Atrial septal defect and platypnea-orthodeoxia syndrome: usefulness of the balloon occlusion test.

A 37-year-old man was referred to our medical center with a diagnosis of Eisenmenger syndrome due to an atrial septal defect (ASD). At admission he had central cyanosis, acrocyanosis, and progressive effort dyspnea; his symptoms improved during lying position.

Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.

OBJECTIVE: To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. METHODS: A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. RESULTS: The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. CONCLUSION: Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

The high optical brightness of the BlueWalker 3 satellite.

Large constellations of bright artificial satellites in low Earth orbit pose significant challenges to ground-based astronomy1. Current orbiting constellation satellites have brightnesses between apparent magnitudes 4 and 6, whereas in the near-infrared Ks band, they can reach magnitude 2 (ref. 2). Satellite operators, astronomers and other users of the night sky are working on brightness mitigation strategies3,4. Radio emissions induce further potential risk to ground-based radio telescopes that also need to be evaluated. Here we report the outcome of an international optical observation campaign of a prototype constellation satellite, AST SpaceMobile's BlueWalker 3. BlueWalker 3 features a 64.3 m2 phased-array antenna as well as a launch vehicle adaptor (LVA)5. The peak brightness of the satellite reached an apparent magnitude of 0.4. This made the new satellite one of the brightest objects in the night sky. Additionally, the LVA reached an apparent V-band magnitude of 5.5, four times brighter than the current International Astronomical Union recommendation of magnitude 7 (refs. 3,6); it jettisoned on 10 November 2022 (Universal Time), and its orbital ephemeris was not publicly released until 4 days later. The expected build-out of constellations with hundreds of thousands of new bright objects1 will make active satellite tracking and avoidance strategies a necessity for ground-based telescopes.

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions.

BACKGROUND: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

Coronavirus (COVID 19) Infection in Pregnancy.

Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health's teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

La enfermedad por coronavirus 2019 (COVID-19) es una infección de las vías respiratorias causada por un nuevo virus (SARS-CoV-2) que se ha diseminado rápidamente en el mundo, afectando a la población general, incluida la población de mujeres cursando un embarazo. Por ser una infección de aparición reciente, la información que soporta las mejores prácticas para el manejo de la infección durante la gestación es escasa y muchas de las preguntas no están completamente resueltas.Esta publicación brinda lineamientos generales orientados a tomadores de decisión, gerentes y equipos de salud en relación con el cuidado de mujeres gestantes y recién nacidos durante la pandemia por COVID 19. Su finalidad es promover intervenciones beneficiosas para prevenir nuevos contagios, y la atención oportuna y adecuada de la gestante para evitar complicaciones graves y/o muertes, adecuándose a los distintos contextos en los que se proporciona atención médica. Los lineamientos se enmarcan en la mejor información científica y las recomendaciones disponibles hasta la fecha.

Endocarditis caused by Leuconostoc lactis in an infant. Case report / Endocarditis por Leuconostoc lactis en un lactante. Reporte de caso

Abstract Introduction: Infections caused by Leuconostoc lactis are rare and are associated with multiple risk factors. According to the literature reviewed, there are no reported cases of endocarditis caused by this microorganism in the pediatric population. Case presentation: An infant with short bowel syndrome was taken by his parents to the emergency department due to malnutrition. During his prolonged hospital stay, he presented multiple infections, so he required central venous catheter, prolonged enteral tube feeding and parenteral nutrition. In one of his nosocomial infection episodes, peripheral blood cultures were taken, and an echocardiogram was performed, achieving the diagnosis of endocarditis by L. lactis, which was treated with linezolid. After 21 days of treatment, the infectious process was controlled; however, in order to improve his condition and due to another bacteremia episode, he remained hospitalized. Finally, after 113 days, the patient was discharged, and comprehensive outpatient care was ordered. Conclusion: Although rare in the pediatric population, endocarditis by L. lactis should be suspected in patients with multiple risk factors and polymicrobial infections. Timely and specific treatment, as in the reported case, can help avoid future complications.

Resumen Introducción. Las infecciones por Leuconostoc lactis son raras y se asocian a múltiples factores de riesgo; además, de acuerdo con lo revisado en la literatura relevante, no hay reportes de endocarditis causada por este microorganismo en población pediátrica. Presentación del caso. Lactante con síndrome de intestino corto que fue llevado por sus padres al servicio de urgencias por desnutrición. Durante su estancia hospitalaria prolongada, el paciente presentó múltiples infecciones, por lo que requirió catéter venoso central (CVC), alimentación enteral prolongada y nutrición parenteral. En uno de los episodios infecciosos intrahospitalarios se tomaron hemocultivos periféricos y se realizó un ecocardiograma, lo que permitió diagnosticarlo con endocarditis por L. lactis y por lo cual se decidió iniciar manejo con linezolid. Luego de 21 días de tratamiento, la infección fue controlada, pero con el fin de mejorar su estado nutricional y debido a un nuevo episodio de bacteremia, se decidió prolongar su estancia hospitalaria. Finalmente, después de 113 días de hospitalización, fue dado de alta para continuar manejo integral ambulatorio. Conclusión. A pesar de ser una entidad poco frecuente en pediatría, la endocarditis por L. lactis debe sospecharse en pacientes con múltiples factores de riesgo y con infecciones polimicrobianas. Un tratamiento oportuno y específico como el usado en el presente caso puede evitar complicaciones futuras.

Coronavirus (COVID 19) Infection in Pregnancy / Coronavirus (COVID 19) Infección en el embarazo

Abstract Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health's teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

Resumen La enfermedad por coronavirus 2019 (COVID-19) es una infección de las vías respiratorias causada por un nuevo virus (SARS-CoV-2) que se ha diseminado rápidamente en el mundo, afectando a la población general, incluida la población de mujeres cursando un embarazo. Por ser una infección de aparición reciente, la información que soporta las mejores prácticas para el manejo de la infección durante la gestación es escasa y muchas de las preguntas no están completamente resueltas. Esta publicación brinda lineamientos generales orientados a tomadores de decisión, gerentes y equipos de salud en relación con el cuidado de mujeres gestantes y recién nacidos durante la pandemia por COVID 19. Su finalidad es promover intervenciones beneficiosas para prevenir nuevos contagios, y la atención oportuna y adecuada de la gestante para evitar complicaciones graves y/o muertes, adecuándose a los distintos contextos en los que se proporciona atención médica. Los lineamientos se enmarcan en la mejor información científica y las recomendaciones disponibles hasta la fecha.

Improving the performance of proton exchange membrane water electrolyzers with low Ir-loaded anodes by adding PEDOT:PSS as electrically conductive binder.

Reducing the iridium catalyst loading in the anode of polymer electrolyte membrane electrolyzers is a major goal to bring down the cost. However, anodes with low Ir-loading can suffer from poor electrical connectivity and hence lower the efficiency of the electrolyzer. In this work, we replace parts of the Nafion binder in the anode with an electrically conductive polymer (poly-3,4-ethylenedioxythiophene and polystyrene sulfonate acid complex, PEDOT:PSS) to counter this effect. At the optimal 50 : 50 blend we achieve a 120 mV lower overpotential (2.02 V) at 3 A cm-2 compared to a pure Nafion reference (2.14 V). This corresponds to a 6% better efficiency. Ex situ resistivity measurements and high frequency resistance measurements indicate that the major cause for this improvement lies in the reduced electrical in-plane resistance due to the electrical conductivity of PEDOT:PSS.

Extreme Maternal Morbidity: a tracer event to improve the quality of obstetric care in Latin America / Morbilidad Materna Extrema: evento trazador para mejorar la calidad de la atención obstétrica en América Latina

Abstract This article reviews critical aspects that have had an impact on the implementation of epidemiological surveillance of extreme maternal morbidity, as a tracer event of quality maternal care at population and institutional level; taking into account that maternal mortality has been usually monitored, and its analysis allows interventions to avoid maternal death. Until 2015, very few countries had been able to meet the goals established in the Millennium Development Goals (MDGs), especially MDG 5 - improving maternal health. As of today, it is observed that maternal mortality rate is quite heterogeneous, with rates from 1 case per 100,000 live births in developed countries, to more than 100 cases per 100,000 live births in developing countries. Therefore, complementary strategies such as surveillance of the extreme maternal morbidity could offer a more effective alternative to identify and implement interventions that allow us to prevent mortality and strengthen the quality of obstetric care. In addition, the importance of extreme maternal morbidity as a quality tracer event is that, unlike what is observed with maternal mortality, this is an event that occurs more frequently, is anticipatory of death, and the surviving pregnant woman is the primary source of information.

Resumen Este artículo revisa aspectos críticos que han tenido incidencia en la implementación de la vigilancia epidemiológica de la morbilidad materna extrema, como un evento trazador de calidad del cuidado materno a nivel poblacional e institucional, ya que usualmente se ha monitoreado la mortalidad materna y su análisis permite realizar intervenciones para evitar la muerte materna. Para el año 2015, muy pocos países lograron cumplir las metas establecidas en los Objetivos de Desarrollo del Milenio (ODM), especialmente el ODM 5- mejorar la salud materna. Al día de hoy se observa que la tasa de mortalidad materna es bastante heterogénea con tasas desde 1 caso por 100,000 nacidos vivos en países desarrollados, hasta más de 100 casos por cada 100,000 nacidos vivos en países en vía de desarrollo. Por lo tanto, estrategias complementarias como la vigilancia de la mortalidad materna extrema podrían ofrecer una alternativa más eficaz para identificar e implementar intervenciones que nos permitan prevenir la mortalidad y fortalecer la calidad de atención obstétrica, a partir de información más confiable y sin esperar que ocurra una muerte materna.

Hollow ZnO microspheres functionalized with electrochemical graphene oxide for the photodegradation of salicylic acid.

Hollow ZnO microspheres were successfully synthesized by a hydrothermal method and then functionalized with graphene oxide (GO) flakes, previously obtained through electrochemical oxidation. Their photocatalytic activity toward the photodegradation of salicylic acid under UV light irradiation was evaluated by UV-Vis spectroscopy. Unfunctionalized microspheres and ZnO functionalized with chemically oxidized graphene were also studied as comparative terms. The hybrid materials of ZnO with both electrochemical and chemical GO gave a similar photodegradation yield of ∼28% against 18% of the non-functionalized microspheres. The similar degradation yields and rate constants obtained with the two GO synthetic methods indicate that electrochemical oxidation of GO represents an eco-friendly option over traditional methods for photocatalytic degradation systems.

Extreme Maternal Morbidity: a tracer event to improve the quality of obstetric care in Latin America.

This article reviews critical aspects that have had an impact on the implementation of epidemiological surveillance of extreme maternal morbidity, as a tracer event of quality maternal care at population and institutional level; taking into account that maternal mortality has been usually monitored, and its analysis allows interventions to avoid maternal death. Until 2015, very few countries had been able to meet the goals established in the Millennium Development Goals (MDGs), especially MDG 5 - improving maternal health. As of today, it is observed that maternal mortality rate is quite heterogeneous, with rates from 1 case per 100,000 live births in developed countries, to more than 100 cases per 100,000 live births in developing countries. Therefore, complementary strategies such as surveillance of the extreme maternal morbidity could offer a more effective alternative to identify and implement interventions that allow us to prevent mortality and strengthen the quality of obstetric care. In addition, the importance of extreme maternal morbidity as a quality tracer event is that, unlike what is observed with maternal mortality, this is an event that occurs more frequently, is anticipatory of death, and the surviving pregnant woman is the primary source of information.

Este artículo revisa aspectos críticos que han tenido incidencia en la implementación de la vigilancia epidemiológica de la morbilidad materna extrema, como un evento trazador de calidad del cuidado materno a nivel poblacional e institucional, ya que usualmente se ha monitoreado la mortalidad materna y su análisis permite realizar intervenciones para evitar la muerte materna. Para el año 2015, muy pocos países lograron cumplir las metas establecidas en los Objetivos de Desarrollo del Milenio (ODM), especialmente el ODM 5- mejorar la salud materna. Al día de hoy se observa que la tasa de mortalidad materna es bastante heterogénea con tasas desde 1 caso por 100,000 nacidos vivos en países desarrollados, hasta más de 100 casos por cada 100,000 nacidos vivos en países en vía de desarrollo. Por lo tanto, estrategias complementarias como la vigilancia de la mortalidad materna extrema podrían ofrecer una alternativa más eficaz para identificar e implementar intervenciones que nos permitan prevenir la mortalidad y fortalecer la calidad de atención obstétrica, a partir de información más confiable y sin esperar que ocurra una muerte materna.

Porphyrins as ligands for 64copper: background and trends.

Porphyrins and 64Cu have emerged as a novel synergic option for applications in PET molecular imaging. Both the characteristics and photophysical properties of macrocyclic porphyrins and the relatively long half-life of the copper isotope, in addition to the increased tumor-specific uptake of porphyrins compared to normal cells, make this complex an attractive option not only for diagnosis but also for therapeutic applications. Herein, we present an overview of the latest results on the development of PET agents based on porphyrins and 64Cu, including methods used to improve the selectivity of these macrocycles when conjugated with biological units such as monoclonal antibodies, peptides or proteins.

Carbon nanotubes: An alternative for platinum-based drugs delivery systems.

Currently, nanomedicine is approaching the research of nanomaterials that could work as drug delivery systems, to increase the efficiency, specificity and safety of drugs reducing toxicity and side effects. In this regard, carbon nanotubes have acquired great interest due to their physicochemical properties. The use of platinum-based drugs is facing some troubles in the clinic due to their side effects such as nephrotoxicity, neutropenia, neurotoxicity, among others. In addition, cases of tumors resistant to these drugs have been recently observed. The goal of this review was to analyze the reports about the use of formulations of platinum-based drugs in carbon nanotubes, to know and establish the most functional and potential conditions for its use in cancer treatment, identifying perspectives and develop areas for the improvement of these nanomaterials in the application of cancer therapy.

Conformation of Novel Azo-Dyes Bearing End-Capped Oligo(ethylene glycol) Studied by UV-vis and NMR Spectroscopy.

Two novel azo-dyes bearing an end-capped oligo(ethylene glycol) chain were synthesized and then studied by UV-visible and NMR spectroscopy. For both azobenzenes, the end-capped oligo(ethylene glycol) segment is on the para position of the first phenyl ring. On the second phenyl ring, a methoxy group is added on the para position for one azo-dye and no substitution group on the other, which made them electronically a push-push and a push system, respectively. The presence of the methoxy group changes significantly the absorption and the photoisomerization behaviors and results in a much less intense absorbance for the trans isomer and a shift from 350 to 360 nm. In the kinetic studies the azobenzene bearing a methoxy group shows a zero-order and a first-order kinetics as a function of the time scale of the study as well as an aggregation phenomenon. This azo-dye in different solvents has been studied by (1)H NMR and pulsed gradient NMR experiments to understand the effects of the photoisomerization and the aggregation on the self-diffusion of these molecules in solutions.

Green microalga Scenedesmus acutus grown on municipal wastewater to couple nutrient removal with lipid accumulation for biodiesel production.

The green microalga Scenedesmus acutus was cultivated in two different municipal wastewater discharges (pre- and post-treated), and was compared to a culture medium with basic nutrients (20% of N, P, K), in order to study the simultaneous potential of nutrient removal and lipid accumulation ability. The highest level of nutrient removal was found in the pretreated wastewater discharge (achieving a high removal of phosphorus [66%] and organic nitrogen [94%]). Likewise, better results on biomass productivity and lipid accumulation were found in cultures using pretreated wastewater compared to enriched medium, obtaining 79.9 mg/L, and 280 mg/L, respectively. Since the best results were found in pretreated wastewater, the biodiesel preparation was performed using said medium at small-scale. After cultivation, 249.4 mg/L of biodiesel were obtained. According to this analysis, S. acutus could be used for wastewater treatment producing biomass with a suitable content of lipids, convenient for biodiesel production.

Ingresos por accidentes en la unidad de cuidados intensivos pediàtricos del hospital central Instituto de Previsiòn Social Noviembre 2005-Noviembre 2009 / Income accident in pediatric intensive care unit of the hospital central social welfare institute in november 2005-november 2009

Ingresos por accidentes en la unidad de cuidados intensivos pediàtricos del hospital central Instituto de Previsiòn Social Noviembre 2005-Noviembre 2009.

Valoración del grado de malignidad e invasión en el carcinoma escamocelular de lengua / Valuation of the degree of malignancy and invasion of the squamous carcinoma of tongue

La presente investigación se realizó con el fin de clasificar los cambios histopatológicos que se presentan en el carcinoma escamocelular de lengua, para predecir mejor el curso de la enfermedad y brindar un tratamiento más óptimo para cada paciente. Se realizó un estudio no experimental descriptivo en la que se tomó una muestra de 30 pacientes con carcinoma escamocelular de lengua del Instituto Nacional de Cancerología de Santa Fe de Bogotá; los cuales se presentaron entre enero 1§ de 1990 y febrero 13 de 1991. La malignidad e invasión del carcinoma escamocelular de lengua se evaluó de acuerdo con los siguientes hallazgos histopatológicos; los cuales a su vez se clasificaron por grados, así: grado de queratinización: I: más de 50 por ciento de queratina, II: de 50 por ciento al 20 por ciento, III: 20 por ciento al 5 por ciento, IV: 5 por ciento al 0 por ciento; grado de mitosis se observó en 10 campos de 40X, I: 0-1 mitosis, II: 2-3 mitosis, III: 4-5 mitosis, IV: mayor de 5 mitosis; grado de polimorfismo nuclear: I: 25 por ciento de células inmaduras respecto a las maduras, II: 25-50 por ciento, III: 50-75 por ciento, IV: 75-100 por ciento; grado de infiltrado linfoplasmocitario: I: Marcado, II: Moderado, III: Leve, IV: Nada, y grado de invasión: I: Bordes de crestas epiteliales redondeadas, II: Bandas o cordones de células infiltrantes, IV: Células individuales dispersas en el estroma. Se concluyó, que a mayor grado de malignidad e invasión en los carcinomas escamocelulares de lengua se encontraba mayor grado de mitosis, mayor grado de polimorfismo nuclear, y mayor grado de infiltrado linfoplasmocitario.