The Association of Hyponatremia with Race, Ethnicity, and Gender in Patients Admitted for Acute Decompensated Heart Failure Diagnoses

Background: Hyponatremia, defined by a serum sodium concentration less than 135 mEq/L, is seen in approximately 25% of patients admitted with congestive heart failure (CHF). Hyponatremia on admission has been shown to increase in-hospital mortality and to be an independent predictor of 6month mortality. Prior work has shown that CHF patients with hyponatremia on admission are more likely to be Caucasian. Given its prognostic significance, hyponatremia and its association with patient characteristics warrants further study. Methods: We queried for unique admissions to Temple University Hospital between 2011 and 2015 with a DRG code of 291-293 to represent a heart failure admission. We identified admissions that had a first sodium lab value after admission available. Chi-square tests were performed to examine association between first Na\u3c135 mEq/L and ethnicity, gender, or ethnic/gender sub-group. Statistical significance was defined as p\u3c0.05. Results: 884 admissions were identified by ethnicity as either African-American , Caucasian (Non-Hispanic) or Hispanic . There was no association between first Na\u3c135 mEq/L and ethnicity (Chi-squared=2.31; p=0.31). 976 admissions were identified as either male or female . There was no association between hyponatremia on admission and gender (Chi-squared=1.17; p=0.27). 768 patient admissions could be classified by both ethnicity and gender. The association between hyponatremia on admission and ethnic/gender sub-group did not achieve statistical significance (Chi-squared=9.49; p=0.09). Conclusion(s): In conclusion, our study demonstrates no statistically significant association between hyponatremia and the patient characteristics ethnicity and gender in a small sample of heart failure admissions. There was a trend toward a lower proportion of African-American/Female admissions having hyponatremia

Using a Resident-Led Process Improvement Committee to Change Pain Medication Prescribing Habits: Early Results

The aims of this project were to: Streamline the ordering of IV and PO pain meds Encourage the appropriate ordering of Ofirmev

MMC impedance modelling and interaction of converters in close proximity

This paper develops a small-signal impedance model of modular multilevel converters (MMCs) using harmonic state-space (HSS) method and studies the stability in a multiple converter scenario. In order to simplify analysis on the coupling characteristics between different frequencies in MMCs, the proposed model is developed in the positive-negative-zero (PN0) sequence-frame, where the zero-sequence current in three-phase three-wire system is directly set to zero without introducing complicated method. A simple 2 by 2 admittance matrix in PN0-frame is extracted from the MMC small-signal model for ease of system stability analysis. Using the developed impedance model, the multi-infeed interaction factor (MIIF) measure is adopted to analyze the most significant interactions for multi-infeed converter systems to be prioritized. Different outer-loop controllers are adopted and compared in the analysis to illustrate the effect of different control modes on converter impedance and system stability. Analytical studies and time-domain simulation results are provided to validate the proposed model and stability analysis

Medical Repatriation in Vermont: The Current Landscape and Recommendations

Background: Medical repatriation is the practice of returning patients to their country of origin when they have major medical problems. Forced repatriation, or “medical deportation”, disproportionately affects undocumented individuals. This project aimed to assess the prevalence of medical repatriation in Vermont, identity factors that lead to it, and recommendations to prevent it. Methods: Interviews were conducted with ten stakeholders including physicians, lawmakers, and advocates for undocumented patients. Team members then analyzed interview transcripts for major themes. Results: This study did not uncover any occurrences of forced repatriation. Qualitative themes included: lack of awareness about medical repatriation, inability to track medical repatriation, social/legal barriers to care among undocumented individuals, and suggestions to prevent medical repatriation. This work also revealed current legislative initiatives focused on healthcare for undocumented individuals. Conclusion: Medical repatriation is not prevalent in Vermont. However, the increasing number of Vermonters with varying legal statuses in conjunction with rising hospital costs may precipitate economic stressors that put vulnerable patients at higher risk for forced repatriation. Moving forward, efforts may focus on protecting against this event with more inclusive health care coverage and improved clinician awareness about available assistance programs

Escabiosis en paciente masculino de 10 años con desnutrición crónica infantil de la amazonia ecuatoriana. Reporte de caso y revisión

Scabies or scabies is an ectoparasitic infection produced by the mite Sarcoptes scabiei var hominis (class Arachnida, subclass Acarina, order Astigmata, family Sarcoptidae). It has a worldwide distribution, with an estimated global prevalence of 300 million cases. It is a disease for which there is universal susceptibility, without significant differences in terms of sex, age, ethnic group or socioeconomic level, although there are predisposing circumstances for its contagion, such as overcrowding, immigration, poor hygiene, malnutrition, dementia and sexual promiscuity.Objective: Early identification of the evolution of scabies for its respective diagnosis and treatment.Description of the case: This case is presented, and a literary review is carried out in order to identify the diagnosis of scabies in a patient with chronic malnutrition.Low-income patient is captured by medical personnel where itching of several weeks of evolution is evidenced where there is evidence of an itchy rash in the abdominal region, in addition to this he presents chronic malnutrition. He is admitted to the dermatology service with nutritional support where he receives treatment for several days which are favorable with an adequate evolution.Conclusions: Scabies in our country Ecuador is endemic, it is a common disease in our Amazon region where most of the people who suffer from it are overcrowded people with low resources who have chronic malnutrition, it is important as doctors to carry out health checks on people vulnerable in rural areasLa escabiosis o sarna es una infección ectoparasitaria producida por el acaro Sarcoptes scabiei var hominis (clase Arachnida, subclase Acarina, orden Astigmata, familia Sarcoptidae). Tiene una distribución mundial, con una prevalencia global estimada de 300 millones de casos. Es una enfermedad para la que hay susceptibilidad universal, sin diferencias significativas en cuanto a sexo, edad, grupo étnico o nivel socioeconómico, aunque existen circunstancias predisponentes para su contagio, como el hacinamiento, la inmigración, la higiene deficiente, la malnutrición, la demencia y la promiscuidad sexual.Objetivo: Identificar de manera temprana la evolución de la escabiosis para su respectivo diagnóstico y tratamiento.Descripción del caso: Se presenta este caso y se realiza un revisión literaria para poder identificar el diagnostico de escabiosis en paciente con desnutrición crónica.Paciente de bajos recursos económicos es captado por personal médico donde se evidencia prurito de varias semanas de evolución donde se evidencia exantema en región abdominal pruriginoso además de ello presenta desnutrición crónica. Es ingresado al servicio de dermatología con apoyo de nutrición donde recibe tratamiento por varios días los cuales son favorables con una evolución adecuada.Conclusiones: La escabiosis en nuestro país Ecuador es endémica, es una enfermedad común en nuestra región amazónica donde la mayoría de las personas que la padecen son personas en hacinamiento con bajos recursos que presentan desnutrición crónica, es importante como médicos realizar controles sanitarios a las personas vulnerables de las zonas rurales

Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient.

BACKGROUND Acute pancreatitis is rare following solid organ transplantation but is associated with high mortality. It has been most commonly reported following renal transplant but can occur with other solid organ transplantations. CASE REPORT A 46-year-old male who had an orthotopic heart transplant 6 months ago presented with a 3-week history of abdominal pain. The patient described it as intermittent, sharp, and stabbing, originating in the periumbilical area and radiating to the back. His lipase was elevated at 232 U/L. Given that the patient\u27s symptoms and lipase were elevated to greater than three times the upper limit of normal, he patient was diagnosed with acute pancreatitis. The patient also mentioned a diffuse itchy rash that started a few days prior to admission. Dermatology was consulted, and given the man\u27s clinical presentation, there was concern for atypical reactivation of varicella zoster virus (VZV). VZV polymerase chain reaction of the vesicles returned positive. The patient was started on acyclovir and his symptoms improved. CONCLUSIONS This is the first reported case of VZV-associated pancreatitis in a heart transplant patient. Our patient presented with acute pancreatitis and was treated supportively. However, he did not receive antiviral treatment until his rash was discovered. Timely treatment of VZV resulted in resolution of both the rash and pancreatitis. Timely diagnosis of pancreatitis and VZV is important to prevent development of multiorgan failure and death

Shell occupancy of the intertidal hermit crab Clibanarius erythropus (Decapoda, Diogenidae) on São Miguel (Azores).

Copyright © 2000 Kluwer Academic Publishers. Printed in the Netherlands.The intertidal hermit crab Clibanarius erythropus was collected at three sites on São Miguel (Azores) during low spring tides. Shells occupied were identified and measured. Crab sizes ranged from 1.78 to 13.67 mm (cephalothoracic shield length), with an average size of 4.40 +- 1.44 mm. Of the 19 different shells utilised, the most frequent were Littorina striata (23.8%), Nassarius incrassatus (22.5%) and Mitra sp. (22.0%). At Fenais da Luz. L. strita was most frequently occupied, while at Água de Alto it was N. incrassatus and, at Caloura, Mitra sp. shells were most frequently used. Shell selection appears to be determined by respective sizes of hermit crab and shell species. Small size-class crabs occupy more shell species than larger crabs. The smallest crab was found at Fenais da Luz occupying a small Bittium sp., whereas the largest crab was found at Caloura inhabiting Stramonita haemastoma