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Hunga Tonga-Hunga Ha'apai had a large eruption (VEI 5-6) on 15 January 2022, which caused a tsunami recorded in all ocean basins. Costa Rica has made many advances in tsunami preparation over the past 9 years since the creation of SINAMOT (Sistema Nacional de Monitoreo de Tsunamis, National Tsunami Monitoring System), both on watch and warning protocols and on community preparedness. For the Hunga Tonga-Hunga Ha'apai event, the government declared a low-threat warning, suspending all in-water activities, even though the country did not receive any official warning from PTWC (Pacific Tsunami Warning Center) due to the lack of procedures for tsunamis generated by volcanoes. The tsunami was observed at 24 locations on both the Pacific and Caribbean coasts of Costa Rica, becoming the second most recorded tsunami in the country, after the 1991 Limon tsunami along the Caribbean coast. At 22 of those locations along the continental Pacific coast, observations were made by eyewitnesses, including one collocated with the sea level station at Quepos, which registered the tsunami. At Cocos Island (~ 500 km southwest of the continental Costa Rica, in the Pacific Ocean), several eyewitnesses reported the tsunami at two locations, and it was recorded at the sea level station. The tsunami was also recorded at the sea level station on the Caribbean coast. The tsunami effects reported were a combination of sea level fluctuations, strong currents, and coastal erosion, proving that the response actions were adequate for the size of the tsunami. Tsunami preparedness and the largest waves arriving during a dry season Saturday afternoon allowed the large number of eyewitness reports. This event then increased tsunami awareness in the country and tested protocols and procedures. Still, many people along the coast were not informed of the tsunami during the alert due to their remote location, the short notice of the warning, and a lack of procedures for some communities. There is thus still much work to do, particularly about warning dissemination, a direction in which communities should take an active role. Supplementary Information: The online version contains supplementary material available at 10.1007/s00445-023-01648-x.
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Los países en desarrollo con sistema de salud de baja inversión encuentran un reto en priorizar el tratamiento de COVID-19 según su eficacia y sus costos. Materiales y métodos: se explora la utilidad hospitalaria de una intervención segura con eficacia ambulatoria comprobada. Se describe la administración de un tratamiento inmunomodulador combinado a base de imdevimab y casirivimab (REGEN COV). Resultados: los resultados individualizados apuntan a resultados prometedores en pacientes de alto riesgo a progresión y mortalidad. Conclusión: se ha demostrado que REGEN COV es eficiente para tratar dicha enfermedad. Sin embargo, se necesitan ensayos clínicos aleatorizados para comprobar su eficacia en combinación. (AU)
Developing countries with low-investment health systems find it challenging to prioritize COVID-19 treatment according to its efficacy and affordability. Materials and methods: therefore, the in-hospital utility of a safe intervention with outpatient efficacy is explored. We describe the administration of immunomodulatory combination therapy based on imdevimab and casirivimab (REGEN COV). Results: individualized results point to promising outcomes in patients at high risk of progression and mortality. Conclusion: REGEN COV has been shown to be efficient in treating said disease. However, randomized clinical trials are needed to verify their efficacy in combination. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia/terapia , Imunomodulação , SARS-CoV-2 , República Dominicana , HospitalizaçãoRESUMO
Objective: The objective of the study was to describe the clinical characteristics and the evolution of the severity of pulmonary arterial hypertension (PAH) and the degree of renal failure. Material and methods: A retrospective observational study was carried out in which the physical and electronic medical records of 60 patients older than 18 years with a diagnosis of pulmonary arterial hypertension were analyzed. Results: In our study, 11.4% of the severe PAH group worsened renal function at six months, and 13.6% of the participants worsened it at one year. In contrast, in the group with moderate PAH, 18.8% worsened at six months, and 12.5% worsened at one year. Also, the GFR at one year was 54.15 mL/min/1.73 m2 in the moderate PAH group and in the severe PAH group was 73.55 mL/min/1.73 m2. Conclusion: The results of this research suggest that the deterioration of kidney function is related to the severity of pulmonary arterial hypertension.
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Liquid-vapor coexistence is calculated via molecular dynamics for a variety of parallelepiped shaped molecules. Models are constructed as an array of tangential hard spheres interacting with an attractive square-well potential. Each shape is formed by varying the number of spheres in their three sides. The initial density of the system is chosen close to the critical density of a SW fluid to obtain an equilibrated liquid-vapor coexistence curve by the process of spinodal decomposition. A pattern that relates the geometry of the molecular models and the existence or non-existence of a liquid-vapor orthobaric curve is shown.
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INTRODUCTION: Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma. METHODS: ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure. CONCLUSIONS: ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.