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Systemic embolization due to non-bacterial thrombotic endocarditis: An autopsy case report and mini review of the literature.
Get PDFNonbacterial thrombotic endocarditis is a rare, non-infectious complication associated with hypercoagulable states, such as malignancies and autoimmune diseases. Due to the difficulty distinguishing marantic endocarditis from infective endocarditis, the diagnosis is often delayed or even a postmortem finding. We present the case of a 70-year-old Caucasian female with marantic endocarditis secondary to metastatic duodenal adenocarcinoma. The patient presented with a short history of memory deficits, personality disturbances, and left homonymous hemianopia. Diffusion-weighted magnetic resonance imaging showed multi-territorial bihemispheric cerebral infarctions. Transthoracic echocardiography revealed native mitral valve endocarditis, and serial blood cultures remained negative. Despite antibiotic therapy, the patient's condition continuously deteriorated, and she died within 3 weeks after her initial presentation. Postmortem examination showed a non-bacterial thrombotic endocarditis. Early clinical suspicion and prompt diagnosis are of decisive importance for the survival of the patients
Case studies for year 1980
No full textThis document contains geographical maps evidencing the trajectories of all Mediterranean cyclones happening in year 1980. Surface impacts and extremes (of wind, precipitation and waves), together with sea-level-pressure fields and synoptic cyclone features, are shown at 6h intervals during the evolution of each cyclone track. The contours of two definitions of "cyclone impact areas" are represented with the impact and feature information, to test the goodness of each definition
The science of prevalence: development of an evidence-based tool to assess the risk of bias in prevalence studies.
No full textPrevalence is a core concept in epidemiology, defined as the proportion of people with specific
characteristics (diseases, risk factors, or protective factors) at a certain point or during a certain
period. The importance of prevalence might have been undervalued because calculating it or
designing prevalence studies are perceived to be straightforward. Furthermore, research on the
methodological aspects on prevalence estimates has not been exhaustive, compared to other
study designs such as randomised controlled trials. The same potential underestimation and
lack of research apply to systematic reviews of prevalence, despite their increase in recent years.
During the COVID-19 pandemic, prevalence gained relevance because prevalence data were
essential for many research questions related to topics such as seroprevalence or the
prevalence of specific symptoms and comorbidities of people with SARS-CoV-2 in different
settings.
The work presented in this thesis aims to provide knowledge about the epidemiology of
prevalence studies, and biases that affect them. The thesis contains seven chapters: an
introduction; four chapters that present the projects conducted during my doctoral studies,
which, at the time of this writing, either have been published or are currently being prepared for
submission; and finally, a discussion of the main findings and implications of the doctoral project.
This thesis also includes two additional projects that contributed to broadening my skills as an
epidemiologist, even though they did not constitute the core of my doctoral project.
In Chapter 1, I comprehensively introduce prevalence and relevant uses of prevalence studies.
Afterwards, I present systematic reviews, and the relevance of risk of bias assessment followed
by systematic reviews of observational studies and systematic reviews of prevalence. Then, I
present the current guidance available to conduct systematic reviews of prevalence.
Chapter 2 is a communication published in the BMJ Open. This publication approaches the basic
concepts of prevalence and the biases that affect prevalence estimates. Each scenario is
illustrated with an example of a study conducted on COVID-19. This communication highlights
how prevalence became more relevant during the pandemic.
Chapter 3 presents a meta-epidemiological study of systematic reviews of prevalence conducted
on adult populations from 2010 to 2020, where I included 1172 publications. I describe their
characteristics and compliance with the PRISMA 2009 checklist and assessed the relationship
between compliance with the PRISMA checklist and study level variables in a linear regression
analysis. Compliance with the PRISMA checklist is still suboptimal for some items, specifically in
the methods section. The year of publication, the number of authors who published the review,
publishing in an open-access journal and reporting the use of a guideline were associated with
completeness of reporting to the PRISMA 2009. This manuscript will be submitted soon.
Chapter 4 presents two iterations of a living systematic review about the proportion of people
with asymptomatic SARS-CoV-2. The first included 80 studies, and it found that the pooled
proportion of people with a truly asymptomatic infection was 20%, 95% CI (17-25), with a
prediction interval of 3% to 67%. In the next version, the eligibility criteria became more strict,
and were met by 146 studies. A pooled proportion of asymptomatic people with SARS-CoV-2 was
not presented, due to the high heterogeneity of the studies. A meta-regression analysis did not
identify the characteristics that were associated with heterogeneity.
Chapter 5 presents the development of a tool to assess bias in the prevalence of mental health
studies conducted during the first wave of the COVID-19 pandemic. The proposed tool
approached selection and information bias with three questions: one about the sample's
representativeness regarding the target population, the second about the representativeness of
the respondents, and the third one dealt with the measurement of the condition. Agreement for
the three items was 83%, 90% and 93%, respectively. The weighted kappa scores were 0.63,
95% CI (0.54 - 0.73), 0.71, 95% CI (0.67 - 0.85), and 0.32, 95% CI (–0.04 - 0.63).
Chapter 6 discusses the findings of the studies, the current stage of an evidence-based tool to
assess the risk of bias for any prevalence study, the study’s strengths and limitations, and future
questions.
This thesis provides a conceptual framework that portrays the bias affecting prevalence studies.
I show how systematic reviews of prevalence have been conducted, which aspects need
improvement, and the need for new methodologies. Furthermore, I present a living systematic
review that used the conceptual framework to answer questions relevant to the COVID-19
pandemic. I conclude with a risk of bias tool that assesses the bias of prevalence studies on
mental health. This tool forms the basis for future development of a domain-based tool to assess
the biases in prevalence studies
Basic Airway Management (BAM) course: A way towards standardised airway management training during anaesthesiology residency
No full textThe inseparability of context and clinical reasoning.
Get PDFEarly descriptions of clinical reasoning have described a dual process model that relies on analytical or nonanalytical approaches to develop a working diagnosis. In this classic research, clinical reasoning is portrayed as an individual-driven cognitive process based on gathering information from the patient encounter, forming mental representations that rely on previous experience and engaging developed patterns to drive working diagnoses and management plans. Indeed, approaches to patient safety, as well as teaching and assessing clinical reasoning focus on the individual clinician, often ignoring the complexity of the system surrounding the diagnostic process. More recent theories and evidence portray clinical reasoning as a dynamic collection of processes that takes place among and between persons across clinical settings. Yet, clinical reasoning, taken as both an individual and a system process, is insufficiently supported by theories of cognition based on individual clinicals and lacks the specificity needed to describe the phenomenology of clinical reasoning. In this review, we reinforce that the modern healthcare ecosystem - with its people, processes and technology - is the context in which health care encounters and clinical reasoning take place
Intraoperative Neurophysiologic Monitoring and Mapping in Children Undergoing Brainstem Surgery.
No full textIntraoperative neurophysiologic monitoring during surgery for brainstem lesions is a challenge for intraoperative neurophysiologists and surgeons. The brainstem is a small structure packed with vital neuroanatomic networks of long and short pathways passing through the brainstem or originating from it. Many central pattern generators exist within the brainstem for breathing, swallowing, chewing, cardiovascular regulation, and eye movement. During surgery around the brainstem, these generators need to be preserved to maintain their function postoperatively. This short review presents neurophysiologic and neurosurgical experiences of brainstem surgery in children
DNA repair, gap suppression, or fork protection: BRCA2 needs a break!
No full textIn this issue of Molecular Cell, Lim et al.1 reveal new insights into the distinct roles of BRCA2 in coping with DNA breaks, highlighting homologous recombination as the pivotal function that affects tumorigenesis and therapy response
The influence of patients' nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements - A secondary analysis of a randomized controlled trial.
Get PDFOBJECTIVES
The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes.
METHODS
Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models.
RESULTS
The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality.
CONCLUSION
The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake
Recovery from the pandemic: planning the reterritorialisation of agricultural activities
No full textThis chapter discusses planning the reterritorialisation of agricultural activities as an avenue of the Covid-19 pandemic recovery. Reterritorialisation indicates local food being targeted to local inhabitants instead of the global market. We argue that the pandemic has accelerated the reterritorialisation process. Supply chain actors actively responded to the local market, local agrifood sector labour was revalued, the rural-urban linkage was rebuilt along with the lifestyle change, and public political awareness was raised in engaging local agrifood issues. We propose planning the reterritorialisation of agriculture as a solution to perpetuating local agrifood activities and recovering from the pandemic. We discuss planning strategies from perspectives of access to land, the transition of farming practices, and structuring local supply chains. We conclude with research agenda drawn from the challenges faced by the coexistence of local and global food systems, the policy coherence and the juxtaposed complex issues like climate change and geopolitical conflicts
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