Thalassemia and Venous Thromboembolism

Although the life expectancy of thalassemia patients has markedly improved over the last few decades, patients still suffer from many complications of this congenital disease. The presence of a high incidence of thromboembolic events, mainly in thalassemia intermedia, has led to the identification of a hypercoagulable state in these patients. In this review, the molecular and cellular mechanisms leading to hypercoagulability in thalassemia are highlighted, with a special focus on thalassemia intermedia being the group with the highest incidence of thrombotic events as compared to other types of thalassemia. Clinical experience and available clues on optimal management are also discussed

Antithrombotic Prophylaxis in the Middle East

Several factors have been proposed to explain the persistence of a high incidence of venous thromboembolism worldwide with its associated morbidity and mortality. Underutilization of anticoagulants and failure of adherence to thromboprophylaxis guidelines are emerging global health concerns. We herein review this alarming observation with special emphasis on the Middle East region. We also discuss strategies that could help control this increasingly reported problem

Digital Transformation Strategy Framework

This chapter presents the construction of a Strategic Digital Transformation operational framework, necessary and adaptable to any type of company and sector of activity. Therefore, the strategic framework suggested includes the patterns, actions, approaches and several measures as follows: a pattern for preparing Internal Training Plan adapted to Digital Strategy, a Tool for diagnosing the level of digital maturity and a Scorecard tool for the assessment and actions associated with the scope of the optimum degree of digital maturity), a Digital Transformation Strategic Framework (elements and phases), a Digital Transformation Strategy Plan (phases and actions) and a Digital Transformation Strategy’s Balance Scorecard.2019-2

O ensino de BIM no Brasil: onde estamos?

A modelagem da Informação da Construção (Building Information Modeling - BIM) envolve um conjunto interrelacionado de políticas, processos e tecnologias para gerenciar a essência do projeto, construção e operação de edifícios no formato digital em todo o ciclo de vida da edificação. Entender BIM apenas como tecnologia é uma distorção advinda de uma simplificação extrema do paradigma. Dessa forma, a abordagem de BIM no ensino deve ir além da capacitação instrumental contida nas disciplinas de informática aplicada. Este artigo apresenta um diagnóstico de experiências brasileiras e internacionais de ensino de BIM, o que permite avaliar a abrangência dos esforços de ensino adotados até o presente no Brasil, neste contexto. Este diagnóstico se dá por meio de revisão bibliográfica sobre relatos de experiência de ensino de BIM, discussão em workshop e experimentação no ensino. Classificam-se as experiências avaliadas identificando-se os estágios de adoção de BIM e os níveis de competência por elas fomentados. Ao utilizar uma mesma classificação aplicada no estudo do cenário internacional para as experiências nacionais, foi possível balizar o nível de desenvolvimento do ensino de BIM no Brasil. Discute-se, à luz das experiências apresentadas, o quão abrangente deve ser a formação em BIM e a quais estágios de adoção de BIM essas experiências de ensino conduzem. Modelos de inspiração que possam contribuir com o cenário brasileiro de adoção do BIM são apresentados, extraídos de boas experiências estrangeiras

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Well Integrity in Heavy Oil Wells: Challenges and Solutions

Abstract Unconventional resources such as Heavy oil are becoming a target of most operators. Wells subjected to steam stimulation for heavy oil recovery are exposed to extreme temperature changes that can vary from 21° C to 348°C. This temperature cycling can have a drastic effect on the set cement sheath causing it to fail with a consequent loss of the well integrity. Loss of hydraulic isolation in the cement sheath will decrease control of steam placement leading to reduced hydrocarbon recovery and potentially health, safety and environmental challenges. Oudeh Petroleum Company (OPC) has been producing heavy oil since 2006 using the Huff and Puff technique. Complete Well Integrity has been achieved using an Advanced Cement System in more than two hundred wells exposed to steam injection temperatures up to 348°C and consequent high induced thermal stresses (Fig. 1 &amp; 2). This paper will discuss the methodology of the risk analysis of the cement sheath failure under steam stimulation and selection criteria for the Advanced Cement System to withstand temperature cycling. Two case histories will be presented as well as a 50 well database.</jats:p

Subclinical chronic kidney disease modifies the diagnosis of experimental acute kidney injury

Extensive structural damage within the kidney must be present before serum creatinine increases. However, a subclinical phase of chronic kidney disease (CKD) usually goes undetected. Here we tested whether experimental subclinical CKD would modify functional and damage biomarker profiles of acute kidney injury (AKI). Subclinical CKD was induced in rats by adenine or aristolochic acid models but without increasing serum creatinine. After prolonged recovery (three to six weeks), AKI was induced with a subnephrotoxic dose of cisplatin. Urinary levels of kidney injury molecule-1 (KIM-1), cytochrome C, monocyte chemotactic protein-1 (MCP-1), clusterin, and interleukin-18 increased during CKD induction, without an increase in serum creatinine. After AKI in adenine-induced CKD, serum creatinine increased more rapidly, while increased urinary KIM-1, clusterin, and MCP-1 were delayed and reduced. Increased serum creatinine and biomarker excretion were associated with diffuse tubulointerstitial injury in the outer stripe of outer medulla coupled with over 50% cortical damage. Following AKI in aristolochic acid–induced CKD, increased serum creatinine, urinary KIM-1, clusterin, MCP-1, cytochrome C, and interleukin-18 concentrations and excretion were greater at day 21 than day 42 and inversely correlated with cortical injury. Subclinical CKD modified functional and damage biomarker profiles in diametrically opposite ways. Functional biomarker profiles were more sensitive, while damage biomarker diagnostic thresholds and increases were diminished and delayed. Damage biomarker concentrations and excretion were inversely linked to the extent of prior cortical damage. Thus, thresholds for AKI biomarkers may need to be lower or sampling delayed in the known presence of CKD