Significant Abnormalities Research Articles

Development and characterization of solriamfetol-loaded PVA/PLGA electrospun nanofiber membranes: A promising approach for sustained narcolepsy treatment

Narcolepsy presents challenges in medication adherence and delivery, with traditional oral medications not always suitable for patients experiencing unexpected sleep episodes or difficulty in swallowing pills. This study focused on developing a solriamfetol (SF) loaded nanofiber membrane using a polymer blend of polyvinyl alcohol (PVA) and polylactic-co-glycolic acid (PLGA) for the management of narcoleptic patients with non-oral dosage options. The design required synthesis, optimization, characterization, and evaluation of these nanofibers for transdermal drug delivery. Using a Box-Behnken design, the nanofibers were produced via the electrospinning technique, achieving a high drug content of 96.31 ± 1.21 % and entrapment efficiency of 96.18 ± 1.42 %. The in vitro drug release studies demonstrated a prolonged release profile of SF over 24 h, with 97 % ± 2 % of the drug released. The SEM analysis revealed that the surface morphology of the nanofibers was smooth and homogenous, and the average diameter of the SF/PVA/PLGA nanofibers was found to be 150.23 ± 2.50 nm. X-ray diffraction results confirmed the amorphous structure of the nanofibers. The zebrafish embryonic toxicological study did not reveal any signs of toxicity or morphological abnormalities in the developing embryos, indicating that the nanofibers are safe. The results point to the applicability of SF nanofiber membranes in personalized narcolepsy therapy, which improves patients’ quality of life and the efficacy of their treatment. These nanofibers can be given in the form of a transdermal patch to patients for sustained drug delivery, even when they fall asleep or when they cannot take medicines orally.

Factors Associated with Complications of Snakebite Envenomation in Health Facilities in the Cascades Region of Burkina Faso from 2016 to 2021

Snakebite envenomation remains a major cause of morbidity and mortality in rural populations. This study identified factors associated with the complications of snakebite envenomation reported in the Cascades region of Burkina Faso. This cross-sectional study used the routine data of patients admitted for snakebite envenomation at five health facilities between 1 January 2016 and 31 December 2021. Data were collected on sociodemographic, clinical, and therapeutic characteristics of patients with signs of envenomation. Bivariate and multivariate analyses were conducted to identify factors associated with complications. Among the 846 patients with envenomation, 355 (42%) experienced complications. Local complications (23.2%, 196/846) included wounds and skin necrosis, whereas systemic complications (34.3%, 290/846) included hemorrhage, shock, and coma. Of all complicated cases, 7.6% (27/355) died. Factors associated with complications were rural residence (AOR: 4.80; 95% CI: 2.21–11.4), incision at the bite site (AOR: 4.31; 95% CI: 2.51–7.52), tourniquet application (AOR: 5.52; 95% CI: 1.42–30.8), bleeding (AOR: 14.2; 95% CI: 8.80–23.4), abnormal vital signs (AOR: 14.3; 95% CI: 9.22–22.7), and lack of antivenom administration (AOR: 2.92; 95% CI: 1.8–4.8). These findings highlight the importance of antivenom availability and public awareness for reducing the incidence of complications of snakebite envenomation.

Management and outcome of fetal abdominal cyst in first trimester: systematic review of the literature.

The detection of a fetal abdominal cyst at the first-trimester ultrasound scan is a rare event, for which the natural history and prognosis are often unknown and unpredictable, owing to various underlying etiologies. The aim of this study was to evaluate the outcome of fetal abdominal cysts detected in the first trimester to better understand their possible clinical significance and improve their clinical management. We present a case report of a fetal abdominal cyst detected in the first trimester, with subsequent diagnosis of congenital multiple arthrogryposis. We also performed a systematic review of the literature to determine the incidence and outcome of similar cases, which was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (CRD42023491729). PubMed, Web of Science and EMBASE were searched from inception to December 2023 to identify case reports and case series documenting an ultrasound diagnosis of a single fetal abdominal cyst in the first trimester. Our case presented at 12 + 6 weeks' gestation with an isolated fetal abdominal cyst, which underwent spontaneous resolution in the second trimester, when multiple congenital arthrogryposis was observed. Data on a total of 60 cases of fetal abdominal cyst detected in the first trimester were extracted from the literature. Of these, 35% were associated with concurrent or late-onset structural anomalies, as in our case, and 65% were isolated. In pregnancies with an isolated fetal abdominal cyst, 54% had a live birth with a normal outcome. A fetal abdominal cyst in the first trimester is usually an isolated finding with a moderate-to-good prognosis, but it could also be an early sign of other associated abnormalities, including arthrogryposis. Increased ultrasound surveillance and additional genetic testing to rule out possible associated anomalies are necessary to assess the risk of adverse pregnancy outcome and provide appropriate parental counseling. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Effectiveness and safety of elexacaftor/tezacaftor/ivacaftor treatment in children aged 6-11 years with cystic fibrosis in a real-world setting.

Elexacaftor-tezacaftor-ivacaftor (ETI) is a highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulating therapy for people with CF and at least one F508del variant. However, there is limited data about the safety and efficacy of this therapy in pediatric populations and in real-world settings. This study aimed at evaluating the effectiveness, tolerability, and safety of ETI in children with CF. This was a prospective observational study including all children aged 6-11 years who initiated ETI therapy between October 2022 and March 2023 at the Pediatric CF Center of Milan (Italy). Study outcomes included changes in sweat chloride concentration, FEV1, LCI2.5, body mass index(BMI), tolerance, and safety. Mean changes in study outcomes from baseline through 24 weeks were estimated using mixed-effects regression models. The study included 34 children with CF (median age: 8.3 years). At Week 12, we observed an average decrease in LCI2.5 of 2.3 units (95% confidence interval [CI]: -3.1; -1.5). At Week 24, sweat chloride concentration decreased by 63 mEq/L (95% CI: -69; -58), FEV1 increased by 8.8 percentage point (95% CI: 3.7; 13.9) and BMI increased by 0.15 standard deviation scores (95% CI: 0.04; 0.25). Skin rashes appeared in 6 patients which spontaneously resolved within a few days. One month after treatment initiation, one patient experienced an elevation in liver function test results, which subsequently decreased during follow-up visits without necessitating discontinuation of therapy. Our data indicate that ETI therapy is well tolerated by children with CF and is effective in improving signs of lung function abnormalities from early childhood.

Toxicological evaluation of LivLonga®, a polyherbal combination, in rodents

There has been keen interest on herbs and phytoconstituents with hepatoprotective property to help restore healthy liver function. Ayurveda, the ancient Indian traditional system of medicine mentions about Curcuma longa, Garcinia indica and Piper nigrum which are reported to have hepatoprotective activity. Apart from supporting metabolism, liver plays pivotal role in numerous bodily processes, immune functions to digestion, detoxification, and storage of nutrients. Factors such as sedentary lifestyle, viral infections, drugs/chemicals, high calorie diet, excess intake of alcohol etc have adverse impact on normal functioning of liver. Development of novel herbal combination with standards of safety and efficacy can help manage liver ailments and protect liver health. LivLonga® is a polyherbal combination of scientifically validated ingredients- curcuminoids, garcinol and piperine to support healthy liver function. The present work was conducted to evaluate toxicity of LivLonga® using in vivo models when administered orally. The acute, subacute, and subchronic toxicity studies were carried out in accordance with the test guidelines established by the Organization for Economic Cooperation and Development. A single-dose acute oral toxicity produced no toxic effects after 14 days of treatment. Four-week (subacute) and 3-months (subchronic) oral toxicity studies were conducted and observed no abnormal clinical signs, no alterations in the body weight, hematology and biochemical parameters or gross and histopathological changes. Thus, oral administration of LivLonga® showed no signs of toxicity when dosed orally to rats, with a no observed adverse effect level (NOAEL) of 600 mg/kg/day.

The safety and feasibility of laparoscopic partial splenectomy: analysis of perioperative indications from different vascular subtypes and improvement of surgical approach.

While laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor. From 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups. The etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 55 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 32 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures. LPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Non epileptiform abnormal neurologic signs in newborns following in-utero psychotropic medication exposure.

Post natal adaptation syndrome is well reported but early presentation of neurological symptoms severe enough to warrant detailed neurological work up is rare. Our aim was to evaluate and describe abnormal early neurological symptoms in infants following in-utero exposure to a varying combination of selective serotonin uptake inhibitor medication and other psychotropic medications, with negative seizure work-up. Descriptive case series of infant exposed to selective serotonin uptake inhibitor medication and other psychotropic medications, presenting with early neurologic signs and symptoms within the first 24 hours of life concerning for seizures, who underwent an extensive neurologic evaluation. Five infants met criteria. Infant #1 : 39-weeks gestational age (GA), with escitalopram, clonazepam, gabapentin, methadone exposure, presented with generalized hypertonia and intermittent back-arching. #2 : 40-weeks GA with escitalopram and hydroxyzine exposure, with bilateral arm stiffening and sucking mouth movements. #3 : 34-weeks GA with fluoxetine, quetiapine and clonazepam exposure, presented with decerebrate posturing. #4 : 38-weeks GA with fluoxetine, clonazepam, clonidine, quetiapine and gabapentin exposure, presented with asynchronous tremoring of all extremities. #5 : 35-weeks GA with citalopram, quetiapine exposure, presented with increased tone and posturing of upper extremities. Electroencephalogram was negative for seizures in all infants. In-utero exposure to selective serotonin uptake inhibitor medication, especially in combination with other psychotropic medications, may be associated with significant abnormal neurological symptoms, which may not represent true seizures.

Ambulance Transports from NCAA Division 1 Football Games.

There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings. Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR. Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS. This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.

Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study

BackgroundVital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.MethodsThis prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.ResultsA total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.ConclusionAmong the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

A large multi-focus dataset for white blood cell classification

The White Blood Cell (WBC) differential test ranks as the second most frequently performed diagnostic assay. It requires manual confirmation of the peripheral blood smear by experts to identify signs of abnormalities. Automated digital microscopy has emerged as a solution to reduce this labor-intensive process and improve efficiency. Several publicly available datasets provide various WBC subtypes of differing quality and resolution. These datasets have contributed to advancing WBC classification using machine learning techniques. However, digital microscopy of blood cells with high magnification often requires a wider depth of field, posing challenges for automatic digital microscopy that necessitates capturing multiple stacks of focal planes to obtain complete images of specific blood cells. Our dataset provides 25,773 image stacks from 72 patients. The image labels consist of 18 classes encompassing normal and abnormal cells, with two experts reviewing each label. Each image includes 10 z-stacks of cropped 200 by 200 pixel images, captured using a 50X microscope with 400 nm intervals. This study presents a comprehensive multi-focus dataset for WBC classification.

“Normal” Cervical Spine Radiographs and Computed Tomography Scans in the Emergency Department: Beware of Posttraumatic Instability of the Mobile Segment of the Lower Cervical Spine

The NEXUS criteria have been introduced in the 1990s to assist emergency department physicians to decide whether to perform radiographic work-up following cervical whiplash injury. Four criteria have been described on these profile radiographs of the cervical spine including angulation between cervical endplates, 3-mm listhesis, posterior facet joints overlap, and widened interspinous space. Although these criteria could help to detect patients suffering from unstable trauma of the mobile segment if the lower cervical spine, the radiographic signs may be so subtle that even specifically trained physicians like spine surgeons and neuroradiologists may miss them, especially during after-hour shifts. Hence, we present the striking case of a young female patient whose radiographs displayed slight but abnormal signs of lower cervical spine instability, but was nonetheless discharged home with dynamic X-rays of the cervical spine to be performed in a delayed setting. We hope that these striking features will help us remind the importance of radiologic semiology of posttraumatic unstable cervical spine.

Machine Learning Assessment of Gestational Age in Accelerated Maturation, Delayed Maturation, Villous Edema, Chorangiosis, and Intrauterine Fetal Demise.

Assessment of placental villous maturation is among the most common tasks in perinatal pathology. However, the significance of abnormalities in morphology is unclear and interobserver variability is significant. To develop a machine learning model of placental maturation across the second and third trimesters and quantify the impact of different pathologist-diagnosed abnormalities of villous morphology. Digitize placental villous slides from more than 2500 placentas at 12.0 to 42.6 weeks. Build whole slide learning models to estimate obstetrician-determined gestational age for cases with appropriate maturation and normal morphology. Define the model output as "placental age" and compare it to the chronologic gestational age. Our model showed an r2 of 0.864 and mean absolute error of 1.62 weeks for placentas with appropriate maturation in the test set. Pathologist diagnosis of accelerated maturation was associated with a 2.56-week increase in placental age (±2.91 weeks, P < .001), while delayed maturation was associated with a 0.92-week decrease in placental age (±1.82 weeks, P < .001). Intrauterine fetal demise causes diverse changes to placental age, driven by the nature of the demise. We tested the impact of training a model, using all live births. The resulting r2 was 0.874 and mean absolute error was 1.73 weeks. Furthermore, by including cases with abnormal maturation in the training data, the effect size of accelerated maturation was blunted to only 0.56 ± 2.35 weeks (P < .001). We show that various abnormalities of villous maturation and morphology correlate with abnormalities in placental age. This "no pathologist" model could be useful in situations where pathologists are unavailable or the need for consistency outweighs the utility of expertise.

CardioGuard: AI-driven ECG authentication hybrid neural network for predictive health monitoring in telehealth systems

The increasing integration of telehealth systems underscores the importance of robust and secure methods for patient data management. Traditional authentication methods, such as passwords and PINs, are prone to breaches, underscoring the need for more secure alternatives. Therefore, there is a need for alternative approaches that provide enhanced security and user convenience. Biometric-based authentication systems uses individuals unique physical or behavioral characteristics for identification, have emerged as a promising solution. Specifically, Electrocardiogram (ECG) signals have gained attention among various biometric modalities due to their uniqueness, stability, and non-invasiveness. This paper presents CardioGaurd, a deep learning-based authentication system that leverages ECG signals—unique, stable, and non-invasive biometric markers. The proposed system uses a hybrid Convolution and Long short-term memory based model to obtain rich characteristics from the ECG signal and classify it as authentic or fake. CardioGaurd not only ensures secure access but also serves as a predictive tool by analyzing ECG patterns that could indicate early signs of cardiovascular abnormalities. This dual functionality enhances patient security and contributes to AI-driven disease prevention and early detection. Our results demonstrate that CardioGaurd offers superior performance in both security and potential predictive health insights compared to traditional models, thus supporting a shift towards more proactive and personalized telehealth solutions.

Safety and immunogenicity of a SARS-CoV-2 mRNA vaccine (SYS6006) in minks, cats, blue foxes, and raccoon dogs.

Minks, cats, and some other species of carnivores are susceptible of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and have a high risk of transmitting SARS-CoV-2 to humans. The development of animal vaccines can be an effective measure to protect animals against SARS-CoV-2 and reduce the potential risk of human infection. We previously developed a messenger ribonucleic acid (mRNA) vaccine SYS6006 that has been proven to be an efficient coronavirus disease 2019 (COVID-19) vaccine widely used in humans. Here, we further evaluated the safety and immunogenicity of SYS6006 as an animal COVID-19 vaccine candidate for SARS-CoV-2 susceptible animals or wild animals. SYS6006 was safe and immunogenic in mice and completely protected mice against mouse-adapted SARS-CoV-2 infection in the upper and lower respiratory tracts. SYS6006 was able to induce neutralizing antibodies against the SARS-CoV-2 wild-type, Delta, and Omicron BA.2 strain on day 7 after prime immunization, and two doses of immunization could enhance the neutralizing antibody responses and produce long-lasting potent antibodies for more than 8 months in minks and cats, blue foxes, and raccoon dogs, while all immunized animals had no abnormal clinical signs during immunization. These results provided here warrant further development of this safe and efficacious mRNA vaccine platform against animal COVID-19.

Antagonistic effects of Bacillus subtilis-derived chitosan nanoparticles on growth performance, stress biomarkers, and histological alterations of cadmium-intoxicated Nile tilapia fingerlings

Heavy metals including cadmium (Cd) are one of the major persistent and non-biodegradable wastewater pollutants. However, Cd reaches the aquatic ecosystem via industrial and agricultural waste discharges and causes serious deterioration in the welfare status of aquatic animals. The use of feed supplements with immune-stimulants to mitigate the toxic influences of heavy metals including Cd is a much more intriguing point. Thus, the current experiment used the bio-synthetized chitosan nanoparticles derived from Bacillus subtilis (Bs-CNPs) as a feed supplement and evaluated its ameliorative impacts on the growth and welfare status of Cd-intoxicated Nile tilapia (Oreochromis niloticus). Bifactorial design (3 Bs-CNPs levels × 3 Cd levels) was used in the current study where Nile tilapia fingerlings (58–63 g) were fed on 0.0, 2, and 4 g Bs-CNPs/kg feed alongside with exposing to 0.0, 0.392, and 0.784 mg Cd/L for 60 days to represent nine treatments as follows: T1: control group (no Cd exposure; no Bs-CNPs supplement); T2 and T3: fish were intoxicated with 0.784 and 0.392 mg Cd/L, respectively; T4 and T5: fish fed on 2 and 4 g Bs-CNPs/kg feed, respectively; T6 and T7: fish were fed on 2 g Bs-CNPs/kg feed along with exposure to 0.784 and 0.392 mg Cd/L, respectively; and T8 and T9: fish were fed on 4 g Bs-CNPs/kg feed along with exposure to 0.784 and 0.392 mg Cd/L, respectively. It is noted that the Cd-intoxicated fish exhibited significant retardation in growth performance and digestive enzyme activities with a decline in their survival rate compared to the control group (T1). The results also revealed that exposing fish to Cd toxicity alone with no feed supplement (T2 and T3) experienced abnormal clinical signs and behavioral changes. Compared with the control group (no Cd with no Bs-CNPs), highest values of cortisol, glucose, aspartate and alanine aminotransferase, and acetylcholine esterase activity were found in fish fed on the control diet along with exposure to 0.784 mg Cd/L. Higher Cd restudies in liver, intestine, gills, kidney, and muscles tissues were detected in fish exposed to 0.784 mg Cd/L alone and the sequence order of Cd levels in different fish organs is intestine > gills > liver > kidney > muscles. Remarkable pathological alterations in hepatic and intestinal tissues were also observed. On the other hand, feeding Nile tilapia on Bs-CNPs-enriched diets alone with no Cd exposure enhanced their growth performance, digestive enzyme activities, and hematological parameters with no Cd residues in fish organs. Interestingly, feeding the Cd-intoxicated fish on diets with Bs-CNPs (4 g/kg feed) returned their growth, digestive enzymes, hematological, and biochemical parameters to approximate those of the control group. Furthermore, these treatments showed histopathological alteration recovery in the intestine and liver tissues is similar to those in the control group (no Cd with no Bs-CNPs). Fish fed on Bs-CNPs levels with no Cd exposure showed no Cd residues in different fish organs. The Cd levels in different organs of fish exposed to 0.392 mg Cd/L along with feeding on Bs-CNPs (4 g/kg feed) were lower than those in Cd-exposed fish treatments. Consequently, the current study evoked that feeding Nile tilapia fingerlings on Bs-CNPs (4 g/kg feed) could enhance their growth performance and protect the fish from the Cd toxicity that may occur in the aquatic ecosystem.

Incidence, severity and changes of abnormal vital signs in trauma patients: A national population-based analysis

BackgroundPhysiological criteria are used to assess the potential severity of injury in the early phase of a trauma patient's care trajectory. Few studies have described the extent of abnormality in vital signs and different combinations of these at a national level. Aim of the study was to identify physiologic abnormalities in trauma patients and describe different combinations of abnormalities and changes between the pre-hospital and emergency department (ED) settings. MethodNorwegian Trauma Registry (NTR) data between 01.01.15 – 31.12.18, where evaluated on the prevalence and characteristics of abnormal physiologic variables. Primary outcome were rates of hypoventilation (respiratory rate [RR] < 10 breaths per min), hyperventilation (RR > 29 breaths per min), hypotension (systolic blood pressure [SBP] < 90 mmHg), and reduced level of consciousness (Glasgow Coma Scale [GCS] < 13). ResultsA total of 24,482 patients were included. Documented values for RR, SBP and GCS were 77.6%, 78.5% and 81.9% in the pre-hospital phase, and the corresponding percentages in the ED were 95.5%, 99.2% and 98.6%, respectively. In the pre-hospital phase, 3,615 (14.8%) patients had at least one abnormal vital sign, whereas the corresponding numbers in the ED, were 3,616 (14.8%) patients. The most frequent combination was low GCS and hyperventilation. A worsened RTS-score from pre-hospital phase to the ED was observed for RR, SBP and GCS in 3.9%, 1.2% and 1.9% of incidents, respectively. Overall 30-day mortality was 3.1% (n=752). Of these, 60.8% had abnormal vital signs, with decreased GCS as the most prevalent (61.3%). ConclusionMost trauma patients had normal vital signs. According to the RTS-score, there were few deteriorations in RR, SBP and GCS between pre-hospital phase and the ED. The most frequent abnormality was low GCS, with a higher proportion in those who died within 30 days.

The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: ASingle Center Cross-Sectional Study.

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads. In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology. In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality. The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

Twenty-eight days of repeated dose sub-acute toxicological evaluation of polyherbal Ayurvedic medicine BPGrit in Sprague-Dawley rats.

A pre-clinical toxicological evaluation of herbal medicines is necessary to identify any underlying health-associated side effects, if any. BPGrit is an Ayurveda-based medicine prescribed for treating hypertensive conditions. High-performance liquid chromatography-based analysis revealed the presence of gallic acid, ellagic acid, coumarin, cinnamic acid, guggulsterone E, and guggulsterone Z in BPGrit. For sub-acute toxicity analysis of BPGrit, male and female Sprague-Dawley rats were given repeated oral gavage at 100, 300, and 1000 mg/kg body weight/day dosages for 28 days, followed by a 14-day recovery phase. No incidences of mortality, morbidity, or abnormal clinical signs were observed in BPGrit-treated rats throughout the study period. Also, the body weight and food consumption habits of the experimental animals did not change during the study duration. Hematological, biochemical, and histopathological analysis did not indicate any abnormal changes occurring in the BPGrit-treated rats up to the highest tested dose of 1000 mg/kg body weight/day. Finally, the study established the "no-observed-adverse-effect level" for BPGrit at >1000 mg/kg body weight/day in Sprague-Dawley rats.

Integrated health monitoring system for checking patients’ vitals

The increasing demand for efficient healthcare services has propelled the development of efficient health monitoring systems. This paper presents a comprehensive system designed to monitor the vital signs of patients in real-time, aimed at enhancing patient care and reducing the burden on healthcare providers. The system integrates various sensors to Data collected from these sensors are transmitted wirelessly to a central database, where it is processed and analyses using sophisticated algorithms. The results are accessible through a user-friendly interface for both healthcare professionals and patients. This health monitoring system offers several critical benefits. it provides real-time alerts for any abnormal vital signs, enabling prompt medical intervention. Secondly, the continuous monitoring allows for the early detection of potential health issues, which can significantly improve patient outcomes. The methodology involves is the analytical and systematic application of Arduino Nano Boards as microcontrollers, such as DS18B20, DHT11 and with WIFI Modula; which are driven- real time-based temperature frameworks for optimization and abstraction of accurate patient’s health data result. Results demonstrated the system's accuracy, reliability, and user satisfaction.

TERAPI HYPNOBREASTFEEDING UNTUK MENURUNKAN KECEMASAN IBU POSTPARTUM

Anxiety in postpartum women is not uncommon, with a number of signaling mental-related issues, such as tenseness, worry, and/or panic attacks, may appear. Its negative impacts are not only limited to affecting the mother’s mental state, but also the baby’s proper growth and well-being.. This study aims to provide a standardized Continuity of Midwifery Care (CoMC) along with its complementary effort on Mrs. E (aged 30) who gave birth in the Hospital of Hj. Bunda Halimah in 2024. The design of the study employs a study case. CoMC coverage started from the antenatal, intranatal, neonatal, postnatal, and Family Planning (FP) through contraceptive proposition on Mrs. E (G1P0A0) whose last menstrual period (LMP) was on 16 June 2023 and the expected delivery date (EDD) was on 23 March 2024. The first contact took place on 27 February 2024 during the last trimester of pregnancy (p. 36 weeks, 3 days) with nil remarks, no signs of difficulty, and was followed by intranatal care on 31 March 2024, via c-section. The newborn was reportedly normal with no signs of abnormalities. Postnatal care showed a sign of anxiety which was anticipated by a series of hypnobreastfeeding technique, conducted four times, with the hopes to stimulate and to help relax the mother to make breastfeeding activity come out as natural as possible.