Factores asociados a la reacción de estrés agudo en gestantes con hiperémesis gravídica hospitalizadas en el Instituto Nacional Materno Perinatal, Lima, Perú (2021)

Objective: To determine the factors associated with hyperemesis gravidarum and acute stress reaction in pregnant women with hyperemesis gravidarum hospitalized at the National Maternal Perinatal Institute during 2021. Materials and Methods: This research corresponds to an analytical, observational, case-control study, where the medical records of pregnant patients hospitalized for hyperemesis gravidarum attended by the psychology service who presented an acute stress reaction meeting the inclusion and exclusion criteria were collected. An analysis of frequencies and percentages of the different variables and a multivariate analysis were performed to find the significant factors (p<0.05) and the calculation of the Odds Ratio (OR) with a confidence level of 95%; this model was evaluated using multiple logistic regression. Results: A relationship was found between pregnancy planning (p<0.044, β=0.957 and OR=2.6047) and nausea rejection (p<0.028, β=1.774 and OR=5.893) in pregnant women with hyperemesis gravidarum. A direct relationship was found between the acute stress reaction in pregnant women with hyperemesis gravidarum, with respect to pregnancy loss (p<0.043, β=0.933 and OR=2.542) and hospitalization in the COVID-19 area (p<0.010, β=1.467 and OR=4.335); and inversely, regarding the acceptance of the pregnancy (p<0.014, β=-1.515 and OR=0.220). Conclusion: Two variables were found to be associated with the presence of hyperemesis gravidarum (pregnancy planning and the rejection of nausea). The acute stress reaction was related to two factors associated with the patients (gestational loss and pregnancy acceptance) and one associated with the pandemic (hospitalization in Covid-19 area) which explain 32% of the variance.Objetivo. Determinar los factores que se encuentran asociados a la hiperémesis y reacción de estrés agudo en gestantes hospitalizadas con hiperémesis gravídica en el Instituto Nacional Materno Perinatal, durante el 2021. Materiales y Métodos. Esta investigación corresponde a un estudio analítico, observacional, de tipo casos y controles, donde se recopilaron las historias clínicas de pacientes gestante hospitalizadas por hiperémesis gravídica atendidas por el servicio de psicología las cuales presentaron reacción de estrés agudo cumpliendo los criterios de inclusión y exclusión. Se realizó un análisis de frecuencias y porcentajes de las diferentes variables y un análisis multivariado para encontrar los factores significativos (p<0.05) y el cálculo de los Odds Ratio (OR) con un nivel de confianza del 95%; este modelo fue evaluado mediante una regresión logística múltiple. Resultados. Se encontró relación entre la planificación del embarazo (p<0.044, β=0.957 y OR=2.6047) y el rechazo a las náuseas (p<0.028, β=1.774 y OR=5.893) en gestantes con hiperémesis gravídica. Se halló relación directa entre la reacción de estrés agudo en gestantes con hiperémesis gravídica, respecto a la perdida gestacional (p<0.043, β=0.933 y OR=2.542) y hospitalización en zona COVID-19 (p<0.010, β=1.467 y OR=4.335); e inversa, respecto a la aceptación del embarazo (p<0.014, β=-1.515 y OR=0.220). Conclusión. Se encontraron dos variables asociadas a la presencia de hiperémesis gravídica (planificación del embarazo y el rechazo a las náuseas). La reacción de estrés agudo se ha relacionado con dos factores asociados a las pacientes (perdida gestacional y aceptación del embarazo) y una asociada a la pandemia (hospitalización en zona COVID-19) las cuales explican el 32% de la varianza

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Factores asociados a la reacción de estrés agudo en gestantes con hiperémesis gravídica hospitalizadas en el Instituto Nacional Materno Perinatal, Lima, Perú (2021)

Objetivo. Determinar los factores que se encuentran asociados a la hiperémesis y reacción de estrés agudo en gestantes hospitalizadas con hiperémesis gravídica en el Instituto Nacional Materno Perinatal, durante el 2021. Materiales y Métodos. Esta investigación corresponde a un estudio analítico, observacional, de tipo casos y controles, donde se recopilaron las historias clínicas de pacientes gestante hospitalizadas por hiperémesis gravídica atendidas por el servicio de psicología las cuales presentaron reacción de estrés agudo cumpliendo los criterios de inclusión y exclusión. Se realizó un análisis de frecuencias y porcentajes de las diferentes variables y un análisis multivariado para encontrar los factores significativos (p<0.05) y el cálculo de los Odds Ratio (OR) con un nivel de confianza del 95%; este modelo fue evaluado mediante una regresión logística múltiple. Resultados. Se encontró relación entre la planificación del embarazo (p<0.044, β=0.957 y OR=2.6047) y el rechazo a las náuseas (p<0.028, β=1.774 y OR=5.893) en gestantes con hiperémesis gravídica. Se halló relación directa entre la reacción de estrés agudo en gestantes con hiperémesis gravídica, respecto a la perdida gestacional (p<0.043, β=0.933 y OR=2.542) y hospitalización en zona COVID-19 (p<0.010, β=1.467 y OR=4.335); e inversa, respecto a la aceptación del embarazo (p<0.014, β=-1.515 y OR=0.220). Conclusión. Se encontraron dos variables asociadas a la presencia de hiperémesis gravídica (planificación del embarazo y el rechazo a las náuseas). La reacción de estrés agudo se ha relacionado con dos factores asociados a las pacientes (perdida gestacional y aceptación del embarazo) y una asociada a la pandemia (hospitalización en zona COVID-19) las cuales explican el 32% de la varianza

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally

Search for High-energy Neutrinos from Binary Neutron Star Merger GW170817 with ANTARES, IceCube, and the Pierre Auger Observatory

The Advanced LIGO and Advanced Virgo observatories recently discovered gravitational waves from a binary neutron star inspiral. A short gamma-ray burst (GRB) that followed the merger of this binary was also recorded by the Fermi Gamma-ray Burst Monitor (Fermi-GBM), and the Anticoincidence Shield for the Spectrometer for the International Gamma-Ray Astrophysics Laboratory (INTEGRAL), indicating particle acceleration by the source. The precise location of the event was determined by optical detections of emission following the merger. We searched for high-energy neutrinos from the merger in the GeV--EeV energy range using the ANTARES, IceCube, and Pierre Auger Observatories. No neutrinos directionally coincident with the source were detected within $\pm500$ s around the merger time. Additionally, no MeV neutrino burst signal was detected coincident with the merger. We further carried out an extended search in the direction of the source for high-energy neutrinos within the 14-day period following the merger, but found no evidence of emission. We used these results to probe dissipation mechanisms in relativistic outflows driven by the binary neutron star merger. The non-detection is consistent with model predictions of short GRBs observed at a large off-axis angle.Comment: 22 pages, 2 figure

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)