The Application of Coronary Contrast Emptying Time in Diagnosing Coronary Slow Flow Phenomenon: A Serial Case Report.

The Coronary Slow Flow Phenomenon doesn't achieve as much attention as its counterpart Coronary Arterial Disease because it is considered a rather benign entity. But now it is proven that coronary slow flow phenomenon can also manifest as an acute coronary syndrome, myocardial ischemia, malignant arrhythmia, and even sudden cardiac death.This entity is usually diagnosed from coronary angiography study when a delayed coronary contrast filling time is found without the presence of significant epicardial narrowing of the related arteries. But, in our center's years of experience, we frequently found cases in which myocardial ischemia or infarction was suggested or proven clinically, on the other hand, angiography study showed no significant epicardial coronary artery narrowing neither delayed coronary contrast filling time. Furthermore, we observed that this group of patients exhibited a rather prolonged coronary contrast emptying time instead.In this serial case report, we presented some of our cases where microvascular disorders were suspected. We demonstrated that not all coronary contrast filling times in ischemic or infarction-related arteries were prolonged, on the other hand, prolongation of coronary contrast emptying time showed a more consistent result.

An Anesthesia Block Room Is Financially Net Positive for a Hospital Performing Arthroplasty.

INTRODUCTION: Regional anesthesia is increasingly used in total joint arthroplasty (TJA). It has shown efficiency benefits as it allows parallel processing of patients in a dedicated block room (BR). However, granular quantification of these benefits to hospital operations is lacking. The goal of this study was to determine the financial effect of establishing a BR using comprehensive operational modeling. METHODS: A discrete-event simulation model of daily operating room (OR) patient flow for TJA procedures at a mid-sized hospital was developed. Two scenarios were tested: (1) without and (2) with a BR. Scenarios were compared according to staffing requirements, hours/day, and labor costs. The number of ORs and cases varied from 2 to 6 ORs performing 3 to 5 cases. These results were used as the inputs of a discounted cash flow (CF) model. Discounted CF model outputs were CF, net present value, internal rate of return, and return on investment. RESULTS: Mean time savings of incorporating a BR were 68 min/d (range: 30 to 80 min/d), reducing the OR closing time by 1 hour. Incremental labor costs/day from nurse overtime pay ranged from $2,025 to $10,125 with no BR and $1,595 to $9,045 with a BR, which resulted in an increase in profit/day from $360 to $1,605. The CF/annum was $54,363, the net present value was $213,082, the internal rate of return was 12%, and the return on investment was 43.61%. DISCUSSION: This study demonstrates that under all scenarios, a BR is more profitable than no BR to a hospital performing TJA via a bundled care or private payer remuneration model. A BR was shown to be financially net positive even when considering the necessary financial investment to establish it. In addition, this study demonstrates the potential of combining discrete-event simulation with financial analyses to assess various operational models of care to improve hospital efficiency, such as dedicated trauma rooms and swing rooms. LEVEL OF EVIDENCE: Level III.

Specific activities of natural rocks and soils at quaternary intraplate volcanism north of Sana'a, Yemen.

The level of natural radioactivity in rocks and soil of 32 samples collected from locations at North Sana'a in Yemen was measured. Concentrations of radionuclides in rocks and soils samples were determined by gamma-ray spectrometer using high purity germanium (HPGe) detector with specially designed shield. The average radioactivity concentrations of (226)Ra, (232)Th, (40)K were determined and expressed in Bq/kg. The results showed that these radionuclides were present in concentrations of 21.79 ± 3.1, 19.5 ± 2.6 and 399.3 ± 16 Bq/kg, respectively, for rocks. For soil, the corresponding values were 48.2 ± 4.4, 41.7 ± 4.5 and 939.1 ± 36 Bq/kg, respectively. Also, the radiological hazard of the natural radionuclide content, radium equivalent activity, total dose rates, external hazard index and gamma activity concentration index of the (rocks/soils) samples in the area under consideration were calculated. The dose rates at 1 m above the ground from terrestrial sources were 38.39 and 86.89 nGy/h for rocks and surface soil, respectively, which present no significant health hazards to humans.