CVAI]) in patients with subclinical hypothyroidism (SCH) as compared to a control population and relative to variations in CV risk.

Methods

A total of 125 Taiwanese patients recently diagnosed with SCH (age: 52.9 ± 10.16 years, 41.6% female) and 1519 healthy volunteers (age: 49.54 ± 9.77 years, 29.0% female) were evaluated for this study. All participants underwent PCF and TAT assessment using a multidetector computed tomography scanner, ABSI, BRI, and CVAI evaluation using a mathematical formula. CV risk was classified by Framingham risk score (FRS).

Results

Multivariable logistic regression models showed that the independent association of TAT and BRI with SCH were stronger in women than men. The adjusted model associations (odds ratio [OR]; 95% CI) with SCH for TAT and BRI in women were 2.61 (95% CI, 1.03-6.97) and 2.04 (95% CI, 1.07-3.92). The incidences of TAT and BRI third tertile were also higher in women with SCH (SCH vs euthyroid, TAT third tertile, 9 [17.3%] vs 35 [7.9%], P = .04; BRI third tertile, 22 [42.3%] vs 111 [25.2%], P = .01). In addition to BRI and TAT, there were higher risks of CVAI in SCH with intermediate/high FRS, especially in women (OR; 95% CI, TAT: 4.01; 95% CI, 1.01-6.640; BRI: 6.91; 95% CI, 1.03-10.23; CVAI: 7.81 95% CI, 1.01-12.03).

Conclusion

Our findings show that patients with SCH have significantly greater TAT, BRI, and CVAI values than control groups, especially in women (with different FRS).
Otherwise than Blackness
Authors: Palmer Tyrone S.
Published: February 2021

This essay thinks through the centrality of the concept of “the World” to theorizations of affect and the presumed correlation between feeling and world—that is, the notion that affective experience is necessarily generative of world(s)—that operates as an uninterrogated maxim in both contemporary and classical theories of affect. Focusing on the figure and question of the World and its grammars of relation(ality) and becoming, this essay considers the implications of an insistence on worlding in the context of anti-Blackness. It argues that the sustenance of the very concept of the World necessitates a foreclosure of Black affect’s destructive drive. Black affect is therefore an impossibility within the World, as that unbearable negativity which drives us toward its necessary destruction. In light of this, the essay argues further that the tendency toward an uncritical embrace of affect as a mode of world-forming within strains of Black critical theory—represented by turns to “the otherwise”—performs a sublimation of Black affect’s radical negativity, as encapsulated in the desire for the End of the World.
A Living Community
Authors: Ben Shimon Ohad
Published: February 2021

This article proposes a theorization of immunity from an embodied autoimmune perspective. Arguing through what it identifies as the limitations in current clinical immunology explanations and politico-philosophical theories of immunity, the article seeks to embody, rather than metaphorize, the theoretical stakes of current immune theory. As a counterargument to dominant theorizations of immunity that pathologize or metaphorize the autoimmune bodily experience, the article forwards a more spacious, material, and affirmative theorization of the body. As the author supplements existing immune theory with their own emergent and embodied theory, they develop an autoimmune methodology based on their experience of living with an autoimmune disease. Part personal narrative, part speculative autoimmune theory, the article ultimately calls for a practice of self-care aimed at coming to tolerate the disagreeing community of the autoimmune body as it challenges normalized notions of what self and other, immunity and community, ease and disease mean.
Shifts in the relative fitness contributions of fecundity and survival in variable and changing environments
Authors: Buckley Lauren B. , Schoville Sean D. , Williams Caroline M.
Published: February 2021

Organisms respond to shifts in climate means and variability via distinct mechanisms. Accounting for these differential responses and appropriately aggregating them is central to understanding and predicting responses to climate variability and change. Separately considering fitness components can clarify organismal responses: fecundity is primarily an integrated, additive response to chronic environmental conditions over time via mechanisms such as energy use and acquisition, whereas survival can be strongly influenced by short-term, extreme environmental conditions. In many systems, the relative importance of fecundity and survival constraints changes systematically along climate gradients, with fecundity constraints dominating at high latitudes or altitudes (i.e. leading range edges as climate warms), and survival constraints dominating at trailing range edges. Incorporating these systematic differences in models may improve predictions of responses to recent climate change over models that assume similar processes along environmental gradients. We explore how detecting and predicting shifts in fitness constraints can improve our ability to forecast responses to climate gradients and change.
Physiological consequences of Arctic sea ice loss on large marine carnivores: unique responses by polar bears and narwhals
Authors: Pagano Anthony M. , Williams Terrie M.
Published: February 2021

Rapid environmental changes in the Arctic are threatening the survival of marine species that rely on the predictable presence of the sea ice. Two Arctic marine mammal specialists, the polar bear (Ursus maritimus) and narwhal (Monodon monoceros), appear especially vulnerable to the speed and capriciousness of sea ice deterioration as a consequence of their unique hunting behaviors and diet, as well as their physiological adaptations for slow-aerobic exercise. These intrinsic characteristics limit the ability of these species to respond to extrinsic threats associated with environmental change and increased industrial activity in a warming Arctic. In assessing how sea ice loss may differentially affect polar bears that hunt on the ice surface and narwhals that hunt at extreme depths below, we found that major ice loss translated into elevated locomotor costs that range from 3- to 4-fold greater than expected for both species. For polar bears this instigates an energy imbalance from the combined effects of reduced caloric intake and increased energy expenditure. For narwhals, high locomotor costs during diving increase the risk of ice entrapment due to the unreliability of breathing holes. These species-specific physiological constraints and extreme reliance on the polar sea ice conspire to make these two marine mammal specialists sentinels of climate change within the Arctic marine ecosystem that may foreshadow rapid changes to the marine ecosystem.
Outcome of patients with acute severe necrotizing pancreatitisin a dedicated hepato-biliary unit of Pakistan
Authors: Alam Laima , Khan Rao Saad Ali , Kazmi Syed Kumail Hasan , Din Rafi ud
Published: February 2021

Objective: To analyze the management of severe necrotizing pancreatitis in a specialized center of a lower middle-income country, Pakistan using multiple outcome measures.

Methods: All the patients in this prospective observational study with severe necrotizing pancreatitis being referred to Pak Emirates Military Hospital from January 2017 to December 2019 were followed over the course of their admission. Demographic data and disease outcomes were duly noted. Cox regression analysis was used to predict fatality outcome.

Results: A total of 57 patients with 48 (84.6%) infected necrotizing pancreatitis were managed in our set up. The most common etiology reported was gall-stones (37%) with male preponderance (72%) and a mean age of 50±11.3 years. The most common complications were acute-kidney-injury (63%), splenic-vein-thrombosis (21%) and ascites (21%). Fourteen patients required mechanical-ventilation with a mean duration of 7±1.4 days on respiratory support. Eight (14%) patients required Endoscopic-Ultra-Sound guided drainage and six (10.5%) underwent surgical-necrosectomy depending upon the patients’ condition and collections characteristics. Mortality, as one of the main outcome measures, was reported to be 12.3% and was statistically related to mechanical-ventilation, organ failure and surgical-necrosectomy while 22 (38.6%) patients were discharged on pancreatic enzymes supplements and 7% required insulin.

Conclusion: Survival outcomes with acute severe necrotizing pancreatitis are improving in a dedicated hepato-biliary unit internationally in lieu with a multidisciplinary team approach. Percutaneous and EUS guided drainage of pancreatic collections have turned out to be an important procedure to manage infected pancreatic necrosis that helps to avoid a morbid procedure in the form of necrosectomy.

doi: https://doi.org/10.12669/pjms.37.3.3440

How to cite this:Alam L, Khan RSA, Kazmi SKH, Rafi ud Din. Outcome of patients with acute severe necrotizing pancreatitis in a dedicated hepato-biliary unit of Pakistan. Pak J Med Sci. 2021;37(3):639-645.   doi: https://doi.org/10.12669/pjms.37.3.3440

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Standing at the edge of mortality; Five-year audit of an emergency department of a tertiary care hospital in a low resource setup
Authors: Mukhtar Sama , Saleem Syed Ghazanfar , Ali Saima , Khatri Sarfraz Ahmed , Yaffee Anna Q
Published: February 2021

Background & Objective: Understanding the demographics of mortality and its burden in the emergency department of a tertiary care setup can lead to better planning and allocation of resources to streamline process flow. This can be achieved systematically through mortality audit that can identify the loopholes and areas of improvement. Our objective was to characterize the epidemiology of ED mortality in a tertiary care hospital of Karachi, Pakistan.

Methods: A five-year retrospective chart review of 322 adult mortalities presenting between January l, 2014 – December 31, 2018 was conducted in the emergency department (ED) of The Indus Hospital (TIH), Karachi. All expiries in ED were included while those brought dead and with do not resuscitate order (DNAR) were excluded.

Results: Mortality incidence of 0.076% (7.6/10,000 ED visits in five years) was reported. Amongst 507,759 adult ED visits, 322 mortalities were documented. Mean time lapse before presentation was 44±147 hours and mean length of stay before death was 3.4±2.8 hours. Acute coronary syndrome (ACS) was the predominant cause of death with 109 (33.8%) expiries. Significant association was reported between no history of prior care and high priority (P1) cases (p=0.013).

Conclusions: This study identified the contributing factors to adverse outcome such as delayed presentation with systemic gaps in management and unknown disposition. The need to improve these factors at local and national level can lead to improvement in Pakistani healthcare sector.

doi: https://doi.org/10.12669/pjms.37.3.3680

How to cite this:Mukhtar S, Saleem SG, Ali S, Khatri SA, Yaffee AQ. Standing at the edge of mortality; Five-year audit of an emergency department of a tertiary care hospital in a low resource setup. Pak J Med Sci. 2021;37(3):633-638. doi: https://doi.org/10.12669/pjms.37.3.3680

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Fpemlocal: Estimating family planning indicators in R for a single population of interest
Authors: Guranich Gregory , Cahill Niamh , Alkema Leontine
Published: February 2021

The global Family Planning Estimation model (FPEM) combines a Bayesian hierarchical model with country-specific time trends to yield estimates of contraceptive prevalence and unmet need for family planning for countries worldwide. In this paper, we introduce the R package fpemlocal that carries out the estimation of family planning indicators for a single population, for example, for a single country or smaller area. In this implementation of FPEM, all non-population-specific parameters are fixed at outcomes obtained in a prior global FPEM run. The development of this model was motivated by the demand for computational efficiency, without loss of model accuracy, when estimates and projections from FPEM were needed only for a single country. We present use cases to produce estimates for a single population of women by union status or all women based on package-provided data bases and user-specified data. We also explain how to aggregate estimates across multiple populations. The R package forms the basis of the Track20 Family Planning Estimation Tool to monitor trends in family planning indicators for the FP2020 initiative. Fpemlocal is available from: https://github.com/AlkemaLab/fpemlocal
National ownership of family planning: What do FP2020 commitments have to do with it?
Authors: Appleford Gabrielle , Emmart Priya
Published: February 2021

Background: In 2020, we reached a family planning (FP) temporal milestone. This paper seeks to understand the political economy of commitments and normative best practice within FP national programs, contributing to “stock taking” of change objectives for national ownership and domestic financing of FP programs post FP2020. Stock taking is needed to understand, for example, do we expect our current approaches to deliver greater commitment or do we need to change our approach? Is time the limiting factor for FP2020 commitments or are other, contextual, mechanistic and implementation factors more critical?

Methods: This paper uses mini-case studies to offer insights in response to these questions. It drew from country status updates of national FP program commitments published on the FP2020 website. These included country self-assessments, country action for acceleration plans and revitalised commitments using standard templates provided by FP2020.

Results:  Critical factors emerging from the case study analysis suggest the following. Context: Country programs that adapted best practices through thoughtful selection, regular monitoring, and course correction, were more responsive to context and better able to scale interventions.  Mechanism: Programs that embedded commitments within national health reforms and transformative agendas were able to sustain commitment and mechanism more effectively over time. Implementation: Programs that were able to balance central coordination with devolved implementation, more effectively translated commitments to action. Monitoring: Programs that placed emphasis on monitoring progress and course correct were better able to steward national commitments and partner inputs.

Conclusions: National FP programs included within the country comparative analysis benefitted from their engagement with FP2020. However, not all were able to convert FP2020 commitments into national ownership. In many FP2020 contexts, there is less need for a technical intervention and greater need for engaging politically on sensitive issues that constrain women’s and adolescent empowerment and rights and access to FP.
Inatividade física no lazer durante a pandemia da COVID-19 em universitários de Minas Gerais
Authors: Tavares Giselle Helena , Oliveira Daniel Paiva de , Rodrigues Lucas Ramos , Mota Caroline Gonçalves da , Sousa Thiago Ferreira de , Polo Maria Clara Elias
Published: February 2021

Os objetivos deste estudo foram estimar a prevalência de inatividade física no lazer e analisar a associação entre as práticas de atividades físicas (AF) pregressas na Educação Física (EF) escolar e fora do contexto escolar, sob a inatividade física no lazer durante o período da pandemia de COVID-19. Estudo transversal em que 1.679 estudantes dos cursos de graduação e pós-graduação da Universidade Federal de Uberlândia responderam um questionário online adaptado do “Indicadores de Saúde e Qualidade de Vida em Acadêmicos (ISAQ-A)". O período de coleta teve duração de 25 dias, em maio de 2020. A análise da associação empregada foram as Razões de Prevalências (RP), complementadas pelo intervalo de confiança a 95% (IC95%), nas análises brutas e ajustadas. A variável dependente foi relatar não praticar AF no lazer durante a pandemia de COVID-19. As variáveis independentes: prática de AF no período da infância e adolescência, fora da escola e participação nas aulas de Educação Física escolar (participação regular e irregular). As variáveis de controle foram estado de saúde, meios para a prática de AF antes da pandemia e renda. O nível de significância adotado foi de 5%. O não envolvimento em atividades físicas fora do contexto escolar está associado a maiores prevalências de inatividade física no lazer (RP = 1,245; IC95%: 1,087 – 1,426). Os achados deste estudo indicam que as AFs realizadas no âmbito do lazer no período da infância e adolescência podem influenciar na manutenção da prática mesmo em situações adversas, como o distanciamento social ocasionado pela pandemia de COVID-19.
Robust Data-Driven Vehicle Routing with Time Windows
Authors: Zhang Yu , Zhang Zhenzhen , Lim Andrew , Sim Melvyn
Published: February 2021

On-time delivery is of utmost importance in today’s urban logistics. However, travel times are uncertain and classical deterministic routing solutions often fail to ensure timely delivery. In this paper, a robust solution that exploits travel times data to determine the best routes for maximal timely delivery is proposed. A new decision criterion is introduced, the service fulfillment risk index (sri), which accounts for both the late arrival probability and its magnitude. Together with Wasserstein distance–based ambiguity in travel times, sri can be evaluated efficiently in closed form. In addition, an exact branch-and-cut approach and a meta-heuristic algorithm are developed to minimize sri with a given travel cost. Simulation studies demonstrate that handling uncertainty improves service punctuality, and that incorporating ambiguity prevents overfitting. Most importantly, sri outperforms the canonical decision criteria of lateness probability and expected lateness duration.
CONSIDERAÇÃO DE EMISSÕES DE GASES DE EFEITO ESTUFA NO PLANEJAMENTO DE LONGO PRAZO DA EXPANSÃO DA GERAÇÃO POR MEIO DO MÉTODO AHP
Authors: Melo Albert C. G. , Justino Thatiana C. , Maculan Nelson
Published: February 2021

Há uma preocupação crescente com o aquecimento global e com o aumento dos níveis de emissões de gases de efeito estufa (GEE) nos sistemas climáticos. Como os benefícios de ações de mitigação das emissões de GEE estão ligados a estratégias de longo prazo, como o planejamento da expansão, faz-se necessário que as metodologias e os modelos para o planejamento da expansão da geração de longo prazo (PEGLP) se tornem facilitadores das ações para a mitigação das mudanças climáticas. Este trabalho apresenta uma metodologia geral para o PEGLP que representa de forma explícita as emissões de GEE na tomada de decisão, baseada em métodos de apoio à decisão multicritério e que emprega ainda técnicas de análise de envoltória de dados e de agrupamento estatístico. A abordagem é flexível e pode ser aplicada a qualquer tipo de sistema elétrico ou circunstância do país. A metodologia proposta, empregando o método AHP, foi aplicada a uma configuração real do sistema interligado brasileiro, de grande porte. Os resultados evidenciaram a sua capacidade de auxiliar o PEGLP considerando emissões de GEE e a sua relevância para a política energética.
Contribuições da linguagem poética à formação do psicólogo clínico a partir da perspectiva fenomenológica existencial
Authors: NUNES ANDRE PRADO
Published: February 2021

Esta investigação busca esclarecer o modo como a linguagem poética pode contribuir na formação clínica do psicólogo, no horizonte da fenomenologia existencial. Ela parte de Projeto de Plantão Psicológico conduzido por laboratório universitário em clínica-escola, no qual estagiários a partir do terceiro semestre realizam os primeiros atendimentos e supervisões. Os relatos dos estagiários revelam uma predominância do pensamento calculante nos atendimentos. Ele se revela nas tentativas de explicação e convencimento dos estagiários junto aos clientes. O pensamento meditativo, via linguagem poética, aparece modestamente no modo como aos poucos, os estagiários passam a trazer imagens, metáforas e sugestões ao atendimento. O surgimento desta linguagem nos atendimentos revelou-se rico recurso à formação, pois ao não se ater no raciocínio lógico, possibilitou ao aluno experienciar como o pensamento meditativo na ação clínica propicia libertar o ser para a busca do sentido, reconduzindo-o ao modo de ser próprio.
Refúgios solitários: percursos filosóficos para viver a quarentena
Authors: Barreto Arthur Siebra
Published: February 2021

O texto em questão é uma reflexão que faço sobre formas de nos potencializarmos nesse momento adverso da pandemia COVID-19; mais especificamente, em como bem viver na quarentena a partir da ajuda do pensamento de alguns filósofos apresentados. Realizamos quatro etapas ou movimentos que acredito serem fundamentais para essa proposta, tendo em vista que a filosofia é um saber que, essencialmente, pode nos levar ao exercício espiritual de autoconhecimento e autoaprimoramento de si, e, como fruto, a um adequado trato das adversidades e bem viver. Ambas as quatro sessões tratam desse exercício gradual que envolve a partida de um trato de nossa subjetividade, a relação do eu consigo mesmo; posteriormente, ao trato do eu com o outro e, por fim, a uma compreensão da vida a partir de uma visão holística do mundo que nos leva a concluir sobre como a consciência da pequenez humana diante da Natureza e sua majestade é algo fundamental para melhor lidarmos com os problemas e fatos que estão para além de nossa vontade.
Resenha de "Heidegger/Wittgenstein: Confrontos"
Authors: Aquino Thiago André Moura de
Published: February 2021

O texto apresenta uma resenha do recém publicado livro de José Arthur Giannotti
Eros Carvalho: diálogos interdisciplinares urgentes
Authors: Fernandes Christiane Costa de Matos , Guimarães Deborah Moreira , Da Silva Taciane Alves , Dos Santos Fábio Candido
Published: February 2021

Entrevista com Eros Carvalho por Christiane Costa M. Fernandes, Deborah Moreira Guimarães, Taciane Alves da Silva e Fábio Candido dos Santos Esta entrevista foi elaborada por Christiane Costa de Matos Fernandes, Deborah Moreira Guimarães, Fábio Candido dos Santos e Taciane Alves da Silva. As perguntas foram enviadas por e-mail ao professor e pesquisador Dr. Eros Carvalho, que as respondeu por escrito. Agradecemos ao Prof. Eros Carvalho não apenas a disposição em realizar a entrevista como também a gentileza e a solicitude para com o corpo editorial da Revista Ekstasis.
Por uma filosofia do presente: em torno da pandemia, da reificação do tempo e de uma utopia do tempo que vem
Authors: Fernandes Paulo Emílio De Paiva Bonillo , Fernandes Andre De Paiva Bonillo
Published: February 2021

Ao longo dos últimos cinco anos, rematados pela pandemia causada pela covid-19, vem se impondo de modo ineludível o cunho que marca a condição geral da civilização ocidental globalizada: a exaustão, o esgotamento – não só dos recursos naturais, mas também dos psíquicos. Antes de mais nada, o ano de 2020 representa o fastígio de uma crise da pólis, não da phýsis. Cumpre, aqui, focalizar as implicações que a crise da covid-19 faculta à experiência do tempo vivido. Para tanto, propõe-se investigar a relação de subordinação entre as categorias do trabalho e do tempo que se dá no interior do capitalismo contemporâneo. Conforme, de um lado, o trabalho, em sua configuração imaterial, invade mais ostensivamente as esferas da subjetividade e da cultura, e, de outro, a semiotização das mercadorias (Cazeloto) as reveste sobremaneira de um valor de culto (Han), as dinâmicas de acumulação e aceleração, cuja imagem mais bem acabada talvez seja a das trocas de sinais da infosfera, se infundem na vivência do tempo e a colonizam. Conclui-se que, na contramão desta caracterização da vida nua contemporânea (Han), tendo como horizonte a instituição de uma imaginação política renovada, que se desvencilhe da colonização do imaginário operada pelo capitalismo em sua forma atual, será preciso ter em conta o papel que cabe à poética, entendida como espaço de exercício da linguagem que escapa à governança levada a cabo pelo agenciamento maquínico das relações socioeconômicas ensejadas pela financeirização digital.
Efficacy of treatment interventions for primary aneurysmal bone cysts: a systematic review
Authors: Bavan Luckshman , Wijendra Asanka , Kothari Alpesh
Published: February 2021

Aims

Aneurysmal bone cysts (ABCs) are locally aggressive lesions typically found in the long bones of children and adolescents. A variety of management strategies have been reported to be effective in the treatment of these lesions. The purpose of this review was to assess the effectiveness of current strategies for the management of primary ABCs of the long bones.

Methods

A systematic review of the published literature was performed to identify all articles relating to the management of primary ABCs. Studies required a minimum 12-month follow-up and case series reporting on under ten participants were not included.

Results

A total of 28 articles meeting the eligibility criteria were included in this review, and all but one were retrospective in design. Due to heterogeneity in study design, treatment, and outcome reporting, data synthesis and group comparison was not possible. The most common treatment option reported on was surgical curettage with or without a form of adjuvant therapy, followed by injection-based therapies. Of the 594 patients treated with curettage across 17 studies, 86 (14.4%) failed to heal or experienced a recurrence. Similar outcomes were reported for 57 (14.70%) of the 387 patients treated with injection therapy across 12 studies. Only one study directly compared curettage with injection therapy (polidocanol), randomizing 94 patients into both treatment groups. This study was at risk of bias and provided low-quality evidence of a lack of difference between the two interventions, reporting success rates of 93.3% and 84.8% for injection and surgical treatment groups, respectively.

Conclusion

While both surgery and sclerotherapy are widely implemented for treatment of ABCs, there is currently no good quality evidence to support the use of one option over the other. There is a need for prospective multicentre randomized controlled trials (RCTs) on interventions for the treatment of ABCs. Cite this article: Bone Jt Open 2021;2(2):125–133.