bluuebunny/crossref_metadata_2025 huggingface dataset:
3035 Pancreatico-Vesical Fistula
Authors: Ghosh Sudeshna , Patel Saumil , Hira Priya , Aswani Yashant
Published: October 2019

INTRODUCTION:

Acute pancreatitis is an important cause of acute abdomen. It involves peripancreatic tissues or even remote organs or organ systems due to the enzyme rich fluid of pseudocyst. Here we report a case where acute pancreatitis resulted in a fluid collection that tracked down to the pelvis and spontaneously drained into the urinary bladder via a pancreatico-vesical fistula.

CASE DESCRIPTION/METHODS:

A 28-year-old male, chronic alcoholic, developed epigastric pain for last 4 days which radiated to the back with raised serum lipase and amylase levels. He was started on conservative therapy for acute pancreatitis and took discharge against medical advice but returned again 3 weeks later with severe pain in epigastrium as well as left flank, which is boring. Abdominal tenderness and muscle guarding were elicited. Diminished bowel sounds. CT abdomen: a bulky pancreas with non-enhancing areas, peripancreatic stranding, and acute fluid collections involving the body and tail of the pancreas extending along the renal fascia toward the pelvis and resting on the left superolateral wall of the urinary bladder. The epigastric pain gradually improved with complaints of burning micturition 2 days after without pyelonephritis signs. The urine had brownish tinge, turbid, foul smelling and microscopy revealed no bacteria/casts. An abdominal sonogram: normal kidneys but thickened UB wall with thick mobile echoes lying on left superolateral UB. Urine lipase and amylase were 499 U/Lit and 350 IU/Lit. CT cystography: contrast leakage from the left superolateral UB wall into the perivesical with fluid-fluid level seen in the UB suggestive of contrast –debris level means pancreatic-vesical fistula. Stenting of the pancreatic duct and percutaneous drainage of the fluid collection are done with regression of urinary symptoms and urinary amylase. 12 days after a repeat cystogram showed spontaneous healing of the fistula. The patient was followed up for 5 months with free of symptoms.

DISCUSSION:

Inappropriate activation of pancreatic proenzymes causes acute pancreatitis. It digests the pancreatic parenchyma, the peripancreatic tissues, leads to arterial pseudoaneurysms, fat necrosis and bowel perforation. Pseudocyst can communicate with the pleura, peritoneum, and gut or to the skin surface. Pancreatic fistulas to the urinary tract are rare and such fistulas usually communicate with the left kidney. Urinary amylase levels can thus be monitored.
3054 Getting to the Bottom of Incessant Diarrhea
Authors: Kulkarni Mayuri , Saxena Rovin , Ponna Pramod , Cosma Cecilia
Published: October 2019

INTRODUCTION:

Clostridium difficile infection (CDI) is a common cause of recurrent diarrhea. Up to 35% of patients experience recurrent infection after initial therapy. Patients with recurrent CDI are occasionally treated empirically with antibiotics. There has been an increase in recurrence in CDI over recent years. In fact, there is a 50-60% chance of a repeat recurrence. Persistent diarrhea is also caused by microscopic colitis, which occurs 7.9 per 100,000 person years. It has been associated with the use of NSAIDs and proton-pump inhibitors (PPI). We present a case of a patient with recurrent CDI who was eventually diagnosed with microscopic colitis.

CASE DESCRIPTION/METHODS:

A 41-year-old male with a history for DM type 1, renal failure, GERD presented with persistent diarrhea for the past 5 years. His temperature was 98.3 F, HR 87 bpm, BP 123/89 mmHg, and RR was 20 per minute. Physical exam was unremarkable. Laboratory studies were insignificant. CT with contrast was negative for any pathologies. Initial stool testing was negative for CDI. A colonoscopy with biopsy was performed which showed no abnormal findings. He was treated with IV fluids and loperamide. His symptoms persisted and repeat stool was positive for Clostridium difficile toxin. According to guidelines at the time of presentation, he was started on metronidazole and his PPI was discontinued. His symptoms resolved over 48-72 hours and he was discharged. Two weeks later, he presented again with CDI and was treated with oral vancomycin and discharged. He presented with diarrhea 2 months later and was treated empirically with metronidazole, showing minimal to no improvement of his symptoms. Stool studies were negative for Clostridium difficile toxin. A repeat colonoscopy with biopsy showed lymphocytic infiltrates within the colonic mucosa, confirming the diagnosis of lymphocytic microscopic colitis. He was started on budesonide with a good clinical response and was discharged. Follow-up at our clinic showed near-resolution of his symptoms.

DISCUSSION:

Recurrent diarrhea is a bothersome symptom. Our patient's microscopic colitis was overshadowed by his history of CDI. He was treated empirically for CDI, exposing him to antibiotics and delaying appropriate treatment. Antibiotics may create iatrogenic consequences such as antibiotic resistance. Clinicians must be aware that patients with history of recurrent CDI may have other underlying etiologies for persistent diarrhea.
3083 Campylobacter coli bacteremia: How Common Is It?
Authors: Pisipati Sindhura , Zafar Yousaf , Elkafrawy Ahmed A. , Ullah Waqas
Published: October 2019

INTRODUCTION:

Campylobacter species are known to cause enteritis, usually self-limited, but with the risk of developing Guillain Barre Syndrome. However, over the past 40-50 years, there have been reports of varying presentations, such as cellulitis, spondylodiscitis, and bacteremia. Of the Campylobacter species, C. jejuni is the most common culprit for causing bacteremia, however, C. coli bacteremia is becoming more prevalent. Here we discuss an unusual case of C. coli bacteremia in a patient with decompensated liver cirrhosis.

CASE DESCRIPTION/METHODS:

59 y/o with history of cirrhosis secondary to alcohol abuse complicated by esophageal varices, who presented with black, watery stools in the previous one week with concurrent scrotal swelling. Vital signs were stable with temperature of 97.6 degrees F, heart rate 84 bpm, respiratory rate 16, blood pressure 117/72, and oxygen saturation 99% on room air. Physical exam was remarkable for voluntary guarding, and right upper quadrant tenderness. Lab tests revealed a white blood count of 2300/cm2, hemoglobin 9.9 g/dL, alkaline phosphatase 132 IU/L, aspartate aminotransaminase 65 U/L, alanine aminotransaminase 26 U/L, lactic acid 5.0 mmol/L, magnesium 1.2 mg/dL, and phosphorus 2.2 mg/dL. Computed tomography abdomen/pelvis with contrast showed findings of colitis. Ultrasound of the scrotum showed possible scrotal cellulitis. Stool culture returned positive for Campylobacter antigen, for which doxycycline was initiated. Blood cultures resulted with gram negative rods, which were later confirmed to be C. coli. Blood cultures continued to grow the bacteria and antibiotics were switched to imipenem until the day of discharge. Unfortunately, the patient left the hospital against medical advice and was sent home with ciprofloxacin to complete a total antibiotic course of 2 weeks after the last negative blood culture. Patient was seen at his primary care physician's office 4 days after leaving the hospital and reported complete resolution of his symptoms.

DISCUSSION:

Campylobacter bacteremia is rare. We must be aware of the possibility of a Campylobacter bacteremia and consider this organism when choosing empiric antibiotics. Additionally, once confirmed of a Campylobacter bacteremia, we must be mindful of resistance and choose treatment wisely. As Campylobacter infections have a wide array of presentations, it is imperative that cases are shared amongst the medical community so that prompt recognition, diagnosis, and treatment can be offered.
3099 Endoscopic Botulinum Toxin Injection for Tacrolimus-Induced Achalasia in a Renal Transplant Recipient
Authors: Campos Marilia , Matlock Jake
Published: October 2019

INTRODUCTION:

Multiple medications have been associated with secondary achalasia. Here we present a patient who developed dysphagia 4 days after his renal transplant and was found to have achalasia thought to be due to his tacrolimus; he was successfully treated with botulinum injection. To our knowledge, this is the first case of tacrolimus-induced achalasia ever reported in a renal transplant patient; it is also the first case in a transplant patient to be treated endoscopically with botulinum injection.

CASE DESCRIPTION/METHODS:

A 58 year old man with a history of end stage renal disease secondary to focal segmental glomerulosclerosis presented with progressive renal failure and underwent deceased kidney transplant without complications. At clinic, follow-up on post-operative day #4, the patient reported difficulty in swallowing since post-operative day two. A modified barium swallow study (Figure 1) demonstrated severe esophageal dysmotility and lower esophageal sphincter dysfunction concerning for achalasia. Upper endoscopy (Figure 2) one week later revealed a dilated esophagus with mild edema but without focal lesions or ulcerations. Esophageal manometry (Figure 3) evidenced outflow obstruction of the esophagogastric junction and weak peristalsis in the esophageal body, confirming the diagnosis of achalasia. Surgical therapy and changing his calcineuron inhibitor for achalasia were considered too high risk in this patient so shortly after transplant. The patient ultimately underwent therapy with endoscopic botulinum toxin injection (100 units) of the lower esophageal sphincter. He had excellent results with immediate and complete resolution of dysphagia.

DISCUSSION:

The proposed mechanism for CNI induced changes in esophageal motility involves inhibition of nitric oxide synthase by CNIs. Nitric oxide (NO) is responsible for esophageal peristalsis as well as relaxation of the lower esophageal sphincter (LES). Although it is unclear why switching between different CNIs would lead to symptom resolution, individual variation in the reaction to the different chemical structures of tacrolimus and cyclosporine has been proposed. Botulinum toxin can be considered as a therapeutic option in those patients who are not candidates for a change in their immunosupression. To our knowledge, this is the first case of botulinum induced achalasia reported after a kidney transplant and also the first successfully treated with botulinum toxin injection.
3102 Atrio-Esophageal Fistula Presenting as Odynophagia: A Rare but Fatal Complication of Cardiac Ablation
Authors: Rashid Mamoon Ur , Khan Muzammil Muhammad , Ullah Waqas , Zafar Hammad , Hussain Ishtiaq , Hasan Badar , Ur Rehman FNU Asad , Hurairah Abu
Published: October 2019

INTRODUCTION:

Atrio-esophageal fistula is one of the challenging complications of catheter ablation. The clinical presentation is unpredictable but rapid diagnosis and surgical treatment may prevent fatality. We are here reporting a case of a patient who initially presented with odynophagia and was diagnosed later with atrio-esophageal fistula.

CASE DESCRIPTION/METHODS:

43 years old male presented to ED with complaints of retrosternal chest pain and odynophagia s/p cardiac ablation for AF 4 days ago. Initial investigation were normal. Patient on upper GI series had focal contrast collection at the distal esophagus. Patient underwent EGD and it was found that patient had linear deep mid esophageal perforation for which 6 hemostatic clips were used for closure patient was discharged on TPN. After 2 weeks patient presented again for shortness of breath and chest discomfort. On examination patient had loud pericardial friction rub suspicious and stat Echo showed pericardial effusion with early signs of cardiac tamponade. Patient underwent emergent pericardiocentesis. After pericardiocentesis patient became febrile and blood cultures were growing Lactobacillus. CT chest (pulmonary veins) revealed Atrio-esophageal fistula, pericardial effusion and left sided pleural effusion suspected for empyema. Patient underwent thoracotomy, decortication of empyema, repair of inferior pulmonary vein/atrial margin, esophageal repair, G/J tube placements, and omental transfer. Patient eventually improved and was discharged home.

DISCUSSION:

The estimated incidence of atrio-esophageal fistula is less than 0.1% – 0.25% after AF ablation procedures. Potential culprit is direct heat of radiofrequency ablation causing damage to already susceptible epithelial esophageal mucosa. After esophageal mucosal necrosis, fistula formation and mediastinitis can occur. Pericardial effusion/tamponade, sepsis and cardioembolic stroke can also occur. Patient may present with fever, nausea, vomiting, dysphagia, odynophagia, hematemesis and melena. CT scan of the chest with intravenous contrast is considered by many as the diagnostic modality of choice as it can identify the leak along with any signs of pneumomediastinum and pneumopericardium. Endoscopy should be avoided as blowing of air inside can result in dislodging of the large embolus to the brain resulting in stroke or death. Treatment options include open surgical repair of fistula via thoracotomy with placement of tissue/omentum between esophagus and left atrium or esophageal stenting.
3173 Spontaneous HBsAg Seroclearance in a Patient With Chronic Hepatitis B: Do We Need Surveillance?
Authors: Singh Khushboo , Subramanian Sruthi K. , Abraham Fiyinfoluwa , Machicao Victor
Published: October 2019

INTRODUCTION:

Hepatitis B virus (HBV) infection is a global health problem despite an effective vaccination program, routine antenatal screening, and perinatal care. Among the individuals infected with the HBV, about 5 % of adults and 90% of children become chronic carriers. A small percentage of carriers undergo spontaneous seroclearance of Hepatitis B surface antigen (HBsAg). We present a case of spontaneous HBsAg seroclearance in a chronic hepatitis B carrier.

CASE DESCRIPTION/METHODS:

A 60-year-old Hispanic male with a history of chronic hepatitis B presented to the hepatology clinic for regular follow-up. He was asymptomatic with no stigmata of chronic liver disease. He had been followed in the clinic for nine years. He was HBsAg positive, hepatitis B surface antibody detectable at 6.9 mIU/ml, hepatitis B e antigen (HBeAg) negative, hepatitis B e antibody positive, undetectable HBV DNA levels, and alpha-fetoprotein 17.2 ng/ml. He persistently had normal liver enzymes. Five months after the last positive HBsAg, routine serology showed loss of HBsAg. CT Abdomen with contrast liver protocol showed no evidence of cirrhosis and hepatocellular carcinoma (HCC). The liver biopsy showed no evidence of fibrosis. The patient is on surveillance with a follow-up in 6 months for repeat serology.

DISCUSSION:

Chronic hepatitis B carriers are at risk of developing decompensated liver cirrhosis and hepatocellular carcinoma. The rate of HBsAg spontaneous seroclearance is estimated to be 1–3% per year. The long-term outcome after HBsAg seroclearance is excellent if there is no pre-existing cirrhosis or viral superinfection. HBsAg carriers who are negative for HBeAg or negative for HBV DNA are more likely to clear HBsAg from serum. AASLD guidelines recommend HCC surveillance in chronic hepatitis B infection, but its usefulness in patients after HBsAg seroclearance without any liver injury remains controversial. Few retrospective studies recommend surveillance in high-risk patients, which include male patients, patients with cirrhosis, HCV superinfection, age ≥50 years at the time of seroclearance and family history of HCC. Surveillance in patients who do not have any risk factors may not be cost effective as the incidence of adverse liver events among them is rare. Our patient had chronic hepatitis B for nine years and underwent spontaneous seroclearance of HBsAg with negative HBeAg and undetectable HBV DNA. He has no evidence of cirrhosis or viral superinfection, thus having a favorable long-term prognosis.
3181 Intravenous Amiodarone: An Uncommon Culprit of Reversible Hyper-Acute Liver Injury
Authors: Ramachandran Rajarajeshwari , Bongu Ramachandra , Ajluni Allison , Jani Niraj
Published: October 2019

INTRODUCTION:

Amiodarone is a commonly used anti-arrhythmic agent and it is important that physicians are familiar with the toxicity profile. We are reporting a case of intravenous (IV) amiodarone induced hyper-acute liver injury.

CASE DESCRIPTION/METHODS:

62-year-old man with history of atrial fibrillation, non-ischemic cardiomyopathy and tobacco abuse, was admitted with atrial fibrillation and rapid ventricular response related to medication non-adherence. Patient was given IV amiodarone (total of 1050 mg) over 24-hour period, following which patient developed marked elevation of aspartate aminotransferase/AST (4021 U/L) and alanine aminotransferase/ALT (3000 U/L) with mild elevation of alkaline phosphatase/ALP (218 U/L) and total bilirubin (2.0 mg/dL). International Normalized Ratio (INR) - 5.3. Viral hepatitis panel, acetaminophen and drug toxicology screen - negative. Ceruloplasmin – normal. Ultrasound abdomen – normal liver and CBD diameter 4 mm. Portal venous duplex – no thrombosis. Patient denied use of over the counter medications or herbal supplements. No hypotensive episodes or evidence of cardiogenic shock. Due to the temporal relationship between the use of intravenous amiodarone and the development of liver injury, amiodarone-induced liver injury was suspected. Amiodarone was immediately discontinued and patient was given IV N-acetylcysteine (NAC). 24 hours later, AST fell by 50% to 2167 U/L. Liver enzymes continued to decrease and on day 4 (day of discharge), AST and ALT levels were 212 U/L and 929 U/L. After the liver enzymes normalized, our patient was started on oral amiodarone without recurrence of liver injury.

DISCUSSION:

IV amiodarone is typically used as a short-term therapy for various arrhythmias and is primarily eliminated by biliary excretion. Acute hepatitis due to parenteral therapy is extremely rare and can develop within 1 day of administration. Amiodarone should be immediately discontinued in those cases. The different mechanisms suspected to cause acute liver toxicity due to IV amiodarone are ischemic liver injury due to relative hypotension, hypersensitivity reaction, toxicity of the vehicle (polysorbate-80), and idiosyncratic toxicity. Limited evidence is available about the use of NAC in amiodarone induced liver injury.
3198 An Unusual Case of Severe Hypertriglyceridemia in an Alcohol Naïve Patient
Authors: Baseer Yaseen
Published: October 2019

INTRODUCTION:

Hypertriglyceridemia (HT) is a metabolic disorder due to an altered synthesis of lipoproteins. Although HT is often asymptomatic, acute cases can result in pancreatitis and chronic elevations of HT can lead to the development of atherosclerotic disease. HT is most commonly caused by obesity, diabetes mellitus and excess alcohol intake. Alcohol-induced HT is due to increased very-low-density lipoprotein secretion and impaired lipolysis. Previous research has shown an association of severe HT with chronic alcohol use. Here, we present an unusual case of new onset severe HT in a patient who recently began drinking alcohol.

CASE DESCRIPTION/METHODS:

A 42 year old female with a history of anxiety presented to the hospital with a primary complaint of suicidal ideation. Patient was subsequently admitted to psychiatric inpatient ward and medical team was consulted after labs revealed triglyceride level of 3930. Patient was questioned about recent travel, recent drug use, and recent medication use and patient's answers were noted to be unremarkable for any concerning history in relation to her HT. She does admit to moderate alcohol use for the first time as an adult during the last week and her alcohol level on admission was slightly elevated at 45. Patient's vitals were reviewed and noted to be within normal limits and patient's laboratory values were also noted to be within normal limits including her CBC, CMP, urine drug screen and chest x-ray. Additionally, triglyceride levels obtained on prior visits have ranged from the 40's to the 120's with the most recent level one year prior to current admission being 47. CT abdomen and pelvis showed no signs of acute intra abdominal pathology. At time of exam, patient was resting comfortably in bed and her only complaint was anxiety. Patient's triglyceride level returned to normal during hospital stay after treatment with insulin and gemfibrozil.

DISCUSSION:

One of the most common causes of HT in the United States is alcohol abuse. More specifically, previous research has shown severe HT developing as a consequence of chronic alcohol use. This case highlights severe HT in a patient who is alcohol naïve and had previous normal triglyceride values. Additionally, her moderate consumption of alcohol during the previous week would not explain such high values of triglycerides. More research is needed to clearly identify the risk of severe HT in a patient who has limited history in drinking alcohol.
3220 Systemic Sclerosis Leading to Recurrent Small Bowel Pseudo-Obstruction
Authors: Kailas Shilpa D.
Published: October 2019

INTRODUCTION:

Systemic sclerosis (SSc) is a chronic systemic disease defined by early microvascular obliterative changes, early activation of T and B-lymphocytes, and extensive fibrosis of the skin and internal organs. Although gastrointestinal involvment of SSc is common, severe intestinal disease manifested by malabsorption, recurrent pseudo-obstruction, or need for parenteral nutrition carries a poor prognosis and is seldom seen. We present the uncommon case of a patient with severe scleroderma bowel causing debilitating disease.

CASE DESCRIPTION/METHODS:

A 76-year-old female with history of atrial fibrillation, systemic sclerosis, achalasia s/p Botox injections, and duodenal bulb ulcer presented to our institution with vomiting of blood-streaked emesis, epigastric abdominal pain, and distension for two days. She had multiple hospitalizations for presumed obstructions in the past treated medically. Endoscopy 3 months prior revealed a large cratered duodenal ulcer located at the duodenal sweep with recent stigmata of bleeding (Forrest Class IIa) treated with epinephrine. Upon evaluation the patient was afebrile and normotensive. Physical exam was significant for mild diffuse abdominal tenderness and no gross blood on rectal exam. Labs were remarkable for Hgb 11.9, MCV 92.8, lactic acid 1.0, and lipase within normal limits. CT A/P showed multiple dilated small bowel loops with air-fluid levels and a fluid-filled patulous esophagus that was unchanged. Trauma surgery was consulted and we managed the patient conservatively with bowel rest, IV fluids, and continuation of her PPI. Her clinical course improved and she was able to pass flatus and stool. We attributed her recurrent symptoms to intestinal pseudo-obstruction precipitated by scleroderma.

DISCUSSION:

SSc is a chronic autoimmune condition commonly affecting the gastrointestinal tract. Major manifestations of small intestinal involvement are due to reduced peristalsis, causing abdominal distension and pain from dilated bowel loops. Acute intestinal pseudo-obstruction is a medical emergency that warrants hospital admission. Most patients have spontaneous resolution with conservative measures like bowel rest, nasogastric decompression, and intravenous hydration but may require frequent readmissions. Surgery is discouraged due to risk of prolonged ileus or anastomotic failure although “venting” jejunostomy allows for air aspiration in chronic pseudo-obstruction. Recurrent intestinal pseudo-obstruction in these patients thus poses a therapeutic challenge.
US 81st Annual Endocrinological Society Conference
Authors: Bershtein L. M.
Published: October 2019

US 81st Annual Endocrinological Society Conference
A língua árabe no contexto plurilíngue de Foz do Iguaçu
Authors: Ribeiro Berger Isis , Da Fonseca Lívia Cristina Carvalho
Published: October 2019

O presente artigo tem como tema as estratégias de gestão e manuten-ção da língua árabe no contexto pluri-língue de Foz do Iguaçu, tendo como objetivo analisar de que maneiras essa língua tem sido gerida e mantida por sua comunidade nesse município. Para tanto, a pesquisa foi desenvolvida sob a ótica da Política Linguística (CALVET, 2007; 2015 SPOLSKY, 2009; 2016) e teve como aporte teórico discussões e reflexões em torno das formas de gestão de línguas (SPOLSKY, 2009; 2016) pela comunidade, seja no âmbito familiar, como língua de herança (FLORES; MELO-PFEIFER, 2014), seja nos espaços públicos e na paisagem linguística (GORTER, 2006; CENOZ; GORTER, 2006). O trabalho re-sulta de investigação de abordagem qua-litativa, envolvendo pesquisa bibliográ-fica, observação em campo e entrevistas.
El impacto de los espacios formativos acerca de las competencias sociales y laborales en la carrera de medicina veterinaria
Authors: FASCENDINI Paola Y , GUAITA María Lucila , PERALTA José , DE GENNARO Mariana
Published: October 2019

El presente trabajo da cuenta de una propuesta de espacios formativos destinados a la adquisición de habilidades sociales en los estudiantes próximos a finalizar la carrera de Medicina Veterinaria de la Facultad de Ciencias Veterinarias de la Universidad Nacional del Litoral, Argentina. Dichos espacios, brindados desde el Servicio de Orientación Educativa, se organizaron en cuatro talleres inspirados en la teoría de las habilidades sociales y laborales. Los cuatro ejes principales fueron autoconocimiento, inserción laboral, habilidades sociales y competencias laborales. Los cuatros ejes principales fueron: autoconocimiento, inserción laboral, habilidades sociales y competencias laborales. El valor pedagógico de la propuesta se evaluó a través de la aplicación de encuestas de opinión y valoraciones de frases significativas. La metodología de abordaje se caracterizó por ser cualitativa, consistente en una estrategia de intervención dentro del ámbito educativo. Algunos resultados preliminares dan cuenta de la necesidad de articular talleres de habilidades sociales a la estructura curricular de la formación universitaria. Los protagonistas de este proceso enfatizan la significatividad que aportan estos espacios como oportunidades válidas para su formación, a la vez que se transforman en instancias de aprendizaje compartido.
METHOD FOR EXPERIMENTAL DETERMINATION OF THE LIQUID DIELECTRIC RESOURCE AND MEASURES FOR ITS RESTORATION
Authors: Vysogorets S. P. , Nazarychev A. N. , Pugechov A. A.
Published: October 2019

The theoretical foundations of changes in the transformer oil quality characteristics, depending on the aging degree, are presented. The introduction of a new indicator of the exploitational transformer oils quality – “stability against oxidation” – is substantiated as a way of solving the scientific and technical problem of assessing the resource characteristics of a transformer insulating system. In order to select the best measures to maintain the quality of power transformers insulating oils, a newly developed “Method for the Experimental Determination of the Luquid Dielectric Resource and Measures for its Restoration” is presented.
China–Latin America: Economic Relations in the 21st Century. Latin American Perspective on Opportunities and Threats
Authors: Ratke-Majewska Anna
Published: October 2019

Artykuł porusza kwestię stosunków gospodarczych Chiny–Ameryka Łacińska w tym stuleciu. W ciągu pierwszych dwóch dekad XXI wieku nastąpił znaczny wzrost handlu między Chinami i Ameryką Łacińską, a inwestycje Chin w Ameryce Łacińskiej wzrosły. Chociaż prezentowany tekst omawia kwestie współpracy gospodarczej, jego głównym celem nie jest jednak prezentacja dynamiki tych stosunków, ale refleksja nad szansami i zagrożeniami dla Ameryki Łacińskiej wynikającymi ze współpracy gospodarczej między Chinami i Ameryką Łacińską. Artykuł omawia zatem możliwości i zagrożenia w wielu aspektach, podając różne argumenty i liczne przykłady. Wnioski z tego artykułu dotyczą zarówno pojawiających się wyzwań, jak i perspektyw współpracy.
From the meaning triad to meaning holism: Unifying life’s meaning
Authors: Seachris Joshua
Published: October 2019

Claims that talk of life’s meaning is misguided, unmanageable or, worse, nonsensical, are overblown. Such claims especially track the cosmically focused the meaning of life. “The meaning of life” is perfectly intelligible, and is centered on a cluster of ideas encapsulated by what I call the “meaning triad.” One component of this triad—I-MEANING
—provides the hermeneutical and conceptual resources for understanding the question “What is the meaning of life?” as asking for a single thing, in contrast to amalgam and pluralist views. I will investigate the meaning triad en route to defending meaning of life holism.
Recent work on the meaning of “life’s meaning”: Should we change the philosophical discourse?
Authors: Metz Thaddeus
Published: October 2019

In this article I critically discuss English-speaking philosophical literature addressing the question of what it essentially means to speak of “life’s meaning”. Instead of considering what might in fact confer meaning on life, I make two claims about the more abstract, meta-ethical question of how to understand what by definition is involved in making that sort of enquiry. One of my claims is that over the past five years there has been a noticeable trend among philosophers to try to change our understanding of what talk of “life’s meaning” connotes. For example, whereas most philosophers for a long while had held that such talk is about a kind of value possible in the life of human beings, recently some have argued that certain non-human parts of nature can exhibit meaningfulness, which, furthermore, is not necessarily something valuable. The second claim I advance is that there is strong reason to reject this trend, and instead for philosophers to retain the long-standing approach.
Why the indifference of the universe is irrelevant to life’s meaning
Authors: Trisel Brooke Alan
Published: October 2019

When pessimists claim that human life is meaningless, they often also assert that the universe is “blind to good and evil” and “indifferent to us”. How, if it all, is the indifference of the universe relevant to whether life is meaningful? To answer this question, and to know whether we should be concerned that the universe is indifferent, we need a clearer and deeper understanding of the concept of “cosmic indifference”, which I will seek to provide. I will argue that the lives of many individuals are meaningful and that human life, in general, is somewhat meaningful, despite the indifference of the universe. Furthermore, I will seek to demonstrate that even if the universe cared about us, or had preferences for how we live our lives, that this likely would not enhance the quality of our lives.
Pago por servicios ambientales hidrológicos y dinámica de la cobertura arbórea en la región Iztaccíhuatl-Popocatépetl, Puebla, México
Authors: Mora Carvajal Manuel Jacobo , Bustamante González Angel , Cajuste Bontemps Lenom , Vargas López Samuel , Cruz Bello Gustavo Manuel , Ramírez Juárez Javier
Published: October 2019

El pago por servicios ambientales hidrológicos es un instrumento de política ambiental aplicado en la mayoría de los países para promover la conservación de los ecosistemas, principalmente los forestales. En 2003, el gobierno de México, a través de la Comisión Nacional Forestal (CONAFOR), implementó el programa de Pago por Servicios Ambientales Hidrológicos (PSAH) para atender los problemas de agua y deforestación en el país. Un prerrequisito para que un área reciba el PSAH es que mantenga una cobertura vegetal mínima de 80%, o la aumente, durante los 5 años posteriores al inicio del contrato. Las evaluaciones de los impactos del Programa sobre la cobertura forestal consisten principalmente en estudios nacionales o regionales. En México no se tienen evaluaciones de los impactos a nivel comunitario, escala a la que el PSAH es ejecutado. En el presente estudio se evaluó el impacto del programa de PSAH en la dinámica de la cobertura arbórea en seis ejidos de la región Iztaccíhuatl-Popocatépetl, Puebla. Para realizar el estudio se utilizaron imágenes Quickbird y se realizó una clasificación supervisada. Los resultados indicaron que el Programa PSAH cumplió con su objetivo en cuatro de los seis núcleos agrarios analizados.
Saúde sexual e reprodutiva dosadolescentes: percepções dos profissionais emenfermagem
Authors: Dutra Sehnem Graciela , Tarasuk Trein Crespo Bruna , Mendes Lipinski Jussara , Cammarano Ribeiro Aline , Antunes Wilhelm Laís , Arboit Jaqueline
Published: October 2019

Objetivo: conhecer como é percebida e abordada a saúde sexual e reprodutiva dos adolescentes pelos enfermeiros na atenção primária à saúde.Materiais e métodos: estudo qualitativo do tipo descritivo, realizado no primeiro semestre de 2018. Participaram nove enfermeiros vinculados às Estratégias Saúde da Família de um município do sul do Brasil. Foram realizadas entrevistas semiestruturadas e os dados foram estudados segundo a análise de conteúdo temática. Resultados: evidenciou-se que persiste uma visão reducionista sobre a saúde sexual e reprodutiva na atenção primária à saúde. As estratégias para abordar tal tema abarcam a compreensão das experiências dos adolescentes acerca da sexualidade por meio do estímulo à autonomia, do acolhimento da demanda espontânea, das consultas de enfermagem, dos grupos educativos e da abordagem no contexto escolar.Conclusão: os profissionais necessitam atuar na promoção da saúde sexual e reprodutiva e identificar os problemas dessa população, conferindo-lhe visibilidade no serviço de saúde. É importante repensar as práticas junto ao adolescente, sendo necessário criar espaços apropriados e relacionar a família e a escola.
Disciplina, profesión y transformación
Authors: Ayala Ricardo
Published: October 2019

El presente número de Avances en Enfermería se despliega en medio de un clima de transición. Asistimos a una evidente reformulación de las narrativas profesionales, luego de varias décadas de un énfasis notorio en lo monoprofesional, a un compás marcado por la institucionalización de la disciplina de enfermería en la región. Para efectos de este editorial, emplearé el térmi-no ‘institucionalización’ (1) como la organización de departamentos de enfermería en universida-des, la producción de doctores/as en enfermería, la realización regular de congresos disciplinares y la creación de revistas académicas en el rubro. Este proceso de institucionalización sirve a dos propó-sitos: facilita la creación de enfoques que permi-ten orientar y fortalecer el carácter científico de la práctica, y hace posible instalar la enfermería como disciplina dentro del sistema científico. En lengua-je sociológico, diríamos que esto corresponde a un proceso continuo de diferenciación (2) desde otros marcos epistémicos (v. g. medicina, sociolo-gía, psicología), aunque como el debate sobre teori-zación en enfermería ha dejado de manifiesto, la disciplina enfermera es un campo ecléctico en que convergen otras varias disciplinas. No es un campo puramente social (v. g. los tejidos y humores corpo-rales existen y se trabaja con ellos); pero tampoco es puramente biológico (v. g. los tejidos y humores corporales en ausencia del individuo no tendrían sentido en el ethos de la enfermería).
Association of XRCC3 18067 C>T (Thr241Met) polymorphism with risk of cervical and ovarian cancers: A systematic review and meta-analysis
Authors: Karimi-Zarchi Mojgan , Moghimi Mansour , Abbasi Hajar , Hadadan Amaneh , Tabatabaei Razieh-Sadat , Javaheri Atiyeh , Neamatzadeh Hossein
Published: October 2019

The 18067 C>T polymorphism of XRCC3 gene has been considered to be implicated in the development of cervical and ovarian cancers, but the results are inconsistent. Thus, we conducted a meta-analysis to assess the association of XRCC3 18067 C>T polymorphism with risk of cervical and ovarian cancers. All studies on the association of XRCC3 18067 C>T polymorphism with cervical and ovarian cancers risk were retrieved. Finally, a total of 17 studies including 10 studies with 5,637 cases and 10,057 controls on ovarian cancer and 7 studies with 1,112 cases and 1,233 controls on cervical cancer were selected. Overall, pooled results showed that the XRCC3 18067 C>T polymorphism was significantly associated with increased risk of ovarian cancer (TC vs. CC: OR = 0.904, 95% CI = 0.841–0.972, p = 0.006; TT + TC vs. CC: OR = 0.914, 95% CI = 0.853–0.979, p = 0.010) and cervical cancer (TC vs. CC: OR = 1.00, 95% CI = 1.066–1.585, p = 0.009). Further subgroup analysis by ethnicity revealed an increased risk of cervical and ovarian cancer in Asians and Caucasians, respectively. The present meta-analysis inconsistent with the previous meta-analysis suggests that the XRCC3 18067 C>T polymorphism might be implicated in the pathogenesis of cervical and ovarian cancers.
An unusual case of sodium citrate-dependent artifactual platelet count
Authors: Dima Francesco , Salvagno Gian Luca , Danese Elisa , Veneri Dino , Lippi Giuseppe
Published: October 2019

Background

Ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia is a rare phenomenon. Spurious pseudothrombocytopenia has also been described in other circumstances, while artifactual platelet count in whole blood samples anticoagulated with sodium citrate is an exceptional occurrence.

Case report

In this study, we describe the case of a 44-year-old ostensibly healthy woman who attended the local outpatient clinic for routine laboratory testing, including platelet count in EDTA and sodium citrate, for suspected artifactual pseudothrombocytopenia previously identified in another center. The results of hematological testing on both specimens were essentially normal, except for mild anemia. Nevertheless, the platelet number was 425 × 109/L in K2EDTA and 266 × 109/L (293 × 109/L after correcting for sample dilution) in sodium citrate, respectively. Microscopic revision of blood smears revealed the presence of platelet aggregates and satellitism only in the sodium citrate specimen.

Conclusion

Unlike previous occasional reports of concomitant EDTA- and sodium citrate-dependent pseudothrombocytopenia, we first describe a paradigmatic case of artifactual platelet count attributable to platelet clumping and satellitism, exclusively developing in blood anticoagulated with sodium citrate.
The pig of the Lençóis Maranhenses, first record of wild boar (Sus scrofa) in Maranhão State, Brazil
Authors: Salvador Gilberto Nepomuceno , Garcia Ristau Nathali , Sanches da Silva Isabel , Nunes André
Published: October 2019

The wild boar is one of the most dangerous invasive species. It is widespread in the world, including records for many Brazilian states. However, there is a lack of record from Maranhão state. In the present study, we reported a population of wild boar inside the Lençóis Maranhenses National Park, in Barrerinhas county, State of Maranhão. We discuss about the negative effects of this introduction on native species, including a record of predation by wild boar in nests of endangered turtles.
Samsun Yöresi Halk Müziği Örneklerinin Müzikal ve Edebi Yönden İncelenmesi
Authors: ÖZER Levent , ÖZDEK Attila , ALGI Soner
Published: October 2019

Bu araştırma TRT repertuvarında Samsun iline kayıtlı
bulunan halk ezgilerinin müzikal ve edebî yönlerinin incelenmesi amacıyla
yapılmış betimsel bir araştırmadır. Çalışmada Karadeniz ve Samsun yöresinin
müziği, Samsun ilindeki müzik eğitimi ve müzikle ilişkili kurumlar, ilin tarihi
ve coğrafi özellikleri, ilin coğrafi konumunun müzik kültürüne olan etkileri,
yörede yaygın olarak kullanılan çalgılar ve halk oyunları hakkında genel
bilgiler verilmiştir. TRT sözlü ve sözsüz repertuarında Samsun iline kayıtlı
toplam 28 halk ezgisi tespit edilmiş ve bu ezgiler alfabetik sıraya göre
incelenmiştir. Bütün ezgiler; makamsal yapı, ses genişlikleri, usul ve edebî
özelliklerine göre incelenmiştir. Elde edilen veriler yorumlanmış ve bu
verilerden bazıları grafikler ile sunulmuştur. 
Sonuçta elde edilen bulgular doğrultusunda önerilerde bulunulmuştur.
Mediating Role of Emotional Quotient in the Relationship between Life Satisfaction and Resilience
Authors: TAŞKIRMAZ Mehmet , BAL Canan Gamze
Published: October 2019

The
study investigates the mediating role of emotional quotient in the relationship
between life satisfaction and resilience. Many studies in the literature
indicate that a person’s life satisfaction is correlated with resilience level.
Also, many authors have reported that emotional quotient is positively
associated with life satisfaction and resilience. Structural equation modeling
has been designed to reveal the relationship between life satisfaction,
resilience and emotional quotient. Study data were obtained from the students
receiving education in Kahramanmaraş Sütçü İmam
University, Faculty
of Economics and Administrative Sciences. As predicted from the previous
studies, it was determined that life satisfaction was positively correlated
with resilience in a statistically significant way. Furthermore, it was
revealed that emotional quotient mediated the relationship between life
satisfaction and resilience. According to the results, the study provides
considerably useful implications for the parties concerned.
Büyükşehir Belediyeleri ve Sosyal Hizmet: Kocaeli Büyükşehir Belediyesi Üzerine Bir İnceleme
Authors: ÖZKARAL Metin , YAŞAR Büşra
Published: October 2019

Sosyal hizmet disiplini; bireyin
problemlerini ele alan, sosyal
yoksunluklarının giderilmesiiçin sosyal refahı
arttırmayı amaçlayan bir uygulama ve paradigma bütünüdür. Sosyal hizmet
faaliyetlerinin gerçekleşmesi içinçeşitli kamu kuruluşları eylemlerde
bulunmaktadır. Bu kamu kuruluşlarından birisi de mahalli idarelerdir.
Ülkemizdeki en güçlü mahalli idari yapılanmalarından birisi de kuşkusuz
Büyükşehir belediyeleridir. Bu araştırmada, Büyükşehir belediyelerini
ilgilendiren mevzuatta yer alan sosyal hizmet alanına ilişkin sorunlar ve
faaliyetlerin uygulanabilirliği araştırılmıştır. Daha somut bilgiler elde
edebilmek için Kocaeli Büyükşehir Belediyesi bünyesinde çalışan uzmanlardan mülakat
tekniği kullanılarak bilgi alınmıştır. Çalışmanın sonuçlarına göre; önemli
işlevlerin yerine getirildiği görülmekle birlikte; uzman istihdam sayısının
arttırılması, personele dönük manevi destek süreçlerinin oluşturulması ve
kurumlar arası koordinasyonun arttırılması önem arz etmektedir.
Açığa Satış Fiyatının Belirleyicileri: Borsa İstanbul Mali Endeksi (XUMAL) Üzerinde Bir Uygulama
Authors: ABDİOĞLU Nida , AYTEKİN Sinan
Published: October 2019

Tasarruflarını sermaye
piyasalarında değerlendirmek isteyen yatırımcıların elde edebilecekleri
getiriler sermaye kazancı ve kar payıdır. Sadece sermaye kazancı elde etmek
isteyen yatırımcı satın aldığı menkul kıymeti ileride bir tarihte daha yüksek fiyattan
satarak getiri elde edebilecektir. Yatırımcı, bunun tersi piyasa hareketlerinde
de fiyat düşüşlerinden faydalanabilir. Bu durum yatırımcının
sahip olmadığı menkul kıymetleri satması ya da satışı için emir vermesi
anlamına gelen açığa satış kavramı ile açıklanmaktadır. Buradan hareketle açığa
satış fiyatına etki eden faktörlerin belirlenmesinin amaçlandığı çalışmada Borsa
İstanbul mali endeksinde işlem gören 93 firmanın 2015-2018 yılları arasındaki günlük
açığa satış verileri ile panel regresyon analizi yapılmıştır. Analiz sonucunda,
bağımlı değişken olan ağırlıklı ortalama
açığa satış fiyatı (AOF) ile bağımsız değişkenler olan açığa satış fiyat
volatilitesi (VOL), DFİYAT ve YFİYAT arasında istatistiksel olarak anlamlı ve pozitif
ilişkiler tespit edilmiştir. Yıl kukla değişkenleri göz önüne alındığında ise
AOF ile HACİM arasında anlamlı ve pozitif bir ilişki bulunurken AOF ile hisse
getirisi arasında anlamlı ilişkinin varlığına dair bir bulguya ulaşılamamıştır.
Şakerim Kudayberdiulı’nın Şiirlerinde Düşünme Hâlleri
Authors: KUNDAKCI Mustafa , BACAKLI Yılmaz
Published: October 2019

Türk
dünyası edebiyat birikiminin Kazak coğrafyasında şiirleriyle dikkati çeken
Şakerim Kudayberdiulı ideal sahibi, düşünen bir şairdir. O şiirlerinde sadece
mensubu olduğu millete değil tüm insanlığa faydalı olabilecek şeyleri bizzat
kavramaya, kavrayabildiklerini de birinci elden okuru ile paylaşmaya çabalar.
Onun şiirlerinde düşünme fiili çoğu zaman oluş hâlinde verilir. Yine bu
şiirlerde bireyin ihtiyaç ve menfaatlerine karşılık gelen, geçici ve
derinliksiz; toplumun faydasına hizmet eden, ahlak hâlini almış, derinlikli
olmak üzere iki farklı düşünme fiiline dikkat çekilir. Şair okuyucularını, bu
iki düşünme biçimi arasında ideal olduğuna inandığı şekilde bir düşünme
yeteneği kazandırmak için uğraşır.

Kazak
coğrafyasında eğitim, millî birlik ve doğru din anlayışı konusunda yaşanan
sıkıntılar sebebiyle ideal düşünme biçiminden uzaklaşıldığını düşünen
Kudayberdiulı, geleceği kurtarmak için bu düşünce şeklinin yeniden kazanılması
gerektiğine inanır. Çünkü ona göre adalet, doğruluk, özgürlük ve hak
kavramlarının hem teorik hem de pratik olarak bireyin ve toplumun hayatında
yerleşik hâle gelebilmesi bu düşünce biçiminin kazanılmasıyla mümkün olacaktır.
Recommendations of Group of States Against Corruption (GRECO) on Improving the Legislation of the Russian Federation on Legal Immunities of Prosecutors and Investigators
Authors: Sinitsyn Valentin
Published: October 2019

The author examines the impact that the activities of GRECO (The Group of States against Corruption) have on the development of the anti-corruption legislation in the Russian Federation, in particular, on the amendment of norms that regulate legal immunities of prosecutors and investigators. The chronological analysis of GRECO recommendations and legal positions regarding the necessity of reducing the number of legal immunities in the sphere of criminal legal procedures for certain categories of people makes it possible to study the key stages of their introduction into the normative legal base of the Russian Federation. The author notes that GRECO standards and recommendations are, on the whole, a rather effective method of improving legislation and combating corruption; the author also presents positive examples of the impact they make on the emergence of new practical anti-corruption institutions in the Russian Federation. At the same time, the author believes that due to a number of factors (historical background, the practice of law enforcement) which influence specific issues, including legal immunities, the introduction of some GRECO initiatives in the legislation of the Russian Federation is premature. The key conclusion of the author is to support the international position of the Russian Federation regarding the absence of norms setting legal immunities of investigators and prosecutors as exemptions from the principle of equality before the law and the courts in Russian legislation. The practical and theoretical value of this research is that its clauses could be further used to work out more specific positions on disputable issues in the interaction between the Russian Federation and GRECO.