Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease

A degeneração hepatocerebral adquirida (AHD) e a degeneração hepatolenticular podem ter apresentações clínicas semelhantes, mas quando uma doença hepática crônica e achados motores atípicos coexistem, a distinção entre AHD e encefalopatia hepática (HE) pode ser ainda mais complicada. Descrevemos três casos de AHD (dois tendo HE) com diferentes achados em neuroimagem, doenças hepáticas distintas e apresentações motoras semelhantes, todos com hipertensão arterial e perda de peso antes das manifestações motoras. O diagnóstico e a fisiopatologia são comentados e comparados com relatos prévios. Concluímos que existem muitas correlações entre HE, degeneração hepatolenticular e AHD, mas a sobreposição de HE e AHD pode ser mais comum dependendo do conhecimento clínico e da acurácia dos critérios diagnósticos adotados para cada enfermidade. Como a AHD não é considerada prioridade na lista de transplante hepático, o prognóstico dos pacientes com AHD permanece ruim, e a interrupção do fluxo nos shunts portossistêmicos deve ser sempre considerada.

Creating Meaningful Homework and Implementing Homework Presentations to Aid in Mathematics Instruction

In this action research study of sixth grade mathematics, I investigated the use of meaningful homework and the implementation of presentations and its effect on students’ comprehension of mathematical concepts. I collected data to determine whether the creating of meaningful homework and the implementation of homework presentations would have a positive impact on the students’ understanding of the concepts being taught in class and the reasoning behind assigning homework. The homework was based on the lesson taught during class time. It was grade-level appropriate and contained problems similar to those students completed in class. A pre-research and post-research survey based on homework perceptions and my teaching practices was given, student interviews were conducted throughout the research period, weekly teacher journals were kept that pertained to my teaching practices and the involvement of the students that particular week, and homework assignments were collected to gauge the students’ understanding of the mathematics lessons. Most students’ perceptions on homework were positive and most understood the reasoning for homework assignments.

Oral Communication and Presentations in Mathematics

In this action research study of my classroom of eighth grade mathematics, I investigated the attitudes of students toward mathematics along with their achievement levels with the use of oral presentations in my Algebra class. During the second semester the class was divided into groups of two for each presentation, changing partners each time. Every other week each group was given a math problem that required more work than a normal homework type problem. On the last day of that week the students gave a short presentation on their problem. I discovered that while there was no significant evidence that student achievement increased, the students did enjoy the different aspect of presentations in a math class. I plan to implement presentations in my classroom more often with the intent to increase student enjoyment.

JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: clinical presentations, associated factors with mortality and outcome

Introduction: Several presentations of neurologic complications caused by JC virus (JCV) in human immunodeficiency virus (HIV)-infected patients have been described and need to be distinguished from the "classic" form of progressive multifocal leukoencephalopathy (PML). The objectives of this study were: 1) to describe the spectrum and frequency of presentations of JCV-associated central nervous system (CNS) diseases; 2) identify factors associated with in-hospital mortality of patients with JCV-associated CNS disease; and 3) to estimate the overall mortality of this population. Material and methods: This was a retrospective study of HIV-infected patients admitted consecutively for JCV-associated CNS diseases in a referral teaching center in Sao Paulo, Brazil, from 2002 to 2007. All patients with laboratory confirmed JCV-associated CNS diseases were included using the following criteria: compatible clinical and radiological features associated with the presence of JCV DNA in the cerebrospinal fluid. JCV-associated CNS diseases were classified as follows: 1) classic PML; 2) inflammatory PML; and 3) JC virus granule cell neuronopathy (GCN). Results: We included 47 cases. JCV-associated CNS diseases were classified as follows: 1) classic PML: 42 (89%); 2) inflammatory PML: three (6%); and 3) JC virus GCN: four (9%). Nosocomial pneumonia (p = 0.003), previous diagnosis of HIV infection (p = 0.03), and imaging showing cerebellar and/or brainstem involvement (p = 0.02) were associated with in-hospital mortality. Overall mortality during hospitalization was 34%. Conclusions: Novel presentations of JCV-associated CNS diseases were observed in our setting; nosocomial pneumonia, previous diagnosis of HIV infection, and cerebellar and/or brainstem involvement were associated with in-hospital mortality; and overall mortality was high. (C) 2012 Elsevier Editora Ltda. All rights reserved.

Coronary artery injury due to catheter ablation in adults: presentations and outcomes

BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up. CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.

Search for non-pointing photons in the diphoton and ETmiss final state in sqrt(s) = 7 TeV proton-proton collisions using the ATLAS detector

A search has been performed for photons originating in the decay of a neutral long-lived particle, exploiting the capabilities of the ATLAS electromagnetic calorimeter to make precise measurements of the flight direction of photons, as well as the calorimeter's excellent time resolution. The search has been made in the diphoton plus missing transverse energy final state, using the full data sample of 4.8 fb(-1) of 7 TeV proton-proton collisions collected in 2011 with the ATLAS detector at the LHC. No excess is observed above the background expected from Standard Model processes. The results are used to set exclusion limits in the context of gauge mediated supersymmetry breaking models, with the lightest neutralino being the next-to-lightest supersymmetric particle and decaying with a lifetime in excess of 0.25 ns into a photon and a gravitino.

The domestic physician or Guardian of health : Pointing out, in the most familiar manner, the symptoms of every disorder incident to mankind; together with their gradual progress and method of cure ... : To which is added, an appendix, forming a complete dispensatory /

Mode of access: Internet.

A Sheltered crisis : the state of fair housing in the eighties : presentations at a consultation sponsored by the United States Commission of Civil Rights, Washington, D.C., September 26-27, 1983.

Mode of access: Internet.

The wrongs of children, or, A practical vindication of children from the injustice done them in early nurture and education : addressed to parents, tutors, guardians, and masters, and to legislators and governors, setting forth the source of much human misery, and pointing out the remedy in a series of essays on education to be published periodically /

Goldsmiths'-Kress no. 22547.

The medical companion, or family physician; treating of the diseases of the United States, with their symptoms, causes, cure and means of prevention: common cases in surgery, as fractures, dislocations, &c. the management and diseases of women and children. A dispensatory, for preparing family medicine, and a glossary explaining technical terms. To which are added, a brief anatomy and physiology of the human body, shewing, on rational principles, the cause and cure of diseases: an essay on hygiene, or the art of preserving health, without the aid of medicine: an American materia medica, pointing out the virtues and doses of our medicinal plants. Also, the nurse's guide,

Mode of access: Internet.

The domestic guide in cases of insanity, pointing out the causes, means of preventing, and proper treatment of that disorder.

Mode of access: Internet.

Letters from Italy, between the years 1792 and 1798, containing a view of the revolutions in that country, from the capture of Nice by the French republic to the expulsion of Pius VI. from the ecclesiastical state; likewise pointing out the matchless works of art which still embellish Pisa, Florence, Siena, Rome, Naples, Bologna, Venice, &c. With instructions for the use of invalids and families ...

Mode of access: Internet.

James Oliver Curwood (pointing) with another individual on horseback overlooking Grizzly Valley in British Columbia

On verso: State Journal Sunday no. 25; 3 col. Sun Outdoors