Texas State Technical College Harlingen

Muestro casos de muda atípica en las primarias del halcón Parabuteo unicinctus harrisi. La muda de las primarias en rapaces accipítridos procede típicamente de manera secuencial, una pluma a la vez a partir de la primaria interna, P1, hacia la primaria externa, P10. En las especies más grandes, no todas las primarias son reemplazadas anualmente, lo que resulta en una Staffelmauser (muda “por etapas” o “relevos”). Del 2002 al 2022, capturé 545 halcones de Harris en el sur de Texas, ya sea que estaban durante o al final de su tercera muda prebásica o de más edad, que estén realizando la segunda muda prebásica o que estén en el plumaje básico II. Aquí reporto 6 instancias en las que 1 o más primarias fueron saltadas o reemplazadas en desorden durante la muda anual en halcones de Harris: 5 durante la segunda muda prebásica y 1 durante la tercera muda prebásica. Encontré 1 reporte publicado de primarias saltadas en buitres Gyps fulvus y otro en cigüeñas Ciconia ciconia. Una posible causa de esto serían folículos primarios dañados. Palabras clave: muda primaria desordenada, salto de muda primaria.

ABSTRACT Acute pulmonary embolism (PE) is a frequent cause of hypoxemic respiratory failure and presentation to the emergency department. The incidence is on the increase since the COVID-19 outbreak. While COVID infection represents a prothrombotic state, the introduction of COVID vaccines to a lesser extent increased the risk of unprovoked venous thrombus formation and risk of pulmonary embolism. PE is mostly associated with deep vein thrombosis (DVT) and only a few cases of isolated or De novo PE exist in literature. We report two cases of isolated PE associated with COVID-19 vaccinations. We aimed to highlight the need to suspect isolated PE in patients presenting with hypoxemic respiratory failure days to several weeks following COVID-19 vaccination and emphasize the importance of post-discharge follow-up for evaluating chronic thromboembolic pulmonary hypertension (CTEPH).

Introduction: Successful and fast reperfusion with endovascular thrombectomy (EVT) improves outcomes in acute ischemic strokes due to large vessel occlusion (LVO). While complete reperfusion (mTICI 3) is the ideal target, multiple passes could prolong EVT and increase complications likelihood without improving clinical outcomes. We hypothesized that pts with a single pass mTICI2b would have similar good outcomes to those with multiple passes mTICI3 with a better safety profile. Methods: From the prospective multicenter cohort study of imaging selection (SELECT), EVT pts who achieved mTICI2b and mTICI3 were stratified into those with single pass vs multiple passes. Functional independence rates at 90 day mRS and safety (sICH, neuro-worsening and mortality) were compared between pts with single pass mTICI 2b and multiple passes mTICI 3. Results: Of 361 pts enrolled, 285 received EVT, of those 70 (25%) achieved mTICI 2b and 159 (56%) mTICI 3. 89 (31%) achieved mTICI 3 with single pass, 70 (25%) with multiple passes, 33 (12%) had mTICI 2b with a single pass and 37 (13%) with multiple passes. Baseline characteristics were similar between the two groups except for larger perfusion deficit (Tmax >6s) volume in pts with multiple passes mTICI3 55 (25, 99) cc vs first pass mTICI 2b 43 (4, 79), p=0.047). Functional independence rates were higher with single pass mTICI 2b as compared to multiple passes mTICI 3 (70% vs 56%, aOR=1.51, 95% CI=0.48-4.76, p=0.78), fig 1 but did not reach statistical significance. Multiple passes mTICI 3 was associated with numerically higher mortality (13% vs 3%, p=0.16) and Neuro-worsening (13% vs 3%, p=0.16) with similar sICH: 4% vs 3%, p=1.00 rates. Conclusion: Complete reperfusion with multiple passes did not confer better outcome rates than single pass mTICI 2b and was associated with worse safety profiles. These results suggest that in the absence of complete reperfusion on first attempt, a single pass mTICI 2b may be sufficient for a successful thrombectomy.

Background: The degree to which the COVID-19 pandemic has affected systems of care, in particular those for time-sensitive conditions such as stroke, remains poorly quantified. We sought to evaluate the impact of COVID-19 in the overall screening for acute stroke utilizing a commercial clinical artificial intelligence (AI) platform. Methods: Data were derived from the Viz Platform, an AI application designed to optimize the workflow of acute stroke patients. Neuroimaging data on suspected stroke patients across 97 hospitals in 20 US states were collected in real-time and retrospectively analyzed with the number of patients undergoing imaging screening serving as a surrogate for the amount of stroke care. The main outcome measures were the number of CTA, CTP, Large vessel occlusions (LVOs) (defined according to the automated software detection), and severe strokes on CTP (defined as those with hypoperfusion volumes>70mL) normalized as number of patients per day per hospital. Data from the pre-pandemic (November 4, 2019 to February 29, 2020) and pandemic (March 1 to May 10, 2020) periods were compared at national and state levels. Correlations were made between the inter-period changes in imaging screening, stroke hospitalizations, and thrombectomy procedures using state-specific sampling. Results: A total of 23,223 patients were included. The incidence of LVO on CTA and severe strokes on CTP were 11.2%(n=2,602) and 14.7%(n=1,229/8,328), respectively. There were significant declines in the overall number of CTAs (-22.8%;1.39 to 1.07 patients/day/hospital,p<0.001) and CTPs (-26.1%;0.50 to 0.37 patients/day/hospital,p<0.001) as well as in the incidence of LVO (-17.1%;0.15 to 0.13 patients/day/hospital,p<0.001) and severe strokes on CTP (-16.7%;0.12 to 0.10 patients/day/hospital, p<0.005). The sampled cohort showed similar declines in the rates of LVOs versus thrombectomy (18.8%vs.19.5%, p=0.9) and CSC hospitalizations (18.8%vs.11.0%, p=0.4). Conclusions: A significant decline in stroke imaging screening has occurred during the COVID-19 pandemic. This underscores the broader application of AI neuroimaging platforms for the real-time monitoring of stroke systems of care.

INTRODUCTION: Cardiorenal syndrome encompasses a bidirectional interaction between heart failure and kidney disease, in which dysfunction of the heart or kidneys can induce dysfunction in the other. CRS presumably occurs due to an inability of the failing heart to sufficiently generate forward flow, leading to prerenal hypoperfusion of the kidneys. We present a case of presumed cardiorenal syndrome with subsequent hypoxic hepatitis complicated by rhabdomyolysis. CASE DESCRIPTION/METHODS: Our patient was a 71-year-old male with numerous medical comorbidities including HFrEF, chronic kidney disease (CKD), chronic alcohol use, and a recent history of abdominal aortic aneurysm repair. He initially presented with symptoms of shortness of breath, dry cough, and abdominal pain that progressively worsened. Upon admission, the patient's laboratory and imaging findings supported a diagnosis of acute on chronic congestive heart failure (CHF) exacerbation. He was started on furosemide and carvedilol. Elevated creatinine and creatine kinase (CK) revealed acute renal injury secondary to rhabdomyolysis. He was given a fluid bolus and started on low rate maintenance fluid due to CHF and CKD. Two days later, repeat CMP showed worsening CK levels. Fluids were increased with adjunctive milrinone therapy. Repeat liver enzymes showed worsening liver; fluid resuscitation was discontinued due to volume overload concerns. Days later shortness of breath improved, and liver and renal enzymes stabilized. Milrinone was discontinued. The patient’s course was complicated due to hospital-acquired pneumonia which worsened his liver hypoxia. Eventually the patient died from multi-organ failure. DISCUSSION: Our patient fits criteria for cardiohepatorenal syndrome (CHRS). The cause for liver shock was likely multifactorial. This case reveals the challenge regarding treatment in patients with CHRS. Fluid administration for rhabdomyolysis is recommended, however our patient was unable to tolerate due to CHF fluid overload. The only established treatment for hypoxic hepatitis involves treating the underlying disease state. Inotropic agents improve cardiac contractility, renal perfusion and preserve liver microcirculation and oxygenation. However, in our CHF patient, chronic use of milrinone was contraindicated due to ischemia and arrhythmia concerns. Establishing a better treatment paradigm for patients with cardiorenal syndrome, particularly when complicated by hypoxic hepatitis and rhabdomyolysis, is important.

The authors administered Spanish versions of 2 measures of subjective well‐being to Latinx college students. Results of a confirmatory factor analysis support the reliability and validity of the Satisfaction With Life and Subjective Happiness scales. Psychometric properties and implications for humanistic counselors are discussed.

To determine whether we are wasting too much time between noncontrast CT (NCT) imaging completion and CTP completion and the effect it has on clinical outcomes.