Hospital Socor

To evaluate the efficiency of the Zetapalatopharyngoplasty (ZPFP) technique for Obstructive Sleep Apnea (OSA). This retrospective study included 36 adult patients treated with ZPFP between 2012 and 2023. Clinical, polysomnographic data, and subjective assessments using the Epworth Sleepiness Scale (ESS) and the Sleep Apnea Quality of Life Index (SAQLI) were analyzed. Surgical success was defined as a ≥50% reduction in the Apnea-Hypopnea Index (AHI) or a postoperative AHI <20. The mean follow-up duration was approximately 40-months. The mean AHI decreased from 34.22 to 19.28 events/hour (p = 0.009), while desaturation time dropped from 51.09 to 17.71 min (p < 0.001). ESS scores improved from 12.36 to 6.25 (p = 0.002), indicating reduced daytime sleepiness. According to the SAQLI, 97% of patients experienced moderate to significant improvements in quality of life. Early complications included tonsillar bleeding (2.8%) and dysphagia (5.6%), while late complications involved pharyngeal reflux (8.3%) and voice changes (8.3%). Nosevere adverse events occurred. ZPFP demonstrated favorable clinical and polysomnographic outcomes, offering a safe and effective surgical alternative for CPAP-intolerant OSA patients. Future prospective studies should assess its long-term effectiveness in reducing cardiovascular risks associated with untreated OSA.

Eles chegaram por último e com eles vieram, por curiosidade, alguns oficiais cristãos, que vieram ouvir o canto dramático e divino do Kol Nidrei. Os chefes de família mal se importavam com essa multidão heterogênea. Os fiéis das últimas fileiras, artesãos e carregadores, no entanto, ficaram encantados:

1. Introduction After the publication of the results from the Women’s Health Initiative (WHI) clinical trial in 2002 showing more risks than benefits to female health with estrogen (alone or combined with progestin) use to control menopausal signs and symptoms, there has been a progressive and sustained decline in the prescription of those drugs.– In […]

ResumenLa agenda 2030 de la Asamblea General de Naciones Unidas (AGNU) propone el logro de condiciones de trabajo decente de todo trabajador en el mundo.El objetivo de esta investigacin es caracterizar el trabajo decente (TD) desde la perspectiva de los directivos de las micro y pequeas empresas en Altepexi, Ajalpan, Santiago Miahuatln y Tehuacn, Puebla, Mxico.La hiptesis es que existen diferencias significativas en la percepcin del TD dependiendo del giro de la empresa y del nivel educativo del directivo.Se llev a cabo un estudio cuantitativo con una muestra de 542 directivos, a quienes se les aplic la escala de trabajo decente para empresarios (TDE).Los resultados indican que los directivos tienen una percepcin regular del TD sin diferencias significativas por giro o nivel educativo, lo que sugiere la homogeneidad en la percepcin de los sujetos y la necesidad de estrategias generales para mejorar la percepcin de los sujetos respecto de cada dimensin.

Introduction: Rheumatic Heart Disease (RHD) is determined by a complex interaction between socioeconomic environment and host susceptibility. Relatives of patients with advanced RHD share both, and may be at high-risk. We aimed to use echocardiographic (echo) family screening to evaluate the risk of RHD among 1 st degree relatives of patients with advanced RHD. Methods: From Feb 2020 - Jun 2021 patients with advanced RHD were consecutively enrolled in the University Hospital’s outpatient clinics. Consented 1 st degree relatives were invited for echo screening (2012 World Heart Federation Criteria) utilizing handheld devices (GE VSCAN) by non-physicians, with telemedicine interpretation by 2 experts. Matched controls (spouses, neighbors) living in the same household were also enrolled in a 1:5 fashion. A confirmatory full echo (GE Vivid IQ) was scheduled if abnormalities were observed, and all positive RHD cases were referred for follow-up. Results: In 16 months, 202 relatives and 42 controls of 117 patients were screened, including 114 children, 68 siblings and 20 parents. Mean age was 41±18 years, 62% were women and 214 (88%) lived with the index case for &gt;10 years. At total 51 (21%) individuals had hypertension, 17 (7%) diabetes, 5 reported a previous stroke and only 5 (all relatives) had personal history of RHD. Among index cases, 73% reported current or past prescription of Penicillin. Echo findings suggestive of RHD were observed in 0 controls and 14 (7%) relatives (p=0.08), being 11 with mitral valve (MV) disease and 3 with mixed (mitral and aortic valve (AV)) disease. Eleven patients had mild/moderate MV regurgitation, 4 with associated MV stenosis and abnormal morphology. Two patients had mild AV regurgitation and abnormal AV morphology, associated with mild AV and MV stenosis, and 1 patient had bioprostheses in the MV and AV. One case of mild left ventricular dysfunction was observed, and 1 patient had indication of commissurotomy for MV stenosis at the time of diagnosis. Conclusions: First-degree relatives of individuals with clinical RHD are at greater risk of having RHD and family screening should be considered. Genotyping studies are warranted to better understand individual and family susceptibility to RHD, in addition to socioeconomic conditions.

We introduce SPARTA, a novel neural retrieval method that shows great promise in performance, generalization, and interpretability for open-domain question answering. Unlike many neural ranking methods that use dense vector nearest neighbor search, SPARTA learns a sparse representation that can be efficiently implemented as an Inverted Index. The resulting representation enables scalable neural retrieval that does not require expensive approximate vector search and leads to better performance than its dense counterpart. We validated our approaches on 4 open-domain question answering (OpenQA) tasks and 11 retrieval question answering (ReQA) tasks. SPARTA achieves new state-of-the-art results across a variety of open-domain question answering tasks in both English and Chinese datasets, including open SQuAD, CMRC and etc. Analysis also confirms that the proposed method creates human interpretable representation and allows flexible control over the trade-off between performance and efficiency.

Cardiovascular complications have been increasingly detected in patients with sickle cell disease (SCD). Two-dimensional speckle-tracking echocardiography (STE) detects early myocardial changes in a number of pathophysiological processes, which may be useful in SCD. This study was designed to examine the value of STE in predicting clinical outcome in adult patients with SCD. A total of 219 patients, mean age 33 ± 12years were prospectively enrolled. Several clinical, laboratory and echocardiographic variables including left ventricular global longitudinal strain (LVGLS) by STE were assessed. The endpoint was a composite of the following events: (1) all-cause mortality, (2) three or more acute painful episodes that require hospitalization in one year, (3) acute chest syndrome and (4) hospitalization due to disease complication. The majority of the patients had enlargement of LV and left atrial (LA) with preserved ejection fraction. During the mean follow-up of 30months, 69 patients (32%) had reached the endpoint, including eight deaths (3.7%). No difference was observed in the parameters of diastolic function comparing the patients with and without events. LVGLS ranged from - 12.25 to - 25.44 (mean - 20.26 ± 2.5), with higher values in the patients who had events compared with those who did not. In the multivariable analysis, higher LVGLS values were associated with adverse events (adjusted OR 1.25; 95% CI 1.04-1.51; p = 0.021), independently of the TR maximal velocity and LV ejection fraction. In patients with SCD, higher LV global longitudinal strain was a predictor of adverse outcome, independently of age, TR velocity and LV function.

Gonadotropin-releasing hormone analogues (GnRH-a) have been used preoperatively before hysteroscopic myomectomy to decrease the size and vascularization of the myomas, but evidence to support this practice is weak. Our objective was to analyze the use of GnRH-a in the reduction of submucous fibroid as a facilitator for surgical hysteroscopy from published clinical trials. Studies from electronic databases (Pubmed, Scielo, EMBASE, Scopus, PROSPERO), published between 1980 and December 2018. The keywords used were fibroid, GnRH analogue, submucous, histeroscopy, histeroscopic resection and their correspondents in Portuguese. The inclusion criteria were controlled trials that evaluated the GnRH-a treatment before hysteroscopic resection of submucous myomas. Four clinical trials were included in the meta-analysis. Two review authors extracted the data without modification of the original data, using the agreed form. We resolved discrepancies through discussion or, if required, we consulted a third person. The present meta-analysis included a total of 213 women and showed no statistically significant differences in the use of GnRH-a compared with the control group for complete resection of submucous myoma (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.80-1.11); operative time (mean difference [MD]: - 3.81; 95%CI : - 3.81-2.13); fluid absorption (MD: - 65.90; 95%CI: - 9.75-2.13); or complications (RR 0.92; 95%CI: 0.18-4.82). The present review did not support the routine preoperative use of GnRH-a prior to hysteroscopic myomectomy. However, it is not possible to determine its inferiority when compared with the other methods due to the heterogeneity of existing studies and the small sample size.