Catastrophic Outcomes Research Articles

The Effect of Direct Anticoagulant Therapy on Haematological Parameters in Atrial Fibrillation: Clinical Significance of Subclinical Haemoglobin Decrease

Background and Objectives: Direct oral anticoagulants (DOACs) have become the cornerstone of stroke prevention in the management of atrial fibrillation (AF). While their efficacy in preventing catastrophic outcomes is well documented, the exploration of their effects on haematological parameters, particularly in clinically stable AF patients, remains markedly underrepresented in existing research. The aim of our investigation was to delineate the variations in key haematological parameters, with a special focus on haemoglobin (Hb), in a cohort of clinically stable patients afflicted with AF and receiving diverse oral anticoagulant treatments. Materials and Methods: In this retrospective study, 742 patients with AF were evaluated. Following exclusion criteria, 530 patients were included and categorised based on the change in their Hb levels (ΔHb < 2 [n = 473] vs. ΔHb ≥ 2 [n = 57]) after one year of initial prescription of DOACs. Results: Patients in the ΔHb ≥ 2 g/dL group demonstrated significantly higher baseline haemoglobin levels during the pre-DOAC period (13.5 [12.3–14.6] vs. 14.6 [13.1–15.7]; p = 0.002). Baseline haemoglobin was identified as a predictive factor for a decrease in Hb ≥ 2 g/dL, with higher initial values being associated with more pronounced reductions (OR, 95% CI: 1.424 [1.178–1.723]; p < 0.005). This pattern was observed consistently across various types and dosages of DOACs. Conclusions: This study underscores the importance of vigilant clinical monitoring for anaemia in patients undergoing DOAC therapy, even when their clinical course appears to be stable.

Bilateral adrenal hemorrhage in a postpartum woman with multiple thromboemboli: A case report

BackgroundBilateral adrenal hemorrhage is a rare but often a fatal cause of primary adrenal insufficiency that can result in adrenal crisis if not identified and managed appropriately.Case presentationWe present a case of a 27-year-old Caucasian female who was admitted to the hospital 17 days postpartum with pleuritic chest and flank pain, shortness of breath and nausea. Computed tomography imaging confirmed multiple thromboemboli including pulmonary emboli and noted bilateral bulky adrenal glands. She was managed for infection and pulmonary emboli; however, she complained of persistent headaches, nausea, and vomiting despite appropriate management. Radiology re-review found the computed tomography imaging was consistent with bilateral adrenal hemorrhage in hindsight. Subsequent endocrine evaluation with hypothalamic–pituitary–adrenal axis interrogation and adrenocorticotropic hormone (Synacthen) stimulation testing confirmed resultant primary adrenal insufficiency. She required urgent intravenous hydrocortisone and was subsequently discharged on oral adrenal replacement therapy and anticoagulation.ConclusionsDelay in identification and treatment of adrenal insufficiency can lead to catastrophic outcomes. This case highlights the challenge of diagnosing bilateral adrenal hemorrhage and resultant adrenal insufficiency as patients may not present with the classic risk factors, signs, symptoms, and electrolyte derangements.

Unexpected and atypical clinical presentation of myocardial infarction in infants and children: complex pathogenesis of progressive and lethal disease.

Myocardial infarction is rare in children but frequently occurs unexpectedly with atypical presentation. It can cause a progressive lethal course unless prompt treatment is initiated. Paediatric cases of myocardial infarction diagnosed by the presence of ischaemic myocardial insults and symptomatic ventricular dysfunction were reviewed retrospectively. Eighteen patients (5 days to 14 years of age; median 3 months) with myocardial infarction were studied. The aetiology was variable, including congenital coronary anomalies: anomalous left coronary artery from pulmonary artery (five patients), pulmonary atresia with intact ventricular septum with right ventricle-dependent coronary circulation (four), anomalous aortic origin of left coronary artery (three), and Williams syndrome with supravalvar aortic stenosis (one). Two acquired coronary anomalies occurred in one patient with undiagnosed Kawasaki disease with complete thrombotic obstruction of the left coronary artery and another with post-transplant cardiac allograft microangiopathy. Three patients developed thromboembolic coronary artery incidents in normal coronary anatomy. Fourteen patients were less than 1 year of age (78%). Electrocardiographic abnormalities were noted in all patients. Four patients required extracorporeal membrane oxygenation support for severe ventricular dysfunction, none of whom survived. Five patients underwent heart transplant. Five patients died during the same hospitalisation, and one patient died after discharge (overall mortality 33%). Transplant-free survival was 39%. Most myocardial infarction occurred in infants who presented with abrupt onset of non-specific clinical manifestations with progressively deteriorating haemodynamic status resulting in poor transplant-free survival rate. Early diagnosis and treatment are essential to prevent catastrophic outcomes.

Case Report: Spontaneous cornual Pregnancy at 7 Weeks: A Gynecological challenge

Introduction and Importance Cornual pregnancy (CP) is a rare and dangerous type of ectopic pregnancy, occurring in 2% to 4% of cases. Due to its atypical location in the uterine horn, it poses a high risk for severe complications, such as rupture of the uterus, and life-threatening bleeding, particularly when diagnosis is delayed. Case Presentation We report the case of a 35-year-old female patient presenting with severe pelvic pain and vaginal bleeding, with 12 weeks of amenorrhea. Clinical evaluation revealed elevated β-HCG levels and transvaginal ultrasound showed a 7-week unruptured right cornual pregnancy. Surgical management involved a mini-laparotomy, which confirmed the diagnosis and a cornuostomy along with a right salpingectomy was performed. The patient’s postoperative course was uneventful, and follow-up confirmed complete recovery. Clinical Discussion Cornual pregnancies, though rare, carry a significant risk of serious complications and maternal death due to delayed diagnosis. Risk factors encompass a history of miscarriage, elective abortion, sexually transmitted infections, and smoking, all contributing to abnormal implantation. Early diagnosis is challenging but crucial, with ultrasound being key for detection. Management depends on gestational age, patient stability, and future reproductive plans, with methotrexate or surgical intervention being standard options. Conclusion Cornual pregnancy, despite its rarity, demands prompt and accurate diagnosis to prevent catastrophic outcomes. This case underscores the need for individualized treatment strategies and highlights the importance of early intervention. Ongoing research is vital to improving diagnostic approaches and therapeutic outcomes.

Fungal Intracranial Infections (Central Nervous System-Invasive Fungal Disease) in Patients With Haematological Disorders-A Single-Centre Retrospective Study.

Invasive fungal disease (IFD) is a sinister complication encountered in patients with haematological disorders. When occurring in the central nervous system (CNS), IFDs can have catastrophic outcomes. To study the clinical presentation, predisposing etiological factors, and prognosis of a CNS-IFD in a patient with a haematological disorder. This is a retrospective study focusing on the clinical profile, diagnosis, treatment strategy and outcomes of 43 patients with an underlying haematological disorder, who were diagnosed with CNS-IFD between 2018 and 2022. Of the 43 patients, 18 were chemotherapy recipients, while 23 were stem cell transplant (SCT) recipients and 2 presented with CNS-IFD at diagnosis. AML/MDS (37.2%) and ALL (18.6%) were the predominant underlying diagnoses. A sudden deterioration in sensorium (53.5%) was the earliest clinical sign, while T2 hyperintensities (26.8%), vascular involvement (26.8%) and ring-enhancing lesions (16.3%) were the commonest radiological findings, with all patients exhibiting diffusion restriction in diffusion-weighted images. Microbiological evidence of infection was obtained in all patients; however, culture positivity was established in only 25 patients. Rhizopus spp (23.2%) and Aspergillus spp (20.9%) were implicated in most cases. Overall survival of the cohort was 27.9% at a median follow-up of 6 months. In patients who succumbed, the median time to death was 4 days (0-46). CNS-IFD is associated with very poor survival in patients undergoing chemotherapy or an SCT, urging the need for prompt diagnosis and initiation of suitable antifungal therapy.

A Classical Manifestation of Eosinophilic Granulomatosis with Polyangiitis with an Unusual Catastrophic Outcome

A 57-year-old male patient, with a known case of bronchial asthma presented with acute dyspnea, cough with expectoration, fever, severe myalgia, and pedal edema. On physical examination, he had tachypnea, high temperature, bilateral polyphonic rhonchi, audible wheeze, and asymmetric sensory and motor neuropathy. Cutaneous examination revealed multiple palpable purpuric lesions with few hemorrhagic bullae and crusted erosions distributed symmetrically over bilateral limbs suggestive of cutaneous small vessel vasculitis. Investigations showed elevated total counts, eosinophilia, deranged electrolytes, and abnormal liver and renal function tests. Histopathology revealed eosinophilic predominant vasculitis. Testing for perinuclear anti-cytoplasmic antibody was positive. A diagnosis of eosinophilic granulomatosis with polyangiitis (Churg–Strauss disease) was thus confirmed. The patient succumbed in 2 weeks due to multi-organ failure. All the characteristic findings were found in our patient, but a fatal outcome in a very short period after diagnosis was an unusual presentation.

Intra-Atrial Course of Right Coronary Artery: Rare Anatomical Variants Are Becoming More Common with Modern Cardiac CT Scanners

Coronary artery anomalies, which range from benign variations to potentially malignant conditions, are increasingly being identified due to advancements in coronary computed tomography (CT) imaging. This case report highlights a 51-year-old male patient who was diagnosed with an intra-atrial course of the right coronary artery while undergoing evaluation for symptoms suggestive of angina. The detection of this rare anatomical variant was facilitated by modern cardiac CT technology. Following diagnosis, the patient was thoroughly reassured and educated about his condition. He was advised to avoid excessive physical exertion and was given guidance on lifestyle modifications to manage his symptoms effectively. It is crucial for healthcare providers to be aware of such anomalies, especially when planning surgical interventions or invasive procedures, to prevent potentially catastrophic outcomes.

The Psychometric Properties of the Persian Version of Emotional Abuse Questionnaire

Objective: Intimate partner emotional abuse is a serious issue that can lead to catastrophic outcomes for victims. Emotional abuse involves psychological tactics to control, manipulate, and degrade a person within an intimate relationship. This research aimed to translate the Emotional Abuse Questionnaire (EAQ) developed by Jacobson and Gottman into Persian for use among Iranian university students. Method: The translation of the 66-item EAQ involved a meticulous forward and backward translation process, linguistic matching, and a pilot review. In this cross-sectional study, 346 university students from Rasht, Iran, completed the EAQ. The mean age of participants was 26.78 ± 8.10 years, with most being female (89.0%). Reliability was evaluated using Cronbach's alpha and test-retest analysis while content and face validity were assessed by a panel of experts. Construct validity was examined through confirmatory factor analysis (CFA) and internal consistency measures. Divergent validity was assessed by comparing the EAQ with the ENRICH Marital Satisfaction Scale (EMS). Results: Impact scores for face validity ranged from 2.33 to 3.92, based on respondents' ratings of frequency and importance. Content validity assessment led to removing four items with a CVR below 0.62, resulting in 62 valid items. The EAQ showed strong internal consistency, with a Cronbach’s alpha of 0.97, exceeding the acceptable threshold of 0.70. CFA results confirmed the validity of the second-order factor model of the EAQ (χ2/df = 4.34, CFI = 0.95, RMSEA = 0.098, SRMR = 0.077). The EAQ demonstrated a strong correlation with EMS measures, confirming divergent validity. Conclusion: The Persian version of the EAQ is a reliable instrument for assessing emotional abuse among Iranian university students. Future research should explore the cultural sensitivity of the questionnaire and investigate associations between emotional abuse and other variables of interest, such as mental health outcomes or relationship dynamics. These avenues promise valuable insights into the frequency and effects of emotional abuse across diverse cultural contexts.

Spontaneous avulsion of left internal mammary artery graft a complication of coronary artery bypass surgery: case report and review of the literature

BackgroundCoronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade.Case presentationWe hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient’s critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection.ConclusionAvulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.

ANTICIPATING BIOSECURITY HAZARDS: DISTRIBUTION AND RECOGNITION OF BIOLOGICAL THREATS

Understanding the potential biological weapons that can be created, the technologies involved, and the entities capable of producing them is crucial for biosecurity. Equally important is comprehending the various targets a biological weapon might be aimed at, the deployment methods, and available detection strategies to counteract illegal biological threats. This chapter delves into these aspects, starting with methods of deployment. The Center for Disease Control and Prevention (CDC) categorizes disease transmission into direct and indirect modes. Direct transmission involves contact with an infected person or environmental reservoir, including droplet spread, proven highly effective in densely populated areas. Indirect transmission occurs through contaminated objects or vectors. Vehicle-based transmission involves contaminating inanimate objects like food, water, and biological products. Vector-based transmission involves organisms carrying and transmitting pathogens. Airborne transmission, receiving significant attention for its potential in biological attacks, involves pathogens suspended in the air, posing significant risks, especially in crowded areas. Biological weapons could target humans, agriculture, technology, and the environment. Attacks on humans, often the focus of biosecurity efforts, pose catastrophic outcomes. State-sponsored programs often focus on human pathogens like Bacillus anthracis and Yersinia pestis. Agroterrorism, targeting agriculture and livestock, can lead to economic losses and social instability. Attacks on technology, utilizing synthetic biology, have shown the potential to manipulate DNA to store and deploy malicious code, highlighting vulnerabilities in sequencing systems. While attacks on the environment remain theoretical, advancements in gene drives raise concerns about manipulating ecosystems. Effective biosecurity involves pre- and post-deployment screening techniques. Pre-deployment screening, particularly gene synthesis, focuses on preventing the acquisition of DNA fragments for weapon production. Current measures involve background checks and screening against pathogen lists, yet gaps exist, including inadequate international policies and the potential to hide malicious sequences within longer ones. Post-deployment detection relies on traditional molecular diagnostic methods, but synthetic pathogens may evade detection, necessitating ongoing advancements in detection techniques. Real-time sensors and biosensors offer promising avenues for quick and accurate pathogen recognition, although challenges remain in detecting novel pathogens against a natural background. In conclusion, understanding the range of biological weapons, their potential targets, deployment methods, and detection strategies is essential for effective biosecurity. Continued research and advancements in detection technologies are crucial to staying ahead of evolving biological threats, ensuring a safer and more secure future.

Genetically predicted effects of 10 sleep phenotypes on revision of knee arthroplasty: a mendelian randomization study

BackgroundAccumulating evidence has suggested that sleep disturbances and disorders are common in patients who undergo knee arthroplasty. Revision surgery represents one of the most catastrophic outcomes of knee arthroplasty. However, it remains unclear whether sleep traits are the causes or consequences of knee arthroplasty revision. This study aimed to genetically examine the relationships between sleep traits and knee arthroplasty revision.MethodsTo determine the causal relationship between sleep traits and knee arthroplasty revision, we employed two-sample Mendelian randomization (MR) using summary statistics from the largest publicly available genome-wide association studies (GWASs). The MR design uses genetic variants as instrumental variables to help separate causal relationships from non-causal associations. The main analyses included an inverse variance weighted (IVW) meta-analysis to obtain primary effect estimates. Sensitivity analyses involving the weighted median approach and MR-Egger regression were also conducted to check for potential pleiotropic biases. Numerous complementary sensitivity analyses were also performed to identify statistically significant causal correlations when there were horizontal pleiotropy and heterogeneity across variants. Finally, a reverse MR analysis was performed to evaluate the possibility of reverse causation.ResultsIn the absence of heterogeneity and horizontal pleiotropy, the IVW method revealed that genetically-predicted short sleep duration short sleep duration (average sleep duration of 24 h is 6 h or less) was positively correlated with the risk of knee arthroplasty revision (odds ratio = 1.03, 95% confidence interval = 1.01–1.05, and P = 0.003), while the association between genetically-predicted long sleep duration and knee arthroplasty was negative. The reverse MR analysis did not yield evidence supporting reverse causality relation between knee arthroplasty revision and sleep phenotypes.ConclusionThis research indicated that, of the 10 sleep phenotypes we analyzed, only sleep duration was causally associated with knee arthroplasty revision. These discoveries added to the understanding of the role of sleep traits in the etiology of knee arthroplasty revision, which might further expand our insights into the prevention of knee arthroplasty revision.

Resilience of weighted networks with dynamical behavior against multi-node removal.

In many real-world networks, interactions between nodes are weighted to reflect their strength, such as predator-prey interactions in the ecological network and passenger numbers in airline networks. These weighted networks are prone to cascading effects caused by minor perturbations, which can lead to catastrophic outcomes. This vulnerability highlights the importance of studying weighted network resilience to prevent system collapses. However, due to many variables and weight parameters coupled together, predicting the behavior of such a system governed by a multi-dimensional rate equation is challenging. To address this, we propose a dimension reduction technique that simplifies a multi-dimensional system into a one-dimensional state space. We applied this methodology to explore the impact of weights on the resilience of four dynamics whose weights are assigned by three weight assignment methods. The four dynamical systems are the biochemical dynamical system (B), the epidemic dynamical system (E), the regulatory dynamical system (R), and the birth-death dynamical system (BD). The results show that regardless of the weight distribution, for B, the weights are negatively correlated with the activities of the network, while for E, R, and BD, there is a positive correlation between the weights and the activities of the network. Interestingly, for B, R, and BD, the change in the weights of the system has little impact on the resilience of the system. However, for the E system, the greater the weights the more resilient the system. This study not only simplifies the complexity inherent in weighted networks but also enhances our understanding of their resilience and response to perturbations.

Evaluating cardiovascular disease risk in type 2 diabetes mellitus patients in a tertiary care hospital in Hyderabad, Sindh, Pakistan

Type 2 Diabetes Mellitus (DM) is the most common type of diabetes. The main adverse effect of diabetes type 2 involves a higher risk of cardiovascular disease. Diabetes patients with this type are more likely to suffer cardiovascular problems. Consequently, this study investigated demographics, CVR factors, age, gender, physical activity, BMI, hemodynamics, HbA1c stage, and lipid profile of 120 patients with type 2 diabetes in Hyderabad, Sindh, Pakistan. The current study covered 120 patients with type 2 diabetes, out of which 40 were male (33.3%) and 80 were female (66.6%), aged 50 to 70. Out of these 120 patients, 17 (14.1%) had coronary artery disease, 15 (12.5) had atherosclerosis, and 8% (6.6) experienced a stroke, according to the findings. Approximately 37.5% of patients had overweight obesity, 54% had poor diabetes control, and 10% had reasonable control based on their HbA1c readings. Furthermore, 55% were hypertensive, and around 12.5% had both macro and microvascular problems. In general, around 33.3% of all Type 2 DM patients have cardiovascular diseases (CVD), indicating that patients with Type 2 DM have a greater risk of increasing CVD. As a result, proper strategies should be implemented to avoid catastrophic outcomes and disease development.

Injury and Section of Flexors in Zone II

Flexor tendon repair is a challenging task in hand surgery, with numerous studies and publications on the subject. The incidence of flexor tendon injuries in India is estimated to be around 14/100,000-person years. The fingers are characterized by five zones: Zone I, Zone II, Zone III, Zone IV, and Zone V. Reparation of these zones involves flap extension, suturing, and band repair. However, tendon repair is fraught with complications, with the most catastrophic outcome being rupture. Tendon adhesions are a common consequence of the healing process and can be limited with atraumatic surgical techniques, robust repair, and early mobilization strategies. Ultrasound imaging is helpful in determining the continuity of the flexor tendon. Tenolysis surgery may be necessary if treatment is unsuccessful, but is generally recommended after three to six months.

Prediction of retrogressive landslide in sensitive clays by incorporating a novel strain softening law into the Material Point Method

Sensitive clays, when subjected to large strains, exhibit a unique strain-softening behavior, transforming into a remolded liquid with remarkably low shear strength. When a slope fails, this behavior leads to the remolded clay moving away from its original position, triggering subsequent failures and catastrophic outcomes. To accurately predict such scenarios, it is crucial to incorporate realistic strain-softening characteristics into the constitutive soil model. This paper presents a novel yet practical strain-softening law developed by the authors that effectively captures the post-peak behavior of sensitive clays down to their remolded strength. The softening law is implemented in an elastoplastic Mohr-Coulomb model and incorporated into Anura3D, an open-source software that uses the Material Point Method to simulate large deformations. The constitutive model is calibrated by simulating the stress-strain behavior through direct shear tests conducted at three sensitive clay landslide locations. The accuracy of the overall numerical framework is assessed by predicting the post-failure movements of these landslides. Notably, two of the landslides, Sainte-Monique (1994) and Saint-Jude (2010), have previously been analyzed using other numerical tools, allowing for a comparative analysis with the method presented here. The third landslide, the Saint-Luc-de-Vincennes landslide, representing a composite flow slide and spread, has been numerically simulated for the first time. The post-failure behavior observed in the landslide events is compared with field observations and other numerical analyses. The results show that the MPM models with the proposed strain-softening law can reasonably predict post-failure retrogression and runout distance, which are crucial parameters for determining the risk of landslides in sensitive clays.

Rapid alleviation of perioperative airway obstruction through positional adjustments in a patient with a giant anterior mediastinal mass: A case report

Rationale: This case describes the rapid resolution of acute airway obstruction after anesthesia induction in a young man with a massive 12.7 × 9 × 12 cm anterior mediastinal tumor. It emphasizes the remarkable effectiveness of positional adjustments in immediately alleviating airway compression caused by large mediastinal masses. The crisis was resolved quickly and without invasive measures through only positional tactics, without the need for emergency invasive interventions. This highlights the decisive role of strategic patient positioning as a primary technique for perioperative management of mediastinal masses, ensuring adequate ventilation and preventing catastrophic outcomes. Patient concerns: Due to the unique anatomical location of mediastinal tumors, the anesthesia risks for patients with mediastinal tumors are very high. These tumors can cause airway compression, leading to severe cardiovascular dysfunction and even mortality during general anesthesia. Diagnoses: Combining the patient’s medical history, symptoms and signs, fiberoptic bronchoscopy and excluding other causes, it was confirmed that the tumor compressed the airway and blocked the airway. Interventions: Ventilation was rapidly improved by adjusting the patient’s position, ultimately to the left lateral decubitus position with head-up tilt. Outcomes: Through positional adjustment, the patient’s airway obstruction symptoms rapidly improved. Airway pressure decreased significantly, end-tidal carbon dioxide returned to 40 mm Hg, and oxygen saturation increased to 95%. The mediastinal tumor was ultimately successfully resected. The surgical procedure went smoothly with successful extubation on the first postoperative day. The patient had a smooth recovery and was discharged on the seventh postoperative day without any lingering postoperative complications. Lessons: This case provides an important educational illustration of how mediastinal mass patients can develop sudden catastrophic airway obstruction after induction despite being asymptomatic preoperatively. It demonstrates an effective crisis rescue technique through positioning that may help inform management of similar high-risk cases.

The Egyptian Campaign and the Middle East

The author of the essay* tells about the main milestones of more than two hundred years old historiography of the Egyptian campaign of 1798–1801, undertaken by the French land forces and navy under the general command of Napoleon Bonaparte, identifies the prerequisites that made such an audacious military enterprise possible, highlights the vicissitudes of the Egyptian and Syrian campaigns of Bonaparte’s Oriental Army, analyzes the motives of the decisive rejection by the local population of the values of the French Revolution, planted by the occupation administration, and establishes the reasons for the final catastrophic outcome of this expedition. The history of the Egyptian campaign is considered by the author in the general context of the evolution of international relations caused by the French Revolution and by the active expansion of revolutionary France. In his opinion, Bonaparte’s Egyptian campaign, which had as its main goal to undermine Britain’s position in the Middle East and Asia, led to exactly the opposite result than the one its initiators had hoped for: the British managed not only to stay in this region, but to gain dominant influence there, whereas France, having spent on this adventure large human and material resources, turned out to be almost completely displaced from there for some time.

Numerical study and dynamics analysis of diabetes mellitus with co-infection of COVID-19 virus by using fractal fractional operator

COVID-19 is linked to diabetes, increasing the likelihood and severity of outcomes due to hyperglycemia, immune system impairment, vascular problems, and comorbidities like hypertension, obesity, and cardiovascular disease, which can lead to catastrophic outcomes. The study presents a novel COVID-19 management approach for diabetic patients using a fractal fractional operator and Mittag-Leffler kernel. It uses the Lipschitz criterion and linear growth to identify the solution singularity and analyzes the global derivative impact, confirming unique solutions and demonstrating the bounded nature of the proposed system. The study examines the impact of COVID-19 on individuals with diabetes, using global stability analysis and quantitative examination of equilibrium states. Sensitivity analysis is conducted using reproductive numbers to determine the disease’s status in society and the impact of control strategies, highlighting the importance of understanding epidemic problems and their properties. This study uses two-step Lagrange polynomial to analyze the impact of the fractional operator on a proposed model. Numerical simulations using MATLAB validate the effects of COVID-19 on diabetic patients and allow predictions based on the established theoretical framework, supporting the theoretical findings. This study will help to observe and understand how COVID-19 affects people with diabetes. This will help with control plans in the future to lessen the effects of COVID-19.

GC-YOLOv9: Innovative smart city traffic monitoring solution

In urban smart city environments, traffic hazards can lead to catastrophic outcomes, including significant property losses and severe threats to public safety. Conventional traffic monitoring systems are limited in terms of accuracy and speed, presenting significant challenges for real-time traffic surveillance. To tackle these challenges, this paper introduces the GC-YOLOv9 algorithm. Specifically, we have enhanced the YOLOv9 model by incorporating Ghost Convolution, markedly improving the model’s perceptual abilities and detection accuracy. Furthermore, this study designed an integrated smart city framework that includes layers for service applications, the Internet of Things, edge processing, and data centers. By deploying the enhanced YOLOv9 model within this framework, our method achieved mAP@0.5 scores of 77.15 and 74.95 on the BDD100K and Cityscapes datasets, respectively, surpassing existing technologies. Additionally, the potential applications of this method in public area fire safety management, forest fire monitoring, and intelligent security systems further underscore its significant value in improving the safety and efficiency of smart cities.

Early Diagnostic and Management of Acute Heart Failure: Can Cardiogenic Shock be Prevented?

Background: Heart failure is a growing health concern, affecting about 2% of the adult population. It emphasizes the importance of recognizing and addressing a specific subgroup of patients suffering from acute heart failure (AHF). AHF is described as a critical clinical condition often overlooked in diagnosis, leading to catastrophic outcomes if not promptly identified. Given its potential severity, understanding the unique characteristics of AHF, along with appropriate therapeutic interventions, is crucial for improving patient outcomes and reducing mortality rates. Methods: The study included 20 patients with heart failure and reduced ejection fraction who presented with decompensated clinical conditions characteristic of acute heart failure. Data were collected preoperatively, perioperatively, and postoperatively up to a 30-day follow-up period. Results: The primary outcome was the 30-day mortality, which was found to be 20%. Among the patients with AHF, 60% had congestive heart failure with an average ejection fraction of 29.8%, indicating severe ventricular dysfunction. Additionally, 45% of patients presented with chronic kidney injury, characterized by a low mean glomerular filtration rate and elevated urea and creatinine levels. The presence of acute congestive and retention syndrome was evident in these patients, exacerbating the underlying disease. Notably, 10% of patients required left ventricular assistance devices, and associated procedures were performed as part of the surgical management of heart failure. Conclusion: The failure to recognize the diagnosis of this serious acute condition can quickly lead to patient’s death. Although, AHF showed 30-days high mortality rate, early diagnose, decongestive therapy and myocardial revascularization had avoided worst outcomes in cardiogenic shock.