The power of feedback.

Cause, conseguenze e strategie di mitigazione Proponiamo il primo di una serie di articoli in cui affronteremo l’attuale problema dei mutamenti climatici. Presentiamo il documento redatto, votato e pubblicato dall’Ipcc - Comitato intergovernativo sui cambiamenti climatici - che illustra la sintesi delle ricerche svolte su questo tema rilevante.

/pdf/climate-change-2007-the-physical-science-basis-1x93ttz9jt.pdf

Climate Change 2007: The Physical Science Basis.

2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture or erosion. However, the disease is chronic, most often progressive, and hence serious, even in clinically apparently silent periods. The dynamic nature of the CAD process results in various clinical presentations, which can be conveniently categorized as either acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). The Guidelines presented here refer to the management of patients with CCS. The natural history of CCS is illustrated in Figure 1.

/pdf/2019-esc-guidelines-for-the-diagnosis-and-management-of-5b7mv2v506.pdf

2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.

The talk with present the key results of the IPCC Working Group III 5th assessment report. Concluding four years of intense scientific collaboration by hundreds of authors from around the world, the report responds to the request of the world's governments for a comprehensive, objective and policy neutral assessment of the current scientific knowledge on mitigating climate change. The report has been extensively reviewed by experts and governments to ensure quality and comprehensiveness.

Climate change 2014 - Mitigation of climate change

A prospective randomised controlled double-blind study to compare between auscultation and lung ultrasonography to assess position of double lumen tube in elective thoracic surgeries involving one lung ventilation at tertiary care cancer institute

- For the repair of a crack in thin aluminium sheets, polymer composite patching is one of the better repair techniques. During service, when the load acts, the patch separates from the substrate due to the stresses developed at the interface. This separation of the patch from the substrate largely depends on the geometrical factors of the patch, i.e

Taguchi Optimization of Geometrical Factors of a Polymer Composite Patch in Crack Repair

Background: Clinical guidelines recommend risk stratification of non-ST elevation acute coronary syndrome (NST-ACS) using the GRACE risk score. However, the GRACE risk score is not followed widely in clinical practice due to various reasons. Our primary objectives of this study were to correlate the presenting electrocardiogram (ECG) of NST-ACS with coronary angiography (CAG) findings and to identify specific ECG changes that are suggestive of severe coronary artery disease (CAD) thus helping to triage all patients with NST-ACS. Materials and Methods: This prospective observational study was undertaken on patients diagnosed with NST-ACS in a medical college hospital, in Northern India over one and a ½ years. The admission ECG of the patients was compared with CAG findings to find out the correlation between the two with respect to severity of CAD. Categorical and quantitative variables were compared using the Chi-square test and independent t-test, respectively. Odds ratio (OR) were calculated using the univariate logistic regression analysis. Results: On comparing the two groups with normal and abnormal ECG, we found that smokers had significantly higher odds of having an abnormal ECG (OR 3.31; 95% confidence interval [CI] [1.29–8.50]). Patients with an abnormal ECG had significantly lower left ventricular ejection fraction compared to those with normal ECG (52.01 ± 10.56 vs. 55.96 ± 6.13%, P = 0.045). The patients with severe CAD on CAG had significantly higher odds of abnormal ECG (OR 3.68, 95% CI [1.2311.04]). Of the specific ECG abnormalities, ST depression and T-wave inversion in same or different leads were significantly associated with severity of CAD (OR 0.13, 95% CI [0.04–0.43], P = 0.001 and OR 0.13, 95% CI [0.03–0.46], P = 0.002, respectively). Conclusion: The identification of ECG changes suggestive of high-risk CAD can dictate to transfer such patients without delay to a percutaneous coronary intervention capable hospital for urgent CAG with intent to revascularization, thus helping in risk stratification of NST-ACS at the community level.

The Role of 12-Lead Electrocardiogram in the Risk Stratification of Non-St Elevation Acute Coronary Syndrome and the Correlation with Coronary Angiography - The CINCHONA Study - A Prospective Cohort Study in Northern India

Background: To determine the efficacy of the current WHO-MDT and U-MDT regimen with regard to relapse rate and acceptability of the patients and to compare both regimen in pauci and multi bacillary cases.Methods: Total of 106 leprosy patients aged between 14-60 years attending department of Dermatology, Venerology and Leprosy at RIMS, Ranchi between May 2011 and October 2012 were included in the study and they were allocated alternatively into two groups, U-MDT and WHO-MDT. Patients were followed up for 12 to 18 months for periodic clinical, bacteriological and histopathological assessment.Results: In histopathological assessment of PB cases, after 6, 12 and 18 months, UPB group showed 91%, 100% and 100% improvement as compared to 77.5%, 86.5% and 95.2% in WPB group. Among multi bacillary cases, after 12 months 32% of UMB group of patients became smear negative whereas in WMB group 48% became smear negative. In histopathological assessment after 12 months, in UMB group, 94% patients showed good improvement whereas in WMB group only 77% patients showed good improvement. After 18 months, in UMB group, 50% patients deteriorated and showed poor improvement whereas almost 100% patients showed good improvements in WMB group.Conclusions: In conclusion, U-MDT was observed to be an effective and useful regimen to treat PB patients of leprosy, but in MB patients it was not found to be very effective regimen when compared to WHO-MDT of 12 months duration. Mere acceptability factor of the U-MDT regimen cannot be sufficient for its routine implementation in the general health service.

Prashant Kumar

Papers

A prospective randomised controlled double-blind study to compare between auscultation and lung ultrasonography to assess position of double lumen tube in elective thoracic surgeries involving one lung ventilation at tertiary care cancer institute

Taguchi Optimization of Geometrical Factors of a Polymer Composite Patch in Crack Repair

The Role of 12-Lead Electrocardiogram in the Risk Stratification of Non-St Elevation Acute Coronary Syndrome and the Correlation with Coronary Angiography - The CINCHONA Study - A Prospective Cohort Study in Northern India

Comparative study of uniform-MDT and WHO-MDT in pauci and multi bacillary leprosy patients over 18 months of observation

Assessment of heart sounds as predictors of rehospitalizations using a noninvasive multiple sensor monitoring device