Primary Angioplasty: From the Artery to the Myocardium

The prognosis of patients suffering from acute myocardial infarction (AMI) is related to the amount of muscle loss and ventricular function deterioration caused by the event. Primary angioplasty is the most effective reperfusion strategy. Early reperfusion limits the size of the infarction and improves the prognosis. However, the incidence of death and post-AMI heart failure remains around 20% during the first year. Factors that contribute to myocardial damage are ischemia, mechanical forces, inflammation, and reperfusion injury. All those take a variable and sometimes unpredictable preponderance at different times during the evolution of acute myocardial infarction. The damage caused by the different mechanisms is irreversible; therefore, any therapeutic strategy must be preventive. Developed treatments for continuous myocardial protection could potentially preserve the myocardium during the delay of the system and during the early evolution of the event. Developed controlled reperfusion procedures where the interventional cardiologist assumes the treatment not only of the culprit vessel but also of the myocardium could potentially decrease myocardial damage, preserve ventricular function, and improve patients’ prognosis

Design of a Single Family Home and Rooftop Rainwater Catchment System in Nepal Using Earthbag Technology

After the devastating April 2015 Gorkha earthquake in Nepal, entire villages were destroyed and remain unbuilt. In addition, rural subsistence farmers in the village of Takure, Nepal are struggling to provide for their families due to a long seasonal dry season from October to May.8 In order to address this crisis, this team designed and implemented a simple earthbag house with a rooftop rainwater catchment system for homeless villagers in Takure. This single-family house design aimed to address Takure’s most urgent needs by being seismically-resistant, locally sourced, economically feasible, and sustainable. The project also created valuable benefits for the Takure community, including local job creation and empowerment

Gallbladder adenocarcinoma: evaluation of the prognostic factors in 100 resectable cases in Brazil

BACKGROUND: In spite its relative rarity, gallbladder adenocarcinoma is a neoplasm who presents an aggressive biologic behavior. The single curative treatment has been radical surgical resection with free margin. Prognostic factors has been studied because are very important to identify long-term survival patients which may benefit of aggressive surgical resection. AIM: To evaluate long-term prognostic predictors from gallbladder cancer. METHODS: The medical records of all patients that presented confirmed histological diagnosis of gallbladder adenocarcinoma operated over a 14 year period were identified and retrospectively reviewed. Uni and multivariate analysis was done. RESULTS: Total sample was 100 patients. Median age was 71 years (34 to 93). There were 17 men and 83 women. Lesion distribution according to TNM stage system was: I (n=22), II (n=59), III (n=6), IV (n=4) and unknown (n=9). Fifty two patients underwent radical resection (R0) while 48 to palliative surgery (R1-R2). Overall major morbidity was 14%, while postoperative surgical mortality rate (30th postoperative day) was 12 %. Five-year survival rate was 28% while median of survival was 10 months. Multivariate analysis identified six prognostic factors: T stage, serum level of CA 19.9, gallbladder perforation, lymphatic embolization, surgical historical cohort (after 2002) and hilar lymphadenectomy. CONCLUSION: Prognostic factors were: T stage, serum level of CA 19.9, gallbladder perforation, lymphatic embolization, surgical historical cohort and hilar lymphadenectomy.RACIONAL: A despeito da sua relativa raridade, o adenocarcinoma de vesícula biliar é neoplasia que apresenta comportamento biológico agressivo. O único tratamento curativo tem sido a ressecção cirúrgica radical com margem livre. Fatores prognósticos têm sido estudados por serem importantes para identificar pacientes que podem se beneficiar de ressecção cirúrgica agressiva. OBJETIVO: Avaliar preditores prognósticos em longo prazo de pacientes com câncer da vesícula biliar. MÉTODOS: Foram identificados e retrospectivamente revisados os prontuários médicos de todos os doentes submetidos a tratamento cirúrgico que apresentavam diagnóstico histológico confirmado de adenocarcinoma de vesícula biliar durante período de 14 anos. Os dados foram submetidos à análise estatística uni e multivariada. RESULTADOS: A amostra total foi de 100 doentes. A mediana de idade foi de 71 anos (34 a 93). Houve 17 mulheres e 83 homens. A distribuição das lesões de acordo com o sistema de estadiamento TNM foi: I (n=22), II (n=59), III (n=6), IV (n=4) e desconhecido (n=9). Cinquenta e dois doentes foram submetidos à ressecção radical (R0) enquanto 48 à cirurgia paliativa (R1-R2). A morbidade global foi de 14% enquanto que a mortalidade pós-operatória (até 30º dia do pós-operatório) foi de 12 %. A taxa de sobrevida em cinco anos foi de 28% enquanto a mediana de sobrevida foi de 10 meses. A análise multivariada identificou seis fatores prognósticos: estádio T, nível sérico de CA 19.9, perfuração da vesícula biliar, embolização linfática, coorte cirúrgico histórico e linfadenectomia hilar. CONCLUSÃO: O tratamento do câncer de vesícula biliar apresenta alta morbimortalidade. Os fatores prognósticos foram: estádio T, nível sérico de CA 19.9, perfuração da vesícula biliar, embolização linfática, coorte cirúrgico histórico e linfadenectomia hilar.HSPE FMO Hospital Francisco Morato de OliveiraUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

A depressão no teste das Pirâmides Coloridas de Pfister

O objetivo desse estudo foi investigar o desempenho de pacientes com depressão no teste das Pirâmides Coloridas de Pfister. Foram investigados 19 pacientes com depressão, previamente diagnosticados pela SCID, e seus desempenhos foram comparados com os resultados obtidos com uma amostra de 110 indivíduos não pacientes que participaram de um estudo normativo. Adotou-se como procedimento a versão do Pfister de 24 matizes e a realização de três pirâmides bonitas. Os resultados apontaram para um significativo aumento do verde acompanhado da constância absoluta da cor violeta, bem como a maior incidência de pirâmides cortadas e de formações tendendo a estruturas. A combinação desses indicadores possibilita identificar pacientes com pânico havendo 86,4% de sensibilidade. Tais resultados permitem afirmar que o teste de Pfister pode colaborar para o diagnóstico de depressão, sendo contudo necessários outros recursos para maior segurança diagnóstica.In this study our purpose was to identify the aspects in the Color Pyramid Test of Pfister which may be useful to the assessment of depressive patients. Our sample was composed by 19 participants previously assessed by the SCID as depressives. We used the Pfister's version composed by 24 colors and only the three beautiful pyramids. The results are compared with the performance of 110 no-patients and demonstrates that the high frequency of green, the absolute constancy of violet, the stratified forms with cuts or tendency to structures are significant for the group of patients Our results indicates that the sensibility of Pfister for the diagnosis of depression based on this aspects is about 86,4%. This test can helps satisfactory for the assessment of depression when associated to others techniques. This study contributes to the necessity to verify the possibilities and limitations in the use of this test

BioTIME: A database of biodiversity time series for the Anthropocene.

MotivationThe BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community-led open-source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene.Main types of variables includedThe database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record.Spatial location and grainBioTIME is a global database of 547,161 unique sampling locations spanning the marine, freshwater and terrestrial realms. Grain size varies across datasets from 0.0000000158 km2 (158 cm2) to 100 km2 (1,000,000,000,000 cm2).Time period and grainBioTIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year.Major taxa and level of measurementBioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates.Software format.csv and .SQL

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The most essential components of TB control are early diagnosis and adequate treatment. Delay in the diagnosis and treatment of tuberculosis may result in more extensive disease and more complications, increase severity of the disease and is associated with higher risk of mortality. The purpose of this study was to identify factors associated with delayed diagnosis of TB in hospitalized patients.</p> <p>Methods</p> <p>We conducted a cross-sectional study in a general, tertiary care, university-affiliated hospital. Adult patients with TB that were hospitalized were identified retrospectively, and risk factors for delayed diagnosis were collected.</p> <p>Results</p> <p>The median delay until diagnosis was 6 days (IQR: 2-12 days). One hundred and sixty six (54.4%) patients were diagnosed ≤ 6 days, and 139 (45.6%) > 6 days after admission. The main factors associated with diagnostic delay (> 6 days) were extra-pulmonary TB and negative sputum smear.</p> <p>Conclusions</p> <p>Although hospitalization permits a rapid management of the patient and favors a faster diagnosis, we found an unacceptable time delay before the diagnosis of pulmonary TB was made. Future studies should focus on attempt to explain the reasons of diagnostic retard in the patients with the characteristics related to delay in this study.</p

The Synoptic All-Sky Infrared (SASIR) Survey

We are proposing to conduct a multicolor, synoptic infrared (IR) imaging survey of the Northern sky with a new, dedicated 6.5-meter telescope at San Pedro M\'artir (SPM) Observatory. This initiative is being developed in partnership with astronomy institutions in Mexico and the University of California. The 4-year, dedicated survey, planned to begin in 2017, will reach more than 100 times deeper than 2MASS. The Synoptic All-Sky Infrared (SASIR) Survey will reveal the missing sample of faint red dwarf stars in the local solar neighborhood, and the unprecedented sensitivity over such a wide field will result in the discovery of thousands of z ~ 7 quasars (and reaching to z > 10), allowing detailed study (in concert with JWST and Giant Segmented Mirror Telescopes) of the timing and the origin(s) of reionization. As a time-domain survey, SASIR will reveal the dynamic infrared universe, opening new phase space for discovery. Synoptic observations of over 10^6 supernovae and variable stars will provide better distance measures than optical studies alone. SASIR also provides significant synergy with other major Astro2010 facilities, improving the overall scientific return of community investments. Compared to optical-only measurements, IR colors vastly improve photometric redshifts to z ~ 4, enhancing dark energy and dark matter surveys based on weak lensing and baryon oscillations. The wide field and ToO capabilities will enable a connection of the gravitational wave and neutrino universe - with events otherwise poorly localized on the sky - to transient electromagnetic phenomena.Comment: Revised version of submitted whitepaper to the "Optical and IR Astronomy from the Ground" Program Prioritization Panel of the Astro2010 Decadal Survey; 23 page

Estimating the current and future cancer burden in Canada: Methodological framework of the Canadian population attributable risk of cancer (ComPARe) study

Introduction The Canadian Population Attributable Risk of Cancer project aims to quantify the number and proportion of cancer cases incident in Canada, now and projected to 2042, that could be prevented through changes in the prevalence of modifiable exposures associated with cancer. The broad risk factor categories of interest include tobacco, diet, energy imbalance, infectious diseases, hormonal therapies and environmental factors such as air pollution and res