Point-of-Care Ultrasound Assisting in the Rapid Diagnosis of Acute Cholangitis 60 Years After Cholecystectomy.

BACKGROUND: Point-of-care ultrasound (POCUS) is used frequently to evaluate the right upper quadrant of patients with high suspicion for biliary pathology. In patients with a history of cholecystectomy, the utility of POCUS can be overlooked. CASE REPORT: We report the case of an 83-year-old female patient who was ultimately diagnosed with cholangitis more than 60 years after undergoing cholecystectomy. POCUS demonstrated a dilated common bile duct (CBD), which was confirmed by computed tomography and magnetic resonance cholangiopancreatography to be due to a large stone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Choledocholithiasis and cholangitis can still occur in patients with a remote history of cholecystectomy. POCUS can be used to rapidly evaluate the CBD for dilatation in patients post cholecystectomy.

New Tools for Taming Complex Reaction Networks: The Unimolecular Decomposition of Indole Revisited.

The level of detail attained in the computational description of reaction mechanisms can be vastly improved through tools for automated chemical space exploration, particularly for systems of small to medium size. Under this approach, the unimolecular decomposition landscape for indole was explored through the automated reaction mechanism discovery program AutoMeKin. Nevertheless, the sheer complexity of the obtained mechanisms might be a hindrance regarding their chemical interpretation. In this spirit, the new Python library amk-tools has been designed to read and manipulate complex reaction networks, greatly simplifying their overall analysis. The package provides interactive dashboards featuring visualizations of the network, the three-dimensional (3D) molecular structures and vibrational normal modes of all chemical species, and the corresponding energy profiles for selected pathways. The combination of the joined mechanism generation and postprocessing workflow with the rich chemistry of indole decomposition enabled us to find new details of the reaction (obtained at the CCSD(T)/aug-cc-pVTZ//M06-2X/MG3S level of theory) that were not reported before: (i) 16 pathways leading to the formation of HCN and NH3 (via amino radical); (ii) a barrierless reaction between methylene radical and phenyl isocyanide, which might be an operative mechanism under the conditions of the interstellar medium; and (iii) reaction channels leading to both hydrogen cyanide and hydrogen isocyanide, of potential astrochemical interest as the computed HNC/HCN ratios greatly exceed the calculated equilibrium value at very low temperatures. The reported reaction networks can be very valuable to supplement databases of kinetic data, which is of remarkable interest for pyrolysis and astrochemical studies.

Cuidado espiritual: componente essencial da prática da enfermeira pediátrica na oncologia / Cuidado espiritual: componente esencial de la práctica de la enfermera pediátrica en la oncología / Spiritual care: an essential component of the nurse practice in pediatric oncology

Este é um artigo que aborda o cuidado espiritual na enfermagem pediátrica oncológica, como parte dos pressupostos para a promoção da saúde de famílias que possuem crianças e adolescentes com câncer. Indica elementos sobre a formação do enfermeiro para o oferecimento desse cuidado, aliados ao conhecimento de sua própria espiritualidade. Apresenta-se como uma oportunidade para o debate sobre o tema, oferecendo subsídios para repensar a prática do enfermeiro na oncologia pediátrica, além de assinalar a necessidade de condução de pesquisas nessa área.

This is an article that addresses spiritual care in pediatric oncology nursing, as part of the concepts for promotion of health in families who have children and adolescents with cancer. Indicates subjects of nursing education that prepares nurses to offer that kind of care together with knowledge of their own spirituality. It is presented as an opportunity to discuss the theme, offering subsidies to rethink the practice of pediatric oncology nurse, also points to the need for additional research in this area.

Este es un artículo que aborda el cuidado espiritual en la enfermería pediátrica oncológica, como parte de los conceptos para la promoción de la salud de familias que poseen niños y adolescentes con cáncer. Indica elementos sobre la formación del enfermero para el ofrecimiento de ese cuidado aliado al conocimiento de su propia espiritualidad. Se presenta como una oportunidad para debatir sobre el tema, ofreciendo subsidios para repensar la práctica del enfermero en la oncología pediátrica, además de señalar la necesidad de realizar investigaciones en esta área.