Spectral Doppler Ultrasonography of Hepatic Vein in a Patient with Atrial Fibrillation and Rapid Ventricular Rate

Background: Point of Care ultrasound (POCUS) is a tool that enables the clinicians to objectively assess hemodynamics at the bedside. Recently, a novel concept of venous excess Doppler ultrasound (VExUS) grading system has been proposed to assess venous congestion at the organ level in real time. This concept evaluates the presence of severe flow abnormalities in 2 or more veins (of the hepatic, portal, and kidney parenchymal veins) with a dilated IVC (≥2 cm). There are reports in literature that tachyarrhythmias alter the flow pattern in the hepatic veins. Case presentation: We present a case of a 88-year-old gentleman with a past medical history of hypertension, paroxysmal atrial fibrillation, CKD and diabetes, who was admitted due to sepsis in the setting of multifocal pneumonia. On admission day 3, the patient developed atrial fibrillation with rapid ventricular response and worsening hemodynamic status. A bedside POCUS was performed as part of the evaluation. Hepatic vein doppler flow showed complete S wave reversal suggesting high right atrial pressures (RAP) and severe intravascular congestion. Diltiazem infusion was started immediately, and diuretics were ordered. Rate control was achieved after 2 hours of diltiazem infusion. Reassessment of hepatic vein Doppler flow showed normalization of S wave with an S \u3c D pattern which is common in atrial fibrillation even in the absence of elevated RAP. A decision was made to discontinue diuretics as S wave reversal was attributed to rapid ventricular rate. Conclusions: VExUS grading is a novel concept, that evaluates intravascular congestion based on IVC diameter, hepatic, portal and kidney veins Doppler waveforms. Awareness of hepatic vein doppler alterations in tachyarrhythmias allows one to avoid misinterpretation of the hepatic vein signal and permits assessment of the impact on right heart hemodynamics

On invariance functions in Relativity Theory

A new result for equivariant functions in terms of invariant functions in the case of Minkowski space is given. This generalizes the work of Hall and Wightman in the sense that only equivariance is required. In particular, it implies the possibility of defining physical magnitudes independently of the choice of the coordinate system, like the center of mass for relativistic particles

Different prostate cancer bone metastasis models respond differently to treadmill exercise (Abstract only)

Background: Prostate cancer (PCa) is a leading cause of death in men with a predilection to metastasize into bone, when the disease is considered to be uncurable. Exercise has been suggested to improve the health of patients with PCa but no current studies on its effects on PCa bone metastasis. Hypothesis: Treadmill exercise can prevent the progression of PCa bone metastasis. Methods: Human xenograft PCa cell line PC3 and murine syngeneic RM1-BM cells were intracardiacally injected (~1x10 cells/injection) into BALB/c nude (n=8) and C57BL/6J mice (n=12), respectively. The following day, the mice were subjected to treadmill exercise (12 meters/minute, 5° inclination, 30 minutes/day, 5 days/week) for 3 weeks. Bioluminescence assay was used to track skeletal tumour growth weekly and micro-CT was used to analyse bone morphometrics ex vivo. Naïve mice (n>6) were subject to the same treadmill protocol and used to assess the osteogenic response. Animal procedures were ethically approved by The University of Sheffield, UK. Results: In the xenograft model, the treadmill exercised mice developed significantly higher tumour burden (p< 0.05, Mann-Whitney test) in their hindlimbs compared to sedentary controls. The bone structure was not improved by treadmill exercise according to micro-CT analysis. In contrast, the syngeneic model showed significantly lower tumour burden in exercised mice compared to controls (p< 0.05, Mann-Whitney test) and a tendency to significantly improved survival curve (p=0.07, Gehan-Breslow-Wilcoxon test). The trabecular thickness (Tb.Th) was found significantly higher compared to controls (p< 0.001, unpaired t-test). In the naïve baseline study, the trabecular BV/TV had a 7.5% increase in C57BL/6J but 8.5% reduction in BALB/c nude mice, compared between exercised to sedentary controls. Conclusion: Treadmill exercise alleviates PCa growth in bones of syngeneic RM1-BM/C57BL/6J but not the xenograft PC3/BALB/c nude model, a possible consequence of different osteogenic response to treadmill by the two mouse strains

Correlates of measured prehypertension and hypertension in Latina women living along the US-Mexico border, 2007-2009.

IntroductionAlthough Latinos have lower hypertension rates than non-Latino whites and African Americans, they have a higher prevalence of undiagnosed and uncontrolled hypertension. Research on predictors of hypertension has mostly focused on intrapersonal factors with no studies assessing the combined influence of intrapersonal, interpersonal, and environmental factors. The purpose of this study was to assess a broad range of correlates including intrapersonal, interpersonal, and environmental factors on measured blood pressure category (nonhypertensive, prehypertensive, and hypertensive) in a sample of Latina women residing in San Diego, California.MethodsThis cross-sectional study used baseline data from the San Diego Prevention Research Center's Familias Sanas y Activas program, a promotora-led physical activity intervention. The sample was 331 Latinas who self-selected into this program. Backward conditional logistic regression analysis was conducted to determine the strongest correlates of measured blood pressure category.ResultsLogistic regression analysis suggested that the strongest correlates of prehypertension were soda consumption (odds ratio [OR] = 1.34, [1.00-1.80], P ≤ .05) and age (OR = 1.03, [1.00-1.05], P ≤ .05). The strongest correlates of hypertension were soda consumption (OR = 1.92, [1.20-3.07], P ≤ .01), age (OR = 1.09, [1.05-1.13], P ≤ .001), and measured body mass index (OR = 1.13, [1.05-1.22], P ≤ .001). All analyses controlled for age and education. No interpersonal or environmental correlates were significantly associated with blood pressure category.ConclusionFuture research should aim to further understand the role of soda consumption on risk for hypertension in this population. Furthermore, interventions aimed at preventing hypertension may want to focus on intrapersonal level factors

Un sistema distribuido para el procesamiento paralelo de algoritmos genéticos

Un sistema distribuido, básicamente, permite que varias tareas se desarrollen en forma conjunta siguiendo un enfoque competitivo o cooperativo. El fundamento de esta última perspectiva está en alcanzar mayor rapidez en la resolución de un único problema. Este tipo de enfoque es el adecuado para aquellas aplicaciones que son inherentemente paralelas. Los algoritmos genéticos son, esencialmente, algoritmos de búsqueda intrínsecamente paralelos. El presente trabajo propone una arquitectura distribuida que permite el procesamiento paralelo de algoritmos genéticos para la posterior evaluación de su performance.Eje: AplicacionesRed de Universidades con Carreras en Informática (RedUNCI

Un sistema distribuido para el procesamiento paralelo de algoritmos genéticos

Un sistema distribuido, básicamente, permite que varias tareas se desarrollen en forma conjunta siguiendo un enfoque competitivo o cooperativo. El fundamento de esta última perspectiva está en alcanzar mayor rapidez en la resolución de un único problema. Este tipo de enfoque es el adecuado para aquellas aplicaciones que son inherentemente paralelas. Los algoritmos genéticos son, esencialmente, algoritmos de búsqueda intrínsecamente paralelos. El presente trabajo propone una arquitectura distribuida que permite el procesamiento paralelo de algoritmos genéticos para la posterior evaluación de su performance.Eje: AplicacionesRed de Universidades con Carreras en Informática (RedUNCI

A Rare Case of COVID Encephalitis in a Vaccinated Patient

Background and Purpose: SARS-CoV-2 infection is known to cause primarily respiratory symptoms, however, neurological disorders such as anosmia and stroke have been seen. Encephalitis is a rare complication of COVID-19 with a reported incidence of less than 1%¹. Most patients develop both COVID-19 symptoms and encephalitis symptoms during the same period¹. In addition, the majority of reports are from patients with no prior vaccination. Here, we present a case of encephalitis 2 weeks after mild COVID-19 in a fully vaccinated male. Case Presentation: A 68-year-old Hispanic male was brought to the ED due to new onset gaze deviation, generalized tonic posturing, facial drooping, and unresponsiveness. Days prior to his symptoms, family members reported he was found staring blankly, confused, disoriented, and experienced multiple falls. The patient had a positive COVID-19 PCR exam 2 weeks prior to developing the symptoms, despite completing two doses of the Moderna vaccine 6 months prior. His sole symptom at the time was a cough. At admission, SARS-CoV-2 PCR was negative. NIHSS was 15. He was intubated and CT head was negative for active bleeding. tPA was administered for suspected ischemic stroke, however brain perfusion CT and MRI ruled out large vessel occlusion. He was started on Levetiracetam for seizures; 6 days later, Valproate was added. He remained intubated due to an altered state of mind, airway protection, and continuous seizure activity. 24-hour cEEG showed: slower background with multiple sedating agents on. CSF analysis showed elevated: protein (73), glucose (116) and pleocytosis (WBC = 26; of which 87% lymphocytes); Panel was: negative for infectious encephalitis (e.g. CMV, HSV, N. Meningitidis, VZV, Cryptococcus), Anti-NMDA receptor Ab, Anti-LGI1 Ab. Serologies were negative for ANCA, ANA, dsDNA and Anti-Proteinase-3 Ab. Post-COVID encephalitis was suspected and plasmapheresis exchange (PLEX) therapy was started. He completed five treatments of PLEX with marked improvement after therapy. Given the significant clinical improvement, he was successfully extubated. Patient’s neurological status progressively improved, reaching closer to his baseline status. He was transferred to the medical floor and eventually to acute rehab. Conclusion: Post COVID-19 encephalitis should be in the differential for patients with new onset altered mental status (AMS) and prior history of recent SARS-CoV-2 infection. Patients presenting with encephalitis should be tested and questioned for COVID diagnosis, even in those fully vaccinated. The length of stay may be reduced with treatments targeted towards COVID encephalitis and shorter delay in presentation to treatment2. Though a COVID CSF PCR was not done in this case, to date, there are no definitive reports of SARS-CoV-2 detection in CSF3. Additionally, this case supports the use of PLEX therapy, as there are multiple other options that are still being studied for the limited cases reported

El efecto del nivel de proteína y lípidos sobre la acción dinámica específica y la excreción postprandial en sub-adultos del camarón blanco Litopenaeus vannamei

The study aimed to evaluate the effect of 4 levels of dietary protein (20, 30, 40 and 50%) and lipids (2, 4, 8 and 16%) on the magnitude and duration of specific dynamic action (SDA) and postprandial nitrogen excretion in the subadult white shrimpLitopenaeus vannameiusing computer-controlled metabolic chambers (continuous-flow respirometer). We determined the oxygen consumption rate at 1 h intervals until the postprandial oxygen consumption rate returned to the pre-feeding level. Shrimp fed all the diets had significantly higher respiration rates after feeding due to the SDA. Oxygen consumption, the SDA coefficient and the SDA magnitude increased notably with increasing dietary protein content. Shrimp fed the 20% protein diet had the lowest levels of pre- and post-feeding respiration and the smallest SDA. A significant change in the SDA coefficient relative to each lipid level was not demonstrable. Additionally, nitrogenous excretion increased with an increase of dietary protein but not with an increase of lipid level. By estimating the SDA of subadults, the response to standard metabolic rate (SMR) was lower than that reported for juveniles and postlarva white shrimp

Acute Hypersensitivity Reaction After Casirivimab/Imdevimab Infusion in a COVID-19-Positive Young Male: Myopericarditis or Kounis Syndrome?

Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as a complication of allergic reaction to antibody infusions might be underreported. We report the case of a 30-year-old man with a previous diagnosis of coronavirus disease 2019 (COVID-19) infection one week prior to presentation, unvaccinated for SARS-CoV-2, who was referred from a monoclonal infusion center where he received casirivimab/imdevimab and 15 minutes after the infusion began to complain of chills, chest pain, shortness of breath, and was hypotensive. In the infusion center, the patient received epinephrine and diphenhydramine and was directed to the ER, where the patient was febrile, tachycardic, and hypotensive. Initial troponin was 1.91 which peaked at 11.73 and CK-MB which peaked at 21.2. EKG had no ischemic changes. A two-dimensional echocardiogram showed an ejection fraction (EF) of about 45%, with a left ventricular dysfunction and trivial posterior pericardial effusion, and it was diagnosed as myopericarditis. On admission, he was started on full-dose enoxaparin, aspirin, fluid resuscitation, steroids, remdesevir, and bilevel positive airway pressure (BiPap) due to his respiratory compromise. Three days later, with clinical improvement, a repeat echocardiogram showed EF of 65%, with normal ventricular contractility and no pericardial effusion. The patient was discharged home with close cardiology follow-up. Though this could be a simple case of viral myopericarditis with troponinemia secondary to demand-ischemia, the differential should be broadened to complication of monoclonal antibody, given the sudden symptom onset after infusion completion and/or a possible Kounis syndrome. Though there have not been any reported cases of casirivimab/imdevimab causing myopericarditis, adverse cardiac events after monoclonal therapy have been reported mainly in cancer patients receiving monoclonal infusions

Enhancing appropriate statin therapy in Type 2 Diabetic patients aged between 40-75 years at Graduate Medical Education (GME) Internal Medicine clinic

Background: The prevalence of type 2 diabetes mellitus (T2DM) is significantly higher in Rio Grande Valley than the rest of the United States. T2DM patients have an elevated risk of Atherosclerotic cardiovascular disease (ASCVD), and clinical trials have demonstrated the beneficial effects of statin therapy on ASCVD. A quality-improvement project was implemented in the GME Internal Medicine (IM) Clinic at Doctors Hospital at Renaissance to improve statin therapy appropriateness. Methods: T2DM patients aged 40-75 were selected from the GME IM Clinic visits from July 2021 to October 2021 for baseline data and from January 2022 to April 2022 after implementing our interventions, which included education of the new practice guidelines of statin therapy in T2DM to the internal medicine residents, as well as development of a clinical decision support tool designed to assess the indication and intensity of statin therapy. Exclusion criteria included patients without T2DM, ages above 75/below 40 years of age, and missing information for ASCVD risk stratification. Statin appropriateness was determined according to the American Diabetes Association standards in diabetes management. Results: The number of patients in the four months after the exclusions pre-intervention and post-intervention were 153 and 207, respectively. Overall, 71.9% (n=110) of the patients pre-intervention were receiving an appropriate statin therapy; the number increased to 80% (n=166) post-intervention (p = 0.003), considered statistically significant using t-test analysis. Of the total patients (N=43) with inappropriate statin therapy, 37% (n=16) had inadequate dose, and 63% (n=27) were not receiving any statin in the pre-intervention cohort. This percentage of inadequate statin dose and no statin therapy decreased to 65% (n=27) and 35% (n=14), respectively post-intervention. Conclusion: Appropriate statin therapy has been shown to reduce all-cause mortality by 19% in T2DM. Appropriateness of statin therapy was increased by 10%, and more than 50% reduction of patients without receiving any statin therapy, after our intervention. Effective implementation of new guidelines regarding risk stratification and prevention of ASCVD in T2DM age 40-75 years of age may be challenging. Barriers such as physicians\u27 adoption and knowledge regarding new guidelines can be overcome with appropriate tools and education, such as those implemented in our project