ABSTRACT Objective: This study was conducted to investigate the distribution of placental villous vessels in pregnant women with different degrees of hyperglycemia. Methods: A cross-sectional study was performed using placental samples from 30 pregnant women without diabetes (n=10), with gestational diabetes mellitus (n=10), and with previous diabetes (type 1 and type 2 diabetes; n=10). Maternal glycemic control was evaluated using the glycemic mean and glycated hemoglobin levels. Placental samples were obtained during elective cesarean sections and processed for villous vessel analysis using immunohistochemistry for Von Willebrand factor. Vessels within 10μm of the villus margin were classified as peripheral, and vessels at a distance greater than 10μm were classified as central. The number, area, and perimeter of all vessels were evaluated, and the relationship between vessel area and total area of placental villus was calculated. Results: Pregnant women with gestational diabetes mellitus and those with previous diabetes had higher glycated hemoglobin levels. The number of vessels was reduced in the villi of the previous Diabetes Group owing to peripheral reduction. Additionally, the area, perimeter, and percentage of peripheral blood were lower in the previous Diabetes Group than in the Non-Diabetic Group. Conclusion: Maternal glycemic levels can modify placental capillary distribution. Objective hyperglycemia Methods crosssectional cross sectional 3 n=10, n10 n n=10 , 10 (n=10) n=10. . n=10) factor μm central calculated Results reduction Additionally NonDiabetic Non Diabetic Conclusion n1 n=1 (n=10 n= (n=1 (n= (n

ABSTRACT Objective: Tofacitinib, an oral Janus kinase inhibitor, has been tested against a placebo in 289 patients with COVID-19 pneumonia. We analyzed the data from the tofacitinib- and placebo-treated patient cohorts to evaluate the laboratory profiles between baseline and day 7. Methods: We performed post hoc analyses on the following laboratory tests over time during the first 7 days after randomization: hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, alanine aminotransferase, and aspartate aminotransferase. Results: Through the first 7 days after randomization, the levels of hemoglobin, white blood cells, neutrophils, and platelet counts were not significantly different between patients treated with tofacitinib or a placebo (all p>0.05). Non-significant differences were observed in aspartate aminotransferase levels over time between treatment groups, whereas alanine aminotransferase levels (U/L) were higher among tofacitinib-treated patients compared to placebo-treated patients (mean ratio, 1.30 [95% confidence interval (95%CI) = 1.14–1.48; p<0.01)]. Conclusion: In patients with COVID-19 pneumonia, the use of tofacitinib compared to placebo did not result in clinically meaningful changes in blood counts or liver enzymes over the first 7 days after randomization. Registry of Clinical Trials: NCT04469114 Objective Tofacitinib inhibitor 28 COVID19 COVID 19 COVID-1 pneumonia placebotreated Methods randomization hemoglobin leukocytes neutrophils lymphocytes platelets Results cells all p>0.05. p005 p p>0.05 . 0 05 p>0.05) Nonsignificant Non significant groups U/L UL U L (U/L tofacitinibtreated mean ratio 130 1 30 1.3 95% 95 [95 95%CI 95CI CI (95%CI 1.14–1.48 114148 14 48 p<0.01. p001 p<0.01 01 p<0.01)] Conclusion Trials NCT NCT0446911 2 COVID1 COVID- p00 p>0.0 13 3 1. 9 [9 1.14–1.4 11414 4 p<0.0 p<0.01) NCT044691 p0 p>0. [ 1.14–1. 1141 p<0. NCT04469 p>0 1.14–1 114 p<0 NCT0446 p> 1.14– 11 p< NCT044 1.14 NCT04 1.1 NCT0

ABSTRACT Major liver resections require extensive margins. Occasionally, insufficient parenchyma is available after surgery to maintain liver function. In such cases, vascular embolization in the affected lobe is necessary to induce contralateral lobe hypertrophy. We present a case of embolization of the right portal and hepatic veins prior to intrahepatic cholangiocarcinoma resection. Embolization was performed because of insufficient residual parenchyma on imaging studies. The patient recovered well with no signs of liver failure, and remains in remission at 3 years postoperatively. Knowledge of the use of this technique in association with surgical resection can reduce postoperative complications and allow the removal of larger tumors than those previously considered borderline. margins Occasionally function cases hypertrophy studies failure postoperatively borderline

ABSTRACT Objective: To assess whether post-discharge telemonitoring reduces hospital readmission in patients participating in the diabetes care program. Methods: This retrospective cohort study was conducted from June 2021 to December 2022 and included patients who were enrolled in the Diabetes Program under a hyperglycemia treatment protocol and eligible for post-discharge telemonitoring. The variables included age, sex, diagnosis, hospital stay, LACE Score, and readmission rate. Results: Among 165 patients who underwent telemonitoring, significant differences emerged in hospital readmission rates between those with and without telemonitoring (p=0.015), with a 15.4% lower readmission rate in the telemonitoring group (95%CI= 3.0-27.9%). Subgroup analyses revealed higher readmission rates in men without telemonitoring (15.2% difference; 95%CI= 0.4-30.0%; p=0.045), and in age groups ≤60 and ≥75 years without telemonitoring (24.2% difference; 95%CI= 4.5-43.9%; p=0.016 for ≤60 years; 37.1% difference; 95%CI= 9.9% to 64.2%; p=0.007 for ≥75 years). Additionally, patients with prolonged hospital stays (>7 days) without telemonitoring had higher readmission rates (19.5% difference; 95%CI= 4.5%-34.5%; p=0.011). Conclusion: This study suggests that post-discharge telemonitoring can effectively lower hospital readmission rates in diabetes management programs, potentially offering improved health outcomes, cost savings, and enhanced healthcare delivery to patients. Objective postdischarge post discharge program Methods 202 sex diagnosis stay Score Results 16 p=0.015, p0015 p p=0.015 , 0 015 (p=0.015) 154 15 4 15.4 95CI CI 95 (95%CI 3.027.9%. 30279 3.0 27.9% . 3 27 9 3.0-27.9%) 15.2% 152 2 (15.2 difference 95%CI 0.430.0% 04300 0.4 30.0% 30 0.4-30.0% p=0.045, p0045 p=0.045 045 p=0.045) 60 ≤6 75 ≥7 24.2% 242 24 (24.2 4.543.9% 45439 4.5 43.9% 5 43 4.5-43.9% p0016 016 p=0.01 371 37 1 37.1 99 9.9 64.2% 642 64 p0007 007 p=0.00 years. years) Additionally >7 7 (> days 19.5% 195 19 (19.5 4.5%34.5% 45345 4.5% 34.5% 34 4.5%-34.5% p=0.011. p0011 p=0.011 011 p=0.011) Conclusion programs outcomes savings 20 p001 01 (p=0.015 15. 027 3.027.9% 3027 3. 279 27.9 3.0-27.9% 15.2 (15. 430 0.430.0 0430 04 0. 300 30.0 0.4-30.0 p004 p=0.04 6 ≤ ≥ 24.2 (24. 543 4.543.9 4543 45 4. 439 43.9 4.5-43.9 p=0.0 37. 9. 64.2 p000 00 > ( 19.5 (19. 4.5%34.5 4534 345 34.5 4.5%-34.5 p00 (p=0.01 02 3.027.9 302 27. 3.0-27.9 (15 0.430. 043 30. 0.4-30. 24. (24 54 4.543. 454 43. 4.5-43. p=0. 64. 19. (19 4.5%34. 453 34. 4.5%-34. p0 (p=0.0 3.027. 3.0-27. (1 0.430 0.4-30 (2 4.543 4.5-43 p=0 4.5%34 4.5%-34 (p=0. 3.027 3.0-27 0.43 0.4-3 4.54 4.5-4 p= 4.5%3 4.5%-3 (p=0 3.02 3.0-2 0.4- 4.5- 4.5%- (p= 3.0- (p

ABSTRACT Objective This study aimed to analyze the relationship between the participation of professionals in simulation-based training and an increase in the rate of vaginal deliveries. Methods This retrospective observational study analyzed professionals’ participation in high-fidelity simulation training during the pilot phase of the Appropriate Delivery Project, spanning from May 21, 2015 to May 21, 2016, along with the rates of vaginal deliveries across various hospitals. Data for participation by nurses and physicians were examined using a gamma distribution model to discern the predictors influencing the changes in the percentage of vaginal births. Results Data from 27 hospitals involved in the project were analyzed. A total of 339 healthcare professionals, including 147 nurses and 192 doctors, underwent the simulation-based training. During the pilot test, the percentage of vaginal births increased from 27.8% to 36.1%, which further increased to 39.8% in the post-intervention period, particularly when the participation rate of nurses exceeded the median. Conclusion This study suggests that simulation-based training is a valuable strategy for achieving positive changes in obstetric practice, specifically an increase in the rate of vaginal births. These findings underscore the potential advantages of incorporating simulation training into improvement initiatives, as evidenced by the correlation between higher training adoption rates and substantial and sustained enhancements in vaginal birth rates. simulationbased based highfidelity high fidelity Project 21 201 2016 2 33 14 19 doctors test 278 8 27.8 361 36 1 36.1% 398 39 39.8 postintervention post intervention period median practice initiatives 20 3 27. 36.1 39. 36.

ABSTRACT Objective Simulation plays an important role in cardiopulmonary resuscitation training. Comparing postsimulation debriefing with rapid cycle deliberate practice could help determine the best simulation strategy for pediatric cardiopulmonary resuscitation training among pediatric residents. Methods This is a single-blind, prospective, randomized controlled study. First- and second year pediatric residents were enrolled and randomized into two groups (1:1 ratio): rapid cycle deliberate practice group (intervention) or postsimulation debriefing group (control). They participated in two rounds of simulated pediatric cardiopulmonary arrest to assess the simulated pediatric cardiopulmonary resuscitation performance gain (round 1) and retention after a 5-6 week washout period (round 2). Scenarios were video-recorded and analyzed by blinded evaluators. The main outcome was the time to initiation of chest compressions. Secondary outcomes included time to recognize a cardiopulmonary arrest, time to recognize a shockable rhythm, time to defibrillation, time to initiation of chest compressions after defibrillation, and chest compression fraction. Results Sixteen groups participated in the first round and fifteen groups in the second one. Time to intiation of chest compressions decreased from preintervention scenario to the round 1 testing scenario and increased from round 1 to round 2 testing scenario. However, no interaction effects nor group effects were observed (p=0.885 and p=0.329, respectively). There were no significant differences between the two groups regarding the secondary outcomes. Conclusion Despite an overall improvement in simulated pediatric cardiopulmonary resuscitation performance, we did not observe significant differences between the two groups regarding the analyzed variables. The decline in simulated pediatric cardiopulmonary resuscitation performance after 5 weeks suggests the need for shorter time intervals between training sessions. singleblind, singleblind single blind, blind single-blind prospective study First 11 (1: ratio ratio) intervention (intervention control. control . (control) 56 6 5- 2. 2) videorecorded video recorded evaluators rhythm defibrillation fraction one However p=0.885 p0885 p 0 885 (p=0.88 p0329 329 p=0.329 respectively. respectively respectively) variables sessions (1 (control p=0.88 p088 88 (p=0.8 p032 32 p=0.32 ( p=0.8 p08 8 (p=0. p03 3 p=0.3 p=0. p0 (p=0 p=0 (p= p= (p

ABSTRACT Circulatory shock is a common fatal condition. Despite this, information on this syndrome in the current medical literature is fragmented and esoteric. Adherence to each basic element of care can have a profound impact on patient outcomes. Disturbances in pumping (cardiogenic), content/container relationship (hypovolemic and vasoplegic), or blockage in blood circulation (obstructive) can induce tissue hypoperfusion, causing hemodynamic shock. If not quickly reversed, hypoperfusion progresses to irreversible multi-organ failure. The course can be fatal even before reaching this stage in cases of obstructive and anaphylactic shock in which the therapeutic window may last for only a few minutes. Thus, it is essential to conduct a joint analysis of clinical data and routine diagnostic tests to infer the probable cause of shock and avoid delays in the diagnosis of diseases that can deteriorate quickly. Point-of-care ultrasonography and echocardiography are the most valuable non-invasive diagnostic tools. Although lactate-guided management has proven to be effective, the use of capillary refill time, other biochemical markers of perfusion, and preload-directed resuscitation have the potential to avoid volume overload and improve outcomes. Faster intravenous fluid infusion and early use of vasopressors have a strong rational appeal. However, in hemorrhagic shock, finding a balance between avoiding excessive crystalloid administration and maintaining adequate perfusion pressure until hemostasis is achieved remains challenging. This review provides an accessible description of bedside management of shock, including the treatment of the main causes. The most relevant information has been organized into tables for quick reference. condition esoteric outcomes cardiogenic, cardiogenic , (cardiogenic) contentcontainer content container hypovolemic vasoplegic, vasoplegic vasoplegic) (obstructive reversed multiorgan multi organ failure minutes Thus Pointofcare Point noninvasive non invasive tools lactateguided lactate guided effective time preloaddirected preload directed appeal However challenging causes reference (cardiogenic

ABSTRACT Objective: Hand reanimation for finger flexion in patients with total paralysis remains a reconstructive challenge, especially when tendon transfers or neurological reconstruction options are no longer viable. This study aimed to describe a series of patients without hand function by evaluating two hand reanimation techniques. Methods: This observational retrospective study used a case series of hand reanimation. Two techniques were performed-functional free gracilis muscle transfer with microsurgical reconstruction, and transfer of the recovered biceps to the flexor digitorum profundus and flexor pollicis longus with tendon graft augmentation. The two groups, each undergoing one of the techniques, were evaluated for the final functional results using the British Medical Research Council (BMRC) grading system. Results: Six consecutive patients with total hand paralysis were included, with a mean final follow-up of 7.5 years. After intervention, two patients, one from each technique group, achieved a BMRC grade 2. In the group where tendon transfer of the biceps to the finger flexors was performed, two patients achieved a BMRC grade 3. Additionally, two patients who underwent functional free muscle transfer were achieved a BMRC grade 4. Conclusion: The transfer of biceps to the finger flexors using tendon grafts, which involves fewer technical difficulties and reduced demands from the surgical team compared to functional free muscle transfer, is a viable alternative for treating patients requiring hand reanimation. However, functional free muscle transfer is recommended as the first option when technically feasible and adequate donor nerves are available, due to its potential for achieving greater final muscular strength in the finger flexors. Reconstructive microsurgeons can use both techniques as viable surgical options for hand reanimation. Objective challenge Methods performedfunctional performed augmentation groups (BMRC system Results included followup follow up 75 7 5 7. years intervention 2 3 Additionally 4 Conclusion grafts However available

ABSTRACT Extracorporeal cardiopulmonary resuscitation is a method of cardiopulmonary resuscitation that uses extracorporeal membrane oxygenation with conventional cardiopulmonary resuscitation and has emerged as a promising intervention for patients with refractory cardiac arrest. This report describes the case of a 44-year-old man at significant risk for mortality according to his high RESCUE-IHCA Score who was awaiting heart transplantation and experienced in-hospital cardiac arrest during hemodialysis. Prompt recognition, immediate activation of the extracorporeal membrane oxygenation team, and initiation of support within 60 minutes contributed to a favorable outcome. This case emphasizes important considerations associated with extracorporeal cardiopulmonary resuscitation implementation, including optimal patient selection, intervention timing, and nuances of cannulation procedures. Continuous monitoring, involvement of a specialized extracorporeal membrane oxygenation team, recognition of extracorporeal membrane oxygenation as bridge therapy, and integration of extracorporeal membrane oxygenation with definitive treatment strategies are highlighted. Extracorporeal cardiopulmonary resuscitation is a vital intervention for patients with refractory cardiac arrest, and adequate patient selection and swift implementation are crucial to improving outcomes. A comprehensive review of extracorporeal cardiopulmonary resuscitation is also presented to highlight its efficacy and challenges associated with in-hospital cardiac arrest. 44yearold yearold 44 year old RESCUEIHCA RESCUE IHCA inhospital in hospital hemodialysis team 6 outcome timing procedures monitoring therapy highlighted outcomes 4

ABSTRACT Objective: To determine the prevalence and factors associated with herbal medicinal product use among primary healthcare patients in southeastern Brazil. Methods: A cross-sectional study combined with documentary research was conducted between August and November 2017, involving interviews with 1,221 adults following dispensing from primary healthcare units. The characterization of herbal medicinal product usage included assessing the prevalence, redundancy, and interaction indicators, as well as identifying sources of recommendation and acquisition. Descriptive statistics were used for variable analysis and logistic regression was used to estimate the factors associated with herbal medicinal product usage, calculating odds ratios at a significance level of 5%. Results: The prevalence of herbal medicinal product usage was 3.8%, with 60% of them prescribed by physicians. Private pharmacies (53%) were the main sources, and Valeriana officinalis (42%) was the most cited plant species and the sole herbal medicinal product on the municipal list. The indicators of redundancy and interactions between concurrently prescribed pharmaceutical and herbal medicinal products were 42.9% and 28.6%, respectively. Herbal medicinal products usage correlated with the female sex (OR= 2.50; 95%CI= 1.11-5.59), non-white race (OR= 0.52; 95%CI= 0.28-0.94), monthly income above 1 minimum wage (OR= 3.48; 95%CI= 1.51-8.01), and self-reported of anxiety, mood disorder or depression (OR= 2.97; 95%CI= 1.55-5.66). Conclusion: Despite the low use of herbal medicinal products, users face a high potential for interactions and therapeutic redundancy. Special attention should be paid to patients taking herbal medicinal products and allopathic medicines concurrently. Women with anxiety, mood disorders, or depression were more likely to use herbal medicinal products, whereas non-white people were 48% less likely to use them, suggesting potential socioeconomic disparities in access. Objective Brazil Methods crosssectional cross sectional 2017 1221 221 1,22 units acquisition 5 5% Results 38 3 8 3.8% 60 physicians 53% 53 (53% 42% 42 (42% list 429 9 42.9 286 28 6 28.6% respectively OR= OR (OR 2.50 250 2 50 95CI CI 95 95%CI 1.115.59, 111559 1.11 5.59 , 11 59 1.11-5.59) nonwhite non white 0.52 052 0 52 0.280.94, 028094 0.28 0.94 94 0.28-0.94) 3.48 348 48 1.518.01, 151801 1.51 8.01 51 01 1.51-8.01) selfreported self reported anxiety 2.97 297 97 1.555.66. 155566 1.55 5.66 . 55 66 1.55-5.66) Conclusion disorders access 201 122 22 1,2 3.8 (53 4 (42 42. 28.6 2.5 25 115 1.115.59 11155 111 1.1 559 5.5 1.11-5.59 0.5 05 280 0.280.94 02809 028 0.2 094 0.9 0.28-0.94 3.4 34 518 1.518.01 15180 151 1.5 801 8.0 1.51-8.01 2.9 29 555 1.555.66 15556 155 566 5.6 1.55-5.66 20 12 1, 3. (5 (4 28. 2. 1.115.5 1115 1. 5. 1.11-5.5 0. 0.280.9 0280 02 09 0.28-0.9 1.518.0 1518 15 80 8. 1.51-8.0 1.555.6 1555 56 1.55-5.6 ( 1.115. 1.11-5. 0.280. 0.28-0. 1.518. 1.51-8. 1.555. 1.55-5. 1.115 1.11-5 0.280 0.28-0 1.518 1.51-8 1.555 1.55-5 1.11- 0.28- 1.51- 1.55-