Prosthetic Valve Endocarditis

The management of infections of the cardiac structures—specifically native heart valves—remains a difficult clinical challenge. Patients often present with a systemic infection that is made worse by embolic complications, such as strokes, along with pathophysiologic sequelae of acute valvular dysfunction. The timing of interventions has a significant impact on short- and long-term outcomes. The challenges and management decisions are even more complex when the infection involves a prosthetic valve—as risks of reoperative cardiac surgery can be substantial. The goal of this chapter is to discuss the history of prosthetic valve endocarditis, review the current literature on the management of specific valvular involvement (i.e., aortic and/or mitral), and illustrate the challenging problems and outcomes that drive clinical decision making. While many of the indications for surgery are similar to those associated with native valve infections, there is increased risk with reoperative surgery, often difficulties in clearing infection due to prosthetic material being in place. Unfortunately, antibiotics alone are not always effective, and frequent communications between the cardiac surgeon and infectious disease physicians are often necessary to find the “sweet spot” to perform the surgery

Which level of preoperative glycated haemoglobin (HbA1c) affect early morbidity and mortality after cardiac surgery?

BackgroundDiabetics account for 34 per cent of all patients undergoing coronary artery bypass graft (CABG) surgery, and have higher rates of postoperative mortality. Furthermore, they are at risk for ICU admission postoperatively due to complications of hyperglycaemia, which in turn increases hospital mortality.AimsThe purpose of this study was to evaluate the level of glycated haemoglobin (HbA1c) in patients undergoing cardiac surgery, and to establish it is an independent predictor for postoperative mortality and morbidity.Methods This retrospective study was conducted at King Fahd University Hospital. Files of 146 diabetic patients who underwent cardiac surgery in the period between September 2015 to June 2018 were included. One hundred and five patients met the inclusion criteria. Depending on the results of HbA1c preoperatively, patients were divided into 2 groups: Group A, with a HbA1c > =8.5 per cent, accounting for 33 patients, and Group B with a HbA1c < =8.4 per cent accounting for 71 patients.Results This study included 79 males and 25 females, with ages ranging in between 17 to 87 years old, with no significant difference between both groups in age and sex. A significant difference was found between Group A and Group B in postoperative mortality (p-value < 0.002). No significant difference was found when comparing length of hospital stay, wound infection postoperatively, reoperation, or readmission.ConclusionThere was a significant difference in mortality postoperativly between the two groups, with patients who had higher HbA1c levels experiencing higher mortality. Since our sample size was small, we recommend that further studies be done in multiple centres

The effectiveness of the stabilization/solidification process on the leachability and toxicity of the tannery sludge chromium

[EN] A stabilization/solidification (S/S) process by using cement was applied to tannery sludge in order to find a safer way of landfilling this waste. The effects of three parameters on the process effectiveness were analysed in terms of leachate toxicity and chromium retention (%). The parameters studied were the relative amount of added water (30e50 wt.%), cement (10e60 wt.% in the solid components), and the use of three different types of cement (clinker with additions of limestone, with additions of limestone and fly ashes, and with additions of pozzolans). Statistical analysis performed by variance analysis and categorical multifactorial tests reveals that all the studied parameters significantly influence the effectiveness of the process. Results showed that chromium retention decreases as the relative amount of cement and water increases, probably due to additional chromium provided by cement and increased in the porosity of the mixtures. Leachate toxicity showed the same minimum value for mixtures with 30% or 40% cement, depending on the type of cement, showing that clinker is the main material responsible for the process effectiveness, and additives (pozzolans or fly ashes) do not improve it. The volume increase is lower as less sludge is replaced by cement and the relative amount of water decreases, and for the cement without additions of fly ashes or pozzolans. Therefore, the latter seems to be the most appropriate cement in spite of being more expensive. This is due to the fact that the minimum toxicity value is achieved with a lower amount of cement; and moreover, the volume increase in the mixtures is lower, minimizing the disposal cost to a landfill.The authors wish to express their gratitude to the tannery facility INCUSA, S.A., to the cement facility CEMEX ESPAÑA, S.A. and to Carles Martínez for his translation assistance.Montañés Sanjuan, MT.; Sánchez Tovar, R.; Roux, MSB. (2014). The effectiveness of the stabilization/solidification process on the leachability and toxicity of the tannery sludge chromium. Journal of Environmental Management. 143:71-79. doi:10.1016/j.jenvman.2014.04.026S717914

Centro de atención para el adulto mayor en Santiago de Surco - Lima

La presente tesis tiene como objeto diseñar un Centro de Atención para el Adulto Mayor, ubicado en la Urbanización Virreina, en el distrito de Santiago de Surco, dicho proyecto busca reunir todos los componentes necesarios para integrarse al entorno y satisfacer las necesidades del adulto mayor (población de 65 a 75 años), que involucra áreas de salud, social, recreativa, espiritual y ambiental, creando así un proyecto de integración para una mejor calidad de vida del adulto mayor. Para esta investigación se recabó información de la zona en mención y se evaluaron las necesidades de la población en estudio; así se determinó como sede de ejecución del proyecto el distrito de Santiago de Surco.TEXTO NO AUTORIZADO POR EL AUTO

Centro de atención para el adulto mayor en Santiago de Surco - Lima

TEXTO NO AUTORIZADO POR EL AUTORLa presente tesis tiene como objeto diseñar un Centro de Atención para el Adulto Mayor, ubicado en la Urbanización Virreina, en el distrito de Santiago de Surco, dicho proyecto busca reunir todos los componentes necesarios para integrarse al entorno y satisfacer las necesidades del adulto mayor (población de 65 a 75 años), que involucra áreas de salud, social, recreativa, espiritual y ambiental, creando así un proyecto de integración para una mejor calidad de vida del adulto mayor. Para esta investigación se recabó información de la zona en mención y se evaluaron las necesidades de la población en estudio; así se determinó como sede de ejecución del proyecto el distrito de Santiago de Surco

Kerr nonlinearity enhancement by double tunnelling from quantum dot nanostructure

A model of the dynamical equations of the density matrix describes double tunnelling between double quantum dot (QD) system states, this is to study Kerr nonlinearity in QD structure. Inhomogeneity in the QD system is included which is not included in earlier studies of Kerr nonlinearity in QDs. Possibilities of subluminal and superluminal light propagation and switching between them are examined. Double tunnelling is shown to obtain giant Kerr dispersion compared with single tunnelling. High conduction- and low valence-band tunnelling components are required to obtain high Kerr dispersion. Working with one tunnel component reduced Kerr dispersion and switching between subluminal and superluminal can be obtained and the EIT window can be removed. Keywords: Quantum dot, Tunnelling, Kerr dispersio