tetricians and midwives are allowed to express their expertise and their intuition in a sound methodological approach to assess cases of pregnant women and suggest a valid route of intrapartum care.

The proposed approach addresses the multi-dimensional nature of judging the most appropriate type of delivery. By utilizing fuzzy logic analysis obstetricians and midwives are allowed to express their expertise and their intuition in a sound methodological approach to assess cases of pregnant women and suggest a valid route of intrapartum care.

Acute kidney injury (AKI) is one of the most frequent but anticipated potential complications. The objective of this meta-analysis was to evaluate the AKI incidence following mannitol administration in traumatic brain injury (TBI) patients worldwide.

So in this study, authors will discuss the incidence of AKI related to the provision of mannitol in TBI cases so it is expected to provide a better prevention of complications.

We were using meta-analysis. Studies were searched throughout Pubmed, Cochrane, JNS in December 2017. Studies that were included ranged from 2009-2018. Keywords were „renal” or „kidney” and „traumatic brain injury”. Inclusion criteria were full-text observational study or randomized control trial, subjects in study were newly diagnosed AKI after TBI, GCS < 13, with age range 15-100 years old, survived and followed at least for 30 days after discharge, and given mannitol at least 1g/kg BW/day for at least 3 days. From 648 studies, total 4 studies were eligible for this study. Statistical analysis was done by using Review Manager 5.

From those 4 studies, it is shown than the pooled risk ratio AKI incidence following mannitol administration in traumatic brain injury (TBI) was 1.57. The pooled risk ratio had wide heterogeneity (I

= 0.95 and 1, p< 0.05) so random effect model was used.

AKI appeared more frequent in patient with TBI with mannitol administration. It still needs more multicentre and long term period researches in the future to get better understanding AKI in TBI following mannitol administration.

AKI appeared more frequent in patient with TBI with mannitol administration. It still needs more multicentre and long term period researches in the future to get better understanding AKI in TBI following mannitol administration.

Some of prostate cancer cases could progress to be Castrate Resistant Prostate Cancer (CRPC). However it is still a challenge to early diagnose it since no reliable examination could be done except PSA, which has high variability. It is now known that miRNAs are involved in nearly all inflammatory responses. Several malignancies in humans that specifically express miRNA have been detected and identified. The expression values of miRNA-21 also correlates with the occurrence of resistant castration of prostate cancer and metastases, therefore miRNA-21 is expected to be a biomarker to estimate the progression of cancer.

The purpose of this study was to analyze the expression values and cut-off markers of miRNA-21 as markers of CRPC progression.

This study used a retrospective cohort design with observational analysis. The forty-eight total sample was obtained from serum, then the RT-PCR was performed to obtain expression values of miRNA-21. Data were analyzed using One Way ANOVA to see the difference in th1 cut-off point is potential to differentiate the diagnosis.

Non-alcoholic fatty liver disease (NAFLD) is an increasingly common cause of chronic liver disease and is becoming a major public health problem. NAFLD has been recognized as a hepatic manifestation of metabolic syndrome, associated with systemic diseases such as cardiovascular disease (CVD) and chronic kidney disease (CKD).

The aim of this study was to examine the role of serum LFT parameters and renal function parameters as predictors of unmanifested liver disease.

In this study, the presence of possible liver disease detected by biochemical parameters and confirmed by Transient Liver Elastography (TE) in a group of patients with different stages of chronic kidney disease (CKD) was investigated. Patients with various stages of CKD were divided into five subgroups regarding aetiology nephroangiosclerosis, diabetic nephropathy, glomerulonephritis and pyelonephritis, autoimmune kidney disease, and polycystic and another morphological kidney disease. Liver stiffness was used to quantify liver fibrosis whi the liver disease in patients with end-stage kidney diseases of different aetiology.

In contrary, low values of phosphorus and higher values of ferritin in patients with nephroangiosclerosis, diabetic nephropathy, glomerulonephritis and pyelonephritis, are in a favour steatosis of the hepatic parenchyma. Serum values of phosphorus and ferritin are valuable predictors of the liver disease in patients with end-stage kidney diseases of different aetiology.

COVID-19 may have a role in myocardial injury in some patients, which can lead to multiple cardiovascular consequences. Electrocardiography (ECG) is useful to detect cardiac involvement of COVID-19.

In this study, we aimed to identify the pattern of ECG findings in COVID-19 patients.

We retrospectively evaluated the clinical data of 176 patients diagnosed with COVID-19 along with their ECG findings on admission and during hospitalization.

Out of 176 patients, 56.8% were males. The mean age of the patients was 64.4 (SD 15.4) years. Twenty-five patients were obese (Body mass index „BMI” > 30). Comorbidities including hypertension, diabetes mellitus, and coronary artery disease were found in 70.5%, 52.3%, and 24.4% of patients, respectively. Only 17% of patients had normal ECG readings, and the rest had abnormalities of various types. Heart rate was normal in 67.6% of patients, the rest were tachycardiac (29.0%) or bradycardiac (3.4%). Findings included a widened QRS complex in 6.2% of patients, 79.0% the diagnostic and prognostic importance of conducting ECG on admission and during hospitalization for COVID-19 patients. More investigation is required to determine the diagnostic accuracy and prognostic value of this modality.

Clinical decision support systems (CDSS) can enhance patient safety and reduce medication errors by giving physicians alerts while dispensing medications. Physicians inappropriately override these alerts for various reasons, which can possibly lead to medication errors and impact patient safety.

To assess the appropriateness of overridden major medication-related alerts, to investigate the reasons behind inappropriate overriding, and to evaluate if medication errors occur in inappropriately overridden alerts.

A mixed-methods study was conducted.. Quantitative Retrospective observation to evaluate the appropriateness of major drug-dose related alert overrides. A simple random sample was taken from appropriate and inappropriate overrides and reviewed for medication errors. Qualitative Semi-Structured Interviews were conducted with ten consultant physicians from various specialties. Interviews were transcribed and coded inductively then analyzed using Thematic Content Analysis.

Out of 1087 alert overridehecks, and alert fatigue. CDSS alerts can be improved by making them more prominent and suppressing or descaling unnecessary alerts. The drop-down justification list can be enhanced by adding free text options and relating recommended dosing to disease or specialty.Emotion-driven impulse control difficulties are associated with negative psychological outcomes. Extant research suggests that high frequency heart rate variability (HF-HRV) may be indicative of emotion-driven impulse control difficulties and potentially moderated by negative emotion. In the current study, 248 eleven- to 14-year-olds and their parent engaged in a negatively emotionally arousing conflict task at Time 1. Adolescents’ HF-HRV and negative emotional expression and experience were assessed before, during, and/or after the task. Adolescents reported on their levels of emotion-driven impulse control difficulties at Time 1 and one year later. Results revealed that higher levels of HF-HRV reactivity (i.e., higher HF-HRV augmentation) predicted higher levels of emotion-driven impulse control difficulties one year later among adolescents who experienced higher negative emotion. These findings suggest that negative emotional context should be considered when examining HF-HRV reactivity as a risk factor for emotion-driven impulse control difficulties and associated outcomes.The COVID-19 pandemic initiated a deep global recession, and with interest rates at very low levels, warrants consideration of the efficacy of different forms of fiscal stimulus in response. History reveals that deep recessions may cause output and total factor productivity (TFP) hysteresis, a permanent or highly persistent fall in the levels of output and TFP relative to pre-recession trends. This article analyses the output and welfare multipliers of fiscal stimulus during a recession using a macro model with TFP and output hysteresis. We find that transfer payments, public consumption and investment all have high output and welfare multipliers due to their positive effects on TFP in a recessionary environment. However, public investment has the highest output and welfare multipliers, because it has a more positive impact on labour productivity due to the increase in the public capital stock.The opening of schools that coincided with the beginning of fall 2020 and the arrival of the second wave of COVID-19 in continental Europe has fostered significant debate in several countries. Some contributions have suggested that youngsters play a minor role in the spread of the virus, given the specific characteristics of this infection; other scholars have raised concerns about the necessary movement that involves keeping schools open, and the consequent potential spread of the virus. In this study, we focus on the Italian case, an interesting setting in which to test the impact of opening schools on the spread of COVID-19, because of the different dates at which schools have opened in the various Italian provinces, and because of the different rates at which the virus has spread across Italy. Our results suggest that open schools have a positive impact on COVID-19 cases, whose spread occurs between 10 and 14 days after opening. While closing schools or using distance learning have other social and economic consequences, making it necessary for policymakers to adopt a holistic evaluation, it should be taken into account that open schools have an impact on the spread of the pandemic.

Distal clavicular osteolysis (DCO) is a musculoskeletal pathology characterized by shoulder pain. Given the high prevalence of shoulder pain due to rotator cuff and subacromial injuries, DCO is often overlooked. Conservative therapy is indicated prior to surgical intervention. However, no literature has described conservative management of DCO in detail. This report will outline conservative management details for DCO to guide future research and clinicians.

A 24-year-old female hockey player presented with trauma-induced injury, where she was diagnosed with type II acromio-clavicular joint separation. She presented 5-months later with residual pain and limitations in ranges of motion (ROM). Radiographic images revealed DCO.

Management entailed strict rest from overhead activities followed by rehabilitation and manual therapy. 6-months later the patient reported resolution of symptoms, improved ROMs, and activities of daily living.

DCO can be difficult to diagnose given its limited etiological understanding, low incidence, and poor radiographic sensitivity.