Potential use of rainwater as a tool for fire stations and firefighting: Literature review, environmental and cost assessments.

Few studies in the literature integrate rainwater harvesting and firefighting. Thus, the general objective of this paper was to evaluate the potential use of rainwater as a source of water for firefighting. To do so, two approaches were proposed for the assessment. The first approach was the analysis of the existing literature. Two databases were evaluated as references in engineering fields, of which 32 articles mentioned rainwater as an alternative for firefighting. The main result of the review was the scarcity of articles in the area under study, with some of the existing articles focusing on forest fires. In contrast, others analysed the use of rainwater within the scope of buildings or fire stations. The second approach involved a case study that started by analysing the fire statistics provided by the Military Fire Department of the state of Santa Catarina, Brazil. It was observed that, between 2017 and 2020, building fires represented 25 % of the state's fires and 50 % of the water consumption in firefighting, while the rest of the fire occurrences represented the other half of water consumption. Rainwater can be used not only to reduce the total consumption of potable water but also as a logistics tool towards better response time in the event of a fire. With the firefighting water demand obtained, a Life Cycle Assessment (LCA) approach was performed to assess the potential environmental optimisation in a simplified scope. It was performed in a cradle-to-gate approach, leaving the potential optimisations in transport and logistics apart. Also, a cost assessment was carried out, obtaining a much lower cost for firefighting and providing financial savings for fire stations. As a result, rainwater is expected to decrease environmental impacts, help logistics in fire and save money for fire supression.

The CHA2DS2-VASc Score for Risk Stratification of Stroke in Heart Failure With-vs-Without Atrial Fibrillation.

A recent study suggested that the CHA2DS2-VASc score can risk stratify heart failure (HF) patients without atrial fibrillation (AF) for stroke. We performed a retrospective analysis using the national Veteran Affairs database to externally validate the findings. Crude incidence rates of end points were calculated. A Cox proportional model was used to study the association between the CHA2DS2-VASc score and outcomes. In HF patients with AF (n = 17,481) and without AF (n = 36,935), the 1 year incidence rate for ischemic stroke, thromboembolism, thromboembolism (without MI), and death were 2.7 and 2.0%; 10.3 and 7.9%; 4.1 and 3.1%; and 19.2 and 26.0%, respectively, with higher rates with increasing CHA2DS2-VASc scores both with and without AF. CHA2DS2-VASc score predicted strokes in HF patients without AF (1-year C-statistic 0.62, 95% CI 0.60-0.64; NPV 85.4%, 95% CI 83.4-87.4%) with similar predictive ability to those with AF (C-statistic 0.59, 95% CI 0.56-0.62; NPV 86.4%, 95% CI 82.6-90.2%). Among patients with HF, there was an increased risk of stroke, thromboembolism, and death with increasing CHA2DS2-VASc scores regardless of AF status. Our findings support the use of the CHA2DS2-VASc score as a prognostic tool in HF.

Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis.

BACKGROUND: The first two randomized control trials (RCTs) studying the role of MitraClip in patients with secondary mitral regurgitation (MR) had antagonizing results. We, therefore, performed an updated meta-analysis of RCTs and propensity score-matched observational studies investigating the role of MitraClips in patients with secondary MR. A novel method of Kaplan Meier Curve reconstruction from derived individual patient data will be used to compare the survival probability of control groups in COAPT and MITRA HF trail, and hence, access inter-study heterogeneity. METHODS: Medline and Cochrane databases was used for systematic search. We used the Mantel-Haenszel method with a random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI) and inverse variance method with a random-effect model to calculate the mean difference (MD) with 95% confidence interval (CI). We used a fixed-effect approach for meta-regression. RESULTS: MitraClip reduced the risk of all-cause mortality [RR: 0.72, CI: 0.55-0.95, P value = 0.02, I2 = 55%, χ2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42-0.92, P value = 0.02, I2 = 90%, χ2P-value<0.01] at two years follow-up. There was no effect of MitraClip on change in cardiovascular mortality and 6 m walking distance at 12 months follow-up. Meta-regression indicated left ventricular end diastolic volume and age among the factors affecting outcomes. Reconstructed Kaplan Meier curves confirmed considerable heterogeneity among patients randomized in MITRA HF and COAPT trial. CONCLUSION: The present meta-analysis confirms the beneficial role of percutaneous mitral valve repair in patients with secondary MR. However, all the results were associated with considerable heterogeneity.

Life cycle energy assessment and economic feasibility of stormwater harvested from pervious pavements.

Pervious pavements are one of the most used construction techniques among the Sustainable Urban Drainage Systems (SUDS). The objective of this article is to analyse the energy life cycle and the life cycle cost of stormwater harvesting systems using pervious pavements models in order to compare and evaluate the differences and verify what influences the profitability and sustainability. The method proposed started with the definition of pervious pavement models based on literature review. The main characteristic of the models analysed was the use of porous asphalt with different underlying layers, i.e. thickness and material. The hydrological-hydraulic design of the pavements was also assessed. The potential for potable water savings due to harvesting stormwater from a parking lot was estimated for a public building in Florianópolis, southern Brazil. The models were compared to identify what most influences the potable water savings, the profitability and the sustainability of the systems. The maximum potable water savings found were 42%. It was also observed that the overall consumption of the building has been decreasing over the years, and the yearly rainfall has increased, which leads to a higher potential. In the current water consumption pattern, none of the systems evaluated was profitable or presented sustainability, evaluated herein as negative energy balance. However, it was verified that if analysed comparatively with non-pervious pavement, it was profitable to use stormwater harvested from the pervious pavement. Thus, it can be concluded that stormwater harvesting systems in combination with pervious pavements are promising, serving as SUDS and saving money for users. It is also noticeable that the use of porous asphalt is not recommended when aiming for systems with low embedded energy.

Abbreviated Dual Antiplatelet Therapy Followed by P2Y12 Inhibitor Monotherapy versus 12 Months' Dual Antiplatelet Therapy Post Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

INTRODUCTION: An increased incidence of stent thrombosis after implantation of first-generation drug-eluting stents led to a recommendation of dual antiplatelet therapy (DAPT) for 12 months after the procedure. However, given the use of second-generation and newer drug-eluting stents, this recommendation needs to be revisited. Several randomized controlled trials (RCTs) have studied an abbreviated DAPT regimen of ≤ 3 months followed by P2Y12 inhibitor monotherapy, and results have been conflicting. OBJECTIVE: We performed a systematic review with meta-analysis of RCTs of abbreviated DAPT for ≤ 3 months followed by P2Y12 monotherapy compared with 12 months of DAPT. METHODS: We performed a systematic search of the MEDLINE/PubMed, Cochrane, and DARE (Database of Abstracts of Reviews of Effects) databases for eligible RCTs. Quantitative analysis was performed based on the intention-to-treat principle. We used the Mantel-Haenszel method with a random-effects model to calculate relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: The final analysis included four RCTs. We found no difference in the risk of all-cause mortality (RR 0.90; 95% CI 0.77-1.05; p = 0.18; I2 = 0%; χ2p = 0.58), myocardial infarction (RR 0.99; 95% CI 0.86-1.15; p = 0.85; I2 = 0%; χ2p = 0.70), stroke (RR 1.14; 95% CI 0.65-1.98; p = 0.65; I2 = 59%; χ2p = 0.06), or stent thrombosis (RR 0.98; 95% CI 0.73-1.33; p = 0.90; I2 = 0%; χ2p = 0.48). Additionally, there was no difference in the risk for major bleeding, defined as BARC (Bleeding Academic Research Consortium) type 3 or 5, between the two groups (RR 0.62; 95% CI 0.37-1.05; p = 0.07; I2 = 79%; χ2p < 0.05). CONCLUSION: Abbreviated DAPT followed by P2Y12 monotherapy resulted in a similar risk of re-ischemic clinical outcomes post percutaneous coronary intervention as compared with the standard 12-month DAPT regimen. The risk of major bleeding (BARC type 3 or 5) also remained similar between the two groups. However, as trials have reported benefits with abbreviated DAPT followed by P2Y12 monotherapy in terms of combined endpoints and all bleeding (BARC type 2-5), additional research is needed.

Vescicovaginal fistula management in low-income setting: a complicated case report.

Obstetric vescicovaginal (VVF) fistulas, most of all as consequences of prolonged neglected obstructed labor, occurs mainly in low-income countries. Considering the limited resources, both of trained specialists and equipments, fistulas have a devastating impact on affected women and their families from physical, social and economic point of view. However, also in low-income settings, fistulas prevalence and consequences could be reduced with focused interventions addressed to pregnant women during antenatal visits and to surgeons which face of these particular diseases. We report a case of obstetric VVF, related to a prolonged labor, treated by surgery and managed with satisfying results in a low-income setting.

Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients. / Pós-operatório imediato de cirurgia bariátrica em unidade intensiva versus unidade de internação. Estudo retrospectivo com 828 pacientes.

OBJECTIVE: To compare the incidence of complications and the duration of hospitalization of patients undergoing bariatric surgery admitted to the intensive care unit or a post-surgical hospitalization unit. METHODS: This retrospective observational study included 828 patients admitted between January 2010 and February 2015 during the immediate postoperative period of bariatric surgery in a hospital. Data were collected via electronic medical records. The Mann-Whitney test was used to compare continuous variables, and the chi-square was used to compare categorical variables. RESULTS: Patients in both groups had similar demographic characteristics, with no significant differences in anthropometric data and comorbidities. There was no significant difference in the comparison of complications between the two groups. However, the group admitted to the intensive care unit had longer hospitalization times (median of 3 days versus 2 days, p < 0.05), and hospital costs were 8% higher. CONCLUSION: The present study found no benefit in the routine admittance of patients to the intensive care unit after undergoing bariatric surgery. This practice increased hospitalization time and hospital costs, which wasted resources. It is necessary to create objective criteria to identify patients requiring intensive care unit admission after bariatric surgery.

OBJETIVO: Comparar a incidência de complicações e a duração da hospitalização de pacientes submetidos à cirurgia bariátrica internados na unidade de terapia intensiva ou de internação pós-cirúrgica. MÉTODOS: Estudo observacional, retrospectivo, que incluiu 828 pacientes admitidos entre janeiro de 2010 e fevereiro de 2015 em pós-operatório imediato de cirurgia bariátrica em um hospital. Os dados foram coletados em prontuários eletrônicos. As variáveis contínuas foram comparadas utilizando-se o teste de Mann-Whitney e as categóricas, o qui quadrado. RESULTADOS: Os pacientes dos dois grupos possuíam características demográficas semelhantes, sem diferença significativa dos dados antropométricos e comorbidades. Comparando-se as complicações entre os dois grupos, não houve diferença significativa. No entanto, o grupo admitido na unidade de terapia intensiva teve maior tempo de internação (mediana de 3 dias versus 2 dias; p < 0,05) e custo hospitalar 8% maior. CONCLUSÃO: O presente estudo não encontrou nenhum benefício na internação rotineira de pacientes submetidos à cirurgia bariátrica em unidade de terapia intensiva. Esta prática aumentou o tempo de internação e o custo hospitalar, desperdiçando recursos. É necessária a criação de critérios objetivos para identificar pacientes que necessitem de internação em unidade de terapia intensiva após cirurgia bariátrica.

Pós-operatório imediato de cirurgia bariátrica em unidade intensiva versus unidade de internação. Estudo retrospectivo com 828 pacientes / Immediate postoperative of bariatric surgery in the intensive care unit versus an inpatient unit. A retrospective study with 828 patients

RESUMO Objetivo: Comparar a incidência de complicações e a duração da hospitalização de pacientes submetidos à cirurgia bariátrica internados na unidade de terapia intensiva ou de internação pós-cirúrgica. Métodos: Estudo observacional, retrospectivo, que incluiu 828 pacientes admitidos entre janeiro de 2010 e fevereiro de 2015 em pós-operatório imediato de cirurgia bariátrica em um hospital. Os dados foram coletados em prontuários eletrônicos. As variáveis contínuas foram comparadas utilizando-se o teste de Mann-Whitney e as categóricas, o qui quadrado. Resultados: Os pacientes dos dois grupos possuíam características demográficas semelhantes, sem diferença significativa dos dados antropométricos e comorbidades. Comparando-se as complicações entre os dois grupos, não houve diferença significativa. No entanto, o grupo admitido na unidade de terapia intensiva teve maior tempo de internação (mediana de 3 dias versus 2 dias; p < 0,05) e custo hospitalar 8% maior. Conclusão: O presente estudo não encontrou nenhum benefício na internação rotineira de pacientes submetidos à cirurgia bariátrica em unidade de terapia intensiva. Esta prática aumentou o tempo de internação e o custo hospitalar, desperdiçando recursos. É necessária a criação de critérios objetivos para identificar pacientes que necessitem de internação em unidade de terapia intensiva após cirurgia bariátrica.

ABSTRACT Objective: To compare the incidence of complications and the duration of hospitalization of patients undergoing bariatric surgery admitted to the intensive care unit or a post-surgical hospitalization unit. Methods: This retrospective observational study included 828 patients admitted between January 2010 and February 2015 during the immediate postoperative period of bariatric surgery in a hospital. Data were collected via electronic medical records. The Mann-Whitney test was used to compare continuous variables, and the chi-square was used to compare categorical variables. Results: Patients in both groups had similar demographic characteristics, with no significant differences in anthropometric data and comorbidities. There was no significant difference in the comparison of complications between the two groups. However, the group admitted to the intensive care unit had longer hospitalization times (median of 3 days versus 2 days, p < 0.05), and hospital costs were 8% higher. Conclusion: The present study found no benefit in the routine admittance of patients to the intensive care unit after undergoing bariatric surgery. This practice increased hospitalization time and hospital costs, which wasted resources. It is necessary to create objective criteria to identify patients requiring intensive care unit admission after bariatric surgery.

Fournier gangrene.

Fournier gangrene is a necrotizing infection involving the soft tissues of the male genitalia. It was first described in 1764 by Baurienne and given its eponymous name after Jean-Alfred Fournier in 1883 presented a case of perineal gangrene in an otherwise healthy young man. While only 600 cases of Fournier gangrene have been reported in the world literature since 1996, it is a common and serious disease in Africa. In Maputo Central Hospital alone, between 12 and 16 cases are admitted every year and treated with a 20% mortality. The typical patient is an elderly male in his sixth or seventh decade with co-morbid diseases. While considered to affect males only, a similar condition may occasionally affect the female genitalia.