Natriuresis as a Way to Assess the Effectiveness of Diuretic Therapy for Acute Decompensated Heart Failure: Data from a Pilot Study

Aim. To analyze the clinical significance of the sodium level in a single urine test obtained 2 hours after the first dose of a loop diuretic was administered in patients with acute decompensation of chronic heart failure (ADHF).Material and methods. An observational study was conducted on the basis of a rapid-care hospital. The concentration of sodium in urine analysis obtained 2 hours after intravenous administration of the first dose of loop diuretic and natriuresis for the first day of hospitalization were evaluated. The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. Oligoanuria was not detected among patients whose sodium concentration was more than 50 mmol/l. The need for escalation (any increase in the dose of a loop diuretic and/or the addition of another class of diuretic drugs) arose in 7 (28%) patients; at the same time, we diagnosed the development of resistance to diuretics in 5 (20%) of them. Resistance to diuretics was more common among patients with a sodium concentration in a single urine test obtained 2 hours after the start of furosemide administration, less than 50 mmol/l (p=0.037); when dividing the recruited patient population into subgroups with a sodium concentration in a single urine test ≥50 mmol/l and <50 mmol/l there was no significant difference in the need for any escalation of diuretic therapy [3 (60%) vs 4 (20%), p=0.07].Conclusion. Resistance to diuretics is more common among patients with a sodium concentration in a single urine test obtained 2 hours after the first dose of furosemide, less than 50 mmol / l. Evaluation of natriuresis allows to identify insufficient effectiveness of diuretic therapy already at the beginning of treatment

ЛУЧЕВАЯ ДИАГНОСТИКА БЦЖОСТИТА ГРУДИНЫ У РЕБЕНКА

BCG osteitis is an uncommon complication of the antitubercular vaccination. We review some information about the epidemiology, clinical presentation and diagnostic methods  of BCG or tuberculous osteitis of sternum. We report a case of BCG osteitis, that was detected with the multispiral computer tomography. We discurse the diagnostic sings of this post-vaccination complication.  The diagnosis was verified by laboratory studies,  which allows to confirm the etiology of the process.БЦЖ-остит — редко встречающееся  осложнение после вакцинации против туберкулеза. В работе приведена краткая  информация  об эпидемиологии, клинической картине и методах диагностики остеомиелита  грудины туберкулезной или БЦЖ-этиологии. Представлено  собственное клиническое наблюдение пациента с оститом грудины БЦЖ-этиологии. Для  его идентификации была  применена  спиральная  компьютерная  томография. Описана  лучевая  семиотика  данного  поствакцинального  осложнения.  Окончательный  диагноз  установлен на основании лабораторных методов исследования, которые позволили подтвердить этиологию процесса

Energy saving potential of buildings integrated with phase change material in hot, arid climate zone

Phase change materials are used to decrease energy cost, dependency on fossil fuels and make the buildings energy efficient. The main aim of this study is to carry out parametric study in BWh zone of Koppen-Geiger climate classification in order to evaluate the hypothesis that a single PCM or a group of PCMs (in the narrow) can be used for the whole BWh climate zone. Hence, the energy performance of two-storey PCM integrated residential building located in eight different cities (Abu- Dhabi, Dubai, Faisalabad, Mecca, Jodhpur, Nouakchott, Cairo and Biskra) from BWh Koppen-Geiger classification was evaluated using the most representative building envelope. Also, the impact of meteorological factors like temperature, wind speed, relative humidity, solar radiance on energy saving have been evaluated. Numerical simulations were performed with thirteen different phase change ranges in DesignBuilder software, which uses EnergyPlus as its calculation engine. According to the test results, the optimum PCMs were able to reduce the temperature fluctuations and the maximum temperature reduced by up to 4.64C. The monthly energy savings results showed that different PCMs were found to be optimum in different months of the year. Except for Cairo and Biskra

Energy saving potential of buildings integrated with phase change material in hot, arid climate zone

Phase change materials are used to decrease energy cost, dependency on fossil fuels and make the buildings energy efficient. The main aim of this study is to carry out parametric study in BWh zone of Koppen-Geiger climate classification in order to evaluate the hypothesis that a single PCM or a group of PCMs (in the narrow) can be used for the whole BWh climate zone. Hence, the energy performance of two-storey PCM integrated residential building located in eight different cities (Abu- Dhabi, Dubai, Faisalabad, Mecca, Jodhpur, Nouakchott, Cairo and Biskra) from BWh Koppen-Geiger classification was evaluated using the most representative building envelope. Also, the impact of meteorological factors like temperature, wind speed, relative humidity, solar radiance on energy saving have been evaluated. Numerical simulations were performed with thirteen different phase change ranges in DesignBuilder software, which uses EnergyPlus as its calculation engine. According to the test results, the optimum PCMs were able to reduce the temperature fluctuations and the maximum temperature reduced by up to 4.64C. The monthly energy savings results showed that different PCMs were found to be optimum in different months of the year. Except for Cairo and Biskra

Burnout syndrome in nurses involved in Covid-19 vaccination process

MāszinībasVeselības aprūpeNursing StudiesHealth CareDarbā tiek analizēta šī brīža situācija Latvijā un pasaulē sakarā ar Covid – 19 pandēmiju. Darbs aktualizēts priekš māsām, kas ikdienā strādā pret Covid – 19 vakcinācijas kabinetā. Šis darbs tika veikts ar mērķi, lai salīdzinātu izdegšanas pakāpi māsām iesācējām un māsām ekspertēm, kas strādā pret Covid – 19 vakcinācijas kabinetos, vēlāk šos datus salīdzināt savā starpā un noskaidrot kurai māsu grupai ir lielākas iespējas izdegšanai darbā. Pēc iegūtajiem teorētiskajiem un pret Covid - 19 vakcinācijā strādājošo māsu pieejamajiem datiem, tikai izstrādāts kvantitatīvs, neeksperimentāls, salīdzinošs šķērsgriezuma pētījums, kurš tika veikts starp māsām, kas nodarbojas ar vakcināciju pret Covid-19 kabinetos. Kā pētniecības instruments tika izmantots K. Maslačas profesionālās izdegšanas tests. Pirmajā daļā teorētiski analizēta izdegšanas sindroms un tā ietekme uz veselības aprūpes darbiniekiem, Covid – 19 epidēmija Latvijā un pasaulē. Otrā daļā aplūkota veicamā taktika un darba specifika pret Covid – 19 vakcinācijas kabinetos strādājošām māsām. Trešā daļā veikts pētījums, kurš ļāva noskaidrot māsu izdegšanas pakāpi pret Covid – 19 vakcinācijas kabinetos strādājošām māsām. Darba mērķis: Noskaidrot izdegšanas sindroma pakāpi Covid-19 vakcinācijas procesā iesaistītajām māsām. Darba hipotēze: Covid – 19 vakcinācijas procesā iesaistītajām māsām iesācējām ir augstāka izdegšanas sindroma pakāpe nekā Covid -19 vakcinācijas procesā iesaistītajām māsām ekspertēm. Pētījuma instruments: anketa. Darbs sastāv no ievada, 6 nodaļām, 10 apakšnodaļām, secinājumiem un 2 pielikumiem. Pētījums tika apkopots ar IBM SPSS statistikas palīdzību un ar Exel programmas palīdzību. Bakalaura darbs sastāv no 43 lapaspuses, 25 attēliem un 26 izmantotās literatūras avotiem. Atslēgvārdi: izdegšanas sindroms, māsa, Covid-19, Covid-19 vakcīnaThe work analyses the current situation in Latvia and the world in relation to the Covid – 19 pandemic. The work has been updated for nurses working daily against Covid – 19 in the vaccination office. This work was done with a view to comparing the burn-out rate for nursing beginners and nursing experts working against Covid-19 in vaccination rooms, later comparing these data to one another and clarifying which group of nurses have more room for burning out at work. According to the theoretical and available data of nurses working against Covid-19 vaccination, only a quantitative, non-experimental, comparative cross-section study has been developed, carried out between nurses engaged in vaccination against Covid-19 in their office. Mr. Maslach's professional burn-out test was used as a research tool. The first part in theory analyses the burn-out syndrome and its impact on health workers, the Covid – 19 epidemic in Latvia and the world. The second part deals with the tactics to be applied and the specific nature of the work against Covid - 19 nurses working in vaccination rooms. A third study was carried out which allowed the degree of burning of nurses against Covid - 19 nurses working in vaccination rooms to be identified. Objective of work: Identify the degree of burn-out syndrome for nurses involved in the Covid-19 vaccination process. Job hypothesis: Covid - 19 nurses involved in the vaccination process have a higher rate of burn-out syndrome than those involved in the Covid -19 vaccination process for experts. Study tool: questionnaire. The work consists of introductory chapters, 6 chapters, 10 sub-chapters, conclusions and 2 annexes. The study was compiled by IBM SPSS statistics and through the Excel program. The bachelor's work consists of 43 pages, 25 images and 26 sources of literature used. Keywords: burn-out syndrome, sister, Covid-19, Covid-19 vaccin

The business and its financing possibilities

Šī darba galvenais mērķis ir izpētīt kredītu veidus un to ietekmi uzņēmējdarbībā. Izmantota teorija par uzņēmējdarbības būtību un ar to saistītam problēmām. Darbs sastāv no trīm daļām. Pirmajā daļā tiek apskatītas uzņēmējdarbības formas un ekonomiskas problēmas. Otrā daļā satur kreditēšanas aspektus, ka arī problēmas saistītas ar kredīta izmantošanu. Trešā daļa ir praktiska. Praktiskā daļā ir apskatīts piemērs, kurā tiek izmantoti bilances, peļņas vai zaudējumu aprēķins ar mērķi pareizi novērtēt uzņēmuma finansiālo stāvokli, lai uzzināt kredīta izmantošanas nepieciešamību. Izmantotas pētījumu metodes: teorētiskās izpētes metodes, analīzes un salīdzināšanas metode, Latvijas oficiālas statistikas un banku interneta resursu izmantošana. Atslēgas vārdi: uzņēmējdarbība, kredīti, finanšu analīze.The main purpose of this work is to probe the kinds of credits, which are intended for business financing. In this work is used theory about business essence and its problems. Work contains of three parts. In the first part are analysed business forms and economic problems. The second part contains crediting aspects, also problems which are connected with credit using. The third part is practical. The practical part is an example, where is used balance, the income or losses calculation, with purpose for correct knowledge of business situation, for let to know if the credit use is necessary. Used methods for the researches in this work: methods of the theoretical research, analyses and compare methods, Latvian official statistics and bank internet resource use. Scarfwise words: business, credits, financial analysis

Controlling in the management of a regional power grid company

The tasks of improving the methods and tools of strategic enterprise management determine the relevance of including the controlling mechanism in the process of managing the enterprise's activities. The purpose of the paper is to substantiate the need to use controlling in the process of strategic enterprise management. The authors use general logical methods and research techniques: a systematic approach, generalization, analysis and synthesis. The paper notes the plurality of views of management theorists and practitioners about the essence of controlling and discrepancies in its functional purpose, which entail the problems of organizing and effectively using the controlling mechanism in enterprise management. In this regard, the authors emphasize the view of controlling as a function of strategic management, systematize the list of implemented controlling tasks and factors that predetermine them, indicate the special role and place of controlling as a kind of tool in the analytical mechanism of self-assessment of the effectiveness of the goal-setting and goal-implementing function of enterprise management, the action of which (i.e. tool) is possible with an adjusted feedback model in the control loop. The prerequisites have been identified and a model for the consistent development of controlling in enterprise management has been tested in relation to the object of research - the regional power grid company PJSC “IDGC of North-West”. The result of the first stage of mastering the controlling functionality is the ability to partially relieve the top management of the company from operational and technical issues in favor of preparing and implementing management decisions of a strategic focus and content. The spectrum of orientation of the controlling functional in the management of PJSC “IDGC of North-West” towards achieving tactical and strategic goals for the long-term existence and development of the company is shown. Prospects for further research into the problem of organizing effective controlling are in the development of methodological support for the process of integrating information flows using digital technologies. Scientific novelty lies in the presentation of controlling as a management function that ensures the company’s activities in accordance with plans in the interests of achieving established goals

Conditions and factors promoting the movement of agricultural producers towards innovation-based development

The article considers the results of a questionnaire survey carried out in 2011 –2013 by the Department of Production Management at the Vologda State Dairy Farming Academy Named after N.V. Vereshchagin. The survey was supported by the Vologda Oblast Department of Agriculture, Food Stocks and Trade in the framework of ongoing research into the issues of transition of agricultural economy to innovation development. The authors present and systematize the opinions of the heads of the region’s agricultural enterprises concerning the challenges and opportunities of innovation-investment activity of agricultural organization

TUBERCULOUS SPONDYLITIS IN ADULTS (clinical and radiographic manifestations)

The clinical and radiographic manifestations of maturity-onset tuberculous spondylitis were analyzed in 107 patients. If there is drug resistance in Mycobacterium tuberculosis (MBT), the extent and degree of spinal bone destruction, the extent of abscess formation, the rate of neurological disorders are greater than those in the MBT drug sensitivity group; however, the significant difference concerns only the involvement of vertebral arches in destruction. The pattern and activity of a tuberculous process in the lung and the proportion of bacteria-excreting persons with drug resistance in MBT significantly exceed those with drug sensitivity. All the patients were operated on; the diagnosis was histologically verified in 100% of cases; the postoperative specimens exhibited MBT culture in 72.9%; the polymerase chain reaction was positive n 98.9%. Bacteriological and molecular genetic studies established multiple drug resistance in 73.4%, polyresistance in 17.3%, and monoresistance in 9.3%

TUBERCULOUS SPONDYLITIS IN ADULTS: CLINICAL AND RADIOGRAPHIC MANIFESTATIONS

The clinical and radiographic manifestations of maturity-onset tuberculous spondylitis were analyzed in 107 patients. If Mycobacterium tuberculosis (MBT) is drug resistant, the extent and degree of spinal bone destruction, the extent of abscess formation, and the rate of neurological disorders are greater than those in the MBT drug sensitivity group; however, the significant difference concerns only the involvement of vertebral arches in destruction. The pattern and activity of a tuberculous process in the lung and the proportion of bacteria-excreting persons with drug resistance in MBT significantly exceed those with drug sensitivity. All the patients were operated on; the diagnosis was histologically verified in 100% of cases; the postoperative specimens exhibited MBT culture in 72.9%; the polymerase chain reaction was positive n 98.9%. Bacteriological and molecular genetic studies established multiple drug resistance in 73.4%, polyresistance in 17.3%, and monoresistance in 9.3%