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In this paper, we introduce topologically IGH-stable, IGH-persistent,average IGH-persistent and pointwise weakly topologically IGH-stable homeomorphisms of compact metric spaces. We prove that every topologically IGH-stable homeomorphism is topologically stable and every expansive topologically stable homeomorphism of a compact manifold is topologically IGH-stable. We further prove that every equicontinuous pointwise weakly topologically IGH-stable homeomorphism is IGH-persistent and every pointwise minimally expansive IGH-persistent homeomorphism is pointwise weakly topologically IGH-stable. Finally, we prove that every mean equicontinuous pointwise weakly topologically IGH-stable homeomorphism is average IGH-persistent.
Edited by
Rachel Thomasson, Manchester Centre for Clinical Neurosciences,Elspeth Guthrie, Leeds Institute of Health Sciences,Allan House, Leeds Institute of Health Sciences
In the absence of defined disease, but also on top of it, functional somatic symptoms indicate subjective distress. They have multidimensional, individual origins and their course is heterogeneous. We do not understand their exact psychophysiological pathways yet, but we know that stressors, attention/expectation and the way we handle them matter a lot. This applies especially to consultation-liaison psychiatry, where patients rarely have one single and simple problem, and there are frequent mismatches between the subjective symptom burden and objective findings.
Management of functional somatic symptoms should be interdisciplinary, mixing diagnostic and therapeutic, physical and psychological techniques. Treatment is based on empathy, psychoeducation, activation and the development of a bio-psycho-social explanatory model. Symptom relief and co-morbid illness can require medication, but passive interventions should only be temporary, with weighted risks and benefits. More severe cases need a multimodal approach or psychotherapy, carefully addressing the embodied self with all its experiences, attitudes and resources.
It is unclear, whether the initial disease severity may help to predict which COVID-19 patients at risk of developing persistent symptoms.
Aim:
The aim of this study was to examine whether the initial disease severity affects the risk of persistent symptoms in post-acute COVID-19 syndrome and long COVID.
Methods:
A systematic search was conducted using PUBMED, Google Scholar, EMBASE, and ProQuest databases to identify eligible articles published after January 2020 up to and including 30 August 2021. Pooled odds ratio (OR) and confidence intervals (CIs) were calculated using random effects meta-analysis.
Findings:
After searching a total of 7733 articles, 20 relevant observational studies with a total of 7840 patients were selected for meta-analysis. The pooled OR for persistent dyspnea in COVID-19 survivors with a severe versus nonsevere initial disease was 2.17 [95%CI 1.62 to 2.90], and it was 1.33 [95%CI 0.75 to 2.33] for persistent cough, 1.30 [95%CI 1.06 to 1.58] for persistent fatigue, 1.02 [95%CI 0.73 to 1.40] for persistent anosmia, 1.22 [95%CI 0.69 to 2.16] for persistent chest pain, and 1.30 [95%CI 0.93 to 1.81] for persistent palpitation.
Conclusions:
Contrary to expectations, we did not observe an association between the initial COVID-19 disease severity and common persistent symptoms except for dyspnea and fatigue. In addition, it was found that being in the acute or prolonged post-COVID phase did not affect the risk of symptoms. Primary care providers should be alert to potential most prevalent persistent symptoms in all COVID-19 survivors, which are not limited to patients with critical–severe initial disease.
In this presentation we describe the case of a woman referred to the Sexology Department after having developed symptoms of Persistent Genital Arousal (PGAD) for the last 5 years, during treatment for Depression with Venlafaxine. PGAD is a clinical entity first described in 2001 by Leiblum and Nathan. Despite having received more attention in the last few years, its etiology remains unclear, with numerous causal factors of different natures being suggested.
Objectives
We aim to describe this clinical case of PGAD and to discuss the possible etiological factors involved as well as to make a brief revision of the literature on this topic.
Methods
We conducted a detailed interview, focused on the nature of the complaints, psychological history, medications, diet and neurologic disorders and performed a thorough clinical examination. We also searched for relevant articles in medical databases such as PubMed and Google Scholar.
Results
A 52 year-old woman previously treated for Depression with Venlafaxine complains of involuntary sensations of genital arousal, with perceived vasocongestion, tingling and pulsatlity during her journey to work in public transportations. The symptoms subsided only after getting home 8-10 hours later and reaching orgasm by masturbating. She stopped Venlafaxine in 2015, but these symptoms persisted. Some authors suggest a link between SSRIs/SNRIs and PGAD.
Conclusions
PGAD is a relatively recent addition to our diagnostic catalog with increasingly more cases being reported in the last few years. It is likely that the condition, however, has no discrete etiology and that a customized approach will be necessary to successfully treat most patients.
Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes.
Methods:
Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay.
Results:
One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004).
Conclusions:
Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.
If an n × n stochastic matrix has a column with no zeros, one can immediately conclude that the chain is ergodic and the state corresponding to that column is persistent and aperiodic. In this paper it is shown that it is decidable whether or not some power of a finite stochastic matrix has a positive column. Some problems regarding positive columns in infinite stochastic matrices are also considered.
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