bluuebunny/crossref_metadata_2025 huggingface dataset:
Calibration of AGILE-GRID with On-ground Data and Monte Carlo Simulations
Authors: Cattaneo P. W. , Rappoldi A. , Argan A. , Barbiellini G. , Boffelli F. , Bulgarelli A. , Buonomo B. , Cardillo M. , Chen A. W. , Cocco V. , Colafrancesco S. , D’Ammando F. , Donnarumma I. , Ferrari A. , Fioretti V. , Foggetta L. , Froysland T. , Fuschino F. , Galli M. , Gianotti F. , Giuliani A. , Longo F. , Lucarelli F. , Marisaldi M. , Mazzitelli G. , Morselli A. , Paoletti F. , Parmigiani N. , Pellizzoni A. , Piano G. , Pilia M. , Pittori C. , Prest M. , Pucella G. , Quintieri L. , Sabatini S. , Tavani M. , Trifoglio M. , Trois A. , Valente P. , Vallazza E. , Vercellone S. , Verrecchia F. , Zambra A.
Published: July 2018

AGILE is a mission of the Italian Space Agency (ASI) Scientific Program dedicated to γ-ray astrophysics, and has operated in a low Earth orbit since 2007 April 23. It is designed to be a very light and compact instrument, capable of simultaneously detecting and imaging photons in the 18–60 keV X-ray energy band and in the 30 MeV–50 GeV γ-ray energy range with a good angular resolution (≈1◦ @ 1 GeV). The core of the instrument is the Silicon Tracker, supplemented by a CsI calorimeter and an AntiCoincidence system, which form the Gamma Ray Imaging Detector (GRID). Before launch, the GRID needed on-ground calibration with a tagged γ-ray beam to estimate its performance and validate the Monte Carlo simulation. The GRID was calibrated using a tagged γ-ray beam with energy up to 500 MeV at the Beam Test Facilities at the INFN Laboratori Nazionali di Frascati. These data are used to validate a GEANT 3-based simulation by comparing the data and the Monte Carlo simulation by measuring the angular and energy resolutions. The GRID angular and energy resolutions obtained using the beam agree well with the Monte Carlo simulation. Therefore the simulation, can be used to simulate the same performance on-flight with high reliability.
Fomitiporia rhamnoides sp. nov. (Hymenochaetales, Basidiomycota), a new polypore growing on Hippophae from China
Authors: Liu Tie-Zhi , Chen Qian , Han Mei-Ling , Wu Fang
Published: July 2018

Based on morphology and phylogenetic analysis, Fomitiporiarhamnoides sp. nov. is described. It is characterised by perennial, pileate basidiomata, distinctly shining poroid surface, a zonate context, 11–13 pores per mm, parallel tramal hyphae and regularly arranged contextual hyphae, the presence of cystidioles, globose, hyaline, thick-walled, smooth, dextrinoid, strongly cyanophilous basidiospores measuring 5.8–7 × 5.4–6.5 µm and growing on Hippophaerhamnoides in northern China. Fomitiporiarhamnoides differs from other Fomitiporia species growing on Hippophae by its smaller pores (11–13 per mm vs. <10 per mm).
Freshwater bryozoans of Lithuania (Bryozoa)
Authors: Šatkauskienė Ingrida , Wood Timothy , Rutkauskaitė-Sucilienė Jurgita , Mildažienė Vida , Tučkutė Simona
Published: July 2018

Nine species of freshwater bryozoans were recorded in Lithuania in a survey of 18 various types of freshwater bodies. Eight species were assigned to the Class Phylactolaemata and families Plumatellidae and Cristatellidae (Plumatellarepens,Plumatellafungosa,Plumatellafruticosa,Plumatellacasmiana,Plumatellaemarginata,Plumatellageimermassardi,HyalinellapunctataandCristatellamucedo). The ninth species,Paludicellaarticulata, represented the Class Gymnolaemata.

PlumatellageimermassardiandP.casmianawere recorded for the first time in Lithuania. For the plumatellids, species identification was achieved partly by analysing statoblasts’ morphological ultrastructures by scanning electron microscopy.
Updated checklist of the extant Chondrichthyes within the Exclusive Economic Zone of Mexico
Authors: Ehemann Nicolás Roberto , González-González Lorem del Valle , Chollet-Villalpando Jorge Guillermo , De La Cruz-Agüero José
Published: July 2018

The checklist presented in this study includes the latest taxonomic and systematic modifications and updates (early 2018) for the Chondrichthyes that inhabit the Exclusive Economic Zone (EEZ) of Mexico. The list is based on a literature review of field-specific books, scientific publications and database information from collections and museums worldwide available online such as, the Ocean Biogeographic Information System (OBIS), Global Biodiversity Information Facility (GBIF), Encyclopedia of Life (EOL), iSpecies, FishBase and the National Biodiversity Information System (SNIB–CONABIO). Information was cross-referenced with digital taxonomic systems such as the Catalog of Fishes of the California Academy of Sciences, the World Register of Marine Species (WoRMS), and the Integrated Taxonomic Information System (ITIS). There is a total of two subclasses two divisions, 13 orders, 44 families, 84 genera, and 217 species that represent approximately 18% of all living and described species of chondrichthyans worldwide. For the Mexican Pacific and the Gulf of California, 92 species of chondrichthyans are listed compared to 94 species for the Gulf of Mexico and the Caribbean Sea. Additionally, 31 species listed occur on both coasts of Mexico. The species richness of the Mexican chondrichthyans will surely continue to increase, due to the exploration of deep-water fishing areas in the EEZ.
Self-perception during the Transition to the Fourth Age in the Czech Republic
Authors: Galčanová Lucie , Petrová Kafková Marcela
Published: July 2018

Le vieillissement de la population signifie également un nombre croissant de personnes dans le soi-disant quatrième âge : l’expérience combinant la vieillesse avec un certain degré d’incapacité et la nécessité de recevoir des soins. Alors que certains auteurs identifient le quatrième âge avec la mort sociale, en parlant de l’impossibilité de la recherche empirique, notre article présente une interprétation des récits des personnes âgées concernant les changements dans leur quotidien par rapport à la transition vers cette période, montrant comment une telle interprétation est liée à leur perception de soi et leur identité.
Families and the Elderly along the Shores of the Mediterranean: Old and New Forms of Relatedness
Authors: Sacchi Paola , Paolo Viazzo Pier
Published: July 2018

Le vieillissement de la population impose des défis de plus en plus semblables aux sociétés situées d’un côté et de l’autre de la Méditerranée, car la famille y est encore un acteur majeur de la protection sociale. Les données sociodémographiques et ethnographiques examinées dans cet article montrent que les anciennes manières de se soutenir, comme la pratique de la co-résidence dans les familles élargies, jouent toujours un rôle important. Cependant, on trouve désormais une plus grande diversité des façons de maintenir les liens et l’entraide qui favorise l’« extension » des familles. Se mettent ainsi en place de nouvelles formes de relations entre les différents acteurs : la proximité résidentielle des enfants et des parents fait que les premiers peuvent faire fonction de soignants, tandis que les personnels soignants à domicile peuvent pénétrer la sphère familiale et y obtenir un statut de quasi-parents.
Autoérotismes : aléas d’un parcours
Authors: Bouchard Christine
Published: July 2018

L’auteur considère que les autoérotismes tiennent une place fondamentale dans l’organisation psychique, qu’on les considère comme une conquête d’indépendance vis-à-vis de l’objet, une opération de déplacement et d’intériorisation, ou comme précurseurs de la structure réflexive de la psychè et du dialogue intérieur. Mais elle soulève aussi la question des obstacles sur la voie de la constitution de ces autoérotismes, en particulier les images aliénantes qui peuvent faire surgir une conflictualité entre l’inves­tissement du corps érogène et les idéaux narcissiques. Elle aborde des situations où c’est le renversement « auto » qui est à construire et d’autres où c’est l’« érotique » qui est défaillant.
Changes of Functional Optical Zone After LASIK for Hyperopia and Hyperopic Astigmatism
Authors: Roesler Christian , Kohnen Thomas
Published: July 2018

PURPOSE:

To evaluate which factors may influence the size of the postoperative functional optical zone after hyperopic LASIK.

METHODS:

Thirty-three eyes with a mean spherical equivalent of +3.55 ± 1.28 diopters (D) underwent LASIK with a Technolas 217 C-LASIK laser (Bausch & Lomb Surgical, Munich, Germany). After 1 week and 1, 4, and 12 months, the authors examined refraction, corneal refractive power by means of computerized videokeratography (Technomed C-Scan; Baesweiler, Germany), and uncorrected/corrected distance visual acuity (UDVA/CDVA). According to the degree of hyperopia, they were divided into low hyperopia (spherical equivalent ≤ 3.00 D) and high hyperopia (spherical equivalent > 3.00 D) groups.

RESULTS:

One year postoperatively, 82% of all eyes had a UDVA of 0.5 or better; in 88%, the spherical equivalent did not deviate more than 1.00 D from the attempted value. Three eyes were slightly undercorrected. After an initial overcorrection (−0.27 D) with subsequent regression, the refraction remained stable at +0.17 D from the fourth postoperative month (low hyperopia group: +0.14 D; high hyperopia group: +0.19 D after 1 year). After 1 year, the functional optical zone diminished by 32%; the reduction was more pronounced in eyes with higher hyperopia: −1.85 ± 1.09 mm (range: +0.5 to −3.4 mm) in the low hyperopia group (P< .0001) and −2.25 ± 1.24 mm (range: +1 to −3.9 mm) in the high hyperopia group (P< .0001). Preoperative spherical equivalent and preoperative corneal refractive power affected the postoperative size of the functional optical zone additively.

CONCLUSIONS:

An expected small functional optical zone in high hyperopia may not be regarded as a compelling exclusion criterion, but can induce possible side effects such as glare and halos.

[J Refract Surg.2018;34(7):476–481.]
Variation of Lenticule Thickness for SMILE in Low Myopia
Authors: Siedlecki Jakob , Luft Nikolaus , Keidel Leonie , Mayer Wolfgang J. , Kreutzer Thomas , Priglinger Siegfried G. , Archer Timothy J. , Reinstein Dan Z. , Dirisamer Martin
Published: July 2018

PURPOSE:

To report the impact of increasing minimum lenticule thickness on the safety and efficacy of small incision lenticule extraction (SMILE) in low myopia up to −3.50 diopters (D).

METHODS:

SMILE was performed in 76 eyes of 76 patients. Thirty-eight eyes of 38 patients with low myopia were prospectively operated on with a programmed minimum lenticule thickness of 15 to 30
μ
m (thicker lenticule group). Thirty-five eyes suitable for analysis were then retrospectively matched by spherical equivalent to 35 eyes operated on with a minimum standard setting of 10
μ
m (standard thickness group), as provided in the database of the SMILE Eyes Clinic Linz, Linz, Austria. Comparison of outcomes was performed with the Standard Graphs for Reporting Refractive Surgery and by analysis of higher order aberrations as provided by Scheimpflug imaging.

RESULTS:

Apart from lenticule thickness, there was no significant difference in preoperative baseline or treatment parameters between both groups. Mean minimum lenticule thickness differed significantly (standard thickness = 10 ± 0
μ
m; thicker lenticule = 20 ± 5
μ
m;
P
< .0001). This also translated into a significant difference in maximum lenticule thickness (standard thickness: 54 ± 11
μ
m; thicker lenticule: 62 ± 8
μ
m;
P
= .0002). Mean SEQ preoperatively was −2.25 ± 0.51 (standard thickness) and −2.24 ± 0.46 (thicker lenticule) D, respectively, and changed to −0.11 ± 0.50 (standard thickness) and +0.01 ± 0.36 (thicker lenticule) D postoperatively (
P
< .0001 for both comparisons). Uncorrected postoperative visual acuity was −0.08 ± 0.35 (standard thickness) versus −0.10 ± 0.09 (thicker lenticule) logMAR (
P
= .706). After SMILE, the thicker lenticule group showed better safety (1.20 vs 1.08;
P
= .025) and efficacy (1.14 vs 0.96;
P
= .011) indices, translating into more eyes within ±0.50 D from target (91% vs 77%) and with at least 0.0 logMAR visual acuity (97% vs 86%), and fewer eyes losing one (3% vs 17%) and two (0% vs 3%) lines.

CONCLUSIONS:

Increasing minimum lenticule border thickness seems to improve the safety and efficacy of SMILE in low myopia.

[
J Refract Surg.
2018;34(7):453–459.]
Pediatric Sepsis: A Primer for the Pediatrician
Authors: Conway Edward E.
Published: July 2018

Sepsis is the body's systemic response to infection and is a serious health care concern that affects neonatal, pediatric, and adult populations worldwide. Severe sepsis (sepsis that has progressed to cellular dysfunction and organ damage or evidence of hypoperfusion) and septic shock (sepsis with persistent hypotension despite adequate fluid resuscitation) are still associated with high mortality rates despite improvements in the management of infectious processes. The cellular processes that occur as a result of the inflammatory response in sepsis, including impaired perfusion and microcirculatory coagulation, can lead to organ system dysfunction. Early recognition of sepsis can help prompt treatment to improve patient care. Current pediatric guidelines emphasize early recognition, aggressive fluid resuscitation, and administration of antibiotics within the first hour for a better outcome. The practitioner needs to always be mindful of the possibility of sepsis when examining a patient with potential symptoms.

[
Pediatr Ann.
2018;47(7):e292–e299.]
Peanut Allergy: Changes in Dogma and Past, Present, and Future Directions
Authors: Boudreau-Romano Sarah , Qamar Nashmia
Published: July 2018

The prevalence of food allergy in the pediatric population, specifically to peanuts, has been rising. Accidental exposure to peanuts in a person who is allergic may have life-threatening consequences. Previous recommendations regarding peanut allergy included a delay in introduction of peanut to infants. However, more recent studies have provided sufficient contrary evidence supporting early introduction of peanuts for prevention of peanut allergy. Therefore, prompt evaluation by a specialist should be considered in infants at high risk of developing peanut allergy. Current treatment is strict avoidance of the allergen; however, future therapies are being sought, including oral immunotherapy, sublingual immunotherapy, and epicutaneous immunotherapy.

[
Pediatr Ann.
2018;47(7):e300–e304.]
Ciudades y villas en el reino de Portugal en la Baja Edad Media. Los factores político y jurisdiccional como criterios de jerarquización
Authors: Millán da Costa Adelaide
Published: July 2018

En los siglos XV e inicios del XVI, conjugadas con su definición o evolución jurisdiccional. Así, el factor político corresponde al enfoque de observación de una posible jerarquía de las comunidades urbanas –de acuerdo con ciertos criterios de delimitación del grupo y, en su interior, del rango asignado a cada una–; mientras que el elemento jurisdiccional es la variable en función de la cual vamos a profundizar en el tema. Se asume la perspectiva de sistematizar el conocimiento ya producido y de presentar nuevos datos, problemas e interpretaciones, estrategia que creemos pueda ser productiva en el contexto de este monográfico, pues hace posible la comparación con realidades de otros reinos.
Los mercaderes toledanos en los reinos hispánicos (1475-1520): una aproximación a partir del observatorio valenciano
Authors: Igual Luis David
Published: July 2018

Este artículo examina la presencia de los mercaderes toledanos en los reinos hispánicos en el periodo 1475-1520. Se basa esencialmente en el observatorio que ofrecen la ciudad de Valencia y sus fuentes, donde menudean las citas de actividades toledanas. Comienza con un balance contextual de las familias y las compañías que protagonizaron el comercio fuera de Toledo y, después, se centra en dos aspectos: los espacios donde actuaron los toledanos, a partir de una serie de letras de cambio testimoniadas en Valencia, y las relaciones entre los toledanos y otros grupos mercantiles gracias al estudio de casos y episodios concretos.
La puissance des institutions ecclésiastiques dans les critères de hiérarchisation des villes: le cas du haut clergé séculier en Catalogne (XVe siècle)
Authors: Conesa Soriano Julia
Published: July 2018

Les cathédrales sont étroitement associées aux cités où elles sont localisées. Sommets de la hiérarchie ecclésiastique du diocèse, évêques et chanoines sont aussi, en Catalogne, susceptibles de participer à la vie politique du Principat, en siégeant aux assemblées de la Diputació del General et aux Corts. De ce fait, les chapitres cathédraux disposent d’une forme de rayonnement politique à travers la carrière de leurs membres. Ils entretiennent entre eux des relations de coopération qui dessinent un véritable réseau de sièges épiscopaux catalans. La puissance des institutions religieuses séculières s’érige alors en critère de hiérarchisation des villes: un critère souvent négligé par l’historiographie, qui s’ajoute aux critères économiques, politiques ou démographiques.
Evaluación y reducción de la vulnerabilidad: un enfoque indispensable para la gestion territorial
Authors: Gray de Cerdán Nelly Amalia
Published: July 2018

No disponible.
Evolución reciente de la población de la mancha occidental
Authors: Romero Calcerrada Raúl , Martínez Vega Javier
Published: July 2018

Evolución reciente de la población de la Mancha Occidental. La Mancha Occidental ha mantenido tendencias similares a la nacional hasta 1960. A partir de este momento se han iniciado tendencias divergentes. La región manifesta los primeros síntomas del proceso despoblador sufrido en otras regiones españolas. En este artículo examinamos algunas de las características principales de la población y su evolución reciente.

[fr] Evolution récente de la population de la Mancha Occidental. La Mancha a presenté certaines tendances démographiques semblables a la nationale jusque 1960. Depuis lors, diverses tendances ont commencé. La région présente les premiers symptômes d'un procédé de dépopulation souffert dans d'autres regions espagnoles. Au cours de cet article, nous examinerons quelques principales caractéristiques de la population et sa récente evolution.
Control del dominio util y salvaguarda del directo en la enfiteusis señorial valenciana: Los Cabreves
Authors: Gil Olcina Antonio
Published: July 2018

Control del dominio útil y salvaguarda del directo en la enfiteusis señorial valenciana: los cabreves. A finales del Antiguo Régimen los señoríos cubrían las tres cuartas partes del territorio entonces valenciano. El elemento solariego quedaba, en extensión, a la zaga del jurisdiccional, y aun más distante el total de tierras establecidas, ya que existía en aquéllos la distinción básica entre/raneas y pechadas. Sin embargo, esa misma contraposición habla de la importancia y alta frecuencia del censo enfitéutico, forma jurídica de explotación ampliamente dominante en el labrantío valenciano señorial. Fuera de algún caso singular, el establiment señorial era perpetuo e irredimible, con grave riesgo de daño o, incluso, extinción, si las transmisiones del dominio útil no eran objeto de control y seguimiento mediante la cabrevación, acto de reconocimiento formal por el enfiteuta de la sujeción al dominio directo de los bienes censidos, detalladamente descritos para prevenir falseamientos u ocultaciones. De ahí el extraordinario interés de los libros resultantes, o cabreves, para el estudio de la propiedad agraria en dicha época.

[fr] Le controle du «dominio útil» et la sauvegarde du «dominio directo» en la enfiteusis valencianne: les cabreves. A la fin de l'Ancien Régime, les domaines seigneuriaux recouvraient les trois quarts du territoire alors valencien. L'élément noble restait, en étendue, en arrière des terres jiuidictionnelles, et encore plus au-delà total des terres établies puisqu'il existait déjà dans celles-ci la distinction basique entre franco et emprunts. Cependant ce même contraste met en relief l'importance et la haute Fréquence de l'emphytéose, une forme juridique d'exploitation très dominante dans le terrain cultivable valencien de la seigneurie. En dehors de cas particuliers, l'établissement seigneurial étail perpétuel et irrachetable, avec un grand risque de dommages ou même l'extinction, si la transmission du domaine utile n'était pas objet de contóle et de suivi au travers de la «cabrevación», un acte de reconnaissance formel par l'emphytéote de la possession directe des biens recensés, décrits de manière très détaillée pour prévenir des faux ou des dissimulations. De là l'extraordinaire intérêt des livres se rapportant à ce thème ou «cabreves» pour l'étude de la propriété agraire pendant cette période.
Differential response to thermal stress of shallow and deep dwelling colonies of Mediterranean red coral Corallium rubrum (L., 1758)
Authors: Cau Alessandro , Bramanti Lorenzo , Cannas Rita , Moccia Davide , Padedda Bachisio Mario , Porcu Cristina , Sacco Flavio , Follesa Maria Cristina
Published: July 2018

Over the last decades, Global Climate Change (GCC) caused increase in seawater temperature, which have shown to be detrimental for Mediterranean red coral populations (Corallium rubrum). Recent researches described how responses to temperature increase can differ depending on location and previous stress history; however, investigations throughout a wide bathymetric range on the thermo-tolerance of specimens sharing the same thermally stable environment are still lacking. In order to test if C. rubrum colonies dwelling below the thermocline threshold have an intrinsic different sensitivity to thermal stress, corals at different depths (32 m and 100 m) were collected, kept in aquaria, and their responses to stress analysed in lab experiments. Oxygen consumption and necrosis dynamics were estimated at different temperature regimes (14°C; 21°C and 25°C). Shallow water samples showed a significant lower oxygen consumption and coenosarc necrosis at all temperatures, revealing a potential higher survival rate in stress conditions. On the other hand, significant differences in oxygen consumption between shallow and deep dwelling samples were detected in the 21°C treatment, and after 5 days in the necrosis experiment, underlining, however, a good capacity of tolerance to temperature increase also in deep colonies. Implications of the obtained results for conservation of Mediterranean red corals are illustrated and discussed.
Using benthic diatoms for estimating lake ecological quality: Comparing different taxonomic resolution
Authors: Marchetto Aldo , Sforzi Tommaso
Published: July 2018

The Water Framework Directive asks to all Member States of the European Union to classify the ecological quality of significant waterbodies on the basis of the biological communities they host. One of the biological communities that must be used for the ecological quality assessment is the periphytic community, mainly composed by diatoms. In Italy, diatom-based lake quality assessment is performed using a specific index, named EPI-L, based on the method of weighted averages. For each species, a trophic score and an indicator weight were calculated.  In order to reduce the complexity of the lake quality assessment, we calibrated a variant of EPI-L, using diatoms genera instead of species, and we compared the performance of these two variants in terms of correlation with the nutrient level and of different classification of each lake.
A call to improve delirium care: the Italian experience
Authors: Paolillo Ciro , Ricevuti Giovanni
Published: July 2018

Not available
Intranasal ketorolac and opioid in treatment of acute renal colic
Authors: Etteri Massimiliano , Maj Marta , Maino Carlo , Valli Riccardo
Published: July 2018

The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non-painful, non-invasive route of administration using intranasal ketorolac plus fentanyl versus IV standard treatment with non steroidal anti-inflammatory drug plus opioid for the relief of pain in renal colic presenting patients to an Emergency Department (ED). We conducted a prospective nonblinded clinical trial. A sample of 82 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous ketorolac plus fentanyl or intranasal ketorolac plus fentanyl. Pain score was rated by using a 10 cm visual analogue scale at 0, 30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Eighty-two patients were enrolled. The first forty-one patients received intranasal ketorolac plus fentanyl and the second forty-one received intravenous ketorolac plus fentanyl. There were not statistically significant differences in reduction of pain between the two groups at 30 and 60 minutes (P-value at 30=0,225; P-value at 60=0,312) although the trend was in favour of IV group. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Intranasal ketorolac and fentanyl are equivalent in analgesic effect to intravenous ketorolac and fentanyl treatment for ED patients with acute renal colic and the intranasal treatment can be considered a valid alternative to the standard intravenous treatment.
Choosing wisely in emergency medicine
Authors: Coen Daniele
Published: July 2018

Not available.
Dizziness and prevention of falls in the elderly
Authors: Casani Augusto P. , Navari Elena
Published: July 2018

Disequilibrium is one of the most common complaints that older adults bring to their physician and falling is a frequent complication; because of the increasing number of elderly patients in western society the problem grows. The increasing susceptibility to falling can be consequence of age-related physiological changes and of a higher prevalence of comorbidities causing dizziness, vertigo and imbalance; these symptoms can worse the already poor balance of old adults increasing the risk of falling. Among the major reasons of vertigo and dizziness, central vertigo and orthostatic vertigo are very common; also vestibular disorders have a great role and are currently thought to account for 48% of dizziness reported by older adults. An early identification of the treatable condition underlying dizziness in elderly would surely ameliorate the outcome of these patients.
Advantages and disadvantages of direct oral anticoagulants in older patients
Authors: Cherubini Antonio , Carrieri Barbara , Marinelli Paolo
Published: July 2018

Atrial fibrillation (AF) and venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, are conditions that increase with age. Anticoagulant therapy is strongly recommended both in patients with AF for the prevention of cardioembolic stroke, and for treatment of VTE and prevention of recurrent VTE. Until recently, vitamin K antagonists (VKAs) were the only oral drugs for long-term anticoagulation. In the past decade, four direct oral anticoagulants (DOACs) were approved: a direct thrombin inhibitor (dabigatran) and three factor Xa inhibitors (apixaban, rivaroxaban, edoxaban). Despite increasing evidence demonstrating the efficacy and safety of DOACs in older patients, there are still gray areas where the use of VKAs might be valuable.
Synchronous cytomegalovirus infection in a newly diagnosed ulcerative colitis patient
Authors: Chieng Jin Yu , Sugumaran Yasotha , Adzman Sellymiah , Yan Pan
Published: July 2018

A 61-year-old Punjabi female patient presented with six months history of mild abdominal discomfort with bloody diarrhea. She did not have underlying chronic medical illness; she neither took steroid nor immunosuppressant. She was found anemic, thrombocytosis, and elevated C-reactive protein. Colonoscopy showed moderate left sided colitis, with histopathology evidence of ulcerative colitis (UC) with cytomegalovirus (CMV) infection. Her serum anti-CMV IgM antibody was detected. She was treated with intravenous ganciclovir, together with 5-ASA and tapering dose of steroid. Anemia was corrected. Subsequent clinic reviews and follow up endoscopies showed dramatically improvement. CMV colitis should be considered for the patients presenting with moderate to severe UC. Early prescription of antiviral would be beneficial in the treatment of flare of UC.
Assessment of serum level cholinesterase as a biomarker of liver cirrhosis in Egyptian cirrhotic patients
Authors: Amin Mona A. , El-Shahat Marwa E. , El-Garem Nouman , Soliman Ahmed , Obaia Eman
Published: July 2018

Serum cholinesterase levels are closely correlated with the severity of liver disease. The aim of the paper was to assess the value of serum cholinesterase in evaluating liver reserve function in cirrhotic patients. 90 patients with liver cirrhosis and thirty healthy control group were included. Liver cirrhosis patients were classified according to child score into three equal groups: Child A liver cirrhosis, Child B liver cirrhosis and Child C liver cirrhosis. Patients were subjected to clinical evaluation, laboratory analysis, abdominal U/S. Measuring serum cholinesterase, and Calculation of both Child and model of end stage liver disease (MELD) scores. The level of serum cholinesterase was higher in control group than the three groups of liver cirrhosis with median (IQR) 17,410 (12,111-21,774), 7528 (5200-9856), 6021 (4500-7542), 3828.5 (1541-6060), respectively P<0.001). And the level of serum cholinesterase was higher in Child A more than Child B and Child C and the level of serum cholinesterase was higher in Child B more than Child C with very strong negative correlation between serum Cholinesterase level and Child score (r=-0.9, P<0.001). Also strong negative correlation between serum Cholinesterase level and MELD score (r=- 0.85, P=0.001), and positive correlation with prothrombin concentration (r=0.554, P=0.009), and serum albumin levels (r=0.582, P=0.0002). Serum cholinesterase is a good biomarker of cirrhosis. Since it distinguishes decompensated from compensated cirrhosis well, low levels in cirrhosis may serve as a useful prognostic marker of advanced liver disease.
Interesting case of spontaneously resolved dysphagia in a young female due to complicated esophageal tuberculosis
Authors: Choksi Dhaval , Chaubal Alisha , Patel Ruchir , Rathi Chetan , Ingle Meghraj , Sawant Prabha
Published: July 2018

Mycobacterium tuberculosis can affect any organ of the body. Gastrointestinal tubercular involvement is fairly common. Esophageal tuberculosis though is uncommon. Esophageal tuberculosis accounts for only 0.3% of gastrointestinal tuberculosis. It presents with dysphagia, retrosternal pain, cough or constitutional symptoms. Complications like hemorrhage from the ulcer and development of fistulas like esophagomediastinal fistula is extremely uncommon. We report a case of a 27 years old female who presented with retrosternal pain, dysphagia and hematemesis. The patient had esophageal ulcer secondary to erosion of the esophagus by the subcarinal lymph nodes. Imaging was suggestive of esophagomediastinal fistula. Esophageal ulcer biopsy showed chronic tubercular infection. Culture from the esophageal biopsy confirmed the presence of tubercular bacilli. Patient responded to anti-tubercular therapy. Spontaneous dysphagia resolution prior to starting therapy was likely due to the rupture of the lymph node into the esophagus, which was compressing it initially. Esophageal tuberculosis presenting with hematemesis and fistula is extremely uncommon.
Prospective study to evaluate the number and the location of biopsies in rapid urease test for diagnosis of Helicobacter Pylori
Authors: Abou Rached Antoine , Saba Jowana , Yaghi Cesar , Sanyour Joyce , El Hajjar Ahmad , Abou Kheir Selim
Published: July 2018

Helicobacter pylori (H. pylori) can cause a wide variety of illnesses such as peptic ulcer disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. The diagnosis and eradication of H. pylori are crucial. The diagnosis of H. pylori is usually based on the rapid urease test (RUT) and gastric antral biopsy for histology. The aim of this study is to evaluate the numbers of needed biopsies and their location (antrum/fundus) to obtain optimal result for the diagnosis of H. pylori. Three hundred fifty consecutive patients were recruited, 210 fulfill the inclusion criteria and had nine gastric biopsies for the detection of H. pylori infection: two antral for the first RUT (RUT1), one antral and one fundic for the second (RUT2), one antral for the third (RUT3) and two antral with two fundic for histology (HES, Giemsa, PAS). The reading of the 3 types of RUT was performed at 1 hour, 3 hours and 24 hours and biopsies were read by two experienced pathologists not informed about the result of RUT. Results of RUT were considered positive if H. pylori was found on histology of at least one biopsy. The RUT1 at 1h, 3h and 24h has a sensitivity of 72%, 82% and 89% and a specificity of 100%, 99% and 87% respectively. The positive predictive value (PPV) was 100%, 99% and 85% respectively and the negative predictive value (NPV) of 81%, 87% and 90%. The RUT2 at 1h, 3h and 24h, respectively, had a sensitivity of 86%, 87% and 91% and a specificity of 99%, 97% and 90%. The PPV was 99%, 96% and 88% and NPV of 89%, 90%, 94%. The RUT3 at 1h, 3h and 24h, respectively, had a sensitivity of 70%, 74% and 84% and a specificity of 99%, 99% and 94%. The PPV was 99%, 99% and 92% and NPV of 79%, 81% and 87%. The best sensitivity and specificity were obtained for RUT1 read at 3h, for RUT2 read 1h and 3h, and the RUT3 read at 24h.This study demonstrates that the best sensitivity and specificity of rapid test for urease is obtained when fundic plus antral biopsy specimens are used with a reading time at 3 hours.
Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to HCV-induced liver cirrhosis
Authors: Hassanien Moataz , El-Ghannam Maged , El-Talkawy Mohamed Darwish , Abdelrahman Yosry , El Attar Gamal , Abu Taleb Hoda
Published: July 2018

Background: this study was designed to validate and to compare accuracy of the prognostic scores; mainly Child Turcotte Pugh (CTP), creatinine-modified Child Turcotte Pugh (CTP-Cr), MELD, albumin bilirubin score (ALBI), and AIMS65, for the predicting clinical outcomes in cirrhotic Egyptian patients presenting with acute variceal bleeding (AVB). Methods: Retrospective single center study involving 725 patients presenting with AVB due to liver cirrhosis and HCV infection either alone or mixed with HBV infection. In hospital mortality prognostic scores were calculated; mainly CTP, modified CTP-Cr, MELD, ALBI, AIMS65. The endpoint is either patient improvement or death. Results: 725 patients were included over 1-year period. 547 (75%) survived and 178 (25%) died. Patients presented with hematemesis (515/71%), melena (120/16.5%) or hematemesis and melena (90/12.5%). Those with hematemesis for the first time were 241 (33%) and recurrent attacks were 484 (66.8%). The non-survivors had significantly more incidence of shock on presentation, more blood transfused units, history of NSAIDS intake, more ICU admission days and were more likely to be Childs C. Child, modified CTP-Cr, MELD, ALBI and ALMS65 scoring systems showed significant difference between survivors and non-survivors. Conclusion: Liver specific scores (Child, MELD) and gastrointestinal bleeding scoring systems (ALBI, AIMS65) are useful in predicting clinical outcomes of AVB in cirrhotic patients. CTP-Cr score had the highest prognostic capability of in hospital mortality. Presence of active bleeding at time of endoscopy, more complications, old age, shock and higher CPT-Cr score are additional independent predictors of in hospital mortality.
Factors associated with Schistosomiasis control measures in Mwaluphamba Location, Kwale County, Kenya
Authors: Juma Ahmad , Ng'etich Arthur K.S. , Naanyu Violet , Mwangi Ann , Kirinyet Ruth C.
Published: July 2018

The study set out to investigate the factors associated with Schistosomiasis control measures in Mwaluphamba location of Kwale County. A descriptive cross-sectional study design was used. Mwaluphamba location was purposely sampled and simple random sampling was used to select 338 respondents in villages in each location. Structured questionnaires were used to collect data. A majority of the respondents were males (60%), Muslim affiliated (85%), aged 41 years and over (39%) and most (56%) of them had achieved at least a primary level of education. Results showed that 40% of the respondents were knowledgeable of health education as a service offered by health care providers to control Schistosomiasis. Male respondents and those of Islamic affiliation were five times (OR: 4.686) and three times (OR: 3.13) more likely to seek health education in comparison to their female counterparts respectively. Respondents’ who had achieved at least a primary level of education and those that earned an income of above one thousand shillings significantly utilized mass treatment. Respondents with income levels below a thousand shillings were less likely to seek both health education and mass treatment compared to those with a higher income. In conclusion, there was a statistically significant association between respondents’ socio-demographic factors and control measures for the infection. There is need for equal implementation of all control measures to overcome the socio-demographic barriers and to ensure effective control of Schistosomiasis infection.
Assessment of nutritional status and its associated factors among people affected by human immune deficiency virus on antiretroviral therapy: a cross sectional study in Siltie zone, south Ethiopia
Authors: Saliya Mewuba Shamil , Azale Telake , Alamirew Atinkut , Tesfaye Dawit Jember
Published: July 2018

Ethiopia is among the countries most affected by malnutrition and nutrition-related complications remain a challenging issue for Human Immunodeficiency Virus (HIV)- infected patients and those involved in their care. The aim of this study was to assess nutritional status among HIV positive adults in South Ethiopia and assess risk factors for malnutrition in this population. Institution based cross sectional study was conducted among 428 HIV positive adults who are taking ART at 12 health centers, Silte zone, Ethiopia. Convenience sampling technique was used to select the study participants. Structured questionnaire and anthropometric measurements were used to collect data. Data were analyzed using SPSS version 20.0 software. Bivariate and multivariate analyses were used to identify predictors of malnutrition. P-value less than 0.05 were used as cut of point to declare statistical significance. Prevalence of chronic energy deficiency was 24.1%. Food insecurity [AOR= 0.35, 95% CI (0.21, 0.62)], feeding ≤ 2 meals/day [AOR= 0.29, 95% CI (0.29, 0.13)], ambulatory functional status [AOR= 3.4, 95% CI (1.67, 6.98)] and absence of dietary counseling [AOR= 1.7, 95% CI (1.05, 2.78)] were found to be independent predictors of chronic energy deficiency among HIV positive adults. Prevalence of malnutrition is high among HIV infected adults who are on ART in the study area. Regular nutritional assessment of the patients and dietary counseling should be integrated with routine care for HIV/AIDS patients. HIV/AIDS prevention and control programs need to involve nutritionists or trained health care provider to integrate nutritional care services.
Increased waist circumference as an independent predictor of hypercholesterolemia in community-dwelling older people
Authors: Araujo Claudineia Matos de , Fernandes Marcos Henrique , Carneiro José Ailton Oliveira , Coqueiro Raildo Da Silva , Pereira Rafael
Published: July 2018

Hypercholesterolemia is a worldwide public health problem, contributing to cerebrovascular and ischemic heart diseases as one of the major cardiovascular risk factors, and associated with approximately 4.4 million deaths each year worldwide. This study aimed to evaluate the association and predictive value of increased waist circumference (WC) to identify hypercholesterolemia in community-dwelling elderly people. In a cross-sectional, homebased epidemiological survey, 296 community-dwelling old adults consented to capillary blood collection and anthropometric evaluation. Total cholesterol was quantified, and the population was stratified as normal or high (≥200 mg/dL). WC was used to stratify the population into normal or elevated values (men: ≥90 cm; women: ≥80 cm). The association was investigated using logistic regression. Increased WC was associated with a greater probability of hypercholesterolemia (OR=2.82, 95%CI 1.68 to 4.74). Thus, the widely used WC cutoff was demonstrated to be significantly associated with hypercholesterolemia in community-dwelling elderly people and could serve as a useful screening tool for hypercholesterolemia in older adults.
Face and content validity and acceptability of the Swedish ICECAP-O capability measure: cognitive interviews with 70-year-old persons
Authors: Gustafsson Susanne , Hörder Helena , Ottenvall Hammar Isabelle , Skoog Ingmar
Published: July 2018

This study is part of a project that aims to culturally adapt the Investigating Choice Experiments for the Preferences of Older People-CAPability Index (ICECAP-O) for use in research and health and social care in Sweden. The objective was to evaluate face and content validity and acceptability. Eighteen 70-year-old community-dwelling persons participated in cognitive interviews. A standardized classification scheme was used to quantify any identified response problems, and a thematic analysis was applied to capture participants’ perceptions of included attributes and experiences of completing the measure. The results show that three participants (18%) had problems completing ICECAP-O, and that judged problems occurred for five (6 %) of participants responses in the standardized classification scheme. Most participants perceived the attributes as understandable even though the meaning of Control brought some uncertainty. ICECAP-O seems to measure what it is supposed to measure, quality of life (QoL) with a capability approach, and acceptability is satisfactory. ICECAP-O has potential for becoming a valuable addition to the supply of QoL measures in research and health and social care in Sweden. However, we recommend further research on more diverse groups of older persons.
Wound Botulism Caused by Clostridium subterminale after a Heroin Injection
Authors: Cook Paris A. , Mishler Aimee , Quan Dan , Parrish-Garcia Ashley
Published: July 2018

Botulism is caused by toxin production from many species of Clostridium, most commonly Clostridium botulinum as well as C. baratii and C. butyricum. Development of wound botulism is associated with injection drug users but has also been described in traumatic injuries with exposure to soil. A patient presented to the emergency department with a complaint of descending, progressive weakness. He recently reported skin popping with heroin injections. Heptavalent botulinum antitoxin was obtained from the [Center for Disease Control and Prevention (CDC)]. On hospital day seven, the anaerobic wound cultures resulted with growth of Clostridium subterminale.
Endothelial dysfunction and reduced heart rate variability in patients with metabolic syndrome
Authors: Smirnova Elena Nikolaevna , Loran Evgeniya Alexandrovna , Shulkina Sofia Grigorievna , Podtaev Sergey Yurievich , Trushin Maxim Victorovich
Published: July 2018

According to experts of the World Health Organization (WHO), metabolic syndrome (MS) can be considered as pandemy of the XXI century, because its prevalence among the population of developed countries is about 25-35%. In this study with the purpose of complex investigation of the autonomic nervous system and endothelial function we included 66 patients with MS between the ages of 25 and 61 (46.9±9.9 years). A comparison group of apparently healthy individuals (16 individuals, average age of 45.3±2.3 years; P>0.05) was studied. To evaluate the response of microvascular tone, we used the method of wavelet analysis of skin temperature oscillations during cooling of the limb. All patients underwent the study of heart rate variability. The levels of insulin, endothelin-1, and vascular endothelial growth factor were determined using enzyme immunoassay. Patients with MS had significant differences in all metabolic parameters. Our study showed that in the group of MS there is a decrease of the variability of heart rhythm compared with the healthy group. Conducting cold test revealed signs of endothelial dysfunction in the MS group, which was manifested by the decrease of the index of vasodilation in the endothelial and neurogenic frequency range. In the study group we determined the increase in biochemical markers of endothelial dysfunction, which correlated with parameters of vasodilation. Also, the presence of endothelial dysfunction significantly correlated with signs of reduction of the variability of the heart rhythm.
Sex differences in adverse drug reaction and liver disease
Authors: Para Ombretta , Crispino Pietro , Barone Nunzia , Macis Sara , Airasca Laura , Gnerre Paola , Politi Cecilia
Published: July 2018

Adverse drug reactions represent a significant public health problem. A share of no small adverse reaction is particularly serious and can even lead to patient’s death. Furthermore, hepatitis induced by serious drug reactions is a rare event but potentially fatal. Finally, we know that epidemiological studies have highlighted male gender as an independent predictor of fibrosis progression towards cirrhosis in hepatitis B and C-virus, as well as non-alcoholic steatohepatitis. The importance of considering the differences between the male and female sex in clinical decision-making is crucial. The physiopathology of liver disease is different in the two genres, but these differences are not yet fully known and several potential mechanisms have been identified.
Bedside lung ultrasound in the diagnosis of pneumonia in very old patients
Authors: Cipollini Francesco , Mirauta Cristina Mirela
Published: July 2018

In several studies mainly undertaken in emergency departments, lung ultrasound (LUS) has a sensitivity similar and/or superior to the one of chest X-ray (CXR) in the diagnosis of pneumonia. The aim was to evaluate if LUS may be applied as first step imaging examination in the diagnosis of pneumonia also in medical/geriatric setting other than in emergency departments. We reviewed the clinical files of 128 very old patients (61 M and 67 F, age ranging from 78 to 94 yrs, mean 84.8 year) discharged in a period of 20 months with diagnosis of pneumonia in which both CXR and LUS were performed. The majority of patients had co-morbidities and/or motor disability and/or cognitive impairment. The sensitivity of LUS resulted in 82.03% (105/128) and those of CXR 75.78% (97/128): the difference was statistically not significant. Only the presence of pleural effusion resulted significantly higher with LUS when compared with the one observed with CXR (55.46% vs 37.5%, P=0.0039). The superiority of LUS with respect to CXR, although statistically not significant, suggests the use of ultrasound as a first step examination not only in emergency departments or in pediatric setting but also in very old patients with symptoms suspicious of pneumonia. The use of LUS in frail old patients with multiple co-morbidities can be easily carried out at the bedside and provides diagnostic information avoiding delaying the appropriate antimicrobial treatment.