Cause Of Transfer Research Articles

Critical patients in general hospitalization wards: a descriptive analysis of factors inherent to the transfer to a closed unit

Unplanned transfers from the General Ward to Critical Care Units occur due to a deterioration in the patient's clinical status. They are of great interest because of their negative impact, associated with longer hospital stays and higher mortality. To report the frequency at which these transfers occur, characteristics of these patients and causes of the transfer. Identify shortcomings in the care process that may allow improvement strategies. cross-sectional study. Cases were considered those who, during the first 24 hours of hospitalization in the General Ward, required transfer to the ICU between January - December 2022 in a high-complexity hospital in Buenos Aires. Results: Of 8317 admissions, 124 were transferred to the ICU, with a rate of 14 per 1000 and an average of 70 years. The most frequent comorbidities were high blood pressure, heart failure, cancer and overweight-obesity. The main causes of hospitalization were respiratory and gastrointestinal symptoms. 67% had non-alarming results in the NEWS score prior to transfer to the ICU. The most frequent causes were respiratory failure, hemodynamic instability and requirement for monitoring. Average hospital stay was 10 days and in-hospital mortality was 26%. Respiratory decompensation in elderly male patients was the most common cause of transfer to a Closed Unit. One of the shortcomings of the care process seems to be the NEWS score, where in 67% of cases it did not warn about the high requirement of patient monitoring.

Characteristics and predictors of outcome in children with severe acute bronchiolitis: A 10-yearexperience

BackgroundSevere acute bronchiolitis (SAB) can be life-threatening for infants and may be responsible for the congestion of intensive care units (ICU) during epidemics. We aimed to study the clinical and paraclinical characteristics of patients with SAB requiring a transfer to the ICU in order to examine their outcomes and to identify the predictors of a stay of ≥7 days and/or death. MethodsThis was a cross-sectional retrospective study including infants aged ≤12 months transferred to the ICU for their first episode of SAB between 1 January 2010 and 31 December 2019. ResultsWe collected data on 380 patients with a median age of 1.75 months. They had a history of prematurity (20.53 %), low birth weight (18.68 %), parental atopy (12.89 %), and comorbidity (7.37 %, mainly congenital heart disease [5 %]). The leading cause of transfer was hypoxemia and increased oxygen requirements (49.73 %). The patients required mechanical ventilation (MV) in 63.42 % of the cases and noninvasive ventilation (NIV) in 67.63 %. NIV has supplanted MV over the years. Its use has increased from 40.4 % in 2010 to 96 % in 2019 compared with 83.84 % and 42 % for MV. A total of 14 (3.68 %) patients died. The independent predictors of a stay of ≥7 days and/or death were young age ≤2 months (p = 0.002), failure to thrive (p = 0.006), apnea (p = 0.045), dehydration (p = 0.018), the presence of biological inflammatory reaction (p = 0.002), isolation of respiratory syncytial virus (p < 0.001), and bacterial coinfection (p = 0.013).NIV was a protective factor (p < 0.001). A severity score ranging from 0 to 17 was established with an optimal cut-off value of 5 points. ConclusionSpecific caution is needed in patients with these severity predictors. The generalization ofNIV in general pediatrics departments would improve SAB management and reduce transfers to the ICU.

Novel Colorimetric and Light Scatter Methods to Identify and Manage Peritoneal Dialysis-Associated Peritonitis at the Point-of-Care

IntroductionPeritoneal dialysis-related peritonitis is a common cause of transfer to haemodialysis, patient morbidity and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests, however this might be achieved earlier if such information was available at the point-of-care, thereby significantly improving outcomes. The presence of culturable microbes and the concentration of leukocytes in effluent both aid peritonitis diagnosis, as specified in the International Society for Peritoneal Dialysis diagnostic guidelines. Here we report the development of two new methods providing such information in simple point-of-care tests. MethodsOne approach uses a tetrazolium-based chemical reporting system, primarily focused on detecting bacterial contamination and associated vancomycin-sensitivity. The second approach uses a novel forward light-scatter device (QuickCheck) to provide an instant quantitative cell count directly from PD patient effluent. ResultsThe tetrazolium approach detected and correctly distinguished lab isolates, taking 10h to provide non-quantitative results. We compared the technical performance of the light scatter leukocyte counting approach with spectrophotometry, haemocytometer counting and flow cytometry (Sysmex) using patient effluent samples. QuickCheck had high accuracy (94%) and was the most precise (coefficient of variation <4%), showing minimal bias, overall performing similarly to flow cytometry. ConclusionsThese complementary new approaches provide a simple means to obtain information to assist diagnosis at the point-of-care. The first provides antibiotic sensitivity following ten hours incubation, whereas the second optical approach (QuickCheck), provides instant accurate total leukocyte count.

Risk factors for readmission of patients with amputation to acute care from inpatient rehabilitation: A retrospective cohort study.

Amputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population. To identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility. Retrospective cohort study. An acute rehabilitation hospital associated with a community-based tertiary medical center. A retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022. The study outcome measure was readmission to acute care from an acute rehabilitation unit. Of the 156 independent admissions, the readmission rate was 19% (29/156). The most common cause of transfer was incision-site complications (9/29, 31%), including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be receivingdialysis (p < .001), have a longer length of stay in acute care before admission to the rehabilitation facility (p = .039), and have a lower Section GG score on admission (p < .001). Age, sex, ethnicity, amputation level, and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ratio [OR] 4.82, p = .006). This study showed that incision-site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation who carry certain risk factors to reduce rehospitalization to the acute care unit.

Unplanned transfer of pediatric patients from the general ward to the intensive care unit.

Introduction. During hospitalization, patients may develop significant clinical deterioration and require unplanned admission to the pediatric intensive care unit (PICU). This may result in increased morbidity and mortality. These events are often preceded by a deterioration phase that may go unnoticed. Objective. To determine the frequency, analyze the causes, and describe the clinical characteristics and outcomes of unplanned transfers of hospitalized pediatric patients from the general pediatric ward (GPW) to the PICU, and analyze the differences between urgent and emergent transfers. Population and methods. Prospective, descriptive study; all unplanned transfers from the GPW to the PICU occurring between January 1st , 2014 and December 31st, 2019 were analyzed. Results. There were 212 unplanned transfers (21 transfers per 1000 admissions). An associated comorbidity was present in 76% of transferred patients -being cancer the most frequent one (36%)- and they had been hospitalized for more than 24 hours in the GPW. The most frequent causes of transfer were respiratory distress (43%), sepsis (20%), and neurological/neurosurgical complications (20%). The overall mortality rate was 8.96% (19 patients). Conclusions. The analysis of unplanned transfers is a critical component in the assessment of the quality of care and patient safety of an area, and should be an indicator integrated into the control panel. The interpretation of unplanned transfers as a preventable event is a key paradigm shift.

#5564 OUTCOMES OF PERITONEAL DIALYSIS AFTER KIDNEY TRANSPLANT FAILURE: A SINGLE-CENTER EXPERIENCE

Abstract Background and Aims There is a hesitation in returning peritoneal dialysis (PD) after kidney transplant (KTx) failure. Studies in larger multicentre matched cohorts are missing. Method We conducted a retrospective study about 19 patients who started PD after KTx failure (PDpostTx group) between January 2010 and August 2022 in Ankara University School of Medicine who were compared with 70 never-transplanted patients having started PD during the same period (PDnoTx group). Patients’ clinical data and PD technique survival as well as peritonitis episodes were analysed. Results Mean age was 51 years and continuous ambulatory PD was the treatment of choice (59.6%) (Table 1). Even the mean time on PD was similar between groups (45.4 months in PDpostTx vs 51.7 months in PDnoTx, p = 0.525), transfer to HD was more common in PDpostTx patients (36.8% vs 10.0%, p = 0.015). The main cause of transfer to HD was ultrafiltration failure, which was significantly higher in PDpostTx group (p = 0.002). Diuresis at baseline was similar between groups, but decreased significantly in PDpostTx group at first year and final follow-up (p &amp;lt; 0.001, and p = 0.001, respectively). Peritonitis was more common in PDpostTx group (68.4% vs 30.0%, p = 0.002). Diabetes mellitus was a risk factor for peritonitis episode (p = 0.012), but we didn’t observe any effect of immunosuppressive therapy on peritonitis and reduction of the diuresis. In multivariate analysis, KTx failure (p = 0.014), peritonitis episodes (p = 0.011) and ultrafiltration failure (p &amp;lt; 0.001) were associated with a higher risk of transfer to HD. Over the study period, patients’ survival was similar between groups (p = 0.766). Conclusion We reported similar patient survival, but higher peritonitis rates and PD technique failure in the PDpostTx group, when compared to patients who started PD for other reasons. Considering these findings, taking precautions against peritonitis is more important for patients who started PD after KTx failure.

Effect of remote patient monitoring for patients with chronic kidney disease who perform dialysis at home: a systematic review

ObjectiveThe purpose of the systematic review was to assess the effectiveness of remote patient monitoring (RPM) follow-up compared with standard care, for patients with chronic kidney disease (CKD) who perform...

Protocol and clinical characteristics of patients under ‘at-home care’ for COVID-19 in South Korea: a retrospective cohort study

ObjectiveAs the number of patients with COVID-19 increased, at-home care was introduced for the first time in South Korea. This study aimed to analyse the characteristics and outcomes of patients...

Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study

PurposeNursing home staff manage increasingly complex patients yet struggle to access education. This study measured the impact of a novel education programme on emergency transfers from nursing homes.MethodsIn this prospective experimental cohort study, ten interactive sessions were provided to 20 nursing homes, using teleconferencing technology through the “Project ECHO” (Extension for Community Healthcare Outcomes) model. Details of all emergency hospital transfers were submitted by participating nursing homes 6 months before and 6 months from commencement of ECHO.ResultsOf 20 nursing homes, 13 submitted sufficient data for inclusion. In these 13, there were 260 emergency transfers over a year. There was no significant difference in the number of transfers before and after ECHO (137/260 pre-ECHO vs 123/260 post-ECHO, p = 0.62). Post-ECHO, it was 50% more likely that transfer wishes were discussed in advance of transfer (62 of 137 (45%) transferred pre-ECHO vs 82 of 123 (67%) post-ECHO, p < 0.001). There was a significant increase in compliance with resident wishes post-ECHO in that transferred residents were less likely to have a documented “Not for Transfer” wish (29/137 pre-ECHO (21%) vs 10/123 post-ECHO (8%), p < 0.001). Point prevalence surveys of residents demonstrated significant increases in “Do Not Resuscitate” orders; 286/589 (49%) residents pre-ECHO vs 386/594 (65%) post-ECHO, p < 0.001. Post-ECHO, pain was less frequently the primary cause for transfer (11/137 (8%) pre-ECHO vs 1/123 (0.8%) post-ECHO, p = 0.006).ConclusionECHO did not affect rates of emergency hospital transfers but did increase advance care planning discussions ahead of hospital transfer by 50% and compliance with the results of those discussions.

Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia

BackgroundAdvantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units.MethodsA prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed.Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed.ResultsFive hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both).Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%).ConclusionOur comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Dextrose Gel for the Treatment of Newborn Hypoglycemia

Hypoglycemia is one of the leading causes of transfers to the NICU at this hospital. This condition leads to separation of newborns from their parents, decreased exclusive breastfeeding rates, exponentially higher hospital costs, increased lengths of stay, and increased levels of invasive procedures required. The goal of this intervention is to provide a low-cost, minimally invasive option for treatment of hypoglycemia in newborns older than 35-weeks’ gestation.

A Legal Cause at the Transfer Security

양도담보는 소유권 이전의 방식에 의하여 채권을 담보하는 제도이다. 양도담보에서 채무자는 금전채권의 담보를 목적으로 채권자에게 소유권을 이전하는데, 이때 문제가 되는 것은 ‘소유권 이전’의 법적 원인을 무엇으로 볼 것인가이다. 소유권의 이전은 대표적인 출연행위로서, 모든 출연행위는 법적 원인을 필요로 하고, 이것에 의해서 출연이 정당화된다. 양도담보는 채권담보라는 경제적 목적을 넘어서서 ‘소유권’이라는 법적 권능을 채권자에게 이전한다. 이러한 경제적 목적과 법적 형식 사이의 괴리 때문에 이것이 허위표시로서 무효가 아닌가라는 의심이 제기된 적도 있다. 이에 대해 독일에서는 이를 신탁행위이론으로 설명하는 견해가 제시되었다. 이는 우리의 학설과 판례에도 영향을 미쳐 양도담보를 ‘신탁적 소유권 이전’으로 보는 것이 판례와 다수설이었다. 그러나 가등기담보 등에 관한 법률이 제정되면서 신탁행위이론을 통해 해결해 왔던 양도담보의 원인문제에 대해 새로운 상황이 생겼다. 가등기담보법에서 채권자에게 인정하는 권리를 담보권으로 보는 견해가 현재 다수를 이루고 있다. 그러나 담보권으로 보는 경우에는 물권법정주의와 충돌을 일으키므로 타당하지 않다. 그리고 신탁행위이론에 의하더라도 가등기담보법은 충분히 설명가능하고, 이렇게 보는 것이 물권법정주의 및 당사자의사에도 부합할 것이다. 가령 판례가 인정하고 있는 ‘담보목적에 의한 제한’, 혹은 ‘종국적, 확정적이지 않은 소유권 이전’은 채무자와 채권자 사이의 채권적 관계로 해결하면 족하다. 그리고 악의의 제3자가 소유권을 상실하는 것은 가등기담보법에 의해 강행성이 인정되는 ‘정산절차의 합의내용’이 소유권 이전의 법적 원인인 담보약속에 영향을 미쳐서 생긴 효과로 보면 될 것이다.A Transfer security is the security of bonds by means of transfer of ownership. In transfer security, the debtor transfers ownership to the creditor for the purpose of collateralizing the monetary claim. At this point, the question is what to consider the legal cause of the ‘transfer of ownership’. A transfer of ownership is a typical act of contribution, and every act of contribution requires a legal cause, thereby justifying the contribution. A transfer security goes beyond the economic purpose of security for bonds and transfers the legal power of “ownership” to the creditor. Due to the discrepancy between the economic purpose and the legal form, doubts have been raised that this is invalid as a false statement. In Germany, a view was proposed to explain this as a theory of trust transfer of ownership. This had an impact on our theories and precedents, and there were many precedents and theories that viewed transfer security as a trust transfer of ownership . However, as the Provisional Registration Security Act was enacted, a new situation arose regarding the legal cause of transfer security, which had been solved through a trust theory. Currently, the majority view that the right granted to creditors in the Provisional Registration Security Act is a security right. However, in the case of a security right, it is not valid because it conflicts with the numerus clausus of property rights. And even according to a trust theory, the Provisional Registration Security Act is sufficiently explanatory, and this view would also be consistent with the numerus clausus of property rights and the intention of the parties. For example, ‘restriction by the purpose of security’ or ‘indefinitive transfer of ownership’ recognized by precedents is sufficient to resolve with the obligatory relationship between the debtor and the creditor. And the loss of ownership by a malicious third party can be seen as the result of the agreement of adjustment procedure enforced by the Provisional Registration Security Act affecting the promise of security, the legal cause of transfer of ownership.

MO707MICROBIOLOGY, CLINICAL SPECTRUM AND OUTCOME OF INFECTIOUS PERITONITIS IN PATIENTS ON AUTOMATED PERITONEAL DIALYSIS

Abstract Background and Aims Automated peritoneal dialysis (APD) is a renal replacement therapy that offers patients various advantages such autonomy and comfort. Peritoneal dialysis-related infectious peritonitis (IP) is the most common and severe complication of APD. It is the main cause of technique failure and transfer to hemodialysis and can even be life-threatening. Given the seriousness of this complication, it is necessary to establish preventive strategies and adapt the therapeutic management.The aim of this study was to determine the microbiological and clinical profile of IP, to specify its causes its rate and outcome in patients treated by DPA at the unit of Charles Nicolle hospital in Tunis between January 2000 and December 2018. Method We conducted a single-center descriptive retrospective study in the peritoneal dialysis (PD) unit of Charles Nicolle Hospital in Tunis. We identified the episodes of IP occurring in patients treated with APD during the period from January 2000 to December 2018. We studied the clinical, biological and evolutionary aspects of IP. Results APD was used in 85% of patients treated at our PD unit during the study period. 322 episodes of IP occurred in 183 patients, that was an IP rate of 0.1 episodes/patient-year. 58% of patients treated with DPA have not presented IP. The mean age of the patients who presented PI was 43 years +/- 15(Extreme: 17-77) with a sex-ratio of 1.23. 74% of patients had a professional activity. 98% of patients had co-morbidities dominated by hypertension (88%), dyslipidemia(73%) and diabetes(16%) with a median Charlson score of 2[2-3] (Extremes: 2-9). Their average Body Mass Index was 24kg/m2+/-5. 33% of the patients were smokers. The average training duration before starting APD was 13days+/-5. The IP were evenly distributed according to seasons (27% occurred in autumn, 26% in spring, 25% in summer and 22% in winter). IP were: a 1st episode in 55% of cases, a new episode in 30% of cases, a relapse in 10% of cases, a recidivism in 3% of cases and a recurrence in 2% of cases. Fever was present in 34% of patients, abdominal pain in 75% of them. The dialysate was cloudy in 98% of cases. The median number of leukocytes in the PD fluid was 380/mm3(Range: 15-8000)with a mean% of neutrophils of 73%+/- 27. Dialysate culture was positive in 60% of cases, negative in 38% of cases and contaminated in 2% of cases. Among the positive cultures, only one was fungal (Candida albicans). Bacterial IP were distributed as follows: 64% Cocci Gram+ dominated by Staphylococcus aureus (48%), 34% Bacillus Gram- (mainly Klebsiella pneumoniae (21%) and Pseudomonas (21%)), 2 cases of Bacillus Gram+ (Corynebacterium afermentans and Lactobacillus) and 2 cases of polymicrobial culture (Cocci Gram+ and Bacillus Gram-).IP was of unknown cause in 48% of cases, related to an asepsis lack in 19% of cases, the orifice infection in 18% of cases and tunnelitis in 2% of cases. The other causes were essentially endogenous. Probabilistic antibiotic therapy was effective in 34% of cases. An adaptation according to the microbiological results was carried out in 19% of cases. Hospitalization was required in 10% of patients. 20% of peritonitis was refractory. Catheter ablation was performed in 14% of patients.IP caused the death of 8 patients and represented 37% of the causes of transfer to hemodialysis. Conclusion IPs are a turning point for the survival of the patient and the technique. Knowing the microbiological profile of these infections will make therapeutic interventions precocious and effective in order to preserve the prognosis of patients in APD at the short and long term.

Peritoneal Dialysis Related Infection – Peritonitis Management and Prevention

Peritonitis is one of the major risks of peritoneal dialysis (PD) causing significant morbidity and in some instances, mortality. It is one of the principal causes of transfer to hemodialysis (HD). Peritonitis rates should be audited by units. The recommended rate by the ISPD is less than 0.5 episodes/year

Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF

Introduction: There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. Methods: This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. Results: There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95–0.97). Compared to 2009–2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81–0.96, and PR 0.91, 95% CI: 0.84–0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94–0.98). Conclusions: Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.

P0295 / #1794: EPIDEMIOLOGY AND RISK FACTORS OF PREMATURITY

Aims & Objectives: The objective of our study was to study the epidemiological aspects and the etiological factors of thePrematurity in the maternity ward of the Mohammed VI university hospital in Marrakech, Morocco Methods: This is a retrospective study wearing on the new born with prematurity and hospitalized during the period from January 2019 to December 2019. Results: During the study period, 585 newborns were collected including 110 premature newborns (18.8%). The average gestational age was 30.4 weeks with a predominance of the age group between 28 weeks and 31.6 weeks (45%), a male predominance was noted (71% of boys).Cesarean delivery was noted in 32.5% of cases. As for maternal history: the low socio-economic level is reported in 54% of cases, the low level of education is present in 55% of cases, 55% of mothers live in rural areas. 32% of mothers are extremely old. 19% percent of mothers have a demanding job. The main causes of prematurity found were: maternal-fetal infections in 30% of cases, the medical decision was objectified in 23% of cases, twin pregnancy was present in 20% of cases. Premature rupture of the membranes was responsible for 15% of the cases. No cause was detected in 12% of cases. Respiratory distress, asphyxia and Prematurity were the main causes of transfer, representing 30%, 20% and 12% of the cases, respectively. Conclusions: In our study, several etiological factors associated with prematurity were identified. Tackling these factors is an effective way to prevent prematurity in our low-income countries.

TEST PARTICLE SIMULATIONS FOR NON-MAXWELLIAN PLASMA TRANSPORT: DISCRETIZED COLLISIONAL OPERATOR

The plasma observed in modern fusion devices is very often characterized by strongly non Maxwellian distribution function. That is the direct result of inevitable application of plasma heating techniques, such as neutral beam injection (NBI) and ion/electron cyclotron resonance frequency (ICRF/ECRF) heating, which induce the non Maxwellian fast ions. Another cause of transfer from Maxwellian to non Maxwellian is the reconnection of magnetic field lines followed by formation of magnetic resonant structures like magnetic islands and stochastic layers. One of the basic approaches used to simulate fusion plasma is test particle approach based on a solution of the equations of test particle motion. To make this approach more comprehensive one should take care of plasma particle interactions, i.e. Coulomb collisions in non Maxwellian environment. In present paper the expressions for the discretized collision operator of a general Monte Carlo equivalent form in terms of expectation values and standard deviation for an arbitrary non Maxwellian bulk distribution function are derived. The modification of transport coefficients of impurity ions caused by the transition from the background Maxwellian to non Maxwellian plasma is studied by means of this discretized collision operator. On this purpose, the set of monoenergetic neon test impurities is followed in a toroidal plasma consisting of bulk deuterons and electrons. The non Maxwellian distribution of the bulk is obtained by adding a fraction of energetic particles of the same species. It is demonstrated that a change of collision frequencies of impurities takes place in presence of this energetic fraction leading to a change of impurity neoclassical transport regime.

Prematurity: Epidemiological Profile and Risk Factors for Prematurity at the CHU Marrakech

Prematurity is the leading cause of neonatal mortality and morbidity. Objective: To study the epidemiological aspects and the etiological factors of prematurity. Material and Methods: A retrospective study about the newborn with prematurity and hospitalized in the neonatal and neonatal resuscitation department of the Mohammed VI university hospital during the period was from January 2019 to December 2019. Results: 585 newborns were collected including 110 premature newborns (18.8%). The average gestational age was 30.4 weeks, with a predominance of the age group between 28 weeks and 31.6 weeks (36%), a male predominance was noted (65%). Cesarean in 32.5% of cases. The low socio-economic level is reported in 68.2% of cases, the low level of education in 60% of cases, 55.4% of mothers live in rural areas. Pregnancies were only well followed in 38.1%. The main causes of prematurity: maternal-fetal infections in 30% of cases, the medical decision in 23% of cases, and twin pregnancy in 20% of cases. Premature rupture of the membranes was responsible for 15% of the cases. No cause was detected in 12% of cases. Respiratory distress, asphyxia and prematurity were the main causes of transfer. The associated pathologies were distress respiratory in 40% of cases, maternal-fetal infection in 30% of cases, hypotrophy in 20% of cases, and jaundice in 8% of cases. Death occurred in 40% of cases. Conclusion: Several etiological factors associated with prematurity were identified. Tackling these factors is an effective way to prevent prematurity in our low-income countries, the medical decision in 23% of cases, and twin pregnancy in 20% of cases. Premature rupture of the membranes was responsible for 15% of the cases. No cause was detected in 12% of cases. Respiratory distress, asphyxia and prematurity were the main causes of transfer. The associated pathologies were distress respiratory in 40% of cases, maternal-fetal infection in 30% of cases, hypotrophy in 20% of cases, and jaundice in 8% of cases. Death occurred in 40% of cases.

Arterial Hypertension and Diabetes Mellitus as Risk Factors in the Evolution of Patients with COVID-19

COVID-19 is one of the most relevant pathologies in recent months, becoming one of the most deadly pandemics that the world has faced; Since the detection of the first cases in Wuhan (China) until today, the evolution of those infected has been a bit unpredictable, although without a doubt comorbidities such as Diabetes Mellitus (DM) and Arterial Hypertension (HTN) have been an essential link in fatality of clinical evolutions and the main cause of transfer to intensive care units. A bibliographic analysis was carried out, using the Scielo, Scopus, EBSCO and Google Academic databases, where information was obtained from twenty-two bibliographic references in order to determine the influence of arterial hypertension and diabetes as risk factors in the evolution of patients with covid 19. Patients diagnosed with COVID-19 who have hypertension and diabetes as a personal medical history are more likely to develop complications during the course of the disease and even die. The control and isolation of these patients is of special importance, taking into account the risk posed by presenting these pathologies. The research work carried out in Cuba maintains the control and knowledge of the health personnel of the state of vulnerable patients.

Changing objects of therapeutics – how neurasthenia a ected scienti c transfer between Germany and Sweden

This paper discusses the transfer of knowledge between Germany and Sweden within the therapeutics of neurasthenia around 1900. The latter was a worldwide spread disease phenomenon and involved such a variance of symptoms that it is retrospectively considered a cultural condition that was strongly linked to medical fashions. As causes of transfer and change in therapeutics, cultural move- ments have been little explored in research so far. Based on the analysis of transfers and an evaluation of medical objects, the following text aims to show the entanglement between Germany and Sweden on both a sci- entific and societal level as well as their impact on the therapy of neur- asthenia. In the popularity of the Swedish medical treatment method of medicomechanics in Germany, this connection becomes particularly obvi- ous. The enhancements and imitations of the objects used in mechanical gymnastics represent a scientific transfer on the level of medicine, which took place in parallel with cultural trends, political changes and technological knowledge. The constant change which the objects of neurasthenia therapy were subject to, was marked by the paradoxical use of a technology-affine medicine to treat a technology-induced disease. With the rediscovery of naturopathic methods within the new body culture, however, the Zander apparatuses underwent an evolution. The Swedish objects have been adopted by users from merely medical technology into new contexts of action – for example, as tools for self-optimisation of the body.