ROLE OF PROPHYLACTIC ANTI COAGULANTS AND ANTI PLATELETS TO REDUCE THE INCIDENCE OF THROMBOSIS, STROKE, MYOCARDIAL INFARCTION IN ASYMPTOMATIC PATIENTS OF COVID19

BACKGROUND: As we are in the middle of the second year of the COVID19 Pandemic,we are observing an increased incidence of conditions like Cerebrovascular Accidents, Ischemic Heart Disease, Myocardial Infarction, Deep Vein Thrombosis,Pulmonary Embolism,and Thrombosis of Other Vessels. MATERIALS AND METHODS: Literature Review and Analysis of Coagulation Profiles of Patients in the past 1 year treated by the author was done. RESULTS AND CONCLUSIONS: 1. COVID19 is not just an infectious disease, but also an Immune Disease. The Immune Part can also happen in Asymptomatic Patients and those who got the vaccine. 2. Most of the disease processes in the body start after the virus has been cleared from the throat. The vigil against complications must not stop when the Throat Swab becomes negative or even when the patient is discharged but must continue for months till all the disease processes stop. 3.It is recommended that: a.Initial Evaluation with PT, aPTT, INR is done for: I.Those suffering from COVID 19 who have not undergone D Dimer evaluation ii.Those recovering from COVID 19. iii.Those likely to have had COVID 19 (based on the symptoms),but the infection was not documented. iv.Those likely to have had asymptomatic COVID 19 (contacts of COVID19 infected patients) v.Those planning to take Vaccines for COVID19. b.An Abnormal Value in PT,aPTT,INR may be managed with appropriate Drugs like Aspirin,Clopidogrel,Dipyridamole, Ticlopidine, Rivaroxaban, Dabigatran, Apixaban, Edoxaban, Heparin, Low Molecular Weight Heparin, Warfarin, and other drugs. c. Serial Evaluation of PT, aPTT, INR be done after 1 month, 3 months, 6 months (and even at more frequent intervals if indicated) and the drugs are added or removed,the dosage of the drugs is increased or reduced based on the results. d.Standard Indication of IVC Filter may be followed. 4.It is the knowledge of the pathogenesis of Thrombosis that is crucial in the prevention and management of Stroke, Heart Attack, Deep Vein Thrombosis, and Pulmonary Embolism rather than fancy gadgets, expensive tests, and exotic drugs.

The validity of SOFA score to predict mortality in adult patients with cardiogenic shock on Veno-Arterial Extracorporeal Membrane Oxygenation

Funding Acknowledgements Type of funding sources: None. Background veno-arterial ECMO is increasingly used in resuscitation of adults patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality and to determine the validity of the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality . Results : one hundred and six patients were retrospectively included in our study between 2015 and 2019 with in-hospital mortality of 56.6% . The mean age of patients was 40.2 ± 14.4 years and mostly males (69.8%) with a mean BMI of 26.5 ± 7 . Presence of CKD , chronic AF , cardiotomies were significantly more frequent in the non-survivors group . The non-survivors had more frequent AKI , more haemodialysis , more GI bleeding , more ICH, higher peak and 24 hours blood lactate and less ICU days as compared to the survivors group. Initial SOFA score ≥ 13 had a 85 % sensitivity and 73.9 % specificity [AUROC = 0.862 , 95% CI: 0.791 – 0.932 ; p <0.001 ] while SOFA score ≥ 13 at day 3 had 100 % sensitivity and 91.3 % specificity for predicting mortality [AUROC =0.995 , 95% CI : 0.986 – 1 ; p <0.001 ]. SOFA score ≥ 15 at day 5 had 98 % sensitivity and 100 % specificity for predicting mortality [AUROC =0.994 , 95% CI : 0.982 – 1 ; p <0.001 ]. The Δ 1 SOFA (3-1) ≥ 2 had 95% sensitivity and 93.5% specificity [AUROC = 0.958 , 95% CI: 0.913 – 1 ; p <0.001 ] while the Δ 2 SOFA (5-1) ≥ 2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958 , 95% CI: 0.909 – 1 ; p <0.001 ] . Increasing Δ 1 SOFA score (OR = 2.506, 95% CI : 1.681 – 3.735,p < 0.001) and increasing lactate level (OR = 1.388 , 95% CI : 1.015 – 1.898 , p = 0.04) were significantly associated with hospital mortality . Conclusion: the use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality . Serial evaluation with SOFA score during first few days of VA-ECMO support is a good predictor of hospital mortality . Increase of SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORCentral VA-ECMO0.2483.1020.455 - 21.154lactate peak level0.0401.3881.015 - 1.898Haemodialysis0.7121.6140.127 - 20.473Δ 1 SOFA (3-1)< 0.0012.5061.681 - 3.735GI bleeding0.9170.8910.102 - 7.815ICH0.42414.5850.020 - 204.51Abstract Figure. SOFA scoring of studied VA-ECMO patients

Serum Concentrations of KL-6 in Patients with IPF and Lung Cancer and Serial Measurements of KL-6 in IPF Patients Treated with Antifibrotic Therapy

Background: Krebs von den Lungen-6 (KL-6) was suggested as ILD biomarker including idiopathic pulmonary fibrosis (IPF). Lung cancer is one of the most severe comorbidity of IPF patients. This study aims to serially analyze KL-6 in IPF patients after 24 months of Nintedanib and to first investigate the biomarker behavior in IPF associated with adenocarcinoma. Materials and methods: One hundred and forty-two ILD patients (median (IQR), 69 (63–75) years; 86 males) were retrospectively enrolled. Serial serum samples were collected from IPF patients before starting antifibrotic therapy and after 12 months. Serum KL-6 levels were measured by KL-6 reagent assay (Fujirebio Europe, UK). Results: Increased KL-6 concentrations were identified in IPF-LC patients than IPF, fibrotic hypersensitivity pneumonitis, and pulmonary fibrosis associated with autoimmune disease groups. A cut-off value was calculated to distinguish IPF and IPF-LC patients. IPF patients monitored for 24 months with Nintedanib showed persisted increased levels of KL-6 with a progressive decline of FVC percentages. Conclusion: This preliminary study offers a first demonstration that very high serum concentrations of KL-6 in IPF-LC patients are associated with poor prognosis. Moreover, serial evaluation of serum KL-6 in IPF patients over 24 months of Nintedanib treatment revealed that most patients experienced a stabilization of lung function parameters and of serum concentrations of KL-6.

Peripherally inserted central cathether migration in neonates: Incidence, timing and risk factors

BACKGROUND: PICC line use is a common practice in neonatal units, but it is associated with various complications. Catheter migration is the most common complication in neonates. Periodic imaging is recommended to monitor the tip position of the PICCs, but the optimal frequency is undetermined. The incidence, timing and risk factors that are associated with PICC migration have not been fully investigated beyond 24 hrs in neonates. The aim of the study was to determine the incidence, timing and risk factors that are associated with peripherally inserted central venous catheter (PICC) migration in neonates. METHODS: This was a single center, retrospective study of 168 PICCs placed in 141 neonates in the neonatal intensive care unit (NICU) between 2015 and 2016. The incidence of catheter migration was determined radiographically at 12–24 hrs and every third day after insertion until it was removed. RESULTS: Overall incidence of PICC migration was 28%and most commonly was detected within the first three days after PICC placement (83%). The incidence of PICC migration was higher in males. The PICC migration was associated with difficulty advancing the PICC at the time of insertion and PICC dressing change. CONCLUSION: Serial evaluation of PICC placement in neonates is required to maintain proper position. Based on our experience in our unit, we recommend periodic imaging at 12–24 hrs and on the third day after PICC placement as most migration occurred within three days after insertion.

A Lookahead Effect in Mbe Reduplication: Implications for Harmonic Serialism

Various phenomena involving the interaction of reduplication and phonology have been brought to bear on evaluating parallel versus serial theories of phonology. In Base-Reduplicant (BR) Correspondence Theory ( McCarthy and Prince 1995 ), implemented in the classic parallel version of Optimality Theory (P-OT; Prince and Smolensky 1993/2004 ), the mapping from the underlying representation to the surface output is direct, without intermediate stages. In P-OT, the candidate-generating function GEN can simultaneously introduce multiple changes to the input. In contrast, the theory of Serial Template Satisfaction (STS; McCarthy, Kimper, and Mullin (MKM) 2012 ) is an approach to reduplication couched within Harmonic Serialism ( McCarthy 2000 et seq .), a version of OT with serial evaluation that includes intermediate levels of structure. In Harmonic Serialism, GEN is restricted to making no more than one change at each derivational step, a property known as gradualness. An argument put forth in favor of STS is that it does not admit a number of reduplicative patterns that MKM claim are unattested, which are otherwise predicted by BR Correspondence Theory in P-OT ( MKM 2012:225 ). Among these are patterns formerly interpreted as overapplication, backcopying, and underapplication. While such patterns previously served as arguments for BR Correspondence Theory ( McCarthy and Prince 1995 , 1999 ), MKM reexamine those cases and conclude that they do not provide solid evidence against a serial approach. Among the remaining patterns, coda-skipping reduplication and derivational lookahead appear to offer the strongest arguments in favor of STS. These are the two patterns for which the parallel and serial versions of OT make quite distinct predictions. However, recent studies have called the status of arguments involving both patterns into question. Zukoff (2017) shows that STS does not actually exclude coda-skipping reduplication, because certain mechanics that STS employs to account for attested partial onset skipping would predict coda skipping. Adler and Zymet (2017) identify a reduplication pattern in Maragoli that poses a type of lookahead problem for STS: the ordering of reduplication and hiatus-driven glide formation depends on lookahead to the surface form of the reduplicant, which favors a simple onset. In light of the ongoing discussion on these issues, this squib focuses on another kind of lookahead effect in reduplication where the amount of material copied would depend on a subsequent phonological change in the setting of a serial evaluation. Due to the stepwise gradual change in Harmonic Serialism, STS predicts that lookahead effects are not possible, while the potential for multiple, simultaneous changes in P-OT predicts that they exist. In this squib, we argue that a reduplicative affixation in Mbe instantiates a lookahead effect—specifically, one that closely resembles a hypothetical pattern that MKM identify as a problem for STS, were it to be attested. Furthermore, the variation in reduplicant size is arguably a case of “simple-syllable reduplication,” a pattern claimed not to be predicted by STS. This reduplicative pattern in Mbe is straightforwardly accounted for in P-OT. However, in STS the pattern cannot be understood as a lookahead phenomenon, which gives rise to a treatment with unwanted stipulations and complications. We consider three alternatives in STS involving allomorphy or different templatic approaches, but find shortcomings in each.

Programa de avaliação seriada da Universidade de Brasília: lições para a avaliação do ensino médio / Serial evaluation program from the University of Brasília: lessons towards the high school’s evaluation

O objetivo desse artigo é abordar a trajetória histórica da experiência do Programa de Avaliação Seriada da Universidade de Brasília (PAS) e as suas contribuições para a avaliação do ensino médio no Distrito Federal. A partir das análises teóricas, bibliográficas e documentais, assinalamos que, por meio da compreensão das parametrizações avaliativas de tendência global e o histórico de construção do PAS, é possível detectar um inventário de elementos que o tornam referência para a entrada no Ensino Superior no país, assim como se apresenta como inovação no tocante às aberturas e às possibilidades para seu aperfeiçoamento e aprimoramento como sistema de avaliação, acompanhando o percurso de aprendizagem dos estudantes ao longo de seu percurso de escolarização no ensino médio.