Use of therapeutic hypothermia and extracorporeal life support after an unusual response to the ajmaline challenge in a patient with Brugada syndrome

AbstractBackgroundBrugada syndrome is a cardiac disorder associated with a high risk of sudden cardiac death, especially in young subjects. The incidence and prevalence are likely underestimated. The diagnosis is based on a characteristic electrocardiography (ECG) pattern. The most commonly performed confirmatory test in cases of equivocal ECG is the intravenous ajmaline challenge. Although relatively safe, it carries the risk of ventricular arrhythmias that could potentially degenerate into a refractory electrical storm.Case reportA 27-year-old man developed sustained ventricular fibrillation after ajmaline challenge. He was rescued on extracorporeal life support after 108min of cardiopulmonary resuscitation. Extracorporeal life support allowed recovery of spontaneous circulation and resulted in a positive neurological outcome.<Learning objective: This case is an example of how extracorporeal life support was instituted after prolonged and unsuccessful cardiopulmonary resuscitation resulting in a positive central neurological outcome.

Masculinidades e experiências masculinas em Bernardo Guimarães Masculinities and masculine experiences in Bernardo Guimarães' literary work

Neste trabalho identificamos e analisamos as diferentes facetas da masculinidade apresentadas na obra de um dos mais importantes literatos brasileiros do século XIX: o mineiro Bernardo Guimarães. Sem abandonar as representações de feminilidade, enfocamos como o autor, em suas diversas obras, constrói as relações de gênero e produz representações sobre homens e mulheres, dando especial relevo às experiências de masculinidade. Desse modo, pretendemos, também, contribuir para uma maior compreensão da forma como, no final do século XIX, a literatura teve uma participação na produção de representações e práticas de masculinidade (e de feminilidade) no Brasil.<br>This article aims to identify and analyze different aspects of masculinity presented in the literature of Bernardo Guimarães, an important 19th century Brazilian writer from Minas Gerais. We shall focus how the author, in his literary work, constructs the gender relations and produces representations about men and women, specially the masculine experiences, without forgetting the feminine ones. We intend, in the same way, to contribute to a broader understanding of the participation of literature in the production of representations and practices of masculinity (and of femininity) in late nineteenth-century Brazil

La enseñanza del derecho en Europa y América: planes de estudio, metodologías, evaluación y acceso a las profesiones jurídicas

La obra trata de la enseñanza universitaria del Derecho en 19 países europeos y americanos: Alemania, Argentina, Bélgica, Brasil, Canadá, Chile, Dinamarca, España, Estados Unidos, Finlandia, Francia, Italia, México, Países Bajos, Polonia, Reino Unido, Rusia, Suecia y Suiza. No se trata de una obra exhaustiva, sino de alta divulgación; académica pero no erudita. El capítulo de cada país ha sido escrito por un autor español, experto o profundo conocedor del sistema universitario del país descrito, en estrecha colaboración con un académico del país estudiado, por lo que se ha obtenido información de primera mano y, además, se ha recurrido a fuentes originales. Pretendemos informar a un amplio elenco de lectores, entre los que no faltaran juristas y profesionales de la docencia del Derecho. Todos los capítulos presentan la estructura de los estudios superiores y el acceso a la universidad; la descripción del plan de estudios del título de Derecho: materias y asignaturas impartidas, duración o peso académico de cada una (unidad de medida, en su caso), semestralización, obligatoriedad y optatividad, etc.; la atención a las metodologías docentes y al sistema de evaluación, dos elementos que se encuentran intrínsecamente unidos, y el acceso a las profesiones jurídicas. Finalmente, se presentan referencias legislativas, bibliografía y enlaces a webs de interés

Copernicus Marine Service Ocean State Report, Issue 4

Editors: Karina von Schuckmann; Pierre-Yves Le Traon.-- Review Editors: Neville Smith (Chair); Ananda Pascual; Samuel Djavidnia; Jean-Pierre Gattuso; Marilaure Grégoire; Glenn Nolan.The authors would like to thank the Institut Cartogràfic i Geològic de Catalunya (ICGC) for providing data. Thanks are due to FCT/MCTES for the financial support to CESAM (UID/AMB/50017/2019), through national funds.Chapter 1: Introduction and the European Environment policy framework.-- CMEMS OSR4, Chapter 2: State, variability and change in the ocean.-- CMEMS OSR4, Chapter 3: Case studies.-- CMEMS OSR4, Chapter 4: Specific events 2018.-

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP