...because mucormycosis reporting is not required in Honduras, it is difficult to determine whether the cases described in this report represent an increase over the country’s baseline mucormycosis ...incidence, which is unknown. Prevention of COVID-19 through vaccination, maintenance of glycemic control in patients with diabetes, and judicious use of steroids†††,§§§ for COVID-19 treatment might help decrease the risk for mucormycosis associated with COVID-19 (2). Because of these reported cases, SHH and partners are conducting clinician outreach and education to improve prevention, diagnosis, and treatment of mucormycosis. Lancet Infect Dis 2019;19:e405–21. https://doi.org/10.1016/S1473-3099(19)30312-3 PMID:31699664 Homer Mejía-Santos1,*; Sandra Montoya2,*; Rafael Chacón-Fuentes3; Emily Zielinski-Gutierrez3; Beatriz Lopez3; Mariangeli F. Ning3; Nasim Farach3; Fany García-Coto4; David S. Rodríguez-Araujo4; Karla Rosales-Pavón1; Gustavo Urbina1; Ana Carolina Rivera1; Rodolfo Peña5; Amy Tovar5; Mitzi Castro Paz6; Roque Lopez6; Fabian Pardo-Cruz7; Carol Mendez7; Angel Flores7; Mirna Varela7; Tom Chiller8; Brendan R. Jackson8; Alexander Jordan8; Meghan Lyman8; Mitsuru Toda8; Diego H. Caceres8,9,†; Jeremy A. W. Gold8,† 1Health Surveillance Unit, Secretary of Health of Honduras, Tegucigalpa, Honduras; 2Department of Mycology, Hospital Escuela, Tegucigalpa, Honduras; 3Central America Regional Office, CDC; 4Council of Ministers of Health of Central America and the Dominican Republic, Tegucigalpa, Honduras; 5Honduras Country Office, Pan American Health Organization, Tegucigalpa, Honduras; 6National Public Health Laboratory, Secretary of Health of Honduras, Tegucigalpa, Honduras; 7Honduras Field Epidemiology Training Program, Tegucigalpa, Honduras; 8Mycotic Diseases Branch, CDC; 9Department of Medical Microbiology, Radboud University Medical Center and Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
La creación del Museo de la Educación de La Universidad de La Laguna (MEDULL) es la respuesta a la inquietud por recuperar, conservar y dar a conocer el patrimonio histórico educativo de Canarias. ...El MEDULL cuenta desde sus inicios con el apoyo del Vicerrectorado de Relaciones Universidad y Sociedad, que lo incorpora dentro de su organigrama como Aula Cultural, así como de la Dirección General de Patrimonio Histórico del Gobierno de Canarias. Su exposición permanente está ubicada en la Facultad de Educación. La exposición se organiza en torno a dos aulas (una de los años 40-50 y otra de los años 70) y permite a los visitantes conocer no sólo los materiales de enseñanza utilizados en esas décadas, sino también diferentes aspectos de la vida del alumnado y de los docentes. Las actividades del Museo forman parte de la formación del alumnado de la Facultad de Educación, y son el objeto de proyectos de trabajo del alumnado de Educación Primaria. y Secundaria que nos visita.
Objetivo: conhecer a percepção de enfermeiros-líderes sobre o gerenciamento de conflitos no ambiente hospitalar. Método: pesquisa qualitativa e descritiva, em que participaram dez enfermeiros que ...trabalhavam em um hospital da região sul do Brasil. A coleta de dados foi realizada nos meses de outubro a novembro de 2014, por meio de entrevistas semiestruturadas e analisadas conforme Proposta Operativa. Resultados: os conflitos de relacionamento foram os mais relatados pelos participantes, sendo causados pela falta de continuidade das atividades desempenhadas pela equipe de enfermagem e excesso de trabalho. O diálogo e a realização de reuniões foram as principais estratégias adotadas para minimizá-los. Considerações finais: para ser resolutivo, o gerenciamento de conflitos carece de maiores investimentos no ensino, durante a graduação.
A 62-year-old woman with no family history of hereditary diseases presented to the ER department in 2008 with the diagnosis of a subarachnoid hemorrhage that required urgent decompressive craniotomy. ...On February 2011, due to resistant hypertension, an abdominal CT scan was performed, revealing a left adrenal gland-dependent tumor of 70x86 mm, with additional increased normetanephrine levels in a 24-hour urine sample. Laparoscopic left adrenalectomy was performed on June 3, 2011, with a histological report of pheochromocytoma. It was also documented an elevation of iPTH (301 pg/ml) with corrected calcium of 11 mg/dL and phosphorus of 2.7 mg/dL. Parathyroidectomy was performed with the report of parathyroid adenoma. On January 2015, an abdominal CT scan was performed, revealing recurrence of the pheochromocytoma at the surgical site. A MIBG PET-CT confirmed the recurrence and detected a left retroperitoneal lesion close to the tail of the pancreas. Metastasectomy of the retroperitoneal lesions, distal pancreatectomy, and dissection of tumor adjacent to left kidney were performed with a histopathologic report of pheochromocytoma with nest pattern and extensive necrosis, negative margins, and three positive lymph nodes. During follow-up a significant increase of normetanephrine in 24-hour urine sample was documented (3 months after surgery). A Ga-DOTATOC PET-CT revealed the presence of hepatic metastases. In the 131-MIBG SPECT-CT performed one year later, a decreased height of C3 vertebral body with an abnormal concentration of the radiopharmaceutical in relation to secondary deposit was also found. On August 2017 the patient was treated with a therapeutic dose of 131-MIBG, achieving complete biochemical remission during 14 months of follow-up. On March 2018 an Invitae Multi-Cancer Panel reported the germline variant C. 416C > G (P. Ser139Cys) related to VHL without mutations in other pathogenic genes related to pheochromocytoma. VHL c.416C>G (at the cDNA level ) is a germline variant of Von Hipple Lindau (VHL) disease, also known as p.Ser139Cys (S139C) at the protein level. It results in the change of a Serine to a Cysteine (TCT>TGT), located in 3p25.3. This variant has been reported in population databases (rs587780732, ExAC 0.06%) and related to familiar erythrocytosis, monogenic diabetes (likely benign) and a type of autosomal recessive A1 deafness (uncertain significance); however, to our knowledge it has not been previously published in the literature as a pathogenic nor benign form of the VHL disease. It was also not observed in the NHLBI Exome Sequencing Project that included 6,500 individuals of European and African American ancestry, indicating it is not a common benign variant in these populations. Because of the lack of evidence to determine its role in disease, to date, it is considered a variant of uncertain significance.
Aim: to know the perception of nurse leaders about managing conflicts in the hospital enviroment. Method: qualitative and descriptive research, which was attended by ten nurses who worked in a ...hospital in southern Brazil. The data collection was conducted from October to November 2014 through semistructured interviews and analyzed according to the Operative Proposal. Results: the relationship conflicts were the most experienced by the participants. Those conflicts were caused by the lack of continuity of the activities performed by the nursing staff and by overwork. Dialogue and meetings were mentioned as the main strategies adopted to minimize them. Final thoughts: to be competent, the conflict management requires greater investment in education, during the graduation
Urban avifaunal surveys in Brazil have been increasing in recent years, despite none of them consisting of long-term studies indicating events of regional colonization and/or missing species. Here, ...we present an avifaunal survey of an urbanized ecosystem in southeastern Brazil, carried out along 30 years, on the campus of the Pontifícia Universidade Católica de Minas Gerais, municipality of Belo Horizonte, Minas Gerais state. Inside the campus there is a forest reserve adjacent to a small lake. The inventory was mainly based on opportunistic records from the years 1982-2013. We recorded 134 bird species along the past 30 years. However, the present avifauna is composed of 123 species. A total of 97 species was recorded in the reserve, including the forest fragment and the adjacent lake, of which 44 were exclusive to this area. Nevertheless, the majority of the current species found in the study area is forest independent (N = 51) or semi-dependent (N = 46). There is a predominance of insectivorous (N = 43) and omnivorous (N = 29) species. The current avifauna is represented by 15 migratory species, which can be found both in the urbanized area and in the forest remnant. However, the majority of the species (N = 75) is resident in the area, including three invasive species, whereas few others (N = 28) are occasional visitors. The remaining species were probably introduced in the area. There were 11 cases of disappearing species, which include typical forest birds, and also species typical of wetlands and rural environments. We also comment on recent colonization and on the possible effects of isolation on birds. Probably, the majority of forest-dependents are on the brink of extinction in the forest fragment. Thus, the species' list provided here can be useful as a database for monitoring long-term effects of urbanization on this bird community.
The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients.
Multicentric descriptive cross-sectional study.
five primary health care centers of the South of ...Madrid.
all patients between 16-100 year-old consulting with their family physician.
Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care. Total points scored at the test were obtained.
A sum of 441 screening test were collected. Mean age was 51,3 years and 51.6% of patients presented a moderate-severe risky drug use out of the nine drugs tested. The more frequent drug use screened were tobacco (41.7%) followed by alcohol (15.4%), hypnotics (13.7%) and cannabis (5.7%). Differences were found between genders in the patterns: men had higher risky drug uses compared to women regarding alcohol and cannabis. Women had higher sedatives/hypnotics consumption prevalence. A 16% of patients presented with polyconsumption drug use patterns.
There is risk derived from drug misuse in primary care for tobacco, alcohol, hypnotics and cannabis as detected by the ASSIST test. There is a higher rate of hypnotics than expected.
Abstract
Background and Hypothesis
It is argued that availability of diagnostic models will facilitate a more rapid identification of individuals who are at a higher risk of first episode psychosis ...(FEP). Therefore, we developed, evaluated, and validated a diagnostic risk estimation model to classify individual with FEP and controls across six countries.
Study Design
We used data from a large multi-center study encompassing 2627 phenotypically well-defined participants (aged 18–64 years) recruited from six countries spanning 17 research sites, as part of the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions study. To build the diagnostic model and identify which of important factors for estimating an individual risk of FEP, we applied a binary logistic model with regularization by the least absolute shrinkage and selection operator. The model was validated employing the internal-external cross-validation approach. The model performance was assessed with the area under the receiver operating characteristic curve (AUROC), calibration, sensitivity, and specificity.
Study Results
Having included preselected 22 predictor variables, the model was able to discriminate adults with FEP and controls with high accuracy across all six countries (rangesAUROC = 0.84–0.86). Specificity (range = 73.9–78.0%) and sensitivity (range = 75.6–79.3%) were equally good, cumulatively indicating an excellent model accuracy; though, calibration slope for the diagnostic model showed a presence of some overfitting when applied specifically to participants from France, the UK, and The Netherlands.
Conclusions
The new FEP model achieved a good discrimination and good calibration across six countries with different ethnic contributions supporting its robustness and good generalizability.
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