Sarcoidosis presenting as granulomatous myositis in a 16-year-old adolescent

BACKGROUND: Sarcoidosis is a multi-system disease characterized by the presence of non-caseating epithelioid granulomas in affected tissues, including skeletal muscle. These organized collections of immune cells have important pathophysiologic action including cytokine production leading to inflammation as well as enzymatic conversion of cholecalciferol to calcitriol via 1-α hydroxylase. There are limited reports of isolated granulomatous myositis causing hypercalcemia in pediatric patients. Our patient uniquely presented with symptoms from hypercalcemia and renal insufficiency caused by an overwhelming burden of granulomatous myositis in her lower extremities, but was otherwise asymptomatic. CASE PRESENTATION: A 16 year old Caucasian female presented with protracted symptoms of fatigue, nausea and prominent weight loss with laboratory evidence of hypercalcemia and renal insufficiency. She lacked clinical and physical findings of arthritis, weakness, rash, uveitis, fever, lymphadenopathy or respiratory symptoms. After extensive negative investigations, re-examination yielded subtle soft tissue changes in her lower extremities, with striking MRI findings of extensive myositis without correlative weakness or serum enzyme elevation. Biopsy showed the presence of non-caseating epithelioid granulomas and calcium oxalate crystals. The patient responded well to prednisone and methotrexate but relapsed with weaning of steroids. She reachieved remission with addition of adalimumab. CONCLUSIONS: Sarcoidosis should be considered in patients presenting with symptomatic hypercalcemia with no apparent causes and negative routine workup. The absences of decreased muscle strength or elevated muscle enzymes do not preclude the diagnosis of granulomatous myositis

Clinical phenotypes and biologic treatment use in juvenile dermatomyositis-associated calcinosis

Abstract Background Few risk factors have been identified for the development of calcinosis among patients with Juvenile Dermatomyositis, and currently no clinical phenotype has been associated with its development. We analyzed a large database of patients to further elucidate any relationships among patients with and without calcinosis. Method The CARRA legacy registry recruited pediatric rheumatology patients from 55 centers across North America from 2010 through 2014, including over 650 subjects with Juvenile Dermatomyositis. We compared the demographic characteristics, clinical disease features and treatment histories of those with and without calcinosis using univariate and multivariate logistic regression. Results Of the 631 patients included in the analysis, 84 (13%) had a current or prior history of calcinosis. These patients were statistically more likely to have longer durations of disease prior to diagnosis and treatment, have lipodystrophy and joint contractures, and to have received intravenous immune globulin or rituximab as treatments. Conclusions Calcinosis is found more often in patients with prolonged active disease, severe disease, and certain clinical features such as lipodystrophy and joint contractures. When these factors are combined with other known associations and predictors, groups of at-risk patients can be more effectively identified, treated and studied to improve overall outcomes

Loss of Pediatric Kidney Grafts During the “High–Risk Age Window”: Insights From Pediatric Liver and Simultaneous Liver–Kidney Recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110551/1/ajt12985.pd

Time‐Trends in Publication Productivity of Young Transplant Surgeons in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90090/1/j.1600-6143.2011.03878.x.pd

ASUHAN KEBIDANAN PADA PRIMIPARA INTRAPARTAL KALA I DENGAN PERPANJANGAN FASE AKTIF DI RUANG BERSALIN RSUD PROF. DR. W. Z. JOHANNES KUPANG TANGGAL 01 - 13 FEBRUARI 2016.

Latar Belakang: Kematian pada ibu disebabkan oleh komplikasi obstetrik yang sering tidak dapat diramalkan pada saat kehamilan maupun persalinan dan kebanyakan komplikasi ini terjadi pada saat atau sekitar persalinan, salah satunya yaitu persalinan lama. Persalinan lama merupakan satu keadaan yang perlu diwaspadai dan perlu penanganan serta observasi yang ketat. Pada persalinan primipara persalinan lama berlangsung lebih dari 12jam, dan multipara lebih dari 6 jam. Penanganan dan observasi yang tidak sesuai dapat menngkatkan angka kematian ibu bersalin dengan penyebab kala I lama. Tujuan:Melaksanakan asuhan kebidanan pada primipara intrapartal dengan perpanjangan fase aktif dengan menggunakan pendekatan manajemen kebidanan. Pembahasan:Berdasarkan asuhan yang dilakukan yang dimulai dengan pengumpulan data yaitu data subyektif dan obyektif, menginterpretasikan data, menentukan masalah potensial yang terjadi, menentukan tindakan segera yang dilakukan untuk mencegah terjadinya masalah potensial, membuat perencanaan berdasarkan kebutuhan yaitu ibu inpartu dengan perpanjangan fase aktif,perencanaan meliputi pemberian induksi oksitosin, tindakan asuhan sayang ibu, mengajarkan ibu teknik relaksasi, melakukan pertolongan persalinan, mengevaluasi dan mengikuti perkembangan ibu selama pemberian asuhan. Berdasarkan teori yang dijelaskan dalam tinjauan teori dan asuhan yang dilaksanakan dalam tinjauan kasus tidak terdapat kesenjangan. Simpulan:Pada tanggal 08 Februari 2016 dilakukan asuhan kebidanan pada ibu G1P0A0AH0, inpartu kala I dengan perpanjangan fase aktif di Ruang Bersalin RSUD Prof. Dr. W.Z.Johannes Kupang. Tindakan yang dilakukan ialah pemberian cairan RL 500 ml dan drip oksitosin 5 IU dimulai dengan 8 tetes/menit dan diobservasi setiap 15 menit sampai pembukaan lengkap

O processo de decisão na gestão de recursos hídricos: a contribuição da Internet das Coisas (IOT) e Big Data

Due to the scarcity of water and the concern about its existence in the future, there is a need to improve the management and decision support systems so that water will not run out. When it comes to decision-making, there is no way to conceive of it without the use of Information and Communication Technologies (ICT). In addition to the existing ones, two emerging ICT seem to be useful in this process, the Internet of Things (IoT) and Big Data. Thus, this work aims to verify how the use of Information and Communication Technologies, especially IoT and Big Data, can help the decision-making process in the management of water resources in river basins. The present study is characterized as an exploratory, qualitative, and prescriptive research. As a result, it is intended to relate these concepts and present how ICT can help in the management of water resources in river basins.Devido à escassez de água e da preocupação com a sua existência no futuro, há necessidade de aprimorar os sistemas de gestão e de apoio à decisão para que a água não venha faltar. Quando se fala em processo decisório, não há como concebê-lo sem o uso de Tecnologias da Informação e Comunicação (TIC). Além das existentes, duas TIC emergentes parecem ser úteis nesse processo, a Internet das Coisas (IoT) e o Big Data. Assim, esse trabalho tem como objetivo verificar como o uso de Tecnologias da Informação e Comunicação, principalmente IoT e Big Data, podem auxiliar o processo decisório na gestão dos recursos hídricos em bacias hidrográficas. O presente estudo caracteriza-se como uma pesquisa exploratória, de caráter qualitativa e prescritiva. Como resultado, pretende-se relacionar esses conceitos e apresentar como as TIC podem auxiliar na gestão dos recursos hídricos em bacias hidrográficas

SUSTENTABILIDADE EM CONDOMÍNIOS RESIDENCIAIS VERTICAIS : Um estudo na região metropolitana de Campinas

Sustainability is a concept that involves three dimensions: environmental, economic and social. In this sense, sustainability should be a concern of vertical residential condominiums, since the large number of urban buildings can negatively impact the environment and people's quality of life. In order to contribute to this theme this work was created. Thus, the work aims to verify and characterize, under the environmental, economic and social dimensions of sustainability, the occurrence of sustainable practices in vertical residential condominiums within the limits of the Metropolitan Region of Campinas. The research method adopted was exploratory research, of a qualitative and quantitative approach, whose data collection was carried out from a field research. In general, the results obtained suggest that the residential condominiums analyzed place a greater emphasis on the economic dimension and less on the social and environmental dimensions.A sustentabilidade é um conceito que envolve três dimensões: a ambiental, a econômica e a social. Nesse sentido, a sustentabilidade deve ser uma preocupação dos condomínios residenciais verticais, uma vez que podem impactar negativamente o meio ambiente e a qualidade de vida das pessoas. No intuito de contribuir com esse tema é que este trabalho foi realizado. Dessa forma, o trabalho tem como objetivo verificar e caracterizar, sob as dimensões ambiental, econômica e social da sustentabilidade, a ocorrência de práticas sustentáveis em condomínios residenciais verticais da Região Metropolitana de Campinas. O método de pesquisa adotado foi a pesquisa exploratória, de natureza quali-quatitativa, cuja coleta de dados foi realizada a partir de uma pesquisa de campo. De modo geral, os resultados obtidos sugerem que os condomínios residenciais analisados colocam ênfase maior para a dimensão econômica e menor para as dimensões social e ambiental

Can Underlying Co-Morbidities Affect Cerebral Oximetry in Cardiac Surgery Patients?

Today, there is a growing number of monitoring Equipment accessible. These equipments ranging invasive to non-invasive. Choosing suitable monitoring methods depends on their benefits, drawbacks, and expenses. Overall, non-invasive brain monitoring is growing in importance because of its precision in performance and increased stability in output. Like the assessment of regional brain oxygen levels and the assessment of anesthesia depth using the BIS device, whose specific role in guidelines remains undefined. Many patients who undergo heart surgeries including valvular, dissection and CABG have various comorbidities. To add details, according to literatures about CVA 28% of patients had (Cerebrovascular Accident), 74% IHD (Ischemic Heart Disease), 82% HTN (Hypertension), 52% DM (Diabetes Mellitus), 61% Smoking History, 36% CKD (Chronic Kidney Disease) and 42% CHF (Congestive Heart Failure). Current study delves into the correlation of short-term complications after cardiac operations with cerebral oximetry alterations and the space under the curve (duration of rSo2 drop) to take the best advantages of cerebral oximetry for heart surgery in the future. This prospective observational study was conducted among 101 patients undergoing cardiac surgery at Imam Khomeini Hospital in Tehran between 2019 and 2020. Following admission to the operating room, standard monitoring of vital signs, including non-invasive blood pressure (NIBP), electrocardiogram (ECG), central venous pressure (CVP), oxygen saturation (SpO2), and end-tidal carbon dioxide (ETCO2), was established. Prior to anesthesia induction, cerebral oxygen saturation (rSO2) was continuously monitored using the INVOS 5100c cerebral oximeter. Patients were followed for 7 days postoperatively, with documentation of intubation duration, intensive care unit (ICU) stay, and complications such as renal failure, cerebrovascular accident (CVA), and mortality. Data analysis was performed using SPSS 25.0 statistical software, with a P of less than 0.05 considered statistically significant. This study investigated rSO2 levels, as measured by a cerebral oximeter, in patients aged 19 to 79 undergoing cardiac surgery. Data were collected from both the right and left sides of the forehead during the operative period. Overall, these findings highlight the importance of rSO2 monitoring during cardiac surgery, particularly in patients with underlying cardiovascular conditions. Further research is needed to elucidate the specific mechanisms underlying these observations and to explore potential strategies for optimizing cerebral oxygenation in this vulnerable patient population

Corporate Strategic Management: A Proposal for the Use of Sustainability Performance Indicators

A sustentação do tema é uma das principais organizações, uma vez que a saúde é sustentável e alinhada com os indicadores sociais e ambientais para melhorar a imagem corporativa e a melhor vantagem competitiva. Por meio de componentes de Planejamento Estratégico de Negócios, contamos com as ferramentas de gerenciamento do Balanced Scorecard, é possível realizar as práticas do ambiente de produção com a implementação de metas e objetivos estratégicos, porém essa integração ainda não é traduzida como real meio ambiente e contraído pela atividade central da empresa dentro da perspectiva da sustentabilidade.Portanto, este estudo é baseado em uma estratégia de gestão baseada no Balanced Scorecard, que também considera os indicadores de desempenho de sustentabilidade, dentro da economia, dimensões sociais e ambientais, a fim de permitir que os gestores se desenvolvam e sigam a organização Planejamento Estratégico de Negócios e Gestão estática está funcionando no nível operacional de sustentabilidade desejável. Como metodologia, o estudo baseou-se em uma pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório.o estudo baseou-se em pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório. o estudo baseou-se em pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório