Objective: The prenatal genetic counseling of fetus diagnosed with the 15q11.2 copy number variant (CNV) involving the BP1-BP2 region has been difficult due to limited information and controversial opinion on prognosis. Design: Case series. Setting: This study uses data from National Taiwan University Hospital. Sample: Data of 36 pregnant women who underwent prenatal microarray analysis from 2012 to 2017 and were assessed at National Taiwan University Hospital. Methods: Data were collected by reviewing patients’ medical record. Comparison of patient characteristics, prenatal ultrasound findings and postnatal outcomes between different cases involving the 15q11.2 BP1-BP2 region were presented. Main outcome measured: Postnatal prognosis. Results: Out of the 36 patients diagnosed with CNVs involving the BP1-BP2 region, 5 were diagnosed with microduplication and 31 with microdeletion. Abnormal ultrasound findings were recorded in 12 cases prenatally. De novo microduplications were observed in 25% of the cases and microdeletions were found in 14%. Amongst the cases, 10 pregnant women received termination of pregnancy and 26 gave birth to healthy individuals (27 babies in total). Conclusion: The prognoses of 15q11.2 CNVs were controversial and recent studies have revealed its connection with developmental delay and autism. In our study, no obvious developmental delay or neurological disorders were detected postnatally in the 1 case of 15q11.2 microduplication and 25 cases of microdeletion.

The hydrological sensitivity of snowmelt-dominated, high mountain headwaters to climate change was investigated using a physically based model to diagnose snow processes and headwater basin runoff response to perturbations of the current climate in three well-instrumented mountain research basins spanning the northern North American Cordillera. High-resolution hourly meteorological observations were perturbed using air temperature increases and precipitation changes and then used to force comprehensive, mountain hydrological models created using the modular, process-based Cold Regions Hydrological Modelling Platform (CRHM) for each basin. Simulations using multiple elevations show that both peak snowpack and annual runoff respond to warming and precipitation changes and these responses vary with latitude. In all three basins, the timing and magnitude of peak snowpack were sensitive to changes in temperature and precipitation, but timing was most sensitive to temperature. Annual runoff was far less sensitive to temperature than the snow regime. The impacts of the range of warming expected from North American climate model simulations on annual runoff, but not peak snowpack, can be offset by the size of precipitation increases projected for the future period 2041-2070. To offset the impact of 2°C warming on annual runoff, precipitation would need to increase by less than 5% in all three basins. To offset the impact of 2°C warming on peak snowpack, however, precipitation would need to increase by 12% in Wolf Creek-Yukon Territory, 18% in Marmot Creek-Canadian Rockies and an amount greater than the maximum projected at Reynolds Mountain-Idaho. The role of increased precipitation as a compensator for the impact of warming on mountain snow hydrology is more effective at the high elevations and high latitudes. Increased precipitation leads to resilient and strongly coupled snow and hydrological regimes in cold regions and sensitive and weakly coupled regimes in the low elevations and temperate climate zones.

Background: Optimizing the monitoring of peripheral venous catheters is essential. We developed a nursing record system at bedside (Patient Smart Reader®) to track peripheral venous catheters acts. Aims: Improve peripheral venous catheter monitoring. To improve the quality of monitoring, we aimed to increase the usage rate of nursing record system at bedside. Methods: We developed a “commitment intervention” course based on binding communication paradigm. Evaluation of its performance on monitoring was analyzed using a p-chart and time series analysis. Findings: Nurses observed a significant improvement in compliance with catheter monitoring over time (shifts after shifts), ranging from 27.6% (CI = [25.3; 30.0]) of compliance before commitment intervention to 47.4% (CI = [45.0; 49.9]) after training. The commitment intervention increased the chances of carrying out monitoring through the tool for acts related to peripheral venous catheter by 2.42 (odds ratio) (CI = [1.88; 3.11]). Conclusion: Binding communication provides an effective method for changing nurses’ behaviors in terms of safe care. The determinants of engagement (individual vs. collective) can be indicators for defining future communication and training strategies in care centers for all Health care workers.

Rationale, aims and objectives: Patient adherence to medication is related to successful pharmacotherapy; however, many patients do not take their medications as prescribed because of poor understanding of their purpose.This study aimed to assess older people’s knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the possible factors related to their level of knowledge about their medications. Method: This was a cross-sectional study conducted in 22 basic health units in Brazil. Older people from this sample who were treated in a primary care setting were interviewed after a consultation with a family practice physician. Data were collected from September 2016 to March 2019. Patients aged ≥ 60 years who visited the primary care units were included in the study (n = 674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using a Poisson regression with robust variance. Results: The mean age of the sample was 70.1 (standard deviation: ± 7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least one of their prescribed drugs; among them 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least one prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. Conclusions: In the studied sample, patients demonstrated a high rate of misunderstanding of the purpose of prescribed drugs. Therefore, it is necessary for health services and professionals to implement strategies that increase the quality of the guidance and instructions given to older people in order to promote adherence to treatment.

The Colorado East River Community Observatory Data Collection Zarine Kakalia1,2, Charuleka Varadharajan1,†, Erek Alper3, Eoin L. Brodie1, Madison Burrus1, Rosemary W.H. Carroll4, Danielle Christianson5, Wenming Dong1,Valerie Hendrix4, Matthew Henderson4, Susan Hubbard1, Douglas Johnson2, Roelof Versteeg2, Kenneth H. Williams1, and Deborah A. Agarwal41Lawrence Berkeley National Laboratory, Earth and Environmental Sciences Area, Berkeley, CA 94720 USA2 University of California Berkeley, College of Natural Resources, Berkeley, CA 94720 USA3Subsurface Insights, LLC, Hanover, NH 03755 USA4Desert Research Institute, Reno, NV 89512 USA5Lawrence Berkeley National Laboratory, Computing Sciences Area, Berkeley, CA 94720 USA†Corresponding Author:Charuleka Varadharajan (cvaradharajan@lbl.gov).1 Cyclotron Road, 84-142 (M/S 74R316C), Berkeley, California, 94720Ph: 510-495-8890

Objectives/Aims: Prostatitis is a common entity that is seen in younger than 50 years old men in urology clinics. Subcategory of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for more than 90% of cases of prostatitis and heterogeneous symptoms cause negative impact on quality of life. Chronic rhinosinusitis (CRS) is a common inflammatory disease of the upper airways and results in a constellation of symptoms that have a significant negative effect on a patient’s quality of life, either. However, both of these entities may share an inflammatory background because of systemic inflammatory responses and endocrine effects of cytokines. In this study, we aimed to find if any symptomatic correlation between CP/CPPS and CRS that can be measurable with National Institute of Health- Chronic Prostatitis Symptom Index (NIH-CPSI) and Sinonasal Outcome Test-22 (SNOT-22) validated symptom scores. Methods: Patients from urology (n:113) and ear-nose-throat (ENT) clinics (n:104) are included in this study. They were questionned with NIH-CPSI and SNOT-22. Also, they were evaluated if there was a correlation between these scores and some parameters (e.g. age, marital status, smoking, masturbation frequency, concomitant inflammatory diseases). Results: As our main result we found out a low-moderate correlation between NIH-CPSI and SNOT-22 scores (r:0.370 for urology, r: 0.466 for ENT patients). Conclusions: In this study we found that, CP/CPPS and CRS have a low correlated relationship symptomatically. We suggest that with further studies and additional data, CP/CPPS and CRS symptom relation might have been connected to a possible main root.

Per far fronte all’aumento della popolazione mondiale, della domanda di cibo e del consumo di risorse, è necessario individuare nuove soluzioni per realizzare uno sviluppo sostenibile. L’acquaponica è un’ottima opportunità: elevati risparmi idrici, spazi ridotti e produzione in loco. L’impianto acquaponico ricrea un ecosistema in cui pesci, batteri e piante lavorano sinergicamente. Il presente lavoro sarà incentrato sull'analisi e sviluppo di trattamenti avanzati per il recupero dei nutrienti da sistemi acquaponici. Il recupero di nutrienti è fondamentale nell’ottica dell’economia circolare perchè ne permette il riutilizzo come fertilizzanti in agricoltura e migliora la qualità delle acque.  L’attività sperimentale si è incentrata sullo studio di due sistemi acquaponici: uno convenzionale ed uno con trattamenti avanzati (MRB, disinfezione con ozono e UV). Sono stati analizzati i principali parametri chimico-fisici di qualità delle acque per valutare l'efficacia dei trattamenti implementati e la loro influenza sull'assorbimento dei nutrienti.

OverviewIn this lesson, students will design a working wind turbine with a goal of maximizing voltage output. After reviewing types of energy and energy transfer, students will split into groups. They will design and test multiple wind turbine blades using different materials and shapes. After determining the best blade type, students will construct their wind turbines. In the following class period, groups will formally test their turbines to determine which group's turbine produces the highest voltage output. Following the testing, the class will discuss generators and how wind turbines use them to produce electricity. An optional follow-up discussion can then take place about clean energy versus fossil fuels.Suggested Time: 100 minutesGrades: 9-11NGSS Standards:HS-PS2-5: Plan and conduct an investigation to provide evidence that an electric current can produce a magnetic field and that a changing magnetic field can produce an electric current.

Pfeiffer syndrome (PS) is a rare autosomal dominant genetic disorder characterized by craniosynostosis, broad thumbs / toes. Here we report a case of PS type 2 with increased nuchal translucency at early trimester.

Purpose: Craniospinal irradiation (CSI) has historically treated the entire vertebral body (VB) in growing children. Vertebral body sparing proton craniospinal irradiation (VBSpCSI) is a technique which spares the majority of the VB from significant irradiation. This retrospective study reviews the acute toxicity of VBSpCSI compared to photon CSI. Methods: Pediatric CSI patients treated between 2008 and 2018 were evaluated. Patients were stratified to the VBSpCSI cohort or the photon cohort and analyzed for acute toxicity profile during treatment and disease-free survival (DFS). Statistical analysis was performed using Kaplan-Meier log rank analysis for DFS and Fisher’s exact test for toxicity. Results: Twenty-five patients received VBSpCSI and 13 patients received photon CSI. Mean patient age at treatment was 7.5y (range 2 to 16). The cohorts were well-matched with respect to gender, age, and CSI dose. Two-year DFS was similar between cohorts (81% VBSpCSI vs 61% photon, p=0.18). Patients receiving VBSpCSI had lower rates of grade 2+ GI toxicity (24% vs 76.5%, p=0.005), grade 2+ nausea (24% vs 61.5%, p=0.035), and any-grade esophagitis (0% vs 38%, p=0.0026). Patients treated with VBSpCSI had lower red blood cell transfusion rates (21.7% vs 60%, p=0.049) and grade 4+ lymphopenia (33.3% vs 77.8%, p=0.046). Conclusions: VBSpCSI in children is a volumetric de-escalation from traditional volumes which irradiate the entire vertebral body. Based on our results, VBSpCSI was associated with less acute gastrointestinal and hematologic toxicity. The study adds to the growing body of evidence supporting the use of protons over photons for pediatric CSI.

Background: The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. Methods: A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in-hospital mortality, bleeding, and neurological outcomes. A random-effect meta-analysis was performed using STATA software (StataCorp, TX, USA). Results: Thirty-five studies were eligible for the present meta-analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in-hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions: It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.

A document by Idriss Noureddine Zaouagui. Click on the document to view its contents.

La crescente domanda alimentare nel mondo rappresenta una sfida per il controllo dell'inquinamento a causa dell'insostenibilità dei sistemi produttivi tradizionali. Nell'ottica dell'economia circolare è fondamentale individuare nuovi modelli sostenibili per la produzione alimentare come l'agricoltura acquaponica. I sistemi acquaponici combinano l’efficacia dell’agricoltura fuori suolo all’acquacoltura a ricircolo, creando un unico sistema integrato per la produzione simultanea di due prodotti alimentari: pesci e piante. Tra i numerosi vantaggi di questa tecnologia spiccano il notevole risparmio idrico, l’assenza di suolo fertile o di fertilizzanti per le coltivazioni, e la grande versatilità impiantistica. Nel panorama delle produzioni acquaponiche esistono molte tecnologie di trattamento delle acque di ricircolo, tradizionali o innovative. Le membrane dinamiche auto-formanti (SFD-MBR) e i processi di ossidazione avanzata (AOPs) sono alcuni esempi di processi avanguardistici che possono essere implementati nei sistemi acquaponici. Se adoperati simultaneamente, permettono di migliorare notevolmente la qualità delle acque, potenziare lo scambio di nutrienti e ridurre la carica patogena per la produzione agricola.

Nest building can represent an energetically-costly activity for a variety of animal taxa. Besides, the determinants of within-species variation in the design of nests, notably with respect to natural and sexual selection, are still poorly known although the situation has been partly remedied recently. Based on an observational study, we examined the influence of nesting conditions (nesting-substrate quality, colony, laying date, and year) on the volume of male-built nests and its potential role as a post-mating sexually-selected display in the whiskered tern Chlidonias hybrida, a monogamous species with obligate bi-parental care breeding on unstable aquatic vegetation beds. No relationship was found between the nest volume and the nesting-substrate quality (i.e. nest stability) indicating that the density of white waterlily leaves was large enough when whiskered terns breed. In contrast, building a large nest likely constitutes a selective advantage since nests were larger in less densely populated colonies and for early breeders whatever the year. Since being influenced by nesting conditions, the volume of male-built nests was unlikely to be a sexually selected trait in whiskered terns. The reproductive effort by females (the probability of laying one, two or three eggs, and variation in mean egg volume per clutch) was indeed not correlated with the volume of male-built nests. The fitness consequences of building a large nest are yet to be studied and additional investigations are recommended to better depict the participation of males early during breeding (including notably courtship feeding) and later to chick provisioning.

Suggested Time: 55 minutesGrade Level: Kindergarten, First Grade, Second GradeOverview:One of the most anticipated days in the life of a child is Halloween!  Kids wait all year for the one night to fill their bags with candy.  Due to the COVID-19 pandemic and social distancing guidelines, some communities cancelled Halloween.  Students will brainstorm ways for adults to pass out candy so kids can go trick-or-treating while still maintaining a social distance of six feet.  NGSS Standards:  K-2-ETS1-1     Ask questions, make observations, and gather information about a situation people want to change, to define a simple problem that can be solved through the development of a new or improved object or tool. K-2-ETS1-2    Develop a simple sketch, drawing, or physical model to illustrate how the shape of an object helps it function as needed to solve a given problem.  K-2-ETS1-3    Analyze data from tests of two objects designed to solve the same problem to compare the strengths and weaknesses of how each performs.  Objectives:  Students will use the engineering design process to:Brainstorm ways to deliver a piece of candy a distance of 6 feetSketch a drawing of their planUse materials to create a prototypePerform a testRecord dataShare their solution with the classVocabulary:ramp, incline, push, pull, pulley, simple machine, measure, angle, build, design, testSuggested Materials: paper towel tubestapestringspoolsLegoswheelspopsicle sticksstrawspipe cleanerscardboardsmall toy carssmall pieces of Halloween candy     The Lesson:Students will gather in groups of 3-4 and use creativity to brainstorm ideas.  They will make a simple sketch of their plan. (See Halloween Transporter Design.docx)Students will gather their materials.Students will collaborate to construct their device. (There are many possible solutions. Possible ideas: use something to push the candy 6 feet to a trick-or-treater, build a chute or ramp to send the candy, use a pulley system with string)Students will perform tests to see if their device works correctly.  Measure how far the candy went. Problem solve ways to make improvements. Does the angle of the device make a difference?Students will record their results.  (See Halloween Transporter Results.docx)Students will share their project with the class.  The class will determine which projects would be the most useful.

A malaria transmission disease model with host selectivity and Insecticide treated bed nets (ITNs), as an intervention for controlling the disease, is formulated. Since the vector is an insect, the vector time scale is much more expeditious than the host time scale. This leads to a singularly perturbed model with two distinctive intrinsic time scales, two-slow for the host and one-fast for the vector. The basic reproduction number R0 is calculated and the local stability analysis is performed at equilibria of the model when the perturbation parameter ɛ > 0. The model is analyzed when ɛ → 0 using asymptotic expansions technique. Merging bed-net control, vector-bias, and singular perturbation have a notable effect on the model dynamics. It is shown that if over %30 of humans use ITNs, malaria disease burden can be reduced. The dynamics on the slow surface indicate that the infected vectors decays very fast when ɛ = 0.001 according to the numerical simulations.

Objective To determine the prevalence of clinically relevant drug-drug interactions in an intensive care unit of a tertiary care hospital in the United States and to compare to an intensive care unit at a Pakistani hospital, which lacks electronic medical record-based drug-drug interaction screening. Study setting A retrospective cross-sectional analysis was conducted in the cardiovascular intensive care unit (CVICU) at Michigan Medicine (MM), Ann Arbor, MI, USA between Jan 2018 – Jan 2019. Study Design Analysis of 300 MM patients was conducted to identify drug-drug interactions using Micromedex® and Lexicomp®. Descriptive statistics and multivariate binary logistic regression was used. Independent samples t-test was used to compare prevalence between MM and in a similar cohort of patients in the cardiac intensive care (CCU) at KTH, Pakistan from a previously published study. Data Collection Data was collected for patients who were admitted to the CVICU for at least 24 hours and were prescribed at least 2 drugs from the electronic health record of MM. Principal Findings In the intensive care unit of the US hospital, 58% of patients had at least one drug-drug interaction, while 16% had a clinically relevant drug-drug interaction. Significantly fewer patients had drug-drug interactions at the US hospital than the Pakistani hospital (58% vs. 95%, p < 0.01). Polypharmacy and length of stay increased drug-drug interaction occurrence in the US hospital (p <0.01). Conclusion The prevalence of drug-drug interactions in the intensive care unit at the US hospital was high but lower than the Pakistani hospital, likely due to electronic medical record-based screening. Despite electronic medical record-based screening at the US hospital, 8 clinically relevant drug-drug interaction pairs were undetected.

Purpose. Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach to treating knee osteoarthritis (OA). However, the efficacy of PRP in advanced stages of the disease is not entirely clear. The purpose of this study was to evaluate whether the use of PRP would be as effective in studies with early-moderate knee OA patients compared to studies including patients with end-stage OA based on the Kellgren-Lawrence classification. Methods. A comprehensive search in MEDLINE, EMBASE, Scopus, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing the effect of PRP injections versus other intra-articular treatments on pain and functionality. A meta-analysis was conducted using a random-effects model and the generic inverse variance method. Results. We included 31 clinical trials that reported data of 2705 subjects. Meta-analysis revealed an overall significant improvement of both pain (MD, -1.05 [95% CI -1.41 to -0.68]; I2 = 86%; P = < 0.00001) and function (SMD, -0.99 [95% CI -1.34, to -0.65]; I2 = 94%; P = < 0.00001), favoring PRP. Subanalysis for pain and functional improvement showed significant pain relief in studies with 1-3 and 1-4 Kellgren-Lawrence OA stages, and a significant functional improvement in studies with 1-2, 1-3, and 1-4 knee OA stages, favoring PRP. Conclusion. Our results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the efficacy of PRP in knee OA is assessed.

Background: This study aims to establish the frequency of severe hypoglycaemia and impaired awareness of hypoglycaemia (IAH) in Type 1 diabetes (T1D) patients in Singapore. We evaluate the utility of the Gold and Clarke scores as screening tools for IAH, and assess the effects of diabetes self-management practices and education in reducing IAH. Methods: This is an observational study of 131 subjects with T1D at a regional hospital, which included review of medical records, self-administered questionnaires and a prospective 4 week period of self-monitoring of blood glucose (SMBG). Results: The frequency of clinically significant hypoglycaemia (blood glucose < 3 mmol/L) during the 4 week period of SMBG was 38.8%, while the frequency of severe hypoglycaemia over the last one year was 22.5%. Based on the Gold score and Clarke score, 28.3% and 24.6% of subjects respectively had IAH. The Clarke score was associated with increased frequency of clinically significant hypoglycaemia, severe hypoglycaemia and hospitalizations for hypoglycaemia. Prior group education, education from a dietitian and education on blood glucose targets were associated with lower Clarke scores, while adjusting insulin doses for blood glucose using an insulin sensitivity factor was associated with lower Gold and Clarke scores. Conclusion: IAH is common in T1D patients in Singapore and is associated with increased risk of severe hypoglycaemia. The Gold and Clarke scores are simple tools which can be routinely administered to identify patients with IAH who might benefit from specific interventions, particularly structured diabetes education, to decrease IAH and its complications.

This study aimed to studying the effects of planned training given to women with preeclamptic pregnancy on stress-anxiety and oxidative stress levels. A non-randomised controlled-study study, carried out in Gynecology and Obstetrics Clinics of Research and Application Hospital of one university. In the study, 28 preeclamptic patients matching the sampling criteria were taken as the experimental group and 22 other preeclamptic patients who also match the sampling criteria constituted the control group. Questionnaire, scale application and laboratory evaluation for the control group were performed only once. In the experimental group, there is a statistically significant difference between the TAS (mmol trolox equ./L) (t = -9.71 P = 0.00) and the TOS (lmol H2O2 equ./L) (t = 6.56 P = 0.00) measurements before and after the training and there is a statistically significant difference between the State-Trait Anxiety Inventory (t = 3.64 P = 0.00) before and after the training. It has been determined in the study that the planned training given to the pregnant women who received a diagnosis of preeclampsia has decreased their oxidative stress levels and state anxiety levels.

Objective: Development of chronic total occlusion (CTO) consists of multiple histological stages, with each stage containing different histopathological features. The monocyte to high-density lipoprotein ratio (MHR) is a useful marker of the degree of inflammatory response. The aim of this study was to investigate the relationship between MHR and long-term survival and mortality in CTO patients. Methods: The study included 493 CTO patients that were followed over a period of 73 months between January 2011 and December 2019. MHR was calculated from the venous blood samples taken from each patient immediately before routine coronary angiography. Results: The study included 493 patients comprising 353 (71.6%) men and 140 (28.4%) women with a mean age of 63.03±10.88 years. Median follow-up period was 48 (interquartile range [IQR]: 26-73) months. Patients were divided into two groups: (I) MHR <17.68 (n=278) and (II) MHR ≥17.68 (n=215). Long-term mortality was significantly higher in group II than in group I (n=70, 32.6% vs. n=43, 15.5%; p<0,001). On multivariate logistic regression analysis, MHR was found to be an independent predictor of long-term mortality (Odds Ratio [OR]: 1.089, 95% Confidence Interval [CI]: 1.055-1.124, p<0,001). The Kaplan-Meier analysis showed lower survival rates in group II (MHR ≥17.68) than in group I (MHR <17.68) (75.223±2.670 vs. 89.220±2.102, p<0,001). Conclusion: MHR could be used as a practical universal biomarker of mortality and survival in CTO patients.

Aims: Adherence to prescribed treatment is important for obtaining the desired outcomes in older people care. Polypharmacy is strictly associated with adherence, and complex pharmacotherapy can lead to poor adherence and unexpected outcomes, which are aggravated by older age. The medication regimen complexity index has been proven to be a valid and reliable tool for quantifying the complexity of medication regimens. The objective of the present study was to evaluate the therapeutic complexity of drugs used by older people in a primary care setting in Brazil. Methods: This was a cross-sectional study conducted in 22 basic health units in Brazil. Older people from this sample who were treated in a primary care setting were interviewed after a consultation with a family practice physician. Data were collected from September 2016 to March 2019. Patients aged ≥ 60 years who visited the primary care units were included in the study. Pharmacotherapeutic complexity was assessed according to the medication regimen complexity index. Results: In all, 675 individuals with a mean age of 70 years (±7.1 years) were included. The mean number of drugs prescribed per capita was 2.9 (±1.8). The median medication regimen complexity index for the sample was 8.0, and 26.1% of the patients interviewed had a high medication regimen complexity index. Conclusion: The complexity of the drug regimen was high in almost one-third of the prescriptions analysed. This high complexity might contribute to non-adherence to medication regimens, leading to safety- and effectiveness-related issues. Key words: drug prescriptions, geriatrics, pharmaceutical preparations, polypharmacy, primary health care, older patient.

Background: Acute hypoxemic respiratory failure (AHRF) is common in COVID-19. Tracheal intubation in such patients is fraught with higher mortality, therefore, high flow nasal oxygen therapy (HFNOT) is being used in AHRF. In this study, we aimed to determine the impact of HFNOT on oxygenation status and also various predictors of HFNOT failure. Methods: A prospective observational cohort study was conducted in COVID-positive critically ill adult patients (aged>18 years) with AHRF, who were unable to maintain SpO2>90% on a non-rebreathing face mask at an oxygen flow ≥15 litres/minute. Respiratory variables (PaO2/FiO2, SpO2, and RR) before HFNOT (baseline), then at 1-hour, 6-hour, 7-day, and 14-day after HFNOT application, were recorded. Borg CR10 scale and visual analog scale were used to evaluate the subjective sensation of dyspnoea and comfort level respectively. Student’s t, Mann–Whitney U or Wilcoxon signed-rank tests were used as applicable. Multivariate logistic regression and Receiver-Operating Characteristic (ROC) analyses were performed to determine factors associated with HFNOT failure. Results: 114 patients were included with HFNOT failure rate of 29%. The Median PaO2/FiO2 ratio at baseline (before initiation of HFNOT) was 99.5 (80-110) which significantly increased at various time points (1-hour, 6-hour, 7-days, and 14-day) after HFNOT initiation in the successful group. Patients reported significant improvement in sensation of breathlessness (9 [8-10], 3 [2-4]; p<0.001) as well as in comfort level (2 [1-2], 8 [4-9]; p<0.001). Multivariate logistic regression analysis, SOFA>7, APACHE II>20, admission P/F ratio<100, D-dimer>2mg/L, IL-6>40 pg/mL, Random Blood Sugar (RBS)>250 mg/dL, 6-hour ROX Index<3.5, were independent prognostic factors of HFNOT failure. Conclusion: In COVID-19 patients with AHRF, the use of HFNOT significantly improved oxygenation levels at various time points after HFNOT initiation. Age, SOFA, APACHE II, and ROX scores, admission P/F ratio, IL-6, D-dimer, and RBS were independent prognostic factors of HFNOT failure in this cohort.

Purpose: To evaluate the correlation between PI-RADSv2.1 and International Society of Urologic Pathologists (ISUP) score for patients who underwent multiparametric-MRI(MpMRI) prior to transrectal ultrasound (TRUS) guided cognitive fusion biopsy (CF-Bx). And to investigate inter-observer agreement of PI-RADSv2.1. Methods: Patients who underwent MpMRI of prostate prior to first TRUS-guided CF-Bx, were included in this prospective study. MpMRI examinations were evaluated by two radiologists before biopsy according to the PI-RADSv2.1. Interobserver agreement was recorded and the final PI-RADS categorization was performed by consensus. Correlation of histopathological results with PI-RADSv2.1 score was evaluated. Lesions with Gleason Score(GS)≥6 were considered as prostate cancer (PCa). Results: A total of 84 patients with 106 lesions were included in the study. The ratio of PCa in the PI-RADS groups 1,2,3,4,5 was 0%, 0%, 22.2%, 56%, 94.45%, respectively. There was a positive correlation with a value of 0.814 between the PI-RADSv2.1 and the ISUP score. When PI-RADS≥3 is accepted as the cut-off value in peripheral zone(PZ) and the whole gland, the NPV for malignancy was 100.00%. For PI-RADS ≥4, it was 76.47% for PZ, and 80.65% for the whole gland. For the whole gland; sensitivity, specificity, and PPV of the PI-RADS≥3 were 100%, 12.9%, and 44.33%, respectively; for PI-RADS≥4, these values were 72.09%, 80.65%, and 72.09% respectively. Without applying cut-off values, the interobserver agreement for PI-RADS score was κappa:0.562. Conclusions: PI-RADSv2.1 was created in the framework of v2 to facilitate to evaluate MpMRI and to increase interobserver agreement. We believe that further studies will be necessary.