Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient\u27s reproductive goals and overall risk profile

Healthcare Provider and Patient Knowledge, Attitudes and Practices (KAP) Regarding Zika Virus

Introduction: Zika virus emergence in the western hemisphere has prompted the critical need for tailored risk counseling. Our team created a KAP survey in order to assess provider and patient awareness of Zika virus symptoms, transmission, treatment, and current and future concerns in order to inform local risk counseling efforts. Methods: The cross-sectional survey was issued in Medical Faculty Associates (MFA) clinics and via online link to healthcare providers and community members. The REDCap Data Collection tool was used to capture responses with subsequent SAS data analysis. Results: A total of 172 responses were collected. Most respondents (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% will restrict travel to Zika endemic regions. 51% will take mosquito protective measures in the US versus 91% in Zika endemic areas. 35% of pregnant women would abstain from sex if their partners traveled to a Zika endemic area whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% are concerned about eventually having a child with microcephaly. Of the healthcare providers sampled, about one-fifth could not identify Zika infection symptoms, 16% were unaware of symptom treatment options and 5.4% did not know that Zika virus could be passed transplacentally. 34% believed DEET to be unsafe in pregnancy and 52% were unsure about permethrin safety in pregnancy. Of the 172 survey respondents, most (97%) were aware of a link between Zika virus and microcephaly. 89% think that a vaccine is important. 52% would restrict travel to Zika endemic regions. 51% would practice mosquito safety in the US versus 91% in Zika endemic countries. 35% of pregnant women would abstain from intercourse if their partners traveled to Zika endemic areas whereas 25% would if they themselves were the traveler. 37% plan to delay pregnancy and 58% worry about future children with microcephaly. Of the healthcare providers, 20% could not identify Zika infection symptoms, 16% were unaware of symptom treatment options, 5% were unaware that Zika virus passes transplacentally, and 34% believed DEET to be unsafe in pregnancy. Conclusion: The survey results provide novel insight into the KAP of patients and healthcare providers regarding Zika virus. This data will be used to optimize information distribution to our community, address large knowledge gaps in both patients and providers, and prepare medical providers to offer needed counseling

A Multinational Study of Acute and Long‐Term Outcomes of Type 1 Galactosemia Patients Who Carry the S135L (c.404C > T) Variant of GALT

Patients with galactosemia who carry the S135L (c.404C > T) variant of galactose-1-P uridylyltransferase (GALT), documented to encode low-level residual GALT activity, have been under-represented in most prior studies of outcomes in Type 1 galactosemia. What is known about the acute and long-term outcomes of these patients, therefore, is based on very limited data. Here, we present a study comparing acute and long-term outcomes of 12 patients homozygous for S135L, 25 patients compound heterozygous for S135L, and 105 patients homozygous for two GALT-null (G) alleles. This is the largest cohort of S135L patients characterized to date. Acute disease following milk exposure in the newborn period was common among patients in all 3 comparison groups in our study, as were long-term complications in the domains of speech, cognition, and motor outcomes. In contrast, while at least 80% of both GALT-null and S135L compound heterozygous girls and women showed evidence of an adverse ovarian outcome, prevalence was only 25% among S135L homozygotes. Further, all young women in this study with even one copy of S135L achieved spontaneous menarche; this is true for only about 33% of women with classic galactosemia. Overall, we observed that while most long-term outcomes trended milder among groups of patients with even one copy of S135L, many individual patients, either homozygous or compound heterozygous for S135L, nonetheless experienced long-term outcomes that were not mild. This was true despite detection by newborn screening and both early and life-long dietary restriction of galactose. This information should empower more evidence-based counseling for galactosemia patients with S135L.info:eu-repo/semantics/publishedVersio

Prostaglandin E2 suppresses the differentiation of retinoic acid–producing dendritic cells in mice and humans

Prostaglandin E2 inhibits the expression of retinal dehydrogenase, thus inhibiting retinoic acid production and the priming of gut-tropic T cells by dendritic cells

estudos artísticos

A memória precisa dos que a motivam e dos que a visitam. Uns, criadores no seu tempo, escrevem as suas delicadas articulações sem saber o seu destino. Outros, nos tempos vindouros, tentam captar a intentio auctoris sabendo que ela se esconde no tecido da criação, nos processos dos artistas. Estes talvez possam ter um ponto de vista que acrescenta algo de novo á matéria do conhecimento. A cultura, a memória dos outros, é também a nossa memória, aqui considerada em perigo. Para salvaguardar a memória pode-se revisitá-la, registá-la, criticá-la, revivê-la. Os espaços discursivos não são assim tantos, mas decerto que a Revista Gama é um deles: aqui se guardam visitas a criadores, se anotam e registam, aqui se resiste. Assim se convocam os artigos que compõem este número da revista Gama. O objetivo é presente: criar discursos de salvaguarda das propostas artísticas mais ou menos dispersas, mais ou menos em perigo, mais ou menos em desligamento. São reativações, renovações de olhares, releiturasinfo:eu-repo/semantics/publishedVersio

estudos artísticos

Crescer na intervenção e na comunicação é um dos objetivos da Revista Gama, estudos artísticos. Promove-se a comunicação, formal, dentro das regras da comunicação académica, através de textos cuja característica comum é serem escritos por artistas, sobre a obra de outros artistas. Este foi o critério base que inspirou o projeto das iniciativas associadas ao Congresso CSO (criadores sobre outras obras), que já completou seis anos de disseminação. A Revista Gama singularizou-se por convocar artistas e obras que de algum modo estariam esquecidos, desconhecidos, ou ainda pouco divulgados. Obras cuja execução tem raízes em passados mais ou menos recentes, mas que pelo excesso de discursos na contemporaneidade, não obtiveram a divulgação desejada. Este é um propósito de intervenção no conhecimento patrimonial: as obras existem, foram executadas, enriquecem o nosso património, mas há que as fazer funcionar, dar a conhecer, aos outros artistas, aos especialistas, ao grande público. Assim se reuniram neste número 6 da Revista Gama vinte e quatro artigos originais, procurando-se, na sua sequência e articulação, algumas relações de pertinência e afinidade. Olhares sobre arquivos, sobre acervos, sobre coleções, conjuntos muitas vezes fechados e em perigo de esquecimento, ou de incompreensão: uma entrada discreta que se abre para o interior de uma câmara escura, que é um espaço cheio de imagens por revelar.info:eu-repo/semantics/publishedVersio

Evil and Explanations: A look at the problem of evil

The problem of evil questions how God and evil can both exist. This is first challenged through the logical problem of evil, dealing with the general incoherence of God and evil existing. If God is a perfectly good being and has infinite power, there should be no reason for evil to exist. Some may use free will as a defense, but an omnipotent God makes free will unlikely to begin with and could also make people freely choose good decisions. The evidential problem of evil uses unjustified evils to disprove God’s existence. While horrific evils and disasters make it seem like God could not exist, the nature of God’s omnipotence means that evil could exist with a justification that humans simply could never understand. Therefore, we cannot conclude that evil does or does not exist or that evils are or are not unjustified, meaning that the logical conclusion from both parts of the problem of evil is agnosticism. The goal of my research is to further study this topic through previous works and current experts to ultimately write a paper providing an answer to this question

Manajemen pemasaran: Analisis. perencanaan. dan pengendalian

413 hlm. : - ; 24 cm