Prospective evaluation of the relationship between cognition and recovery outcomes after cardiac arrest.

PURPOSE: Cognitive function is often impaired for cardiac arrest (CA) survivors due to hypoxic-ischemic brain injury. Whether cognitive impairment at hospital discharge is associated with recovery defined as functional status and fatigue measured at 1-month post-discharge is not known. METHODS: Consecutive CA patients admitted at an academic center (May 14, 2021-June 23, 2023) were assessed for cognitive impairment (modified Telephone Interview for Cognitive Status, TICS-m < 33) and depressive symptoms (8-item Patient Health Questionnaire) at hospital discharge. Poor functional status (primary outcome; modified Rankin Scale, mRS > 3) and fatigue severity (patient-reported outcome; Modified Fatigue Impact Scale) were assessed 1-month post-discharge. Hierarchical regressions tested associations of cognitive function with outcomes. RESULTS: Of 112 participants (mean age 54.4 ± 14.8; 38% female; 43% White race, 20% Black race, 29% Hispanic ethnicity) completing discharge TICS-m, 63 (56%) had indicated cognitive impairment, and 68 (61%) had poor 1-month functional outcome. Worse discharge cognitive function was independently associated with a higher risk of poor 1-month functional outcome (OR = 0.88, 95% CI [0.79, 0.98], p = 0.02) after adjusting for age, education, sex, race, ethnicity, length of hospital stay, comorbidities, and depressive symptoms. Fatigue severity lacked significant associations with cognitive function, but was associated with depressive symptoms (B = 1.03 [0.00, 2.05], p = 0.04). CONCLUSION: Cognitive function at discharge after CA was significantly and independently associated with functional outcome 1 month after hospital discharge. Psychological distress contributed to fatigue severity. This highlights the need for screening and addressing cognitive and emotional problems pre-hospital discharge.

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society.

Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.

Isquemia intestinal, una manifestación inusual de la embolia paradójica. Un reporte de caso / Intestinal ischaemia as a rare manifestation of a paradoxical embolism. A case report

Introducción. La embolia paradójica es un evento trombótico originado en la circulación venosa, que se manifiesta como embolismo arterial por medio de un defecto anatómico a nivel cardíaco o pulmonar. Se asocia principalmente a eventos cerebrovasculares, aunque se han encontrado casos de infarto agudo de miocardio, infarto renal y otros eventos isquémicos. Caso clínico. Paciente de 47 años, quien consultó por cuadro de dolor abdominal, que requirió manejo quirúrgico de urgencia, donde identificaron isquemia intestinal importante. Los estudios adicionales hallaron déficit de proteína S y persistencia de foramen oval permeable. Resultados. La presencia de trombosis arterial se conoce como trombosis de sitios inusuales y requiere de estudios para descartar trombofilias asociadas u otros estados protrombóticos. El déficit de proteína S es una trombofilia infrecuente, la cual se asocia en la vida adulta a eventos trombóticos de origen venoso. En presencia de defectos anatómicos, como un foramen oval permeable, puede progresar a embolia arterial, configurando un cuadro de embolismo paradójico. La estratificación de estos pacientes requiere imágenes que demuestran el defecto mencionado, así como el posible origen de los émbolos. El manejo se basa en anticoagulación plena, manejo de soporte, resolver las manifestaciones trombóticas existentes y un cierre temprano del defecto anatómico. Conclusiones. El embolismo paradójico debe sospecharse en caso de trombosis de sitios inusuales. Requiere de un estudio exhaustivo con imágenes y su manejo debe basarse en anticoagulación y cierre del defecto.

Introduction. Paradoxical embolism is a thrombotic event originating in the venous circulation, which manifests as arterial embolism through an anatomical cardiac or pulmonary defect. It is mainly associated with stroke, also presenting as acute myocardial infarction, renal infarction, and other ischemic events. Clinical case. A 47-year-old patient was admitted due to abdominal pain, which required emergency surgical management, finding significant intestinal ischemia. Additional studies found protein S deficiency and evidence of a patent foramen ovale. Discussion. Arterial thrombosis is known as unusual thrombosis; this situation requires to rule out associated thrombophilia or other prothrombotic diseases. Protein S deficiency is a rare thrombophilia, which in adults causes venous thrombosis. In the presence of anatomical defects, such as a patent foramen ovale, it can progress to arterial embolism, presenting a picture of paradoxical embolism. The study work of these patients requires imaging that demonstrates the aforementioned defect, as well as the possible origin of the emboli. Management is based on full anticoagulation, treatment of existing thrombotic manifestations, and management of the anatomical defect. Conclusions. Paradoxical embolism should be suspected in case of unusual thrombosis. It requires exhaustive studies based on imaging, and management should consist of anticoagulation and closure of the defect.

Model to subtract contributions of scattered radiation from measured direct transmittance and specular reflectance by light diffusing materials.

The formalism of the Lorenz-Mie (LM) theory is used to estimate the contributions of radiation being scattered into the detector acceptance angle of spectrophotometers (with or without an integrating sphere) to the apparent direct transmittance and specular reflectance measurements. These contributions are subtracted from the measurements before doing the inversion to obtain the spectral variation of the scattering and absorption (S&A) coefficients of optically particulate liquid samples, decoupling the contribution to extinction from these two mechanisms. The method is applied to transmittance spectra of Pickering emulsions of dodecane oil (DO) and DO micelles with saturated dissolved Nile red dye, stabilized with anatase (T i O 2) in water. What we believe to be novel expressions are given to estimate the forward and backward average path-length parameters of propagating diffuse radiation from its equivalent quantities defined within the formalism of the LM theory and to relate these single particle average path-length parameters with the forward scattering ratio, asymmetry parameter, and higher-order coefficients in the expansion of the LM phase function. This novel approach makes it possible to avoid the underestimation of the S&A coefficients, which arises when the correction is not made by subtracting that contribution due to scattered radiation that is reaching the detectors from the directional reflectance and transmittance measurements.

Atrial fibrillation with low cardioembolic risk and ischemic cerebrovascular accidents / Fibrilación auricular con riesgo cardioembólico bajo y accidente cerebrovascular isquémico

Abstract Atrial fibrillation is the most prevalent disease in hypertensive patients over the age of 60. Although a large proportion of patients have symptoms related to this arrhythmia, some asymptomatic patients may experience cerebrovascular accidents as the only clinical manifestation. It is very important for clinicians to have a clear understanding of the tools, scales and specific information required for performing an appropriate assessment of patients with atrial fibrillation, in order to prevent its complications. We present the case of a male patient with atrial fibrillation and a low risk of ischemic cardiovascular accidents, whose implanted event monitor showed no evidence of arrhythmias for over one year, and who developed an ischemic CVA in multiple cerebral territories, with subsequent documentation of a thrombus in the left atrial appendage. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2006).

Resumen La fibrilación auricular es la enfermedad más prevalente en pacientes hipertensos mayores de 60 años. Si bien una gran proporción de pacientes tiene síntomas relacionados con esta arritmia, algunos pacientes asintomáticos pueden desarrollar accidentes cerebrovasculares como única manifestación clínica. Para el clínico es importante tener un conocimiento claro sobre las herramientas, escalas e información específica para realizar una correcta valoración del paciente con fibrilación auricular, con el objetivo de prevenir las complicaciones relacionadas con esta arritmia. Se presenta el caso de un paciente de sexo masculino con fibrilación auricular y riesgo bajo de accidente cerebrovascular isquémico, portador de monitor de eventos, sin evidencia de arritmia por más de un año, quien desarrolló un ACV isquémico en múltiples territorios cerebrales, con posterior documentación de trombo en la auriculilla izquierda. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2006).

Anomalía de Ebstein y aneurisma del seno coronario / Ebstein’s anomaly and coronary sinus aneurysm

Resumen La anomalía de Ebstein es una cardiopatía congénita poco común que se asocia a la presencia de vías de conducción anómalas y episodios de taquicardia supraventricular frecuentes, algunos inestables. La asociación con alteraciones anatómicas del seno coronario es rara y no ha sido reportada. Se presenta el caso de una paciente de 58 años con enfermedad coronaria, anomalía de Ebstein, episodios de taquicardia ortodrómica y aneurisma del seno coronario, a quien se realizó ablación.

Abstract Ebstein’s disease is a congenital cardiomyopathy, with a low prevalence in the general population. This abnormality has been associated with abnormal cardiac conduction problems, one of the most important being the accessory pathways. In the presence of an accessory pathway, frequent supraventricular tachycardias may occur, some of which are poorly tolerated. The association with the anomalies of the coronary sinus is not currently reported. The case of a 58-year-old woman with Ebstein’s disease, episodes of supraventricular tachycardia, and coronary sinus aneurysm undergoing ablation therapy is presented.

Descripción de los pacientes de 80 o más años intervenidos quirúrgicamente en el laboratorio de electrofisiología en un hospital de tercer nivel / Description of patients aged 80 or older undergoing surgery in the electrophysiology lab of a tertiary care hospital

Resumen Introducción: en una unidad de electrofisiología de un hospital de tercer nivel de Manizales, Caldas, se han atendido pacientes en la cuarta edad; sin embargo, existe poca claridad en la literatura sobre las conductas terapéuticas en este grupo etario. Presentamos nuestra experiencia de atención e intervención en pacientes mayores de 80 años entre el 20 de septiembre de 2017 y 7 de octubre de 2019. Métodos: estudio tipo cohorte longitudinal, se recogió información con base en revisión de historias clínicas. Se realizaron seguimientos telefónicos al tercer y sexto mes del procedimiento. Se incluyeron pacientes mayores de 80 años intervenidos de cualquier procedimiento en la sala de electrofisiología. Se excluyeron los pacientes sin información sobre los datos de seguimiento. Resultados: se recogieron datos de 75 pacientes llevados a procedimiento. El 62.7% de los pacientes fueron hombres, las edades oscilaron entre 80 y 95 años. 32.7%, de pacientes con diagnóstico de disfunción sinusal. La comorbilidad más prevalente fue hipertensión arterial (92%). El procedimiento más realizado fue el implante de marcapaso bicameral. La mediana del tiempo de estancia hospitalaria fue de 1 día. EL 70% de los pacientes tuvieron riesgo medio o bajo según la escala CHA2DS2VASc. En el lapso de seis meses se encontró una incidencia acumulada de complicaciones de 4%, con 8% de reconsultas y una mortalidad de 1.3%. Conclusiones: las complicaciones posquirúrgicas, la necesidad y duración de la hospitalización, la tasa de reconsulta y la mortalidad asociada a los procedimientos en este grupo de edad son similares a las observadas en estudios con población menor de 80 años.

Abstract Introduction: fourth age patients have been cared for in the electrophysiology unit of a tertiary care hospital in Manizales, Caldas; however, there is little clarity in the literature regarding therapeutic conduct in this age group. We present our experience of care and intervention in patients over the age of 80 between September 20, 2017 and October 7, 2019. Methods: a longitudinal cohort study in which data was collected from a chart review. Telephone follow up was performed three and six months after the procedure. Patients over the age of 80 who had undergone any procedure in the electrophysiology lab were included. Patients without follow up information were excluded. Results: data were collected on 75 patients undergoing a procedure: 62.7% of the patients were men, ages ranged from 80 to 95, and 32.7% of the patients had a diagnosis of sinus dysfunction. The most prevalent comorbidity was arterial hypertension (92%). The most frequently performed procedure was dual chamber pacemaker implantation. The median hospital stay was one day. Seventy percent of the patients had a medium or low risk according to the CHA2DS2-VASc scale. Over a six-month period, a 4% cumulative incidence of complications was found, with 8% reconsultation and 1.3% mortality. Conclusions: postsurgical complications, the need for and length of hospitalization, the rate of reconsultation and the mortality associated with procedures in this age group are similar to those seen in studies of populations under 80 years old.

Impact of frailty and viral load on acute kidney injury evolution in patients affected by Coronavirus Disease 2019.

This paper describes the main characteristics of coronavirus diseases 2019 (COVID-19) patients suffering from acute kidney injury (AKI) assisted at a high complexity clinic in Barranquilla, Colombia. The patients included in this study (n = 48) were those with a positive diagnosis of COVID-19 confirmed by polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2, who had developed AKI during their hospital stay. Serum and urine parameters, as well as patient's viral load and clinical frailty scale (CFS) were recorded. A statistical analysis of the recorded parameters, such as comparisons, and correlations between variables of interest, were explored. The prevalence of COVID-19 induced AKI was 41%, being the majority of them classified as AKI network classification 3, with a renal replacement therapy requirement of 29%, and an associated mortality of 73%. AKI patients' mortality showed a significant positive correlation (33%) with patients' CFS score but not with their viral load. COVID-19 induced AKI significantly correlated with patients' frailty status but not to their viral load.

Reporte de cuatro casos COVID-19 hospitalizados en unidad de cuidados intensivos en una institución hospitalaria en Barranquilla, Colombia / Original article: Case-Serie of 4 COVID-19 patients hospitalized in an intensive care unit in a hospital institution in Barranquilla, Colombia

Resumen Presentar una serie de casos de COVID-19 con requerimiento de ingreso a Unidad de Cuidados Intensivos. La información fue tomada de las historias clínicas, y su evaluación y diagnóstico fue realizado mediante estudios paraclínicos en sangre, orina, PCR e imágenes diagnósticas en 4 pacientes con diferentes comorbilidades y nexo epidemiológico presente para desarrollo de la enfermedad. Los cuatro casos fueron manejados con cloroquina 300 mg vía oral, cada 12 horas, y azitromicina 1 gr vía oral, cada 24 horas, durante 5 días, sin complicaciones ni toxicidad asociada. El caso 1 desarrolló falla orgánica múltiple, incluyendo injuria renal aguda con una estancia en UCI de 4 días antes de su fallecimiento, mientras los casos 2, 3 y 4 tuvieron una evolución favorable y fueron dados de alta de UCI. Se requieren estudios multicéntricos rápidos que orienten científicamente hacia un mejor abordaje diagnóstico y manejo, en el contexto de una enfermedad con un comportamiento clínico-epidemiológico que debe estudiarse en profundidad y que probablemente cobrará muchas vidas; además, debido a la ausencia de pruebas diagnósticas rápidas, la utilización de una clasificación basada en la severidad de lesiones radiológicas llamada CO-RADS (Covid-19 Imaging Reporting and Data System) podría ser de gran importancia para instalar de manera temprana los tratamientos farmacológicos disponibles y la asistencia respiratoria mecánica precoz.

Abstract To present a COVID-19 case series with clinical admission criteria to Intensive Care Unit. Patients information was obtained from medical records, and daily clinical evaluation whereas diagnosis was carried out through paraclinical studies in blood, urine, PCR and diagnostic images in 4 patients with different comorbidities and epidemiological link for the development of COVID-19. All four cases were managed with chloroquine 300 mg orally every 12 hours and azithromycin orally every 24 hours for 5 days without complications or associated toxicity. The case 1 developed multiple organ failure, including acute kidney injury with an ICU stay of 4 days before his death, while cases 2, 3 and 4 had a favorable evolution and were discharged from the ICU. Rapid multicenter studies are required to scientifically guide a better diagnostic and management approach, in the context of a disease with a clinical-epidemiological behavior that must be studied in depth and will probably take many lives. In addition, due to the absence of sufficiently rapid tests, the use of a classification based on the severity of radiological lesions called CO-RADS (Covid-19 Imaging Reporting and Data System) could be of great importance to install available pharmacological treatments early and early mechanical respiratory support.

Impact of umbilical cord length on fetal circulatory system by Doppler assessment.

INTRODUCTION: Numerous studies have revealed the impact of umbilical cord (UC) length on fetal perfusion; abundant data implicate abnormal UC length to neurological delay and subsequent poor prognoses for fetuses and newborns. Indeed, our group previously developed theoretical approximations that contributed to formulas capable of explaining the impact of UC length on cardiac output. METHODS: We performed an observational study that measured the pulsatility index and flow velocity in umbilical arteries. A special Doppler measured proximal and distal indexes in both arteries. After birth, medical staff measured complete UC length. We obtained maternal and neonatal outcomes from clinical records. RESULTS: Our study enrolled 20 pregnant mothers. We found that flow velocities in the two edges were different: fetal edges exhibited greater velocity in the majority of cases; but, when we compared pressure differentials (ΔP), the pulsatility index was significantly related to umbilical cord length. CONCLUSIONS: Fetal perfusion, welfare, and viability are related to UC function as the conveyor of all fetal volemia. Excessive UC length affects cardiac dynamics and increases peripheral vascular resistance. Further studies could validate routine use of the differential proximal and distal measurements proposed in this article, and their implications in in utero fetal heart function. We also hope that early diagnosis or UC alterations could alert neonatologists and obstetricians to clinical conditions of the fetus.

Asystole in an older patient with recurrent falls. case report

ABSTRACT Introduction: Recurrent falls are a usual problem in older patients. It is therefore important to learn how to differentiate a pathological or syncopal episode from a simple stumbling fall, especially in patients who have limitations for communicating clearly and are poorly understood, in general terms, during the medical consultation. Implantable loop recorders (ILR) have been used as an investigation tool in selected cases of recurrent falls in older patients. Consequently, this case report aims to describe its usefulness in this type of patients. Case presentation: An 87-year-old female patient, hypertensive, with a history of recent stroke and frequent falls -referred to as stumbling-, received an implantable loop recorder due to atrial fibrillation. During one follow-up appointment, a 36-second pause related to a fall was documented, so a bicameral pacemaker was implanted. Conclusions: Evaluating repeated falls in older patients is complex; it must be done in detail to rule out syncopal episodes. Implantable devices to diagnose arrhythmic causes are useful and allow achieving accurate diagnoses and establish specific behaviors aimed at improving the quality of life of patients.

RESUMEN Introducción. Las caídas frecuentes son un problema común en pacientes de la tercera y la cuarta edad, por tanto es importante saber diferenciar cuando se trata de un evento patológico o sincopal, y cuando es un simple tropiezo, sobre todo en pacientes que tienen limitaciones para comunicarse de forma clara y son poco entendidos en términos generales durante la consulta médica. Los monitores de eventos cardiacos pueden ser usados en casos seleccionados de caídas frecuentes en adultos mayores para determinar las posibles causas de estos eventos, por lo que el presente reporte de caso pretende mostrar cuál es su utilidad en un paciente con caídas no sincopales a repetición. Presentación del caso. Paciente femenina de 87 años, hipertensa, con evento cerebrovascular reciente e historia de caídas a repetición referidas como tropiezos, a quien se le implantó un dispositivo diagnóstico de fibrilación auricular. En uno de los controles se observó pausa de 36 segundos relacionada con episodio de caída, por lo que se implantó un marcapasos bicameral. Conclusiones. La evaluación de caídas a repetición en pacientes mayores es compleja y debe realizarse de forma detallada para descartar síncope. El uso de monitores de eventos cardiacos para la identificación de causas arrítmicas de estos eventos permite diagnósticos certeros, con lo que a su vez es posible establecer tratamientos específicos que mejoren la calidad de vida de los pacientes.

Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011-2015.

Introduction: Is achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public's health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015. Methods: We conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage. A two-sample, two-sided Z-test of proportions tested for changes in national health service coverage between 2011 (n=11 800) and 2015 (n=10 792). Results: Twenty-two of 27 national indicator estimates (81.5%) of MNCRH service coverage improved significantly. Examples: malaria prophylaxis in pregnancy increased by 8.6% (p<0.001) to 33.1% (397/1199 mothers, 95% CI ±2.9%), institutional deliveries by 10.5% (p<0.001) to 20% (230/1199 mothers, ±2.6%) and measles vaccination coverage in children aged 12-23 months by 11.2% (p<0.001) to 49.7% (529/1064 children, ±2.3%). The largest increase (17.7%, p<0.001) occurred for mothers treating diarrhoea in children aged 0-59 months with oral rehydration salts to 51.4% (635/1235 children, ±2.9%). Antenatal and postnatal care, and contraceptive prevalence did not change significantly. Child vitamin A supplementation decreased. Despite significant increases, coverage remained low (median of all indicators = 31.3%, SD = 19.7). Coverage varied considerably by state (mean SD for all indicators and states=11.1%). Conclusion: Health system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased.

Photonic Crystal Characterization of the Cuticles of Chrysina chrysargyrea and Chrysina optima Jewel Scarab Beetles.

A unified description involving structural morphology and composition, dispersion of optical constants, modeled and measured reflection spectra and photonic crystal characterization is devised. Light reflection spectra by the cuticles of scarab beetles (Chrysina chrysargyrea and Chrysina optima), measured in the wavelength range 300-1000 nm, show spectrally structured broad bands. Scanning electron microscopy analysis shows that the pitches of the twisted structures responsible for the left-handed circularly polarized reflected light change monotonically with depth through the cuticles, making it possible to obtain the explicit depth-dependence for each cuticle arrangement considered. This variation is a key aspect, and it will be introduced in the context of Berreman's formalism, which allows us to evaluate reflection spectra whose main features coincide in those displayed in measurements. Through the dispersion relation obtained from the Helmholtz's equation satisfied by the circular components of the propagating fields, the presence of a photonic band gap is established for each case considered. These band gaps depend on depth through the cuticle, and their spectral positions change with depth. This explains the presence of broad bands in the reflection spectra, and their spectral features correlate with details in the variation of the pitch with depth. The twisted structures consist of chitin nanofibrils whose optical anisotropy is not large enough so as to be approached from modeling the measured reflection spectra. The presence of a high birefringence substance embedded in the chitin matrix is required. In this sense, the presence of uric acid crystallites through the cuticle is strongly suggested by frustrated attenuated total reflection and Raman spectroscopy analysis. The complete optical modeling is performed incorporating the wavelength-dependent optical constants of chitin and uric acid.

Optical, magnetic, and charge-carriers transport properties of a transition metal: bulk palladium.

Three parametric models of Drude-Lorentz (DL) are used to describe the spectral variation of the dielectric function of bulk palladium. An improved version of the acceptance-probability-controlled simulated annealing method is applied to optimize the values of the parameters involved in the models: high-frequency dielectric constant, free-electron collision frequency and corresponding relaxation time, oscillation strengths, nominal resonance frequencies, and Lorentzian widths. Normalization of the oscillation strengths allows the introduction of a new parameter in the context of the original DL model: the number density ratio, which is the ratio between the number density of conduction electrons and the number density of metal atoms. Inclusion of this parameter in the optimization procedure allows us to evaluate additional parameters related to the charge-carriers transport: the number density of conduction electrons, average effective mass of conduction electrons and holes, Fermi energy and electronic density of states at the Fermi energy, electrical resistivity, intrinsic mean-free path of conduction electrons, electronic heat capacity, Hall coefficient, as well as the mobilities of conduction electrons and holes. The paramagnetic and diamagnetic susceptibilities are also included as derived parameters. A parametric form of the bulk Pd dielectric function, with incorporation of the average local electric field effect in the Lorentz contribution, is reported.

Dielectric functions of Pd and Zr transition metals: an application of Drude-Lorentz models with simulated annealing optimization.

An accepted-probability-controlled simulated annealing (APCSA) method has shown to be a valuable tool to describe, in parametric form, by means of an extended Drude-Lorentz model, the dielectric function of several metals through infrared, visible, and ultraviolet photon energies [Appl. Opt.37, 5271 (1998)APOPAI0003-693510.1364/AO.37.005271]. In this work, an improved APCSA approach is used to estimate the parameters involved in an extended Drude-Lorentz type model which incorporates the dielectric constant due to a background electronic polarization in the Drude term and the normalization of the individual oscillation strengths involved in the Lorentz contributions to the dielectric function. This last approach allows us to introduce a new parameter z to be optimized: the number density ratio, i.e., the ratio between number density of conduction electrons and number density of metal ions. From the optimization of the z value within this novel approach, we evaluate other parameters: electrical resistivity, electron mean free path, effective mass of conduction electrons and relaxation time, Fermi energy, electronic density of states at the Fermi level, and electronic heat capacity coefficient. Application of the model is carried out to describe the dielectric functions of two transition metals, Pd and Zr, through ultraviolet, visible, and infrared photon energies.

Uso de los sistemas de presión negativa en el tratamiento de infecciones asociadas a dispositivos: ''una vieja terapia con un uso novedoso'' / Use of negative pressure systems for the management of infections associated to devices: ''an old therapy with a new use''

Resumen Introducción: El cuidado de los pacientes con infecciones asociadas al dispositivo sin endocarditis, incluye: la extracción completa y la realización de capsulectomía para evitar la reinfección. El uso de nuevos elementos como el sistema de la presión negativa es una terapia novedosa que ha demostrado disminuir: los tiempos de recuperación, el tiempo de estancia intrahospitalaria, la necesidad de nuevas intervenciones por sangrado o lavado y el tiempo de espera para un nuevo implante. Nuestro objetivo es describir la experiencia de un centro de cuarto nivel, en el manejo de las infecciones asociadas a los dispositivos sin endocarditis, con el uso de la terapia de presión negativa como parte del manejo. Metodología: Se realizó una descripción retrospectiva de la experiencia en el manejo de la terapia de presión negativa en pacientes con infecciones asociadas a dispositivo, en un centro de cuarto nivel. Se exponen cinco casos, a los que se les realizó: la extracción completa del dispositivo, la capsulectomía anterior y posterior, el lavado quirúrgico y el implante de la terapia con presión negativa. Conclusión: La experiencia presentada demuestra que el uso de la terapia de presión negativa es un protocolo de tratamiento novedoso, que en nuestros pacientes con infección asociada a dispositivo sin endocarditis, es segura y de fácil utilización.

Abstract Introduction: Care for patients with infections associated to the device without endocarditis include complete extraction and performing a capsulectomy to avoid reinfection. The use of new elements, such as the negative pressure system, is a new therapy that has shown to reduce recovery time, inpatient stay, need of new interventions due to bleeding or washing and waiting time for a new implant. The goal is to describe the experience of a fourth level centre for managing infections associated with devices without endocarditis using a negative pressure system as part of the therapy. Methods: Descriptive retrospective study of the experience of negative pressure therapy for managing patients with device-related infections at a fourth level centre. Five cases are exposed where complete removal of the device, anterior and posterior capsulectomy, surgical washing and negative pressure therapy were performed. Conclusion: Presented experience shows that the use of negative pressure therapy is a new therapy protocol that is safe and easy for managing our patients with an infection associated to the device without endocarditis.

Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.

BACKGROUND: It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. METHODS: We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups. RESULTS: We show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. CONCLUSIONS: Our results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year.

Masa en cuello secundaria a electrodo de estimulación cardiaca abandonado / Neck mass secondary to an abandoned pacing lead

Mujer de 70 años de edad, con historia de un electrodo de estimulación cardiaca abandonado, que genera: un trastorno de la deglución y una deformidad estética que la hacen consultar en múltiples oportunidades. A pesar de que se planteó la opción del retiro quirúrgico, se logró una extracción endovascular por la tracción de un electrodo. Describimos la utilidad del eco intracardiaco y el catéter ENSnare®, para la extracción de los electrodos en este tipo de casos.

70-year-old woman with a history of an abandoned pacing lead who developed a deglutition disorder and an aesthetic deformity that made her consult in multiple specialties. Even though surgical removal was considered, endovascular extraction was accomplished with the traction of the lead. We describe the usefulness of the intracardiac echocardiography and the ENSnare® catheter for this type of lead extractions.