COVID-19 Infection: Implications for Perioperative and Critical Care Physicians.

Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19-associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19

Emigration of doctors, military and alternative service service Some proposals based on a survey of medical students

In the face of a critical shortage of skilled medical personnel, especially in the rural areas of South Africa, and high rates of emigration of doctors, a survey was conducted in 1989 of white male medical stl!dents at the University of the Witwatersrand to assess their intentions to emigrate, their reasons for emigrating and their attitudes to alternative civilian service. Ninety-five per cent of respondents still had military service obligations; 39% said they were considering emigrating. Military service was ranked as the first or second most important reason by 59% of those intending to emigrate and 47% said they would remain in South Africa if alternative service were available. The majority of those willing to do alternative service were also willing to do this in rural areas. The introduction of the option of alternative service would reduce emigration, increase the provision of medical care in rural areas, and acknowledge the right of individuals to serve the country in a non-militar: capacity

FENOMENOLOGÍA, VERDAD Y HORIZONTE

El presente articulo retoma la larga discusión sobre la relación entre los principales conceptos de verdad de la fenomenología – la evidencia (Evidenz) husserliana y el estar al descubierto (Entdecktheit) heideggereano – para argumentar contra las dos vertientes analíticas imperantes que, transitando caminos diferentes, han arrojado sin embargo la misma conclusión en cuanto a una insalvable mutua exclusión entre tales conceptos. A continuación se darán algunas claves que permitirán exponer tales conceptos como modos complementarios de un fenómeno de verdad mas amplio, para finalmente y en base a esta exposición poner de relieve de forma critica ciertos aspectos de la comprensión de historia de Heidegger que como se mostrará han repercutido negativamente en una visión unificadora de la fenomenología

Sí mismo como pueblo: Comunidad en el pensamiento de M. Heidegger

The present analysis aims at a synthetic but finished description of the phenomenon of alterity in M. Heidegger's thought, first addressing the double treatment that is given to this in Being and time as otherness and community, as well as the subsequent development and deepening that it experienced in the 1930s hand in hand with the concept of people. Two central questions guide this writing: the first is that due to the methodical necessity that determines the people as the broadest possible form of the human community and the second one that seeks to determine to what degree the Volk is a community characterized by a true openness to the Other.El presente análisis tiene como objetivo una descripción sintética pero acabada del fenómeno de la alteridad en el pensamiento de M. Heidegger, abocandose primero al tratamiento doble que se le da a esta en Ser y tiempo como otredad y comunidad, así como al posterior desarrollo y profundización que experimenta en los años 30 de la mano del concepto de pueblo. Dos preguntas centrales guían el presente escrito: la primera es aquella por la necesidad metódica que determina al pueblo como la forma más amplia posible de la comunidad humana y la segunda aquella que busca determinar en que grado es el Volk una comunidad caracterizada por una verdadera apertura al Otro

Evidenz und Entdecktheit als komplementäre Wahrheitsmodi: Eine Untersuchung zum Wahrheitsbegriff in der Phänomenologie

Es wird der Versuch gemacht die wichtigsten Wahrheitsbegriffe der Phänomenologie –die Husserlsche "Evidenz" und die Heideggersche "Entdecktheit"– in eine Einheit zu bringen. Dafür muss belegt werden, dass Evidenz nicht nur die Struktur einer Übereinstimmung hat und Entdecktheit kein von der metaphysischen isoliertes Konzept ist

Cervical intra-epithelial neoplasia in HIV-positive women after excision of the transformation zone – does the grade change?

Objective. After previously reporting the presence of disease by cytology findings after treatment for cervical intra-epithelial neoplasia (CIN) in 64.6% of HIV-infected women and in 13.0% of HIV-negative women, we aimed to determine the severity of cytological disease after treatment in HIV-infected women.Methods. We studied HIV-infected (N=571) women treated at the Colposcopy Clinic at Chris Hani Baragwanath Hospital, Gauteng, between April 2003 and December 2006. We compared the initial histology results with Pap smears .6 months later, and evaluated factors associated with reduction in the grade of disease.Results. Mean age was 36.68 (SD+7.33) years; mean parity was 2 (SD+1.46); mean CD4+ count was 242.70 cells/ƒÊl (SD+187.56); 262 (45.80%) were receiving antiretroviral treatment. Persistent disease was detected on the repeat Pap smear in 199 (65.03%); of these, 223 (72.88%) were of a lesser grade than in the original histology results. Of the 152 with histologically confirmed CIN3, 67 (44.08%) had improved to a lesser grade, and 54 (44.63%) had normal cytology results. Among the latter two subject groups (n=141) who had CIN2 histologically, 91 (64.53%) had improved, 29 (20.57%) remained unchanged, and 20 (14.88%) had CIN3; 13 (4.25%) patients with CIN1 returned for follow-up; 11 (84.62%) of these had normal Pap smears and 2 (15.38%) had CIN3.Conclusion. Recurrences were of a lesser degree than initial histology results. This reduction in the grade of disease was related to CD4+ count, complete excision and parity. Antiretroviral therapy use did not improve outcome, perhaps owing to low initial CD4 counts

Detection of Parechovirus (P) and Enterovirus (E) Among Infants Evaluated for Late-Onset Sepsis in the Neonatal Intensive Care Unit (NICU): The VIRIoN-P-E Study

Background: Limited data exist on the role of human parechoviruses (HPeV) and enteroviruses (EV) as causes of late-onset sepsis (LOS) in the NICU. Objective: To determine the frequency of detection of parechoviruses and enteroviruses among infants >72 hr of age who were evaluated for LOS in 2 academic NICUs (Parkland Memorial Hospital [PMH], Dallas -shared bays; Women & Infants Hospital [W&I], RI -single patient rooms) Design/Methods: Prospective cohort study of inborn infants hospitalized in the NICU at PMH and WIH from 1/2012 to 1/2013 and were enrolled in the Viral Respiratory Infections in the Neonatal Intensive Care Unit (VIRIoN-I; J Pediatr 2014:165:690). Eligible subjects were infants of all gestational ages (GA) and birth weights (BW) who were >72 hrs of age, remained in the NICU since birth, and underwent evaluation with initiation of antibiotic therapy for suspected LOS. Nasopharyngeal specimens were obtained within 72 hrs of the sepsis evaluation using flexible flocked nylon swabs that were placed in universal transport medium and frozen at -80\ub0C until tested for parechovirus and enterovirus RNA by polymerase chain reaction (PCR) assay (Virology Laboratory, Nationwide Children\u2019s Hospital, Columbus, OH). Demographic, clinical, laboratory, and radiographic data were obtained. Results: Of the 100 infants enrolled in the VIRIoN-I study, nasopharyngeal specimens were available from 65 (59, PMH; 6, WIH) for parechovirus and enterovirus PCR testing. These 65 infants (38, male; 27, female; 49, Hispanic; 6, white; 9, Black; 1, unknown) had a mean \ub1SD gestational age of 30 \ub1 5 wks and birth weight of 1619 \ub1 929 g, and received empirical antibiotics for possible LOS. Infants had a total of 94 sepsis evaluations (65, 1 evaluation; 16, 2; 8, 3; 4, 4) at a mean age of 20 days. Reasons for the sepsis evaluations included fever (9), hypothermia (65), apnea (50),feeding intolerance (51), seizure (1), irritabilitiy (5), emesis (20), diarrhea (1), bloody stool (5), rhinorrhea/congestion/cough (6), and lethargy (9). Four infants died. None of the infants had parechovirus or enterovirus detected in nasopharygeal specimens either at the first or subsequent sepsis evaluations. Conclusion(s): The burden of disease due to parechovirus and enteroviruses among inborn infants who remain in the NICU since birth appears to be low in those evaluated for LOS. Larger, prospective studies are needed to fully determine their contribution to \u201cculture-negative\u201d sepsis in the NICU. Publication Number: 3860.53