Aorto-left ventricular tunnel : a rare cause of heart failure in the newborn

Aorto-left ventricular tunnel is a rare congenital cardiac anomaly, consisting of a short abnormal pathway, usually from a sinus of Valsalva into the left ventricular cavity. It is usually diagnosed with echocardiography. We report a case of a newborn presenting with heart murmur and rapid progression to heart failure and left ventricular enlargement due to an aorto-left ventricular tunnel. Despite successful closure of the tunnel, the patient required a Ross procedure due to progressive aortic disease.peer-reviewe

La investigación como proceso transformador en los estudiantes de grado 11 de la Institución Educativa “Pantano de Vargas” del Municipio de Paipa Boyacá.

TablasEste trabajo de grado se centra en la investigación como proceso transformador en los estudiantes de grado once de la institución educativa “Pantano de Vargas” del Municipio de Paipa Boyacá. Se realizó una revisión a las estrategias desarrolladas hacia el fomento de la investigación en la institución Educativa Pantano de Vargas, que han transcendido la vida de los estudiantes; tales como Historias de Vida, Indagaciones Bibliográficas, Salidas Pedagógicas, Grupos de investigación. Se aplicó una encuesta de trece preguntas a determinada muestra de maestros y estudiantes de grado once de la Institución, con el fin de indagar sobre las estrategias utilizadas para motivar la investigación en los maestros y estudiantes; el valor o papel que se le asigna, si se contempla dentro del plan de estudios como algo fundamental dentro del proceso formativo y el quehacer pedagógico de estudiantes y maestros, los parámetros con que se hace los medios y mecanismos apropiados para incentivar y promover la investigación en los estudiante y por ende en los maestros; el tiempo que se le asigna a la investigación como parte de la asignación académica; Así mismo, se indagó sobre la cantidad de grupos de investigación conformados, la participación en los mismos; o en su efecto el conocimiento que se tiene a acerca de los diferentes grupos de investigación a nivel institucional y su relevancia a nivel institucional e interinstitucional. Los resultados mostraron, que estrategias pedagógicas como desarrollo de proyectos, consultas, observaciones, estudios de caso, indagaciones, creaciones y participaciones en clubes de robótica y tecnología, lectura, etc… aunque muchas de estas evidencias se catalogan como estrategias, otras como actividades, en suma son un aporte valioso para introducir e iniciar a los estudiantes en el mundo de la investigación, éstas aportan a la formación de investigación y de investigadores. Por otro lado, se evidencio que aún a pesar de los esfuerzos, no solo de carácter pedagógico sino económico por parte de los maestros, aún es incipiente y deficiente el apoyo a la investigación.This work focuses on undergraduate research as a transformative process in eleventh grade students of the educational institution "Pantano de Vargas" Paipa Boyacá Township. A review of the strategies developed to the promotion of research in educational institution Pantano de Vargas, who have transcended the life of students; such as Life Stories, Bibliographic Inquiries, outputs Pedagogical Research groups. A survey of thirteen questions given sample of teachers and eleventh grade students of the institution, in order to investigate the strategies used to motivate research on teachers and students, the value or role that is assigned , if contemplated within the curriculum as essential in the learning process and the pedagogical practice of students and teachers, the parameters that becomes appropriate means and mechanisms to encourage and promote research in the student and therefore the teachers ; the time that is given to research as part of academic assignment , addition, questions were asked about the number of research groups formed , participation in the same , or in effect the knowledge we have to about the different research groups at the institutional level and its relevance and inter- institutional level . The results showed that teaching strategies such as project development, consultations, observations, case studies, investigations, creations and interests in robotics and technology clubs, reading, etc. But many of these strategies are classified as evidence, other such activities, in short are a valuable contribution to introduce and initiate students into the world of research, they contribute to the formation of research and researchers. On the other hand, is evidenced that even despite the efforts of not only economic but also pedagogical by teachers, is still young, poor research support

Obesity dialogues – fostering policy options in Western Balkans and Central Asia

Introduction: Obesity has been identified as a serious public health challenge globally and a major determinant of premature death and disability in the WHO European Region. More than 50% of adults and one in three children around the Region are living with overweight or obesity, with prevalence close to 70% in several countries. In 2022, The WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD office) organized two policy dialogues with the objectives to highlight the obesity situation, present possible interventions and prioritize policy actions to tackle this public health issue in the regions of Western Balkans and Central Asia. Methods: Two key professionals and decision makers per country/territory were invited to discuss the current state as well as challenges and opportunities related to prevention and management of obesity in Skopje, North Macedonia (MKD) for the Western Balkans countries/territory and in Bishkek, Kyrgyzstan (KGZ) for the Central Asian countries. Dialogues were kindly supported by the Ministries of Health of the host countries with personal presence of the Ministers of Health and in MKD with the presence of the First Lady of the country. Results: WHO’s representatives presented on the burden of obesity in the countries of the Region by providing comprehensive data collected by the NCD Office through regular surveillance, as well as a summary of possible multisectoral actions listed in the recently published WHO European Obesity Report and other documents like the “Best Buys” to tackle NCDs. Country experiences were shared on implementing policies to reduce obesity burden like the public health tax in Hungary and the SSB tax and food marketing regulation in Portugal and also double duty actions to address the burden of both undernutrition and obesity, particularly important in the Central Asian countries. Participating countries, as final exercise of the one-day event, were asked to prioritize actions, according to the national context, and to assess the feasibility of its implementation over the short, medium, and long term. Conclusions: Participating countries at both events found that this activity was a novelty in their national approaches to tackle obesity in Western Balkans and the double burden of obesity and malnutrition in Central Asia and increased their knowledge on a whole-of government multicomponent approach to address obesity. Both the representatives of the European Region of the WHO and the participating countries concluded that dialogues among stakeholders at national level, as initiated at these meetings, should be stimulated, and executed if any success in tackling rising trends of obesity should be expected. Follow up on countries’ priorities should be performed to assess the progress and to support experts and policy makers in evidence-informed decision making for obesity.This study has been produced with financial assistance of the Government of the WHO European Office for the Prevention and Control of NCDs. The funders played no role in the design, conduct or reporting.info:eu-repo/semantics/publishedVersio

Recurrent hypercortisolism after removal of an ACTH secretor pituitary adenoma associated with an adrenal macronodule

A 29 years old patient was sent to our Outpatient Clinic of Endocrinology presenting clinic of hypercortisolism. Laboratorial study: High urinary free cortisol (UFC); serum cortisol - 25 microg/dl (8 am) (5-25) and 20 microg/dL (11pm); ACTH - 20 pg/mL (9-52) (8 am) and 14 pg/mL (11 pm); serum cortisol after dexamethasone suppression test: 14,9 mg/dL; CRH test: elevation of ACTH; Pituitary MRI: microadenoma; abdominal CT: nodule on the left adrenal. During inferior petrosal sinus sampling with CRH stimulation, ACTH reached 368 pg/mL on the right and 136 pg/mL on the left side. The patient was submitted to transsphenoidal surgery. After surgery, hypertension and physical stigmata improved. In 2006, a relapse of Cushing syndrome was suspected due to worsening of hypertension and increase of weight. A slight increase of UFC, undetectable ACTH and serum cortisol after dexamethasone suppression test equal to 16 microg/dL were found. On abdominal CT, the adrenal nodule kept the same characteristics. In December 2006, the patient was submitted to left adrenalectomy. After surgery, blood pressure normalized, UFC and serum cortisol were reduced, needing substitutive therapy. Progressive tapering of hydrocortisone doses lead to discontinuation in March 2007. He is clinically well, without any treatment. This is an unusual case, in which after surgical cure of Cushing disease, secretory autonomy of a coexisting adrenal nodule occurred. This clinical case is relevant, pointing out the complexity of hypercortisolism cases and the need of long follow-up

Intravitreal ranibizumab for myopic choroidal neovascularization: 12-month results

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravitreal ranibizumab after 12 months in the treatment of choroidal neovascularization secondary to pathologic myopia. METHODS: This was a prospective, multicenter, consecutive, nonrandomized, interventional case series. The study included 34 eyes of 32 patients with choroidal neovascularization secondary to pathologic myopia; 13 eyes had previous photodynamic therapy, and 21 eyes had no previous treatment. The patients were followed for > or = 12 months. Best-corrected visual acuity, optical coherence tomography, and the presence of metamorphopsia were assessed monthly. RESULTS: Mean visual acuity improved 8 letters from baseline to 12-month follow-up, and the difference was statistically significant (P or = 3 lines, 44% improved > or = 2 lines, 65% improved > or = 1 line, and 79% improved > or = 0 lines. Central retinal thickness decreased significantly from baseline to the 12-month follow-up (P < 0.01). A mean of 3.6 treatments were performed during the 12-month follow-up, and no systemic or ocular side effects were registered during that time. CONCLUSION: One-year results of intravitreal ranibizumab for myopic choroidal neovascularization are very promising. Additional prospective studies are necessary to better determine long-term efficacy and safety

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010

Background: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Methods: Using cross-sectional nationally representative samples of 6−9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. Results: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 − 31% of boys and 5 − 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from −0.4 to +0.3) and BMI-for-age Z-scores (range: from −0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. Conclusions: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation

Experiência do HFF em DISE

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Salt reduction strategies in Portuguese school meals, from pre-school to secondary education-the Eat Mediterranean program

High sodium (salt) consumption is associated with an increased risk of developing non-communicable diseases. However, in most European countries, Portugal included, sodium intake is still high. This study aimed to assess the sodium content of school meals before and after the Eat Mediterranean (EM) intervention-a community-based program to identify and correct nutritional deviations through the implementation of new school menus and through schools' food handlers training. EM (2015-2017) was developed in 25 schools (pre to secondary education) of two Portuguese Municipalities, reaching students aged 3-21 years old. Samples of the complete meals (soup + main course + bread) from all schools were collected, and nutritional quality and laboratory analysis were performed to determine their nutritional composition, including sodium content. Overall, there was a significant decrease (-23%) in the mean sodium content of the complete school meals, which was mainly achieved by the significant reduction of 34% of sodium content per serving portion of soup. In conclusion, EM had a positive effect on the improvement of the school meals' sodium content, among the participant schools. Furthermore, school setting might be ideal for nutrition literacy interventions among children, for flavors shaping, and for educating towards less salty food acceptance

A service-oriented admission control strategy for class-based IP networks

The clear trend toward the integration of current and emerging applications and services in the Internet launches new demands on service deployment and management. Distributed service-oriented traffic control mechanisms, operating with minimum impact on network performance, assume a crucial role as regards controlling services quality and network resources transparently and efficiently. In this paper, we describe and specify a lightweight distributed admission control (AC) model based on per-class monitoring feedback for ensuring the quality of distinct service levels in multiclass and multidomain environments. The model design, covering explicit and implicit AC, exhibits relevant properties that allow managing quality of service (QoS) and service-level specifications (SLSs) in multiservice IP networks in a flexible and scalable manner. These properties, stemming from the way service-dependent AC and on-line service performance monitoring are proposed and articulated in the model’s architecture and operation, allow a self-adaptive service and resource management, while abstracting from network core complexity and heterogeneity. A proof of concept is provided to illustrate the AC criteria ability in satisfying multiple service class commitments efficiently. The obtained results show that the self-adaptive behavior inherent to on-line measurement-based service management, combined with the established AC rules, is effective in controlling each class QoS and SLS commitments consistently

Economic evaluation of the primary recovery of tetracycline with traditional and novel aqueous two-phase systems

Antibiotics are a key pharmaceutical to inhibit growth or kill microorganisms. They represent a profitable market and, in particular, tetracycline has been listed as an essential medicine by the WHO. Therefore it is important to improve their production processes. Recently novel and traditional aqueous two-phase systems for the extraction have been developed with positive results. The present work performs an economic analysis of the production and recovery of tetracycline through the use of several ATPS through bioprocess modeling using specialized software (BioSolve, Biopharm Services Ltd, UK) to determine production costs per gram (CoG/g). First, a virtual model was constructed using published data on the recovery of tetracycline and extended to incorporate uncertainties. To determine how the model behaved, a sensitivity analysis and Monte Carlo simulations were performed. Results showed that ATPS formed by cholinium chloride/K3PO4 was the best option to recover tetracycline, as it had the lowest CoG/g (US$ 672.83/g), offered the highest recovery yield (92.42%), second best sample input capacity (45% of the ATPS composition) and one of the lowest materials contribution to cost. The ionic liquid-based method of ATPS is a promising alternative for recovering tetracycline from fermentation broth.publishe