Conventional and frugal methods of estimating COVID-19-related excess deaths and undercount factors.

Across the world, the officially reported number of COVID-19 deaths is likely an undercount. Establishing true mortality is key to improving data transparency and strengthening public health systems to tackle future disease outbreaks. In this study, we estimated excess deaths during the COVID-19 pandemic in the Pune region of India. Excess deaths are defined as the number of additional deaths relative to those expected from pre-COVID-19-pandemic trends. We integrated data from: (a) epidemiological modeling using pre-pandemic all-cause mortality data, (b) discrepancies between media-reported death compensation claims and official reported mortality, and (c) the "wisdom of crowds" public surveying. Our results point to an estimated 14,770 excess deaths [95% CI 9820-22,790] in Pune from March 2020 to December 2021, of which 9093 were officially counted as COVID-19 deaths. We further calculated the undercount factor-the ratio of excess deaths to officially reported COVID-19 deaths. Our results point to an estimated undercount factor of 1.6 [95% CI 1.1-2.5]. Besides providing similar conclusions about excess deaths estimates across different methods, our study demonstrates the utility of frugal methods such as the analysis of death compensation claims and the wisdom of crowds in estimating excess mortality.

Wire Arc Additive Manufactured Mild Steel and Austenitic Stainless Steel Components: Microstructure, Mechanical Properties and Residual Stresses.

Wire arc additive manufacturing (WAAM) is an additive manufacturing process based on the arc welding process in which wire is melted by an electric arc and deposited layer by layer. Due to the cost and rate benefits over powder-based additive manufacturing technologies and other alternative heat sources such as laser and electron beams, the process is currently receiving much attention in the industrial production sector. The gas metal arc welded (GMAW) based WAAM process provides a higher deposition rate than other methods, making it suitable for additive manufacturing. The fabrication of mild steel (G3Si1), austenitic stainless steel (SS304), and a bimetallic sample of both materials were completed successfully using the GMAW based WAAM process. The microstructure characterization of the developed sample was conducted using optical and scanning electron microscopes. The interface reveals two discrete zones of mild steel and SS304 deposits without any weld defects. The hardness profile indicates a drastic increase in hardness near the interface, which is attributed to chromium migration from the SS304. The toughness of the sample was tested based on the Charpy Impact (ASTM D6110) test. The test reveals isotropy in both directions. The tensile strength of samples deposited by the WAAM technique measured slightly higher than the standard values of weld filament. The deep hole drilling (DHD) method was used to measure the residual stresses, and it was determined that the stresses are compressive in the mild steel portion and tensile in austenitic stainless steel portion, and that they vary throughout the thickness due to variation in the cooling rate at the inner and outer surfaces.

Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART / Incidence of cardiovascular events and changes in the estimated risk and treatment of familial hypercholesterolemia: the SAFEHEART registry

INTRODUCCIÓN Y OBJETIVOS: El estudio SAFEHEART se diseñó para analizar la situación y mejorar el conocimiento de la hipercolesterolemia familiar heterocigota (HFH) en España. Nuestro objetivo es determinar la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento y su modificación, el empleo de tratamiento hipolipemiante y la consecución de objetivos de colesterol unido a lipoproteínas de baja densidad en pacientes con HFH. MÉTODOS: El SAFEHEART es un estudio prospectivo de cohorte, abierto, multicéntrico, de escala nacional, con seguimiento protocolizado a largo plazo en una población de HFH caracterizada molecularmente. Se analizó a los pacientes mayores de 18 años con seguimiento completo. RESULTADOS: El análisis en este estudio se hizo con 2.648 pacientes con HFH. La mediana de seguimiento fue de 6,6 (4,8-9,7) años. La tasa de incidencia general de eventos cardiovasculares fue de 1,3 eventos/100 pacientes-año. El riesgo estimado de sufrir un evento cardiovascular a 10 años se redujo en el seguimiento, y pasó del 1,6 al 1,3% (p <0,001). En el último seguimiento, el 20,6 y el 22,2% de los pacientes en prevención primaria y secundaria consiguieron un colesterol unido a lipoproteínas de baja densidad <100 y <70 mg/dl respectivamente. CONCLUSIONES: En este estudio se muestra la tasa de incidencia de eventos cardiovasculares, el riesgo estimado de sufrir un evento cardiovascular en la mayor población de pacientes con HF en España, así como su modificación, la consecución de objetivos en colesterol unido a lipoproteínas de baja densidad y su tratamiento. Aunque el riesgo cardiovascular de la HFH es elevado, un adecuado tratamiento reduce la probabilidad de sufrir un evento

INTRODUCTION AND OBJECTIVES: The SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. METHODS: SAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. RESULTS: We included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P <.001). In the last follow-up, 20.6% and 22.2% of the patients in primary and secondary prevention achieved low-density lipoprotein cholesterol values <100mg/dL and <70mg/dL, respectively. CONCLUSIONS: This study was performed in the largest population of patients with FHH in Spain. We identified the incidence rate of cardiovascular events, the estimated risk of developing a cardiovascular event and its modification, the achievement of low-density lipoprotein cholesterol targets, and the therapeutic management in this population. Although the cardiovascular risk of FHH is high, appropriate treatment reduces the likelihood of an event

Incidence of cardiovascular events and changes in the estimated risk and treatment of familial hypercholesterolemia: the SAFEHEART registry.

INTRODUCTION AND OBJECTIVES: The SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. METHODS: SAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. RESULTS: We included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P <.001). In the last follow-up, 20.6% and 22.2% of the patients in primary and secondary prevention achieved low-density lipoprotein cholesterol values <100mg/dL and <70mg/dL, respectively. CONCLUSIONS: This study was performed in the largest population of patients with FHH in Spain. We identified the incidence rate of cardiovascular events, the estimated risk of developing a cardiovascular event and its modification, the achievement of low-density lipoprotein cholesterol targets, and the therapeutic management in this population. Although the cardiovascular risk of FHH is high, appropriate treatment reduces the likelihood of an event. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Identifier: NCT02693548.

Removal of contaminants of emerging concern by continuous flow solar photo-Fenton process at neutral pH in open reactors.

For the first time, the operational feasibility of the solar photo-Fenton process at neutral pH in continuous flow has been tested for three consecutive days. The aim of the treatment was to remove of contaminants of emerging concern (CECs) from wastewater treatment plant secondary effluents. To this end, a 5 cm-deep raceway pond reactor was run in continuous flow mode and the degradation of the CECs present in real secondary effluents was monitored at their natural concentrations. To keep dissolved iron at neutral pH, ethylenediamine-N,N'-disuccinic acid (EDDS) was used to form the complex Fe(III):EDDS as an iron source for the photo-Fenton reactions. At pilot scale the effects of the Fe(III):EDDS molar ratio (1:1 and 1:2) and hydraulic residence time (HRT) (20 and 40 min) on CEC removal were studied. The best operating condition was 20 min of HRT, giving rise to a treatment capacity of 900 L m-2 d-1 with CEC removal percentages of around 60%. The reactant concentrations were 0.1 mM Fe(III):EDDS at a 1:1 M ratio and 0.88 mM H2O2. Under these operating conditions, the short-term stability of the process was also demonstrated, thus pointing out the potential of this solar technology as a tertiary treatment.

[Commercial video games in the rehabilitation of patients with sub-acute stroke: a pilot study]. / Videojuegos comerciales en la rehabilitacion de pacientes con ictus subagudo: estudio piloto.

INTRODUCTION: Stroke generates dependence on the patients due to the various impairments associated. The use of low-cost technologies for neurological rehabilitation may be beneficial for the treatment of these patients. AIM: To determine whether combined treatment using a semi-immersive virtual reality protocol to an interdisciplinary rehabilitation approach, improve balance and postural control, functional independence, quality of life, motivation, self-esteem and adherence to intervention in stroke patients in subacute stage. PATIENTS AND METHODS: A longitudinal prospective study with pre and post-intervention evaluation was carried out. Fourteen were recruited at La Fuenfria Hospital (Spain) and completed the intervention. Experimental intervention was performed during eight weeks in combination with conventional treatment of physiotherapy and occupational therapy. Each session was increased in time and intensity, using commercial video games linked to Xbox 360° videoconsole and Kinect sensor. RESULTS: There were statistical significant improvements in modified Rankin scale (p = 0.04), baropodometry (load distribution, p = 0.03; support surface, p = 0.01), Barthel Index (p = 0.01), EQ-5D Questionnaire (p = 0.01), motivation (p = 0.02), self-esteem (p = 0.01) and adherence to the intervention (p = 0.02). CONCLUSIONS: An interdisciplinary rehabilitation approach supplemented with semi-immersive virtual reality seems to be useful for improving balance and postural control, functional independence in basic activities of daily living, quality of life, as well as motivation and self-esteem, with excellent adherence. This intervention modality could be adopted as a therapeutic tool in neurological rehabilitation of stroke patients in subacute stage.

TITLE: Videojuegos comerciales en la rehabilitacion de pacientes con ictus subagudo: estudio piloto.Introduccion. El ictus genera dependencia por los numerosos deficits asociados. El uso de tecnologias de bajo coste para la rehabilitacion neurologica podria ser beneficioso para el tratamiento de estos pacientes. Objetivo. Determinar si el tratamiento combinado mediante un protocolo con realidad virtual semiinmersiva, junto con un abordaje rehabilitador interdisciplinar, mejora el equilibrio y el control postural, la independencia funcional, la calidad de vida, la motivacion, la autoestima y la adhesion a la intervencion en pacientes que han sufrido un ictus en fase subaguda. Pacientes y metodos. Estudio piloto prospectivo longitudinal con valoracion pre y postintervencion. Se seleccionaron 14 participantes ingresados en el Hospital La Fuenfria. La intervencion experimental se realizo durante ocho semanas en combinacion con el tratamiento convencional de fisioterapia y terapia ocupacional. Cada sesion fue incrementandose en tiempo-intensidad y requerimientos motores mediante videojuegos comerciales vinculados a la videoconsola Xbox 360° y el dispositivo Kinect. Resultados. Se obtuvieron mejorias estadisticamente significativas en la escala de Rankin modificada (p = 0,04), baropodometria (distribucion de carga, p = 0,03; superficie de apoyo, p = 0,01), indice de Barthel (p = 0,01), cuestionario EuroQoL 5D (p = 0,01), motivacion (p = 0,02), autoestima (p = 0,01) y adhesion a la intervencion (p = 0,02). Conclusiones. El abordaje rehabilitador complementado con realidad virtual semiinmersiva parece ser util para mejorar el equilibrio y el control postural, la independencia funcional en las actividades basicas de la vida diaria, la calidad de vida, asi como la motivacion y la autoestima, con excelente adhesion a las intervenciones, por lo que podria constituir una herramienta terapeutica coadyuvante en la rehabilitacion neurologica del ictus en fase subaguda.

Ecotoxicity evaluation of a WWTP effluent treated by solar photo-Fenton at neutral pH in a raceway pond reactor.

Some pollutants can be resistant to wastewater treatment, hence becoming a risk to aquatic and terrestrial biota even at the very low concentrations (ng L-1-µg L-1) they are commonly found at. Tertiary treatments are used for micropollutant removal but little is known about the ecotoxicity of the treated effluent. In this study, a municipal secondary effluent was treated by a solar photo-Fenton reactor at initial neutral pH in a raceway pond reactor, and ecotoxicity was evaluated before and after micropollutant removal. Thirty-nine micropollutants were identified in the secondary effluent, mainly pharmaceuticals, with a total concentration of ≈80 µg L-1. After treatment, 99 % microcontaminant degradation was reached. As for ecotoxicity reduction, the assayed organisms showed the following sensitivity levels: Tetrahymena thermophila > Daphnia magna > Lactuca sativa > Spirodela polyrhiza ≈ Vibrio fischeri. The initial effluent showed an inhibitory effect of 40 % for T. thermophila and 20 % for D. magna. After 20 min of photo-Fenton treatment, no toxic effect was observed for T. thermophila and toxicity dropped to 5 % for D. magna. Graphical abstract Ecotoxicity removal by solar photo-Fenton at neutral pH. ᅟ.

Contact urticaria to Cannabis sativa due to a lipid transfer protein (LTP)

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Multivisceral Resection for Locally Advanced Rectal Cancer: Prognostic Factors Influencing Outcome.

AIMS: To assess outcome in patients with locally advanced rectal cancer undergoing multivisceral resection. METHODS: Retrospective study of 30 consecutive patients (mean age 67.8 years) with primary locally advanced rectal cancer undergoing en bloc multivisceral resection of the organs involved with curative intent between 1998 and 2010. Overall survival, local and distal recurrence, and disease-free survival were analyzed by the Kaplan-Meier method. Risk factors for clinical outcome were obtained using a Cox multivariate model. RESULTS: Postoperative complications occurred in 76.7% of patients and the in-hospital mortality rate was 10%. The median follow-up was 28.8 months. A total of 19 patients died at follow-up. Of the 11 patients who were alive, 7 were free of disease. In the multivariate analysis, lymph node involvement, stage II, and lymph vascular invasion were significantly associated with survival, and stage III showed a strong trend towards significance. Suture dehiscence (peritonitis and intra-abdominal abscess) showed a significant trend towards a higher local recurrence. Lymph vascular invasion was associated with a higher distant recurrence. CONCLUSION: Lymph node involvement was associated with worse survival, whereas stage II and absence of lymph vascular invasion were associated with a better survival. Lymph vascular invasion was associated with a higher distant recurrence.

Registro de la actividad muscular en abductores y adductores en las alteraciones de cadera de los individuos con parálisis cerebral / Recording of the muscle activity in abductors and adductors in hip alterations of individuals with cerebral palsy

Objetivos. Asociar la contracción en bipedestación de abductores y adductores de cadera con las alteraciones coxofemorales y el nivel de la función motora gruesa en los individuos con parálisis cerebral. Método. Se valoró la actividad muscular en bipedestación de abductores y adductores de cadera en 22 individuos con parálisis cerebral mediante electromiógrafo de superficie. La contracción se expresó en porcentaje respecto a la contracción máxima isométrica de los mismos grupos musculares. Resultados. El 100% de las luxaciones de cadera bilaterales presentan un porcentaje de contracción de abductores y adductores en bipedestación en relación con la máxima isométrica mayor de 3 desviaciones típicas. Para el porcentaje de contracción en dichos grupos musculares de menos de 3 desviaciones típicas el número de luxaciones es 0. El 80% de los individuos que pertenecen al grupo V de la GMFCS presentan en los grupos musculares valorados un porcentaje de contracción de más de 3sigma. Conclusión. En la parálisis cerebral tanto las grandes lesiones en la cadera como las limitaciones en la deambulación parecen depender de trastornos globales del tono que implican tanto a los músculos adductores como a los abductores (AU)

Aims. To associate contraction of hip abductors and adductors in upright position with coxofemoral changes and level of gross motor function in individuals with cerebral palsy. Methods. Muscle activity of hip abductors and adductors was assessed in standing position in 22 individuals with cerebral palsy using surface electromyography. Contraction was expressed as a percentage of maximal isometric contraction of the same muscle groups. Results. One hundred percent of bilateral hip dislocations show a percentage of contraction of abductors and adductors in standing position in relation to the maximum isometric higher than 3 standard deviations (sigma). When the percentage of contraction in these muscle groups is lower than 3 standard deviations, the number of dislocations is zero. Eighty percent of individuals belonging to group V of the gross motor function classifications (GMFCS) have a contraction percentage of more than 3sigma in the muscle groups assessed. Conclusions. In cerebral palsy, both major hip injury and limitations in walking seem to depend on overall tone disorders involving both adductor and abductor muscles (AU)

Automated Identification of Fiducial Points on 3D Torso Images.

Breast reconstruction is an important part of the breast cancer treatment process for many women. Recently, 2D and 3D images have been used by plastic surgeons for evaluating surgical outcomes. Distances between different fiducial points are frequently used as quantitative measures for characterizing breast morphology. Fiducial points can be directly marked on subjects for direct anthropometry, or can be manually marked on images. This paper introduces novel algorithms to automate the identification of fiducial points in 3D images. Automating the process will make measurements of breast morphology more reliable, reducing the inter- and intra-observer bias. Algorithms to identify three fiducial points, the nipples, sternal notch, and umbilicus, are described. The algorithms used for localization of these fiducial points are formulated using a combination of surface curvature and 2D color information. Comparison of the 3D co-ordinates of automatically detected fiducial points and those identified manually, and geodesic distances between the fiducial points are used to validate algorithm performance. The algorithms reliably identified the location of all three of the fiducial points. We dedicate this article to our late colleague and friend, Dr. Elisabeth K. Beahm. Elisabeth was both a talented plastic surgeon and physician-scientist; we deeply miss her insight and her fellowship.

Microwave-promoted catalyst- and solvent-free aza-Diels-Alder reaction of aldimines with 6-[2-(dimethylamino)vinyl]-1,3-dimethyluracil.

A microwave-promoted aza-Diels-Alder reaction between 6-[2-(dimethylamino)vinyl]-1,3-dimethyluracil and aldimines has been developed for the construction of dihydropyrido[4,3-d]pyrimidines. Urea is effectively employed as an environmentally benign source of ammonia in the absence of any catalyst or solvent. The key step in the reaction is in situ generation and trapping of the reactive aldimine formed from urea and aldehyde by the diene system of the uracil. The reaction is clean, and excellent yields are obtained in a matter of a few minutes.

Enfermedad de Scheuermann / Scheuermann's disease

Presentamos dos casos clínicos de dos pacientes diagnosticados después de una detenida anamnesis y exploración física completa, y con la ayuda de una simple radiología convencional, de enfermedad de Scheuermann. Habitualmente es un hallazgo casual, pues la mayoría de las veces son pacientes asintomáticos, pero, en estos dos casos es a raíz de un dolor dorsal-lumbar persistente, inicialmente atribuido a esfuerzo en el trabajo o a una mala postura, que al persistir les hace acudir al médico de familia. Inicialmente los hallazgos radiológicos consisten en irregularidades del margen superior de la mayoría o de todas las vértebras, esclerosis y formación de nódulos cartilaginosos en una proyección radiológica lateral. En los casos en los que las lesiones progresan, se observa que las vértebras adquieren forma de cuña, de tal manera que la cifosis dorsal normal aumenta a un grado patológico (AU)

We present two cases of two patients diagnosed Scheuermann's disease after a detailed anamnesis and complete physical examination, and with the help of a simple conventional radiology. This is usually a casual finding as most patients are often asymptomatic, but in both cases there was a persistent dorsal-lumbar pain initially attributed to work effort or poor posture, which made them go to the family doctor. Initially, the radiological findings are irregularities in the upper of most or all of the vertebrae, sclerosis and formation of cartilaginous nodules in a lateral x-ray projection. In some cases where the lesions are progressing, it is noted that the vertebrae become wedge-shaped, so that the normal dorsal kyphosis increases to a pathological level (AU)

Role of EUS/EUS-guided FNA in the management of proximal biliary strictures.

BACKGROUND/AIMS: Optimal management of proximal biliary strictures depends on staging and adequate tissue diagnosis of suspected malignant lesions. Sensitivity of ERCP brush cytology is poor. EUS/EUS-FNA of these lesions is challenging with limited data on its diagnostic accuracy. We report our experience of EUS/ EUS guided FNA of proximal biliary strictures in a tertiary referral centre. METHODOLOGY: All patients who underwent EUS guided FNA of hilar lesions between October 2003 to July 2007 were identified. The final diagnosis was determined by surgical pathology, results of EUS-FNA or follow-up. RESULTS: 32 patients underwent 36 procedures for hilar lesions during the study period. EUS detected a mass in 9/14 patients who did not have a mass seen on imaging. The mean followup period was 39.43 months. The cytological specimen was adequate in 26 patients. The final diagnosis was adenocarcinoma (24) and benign (8). The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA were 68%, 52 %, 100%, 100% and 54%, respectively. If only adequate aspirates were included in the analysis, the values were 74%, 60%, 100%, 100% and 55% respectively. CONCLUSIONS: EUS guided FNA is a useful modality in the diagnosis and management of hilar lesions.