Hasil untuk "Special situations and conditions"

A. Banerjee

T. Pettigrew

Lara Mencarini, A. Vestito, R. Zagari et al.

Acute cholecystitis (AC), generally associated with the presence of gallstones, is a relatively frequent disease that can lead to serious complications. For these reasons, AC warrants prompt clinical diagnosis and management. There is general agreement in terms of considering early laparoscopic cholecystectomy (ELC) to be the best treatment for AC. The optimal timeframe to perform ELC is within 72 h from diagnosis, with a possible extension of up to 7–10 days from symptom onset. In the first hours or days after hospital admission, before an ELC procedure, the patient’s medical management comprises fasting, intravenous fluid infusion, antimicrobial therapy, and possible administration of analgesics. Additionally, concomitant conditions such as choledocholithiasis, cholangitis, biliary pancreatitis, or systemic complications must be recognized and adequately treated. The importance of ELC is related to the frequent recurrence of symptoms and complications of gallstone disease in the interval period between the onset of AC and surgical intervention. In patients who are not eligible for ELC, it is suggested to delay surgery at least 6 weeks after the clinical presentation. Critically ill patients, who are unfit for surgery, may require rescue treatments, such as percutaneous or endoscopic gallbladder drainage (GBD). A particular treatment approach should be applied to special populations such as pregnant women, cirrhotic, and elderly patients. In this review, we provide a practical diagnostic and therapeutic approach to AC, even in specific clinical situations, based on evidence from the literature.

L.Amico, M.Boshier, G.Birkl et al.

Atomtronics deals with matter-wave circuits of ultracold atoms manipulated through magnetic or laser-generated guides with different shapes and intensities. In this way, new types of quantum networks can be constructed in which coherent fluids are controlled with the know-how developed in the atomic and molecular physics community. In particular, quantum devices with enhanced precision, control, and flexibility of their operating conditions can be accessed. Concomitantly, new quantum simulators and emulators harnessing on the coherent current flows can also be developed. Here, the authors survey the landscape of atomtronics-enabled quantum technology and draw a roadmap for the field in the near future. The authors review some of the latest progress achieved in matter-wave circuits' design and atom-chips. Atomtronic networks are deployed as promising platforms for probing many-body physics with a new angle and a new twist. The latter can be done at the level of both equilibrium and nonequilibrium situations. Numerous relevant problems in mesoscopic physics, such as persistent currents and quantum transport in circuits of fermionic or bosonic atoms, are studied through a new lens. The authors summarize some of the atomtronics quantum devices and sensors. Finally, the authors discuss alkali-earth and Rydberg atoms as potential platforms for the realization of atomtronic circuits with special features.

Ruhi Khan, Sruthi Ramindla, Saif Quaiser et al.

Rationale: Enteric fever is a major public health problem in developing and underdeveloped counties. Extraintestinal manifestations in typhoid are estimated in 27% cases and are associated with severe and complicated diseases. Patients concerns: We report three cases of enteric fever with rare extra intestinal manifestations. Diagnoses: Enteric fever with acute motor-sensory axonal neuropathy, enteric fever with myocarditis, and enteric fever with splenic vein thrombosis. Interventions: All patients were treated with antibiotics. Additionally, Patient 1 was treated with IV immunoglobulin; Patient 2 was treated with vasopressors and anti-cardiac remodeling drugs like ramipril and metoprolol; Patient 3 was treated with anticoagulation with low molecular weight heparin. Outcomes: All patients improved clinically and were followed up on outpatient. Lessons: The diagnosis of enteric fever is challenging and there is an urgent need for prompt-targeted management for better outcomes. Especially in endemic zones and in non-endemic zones as a disease of emporiatric significance.

Kinga Racisz, Joanna Duda, Jakub Kędzia et al.

Introduction According to data, 5% of people in Europe and 6% of people in Poland are vegetarians. Therefore, an increasing percentage of pregnant women will follow a plant-based diet. During pregnancy, the need for vitamins and minerals increases, and the proper balance and possible supplementation of a vegetarian diet are crucial for proper fetal development and a pregnant woman's health. Aim of study This study aims to evaluate and compare information regarding the adequacy of a vegetarian diet for pregnant women and its impact on maternal outcomes, fetal development, newborn health and lactation. Materials and methods The search methodology incorporated the terms “vegetarian diet” or “plant-based diet” or “vegan” AND “pregnancy” or “pregnant” or “health benefits”, along with variations of these terms, found in many scientific databases. Publications issued before 2019 and case reports were excluded. Conclusion There is a consensus that a plant-based diet is safe during both pregnancy and lactation. Nevertheless, it may be associated with many nutrient deficiencies. A vegetarian diet promotes a lower incidence of excessive weight gain, which results in a less frequent occurrence of EWG-related complications. There was no higher prevalence of premature births or infant mortality. The occurrence of gestational diabetes, small gestational age/low birth weight and congenital anomalies require further study. Breastfeeding during a vegetarian diet is possible, but appropriate supplementation is recommended.

Nancy Yesenia Ortiz-Garcia, Diego Eduardo Rueda-Capristran, Ajay Kumar et al.

Abstract Background Neuromuscular diseases (NMDs) can impair respiratory muscle function, leading to increased morbidity and mortality. Respiratory muscle training (RMT) is widely used to manage these respiratory complications, but its efficacy across different NMDs remains unclear. This systematic review and meta-analysis evaluated the impact of physiotherapy interventions, specifically RMT, on respiratory muscle function in NMD patients. Methods A systematic search of multiple databases, including MEDLINE, EMBASE, Web of Science, Cochrane, CRS-Web, PEDro, LILACS, ICTPR, the China National Knowledge Infrastructure database, and ClinicalTrials.gov, was conducted up to February 2025. Randomized controlled trials (RCTs) and cohort studies evaluating RMT’s effect on lung volumes and respiratory muscle strength in NMD patients were included. Risk of bias assessment was performed using Cochrane Risk of bias tool for RCTs and Newcastle-Ottawa Scale for cohorts. Meta-analyses were performed using a random-effects model, and heterogeneity was assessed with I² statistics. Results Sixteen studies were analyzed from 9,626 screened articles. The meta-analysis demonstrated significant improvements in respiratory muscle strength, particularly in maximal inspiratory pressure (MD: 6.83 cmH₂O, 95% CI: 2.08 to 11.58, p < 0.01, I² = 3.8%) and maximal expiratory pressure (MD: 13.05 cmH₂O, 95% CI: 3.65to 22.42, p < 0.01, I² = 43%). No significant improvements were observed in forced vital capacity (MD: 3.13%, 95% CI: -8.06 to 14.34, p = 0.58), sniff nasal inspiratory pressure (MD: 1.47 cmH₂O, 95% CI: -15.45 to 18.39, p = 0.86), forced expiratory volume in one second (MD: -0.02 L, 95% CI: -0.17 to 0.13, p = 0.78), and vital capacity (MD: -0.10 L, 95% CI: -0.31 to 0.11, p = 0.33). Conclusion This review supports the role of respiratory muscle training in improving inspiratory and expiratory muscle strength in patients with neuromuscular diseases. However, variability in study methodologies and patient populations limits the statistical significance of some respiratory parameters. Future studies should aim to standardize interventions and outcome measures to provide more conclusive evidence on the efficacy of RMT.

Kendra Cooling, Danielle R. Bouchard, Molly Gallibois et al.

Objective: To examine the effects of a standing intervention on gait speed for older adults living in long term care (LTC) residences. Design: A parallel superiority cluster randomized controlled trial. Setting and participants: LTC residences. A total of 95 LTC residents (n = 47 control; n = 48 intervention) participated in the study. Methods: LTC residences and therefore the residents from the homes were randomized to either the intervention group (standing up to 100 minutes/week) for 22 weeks or the control group (socializing with staff with no encouragement to stand for up to 100 minutes/week) for 22 weeks. The primary outcome is gait speed measured by the 10-meter walking speed test. Results: A total of 95 participants (n= 47 in the control group and n=48 in the intervention group) age 86 ± 8 years completed the trial, averaging 41.9 ± 30.3 min of standing per week in the intervention group and 48.4 ± 22.8 min of time matched activity in the control group. There was no significant difference between groups in changes in gait speed (β=-0.034, 95 % C.I. (-0.097 0.028)). Conclusions and implications: This 22-week standing intervention did not improve gait speed in older adults living in LTC residences.Trial registration: clinicaltrials.gov - NCT03796039

Frank Konietschke, Marius Placzek, F. Schaarschmidt et al.

One-way layouts, i.e., a single factor with several levels and multiple observations at each level, frequently arise in various fields. Usually not only a global hypothesis is of interest but also multiple comparisons between the different treatment levels. In most practical situations, the distribution of observed data is unknown and there may exist a number of atypical measurements and outliers. Hence, use of parametric and semiparametric procedures that impose restrictive distributional assumptions on observed samples becomes questionable. This, in turn, emphasizes the demand on statistical procedures that enable us to accurately and reliably analyze one-way layouts with minimal conditions on available data. Nonparametric methods offer such a possibility and thus become of particular practical importance. In this article, we introduce a new R package nparcomp which provides an easy and user-friendly access to rank-based methods for the analysis of unbalanced one-way layouts. It provides procedures performing multiple comparisons and computing simultaneous confidence intervals for the estimated effects which can be easily visualized. The special case of two samples, the nonparametric Behrens-Fisher problem, is included. We illustrate the implemented procedures by examples from biology and medicine.

Horace Cox, Friederike Roeder, Lucy Okell et al.

Objective. To identify challenges that may raise pathogens’ resistance to antimicrobial drugs by exploring the private market for antimicrobials in two selected mining and frontier areas of Guyana. Methods. The private sector supply was mapped by approaching all authorized pharmacies and informal outlets, e.g., street vendors and grocery stores, around the two selected towns. Interviews were conducted with a) sellers on the availability of drugs, expiration dates, prices, and main producers; and b) customers on purchased drugs, diagnoses, and prescriptions received before purchasing drugs, and intention to complete the treatment. The information collected was described, and the determinants of the self-reported intention of customers to complete the whole treatment were identified. Results. From the perspective of the supply of antimicrobials, essential medicines faced low and insecure availability, and prescriptions frequently deviated from diagnoses. From the perspective of the demand for antimicrobials, one-third of purchased antibiotics had a high potential for antimicrobial resistance as per the World Health Organization AWaRe classification. A high price reduced the self-reported intention to complete the treatment among those who had a prescription, while buying the medication in a licensed pharmacy increased such intention. Conclusions. In Guyana, there persists a need to establish and revise policies addressing both supply and demand, such as restricting the sale of antimicrobials to licensed pharmacies and upon prescription, improving prescription practices while reducing the financial burden to patients, guaranteeing access to first-line treatment drugs, and instructing patients on appropriate use of antimicrobials. Revising such policies is an essential step to contain antimicrobial resistance in the analyzed areas and across Guyana.

Ichiro Okada, Toru Hifumi, Hisashi Yoneyama et al.

Abstract Background A team approach is essential for effective trauma management. Close collaboration between interventional radiologists and surgeons during the initial management of trauma patients is important for prompt and accurate trauma care. This study aimed to determine whether trauma patients benefit from close collaboration between interventional radiology (IR) and surgical teams during the primary trauma survey. Methods A retrospective observational study was conducted between 2014 and 2021 at a single institution. Patients were assigned to an embolization group (EG), a surgery group (SG), or a combination group (CG) according to their treatment. The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course of treatment. Results The analysis included 197 patients, consisting of 135 men and 62 women, with a median age of 56 [IQR, 38–72] years and an injury severity score of 20 [10–29]. The EG, SG, and CG included 114, 48, and 35 patients, respectively. Differences in organ injury patterns were observed between the three groups. In-hospital survival rates in all three groups were higher than the Ps. In particular, the survival rate in the CG was 15.5% higher than the Ps (95% CI: 7.5–23.6%; p < 0.001). In the CG, the median time for starting the initial procedure was 53 [37–79] min and the procedure times for IR and surgery were 48 [29–72] min and 63 [35–94] min, respectively. Those times were significantly shorter among three groups. Conclusion Close collaboration between IR and surgical teams, including the primary survey, improves the survival of severe trauma patients who require both IR procedures and surgeries by improving appropriate treatment selection and reducing the time process.

Jianxin Xiao, M. Khan, Yulin Ma et al.

Dairy cattle experience health risks during the periparturient period. The continuous overproduction of reactive oxygen species (ROS) during the transition from late gestation to peak lactation leads to the development of oxidative stress. Oxidative stress is usually considered the main contributor to several diseases such as retained placenta, fatty liver, ketosis, mastitis and metritis in periparturient dairy cattle. The oxidative stress is generally balanced by the naturally available antioxidant system in the body of dairy cattle. However, in some special conditions, such as the peripariparturient period, the natural antioxidant system of a body is not able to balance the ROS production. To cope with this situation, the antioxidants are supplied to the dairy cattle from external sources. Natural antioxidants such as selenium and vitamin E have been found to restore normal health by minimizing the harmful effects of excessive ROS production. The deficiencies of Se and vitamin E have been reported to be associated with various diseases in periparturient dairy cattle. Thus in the current review, we highlight the new insights into the Se and vitamin E supplementation as antioxidant agents in the health regulation of periparturient dairy cattle.

D. Dumitrascu, Igor Bakulin, A. Berzigotti et al.

Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.

Raffaele Pagliuca, Mario Virgilio Papa, Pagliuca Mena Ilaria et al.

The rivastigmine patch is the only existing transdermal delivery system used for the treatment of Alzheimer disease. Among the most common adverse events derived from its use are gastrointestinal events, particularly diarrhea. We report a clinical case of an 81-year-old patient admitted to our hospital under long-standing treatment with rivastigmine transdermal patch who presented with atypical watery diarrhea. Anamnesis showed that the patient presented with a likely infectious gastroenteric event, the diarrheal symptoms of which persisted upon resolution of the event and resolved only upon temporary discontinuation of acetylcholinesterase inhibitors. Failure to rapidly identify the causes of profuse diarrhea in older adults can have lethal consequences. When these symptoms occur, quickly recognizing the causes and providing proper management can be lifesaving.

M. Torrilhon

D. Trejo, P. Gardoni

Infrastructure are sustainable when they are able to address the needs of the present without sacrificing the ability of future generations to meet their needs. Infrastructure are resilient when they are able to recover from disasters brought by natural hazards (e.g., earthquakes, tsunamis, hurricanes, cyclones, tornados, floodings, and droughts) and anthropogenic hazards (e.g., human errors, malevolent attacks). Sustainability and resilience depend on each other but they also may call for conflicting actions. Because of this, it is essential to find the right balance with tradeoffs. Sustainability calls for sensible and parsimonious use of limited resources, and a minimal impact on the environment. At the same time, long-term sustainability depends on infrastructure resilience where infrastructure built today can serve communities for many years, weathering possible disruptions without the need for major reconstruction. However, infrastructure resilience often calls for significant use of scarce resources with significant environmental impact, which in turn hurts sustainability. A crucial challenge that will likely be the focus of significant research in the coming years is to find solutions that are both sustainable and resilient. Resilience depends on both the performance of the built and modified natural environment and on the contextual characteristics of social, economic, and political institutions. Both sustainability and resiliency are impacted by the external environment, and today’s external environment is changing in ways that increase the uncertainty associated with the performance of infrastructure. Climate change, dynamic geopolitical situations and policies, fluctuating economic conditions, changing human behaviors, urban growth, and other factors lead to dynamic changes, new needs, and increasing uncertainty. Societies must learn how to deal with these changes and growing uncertainty so that societies can achieve longterm infrastructure sustainability and resilience. Although sustainability and resilience are often associated with the built environment, infrastructure can be both physical and non-physical systems. Designers, engineers, scientists, economists, and policyand decision-makers must learn how to address and deal with these changes, new needs, and growing uncertainties. Historical processes have been static. Dynamic processes are required. Understanding the causes and impacts of disasters through holistic, systemic, and multi-disciplinary analysis will be essential to deal with these changing external environments. Robust decisionmaking and dynamic planning processes are necessary to achieve reliable and sustainable services under the stresses from climate change, disasters, and other stressors. Adaptive and integrated disaster resilience, and thus sustainability, is dependent on nations and communities designing and building resilience in a systematic and integrated manner that can adapt to changing environments. This approach must address complexities and uncertainties by designing institutional processes that function across scales and sectors to engage multiple stakeholders that promote social learning, Djalante et al. (2013) and optimize sustainability and resiliency. Adaptive pathways are a sequence of actions that should be progressively implemented and depend on future dynamics Werner et al. (2021). This special issue on Adaptive Pathways for Resilient Infrastructure, sponsored by the Coalition for Disaster Resilient Infrastructure (CDRI), seeks to better understand how to integrate flexibility into infrastructure planning and design under changing environmental conditions. This planning and design must depend on future states and dynamics, and adaptive pathways must identify actions or processes that can be implemented progressively for inclusive, economic, resilient, and sustainable infrastructure. This Special Issue on Adaptive Pathways for Resilient Infrastructure sought innovative approaches to address knowledge gaps to highlight adaptive pathway solutions that foster resilience and sustainability of infrastructure systems under changing environments. The Special Issue sought literature reviews, evidence-based science and engineering, and case studies that promote adaptive pathways to target policymakers and practitioners. The ultimate objective is to implement the practices presented herein to enhance the robustness of methods and processes used to make sustainable and resilient infrastructure. This Special Issue covers a wide range of topics associated with adaptive pathways. These topics include implementing adaptive pathways in policy, finance, and SUSTAINABLE AND RESILIENT INFRASTRUCTURE 2023, VOL. 8, NO. S1, 1–2 https://doi.org/10.1080/23789689.2022.2139564

Ayfer Colak, Dilek Oncel, Zeynep Altın et al.

ABSTRACT In the present study, the importance of laboratory parameters and CT findings in the early diagnosis of COVID-19 was investigated. To this end, 245 patients admitted between April 1st, and May 30th, 2020 with suspected COVID-19 were enrolled. The patients were divided into three groups according to chest CT findings and RT-PCR results. The non-COVID-19 group consisted of 71 patients with negative RT-PCR results and no chest CT findings. Ninety-five patients with positive RT-PCR results and negativechest CT findings were included in the COVID-19 group; 79 patients with positive RT-PCR results and chest CT findings consistent with COVID-19 manifestations were included in COVID-19 pneumonia group. Chest CT findings were positive in 45% of all COVID-19 patients. Patients with positive chest CT findings had mild (n=30), moderate (n=21) andor severe (n=28) lung involvement. In the COVID-19 group, CRP levels and the percentage of monocytes increased significantly. As disease progressed from mild to severe, CRP, LDH and ferritin levels gradually increased. In the ROC analysis, the area under the curve corresponding to the percentage value of monocytes (AUC=0.887) had a very good accuracy in predicting COVID-19 cases. The multinomial logistic regression analysis showed that CRP, LYM and % MONO were independent factors for COVID-19. Furthermore, the chest CT evaluation is a relevant tool in patients with clinical suspicion of COVID-19 pneumonia and negative RT-PCR results. In addition to decreased lymphocyte count, the increased percentage of monocytes may also guide the diagnosis.

A. Milton, Mijanur Rahman, Sumaira Hussain et al.

The Rohingya people are one of the most ill-treated and persecuted refugee groups in the world, having lived in a realm of statelessness for over six generations, and who are still doing so. In recent years, more than 500,000 Rohingyas fled from Myanmar (Burma) to neighboring countries. This article addresses the Rohingya refugee crisis in Bangladesh, with special emphasis on the living conditions of this vulnerable population. We reviewed several documents on Rohingya refugees, visited a registered refugee camp (Teknaf), collected case reports, and conducted a series of meetings with stakeholders in the Cox’s Bazar district of Bangladesh. A total of 33,131 registered Rohingya refugees are living in two registered camps in Cox’s Bazar, and up to 80,000 additional refugees are housed in nearby makeshift camps. Overall, the living conditions of Rohingya refugees inside the overcrowded camps remain dismal. Mental health is poor, proper hygiene conditions are lacking, malnutrition is endemic, and physical/sexual abuse is high. A concerted diplomatic effort involving Bangladesh and Myanmar, and international mediators such as the Organization of Islamic Countries and the United Nations, is urgently required to effectively address this complex situation.

Gregorio Gonzalez-Alcaide, Sergio Palacios-Fernandez, Jose-Manuel Ramos-Rincon

Abstract Background Population aging will be one of humanity’s major challenges in the decades to come. In addition to focusing on the pathologies causing the greatest mortality and morbidity in this population, such as dementia, health research in elderly people must consider a myriad of other interlinked factors, such as geriatric syndromes, social aspects, and factors related to preserving quality of life and promoting healthy aging. This study aims to identify the main subject areas attracting research attention with regard to very old (≥ 80 years) populations. Methods Documents assigned with the medical subject heading “Aged, 80 and over” were retrieved from MEDLINE and the Web of Science. This dataset was used to determine publication output by disease, geographic region, country, and discipline. A co-word analysis was undertaken to identify thematic research clusters. Results Since the mid-2000s, there has been a boom in scientific output focusing specifically on very old populations, especially in Europe (43.7% of the documents) but also in North America (30.5%) and Asia (26%); other regions made only nominal contributions (0.5 to 4.4%). The USA produced the most research, while the most growth over the study period occurred in Japan, Spain, and China. Four broad thematic clusters were identified: a) geriatric diseases, health services for the aged, and social and psychological issues of aging; b) cardiovascular diseases; c) neoplasms, and d) bacterial infections & anti-bacterial agents. Conclusions Scientific research in very old populations covers a wide variety of interrelated topics. In quantitative terms, the top subject areas have to do with cardiovascular and cerebrovascular diseases (including aortic valve stenosis and stroke), dementia, and neoplasms. However, other degenerative pathologies, geriatric syndromes, and different social and psychosocial aspects also attract considerable interest. It is necessary to promote more equal participation in global research on pathologies and topics related to very elderly populations, as the highest rates of population aging and the largest numbers of elderly people in the next decades will be in low- and middle-income countries.

Luciano Izzo, Daniela Messineo, Emiliano Venditti et al.

Aortic aneurysms are of different types as different ones are the types of treatment available to us. Following the advent of endovascular surgery, perioperative mortality has been significantly reduced, but open surgery remains the first choice under some occurrences. The purpose of this chapter is to try to clarify the dichotomy between open and endovascular aortic aneurysms in the several types of aortic aneurysms, highlighting the indications and complications to guide to the best therapeutic choice.