Modifikasi Postural dari Standar Manuver Valsalva untuk Perawatan Kedaruratan pada Takikardia Supraventrikular

This study aims to determine the effectiveness of the modified valsalva maneuver in restoring sinus rhythm in patients presenting to the emergency department of the Harapan Kita National Heart Hospital Jakarta with Supraventricular Tachycardia (SVT). The method used is quantitative with a pre-experimental research design. The results showed that the modified valsalva maneuver affected systolic and diastolic blood pressure and heart rate, with the average difference between pre and post-valsalva maneuver modification being 0.399 in systole; 0.075 in diastole; and a heart rate of 0.081. In conclusion, the valsalva maneuver modification is able to change the SVT ECG image into a Sinus Rythem ECG. Keywords:  Modified Valsalva Maneuver, Emergency Treatment, Supraventricular Tachycardi

Peningkatan Kemampuan Perawat dalam Interpretasi EKG Normal dan Aritmia dengan Metode Angka “3”

This study aims to determine the effect of the number 3 method on nurses' ability to interpret normal ECG and arrhythmias. The research method used a quasi-experimental design with one group pre-test and a post-test with a control group. The results showed that there was a significant difference in the mean score of nurses in the interpretation of normal ECG and arrhythmias in both the intervention and control groups (p-value 0.007 and 0.002). The multiple linear regression test showed that the treatment variable contributed to the nurse's ability to interpret normal ECG and arrhythmias with a p-value of 0.002 with a negative linear pattern (Nurses' ability = 66.099 - 9.156 (treatment). In conclusion, there is a significant difference in the average score of nurses in interpretation. Normal ECG and arrhythmia in both the intervention and control groups. However, the intervention group with the number 3 method had a greater difference in mean values ​​than the control group. Statistically, the more research treatments, the nurses' ability to interpret normal ECG and arrhythmias would decrease.   Keywords: Arrhythmia, Normal EKG, Interpretation of ECG, Number Method

Extinction-to-Backscatter Ratios of Saharan Dust Layers Derived from In-Situ Measurements and CALIPSO Overflights During NAMMA

We determine the extinction-to-backscatter (Sa) ratios of dust using (1) airborne in-situ measurements of microphysical properties, (2) modeling studies, and (3) the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) observations recorded during the NASA African Monsoon Multidisciplinary Analyses (NAMMA) field experiment conducted from Sal, Cape Verde during Aug-Sept 2006. Using CALIPSO measurements of the attenuated backscatter of lofted Saharan dust layers, we apply the transmittance technique to estimate dust Sa ratios at 532 nm and a 2-color method to determine the corresponding 1064 nm Sa. This method yielded dust Sa ratios of 39.8 plus or minus 1.4 sr and 51.8 plus or minus 3.6 sr at 532 nm and 1064 nm, respectively. Secondly, Sa at both wavelengths is independently calculated using size distributions measured aboard the NASA DC-8 and estimates of Saharan dust complex refractive indices applied in a T-Matrix scheme. We found Sa ratios of 39.1 plus or minus 3.5 sr and 50.0 plus or minus 4 sr at 532 nm and 1064 nm, respectively, using the T-Matrix calculations applied to measured size spectra. Finally, in situ measurements of the total scattering (550 nm) and absorption coefficients (532 nm) are used to generate an extinction profile that is used to constrain the CALIPSO 532 nm extinction profile and thus generate a stratified 532 nm Sa. This method yielded an Sa ratio at 532 nm of 35.7 sr in the dust layer and 25 sr in the marine boundary layer consistent with a predominantly seasalt aerosol near the ocean surface. Combinatorial simulations using noisy size spectra and refractive indices were used to estimate the mean and uncertainty (one standard deviation) of these Sa ratios. These simulations produced a mean (plus or minus uncertainty) of 39.4 (plus or minus 5.9) sr and 56.5 (plus or minus 16.5) sr at 532 nm and 1064 nm, respectively, corresponding to percent uncertainties of 15% and 29%. These results will provide a measurements-based estimate of the dust Sa for use in backscatter lidar inversion algorithms such as CALIOP

Is there a role for melatonin in fibromyalgia?

Fibromyalgia, characterised by persistent pain, fatigue, sleep disturbance and cognitive dysfunction, is a central sensitivity syndrome that also involves abnormality in peripheral generators and in the hypothalamic pituitary adrenal axis. Heterogeneity of clinical expression of fibromyalgia with a multifactorial aetiology has made the development of effective therapeutic strategies challenging. Physiological properties of the neurohormone melatonin appear related to the symptom profile exhibited by patients with fibromyalgia and thus disturbance of it’s production would be compatible with the pathophysiology. Altered levels of melatonin have been observed in patients with fibromyalgia which are associated with lower secretion during dark hours and higher secretion during daytime. However, inconsistencies of available clinical evidence limit conclusion of a relationship between levels of melatonin and symptom profiles in patients with fibromyalgia. Administration of melatonin to patients with fibromyalgia has demonstrated suppression of many symptoms and an improved quality of life consistent with benefit as a therapy for the management of this condition. Further studies with larger samples, however, are required to explore the potential role of melatonin in the pathophysiology of fibromyalgia and determine the optimal dosing regimen of melatonin for the management of fibromyalgia

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

A systematic review and meta-analysis of neurological soft signs in relatives of people with schizophrenia

<p>Abstract</p> <p>Background</p> <p>Neurological soft signs are subtle but observable impairments in motor and sensory functions that are not localized to a specific area of the brain. Neurological soft signs are common in schizophrenia. It has been established that soft signs meet two of five criteria for an endophenotype, namely: association with the illness, and state independence. This review investigated whether soft signs met a further criterion for an endophenotype, namely familial association. It was hypothesized that if familial association were present then neurological soft signs would be: (a) more common in first-degree relatives of people with schizophrenia than in controls; and (b) more common in people with schizophrenia than in their first-degree relatives.</p> <p>Method</p> <p>A systematic search identified potentially eligible studies in the EMBASE (1980-2011), OVID - MEDLINE (1950-2011) and PsycINFO (1806-2011) databases. Studies were included if they carried out a three-way comparison of levels of soft signs between people with schizophrenia, their first-degree relatives, and normal controls. Data were extracted independently by two reviewers and cross-checked by double entry.</p> <p>Results</p> <p>After screening 8678 abstracts, seven studies with 1553 participants were identified. Neurological soft signs were significantly more common in first-degree relatives of people with schizophrenia than in controls (pooled standardised mean difference (SMD) 1.24, 95% confidence interval (c.i) 0.59-1.89). Neurological soft signs were also significantly more common in people with schizophrenia than in their first-degree relatives (SMD 0.92, 95% c.i 0.64-1.20). Sensitivity analyses examining the effects of age and group blinding did not significantly alter the main findings.</p> <p>Conclusions</p> <p>Both hypotheses were confirmed, suggesting that the distribution of neurological soft signs in people with schizophrenia and their first-degree relatives is consistent with the endophenotype criterion of familial association.</p

3D Multi-system Bayesian Calibration with Energy Conservation to Study Rapidity-dependent Dynamics of Nuclear Collisions

Considerable information about the early-stage dynamics of heavy-ion collisions is encoded in the rapidity dependence of measurements. To leverage the large amount of experimental data, we perform a systematic analysis using three-dimensional hydrodynamic simulations of multiple collision systems -- large and small, symmetric and asymmetric. Specifically, we perform fully 3D multi-stage hydrodynamic simulations initialized by a parameterized model for rapidity-dependent energy deposition, which we calibrate on the hadron multiplicity and anisotropic flow coefficients. We utilize Bayesian inference to constrain properties of the early- and late- time dynamics of the system, and highlight the impact of enforcing global energy conservation in our 3D model

Evidence for Involvement of Th17 Type Responses in Post Kala Azar Dermal Leishmaniasis (PKDL)

Post kala azar dermal leishamniasis (PKDL), an unusual dermatosis, develops in 5–15% of apparently cured visceral leishmaniasis cases in India and in about 60% of cases in Sudan. PKDL cases assume importance since they constitute an important human reservoir for the parasite. Host immunological responses, considered as major factors in PKDL development, are poorly understood. Limited studies have been performed to explore the host immune responses and that too, restricted to a few immune parameters. The present study employed cDNA array technique that identified various host immuno-determinants including cytokines, chemokines, apoptotic and signaling molecules which were not reported previously in PKDL. In addition, we showed for the first time that Th17 responses are present during L. donovani infection in PKDL which possibly contributes significantly to disease pathogenesis by inducing TNF-α and nitric oxide production. Our findings lead to improved understanding of the host parasite interaction in terms of immune responses and pathology in tissue lesions of PKDL