Management of tubal ectopic pregnancy with methotrexate in the setting of symptomatic Coronavirus disease 2019 (COVID-19): A case report.

Background: Coronavirus Disease 2019 (COVID-19) represents a complex therapeutic challenge. As the pandemic progresses, patients are presenting with ectopic pregnancies (EPs) and symptomatic COVID-19. Objective: We present the management of a patient with multiple medical comorbidities and tubal EP in the setting of severe symptomatic COVID-19 infection where all management options were precluded. Methods: Case report with literature review of management of tubal EP in the setting of severe symptomatic COVID-19 infection. Result: After careful consideration of options, the patient underwent successful medical management with methotrexate while receiving supportive care for COVID-19. Conclusions: Methotrexate proved to be the safest therapeutic option in this patient. Management of patients with severe COVID-19 and gynaecologic emergencies should be individualised and carefully reviewed with evolving knowledge of COVID-19.

Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study.

BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

Neumonitis por taxanos en un servicio de neumología / No disponible

No disponible

Mathematical modelling of respiratory syncytial virus (RSV): vaccination strategies and budget applications.

We propose an age-structured mathematical model for respiratory syncytial virus in which children aged <1 year are especially considered. Real data on hospitalized children in the Spanish region of Valencia were used in order to determine some seasonal parameters of the model. Weekly predictions of the number of children aged <1 year that will be hospitalized in the following years in Valencia are presented using this model. Results are applied to estimate the regional cost of paediatric hospitalizations and to perform a cost-effectiveness analysis of possible vaccination strategies.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy.

OBJECTIVES: To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population. STUDY DESIGN: Cross-sectional survey. METHODS: Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family. RESULTS AND CONCLUSIONS: The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.

Pseudothrombosis of the right ovarian vein. Pitfall of abdominal spiral CT.

We present the computed tomography (CT) findings of pseudothrombosis of the right ovarian vein. In two young multiparous women, pseudothrombosis was detected on early-phase spiral CT scans by the presence of retrograde flow of contrast medium down the left ovarian veins. Asymmetry of density seen in the ovarian veins in the early phase of spiral CT scanning related to reflux in the left ovarian vein should not be mistaken for right ovarian vein thrombosis.

The relationship of workplace social support to perceived work-related stress among staff nurses.

This ex post facto study investigated the relationship of social support from two workplace sources, unit managers and registered nurse (RNs) coworkers, to work-related stress among staff nurses. Sample participants included 51 full-time RNs from a variety of clinical specialties in one nursing organization. The three theoretical components--affect, affirmation, and aid--were measured by the Norbeck Social Support Questionnaire. The Nursing Stress Scale was used to quantify the levels of perceived work-related stress. Statistically significant negative correlations were found between affect from unit managers (r = -299; P = 0.15) and aid from coworkers (r = -.294; P = .036) on levels of perceived work-related stress. Additionally, the increased age of the subjects (r = -.342; P = .007), years of nursing experience (r = -252; P = .037), and length of employment (r = -329; P = .009) had a negative relationship with work stress. The results of this research demonstrated that two components of social support--affect (emotional support) from unit managers and aid (services, information, materials) from coworkers--were linked to lower stress scores in this sample of staff nurses.

Observations on the calf venous pump mechanism: determinants of postexercise pressure.

PURPOSE: We investigated the factors determining postexercise pressure and the relationship of venous valve closure and venous column segmentation to ambulatory venous pressure changes. METHODS: Valve closure and venous segmentation were observed during dynamic ascending phlebography in 40 nonrefluxive limbs and by duplex imaging in 25 normal limbs in healthy volunteers. Simultaneous volume (air plethysmography) and pressure studies during calf exercise were also carried out. Some studies used a simple mechanical model comprised of a collapsible latex tube ("calf pump") and a graduated "popliteal" valve. RESULTS: The femoropopliteal venous column above the popliteal valve remains unsegmented and continuous during ambulatory venous pressure changes in response to calf muscle contraction. Therefore ambulatory venous pressure changes cannot be explained purely on the basis of hydrostatic column pressure changes. Postexercise pressure appears to be determined by a complex set of factors: (1) physical segmentation of the venous column below the popliteal valve (i.e., tibial valve closure); (2) tube collapse below the closed valve, which further aids in the breakup of the hydrostatic column pressure and dampens the effect of any reflux through or around the closed valve; (3) ejection fraction, which influences the degree of tube collapse; and (4) the interaction of the resultant pressure forces with the wall properties of the venous pump. CONCLUSIONS: The mechanism of ambulatory venous pressure reduction is complex and multifactorial. The importance of venous wall characteristics as a determinant of postexercise pressure has not been previously appreciated. Changes in venous wall property after a thrombotic process, for example, could conceivably influence ambulatory venous pressure and recovery time in the absence of reflux.

Pilot scale production of pyrogen-free human hemoglobin for research.

A pilot scale production facility for the preparation of 20 to 30 liters of stroma-free hemoglobin is described. The system is capable of producing pyrogen-free solutions for research purposes. It is not certified for production of parenteral solutions for human use, but the plan could be implemented to meet standards for such materials. Products of the facility should be of adequate quality to address most of the toxicity and efficacy issues facing further development of hemoglobin-based red cell substitutes.

Intracranial bullet migration--a sign of brain abscess: case report.

An unusual case of migration of an intracranial bullet fragment within a brain abscess is reported. Movement of the bullet was first detected on skull films, and the significance of this finding on plain radiographs is emphasized.

[The role of prostacyclin and thromboxane in the antihypertensive action of enalapril]. / Papel de la prostaciclina y tromboxano en la acción antihipertensiva del enalapril.

Enalapril produces an inhibition of the angiotensin-renin system, correlating the pre-therapy plasmatic renin activity with blood pressure decrease, during its administration. This does not always happen, data to the contrary existing in literature, suggesting that there are some other acting mechanisms. We studied 34 hypertensive patients, whose blood pressure levels were controlled by Enalapril at a mean dosage of 12.32 +/- 0.9. Determining plasmatic concentration of 6-keto PGF1a (a prostacyclin metabolite), T x B2 (a thromboxane A2 metabolite), their distribution, plasmatic renin activity and a radiological and biochemical study. We found a significant increase in their distribution and plasmatic renin at the end of the essay. The results suggest a possible double active mechanism: angiotension-renin and prostaglandins systems, owing to the imbalance occurring between prostacyclin and thromboxane, the first named being the most favoured. This, together with easy application and the lack of side effects, made this drug useful for treatment of blood hypertension.

Chronic venous insufficiency: assessment with descending venography.

Six hundred forty-four legs were examined by means of descending venography in patients with chronic venous insufficiency. Three patient positions (supine, 30 degrees semierect, and 60 degrees semierect) were used with a standard angiographic technique. Patients were also studied during either normal respiration or a Valsalva maneuver. The deep venous valvular system was incompetent more often than the superficial (saphenous) venous system. Positive venograms revealed that reflux occurred into the deep venous system alone in 82%, the superficial venous system alone in only 2%, and a combination of deep and superficial systems in 16%. The authors conclude that descending venography is best performed at the more physiologic 60 degrees semierect position and with the Valsalva maneuver, which enables evaluation of the competence of valves in the closed position.

Radiological seminar CCXLXIII: percutaneous gastrojejunostomy--a interventional radiologic procedure.

The authors describe the recent emergence of an interventional radiologic procedure, percutaneous gastrostomy and gastroenterostomy. They present a case report, and discuss indications, methods, and advantages of the procedure for some patients.