1,722,422 research outputs found
Italian asylum reception system and health challenges: The Apulian case
No full textThis research investigates the health and migration nexus regarding service provision and migration governance, particularly asylum seekers’ health access. We decided to analyse the case of the Apulia Region, one of the main Mediterranean routes for asylum seekers heading for Europe and representing an exception in the Italian national territory, extending the medical treatments and services provided for Italians and regular migrants to those irregular ones. The analysis relies on the data collected within a research project that aims to create an integrated system of prevention, diagnosis, treatment, and rehabilitation of asylum seekers and holders of international protection on the regional territory. It is mixed-method research based on (1) quantitative data from an ad hoc field survey organised in the reception centres and drafted to retrieve information unavailable in other databases and distributed to, and (2) qualitative data collected through semi-structured interviews with local policymakers, representatives of reception centres, and NGOs. Our results highlight that in the reception process, the medical service appears decisive, and the absence of constant control of health status can cause the worsening of not visible symptoms, creating further psycho-physical problems. Another essential aspect is the importance of the communication: the diffusion of the information and the role of competent intercultural mediators in the outpatient visits in the first-level reception centres, especially during the certification and treatment of violence, torture, or other severe forms of physical, psychological, or sexual violence. Some best practises are presented and some suggestions for further implementations of health services for asylum seekers and refugees are proposed
Towards integrative physiological monitoring of the critically ill: From cardiovascular to microcirculatory and cellular function monitoring at the bedside
Full text linkCurrent hemodynamic monitoring of critically ill patients is mainly focused on monitoring of pressure-derived hemodynamic variables related to systemic circulation. Increasingly, oxygen transport pathways and indicators of the presence of tissue dysoxia are now being considered. In addition to the microcirculatory parameters related to oxygen transport to the tissues, it is becoming increasingly clear that it is also important to gather information regarding the functional activity of cellular and even subcellular structures to gain an integrative evaluation of the severity of disease and the response to therapy. Crucial to these developments is the need to provide continuous measurements of the physiological and pathophysiological state of the patient, in contrast to the intermittent sampling of biomarkers. As technological research and clinical investigations into the monitoring of critically ill patients have progressed, an increasing amount of information is being made available to the clinician at the bedside. This complexity of information requires integration of the variables being monitored, which requires mathematical models based on physiology to reduce the complexity of the information and provide the clinician with a road map to guide therapy and assess the course of recovery. In this paper, we review the state of the art of these developments and speculate on the future, in which we predict a physiological monitoring environment that is able to integrate systemic hemodynamic and oxygen-derived variables with variables that assess the peripheral circulation and microcirculation, extending this real-time monitoring to the functional activity of cells and their constituents. Such a monitoring environment will ideally relate these variables to the functional state of various organ systems because organ function represents the true endpoint for therapeutic support of the critically ill patient
Multipl Skleroz Hastalarında İnce Liflerin Histopatolojik Olarak Değerlendirilmesi
No full textJahanroshan J., The histopathologic evaluation of small fibers in Multiple Sclerosis patients, Hacettepe University Faculty of Medicine, Thesis of Neurology. Ankara, 2018. Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. Neuropathic pain is a common symptom in all MS types.The pathology of multiple sclerosis is the demyelination of central neurons, however the patients may have neuropathic pain in distal extremities similar to A-delta and C fiber dysfunction. It is not known whether the loss of small fiber may have a role in the generation of neuropathic pain in these MS patients. In this study we aim to investigate the small fiber loss and its length dependency. For this purpose, we evaluated the skin biopsies taken proximal and distal leg of MS patients with neuropathic pain. Twenty MS patients including 6 primary progressive MS, 7 relapsing-remitting MS and 7 secondary progressive MS, as control group ten age and sex-matched patients with different neurological disorders without neuropathic pain were included. Neurological examination, electrophysiological evaluation and DN4 questionnaire were performed. Subsequently, skin punch biopsies from 10 cm above the lateral malleolus and proximal thigh were done. The biopsy samples were stained with PGP9.5 antibody and intraepidermal nerve fiber density (IENFD) was determined. Sixty-five percent of our MS patients complaint about neuropathic pain and three of them had glove-stocking sensation loss. The mean of IENFD was 8.58 (4.15-17.58) fiber/mm in proximal leg whereas 9.48 (4.92-20.03) fiber/mm in distal leg of MS patients. IENFD did not differ between MS and control groups. Moreover IENFD did not differ among MS subgroups. Although the intraepidermal nerve fiber density tends to be lower in proximal part of the leg in 80% of MS patients, there was not any statistical significance. Intraepidermal nerve fiber density in MS patients did not differ from control group. However IENFD was lower in proximal leg in 80% of MS patients. This finding has to be verified with new studies involving larger patient groups and quantitative sensory tests.
Keywords: Small fiber neuropathy, multiple sclerosis, neuropathic pain, DN4 questionnarJahanroshan J., Multipl skleroz hastalarında ince liflerin histopatolojik olarak değerlendirilmesi, Hacettepe Üniversitesi Tıp Fakültesi, Nöroloji Uzmanlık Tezi. Ankara, 2018. Multipl skleroz santral sinir sisteminin otoimmün ve demiyelinizan hastalığıdır. Hastalığın seyrinde nöropatik ağrı sık karşılaşılan bir semptomdur. Her ne kadar santral sinir sistemi demiyelinizasyonu ile giden bir hastalık olsa da bazı hastalar ekstremite distallerinde paresteziler gibi A delta ve C liflerinin hasarında ortaya çıkan şekilde periferik nöropatik ağrıdan da şikayetçi olmaktadır. Bu nedenle çalışmamızda söz konusu nöropatik ağrısı olan ve olmayan MS hastaların ince lifleri alt ekstremite proksimalinden ve distalinden aldığımız deri biyopsilerinde incelemeyi planladık. Bu amaçla altısı primer progresif, yedisi sekonder progresif ve yedisi relapsing remiting MS olmak üzere 20 MS hastası ve kontrol grubu olarak aynı yaş ve cinsiyette herhangi bir nöropatik ağrısı veya ince lif nöropatisine neden olabilecek hastalığı olmayan 10 birey dahil edildi. Nörolojik muayene ve DN4 anketi uygulandı. Sonrasında lateral malleolün 10 cm proksimalinden ve uyluk proksimalinden olacak şekilde iki deri “punch” biyopsisi uygulandı. Örnekler PGP9.5’a karşı geliştirilmiş antikorla boyandıktan sonra her iki grupta intraepidermal sinir lifi yoğunluğu (IENFD) değerlendirildi. Multipl skleroz hastalarının %65’inde DN4 anketi ile nöropatik ağrı tespit edilirken bu hastaların üçünde nörolojik muayenede eldiven-çorap hipoestezisi mevcuttu. Ortalama IENFD proksimalde 8.58 (4.15-17.58) lif/mm iken distalde 9.48 (4.92-20.03) idi. Lif yoğunluğu MS hastaları ile kontrol grubunda veya MS alt grupları arasında farklılık göstermedi. Çalışmada en dikkat çekici bulgu MS hastaların %80’inde IENFD’nin beklenenin aksine proksimalde daha fazla azalmış olmasıydı. Bu bulgunun daha fazla MS hastanın dahil edildiği ve kantitatif duyu testlerinin de uygulandığı daha geniş bir çalışma ile desteklenmesi gerekmektedir.
Anahtar kelimeler: İnce lif nöropatisi, multipl skleroz, nöropatik ağrı, DN4 anket
Acute Kidney Injury and Fluid Resuscitation in Septic Patients: Are We Protecting the Kidney?
Full text linkAcute kidney injury (AKI) is a common complication in critically ill patients, especially among septic patients. Sepsis and hypovolemia are the 2 most frequent etiologies of AKI in intensive care units and frequently coexist in critically ill patients. Effective fluid resuscitation is crucial for the stabilization of sepsis-induced tissue hypoperfusion or septic shock. However, the lack of a goal-directed therapy targeting kidney oxygenation prevents from optimization of the fluid therapy with regard to improvement of renal oxygen delivery and extraction. Similarly, fluid administration as all therapeutic actions carries adverse effects such as the activation of cytokines, disruption of the capillary glycocalyx, and adverse effects on kidney metabolism and oxygenation. Moreover, a positive fluid balance is associated with an increased risk of AKI and is a negative predictor for recovery of renal function. The role of fluid resuscitation on kidney injury stems from the high renal vulnerability to hypoxemic injury. Indeed, fluids have a poor oxygen solubility and hemodilution decreases blood viscosity both promoting intrarenal shunting and heterogeneity with a decreased capillary density and enhanced intrarenal cortex and medullary hypoxia. The development of physiological biomarkers that are able to detect the early development of AKI specifically aimed at the identification of renal microcirculatory dysfunctions should form a valuable contribution to monitoring therapeutic modalities
From macrohemodynamic to the microcirculation
Full text linkHemodynamic monitoring allows clinicians to manage macrocirculation. In a prospective, randomized, controlled trial, on surgical abdominal patients, protocol group managed to keep O₂ER < 27%, versus control group with "standard" therapy, had fewer organ failures and lower length of hospital stay. Vasoconstrictive and positive inotropic effects of methylene blue during septic shock, wasn’t associated with hemodynamic or respiratory changes. However just monitoring macrocirculation appeared to be not enough to improve patient outcome and splanchnic perfusion was monitored with tonometer. In 12 abdominal surgical patients, intraoperative splanchnic ischemia, was documented by gastric intramucosal pH-i, and directly correlated to IL-6 plasma levels increase of and to postoperative complications. PHi and ΔCO₂ were sensitive prognostic indices during abdominal aortic aneurysm surgery in 29 patients. Recently NIRS and SDF techniques were introduced to monitor microcirculation. In septic patients treatment with activated protein C (rh-aPC) improved StO₂ baseline and reperfusion and increased tissue metabolism. Moreover rh-aPC treatment improves sublingual microcirculation in 13 patients with severe sepsis compared to 9 patients. Levosimendan compared to dobutamine in a double-blind clinical trial improved sublingual microcirculatory blood flow in patients with septic shock. A prospective randomized trial, on 20 septic patients, suggests more favorable effect on microcirculation of leukodepleted RBC transfusions compared with non-leukodepleted ones. In a secondary analysis old RBC transfusion was associated with plasmatic fHb increase and decreased microvascular density. In conclusion monitoring microcirculation help physician to treat patients. We can observe in vivo physiopathological alterations and study the effects of therapies aiming to fix these alterations
The microcirculation is the motor of sepsis
Full text linkRegional tissue distress caused by microcirculatory dysfunction and mitochondrial depression underlies the condition in sepsis and shock where, despite correction of systemic oxygen delivery variables, regional hypoxia and oxygen extraction deficit persist. We have termed this condition microcirculatory and mitochondrial distress syndrome (MIMIDS). Orthogonal polarization spectral imaging allowed the first clinical observation of the microcirculation in human internal organs, and has identified the pivotal role of microcirculatory abnormalities in defining the severity of sepsis, a condition not revealed by systemic hemodynamic or oxygen-derived variables. Recently, sublingual sidestream dark-field (SDF) imaging has been introduced, allowing observation of the microcirculation in even greater detail. Microcirculatory recruitment is needed to ensure adequate microcirculatory perfusion and the oxygenation of tissue cells that follows. In sepsis, where inflammation-induced autoregulatory dysfunction persists and oxygen need is not matched by supply, the microcirculation can be recruited by reducing pathological shunting, promoting microcirculatory perfusion, supporting pump function, and controlling hemorheology and coagulation. Resuscitation following MMDS must include focused recruitment of hypoxic-shunted microcirculatory units and/or resuscitation of the mitochondria. A combination of agents is required for successful rescue of the microcirculation. Single compounds such as activated protein C, which acts on multiple pathways, can be expected to be beneficial in rescuing the microcirculation in sepsi
To beta block or not to beta block; that is the question
Full text linkThe fast-acting β-1 blocker esmolol has been the center of attention since the landmark article by Morrelli and colleagues suggesting that, in patients with sepsis, reducing heart rate by administering esmolol can result in a survival benefit. However, the use of esmolol for the treatment of sepsis and the underlying mechanism responsible for this benefit remain controversial. This commentary discusses the study by Jacquet-Lagrèze and colleagues, who in a pig model of sepsis tested the hypothesis that administration of esmolol to reduce heart rate may correct sepsis-induced sublingual and gut microcirculatory alterations which are known to be associated with adverse outcome
İnce filmlerin otiksel özelliklerinin tespitinde prizma çiftlenimi
No full textBu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır.ÖZET Anahtar Kelimeler: Dalga Kılavuzu, Prizma Çiftlenimi, İnce Film, Polimer, Lineer Optik. Kristal büyütmenin zor ve pahalı olması, optik uygulamalarda kristal yerine kullanılabilecek yeni malzemelerin araştırılmasına yol açtı. 1980'ler de polimerik maddelerin lineer optiksel ve nonlineer optiksel uygulamalarda kullanılabileceği tesbit edildi.Polimerler saydam olmaları, ucuz olmaları, seri üretilebilmeleri (ince film formunda), geniş bant aralığına sahip olmaları, yüksek termal kararlılıkta bulunmaları (300°C), düşük di elektrik katsayısına ve büyük nonlineer katsayısına sahip olmaları ile inorganik kristallerden daha avantajlı duruma gelmiştir. Optik devre elemanları ince film katmanları şeklide hazırlanabilir. Uygulamada ince film aygıtlarının kristal aygıtlarından olan üstünlüğü: ince film aygıtlarının çok küçük yapılabilmeleri, ince filmin tüm elemanları yüzeye yayıldığından ölçüm açısından yüzeyin rahatlıkla incelenebilmesidir. İnce film kalınlıkların optik dalga boyu ile kıyaslanabilir olması, ışık enerjisinin büyük bir kısmının film içine hapsolmasını ve dolayısıyla film içindeki ışık şiddetinin bir lazer gücü seviyesinden çok daha büyük olmasıdır. Bu nonlineer etkilerin gözlenmesi açısından önemlidir. Işık film içerisine bir kaç teknik ile kılavuzlanabilir. Bunların içinde en verimli olanı prizma çiftlenimi tekniğidir. Bu teknikte ışığın film içinde kılavuzlarıma verimliliği % 81 dir[l]. Bu teknikle ince filmlerin kırılma indisleri, kalınlıkları ve hatta kayıp (loos) miktarları tespit edilebilir.Prizm Coupling Technique In Characterization Of Optical Properties Of Thin Films Keywords: Wave Guiding, Prizm Coupling, Thin Film, Polymers, Linear Optic Crystal growth is an expensive and time consuming process. These problems lead to search for new materials. In the 1980's it has been found that polymeric materials can be used for linear and nonlinear optical applications. Polymers have some characteristics which make them superior to inorganic crystals. These are ease of fabrication, 'suitability for inexpensive mass production, chemically-tailored control of their physical and optical properties, low relative permittivity, high termal stability (as high as 300 °C), wide bandwidth and large nonlinearities. Polymeric materials can be formed in thin film layers. In technological applications thin film forms have the advantage of being used for making small devices and because all the elements of the thin films are exposed on the surface they easily accessible for probing measurement or modification. Since film thicknesses comperable with light wavelangth, when the light confined into film laser power within the film gets very high. High laser power is important for nonlinear optical effects. Light can be guided into film with two or three different techniques. Within these techniques the prism coupling is one of the best technique from coupling efficiency point of wiev. The coupling efficiency in this technique is 81%[1]. By using this technique refractive index, thickness of the films can be measured. In this study a prism-coupling experimental set up is established
Generalized Ince Gaussian beams
Full text linkIn this work we present a detailed analysis of the tree families of generalized Gaussian beams, which are the generalized Hermite, Laguerre, and Ince Gaussian beams. The generalized Gaussian beams are not the solution of a Hermitian operator at an arbitrary z plane. We derived the adjoint operator and the adjoint eigenfunctions. Each family of generalized Gaussian beams forms a complete biorthonormal set with their adjoint eigenfunctions, therefore, any paraxial field can be described as a superposition of a generalized family with the appropriate weighting and phase factors. Each family of generalized Gaussian beams includes the standard and elegant corresponding families as particular cases when the parameters of the generalized families are chosen properly. The generalized Hermite Gaussian and Laguerre Gaussian beams correspond to limiting cases of the generalized Ince Gaussian beams when the ellipticity parameter of the latter tends to infinity or to zero, respectively. The expansion formulas among the three generalized families and their Fourier transforms are also presented
Sustainability and Techno-Economic Assessment of Batch and Flow Chemistry in Seven Industrial Pharmaceutical Processes
Full text linkThe synthesis of active pharmaceutical ingredients (APIs) is commonly perceived as more efficient when performed using continuous-flow methods, whereas batch processes are often seen as less favorable due to their limitations in yield, heat and mass transfer, and safety. This perception largely stems from existing studies that focus on green metrics such as the E-factor and yield. However, a comprehensive comparison of batch and flow processes through full techno-economic analyses (TEA) and life-cycle assessments (LCA) remains underexplored, leaving key aspects of their environmental and economic impacts inadequately assessed. This work addresses this gap by presenting a detailed comparison of batch and flow syntheses of seven industrially relevant APIs, including amitriptyline hydrochloride, tamoxifen, zolpidem, rufinamide, artesunate, ibuprofen, and phenibut. Eleven environmental impact categories within the framework of nine planetary boundaries were assessed, and the study also included an evaluation of capital and operating costs for both production methods. The results demonstrated that, on average, continuous-flow processes are significantly more sustainable with improvements in energy efficiency, water consumption, and waste reduction. Flow processes also show a marked reduction in carbon emissions and up to a 97% reduction in energy consumption, highlighting their potential for greener API manufacturing. Despite these advantages, the study identified areas where the continuous-flow technology requires further development. Specifically, manufacturing certain APIs in flow show lower-than-average improvements in operating expenditure and land system changes, the latter being directly correlated with the consumption of organic solvents, that can be comparable to or even higher than in batch. These challenges highlight the need for further optimization of flow processes to fully realize their potential in API production
- …
