Challenge of Diagnosing and Treating a Mediastinal Mass in a Young Patient

Background: Germ cell tumors (GCT) are neoplasms arising in the testicles (1). Rarely these tumors can grow outside of the reproductive organs without involving them, acquiring the name of extragonadal GCT (2). Mediastinal extragonadal GCT is further divided into seminomatous, non-seminomatous (yolk sac tumor, choriocarcinoma and/or embryonal cell tumor), mature teratoma, and immature teratoma according to the histological pattern (2). Case Presentation: 24-year-old-male patient presented to the ER with complaints of a persistent cough of one-month duration accompanied by orthopnea, pleuritic chest pain, and worsening shortness of breath. The patient denied weight loss, testicular pain, night sweats, fever, or hemoptysis. Vital signs on admission were stable. CXR showed a large mass-like density overlying the right hilum. CT chest with contrast showed a 13 cm anterior mediastinal mass with a right loculated pleural effusion. Biopsy was performed with immunohistology compatible with nonseminatomous germ cell tumor. Serological tumor markers including Alpha-fetoprotein, LDH and Beta HCG were significantly elevated. AFP 1,680.4, LDH 399, Beta HCG 113 and CEA 1.3 supported this diagnosis. Conclusion: Nonseminomatous extragonadal GCT is a rare but aggressive neoplasm that arises in the anterior mediastinum. Statistically, they occur more often in men than in women, commonly between the ages of 20 and 40 years old. Treatment with chemotherapy followed by surgical resection of the mass is recommended and should be initiated as soon as the diagnosis is made. Our patient opted to be transferred to MD Anderson Cancer Center for a higher level of care

Pelvic Pain, Pelvic Organ Prolapse, Urinary and Colorectal Distress Incidence and Relationship to Quality of Life and Birth Mode

Abstract Purpose: To determine the incidence and impact of pelvic pain, pelvic organ prolapse, urinary and colorectal distress and quality of life by birth mode for women in the chronic postpartum period. Study design: Cross-sectional correlational design utilizing purposive sampling of (n=21) female postpartum subjects ages 18-45. Background: Caesarean Section (CS) incidence is reported at 32% nationwide, well above the recommended safe rate of 10% (WHO). Literature is not clear regarding role of birth mode in postpartum symptoms including: pelvic pain, colorectal distress, pelvic organ prolapse, and quality of life. Methods: Data collection took place after IRB approval from Andrews University. Each subject who agreed to volunteer for the study and met the inclusion criteria completed (1) Health History Questionnaire, (2) SF-36, and (3) Pelvic Floor Distress Inventory. Result: Incidence reports of UI were 80% in CS and 50% in the NVD group. The CS reported significantly higher mean scores for PFIQb, UDI, POPDI and CRADI. Age was negatively correlated with CRADI and pain (Chi-square=7.02, p=0.030). NVD reported a significantly higher quality of life (as measured by the SF-36) in general and mental health compared to published norms and CS (p\u3c0.05). BMI showed a significant moderate correlation (r=0.682, p\u3c0.001) with pelvic organ prolapse. Conclusion: Our study found significant increased incidence and impact of UI, CRADI, POPDI and PFIQb symptoms and a decrease in QOL in CS compared to NVD. Age showed significant correlation with colorectal symptoms and BMI showed significant relationship to pelvic organ prolapse

Infrared thermography comparison of heat generation between simplified and conventional implant site preparation techniques

ABSTRACT Introduction: The predictability of osseointegration depends on a non-traumatic surgical technique that maintains cell viability. It is known that during the drilling osteotomy for implant placement occurs heat generation, being able to influence osseointegration due to thermal damage. The objective of this research was to evaluate and compare the heat generated by the drills during the preparation of surgical sites for implant placement between two different techniques: simplified (Simplified Drilling, SD) and conventional, in an in vitro model. Material and methods: Fifty implant site preparations were performed in segments of bovine ribs, divided into two groups, with the respective drill sequences: control group, conventional preparation, Ø2.0mm spear drill and Ø2.15mm, Ø2.85mm, Ø3.35mm, Ø3.85mm twist drills; SD group, Ø2.15mm and Ø3.85mm twist drills. The measurement of the temperature variation generated by each drill in each group was performed by an infrared thermal camera at three points in the bovine rib segment. Results: The temperature variations at one and thirteen millimeters below the drilling site were, respectively, 0.51±0.64°C and 0.46±0.59°C for the control group, and 0.62±0.76°C and 0.5±0.86°C for the SD group. No statistically significant differences were found between the control and SD groups in relation to heat generation in any of the evaluated points; p=0.288 and p=0.584, respectively for analyzes one and thirteen millimeters below the drilling site. Discussion: The technique of implant site preparation can be simplified, using only two drills in this modality, without showing significant differences in relation to heat generation when compared to the conventional preparation technique

O CONTROLE DO TCE-PE NA ADMISSÃO DE SERVIDORES TEMPORÁRIOS: O PAPEL DO TAG E DA ECPBG DIANTE DAS ILEGALIDADES EVIDENCIADAS

O presente estudo tem por objetivo apreciar a atuação do Tribunal de Contas do Estado de Pernambuco, TCE-PE, frente à fiscalização da admissão de temporários. Escrito a partir de pesquisas bibliográficas, jurisprudenciais e entrevistas semiabertas. O trabalho analisou as consequências da atividade do Termo de Ajustamento de Gestão, TAG, enquanto instrumento alternativo, e da Escola de Contas Públicas Professor Barreto Guimarães, ECPBG, em seu caráter de complementariedade, para a concretização do princípio da eficiência que cerceia a Administração Pública. Deste modo, ressaltou a importância da utilização do TAG e atuação da ECPBG para o aprimoramento do controle dos atos administrativos e eficiência do serviço público, no âmbito de competência do TCE-PE

The Grizzly, August 30, 2001

Construction on Campus: Residents Return to Numerous Campus Improvement Projects • What is a Watson? • Lending a Helping Hand: Class of 2005 Volunteers at Philadelphia\u27s Cobb Creek Park • UC Students Complete Summer Research • Class of 2005 Receives Dell Laptops • Tumultuous Tuition? • Opinions: Potty Improvement?; Pet for a New Age; Mind the Dust: A Student Perspective of Construction on Campus • More Bang for Your Buck: A Comparative Report on the Prices of Condoms in Collegeville • What is There to do in Collegeville? • Francoise Gilot Exhibit in Berman Museum of Art • Art Fair Coming to Berman Museum of Art • Looking Back: The Life of an Ursinus Student in 1870 • What\u27s in a Name? • Drug-Testing for College Athletes • New Fitness Area Not Quite Ready for Students • Ursinus College Football Head Coach Peter Gallagher • Dog Days of Summer May Lead to Heat-Related Illnesseshttps://digitalcommons.ursinus.edu/grizzlynews/1491/thumbnail.jp

Evolução dos índices de sonolência e fadiga em pacientes com síndrome da apnéia obstrutiva do sono portadores ou não de associação com síndrome das pernas inquietas após CPAP nasal

Objetivo: A associação síndrome de apnéia obstrutiva do sono / síndrome de pernas inquietas (SAOS-SPI) tem sido mencionada na literatura há muito. Ambas podem ser responsáveis por queixas de fadiga e sonolência secundárias à fragmentação do sono noturno. O objetivo deste estudo é avaliar a evolução dos sintomas de fadiga e sonolência diurna excessiva antes e após o tratamento com pressão aérea positiva contínua (CPAP) em pacientes portadores de SAOS, com e sem SPI. Método: Estudo prospectivo e comparativo entre um grupo de 13 pacientes com SAOS e um grupo de 17 com SAOS +SPI. Exames laboratoriais e polissonografia (PSG) foram realizados no início do estudo. A escala de sonolência de Epworth (ESE) e o questionário de fadiga/depressão de Pichot (PIC) foram aplicados antes do tratamento com CPAP e 3 meses após. Os resultados foram comparados. Resultados: No início do estudo não foram encontradas diferenças significativas na avaliação laboratorial e PSG. Ambos os grupos apresentavam inicialmente pontuação semelhante na avaliação da ESE e PIC (p=0,73 e 0,08, respectivamente). Após CPAP, os pacientes SAOS+SPI apresentaram maiores ESE e PIC (p=0,017 e 0,03, respectivamente). Conclusão: Apesar de resposta inicial favorável em ambos os grupos, o CPAP foi aparentemente menos eficaz na redução das queixas de fadiga e sonolência nos pacientes apnéicos com associação a SPI.Background and Purpose: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. The primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (CPAP) treatment in OSAS patients with and without RLS. Method: A prospective and comparative study between a group of 13 patients with OSAS and a group of 17 patients with OSAS+RLS. Laboratory blood tests and polysomnography were performed at baseline. The Epworth Sleepiness Scale (ESS) and the Pichot’s questionnaire of fatigue/depression (PIC) were applied before and after 3 months of CPAP treatment. Results were compared. Results: No significant differences were found on PSG and laboratory results at baseline. Both groups had similar ESS and PIC scores at baseline (p=0.73 and 0.08, respectively). After n-CPAP, OSAS+RLS patients showed higher ESS and PIC scores (p=0.017 and 0.03, respectively). Conclusions: Despite a favorable general response, n-CPAP seemed less effective in treating fatigue and sleepiness in the OSAS+RLS group

The Grizzly, September 6, 2001

Activities Fair Helps Students Get Involved on Campus • Ursinus Leadership Scholar Program Teaches Students Skills to Succeed • Students Express Concern About Unsafe Campus Pathways • Opinions: Roommate: Friend or Foe?; Is our Campus Safe?; Homesickness not so Uncommon • Former UC Professor to Perform in Seven Stars Music and Art Festival • Free Museums on the Philly Parkway! • Wash, Cut, Blow Dry: It Doesn\u27t Have to Empty Your Wallet! • A Face From the Past: Dr. John Henry Augustus Bomberger • Women\u27s Soccer Team Victorious at UC Invitational • La Roche College Men\u27s Soccer Invitational Champions • Soggy Soccer Field Creates Muddy Waters • Women\u27s Volleyball Defeats Hood in their own Tournament • Bears Fall to Presidents in Heated Battle at Patterson Field • Blood, Sweat and Tearshttps://digitalcommons.ursinus.edu/grizzlynews/1492/thumbnail.jp

Frailty and cardiac rehabilitation : A call to action from the EAPC Cardiac Rehabilitation Section

Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation.The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients.Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients

Estrutura e processo de trabalho na atenção primária e internações por condições sensíveis

OBJETIVO Investigar se características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica estão associadas ao número de internações por condições sensíveis à atenção primária. MÉTODOS Neste estudo ecológico, foram analisados dados de municípios brasileiros relativos a características sociodemográficas, de cobertura de programas assistenciais, de estrutura das unidades básicas de saúde e processo de trabalho das equipes de atenção básica. Os dados foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica, do Departamento de Informática do Sistema Único de Saúde, do Instituto Brasileiro de Geografia e Estatística e do Programa das Nações Unidas. Estimaram-se as associações por meio de coeficientes de regressão binomial negativa (β) e respectivos intervalos de confiança a 95%, com abordagem hierarquizada em três blocos (alpha = 5%). RESULTADOS Na análise ajustada, para o desfecho em 2013, no bloco distal, a cobertura do Programa Bolsa Família (β = -0,001) e de plano privado (β = -0,01) apresentaram associação negativa; e o índice de desenvolvimento humano (β = 1,13), a proporção de pessoa idosa (β = 0,05) e de menor de cinco anos (β = 0,05) e a cobertura da Estratégia de Agentes Comunitários de Saúde (β = 0,002) mostraram associação positiva com internações por condições sensíveis à atenção primária. No bloco intermediário, apresentaram associação negativa o horário mínimo (β = -0,14) e a disponibilidade de vacina (β = -0,16); e associação positiva, a disponibilidade de medicamentos (β = 0,16). No bloco proximal, apenas a variável apoio matricial (β = 0,10) mostrou associação positiva. Na análise ajustada do número de internações por condições sensíveis à atenção primária em 2014, as variáveis apresentaram o mesmo sentido de associação de 2013. CONCLUSÕES Características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica impactam no número de internações por condições sensíveis à atenção primária nos municípios brasileiros.OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities