PRESENTATION AT Research Articles

305: Acute Respiratory Failure in a Healthy Adolescent: It’s Not Always COVID-19

INTRODUCTION: During a time in which SARS-CoV-2 is endemic, it is possible to overlook other causes of acute hypoxemic respiratory failure We present the case of a teenager with a history of anxiety, depression, and PTSD who developed respiratory failure in the spring of 2020 He had recently returned from a wilderness camp in the Southwest United States, where he was exposed to caves, mice, bats, horses, and cows Upon return to the Midwest, he spent the 10 days prior to presentation living in urban parks, where he vaped tobacco and marijuana, and smoked used cigarettes METHODS: The patient was brought to the Emergency Department for 3-4 days of progressive cough and dyspnea On arrival, he was in respiratory failure requiring heated-high flow nasal cannula He was febrile to 39 7 Initial work-up was notable for a white cell count 29,000 with neutrophilia, elevated CRP, procalcitonin and D-dimer Chest xray showed diffuse reticulonodular interstitial pattern Chest CT showed bilateral nodular pleural thickening, peripheral airspace disease and ground glass opacities Antibiotics were initiated for pneumonia Initially, COVID-19 infection was considered the leading diagnosis;however, nasopharyngeal PCRs for SARS-CoV-2 were negative Given the patient's travel, a fungal pneumonia was considered, and fluconazole was started On hospital day 3, he developed worsening respiratory distress on non-invasive ventilation, so he was started on amphotericin and intubated A fungal pneumonia was still favored, but there was also concern for atypical infections, e-cigarette/vaping associated lung injury (EVALI), or other eosinophilic pneumonia He was given methylprednisone 1mg/kg Bronchoscopy demonstrated edematous-friable airways and copious brown-tinged secretions Cultures and immunologic studies were negative for infection BAL fluid notable for 31% eosinophils consistent with idiopathic eosinophilic pneumonia Steroids were continued with rapid improvement, and he was extubated 39 hours later RESULTS: This case highlights the overlapping differential of COVID-19 and other atypical pulmonary infections with EVALI and acute eosinophilic pneumonia in a patient with multiple risk factors A multidisciplinary stepwise approach to diagnosis led to diagnosis and targeted management

238: COVID-19 L-Phenotype Treatment Approach

INTRODUCTION: Although initially compared to ARDS, COVID-19 pneumonitis presents with unique features, suggesting tailored approaches may be required Gattinoni et al recently described two distinct phenotypes of COVID-19, L-type and H-type, with low or high elastance, V/Q ratio, lung weight, and recruitability, respectively METHODS: 76 F with lymphoma presented with worsening cough and fever and tested positive for COVID-19 She was saturating 93% on room air with no increased work of breathing (SpO2/FiO2 442), suggesting L-phenotype CT chest showed multifocal groundglass opacities On day 3, she developed worsening hypoxemia (SpO2/FiO2 158 3) Despite a significant drop in SpO2/FiO2 ratio, she denied subjective dyspnea and had no increased work of breathing, continuing to demonstrate L-phenotype The patient requested to avoid invasive mechanical ventilation and a timed trial of HFNC was agreed upon She received therapies as per institutional protocol, which included remdesivir, convalescent plasma, steroids, aspirin once daily, enoxaparin 40 mg twice daily, and three doses of tocilizumab Despite receiving all this, she continued to worsen, requiring 100% FiO2 HFNC A 7-day course of anakinra was started The patient continued to remain an L-phenotype with no increased work of breathing Following the first dose of anakinra, FiO2 requirements decreased significantly from 100 to 70%, and over the course of 2 weeks, she weaned to 2L NC, making a complete clinical recovery and was discharged to a long-term acute care facility for further rehabilitation RESULTS: The difference in pulmonary presentation and treatment of COVID-19 remains undetermined Our patient had severe hypoxemia with no increased work of breathing, consistent with L-phenotype Due to a high provider to patient ratio at our institution, we were able to provide a prolonged time limited trial of HFNC and avoid invasive mechanical ventilation We found the patient's respiratory status dramatically improved following anakinra The treatment of select COVID-19 patients with HFNC and anakinra may avoid invasive mechanical ventilation, preventing ventilator complications and conserving resources

Análisis perceptual del mercado energético basado en biomasa lignocelulósica de origen arbóreo en Costa Rica

En la última década, la biomasa se ha convertido en una opción de energía renovable; sin embargo, la ausencia de estudios que permitan entender su mercado limita su implementación. El presente estudio analizó la percepción de los actores que componen el mercado de la biomasa vegetal con fines energéticos desde las perspectivas de productores, intermediarios y consumidores. Se encuestaron 52 productores, 33 intermediarios y 55 demandantes de biomasa arbórea de la zona norte de Costa Rica, estudiando el mercado desde la perspectiva técnica, ambiental, financiera y social e identificando las variables que limitan el mercado. Los resultados mostraron que para los aspectos ambientales y sociales hay una similitud de percepción entre los tres sectores; sin embargo, en los aspectos financieros y técnicos existen diferencias significativas en las percepciones, específicamente en el precio de la biomasa, en la homogeneidad de esta y en los costos asociados, además de la competencia con otras fuentes de biomasa agroindustrial. Los análisis mostraron que la variabilidad de la biomasa en cuanto a presentación afecta en 40,5% del mercado, la variación de especies en 24,8%, el contenido de humedad en 10,6%, la disponibilidad de biomasa en el tiempo en 8,4%, la organización y estructuración del mercado en 8,9% y otras variables suman el restante 6,8%. Esto hace necesaria una organización en cuanto a la venta de la biomasa y la correspondiente articulación entre ofertantes y demandantes con la participación de los intermediarios para la viabilidad del mercado de biomasa en Costa Rica.

Presentación

Presentación

The National GSBPM Glossary: Methodology and Practice

This study aims to contribute to the national statistical glossary compilation, namely a glossary supporting the Generic Statistical Business Process Model (GSBPM). The GSBPM is a standard framework that allows statistical authorities to use corporate and harmonized terminology for the statistical business process. In Ukraine, the implementation of the GSBPM in statistical practice puts forward the need for its terminological support. The glossary is a means of understanding among statisticians and contributes to professional vocabulary formation. Statistical terminology today creates an independent terminological system. The system nature of statistical language is related to the professional limits and the interdependence of phenomena within these limits. As a subsystem of the general statistical system, the GSBPM has its vocabulary. We argue a complex, non-linear, and dynamic interrelation between statistical business processes in the GSBPM. The business processes form some synergy and involve professional vocabulary for different business phases, implying a non-mechanical approach to glossary compilation. According to studied international practice, there is no single approach to statistical glossaries construction and presentation. The choice of basiс international standards is crucial to ensure the GSBPM methodology and quality. We formulated several experience-based requirements and principles for the GSBPM glossary. Identified problematic issues may be useful for further work on statistical terminology. The progress in official statistics, both international and national, significantly affects this work's qualitative aspects. An essential factor in bringing national statistical language closer to international standards is undoubtedly the dialogue between the academic community and statisticians-practitioners. The development of glossaries for the General Activity Model for Statistical Organizations (GAMSO) and the Generic Statistical Information Model (GSIM) is outlined as a prospective area of further studies.

RELATIONSHIP BETWEEN NURSES WORKPLACE AND DISINFECTION IMPLEMENTATION DURING THE COVID-19 PANDEMIC

Background: Disinfection is a protocol for preventing Covid-19 infection that can be carried out by nurses. The workplace can influence nurses to carry out disinfection measures during the Covid-19 period Purpose: The study aims to determine the differences in workplaces and the implementation of disinfection in health centers, Covid-19 Non-Referral Hospitals and Covid-19 Referral Hospitals during the Covid 19 pandemic. Methods: This study is a quantitative study with a cross sectional approach. A sample of 211 respondents was taken using the snowball sampling technique. Data analysis used univariate analysis with frequency distribution presentation and bivariate analysis with Chi Square test and multivariate analysis using logistic regression. Results: Most of the nurses had good behavior in the implementation of disinfection, namely 146 people (69.2%). Then there was a difference between the workplace and the behavior in implementing disinfection with p value = 0.006. Conclusion: There is a difference between the workplace and the implementation of disinfection during the Covid-19 pandemic

Long-Standing Ulcerative Colitis and Sulphasalazine Treatment Complicated by Adult Celiac Disease

The risk of celiac disease may be increased in patients with inflammatory bowel disease (IBD), however, the precise pathogenetic mechanisms involved remain controversial. In this report, an elderly man with long-standing and extensive ulcerative colitis was treated with daily salazopyrine for over 30 years. His medication was eventually discontinued although endoscopic surveillance studies showed healed colitis with minimal inflammatory change and no dysplasia. He subsequently volunteered as an IBD control in a celiac disease research study. Endomysial and tissue transglutaminase antibodies were unexpectedly positive and a small bowel biopsy showed changes of celiac disease that later responded to a gluten-free diet. Earlier historical duodenal and ileal biopsies had been normal suggesting that changes were new, developing after cessation of the salazopyrine. This unusual presentation “unmasking” celiac disease after cessation of long-standing salazopyrine for colitis raises the potential that the drug may have acted to suppress the inflammatory process in celiac disease and may offer another alternate and inexpensive therapeutic approach.

How to…

Matthew Green of Dovecote Veterinary Referrals discusses a challenging presentation when funds are limited.

The Trend and Popular Musicality Shown in the Traditional Music Presentation at Performing Arts Market in Seoul

The Trend and Popular Musicality Shown in the Traditional Music Presentation at Performing Arts Market in Seoul

Presentation of Results Using Poly-L-Lactic Acid in the Treatment of Orofacial Harmonization

Presentation of Results Using Poly-L-Lactic Acid in the Treatment of Orofacial Harmonization

Mándame cero besos. La sesión montessoriana

El artículo analiza algunos pasajes del método montessoriano, concibiéndolo como si de una gestión del gozo (jouissance) infantil se tratara: la capitalización educativa de la compulsión a la repetición del niño va derivando sucesivamente las pulsiones de éste hacia distintas casillas, desde la presentación del material educativo como objeto supuestamente predestinado del deseo, a la obsesión por la perfección y al histerismo en la inhibición como ejercicios didácticos en poco o nada concernidos por la funcionalidad del objeto, hasta llegar al escaque vacío de la falta constitutiva del sujeto—el ejercicio del cero.

Presentation Counts—Just Ask Galileo

Presentation Counts—Just Ask Galileo

Química do Solo: produção de uma sequência didática pautada na abordagem ciência, tecnologia e sociedade

Este trabalho tem como objetivo apresentar uma proposta de sequência didática (SD) para o ensino de química do solo baseada no uso do sistema de agricultura sintrópica e investigar suas potencialidades para a abordagem das relações entre Ciência, Tecnologia e Sociedade (CTS). Com base em referenciais teóricos da abordagem de ensino CTS e em conceitos sobre química dos solos e agricultura sintrópica, teceu-se as etapas da SD. A SD foi elaborada tendo como público-alvo estudantes do segundo ano do ensino médio e foi organizada em nove etapas que contêm atividades como: apresentação e discussão de vídeos e reportagens relacionados ao tema; práticas experimentais e resolução de situação problema; cultivo de hortaliças na escola; coleta, organização e apresentação de dados do projeto. A elaboração da SD seguiu a estrutura de ensino CTS, uma vez que se inicia a proposta por meio da introdução de temática social, seguindo para discussões técnico-científicas e posterior retorno à questão inicial. Verificou-se ainda que, ao longo das principais atividades propostas na SD, vários elementos de ciência, tecnologia e sociedade, bem como suas relações, foram inseridos.

Aplicação da modelagem epidemiológica Suscetível - Infectado - Recuperado frente à ocorrência da COVID-19: uma revisão sistemática de literatura

O objetivo deste artigo é analisar, através de uma revisão sistemática de literatura, a aplicação da modelagem epidemiológica Suscetível-Infectado-Recuperado, SIR, no cenário da pandemia causada pelo SARS-CoV-2. Para isso, foi realizado um levantamento bibliográfico de produções científicas por meio da interface PubMed, a qual possui vínculo com a base de dados MEDLINE, e Biblioteca Virtual de Saúde, enfatizando achados que apresentassem alguma referência ao modelo epidemiológico SIR com comparações, aplicação à doença e críticas no contexto da COVID-19. Foram encontrados 151 documentos e após a leitura e critérios de seleção definidos, 7 artigos foram selecionados para a análise mais aprofundada da aplicação do modelo. Como resultado da coleta de dados identificou-se as seguintes categorias de análise: Público alvo, aspectos e contribuições para o entendimento da doença, modelos utilizados como referência aos artigos, avaliação e apresentação de limitações e críticas identificadas no uso desses modelos frente à COVID-19. Foi observado que não existe uma conformidade com relação ao uso de um modelo matemático mais adequado, sendo que para o modelo SIR ser utilizado, nesse contexto, foram sugeridas adaptações com a finalidade de obter um resultado mais preciso.

La astucia de la Corte Suprema de Justicia de la Nación: argumentos para el rechazo o para la declaración de certeza pretendida respecto del art. 30 del Reglamento del Senado de la Nación

El trabajo analiza el fallo de la CSJN en la causa “Fernández de Kirchner, Cristina en carácter de Presidenta del Honorable Senado de la Nación s/ acción declarativa de certeza”, del 24/04/2020. Para el autor, la decisión comentada versa sobre un debate jurídico de profunda raíz política. Por esta razón, cree que el derecho, como producto de su tiempo, ha dado un resultado positivo y acorde a las necesidades que la pandemia nos exige, receptando las imperiosas demandadas de un contexto imprevisible. Ello es así, toda vez que esta sentencia, sin comprometerse más allá de lo necesario, lo hizo de manera suficiente para facilitar el camino al Poder Legislativo y que éste cumpla su mandato constitucional, aún en las condiciones excepcionales en las que la presentación de la Presidenta del Senado fue realizada.

An Assessment of the Visual Expression Forms of the Presentation of Christ in the Temple Scene

Bizans Dönemi tasvirlerinde sıklıkla işlenen on iki yortudan biri olan “İsa’nın Mabede Takdimi” sahnesinin uygulandığı mozaikler ve farklı teknikte işlenen, on iki eserdeki betimlemeler incelendiğinde, Batı üretimi eserlerle Bizans üretimlerinde temel kompozisyonun paylaşıldığı ancak imgelemede belli farklılıkların bulunduğu görülmektedir. Aynı anda gerçekleşen iki önemli olay olan İsa’nın Simeon ile buluşması ve Meryem’in arınmasını içinde barındıran törenlerin, Doğuda ve Batıda, farklı içerik ve tarihlerde kutlandığı izlenmektedir. Doğuda Epifani’den kırk gün sonra “İsa’nın Mabede Takdimi” olarak kutlanan bayram, Batıda “Meryem’in Arınması” onuruna kutlanılmaktadır. Çalışmamız kapsamında, bu sahnenin betimlendiği eserlerden seçilen bazı örnekler incelenerek, ikonografik açıdan ortaklıklarının ve farklılıklarının saptanması amaçlanmıştır.

Nódulos do ordenhador: um relato de caso

Nódulos do ordenhador é uma dermatovirose causada por vírus da família Poxviridae, que acometem o homem e animais. Em humanos, apresenta-se em forma progressiva com lesões maculopapulares de base eritematosa passando por formato de alvo, nódulo exsudativo, regenerativo, papilomatoso e cicatricial com crosta. O estudo objetivou descrever um Relato de Caso que contribuirá para conhecimento multiprofissional de saúde nas especialidades infecto-dermatológicas que apresentem manifestações cutâneas semelhantes, a fim de ampliar diagnósticos diferenciais. Trata-se de um estudo retrospectivo, descritivo e observacional no formato de Relato de Caso de um paciente que esteve internado no Hospital de Doenças Tropicais da Universidade Federal do Tocantins (HDT-UFT), localizado no município de Araguaína -TO. Os dados foram coletados por meio de prontuário médico eletrônico e relatório dos profissionais de saúde que realizaram o atendimento, após liberação do Comitê de Ética em Pesquisa da instituição hospitalar e assinatura do Termo de Consentimento Livre e Esclarecido, autorizando a divulgação do trabalho e imagens de forma que não cause constrangimentos ao participante. O paciente apresentou manifestações de lesões clássicas na região palmar, mas com presença também no couro cabeludo e joelho, cujos testes histopatológicos não foram realizados pelas limitações do serviço hospitalar; é importante que os médicos compreendam as formas cutâneas desta doença viral, realizar o tratamento ideal e orientar medidas preventivas de infecção secundária. Deve existir um maior aprofundamento quanto à temática com implementação de medidas de controle pelos órgãos responsáveis pela fiscalização da saúde dos animais bovinos e caprinos leiteiros visando combater o contágio em humanos.

La marcación diafásica de locuciones verbales eufemísticas

Se analiza la marcación diafásica de locuciones verbales eufemísticas en el diccionario de la Real Academia Española y en el de Seco, Andrés y Ramos (2017), partiendo de datos obtenidos del Diccionario de locuciones idiomáticas del español actual (Penadés Martínez 2019a). El estudio se centra en las locuciones verbales referidas a la esfera de la muerte, un campo de interdicción lingüística que no suele estar adecuadamente tratado en los diccionarios en relación con la marca eufemístico ni en relación con otras marcas de uso. La marcación de las locuciones eufemísticas plantea estos problemas: falta de acuerdo sobre la necesidad y la posibilidad de su marcación; coincidencia parcial en la concepción del término eufemístico; escasa sistematicidad en el tratamiento lexicográfico de la marca eufemístico; desacuerdos sobre la presentación de la marca y sobre su valor; y no existencia de reflexiones teóricas sobre la combinación de eufemístico con otras marcas de registro.

M401 CHALLENGING CASES OF ASTHMATICS WITH COVID19 INFECTION

Introduction: We report 3 challenging cases of asthmatics, with COVID19, that elucidate the heterogeneity of presentation and disease progression Case Description: Our first case is a 66-year-old African American female managed on omalizumab, fluticasone furoate-vilanterol, montelukast, and tiotropium for moderate persistent asthma and allergic rhinitis She developed a fever of 102°°F, nonproductive cough, dyspnea, headache, and diarrhea Azithromycin initially improved her symptoms, but her cough and dyspnea relapsed, requiring hospital admission While inpatient, she was found to be COVID positive Management included IV hydration, hypokalemia management, and oxygenation via nasal cannula She was discharged after 9 days with all symptoms resolved save for mild to moderate dyspnea Second, we have a 47-year-old Hispanic female with allergic rhinitis and moderate persistent asthma managed on omalizumab, budesonide-formoterol, tiotropium, fluticasone, and montelukast She experienced a persistent cough, dyspnea, anosmia, ageusia, and an ongoing temperature > 100 4° °F She tested positive for COVID 19 and was started on prednisone 60 mg along with azithromycin Her dyspnea persisted so hydroxychloroquine was added to her regimen and her dyspnea resolved within 6 weeks Our final case is a 69-year Caucasian COVID19 positive female with mild persistent asthma and allergic rhinitis managed with montelukast She developed diarrhea, ear pain, anosmia, ageusia, weight loss, productive cough, and an average temperature of 101 9° °F She started azithromycin with symptom resolution by 14 days Discussion: In our experience, COVID19 infected asthmatics, with comorbid allergic rhinitis, all recovered between 14-42 days without developing pneumonia or acute respiratory distress syndrome

Athaliah and Alexandra: Gender and Queenship in Josephus

Abstract Athaliah and Alexandra were the only two women to rule as queens of Judah/Judaea in their own right and both women’s reigns are reported in Josephus’ writings. Despite their uniqueness, however, Athaliah and Alexandra are rarely compared in scholarship; the former is usually dismissed, and focus centred on the latter. This article contends that there are historical similarities between the two, but literary differences. Josephus could have referred to Athaliah or used elements of her portrayal in his presentation of Alexandra but does not, creating the impression that Alexandra was completely different to her predecessor. It may be instructive, therefore, to consider why Josephus literarily isolates the queens and what this means for his interpretation of Alexandra.