Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review.

Introduction: Critical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.

ECG Case of the Month: ECG in a 20-Year-Old Woman with Dyspnea. Sinus tachycardia (104 beats/minute), slight right axis deviation of the QRS (+92°), an R/S ratio greater than 1 in lead V1 with ST depression and T wave inversion in leads V1 - V4, and a prominent S wave in lead I, Q wave in lead III, and inverted T wave in lead III(S1 Q3 T3). These findings suggest right ventricular hypertrophy or strain and are consistent with pulmonary emboli.

A 20-year-old Hispanic woman presented to the emergency department complaining of six months of progressive dyspnea on exertion associated with intermittent palpitations. Her only past medical history was a stillbirth at 32 weeks gestation about two years ago. Her vital signs in the emergency department were a heart rate of 120 beats/minute, a blood pressure of 145/86 mmHg, and an arterial oxygen saturation of 98 percent with her breathing air.

Clinical Case of the Month. A 44-Year-Old HIV-Infected Man With Righ-Shoulder Swelling.

Immunocompromised patients are susceptible to various joint infections with less-common pathogens, such as mycobacterium. Physicians should have a low threshold to investigate the cause of an arthropathy further. An aspiration of the effusion is usually warranted to identify the possible pathogen and target treatment.

Photoperiod alters phase difference between activity onset in vivo and mPer2::luc peak in vitro.

Photoperiod is a significant modulator of behavior and physiology for many organisms. In rodents changes in photoperiod are associated with changes in circadian period and photic resetting of circadian pacemakers. Utilizing rhythms of in vivo behavior and in vitro mPer2::luc expression, we investigated whether different entrainment photoperiods [light:dark (L:D) 16:8 and L:D 8:16] alter the period or phase relationships between these rhythms and the entraining light cycle in Per2::luc C57BL/6J mice.