Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of ...traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed.
Highlights • to evaluate long-term effects of HCV eradication in HIV-HCV co-infected patients. • SVR (sustained virological response) and non-SVR groups compared. • decreasing FIB-4 and APRI trends ...observed after SVR (median 8 year-follow-up). • no difference in absolute or percentage CD4 slope and CD4/CD8 ratio trend over time. • higher mortality in non-SVR group, with no difference in AIDS and non-AIDS events
COPD is among the major causes of death, and it is associated with several comorbid conditions. Chronic kidney disease (CKD) is frequently diagnosed in older people living in Western societies and ...could impact COPD patients' mortality. We evaluated the relationship between burden of comorbidities, CKD, and mortality in a population-based cohort of patients discharged with a diagnosis of COPD.
A longitudinal cohort study was conducted evaluating 27,272 COPD patients. Recruitment of COPD subjects and identification of CKD and other comorbidities summarized by the Charlson comorbidity index (CCI) were based on claims data coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Severity of COPD was classified by hospital diagnosis or exemption from medical charges due to respiratory failure or previous hospitalizations for COPD. The impact of comorbidities on survival was assessed by Cox regression.
Less than 40% of patients were still alive at the end of a median follow-up of 37 months (17 months for patients who died and 56 months for those alive at the end of follow-up). After adjustment for age, gender, and severity score of COPD, CKD (hazard ratio =1.36, 95% confidence interval 1.30-1.42) independently from comorbidities summarized by the CCI was a significant risk factor for mortality.
In spite of limitations due to the use of claims data, long-term survival of COPD patients was heavily affected by the presence of CKD and other comorbidities.
Several systems have been proposed in recent years for Advanced Traveler Information Systems (ATIS), ranging from personal (mobile application, on-board) navigation to VMS (Variable Message Signs). ...All these applications are essentially aimed at assisting the travelers in their travel choices by means of technologically dispatched information about traffic network structure and traffic conditions. It is well known that in ATIS applications one of the key issues to be addressed concerns the accuracy of the dispatched information, here intended as the ability of the system in supplying information that can be verified by the travelers to be correct (affected by a small error). This paper aims at proposing some analytical models able to simulate the effects of the (in)accuracy on travelers' compliance with information.
Resumen Afortunadamente, las arritmias malignas en un embarazo de curso normal son raras y la mayoría de las quejas por palpitaciones se deben a arritmias benignas. Dentro de ellas las taquicardias ...supraventriculares paroxísticas (TSP) se describen en la literatura con relativa frecuencia y pueden ocurrir sólo, o incluso exacerbarse, durante el embarazo, debido a un efecto pro-arritmogénico de la gestación. Así en pacientes gestantes la carga hemodinámica y los cambios del tono autonómico facilitan la aparición de arritmias, más frecuentemente en mujeres con limitada reserva cardíaca y pueden llegar a comprometer la supervivencia del feto y de la madre debido a las consecuencias hemodinámicas o los efectos adversos de los tratamientos farmacológicos y no farmacológicos. Presentamos el caso de una gestante a término que durante el trabajo de parto, posterior a la administración de analgesia epidural con ropivacaína y fentanilo, sufre un cuadro de hipotensión materna y bradicardia materna/fetal mantenida que requiere ser medicada con efedrina y atropina intravenosa. Inmediatamente presenta palpitaciones y dolor torácico sostenido, diagnosticándosele TSP que cede con la administración de adenosina intravenosa, no repitiendo nuevos episodios durante el trabajo de parto ni puerperio. En nuestro caso la arritmia ocurrió como efecto adverso de la efedrina y administradas para recuperar el cuadro de hipotensión causada por la analgesia epidural.
This paper reviews the feasibility in function and design of an alternative to the jetty-hardened coastal inlet to develop tidal exchange between the ocean and an estuary. The proposed alternative is ...a subseabed (buried) tidal siphon. The proposed siphon will be best suited for inlets where navigation is not required and a tidal lag can be tolerated. The four main objectives of this paper are: (1) to present the immediate reasons for coastal inlet closures; (2) to identify the tidal exchange best suited for the tidal siphon; (3) to determine the shallowest functional depth of the inlet/outfall; and (4) to evaluate the hydraulic performance of the designed tidal siphon. It was determined the best tidal exchange for the tidal siphon is in the lower one-third of the stable tidal prism, the stability prism, and the reasonable depth for the offshore inlet/outfall structure is the depth of closure. Based on an analytical evaluation, the tidal siphon as designed preformed as required. Collection of field data included offshore wave height and length, turbidity as a function of elevation from the oceanbed, tidal range in the lagoon and tidal lag as a function of offshore tide, and inlet velocity as a function of tidal phase. The estuary used in this study is a recently constructed tidal inlet at the Batiquitos Lagoon in Carlsbad, Calif.
The spread of COVID-19 poses an unprecedented challenge to care delivery in post-disaster and conflict situations. In Mozambique, the 2019 cyclone Idai and the violence by Non-State-Armed-Groups ...devastated the province of Sofala and Cabo Delgado respectively and led to the displacement of thousands of people living in poor and overcrowded conditions. The pandemic has further aggravated the situation. Doctors with Africa CUAMM (University college for aspiring missionary doctors) implemented surveillance activities in these regions between October 2020 and September 2021. The aim of this study is to give an overview of the prevalence of malaria, malnutrition, COVID-19 related symptoms and access to HIV testing.
Data were collected in targeted internally displaced people (IDP) sites in Sofala and Cabo Delgado province between 31st January and 25th September 2021. The tool used enabled to assess COVID-19 symptoms, risk of HIV infection, malaria cases and malnutrition in children under five.
The project reached 93 503 people. During the study period, 13.6% people reported at least one symptom suggestive of COVID-19 infection. Malaria Rapid Diagnostic Tests (RDT) were administered to 86% of the recruited people (n = ?), with a positive diagnosis in the 4.5% of them (n = ?). Among the recruited Internally Displaced Persons (IDP), 23.1% were considered eligible for HIV screening, but only 1.4% were referred for testing. Acute malnutrition was found in 6.3% of children screened and, among these, a higher prevalence of concurrent COVID-19 symptoms was reported.
Our study highlights the importance of mass clinical screening for COVID-19 infection in this target population to enact prevention behavior, although this may not be enough, due to the pivotal role played by asymptomatic transmissions. Considering the overlap of the symptoms of COVID-19 and malaria, a combined diagnostic algorithm is urgently needed to avoid underdiagnosing malaria. Moreover, the high prevalence of respiratory symptoms in malnourished children confirmed the known correlation between malnutrition and respiratory infection. Finally, access to HIV screening needs to be implemented, given the high prevalence of people with HIV risk factors to avoid diagnostic delay.
Population-specific needs make necessary to develop new screening methods that respond to the specific characteristics of the target population.
Background Nursing workload is largely studied but poorly explored under physical, mental, and emotional dimensions. Currently, only a limited number of variables have been linked to nursing workload ...and work contexts. Purpose The study aimed to investigate whether it is feasible to identify variables that consistently correlate with nursing workload and others that are specific to the context. Methods We employed a descriptive correlational analysis and a cross-sectional design. Data were collected through a survey distributed to registered nurses working across Italy, at the conclusion of randomly assigned morning or afternoon shifts. Results We received 456 surveys from 195 shifts, collected from nurses in four public and two private hospitals. Commonly associated variables with nursing workload dimensions included patient complexity of care, admission/discharge or transfer, informing patients/relatives, contacting physicians, and unscheduled activities. Variables categorized as setting-specific were patient isolation and specialties, nurse-to-patient ratio, adequacy of staff in the shift, peer collaboration, healthcare documentation, educating others, and medical urgency. Conclusions In summary, certain variables consistently correlate with nursing workload across settings, while others are specific to the context of care. It is imperative for nurses and nurse managers to measure the nursing workload in various dimensions, enabling the prompt implementation of improvement actions.
PDF
