Additional diagnostic value of implantable loop recorder in patients with initial diagnosis of real or apparent transient loss of consciousness of uncertain origin

Aims Non-syncopal transient loss of consciousness (T-LOC) encompasses disorders that sometimes resemble syncope, and the differential diagnosis with true syncope may be challenging. The implantable loop recorder (ILR) is potentially useful, but has never been systematically assessed. The aim of the study is to evaluate the diagnostic value of ILR in distinguishing syncope from non-syncopal forms of T-LOC. Methods and results We implanted an ILR in 58 patients (mean age 71 ± 17 years, 25 males) who had had 4.6 ± 2.3 episodes of real or apparent T-LOC, in order to distinguishing epilepsy from syncope (#28), unexplained fall from syncope (#29), or functional pseudo-syncope from syncope (#1). During 20 ± 13 months of follow-up, 33 patients (57%) had a spontaneous event documented by ILR. A diagnosis of syncope was established by ILR documentation of an arrhythmia in 15 (26%) patients: an asystole of 6 s (IQR 4–10 s) duration was documented at the time of the spontaneous event in seven patients with initial suspicion of epilepsy and in five patients with unexplained fall; atrial tachyarrhythmia was documented at the time of the spontaneous event in 1 and 1 patient, respectively, and ventricular tachycardia in 1 patient with unexplained fall. Conversely, in another 18 patients, ILR monitoring documented no significant rhythm abnormalities at the time of T-LOC recurrence, thus excluding an arrhythmic syncope. Finally, ILR was unable to document any syncopal episode in 25 (43%) patients. Among the 15 patients with an established diagnosis of arrhythmic syncope, syncope recurred during follow-up in 2 of 11 patients who were on pacemaker therapy and in 3 of 4 patients who were on other therapies. Conclusion Implantable loop recorder monitoring provides additional diagnostic value in 'difficult' patients with an initial diagnosis of non-syncopal real or apparent T-LOC

Disposition à payer pour des attributs de responsabilité sociale des entreprises: Une étude avec des jeunes de Medellín (Colombie)

El presente trabajo tiene como objetivo determinar la disposición a pagar (DAP) de los jóvenes de Medellín (Colombia) por atributos de responsabilidad social empresarial (RSE), así como también analizar si el género, la edad y el contar con un nivel educativo técnico o superior, influyen sobre ella. Para cumplir con los objetivos se procedió a describir las variables utilizando promedios, porcentajes y estadísticos descriptivos y, posteriormente, se aplicó un modelo econométrico (regresión logística binaria) para estimar la disposición a pagar por los atributos de RSE. Del análisis de los resultados se puede destacar que los encuestados presentan una DAP positiva para el atributo de RSE “Protección al Medio Ambiente”, y que la DAP positiva se relaciona inversamente con el género, lo que implica que el monto de la DAP disminuye en caso de ser hombre. De la investigación surgen oportunidades para las empresas cuya oferta se dirige a un mercado joven: por un lado de desarrollar nuevos productos socialmente responsables y, por otro lado, de reforzar su imagen de marca destacando los atributos de RSE que actualmente poseen, puesto que, como se observó, estos son vistos, en general, de forma positiva por los consumidores.This work has as objective to establish the willingness to pay of the young people of Medellín (Colombia) for corporate social responsibility attributes, as well as to analyze if the genre, the age and the technical or university educational level have influence on this. In order to achieve the objectives the variables were described by using mean values, percentages and descriptive statistics and, after that, it was applied an econometric model (Binary logistic regression) to estimate the willingness to pay for the corporate social responsibility attributes. From the analysis of the results it should be noted that the asked people have a positive willingness to pay for the attribute “environment protection” and that this positive willingness is inversely related to the genre, which implies that the amount of the willingness to pay decreases for males. From this research offers opportunities for the companies having a supply oriented towards a young market: on the one hand to develop socially-responsible new products and, on the other hand, to reinforce their brand image by emphasizing on the attributes they currently have, because, as observed, this attributes are considered, in general, in a positive way by consumers.Cet article a comme objectif de déterminer la disposition à payer des jeunes de Medellín (Colombie) pour attributs de responsabilité sociale des entreprises, de même que d’analyser si le genre, l’âge et d’avoir un niveau éducatif technique ou d’éducation supérieur, ont une influence sur cette disposition. Pour réussir les objectifs on a décrit les variables en utilisant des moyennes, pourcentages et statistiques descriptives et, après, on a applique un modelé économétrique (régression logistique binaire) pour estimer la disposition à payer pour les attributs de responsabilité sociale des entreprises. En se basant sur le analyse des résultats on peut souligner que les interviewés présentent une disposition à payer positive pour l’attribut « protection de l’environnement », et que cette disposition positive est lie à l’inverse avec le genre, c’est-à-dire, la quantité à payer diminue chez les hommes. De cette recherche se dérivent des opportunités pour les entreprises qui ont un offre dirigé vers a un marché des jeunes: d’un côté pour développer des nouveaux produits socialement responsables et, d’un autre côté, de renforcer leur image de marque en soulignant leurs attributs actuels de responsabilité social, parce que, comme on a trouvé, ces attributs son considérés, en général, de manière positive par les consommateurs.Facultad de Ciencias Económica

Nocardiose disseminada com abscesso do psoas em paciente com AIDS: primeiro caso relatado

O abscesso do músculo psoas é uma infecção pouco comum que tem sido diagnosticada de maneira crescente nos últimos anos. Apresentamos um caso de paciente com infecção avançada pelo vírus da imunodeficiência humana (HIV) que desenvolveu uma infecção disseminada por Nocardia asteroides senso estrito tipo VI, com abscesso no psoas. Em nosso conhecimento, não foram relatados na literatura outros casos de abscesso do psoas por Nocardia, no contexto da infecção por HIV.Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature

CSR indicators proposed by GRI and its application to field of SMEs in Argentina

The objectives of the following article are to perform a bibliographic review about the indicators proposed by the GRI for the measurement of CSR, its relation MDG and SDG. At the same time, the application of the indicators proposed by the GRI in the field of Argentine SMEs is analyzed. This article concluded fundamentally according to the information shown, that in Argentina, given that only 11% of the companies adhering to the GRI are SMEs, it is evident the importance of deepening the subject and of further compromising those who manage these companies. We propose, for future research, to deepen the design of a CSR management model that allows SME entrepreneurs to also actively participate in compliance with the SDG, thus contributing to the improvement of the quality of life of the whole humanity.Facultad de Ciencias Económica

Doença meningocócica: epidemiologia e controle dos casos secundários

Epidemiological features of meningococcal disease described as from the second half of the 80's inclusive, have motivated a revision of current guidelines for sporadic disease and outbreak control. The increase of disease among teenagers and linked cases involving schools are the two most significant aspects that have prompted the revision of control measures. Vaccination routines and advice for the disease management of clusters are also relevant features recently revised. This present paper describes the management and some epidemiological features of secondary cases.Aspectos epidemiológicos da doença meningocócica registrados a partir da segunda metade da década de 80 impulsionaram as autoridades de saúde pública a discutirem as medidas de controle disponíveis. A ocorrência da doença entre adolescentes e o registro de surtos envolvendo escolas são os dois pontos que mais pressionaram uma revisão das medidas de controle disponíveis. O uso das vacinas antimeningocócicas polissacarídeas e as recomendações para o controle de surtos localizados (clusters) são outros aspectos que mereceram atenção recentemente. Objetivou, assim, apresentar um panorama atual de alguns aspectos da epidemiologia e do controle dos casos secundários da doença meningocócica

Conversion to secondary progressive multiple sclerosis: patient awareness and needs. results from an online survey in Italy and Germany

Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders.Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified.Methods: Participants were consenting adults with SPMS since <= 5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs.Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001).Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients).All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany.Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection