High Vigilance Research Articles

Bone resorption as a marker for delayed esophageal perforation post anterior cervical spine surgery: a retrospective analysis and call for increased vigilance.

Delayed esophageal perforation following anterior cervical spine surgery (ACSS) is a rare but serious complication. This study is to investigate the clinical characteristics, diagnostic approaches, and treatment outcomes of delayed esophageal perforation following ACSS, with a focus on the role of bone resorption around internal fixations as a potential diagnostic indicator. We retrospectively analyzed patients diagnosed with delayed esophageal perforation after ACSS from January 2010 to December 2023 and described their clinical characteristics, diagnostic approaches, and treatment outcomes. Through the analysis of the differences in the radiomics of patients, we identified the possible clinical signs of esophageal perforation and shared our experience in treating esophageal perforation. A total of five patients met our criteria. All five patients exhibited bone resorption around their internal fixations on radiography. Although bone resorption typically suggests local infection, none of the patients showed clear signs of neck skin infection, leading us to suspect esophageal perforation as the underlying cause. Further diagnostic procedures including CT, MRI, esophagography, and endoscopy were crucial for confirming the diagnosis of delayed esophageal perforation and assessing its severity. All patients underwent surgical intervention involving implant removal and esophageal repair using a sternocleidomastoid muscle flap transfer. All patients recovered and were discharged after treatment, with no recurrence of symptoms during follow-up. Delayed esophageal perforation should be considered in patients with neck pain or nonspecific symptoms after ACSS, especially with bone resorption around internal fixations. Clinicians should maintain high vigilance and use multimodal imaging and endoscopy for timely diagnosis. Our study indicates a significant link between bone resorption and delayed esophageal perforation despite the limited number of cases. Highlighting this association aims to raise awareness and encourage further research. Larger studies are needed to validate our findings, improve clinical guidelines, and ultimately enhance patient outcomes in orthopedics.

Urogenital schistosomiasis, a leading cause of bladder squamous cell carcinoma

Abstract Introduction/Objective Schistosoma, genus of trematodes, commonly known as blood flukes are parasitic flatworms responsible for a group of infections in humans termed schistosomiasis and hundreds of millions of people are infected worldwide. In areas where Shistosoma is not endemic to the region most cases of bladder malignancy are of urothelial origin. In areas where Shistosoma is endemic bladder malignancy is more commonly squamous cell carcinoma. However, with increased travel, migration and tourism it is important to potentially consider Shistosoma infection in areas that are not typically considered endemic regions. Methods/Case Report A 62-year-old male presented to our hospital and revealed through an interpreter he has had 1.5 years hematuria with “pieces of meat or brown dirt”. Cystoscopy was performed and showed a large necrotic mass. CT scan showed an 8.2 cm exophytic bladder dome mass. TURBT was performed and a diagnosis of invasive high-grade urothelial carcinoma with squamous differentiation and with multiple Schistosoma organisms identified.The patient received Schistosoma treatment and was scheduled for radical cystectomy and ileal conduct. A few days before the scheduled procedure the patient presented to our emergency department with acute abdominal pain. He was subsequently diagnosed with progressive bladder cancer with new left malignant ureteral obstruction, which lead to hydronephrosis, DVT, abdominopelvic ascites and intraperitoneal bladder perforation. Abdominal fluid cytology showed atypical keratinizing squamous cells suspicous for malignancy and marked acute inflammation. Patient underwent cystectomy with ileal conduit and the specimen was sent to pathology for examination. Results (if a Case Study enter NA) NA Conclusion Gross examination showed an irregular perforated bladder. Microscopic examination showed a high grade urothelial carcinoma with squamous and sarcomatoid differentiation with detrusor muscle invasion. Additionally, Schistosoma organisms with a terminal spine and calcified eggs were identified. Some of the calcified egg material was engulfed by giant cells. The organisms are surrounded by a prominent eosinophilic infiltrate. Lymphovascular invasion is also noted. Schistosomiasis is associated with the development of squamous cell carcinoma of the bladder. It is important to maintain high oncological alertness for squamous cell carcinoma, particularly for patients arriving from endemic areas. Such as in our case, a patient from Somalia living in Kansas City.

6794 Primary Adrenal Insufficiency Following Bilateral Adrenal Hemorrhage Secondary To Antiphospholipid Syndrome

Abstract Disclosure: M. Alameri: None. A.M. Alnuaimi: None. Y. Alabrach: None. A. Abbas: None. S. Baroud: None. M. El Khazendar: None. Introduction: Adrenal insufficiency (AI) is a rare life-threatening complication of antiphospholipid antibody syndrome (APS) accounting for 0.4% to 0.5% of Al cases. Case report: A 26-year-old female with background history of primary antiphospholipid syndrome (PAPS) presented with 3 weeks history of dull abdominal pain and fatigue. Examination revealed dehydration, orthostatic hypotension and hyperpigmented skin. Biochemistry assessment was consistent with primary adrenal insufficiency (hyponatremia 125 mol/L, hyperkalaemia 6.8 mmol/L, low random cortisol 142 mol/L, high ATCH 440 pmol/L [N 1.6-13.9], low aldosterone <1.05 ng/dL and high renin 128 ng/L [N 4-23.7]). She received 100mg hydrocortisone followed by regular IV hydrocortisone q6hrs. CT abdomen revealed bilaterally enlarged hyperdense adrenal glands suggestive of haemorrhage. Adrenal MRI confirmed subacute bilateral adrenal haemorrhage (BAH) replacing whole adrenal glands with hemosiderin depositions and calcifications without evidence of underlying tumor. Anti-21-hydroxylase antibody came back negative. She was discharged on hydrocortisone, fludrocortisone and hydroxychloroquine. Education was given for sick days rule and hydrocortisone emergency kit was provided for adrenal crisis. Discussion and conclusion: We describe a patient with APS, who developed Al due to bilateral subacute adrenal haemorrhages. Adrenal haemorrhage is rare but life-threatening complication of APS. High clinical vigilance is important to consider adrenal haemorrhage in differential diagnosis of Al, specifically in patients with known antiphospholipid antibody syndrome (APS). Presentation: 6/3/2024

Anti-seizure effects of norepinephrine-induced free fatty acid release.

The brain's ability to rapidly transition between sleep, quiet wakefulness, and states of high vigilance is remarkable. Cerebral norepinephrine (NE) plays a key role in promoting wakefulness, but how does the brain avoid neuronal hyperexcitability upon arousal? Here, we show that NE exposure results in the generation of free fatty acids (FFAs) within the plasma membrane from both astrocytes and neurons. In turn, FFAs dampen excitability by differentially modulating the activity of astrocytic and neuronal Na+, K+, ATPase. Direct application of FFA to the occipital cortex in awake, behaving mice dampened visual-evoked potential (VEP). Conversely, blocking FFA production via local application of a lipase inhibitor heightened VEP and triggered seizure-like activity. These results suggest that FFA release is a crucial step in NE signaling that safeguards against hyperexcitability. Targeting lipid-signaling pathways may offer a novel therapeutic approach for seizure prevention.

The first review on prenatal drug exposure and ocular malformation occurrence.

Even though a non-negligible portion of congenital eye anomalies has a clear genetic origin, an etiology is not found for most patients. Prenatal medication exposure is recognized to be involved in fetal malformations and several medications are specifically known to alter eye morphogenesis during embryonic development leading to congenital eye defects. We explored and reviewed the role of medications described in the genesis of ocular malformations, a role that has been little evaluated and probably still underestimated especially since several studies have shown the wide exposure of pregnant women to medication. We present our results in two sections; the first describes medications reported to be associated with ocular malformations in humans; the second details medications responsible for ocular malformations in animal models. We have summarized these results in tables, providing a relevant tool for clinicians. As most of the associations between medication exposure and congenital eye defects are either old or single case reports, this study highlights the needs for high epidemiological vigilance, accurate clinical description as well as a combination of studies on human genetics and experimental studies. Since medication exposures are potentially modifiable risk factors for congenital anomalies, this represents an important opportunity to implement preventive measures.

A Retrospective Study Establishing a Nomogram Predictive Model for Postoperative High-Activity Delirium After Non-Cardiac Surgery.

Postoperative high-activity delirium (PDHA) manifests as a high alertness, restlessness, hallucinations, and delusions. Occurrence of PDHA represents an increased risk of poor prognosis for patients. To establish and validate a nomogram prediction model for high-activity delirium after non-cardiac surgery in a post-anesthesia care unit (PACU). This study retrospectively enrolled adult patients who underwent non-cardiac surgery and were observed in the PACU as training data. Patients were divided into PDHA (199 patients) and non-PDHA (396 patients) groups. Patients' general data, preoperative indicators, intraoperative conditions, and postoperative PACU conditions were collected. The risk factors for PDHA were identified using univariate and multivariate logistic regression analyses. A predictive column chart was created using R language. Adult patients who underwent non-cardiac surgery and entered the PACU for observation were randomly selected as the validation set data (198 cases) for model performance validation. The incidence rate of adult PDHA in the PACU was 0.275%. Sex, age, smoking history, low preoperative albumin level, Society of Anesthesiologists (ASA) classification, anesthesia duration, and postoperative PACU pain score were independent risk factors for hyperactive delirium in PACU adults. In this study, an adult PACU PDHA nomogram prediction model was developed. The training dataset verified that the ROC curve (area under the curve) and 95% confidence interval (95% CI) were 0.936 (0.917-0.955). The ROC curve of the validation data row showed that the area under the curve and 95% CI were 0.926 (0.885-0.967). The nomogram predictive model for PACU adult high-activity delirium constructed in this study showed good predictive performance. This model could enable the visualization and graphical prediction of adult high-activity delirium occurrence after PACU, which has clinical value.

Tracking Vigilance Fluctuations in Real-Time: A Sliding-Window HRV-based Machine-Learning Approach.

Heart rate variability (HRV)-based machine learning models hold promise for real-world vigilance evaluation, yet their real-time applicability is limited by lengthy feature extraction times and reliance on subjective benchmarks. This study aimed to improve the objectivity and efficiency of HRV-based vigilance evaluation by associating HRV and behavior metrics through a sliding-window approach. Forty-four healthy adults underwent psychomotor vigilance tasks under both well-rested and sleep-deprived conditions, with simultaneous electrocardiogram recording. A sliding-window approach (30s length, 10s step) was used for HRV feature extraction and behavior assessment. Repeated-measures ANOVA was used to examine how HRV related to objective vigilance levels. Stability selection technique was applied for feature selection, and the vigilance ground truth-high (fastest 40%), intermediate (middle 20%), and low (slowest 40%)-were determined based on each participant's range of performance. Four machine-learning classifiers-k-nearest neighbours, support vector machine (SVM), AdaBoost, and random forest-were trained and tested using cross-validation. Fluctuated vigilance performance indicated pronounced state instability, particularly after sleep deprivation. Temporary decrements in performance were associated with a decrease in heart rate and an increase in time-domain heart rate variability. SVM achieved the best performance, with a cross-validated accuracy of 89% for binary classification of high versus low vigilance epochs. Overall accuracy dropped to 72% for three-class classification in leave-one-participant-out cross-validation, but SVM maintained a precision of 84% in identifying low-vigilance epochs. Sliding-window-based HRV metrics would effectively capture the fluctuations in vigilance during task execution, enabling more timely and accurate detection of performance decrement.

Research Progress in Examination Methods,Influencing Factors, and Drug Treatment of Vigilance

Vigilance is a sensitive ability to respond to small changes in the environment and it is a major component of various cognitive performance tasks.Professionals in a variety of fields require high physical and vigilance performance during the working process to ensure productivity,workplace safety,and their own safety. This article reviews the research progress in vigilance in terms of the examination methods,influencing factors,and drug treatment in recent years,aiming to improve the understanding of vigilance and provide support for the research on vigilance and clinical treatment of vigilance-related dysfunctions.

Anthropozoonotic parasitoses of dogs and cats in the urban ecosystem of Vladivostok, Russia

To investigate the role of domestic dogs and cats in the spread of parasitoses in the Vladivostok urban ecosystem. Biological materials from 782 dogs and 189 cats were used in the research, which were examined by methods of complete parasitological autopsy, microscopy and flotation of faecal samples using saturated solutions of zinc sulfate and sodium nitrate.Fourteen parasite taxa have been identified: nematodes (Nematoda) Ancylostoma caninum, Dirofilaria immitis, Toxascaris leonina, Toxocara canis, T. mystax, Uncinaria stenocephala, Taenia sp., T. hydatigena; tapeworms (Cestoda) Diphyllobothrium latum, Dipylidium caninum, Hydatigera taeniaeformis; flukes (Trematoda) Metagonimus sp.; and parasitic alveolates (Conoidasida) Cystoisospora sp., C. felis. The paper presents the values of the prevalence of infection and statistical reliability of their differences for different groups of animals, depending on gender and age. Nematodes were the core taxa of the parasitofauna identified. Explanations for the results obtained are offered and possible sources of human infection are described. Despite the fact that parasitic‐faunal complexes in the ecosystem of a modern city are much less branched and represented by fewer species than in the wild, there remains a high risk of human infection with zoonotic parasites in urban biocenoses due to the high level of intensive population interactions. Therefore, there is a requirement of high alertness of supervisory authorities in relation to anthropozoonotic parasitoses in an urban environment.

LASSO-derived nomogram for early identification of pediatric monogenic lupus.

Monogenic lupus is defined as systemic lupus erythematosus (SLE)/SLE-like patients with either dominantly or recessively inherited pathogenic variants in a single gene with high penetrance. However, because the clinical phenotype of monogenic SLE is extensive and overlaps with that of classical SLE, it causes a delay in diagnosis and treatment. Currently, there is a lack of early identification models for clinical practitioners to provide early clues for recognition. Our goal was to create a clinical model for the early identification of pediatric monogenic lupus, thereby facilitating early and precise diagnosis and treatment for patients. This retrospective cohort study consisted of 41 cases of monogenic lupus treated at the Department of Pediatrics at Peking Union Medical College Hospital from June 2012 to December 2022. The control group consisted of classical SLE patients recruited at a 1:2 ratio. Patients were randomly divided into a training group and a validation group at a 7:3 ratio. A logistic regression model was established based on the least absolute shrinkage and selection operator to generate the coefficient plot. The predictive ability of the model was evaluated using receiver operator characteristic curves and the area under the curve (AUC) index. A total of 41 cases of monogenic lupus patients and 82 cases of classical SLE patients were included. Among the monogenic lupus cases (with a male-to-female ratio of 1:1.05 and ages of onset ranging from birth to 15years), a total of 18 gene mutations were identified. The variables included in the coefficient plot were age of onset, recurrent infections, intracranial calcifications, growth and developmental delay, abnormal muscle tone, lymphadenopathy/hepatosplenomegaly, and chilblain-like skin rash. Our model demonstrated satisfactory diagnostic performance through internal validation, with an AUC value of 0.97 (95% confidence interval = 0.92-0.97). We summarized and analyzed the clinical characteristics of pediatric monogenic lupus and developed a predictive model for early identification by clinicians. Clinicians should exercise high vigilance for monogenic lupus when the score exceeds - 9.032299.

Watch out! High vigilance at small waterholes when alone in open trees.

An animal's environment contains many risks causing animals to scan their environment for potential predators and threats from conspecifics. How much time they invest in such vigilance depends on environmental and social factors. Most vigilance studies have been conducted in a foraging context with little known about vigilance in other contexts. Here we investigated vigilance of Gouldian finches at waterholes considering environmental and social factors. Gouldian finches are colour polymorphic with two main head colours in both sexes co-occurring in the same population, black-headed and red-headed. Data collection was done on birds sitting in trees surrounding waterholes by measuring the frequency of head movements, which reflects how frequently they change their field of view, i.e., scan different areas in their environment. A higher frequency generally reflects higher vigilance. Gouldian finches had a higher frequency of head movements when at small waterholes and when sitting in open, leafless trees. Moreover, head movements were higher when birds were alone in the tree as compared to groups of birds. Finally, birds in same head colour morph groups had a higher frequency of head movements than birds in mixed head colour groups. Results indicate heightened vigilance with increased perception of predation risk (small waterholes, open exposed perch, when alone) but that social vigilance also played a role (group composition) with particularly the aggressive red-headed birds being more vigilant when together with other red-headed birds. Future research should investigate the effect of smaller waterholes as global warming will cause smaller waterholes to become more common for longer periods of time, which can increase stress in the birds.

Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis.

The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.

The Dawn of Earthquake Prediction Research in China: A Case Study of Seismic Activity in the Tianshan Mountains

The paper adopts the Unified Earthquake Catalog of China and according to the Chen Lijun's Seismo-geothermcs and its working method, and studies the planar and three-dimensional distribution images, sequential processes, abnormal states in the last two years, the background of historical seismic activity and the influence of seismic cone tectonic environment in the Tianshan Mountains. In this paper, with reference to the author's experience in the global case study of intracrustal strong seismic activity, it is believed that the seismic geothermal anomaly of the Nantianshan seismic sub-seismic cone tectonic can be confirmed without error, so it is speculated that the intracrustal strong seismic activity of M6. 5-7 may occur in Aksu area in the next 1-2 years in the tectonic influence area, which is worthy of high vigilance and close attention. This strong earthquake prediction opinion has been verified by the M7. 1 earthquake in Aksu, Xinjiang on January 23, 2024, which deserves affirmation.

Captive birds exhibit greater foraging efficiency and vigilance after anti-predator training

Abstract Rearing animals in captivity for conservation translocation is a complex undertaking that demands interdisciplinary management tactics. The maladapted behaviors that captive animals can develop create unique problems for wildlife managers seeking to release these animals into the wild. Often, released captive animals show decreased survival due to predation and their inability to display appropriate anti-predator, vigilance, and risk-analysis behaviors. Additionally, released animals may have poor foraging skills, further increasing their vulnerability to predation. Often conservation translocation programs use anti-predator training to ameliorate these maladapted behaviors before release but find mixed results in behavioral responses. The behavioral scope of analyzing the effect of anti-predator trainings is frequently narrow; the effect of this training on an animal’s risk-analysis competency, or ability to assess the predation risk of a foraging patch and subsequently adjust its behavior, remains unstudied. Using a captive-reared passerine species, the American robin (Turdus migratorius) (46 individuals), we applied an experimental giving up density test (GUD) to analyze the effect of anti-predator training on the robins’ vigilance/risk-analysis behaviors, patch choice, and the GUD of food left behind after one foraging session. Robins moved and foraged freely between 3 foraging patches of differing predation risk before and after a hawk silhouette was presented for 1 min. Results indicate that after anti-predator training, robins displayed increased vigilance across most foraging patches and better foraging efficiency (higher vigilance and latency to forage with simultaneous lower GUD) in the safest patch. These results can have positive survival implications post-release, however, more research on this training is needed because anti-predator training has the potential to elicit indiscriminate increased vigilance to the detriment of foraging gains. Further research is required to standardize GUD’s application in translocation programs with multigenerational captive-bred animals to fully comprehend its effectiveness in identifying and correcting maladaptive behaviors. GUD tests combined with behavioral analysis should be used by conservation translocation managers to examine the need for anti-predator and foraging trainings, the effects of trainings, and a group’s suitability for release.

Cerebral air embolism: neurologic manifestations, prognosis, and outcome.

Cerebral air embolism (CAE) is an uncommon medical emergency with a potentially fatal course. We have retrospectively analyzed a set of patients treated with CAE at our comprehensive stroke center and a hyperbaric medicine center. An overview of the pathophysiology, causes, diagnosis, and treatment of CAE is provided. We retrospectively identified 11 patients with cerebral venous and arterial air emboli that highlight the diversity in etiologies, manifestations, and disease courses encountered clinically. Acute-onset stroke syndrome and a progressive impairment of consciousness were the two most common presentations in four patients each (36%). Two patients (18%) suffered from an acute-onset coma, and one (9%) was asymptomatic. Four patients (36%) were treated with hyperbaric oxygen therapy (HBTO), high-flow oxygen therapy without HBOT was started in two patients (18%), two patients (18%) were in critical care at the time of diagnosis and three (27%) received no additional treatment. CAE was fatal in five cases (46%), caused severe disability in two (18%), mild disability in three (27%), and a single patient had no lasting deficit (9%). Cerebral air embolism is a dangerous condition that necessitates high clinical vigilance. Due to its diverse presentation, the diagnosis can be missed or delayed in critically ill patients and result in long-lasting or fatal neurological complications. Preventative measures and a proper diagnostic and treatment approach reduce CAE's incidence and impact.

Tracing the Untraceables: A Joint Outbreak Investigation With Law Enforcement Using a Geographic Information System.

The application of geospatial data often allows the tracing of people who are involved in activities of an illegal nature. In June 2021, we estimated the true magnitude of the spread of COVID-19 within the networks of escort-karaoke bars in Seoul, Republic of Korea, using geographic information system (GIS)-based contact tracing that was applied to our epidemiological investigation. Our joint rapid response team, composed of epidemic investigation officers and police personnel, identified 19 paper-traced cases and 158 GIS-traced cases from 5,692 confirmed cases in Seoul during the study period (June to July 2021). Our findings suggest that collaboration with law enforcement agencies and the use of overlaid satellite imagery in outbreak investigations enhances high vigilance and reduces the risk of potential breaches of human rights in the process.

A Narrative Review of Neurological Complications of SARS-CoV-2 Vaccination

AbstractAdverse reactions to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine depict a tropism for neural structures. This narrative review was aimed to discuss published data on the spectrum of neurological side effects of SARS-CoV-2 vaccines, which were accorded emergency use authorization. The majority of the neurological manifestations of SARS-CoV-2 vaccination are usually mild, brief, self-limiting, and easily manageable. Rarely, these side effects can be of serious nature and require hospitalization. High vigilance helps in early identification and treatment of these complications leading to good outcomes. The reported incidence of neurological complications in vaccinated population is a miniscule, and the overall benefits of the vaccine outweigh the risks of side effects. However, it is crucial to conduct larger collaborative multicenter studies to prove or reject the causal association between the SARS-CoV-2 vaccines and the postvaccination neurological side effects. Herein, we have tried to summarize the various neurological manifestations related to SARS-CoV-2 vaccines published in the literature from 2021 to mid-2023.

Dengue fever coinfection in COVID-19 era: A public health concern.

Dengue and SARS-CoV-2 coinfection is commonly encountered and constantly reported in particularly the dengue-endemic regions thus posing a co-epidemic threat. Coinfection is also significantly associated with morbidity and mortality. Comorbidity risk during a coinfection is of a greater concern. Although the pathophysiologies of the two infections vary, their identical clinical symptoms during coinfection result in diagnostic and therapeutic complexities. A literature search for the current relevant reports was carried out. The searched databases were Scopus, PubMed, Google Scholar and the Web of Science, with health agencies like the WHO. Based on the selection criteria, the most recent and pertinent reports published in English language were included for the ease of understanding, deciphering and analysing the secondary data. A delay in proper diagnosis of coinfection could result in serious complications with poor patient outcome. Whether it is a standalone dengue or COVID-19 infection or a coinfection, specific biomarkers may be utilized for its foolproof diagnosis. This article highlights the various diagnostic techniques and immune responses from the perspective of prompt and appropriate public health management for patients suffering from COVID-19 and dengue viral coinfections, both being independently or collectively capable of damaging a human body. As coinfection poses significantly large burden on an already-fragile healthcare facility, constant monitoring of a coinfected patient is needed for prompt and suitable therapeutics. Also, to maintain high vigilance and invoke appropriate preventive measures particularly in dengue endemic regions, the government, healthcare authority and the general public need to collaborate and cooperate.

Perioperative management of a double valve replacement and coronary artery bypass graft in a patient with carcinoid syndrome; a case report and literature review

Introduction Carcinoid tumors are rare neuroendocrine tumors; about 5% of patients develop the carcinoid syndrome. We present the case of a patient with carcinoid syndrome undergoing cardiac surgery. Case report A 74-year-old patient with carcinoid heart disease and hepatic metastases underwent double valve replacement and CABG. The patient was on octreotide therapy and antihypertensive medication. An octreotide infusion was commenced perioperatively. Pharmaceutical agents that could potentially precipitate histamine release or exacerbate catecholamine secretion and carcinoid crises were avoided. Postoperatively, recovery was complicated by atrial fibrillation, chest infection, pleural effusions, acute kidney injury and delirium. Discussion Hepatic metastases cause systemic hormones’ secretion, which cause a carcinoid crisis. Perioperative administration of octreotide is used, while vigilance is required to differentiate between hemodynamic effects related to the operation or disease specific factors. Conclusion No carcinoid crisis was evident perioperatively. High vigilance with appropriate monitoring, aggressive management combined with meticulous choice of pharmaceutical agents led to this outcome.

The Role of Emotional Intelligence in Making Successful Financial Decisions

Emotional intelligence (EI) as the ability for self-analysis, self-motivation, and self-regulation is necessary in the process of financial activity. It ensures informed decision-making, considering consequences and perspectives. The aim is to identify the influence of emotional intelligence on the effectiveness of decision-making by financiers. The following tests were used: EQ (Emotional/Empathy Quotient) test, Melbourne Decision Making Questionnaire, the Rathus Assertiveness Schedule, the Schubert Risk Propensity Test. Statistical processing of the results included the use of descriptive analysis, ANOVA, and regression analysis. The study found that financial workers with a high level of emotional intelligence have a pronounced “vigilance” decision-making style (F=113.4, p≤0.01), high assertiveness (F=103.3, p≤0.01), and risk propensity (F=137.3, p≤0.01). It was proved that emotional intelligence explains the “vigilance” decision-making style (β=0.943, R²=0.572), risk propensity (β=0.896, R²=0.424) and explains 48% of assertiveness (β=0.945, R²=0.483). It was confirmed that emotional intelligence is a predictor of successful financial decisions, it determines high assertiveness, vigilance, and risk propensity. Such results are useful for the development of training and retraining programmes for financiers. At the same time, including the development of assertiveness and risk propensity in professional and corporate training in parallel with the development of EI will give greater chances for the success of financial decisions. The obtained results are important for the financial and economic sphere, as they prove the effectiveness of EI in decision-making. This contributes to the improvement of the system of training competitive financiers and allows to expand aspects of the study of financial success.