scholarly journals The International (Seattle) Criteria

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Diagnostic Accuracy ◽  
Continuous Improvement ◽  
Screening Tool ◽  
The Other ◽  
Pathological Findings ◽  
Other Hand ◽  
Ecg Criteria

Through continuous improvement of diagnostic accuracy of ECG criteria for athletes sensitivity as well as specificity have grown so much that foregoing this screening tool is not feasible anymore. The most updated guidelines, the so-called “International (Seattle) Criteria” globally exhibit the most important reference publication, currently. The criteria were created with the purpose that particularly “non-cardiologists” should be able to use them before clearly pathological findings lead to further follow-up examinations at a specialist. On the other hand, physiologic ECG findings should not prompt expensive further evaluations, as it used to happen quite frequently.

Effectiveness of Virtual Resilience Training on Assertiveness in Student Girls Aged 9–10 Years: A 1-Month Follow-Up

2021 ◽  
pp. 105984052110135
Author(s):  
Shima Gadari ◽  
Jamile Farokhzadian ◽  
Parvin Mangolian Shahrbabaki
Keyword(s):  
Experimental Study ◽  
Internal Stress ◽  
Intervention Group ◽  
The Other ◽  
Hormonal Changes ◽  
Emotional Instability ◽  
Other Hand ◽  
Significant Difference ◽  
Resilience Training

Girls between the ages of 9 and 10 begin to experience physical, physiological, and hormonal changes that may lead to internal stress. At this age, children are struggling for autonomy; on the other hand, they may experience emotional instability, and for these reasons, they may be vulnerable in many ways. This experimental study aimed to investigate the effect of resilience training on assertiveness in student girls aged 9–10. Data were collected before, immediately after, and 1 month after the intervention in the control ( n = 40) and intervention ( n = 37) groups. There was a significant difference between the assertiveness of the intervention immediately (26.80 ± 3.73) and 1 month after the intervention (27.05 ± 3.73), and assertiveness significantly increased in the intervention group ( p = .0001). Resilience training leads to improvements in assertiveness in student girls aged 9–10.

scholarly journals Long-Term Outcome of Deferasirox Chelation in Patients with Thalassemia Major

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3620-3620
Author(s):  
Sule Unal ◽  
Neslihan Kalkan ◽  
Mualla Cetin ◽  
Fatma Gumruk
Keyword(s):  
Serum Creatinine ◽  
Sample Size ◽  
Serum Ferritin ◽  
Thalassemia Major ◽  
Iron Chelator ◽  
The Other ◽  
Single Center ◽  
Other Hand

Abstract Introduction: Iron overload is one of themajor complicationsof transfusion treatment in patient with thalassemia major. Deferasirox is a once-daily orally active iron chelator and long-term efficacy and safety data are being published. Herein we report the long-term follow-up data of thalassemia major patients in a single center. Methods: Of the 67 patients with thalassemia major who were under follow-up in a single center, 42 who were on deferasirox chelation for at least three years were included in the study. Patients' initial serum ferritin, ALT, creatinine, cardiac T2* and hepatic T2* values were recorded at the time of deferasirox initiation and at last visit. Deferasirox was not initiated as an iron chelator to none of the patients with a cardiac T2* value below 8 ms. All of the patients had creatinine clearance above 40 ml/minute and had serum creatinine levels within age appropriate normals at deferasirox initiation. None of the patients received any other chelations during the follow-up period. Results: Mean age of the patients were 16±9.4 years (2-33.4 years) at initiation of deferasirox and 22 (52%) were females. Eighteen (43%) of the patients were splenectomized. Median follow-up time of deferasirox chelation was 7.9 years (3-10). The median deferasirox doses at initiation of chelation and at last visit were 20.5 mg/kg/day and 30.7 mg/kg/day (7-40), respectively. Serum ferritin levels decreased significantly with deferasirox chelation (median 1969 ng/ml (516-5404) vs 1113 ng/ml (339-4003), p<0,001). We did not find statistically significant difference between the inital cardiac T2* values and the values at the last visit (median 25 .3 ms((8.7-42) vs 32 ms (6.6-42), p=0.607), despite a dramatic increase. On the other hand, hepatic T2* values did not significantly change compared to initial values, as well (median 3.7 ms (1-13.6) vs 3.3 (1-16), p=0.865). However of the patients who had cardiac T2* value between 10-20 ms, 67% was found to have T2* value above 20 ms by the end of the follow-up duration. On the other hand 53% of the patients with hepatic T2* value below 3.5 ms, had T2* values above 3.5 ms by the end of the follow-up, indicating improvement in iron stores. None of the patients exibited an adverse event that requires cessation of the drug totally, but patients exibited transient hypertransaminasemia that required transient cessation and/or dose decrement. The changes in serum ALT and serum creatinine levels at the initiation and at last visit were not significant. Conclusions: This is a a study that includes patients with a relatively long duration of follow-up. Although the cardiac T2* values improved by the end of the follow-up, this change was not found statistically significant. This can be attributed to the sample size and in a larger sample size, the change might be found significant. Additionally, the patients included in the study were composed of not only naive patients to chelation but also of the patients who were imcomplant to previous chelation and who were highly iron loaded before initiation of deferasirox. Disclosures No relevant conflicts of interest to declare.

Human Capacity and Human Incapacity: A Theological Exploration of Personhood

1975 ◽  
Vol 28 (5) ◽  
pp. 401-447 ◽  
Author(s):  
J. D. Zizioulas
Keyword(s):  
Methodological Problem ◽  
The Other ◽  
Human Being ◽  
Other Hand ◽  
Christian View ◽  
Human Capacity

Theology, unlike other disciplines dealing with man, is faced with a fundamental methodological problem in its attempt to understand the human being. This problem is due to the Christian view of the Fall. Whatever we may wish to mean by the Fall, the fact remains that there is something which can be called ‘sin’, and which gives rise to the question: is man that which we know and experience as ‘man’? If we answer the question in the affirmative, then we are bound to imply that sin is not an anthropological problem and redemption from sin does not essentially alter our view of man; in fact if we follow up the consequence of this position, we are bound to say that unfallen man or man restored by redemption is not properly speaking ‘man’ but something of a super-man. If, on the other hand, we do not approach man from the angle of his actual sinful situation, how can we approach him? Is there another angle from which to look at man except from that of what we actually see as man?

scholarly journals Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review

2021 ◽  
Author(s):  
Carla Colombo ◽  
Simone De Leo ◽  
Marta Di Stefano ◽  
Matteo Trevisan ◽  
Claudia Moneta ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Risk Group ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
The Other ◽  
Intermediate Risk ◽  
Other Hand

Abstract Background Controversies remain about the ideal risk-based surgical approach for differentiated thyroid cancer (DTC). Methods At a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up. Results Event-free survival by Kaplan–Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs. intermediate-risk, P = 0.553). Nevertheless, 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments. On the other hand, macrocarcinomas were significantly more persistent if treated with LT than with TT (low-risk, P = 0.036 vs. intermediate-risk, P = 0.004). Permanent hypoparathyroidism was more frequent after TT (P = 0.01). After LT, thyroglobulin (Tg)/thyroid-stimulating hormone (TSH) had shown decreasing trend in 68% of the event-free patients and an increasing trend in the persistent cases. Conclusions Lobectomy can be proposed for low-risk microcarcinomas, although in a minority of cases, additional treatments are needed, and a longer follow-up period usually is required to confirm an event-free outcome compared with that for patients treated with TT. On the other hand, to achieve an excellent response, TT should be favored for intermediate-risk micro- and macro-DTCs despite the higher frequency of postsurgical complications.

Abstract 16603: Appropriate Timing of Pacemaker Implantation in Patients With Wild-Type and Variant Amyloidogenic Transthyretin Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yusei Kawahara ◽  
Miwa Ito ◽  
Tadashi Hoshiyama ◽  
Hisanori Kanazawa ◽  
Kenichi Tsujita
Keyword(s):  
Cardiac Amyloidosis ◽  
Pacemaker Implantation ◽  
The Other ◽  
Cardiac Conduction ◽  
Wild Type ◽  
Conduction Disorders ◽  
Other Hand ◽  
Conduction Disorder ◽  
Second Degree

Background and Objectives: It has been shown that cardiac conduction disorders can be seen in patients with wild-type amyloidogenic transthyretin (ATTRwt) and variant ATTR (ATTRv) cardiac amyloidosis. However, its appropriate timing of pacemaker implantation has not been clarified yet. Methods and Results: The consecutive 100 patients with ATTRwt cardiac amyloidosis who diagnosed by myocardium biopsy and/or technetium-99m-pyrophosphate scintigraphy and 62 patients with ATTRv cardiac amyloidosis who diagnosed by means of genetic screening were included in this study. In patients with ATTRwt cardiac amyloidosis, 21 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in only 5 patient (first degree atrioventricular block (AVB); 4 patients, complete AVB; 1 patients) and only one patient underwent cardiac implantable electric device (CIED) implantation during follow-up period. On the other hand, in patients with ATTRv cardiac amyloidosis, 36 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in 13 patient (first degree AVB; 8 patients, second degree AVB; 3 patients, trifascicular block; 1 patients, complete AVB; 1 patients) (5/21 vs 13/36, p=0.335) and 6 patients underwent CIED implantation during follow-up period (1/21 vs 6/36, p=0.186). Furthermore, in ATTRwt cardiac amyloidosis, 10 patients (first degree AVB; 2 patients, second degree AVB; 1 patient, trifascicular block; 7 patients) had underwent CIED implantation because of cardiac conduction disorders and/or prevention of sudden cardiac death. However, only 4 patients with trifascicular block progressed to complete AVB.On the other hand, In ATTRv cardiac amyloidosis, 14 patients (first degree AVB; 2 patients, second degree AVB; 4 patient, trifascicular block; 8 patients) had underwent CIED implantation for same reason. However, only 3 patients with trifascicular block progressed to complete AVB. Conclusions: Patients with ATTRv cardiac amyloidosis were more likely to progress conduction disorders than those with ATTRwt cardiac amyloidosis. However, prophylactic pacemaker implantation might had not need in both ATTRwt and ATTRv patients with first or second degree AVB.

Surgery of the Lacrimal System

2011 ◽  
Author(s):  
Roger A. Dailey ◽  
Mauricio R. Chavez
Keyword(s):  
Prospective Study ◽  
Success Rate ◽  
Nasolacrimal Duct ◽  
The Other ◽  
Success Rates ◽  
Lacrimal Sac ◽  
Other Hand ◽  
A Prospective Study ◽  
External Dcr

Obstruction of the tear outflow system can occur anywhere along its course from the tear lake to the inferior meatus of the nose. Surgical techniques designed to relieve this functional or complete obstruction have been available for a long time. Toti of Italy described the dacryocystorhinostomy (DCR) procedure in 1908 as a treatment modality for obstruction of the nasolacrimal duct. His technique did not make use of mucosal flaps. Dupuy-Dutemps of France, on the other hand, encouraged the use of flaps. He recommended suturing together the nasal mucosal and lacrimal sac flaps. The success rate of the operation improved dramatically. Today the external DCR procedure makes use of modifications of both of these historically described procedures. In recent years, intranasal DCR has enjoyed renewed popularity. This procedure had been performed by Lester Jones and others for years but was dropped because the success rate was 80% at best. Although the use of endoscopic techniques and laser technology has been advocated by some authorities, the success rate (approximately 70%) with relatively short-term follow-up has limited its acceptance. More recently, Javate and associates reported a series of patients undergoing endoscopic DCR with the radiofrequency Ellman unit. Their reported success rate of 90% compared favorably with a 94% success rate in 50 age-matched patients undergoing external DCR with a follow-up of 9 months. This rate also compares favorably to the present authors’ success rate of approximately 95% in uncomplicated cases undergoing external DCR and a similar rate with the endoscopic approach without use of a laser. Therefore, the laser does not appear to offer any significant advantage over more traditional intranasal approaches, and the cost may actually be a financial disincentive to its use. The benefit of mitomycin continues to be debated. You and associates performed a prospective study showing favorable long-term success rates with the use of mitomycin. On the other hand, Liu and associates performed a prospective study that demonstrated no benefit. While the DCR works well for lacrimal sac or nasolacrimal duct obstruction, it does not address obstructions of the puncta and canaliculi.

scholarly journals P0740HYPERKALEMIA, CKD AND RAAS INHIBITION: A TRIAD WITH A FINE BALANCE TO PREVENT MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luis Falcao ◽  
Adriana Paixão Fernandes ◽  
Sara Fernandes ◽  
Beatriz Donato ◽  
Mário Raimundo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Mortality Risk ◽  
Therapeutic Agents ◽  
The Other ◽  
Ckd Progression ◽  
Other Hand ◽  
Ckd Stage ◽  
The Impact

Abstract Background and Aims Hyperkalemia (HK) is a common and dangerous complication of CKD because of impaired kidneýs ability for potassium elimination. On the other hand, HK is a common complication of extremely beneficial therapeutic agents acting on the renin–angiotensin–aldosterone system (RAAS). Its initiation at early CKD stages is even more benefic but HK could lead to stop it. We wonder if there is a possible relation between HK, therapeutic changes in RAAS inhibition (not initiating or stopping it) and mortality. Our goal was to investigate incidence, prevalence and clinical outcomes of at least one episode of HK in a CKD population outpatient setting. Additionally, we investigated the association of HK with changes in RAAS inhibition and mortality risk. Method We conducted a patient-level, retrospective, cohort analysis of all adult patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 24 months of follow up and three or more serum potassium determinations. The prevalence of HK (blood potassium level ≥ 5,5mmol/L) at first consultation and incidence during follow up were accessed. Patients were spited in two groups prior to analysis: A) Patients without any HK episode and B) Patients with at least one HK episode. Baseline and follow up covariates included demographics, comorbid conditions, laboratory values, HK-associated drugs [ACEis, ARBs, potassium-sparing diuretics and diuretics]. The impact of HK and therapeutic changes on mortality was evaluated through a logistic regression. Results Out of the 3008 patients referred to the nephrology clinic, 575 (19.1%) met the inclusion criteria (mean age: 70.4 years; 63.7% male and 94.0% caucasians). Mean follow-up was 4.1±1.8 years. Important cardiovascular comorbidities included hypertension (HTN) (90.3%); overweigh (67.4%), DM (49.0%) and Heart Failure (31.4%). CKD stage progression was present in 122 (21.2%). The prevalence of HK at first consultation was 8.7% and follow up incidence 21.7%. From this cohort, 164 (28.5%) had at least on episode of HK (Group B) and 101 (17.6%) died. During the follow up, RAAS inhibition drugs was removed or not started in 200 (34.8%) patients and diuretic was initiated in 165 (28.7%). In univariate analysis, at least one HK episode was associated with Diabetes (65.9 vs 42.3%, p&lt;0.001), Heart failure (36.6 vs 28.0%, p=0.007), Macroalbuminuria (34.1 vs 21.2%, p=0.001), CKD progression (33.5 vs 16.3. p&lt;0.001) higher frequency of diuretic initiation (38.4 vs 24.8%, p&lt;0.001) and higher mortality (27.6 vs 13.7%, p&lt;0.001). In multivariate logistic regression analysis, the independent predictors of mortality were: At least one HK episode (OR 1.82, 95% CI 1.08-3.04, p=0.02); Heart Failure (OR 1.97, 95% CI 1.16-3.35, p=0.01); Older age (OR per 1 year increase 1.04, 95% CI 1.02-1.07, p=0.001); CKD progression (OR 4.18, 95% CI 2.43-7.19, p&lt;0.001). Predictors of lower mortality risk were: Patients who maintained RAAS inhibition during follow up (OR 0.50, 95% CI 0.26-0.96, p=0.03); Patients who started RAAS inhibition during follow up (OR 0.38, 95% CI 0.16-0.88, p=0.02). Conclusion Our study confirms that RAAS inhibition had a protector and independent impact in mortality when prescribed in CKD early stages. On the other hand, patients with at least one episode of HK have a higher risk of mortality. All efforts should be made to maintain these therapeutic agents, looking for other ways to control hyperkalemia rather than stop it.

scholarly journals Management Strategies and Stakeholders Analysis to Strengthen the Management and Use of Biosolids in a Colombian Municipality

2021 ◽  
Vol 13 (21) ◽  
pp. 12180
Author(s):  
Camilo Venegas ◽  
Andrea C. Sánchez-Alfonso ◽  
Crispín Celis ◽  
Fidson-Juarismy Vesga ◽  
Mauricio González Mendez
Keyword(s):  
Continuous Improvement ◽  
Positive Attitude ◽  
Management Strategies ◽  
The Other ◽  
Organizational Policy ◽  
Effective Management ◽  
Joint Work ◽  
Other Hand ◽  
The People ◽  
Integration Levels

The difficulties in the management and use of biosolids in Colombia make it necessary to evaluate and analyze the factors involved through various methodologies to achieve the effective management and recycling of this type of waste. The objective of this study was to evaluate the management of sludge and biosolids from a WWTP in a Colombian municipality through the application of three methodologies (SWOT/TOWS, surveys, and stakeholder (player) weighing) for their subsequent use in agriculture. As a result, strategies were proposed at the regulatory, organizational policy, and entity integration levels, among others. It was identified that about 93.6% of the people surveyed had a positive attitude towards the use of biosolids in agriculture, despite recognizing the existence of a risk (27.3%) in this type of practice. On the other hand, regarding the communication of WWTP management of these wastes, they perceived that it to be absent (65%) and the lack of knowledge regarding the destination of these wastes was even greater (72.7%). Through the weighting of actors, 16 players were classified with whom it is necessary to work closely, regularly, or occasionally. The methodologies proposed will allow similar WWTPs to optimize their processes through continuous improvement and joint work between the different entities and communities. It is recommended that other methodologies be used to evaluate player position level in relation to planned strategies, as well as the level of associations of one player with another, independent of power and influence.

scholarly journals Performance of Adenosine Deaminase assay in diagnosis of pulmonary & extrapulmonary tuberculosis

2021 ◽  
Author(s):  
Anuja N Mulmule ◽  
Arti R Mishra ◽  
Vinita R Hutke ◽  
Seema D Shekhawat ◽  
Amit R Nayak ◽  
...  
Keyword(s):  
Adenosine Deaminase ◽  
Large Scale ◽  
Extrapulmonary Tuberculosis ◽  
Central India ◽  
Abdominal Tuberculosis ◽  
The Other ◽  
Clinical Samples ◽  
Other Hand ◽  
Study Results

Adenosine Deaminase (ADA) estimation in all forms of tuberculosis (TB) is done by several investigators, however, there has been a lot of debate about the use of the ADA for TB diagnosis. In the present study, to overcome this debate, we have planned a large scale study in the Central India population for all forms of TB i.e. pulmonary TB (PTB), tuberculous meningitis (TBM), TB arthritis (TBAR), and abdominal tuberculosis (ATB) to access the performance of ADA for diagnosis of TB. In addition to that, we have also studied the performance of the ADA test in the prognosis of TB. ADA activity was evaluated using the method of Guisti and Galanti. To evaluate the role of the ADA test as a prognostic marker in TB, we have collected follow-up clinical samples of PTB and TBM cases. The sensitivity of the ADA test is impressive in all forms of TB clinical samples analyzed for the study (PTB [82%], TBM [85%] TBAR [85%]), and (ATB) [84%]. However, the specificity was variable as ADA test results were found to be satisfactory for extrapulmonary TB (EPTB) cases ( i.e TBM [89%], (ATB) [88%], TBAR [88%]), on the other hand, poor specificity was observed in PTB cases (PTB [48%]). In the follow-up clinical samples (collected before and after anti-TB treatment [ATT]). In the follow-up samples, the result of the ADA test was observed to have declined drastically thereby showing a negative value after the ATT. Our study, which consists of a large number of samples, suggests that the ADA has very limited value in the diagnosis of PTB, and hence it is not recommended for PTB diagnosis. On the other hand, the ADA test is found to be useful for the diagnosis of EPTB in correlation to the patient's clinical condition. Along with the above-mentioned aspects and according to our follow-up study results, we recommend that ADA be useful as a prognostic indicator for TB.

De effectiviteit van oplossingsgericht werken en cliëntgeleide contractering bij coaching en advisering: lessen uit de psychotherapie

2008 ◽  
Vol 21 (1) ◽  
Author(s):  
Coert Visser ◽  
René Butter
Keyword(s):  
The Other ◽  
Knowledge Development ◽  
Web Based ◽  
Other Hand ◽  
The One ◽  
Organizational Consultants ◽  
Solution Focused ◽  
The Way

The effectiveness of solution-focused working in coaching and consultancy The effectiveness of solution-focused working in coaching and consultancy C. Visser & R. Butter, Gedrag & Organisatie, volume 21, March 2008, pp. 35-55 Until now, little research has been done on the effectiveness of organizational consultancy and coaching. This study aims to make a contribution to the knowledge development in this area. A web-based questionnaire was administered with 158 clients of coaches and organizational consultants. Through this questionnaire, the relation was studied between, on the one hand, the way of contracting and the approach followed, and on the other hand the effectiveness of the project. One of the most striking conclusions is that a client-led way of working – which is one of the important characteristics of the solution-focused approach – in which the client directs the process while the advisor responds flexibly, is strongly associated with success. The article closes with some practical suggestions for advisors and for follow-up research.

Sign in / Sign up

Export Citation Format

Share Document