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Healthcare is realizing the importance of health information technology - its applications and devices in play today. Advancing healthcare best practices will rely on up to date data and analysis to provide the most effective forms of therapy. Healthcare is becoming more reliant on patients who are engaging in their own healthcare. With this we are seeing an increase in available health related apps for these devices. This summary reviews various connected health strategies using proven apps and devices to improving the quality of care, promoting patient engagement, and improving outcomes. Here we discuss several trends and the healthcare delivery implications.

A 64-year-old woman was referred to our hospital due to progressive dypnoea for the past week, combined with fever and type 1 respiratory failure. White blood cell count and procalcitonin level were normal. The Chest X-ray showed bilateral disseminated pulmonary infiltrates. Within the next 24 hours the patient developed a severe ARDS. A first diagnostic work-up for typical and atypical pathogens as well as serological tests for CMV, RSV, HIV and HSV were negative. Analysis of a second bronchoalveolar lavage fluid revealed Pneumocystis jiroveci DNA. The patient was successfully treated with trimethoprim-sulfamethoxazole and off label use with caspofungin. The cause of the infection was a six week treatment with dexamethasone. The patient developed a toxic epidermal necrolysis during further course, but completely recovered. Pneumonia with Pneumocystis jirovecii must also be taken into account in non-HIV patients, whenever there are any indications that cellular immunity may be depressed.

Introduction: Hypertensive crisis (HC) is recognized consequence of inadequate blood pressure (BP) control. A hypertensive crisis is further divided into hypertensive emergency (HT-E) and hypertensive urgency (HT-U). Method: Using a cross-sectional hospital-based study design, patients who had been diagnosed as having HC between January and October 2017 were consecutively recruited in the study. The criteria proposed by the Seventh Joint National Committee were used for the definition of HC. Result: A total of 81 (.81%) patients newly diagnosed as having HC were enrolled in the study. Of these patients, 50 (61.7 %) patients met criteria for HT-E, while 31 (38.3%) patients had HT-U. Renal impairment (16%), stroke (30.8%), acute coronary syndrome (13.6%) and heart failure (22.2%) were predominant complications associated with HT-E. Out of 81 study subjects, 13 (16%) patients died. Although there was no significant difference in residence, history of smoking, Diabetes mellitus and history of alcohol consumption between groups, old age (P=.o22), male gender(.046), history of hypertension(.007), history of non-governmental employee(.003), poor compliance (p=.002) and high case fatality rate (p=.041) were significantly associated with hypertensive emergency (HT-E). Conclusion: This study showed that HT-E has high case fatality rate among patients admitted with hypertensive crisis at kassala teaching Hospital. Therefore early detection of hypertension and appropriate management are the main stay for reducing morbidity and mortality among patients with hypertensive crisis.

The Uranium extraction and processing plant of INB (Brazilian Nuclear Industries) is in Caetité, a city located in a region hosting the largest Uranium reserve of the country. The degree of Uranium contamination in the Caetité population was investigated before using teeth as bioindicator, where a quite high Uranium concentration was measured in this region, about 160 times higher than the world-wide average. Radiobiological risks are here evaluated from Uranium burdens in organs as skeleton, kidneys, liver, tissues and blood, which were estimated from transfer coefficients and effective internal doses. This was accomplished by means of calculations with the use of the STATFLUX/ICRP approach, plus a set of Uranium transfer rate parameters as function of individual’s age assuming an uninterrupted exposure over a period of 60 years. It was found that U ingestion rates by residents of Caetité are three orders of magnitude higher than worldwide average, indicating that food and water would exhibit high levels of contamination. Calculated effective internal doses range from a minimum of one to a maximum of three orders of magnitude higher than background doses, for blood and bones respectively. The likelihood that this circumstance could lead to serious health problems as e.g. neoplasia is addressed. The methodology presented in this work offers subsidies for further studies on environmental pollution by radionuclides.

Background: AngioJetTM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis. Report: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confirmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJetTM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profile and blood film showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confirmed by raised LDH (1714u/L) and low haptoglobin (<0.1units). Direct Coomb’s test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient’s renal function normalised over 3 months. Conclusions: The likely cause of this man’s AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identification and intervention to reduce the risk of renal injury from AngioJetTM associated haemolysis.

Bronchiolitis obliterans (BO) is an infrequent clinical syndrome characterized by the chronic obstruction of small airways due to fibrosis [1]. Intravenous immunoglobulin (IVIG) could be used for treatment while underlying immune mechanisms in the pathogenesis of BO exist [2]. Here, we present two children with BO due to adenovirus infection whose complaints resolved after IVIG replacement.

Two of the most recent LABA/ICS combinations for treatment of persistent asthma are Fluticasone furoate/Vilanterol 92/22 µg (Ellipta) and Beclomethasone dipropionate/Formoterol 100/6 µg (Nexthaler). Objective: To compare once-daily Fluticasone/ Vilanterol combination with twice daily Beclomethasone/ Formoterol association in moderate asthma, in terms of quality of life and lung function. Methods: Fourty patients with moderate asthma treated with Beclomethasone/Formoterol 100/6 µg or Fluticasone/Vilanterol 92/22 µg. We revalued patients in terms of lung function and Asthma Control Test, at 4, 8 and 12 weeks to assess any differences between the two groups. After 4 weeks, thirty-one of the fourty patients were evaluated in terms of respiratory function at predetermined time intervals. Result: In patients treated with beclomethasone/formoterol FEV1 presented a mean value of 78% at the third visit and of 79.1% during the final check, compared with 74.5% and to 75.8% in patients in treatment with fluticasone/vilanterol (p 0.01). Mean values of IC and MMEF25-75% were higher in patients treated with beclomethasone/formoterol compared with fluticasone/vilanterol. For the dyspnea it was a difference at the third observation. For the nocturnal symptoms and the use of rescue drug there was a significant difference, except at the beginning. For the perception of control by patients, there was a difference in the two groups at the beginning, after 4 and 8 weeks. Total ACT score showed a significant difference after 4, 8 and 12 weeks. In the group treated with beclomethasone/formoterol FEV1 value was significantly higher at a distance of four hours after drug administration (p 0.04) and after the second dose (p 0.02) compared with the group treated with fluticasone/vilanterol. Discussion: Patients in treatment with beclomethasone/formoterol showed improved asthma control and nocturnal symptoms and more stable respiratory function compared with patients receiving fluticasone/vilanterol.

In the beginning of 1973 in the USSR the study of possibility of LJE designing was conducted. The reflector, located in the tail of the rocket prototype, concentrated the obtained radiation in air and ensured micro-burst that the reactive thrust was created. The successful results of different models of the reflectors tests, which were at the same time the laser light receivers, had been obtained. One should note that all experiments pointed out above were conducted with the use of electric discharge CO2- lasers with power up to 10 kW, while for the injection into orbit of different highly and technologically effective equipment (global network connections, Internet, photo-monitoring of Earth surface, debris cleaning) the radiated power substantially higher is required. Thus, for example, for SC launching with the weight 1000 kg the laser with power not less than 15 MW is necessary [1,2].

This paper is a study of nuclear reactions involving 12c + 12c nuclei carried out with a heavy-ion nucleus-nucleus optical potential derived from a new M3Y-type effective interaction, called B3Y-Fetal, within the framework of optical model at the incident energies of 112, 126.7, 240, 300, 1016 MeV. Folding analyses of the differential cross sections associated with the elastic scattering of the nuclear system, determined at these incident energies with four B3Y-Fetal-based folded potentials constructed from double folding model, have shown the DDB3Y1- and BDB3Y1-Fetal potentials to be the best in excellent agreement with previous work done with the M3Y-Reid. The agreement of the B3Y-Fetal with the famous M3Y-Reid effective interaction, which is also used for folding analysis in this work, is further buttressed and well-established by the findings of this study Herein, the values of the renormalization factor, NR ranging from 1.1117 to 0.8121, obtained with the B3Y-Fetal have been found to be slightly higher, with lower reaction cross sections, aR = 1418 - 1047 millibarns, than NR = 0.9971 - 0.8108 obtained with the M3Y-Reid effective interaction whose accompanying reaction cross sections, being higher, range from 1431 to 1050 millibarns. This depicts the B3Y-Fetal as having a better performance. Additionally, results of folding analyses have shown the best-fit folded potentials, DDB3Y1- and BDB3Y1-Fetal potentials to be in agreement at all incident energies, implying that the cold nuclear matter has an underlying soft equation of state.

This report illustrates and provides a novel explanation for post-trabeculectomy improvements in the visual field, cup disc contours, and apparent deepening of an arcuate nerve fiber layer (NFL) defect after trabeculectomy for open-angle glaucoma. These changes are all plausible manifestations of recovered axonal transport and thickening retina, previously thinned by elevated intraocular pressure (IOP). Serial pre-and post-operative clinical fundus photos in case 1(A,B) demonstrate increased prominence of an inferior temporal arcuate nerve fiber layer defect, improved cup disc ratio, and visual field following eye pressure lowering by + 50% after trabeculectomy. Case 2 (C,D) also demonstrates obvious cup disc improvement in post-operative photos with associated improvement in visual field after trabeculectomy and lowering IOP by + 30%. We suggest that elevated IOP suppresses primarily orthograde axonal transport resulting in nerve fiber layer (NFL) thinning that can recover back to normal thickness when IOP is surgically lowered by the magnitude achieved in these two examples.