Early Deterioration Research Articles

Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences.

Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n=23 ears), and 50% by 5 years in bilateral passes (n=62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n=91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. 3 Laryngoscope, 132:S1-S24, 2022.

Glenoid retroversion does not impact clinical outcomes or implant survivorship after total shoulder arthroplasty with minimal, noncorrective reaming.

HypothesisBoth clinical outcomes and early rates of failure will not be associated with glenoid retroversion.MethodsAll patients who underwent an anatomic total shoulder arthroplasty with minimal, noncorrective reaming between 2006 and 2016 with minimum 2-year follow-up were reviewed. Measurements for retroversion, inclination, and posterior subluxation were obtained from magnetic resonance imaging or computerized tomography. A regression analysis was performed to assess the association between retroversion, inclination and subluxation, and their effect on patient reported outcomes (PROs). Clinical failures and complications were reported.ResultsOne hundred fifty-one anatomic total shoulder arthroplasties (90% follow-up) with a mean follow-up of 4.6 years (range, 2-12 years) were assessed. The mean preoperative retroversion was 15.6° (range, 0.2-42.1), the mean posterior subluxation was 15.1% (range, −3.6 to 44.1%), and the mean glenoid inclination was 13.9° (range, −11.3 to 44.3). All median outcome scores improved significantly from pre- to post-operatively (P < .001). The median satisfaction was 10/10 (1st quartile = 7 and 3rd quartile = 10). Linear regression analysis found no significant association between retroversion and any postoperative PRO. A total of 5 (3.3%) failures occurred due to glenoid implant loosening (3 patients) and Cutibacterium acnes infection (2 patients) with no association between failure causation and increased retroversion or inclination. No correlation could be found between the Walch classification and postoperative PROs.ConclusionAnatomic total shoulder replacement with minimal and noncorrective glenoid reaming demonstrates reliable increases in patient satisfaction and clinical outcomes at a mean of 4.6-year follow-up in patients with up to 40° of native retroversion. Higher values of retroversion were not associated with early deterioration of clinical outcomes, revisions, or failures. Long-term studies are needed to see if survivorship and outcomes hold up over time.

Predictors of Early Deterioration of Renal Function in Patients Older Than 70 Years Undergoing Valvular Surgery.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open-heart surgery, with an incidence between 8.9% and 39%. Studies have shown that even a slight increase in serum creatinine levels after cardiac surgery significantly affects the mortality and morbidity of these patients. This study sought to determine the predictors and incidence of acute kidney injury (AKI) in patients older than 70 years undergoing elective valvular surgery. Prospective study included 156 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) at Dedinje Cardiovascular Institute between January and September 2019. Isolated valvular surgery was performed in 87 patients, while the remaining 69 patients underwent combined coronary and valvular surgery. The development and stage of CSA-AKI were diagnosed, according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Predictors and incidence of CSA-AKI development were assessed using univariate binary logistic regression analysis. The incidence of CSA-AKI was 17.3%. CSA-AKI stage 1 was diagnosed in 25 patients (16.02%). CSA-AKI stage 2 was noted in one patient (0.64%), as well as stage 3 (0.64%). In six patients (3.85%), renal replacement therapy (RRT) was required. Using univariate binary logistic analysis, the following parameters were identified as predictors for CSA-AKI development: duration of cardiopulmonary bypass (OR 1.01; CI 95% (1.01-1.02); P = .002), duration of aortic clamping (OR 1.02; CI 95% (1.01-1.03); P = .002), lactate levels during the intensive care unit (ICU) stay (OR 1.33; CI 95% (1.04-1.70); P = .026), duration of mechanical ventilation (MV) (OR 1.03; CI 95% (1.1-1.07); P = .014), the use of inotropic drugs (adrenaline, dobutamine) (OR 0.38: CI 95% (0.16-0.9); P = .026; and OR 0.23; CI 95% (0.1-0.56); P = .0019, respectively), and the use of diuretics (OR 0.24; CI95% (0.06-095); P = .041). Using Mann-Whitney U test for independent samples show that the group of patients who developed CSA-AKI had significantly longer duration of hospitalization (Z = -2.751); P = .006), prolonged ICU stay (Z = -4.160; P < .001), and need for prolonged mechanical ventilation (Z = -4.411; P < .001). Independent predictors for AKI development after valvular surgery in patients older than 70 years are prolonged mechanical ventilation and increased lactate values, while the use of diuretics after surgery reduces the incidence of AKI. Also, the development of CSA-AKI is associated with prolonged ICU stay and a longer duration of hospitalization.

The predictive performance and impact of pediatric early warning systems in hospitalized pediatric oncology patients-A systematic review.

Pediatric early warning systems (PEWS) arewidely used to identify clinically deteriorating patients. Hospitalized pediatric oncology patients are particularly prone to clinical deterioration. We assessed the PEWS performance to predict early clinical deterioration and the effect of PEWS implementation on patient outcomes in pediatric oncology patients. PubMED, EMBASE, and CINAHL databases were systematically searched from inception up to March 2020. Quality assessment was performed using the Prediction model study Risk-Of-Bias Assessment Tool (PROBAST) and the Cochrane Risk-of-Bias Tool. Nine studies were included. Due to heterogeneity of study designs, outcome measures, and diversity of PEWS, it was not possible to conduct a meta-analysis. Although the studies reported high sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) of PEWS detecting inpatient deterioration, overall risk of bias of the studies was high. This review highlights limited evidence on the predictive performance of PEWS for clinical deterioration and the effect of PEWS implementation.

Physical properties of portland cement based concrete exposed at a depth of 3520 m in the Nankai Trough

Concrete is widely used in large-scale construction of submarine infrastructure because of its high strength, durability, and ease of handling. However, knowledge of its durability in deep seawater is lacking. In the deep sea, materials are exposed to high pressures and low temperatures, which may cause early deterioration of concrete over time. Concrete materials may also be affected by the chemical composition of seawater, which induces the leaching of calcium. In situ exposure tests are therefore important for understanding degradation processes in the deep sea. In this study, Portland cement based concrete specimens were placed at a depth of 3520 m on the northern edge of the Nankai Trough in 2018 and retrieved in 2019, in the deepest exposure testing conducted to date. Here we provide an outline of the tests, describe the physical properties of materials exposed to deep seawater, freshwater, and air, and discuss possible concrete degradation mechanisms.

COVID-19 Oximetry @home: evaluation of patient outcomes.

BackgroundCOVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID-19 Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care.MethodsWe conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 General Practitioner (GP) practices covering 230 000 people). We have compared outcomes for patients admitted to Basingstoke and North Hampshire Hospital who were CO@h patients (COVID-19 patients with home monitoring of oxygen saturation (SpO2; n=115), with non-CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Crude and adjusted OR analysis was performed to evaluate the effects of CO@h on patient outcomes of 30-day mortality, Intensive care unit (ICU) admission and hospital length of stay greater than 3, 7, 14 and 28 days.ResultsAdjusted ORs for CO@h show an association with a reduction for several adverse patient outcome: 30-day hospital mortality (p<0.001, OR 0.21, 95% CI 0.08 to 0.47), hospital length of stay larger than 3 days (p<0.05, OR 0.62, 95% CI 0.39 to 1.00), 7 days (p<0.001, OR 0.35, 95% CI 0.22 to 0.54), 14 days (p<0.001, OR 0.22 95% CI, 0.11 to 0.41), and 28 days (p<0.05, OR 0.21, 95% CI 0.05 to 0.59). No significant reduction ICU admission was observed (p>0.05, OR 0.43, 95% CI 0.15 to 1.04). Within 30 days of hospital admission, there were no hospital readmissions for those on the CO@h service as opposed to 8.7% readmissions for those not on the service.ConclusionsWe have demonstrated a significant association between CO@h and better patient outcomes; most notably a reduction in the odds of hospital lengths of stays longer than 7, 14 and 28 days and 30-day hospital mortality.

CHARACTERISTICS OF ARABIC HANDWRITING ON GRAPHIC TABLET IN NEURODEGENERATIVE DISEASE: PRELIMINARY RESULTS BETWEEN PATIENTS WITH ALZHEIMER’S DISEASE AND HEALTHY CONTROLS

Handwriting is a component of the complex language that came about late in the history of mankind and which develops late in human beings. Numerous works have raised changes in both the graphic and kinematic characteristics of writing. Although, age does not modify the lexical and syntactic parameters of language, it can however modify its spatial structure, especially pressure and speed. Many neurodegenerative pathologies, especially Alzheimer's disease, are characterized by a progressive disorganization of writing. Depending on the cognitive stage of the dementia, the graphic gesture deteriorates as does the spatial construction. Objective: Our study aims at assessing the characteristics of Arabic writing in a healthy Moroccan population and to compare it to people with mild to moderate Alzheimer's disease. Our objective is to help health professionals detect early cognitive deterioration in neurodegenerative diseases by analyzing the graphic gesture. Handwriting is captured on a graphic tablet (WACOM) and is analyzed "online" as a sequence of acquired signals (position, pressure, speed and pen inclination) in Moroccan patients with mild to moderate Alzheimer's disease and these were compared to those of normal volunteers. We performed a first analysis of the results from 18 Alzheimer's patients compared to 18 control subjects. The results reveal differences between the control and Alzheimer's groups. AD subjects had lower speeds and accelerations compared to the control subjects. The time spent on paper and in the air was significantly greater in the AD subjects. This preliminary analysis of the results allowed us to identify distinguishing characteristics through the analysis of different handwriting parameters in order to identify the two groups studied.

Beyond Sarcopenia: older adults with type II diabetes mellitus tend to experience an elevated risk of poor dynamic balance\u2014a case\u2013control study

BackgroundPeople with type 2 diabetes mellitus (T2DM) tend to be vulnerable to geriatric syndromes such as sarcopenia and frailty. Reduced physical activity also accompanies sarcopenia and frailty, which is generally typical of patients with T2DM. However, a comprehensive assessment of physical fitness in patients with T2DM has seldom been carried out and verified. This study is thus an attempt to determine the associations among sarcopenia, frailty, and the SFT in diabetic patients and non-diabetic controls to provide a more comprehensive understanding of such associations in future evaluations of T2DM in older individuals.MethodsSarcopenia, frailty, and the senior fitness test (SFT) were compared between 78 older men with T2DM (66.5 ± 9.0 years) and 48 age-matched normoglycemic controls (65.8 ± 5.3 years) in this case–control study. The skeletal muscle index (SMI), grip strength, and 4-m walk test were employed to assess for sarcopenia. Frailty was evaluated using the Study of Osteoporotic Fractures index (SOF). The SFT comprises five components, including body composition, muscle strength, flexibility, balance, and aerobic endurance.ResultsThe risk level of sarcopenia was significantly higher (p < 0.05) in the T2DM group as compared to the control group. No significant difference between-group differences were found in SMI and grip strength in the T2DM and control groups. However, the T2DM group showed a significant decrease in gait speed (p < 0.01) in comparison with the control group, as well as significant increases in frailty (p < 0.01) and depression (p < 0.05). With respect to the SFT, obvious elevation in BMI, significant declines in extremity muscle strength (elbow extensor, knee flexor, hip abductor, hip flexor, sit to stand), static/dynamic balance (single leg stand: p < 0.05; up-and-go: p < 0.01) and aerobic endurance (2-min step: p < 0.01; 6-min walk: p < 0.01) were found in the T2DM group. Furthermore, the SOF (OR = 2.638, 95% CI = 1.333–5.221), BMI (OR = 1.193, 95% CI = 1.041–1.368) and up-and-go (OR = 2.089, 95% CI = 1.400–3.117) were found to be positively and significantly associated with T2DM.ConclusionsThe findings of this study indicated the importance of countering frailty and maintaining physical fitness, especially dynamic balance, during the early physical deterioration taking place in diabetic patients.

Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities

Ivermectin, an inexpensive and widely available antiparasitic drug, is prescribed to treat COVID-19. Evidence-based data to recommend either for or against the use of ivermectin are needed. To determine the efficacy of ivermectin in preventing progression to severe disease among high-risk patients with COVID-19. The Ivermectin Treatment Efficacy in COVID-19 High-Risk Patients (I-TECH) study was an open-label randomized clinical trial conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between May 31 and October 25, 2021. Within the first week of patients' symptom onset, the study enrolled patients 50 years and older with laboratory-confirmed COVID-19, comorbidities, and mild to moderate disease. Patients were randomized in a 1:1 ratio to receive either oral ivermectin, 0.4 mg/kg body weight daily for 5 days, plus standard of care (n = 241) or standard of care alone (n = 249). The standard of care consisted of symptomatic therapy and monitoring for signs of early deterioration based on clinical findings, laboratory test results, and chest imaging. The primary outcome was the proportion of patients who progressed to severe disease, defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher. Secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events. Among 490 patients included in the primary analysis (mean [SD] age, 62.5 [8.7] years; 267 women [54.5%]), 52 of 241 patients (21.6%) in the ivermectin group and 43 of 249 patients (17.3%) in the control group progressed to severe disease (relative risk [RR], 1.25; 95% CI, 0.87-1.80; P = .25). For all prespecified secondary outcomes, there were no significant differences between groups. Mechanical ventilation occurred in 4 (1.7%) vs 10 (4.0%) (RR, 0.41; 95% CI, 0.13-1.30; P = .17), intensive care unit admission in 6 (2.4%) vs 8 (3.2%) (RR, 0.78; 95% CI, 0.27-2.20; P = .79), and 28-day in-hospital death in 3 (1.2%) vs 10 (4.0%) (RR, 0.31; 95% CI, 0.09-1.11; P = .09). The most common adverse event reported was diarrhea (14 [5.8%] in the ivermectin group and 4 [1.6%] in the control group). In this randomized clinical trial of high-risk patients with mild to moderate COVID-19, ivermectin treatment during early illness did not prevent progression to severe disease. The study findings do not support the use of ivermectin for patients with COVID-19. ClinicalTrials.gov Identifier: NCT04920942.

Plastic Bituminous Roads: A Sustainable Technology – For Better Handling Distresses

The present era, in particular, the last 3 to 4 decades can be easily named the “Plastic Age” and dealing with plastic waste has always been a challenging affair for Urban local bodies. Plastic roads are bituminous roads or pavement that have a waste plastic blended mix for their wearing courses. Plastic bituminous roads being a sustainable technology are becoming very popular nowadays as a substitute for conventional bituminous roads in India and other parts of the World. Evaluation of pavement is important to plan its maintenance strategy timely to avoid the complete deterioration of the pavement. In the present study, plastic bituminous roads and normal bituminous roads are evaluated for their various distress parameters and are compared based on distress parameters over the years. This paper tries to answer a basic question of whether Plastic Bituminous Roads are definitely sustainable but are they also better in handling the distresses. The study has also revealed that plastic bituminous roads perform better in early deterioration as compared to normal bituminous roads which will encourage field professionals and Urban Local bodies to use this sustainable technology.

Plastic Bituminous Roads: A Sustainable Technology – For Better Handling Distresses

The present era, in particular, the last 3 to 4 decades can be easily named the “Plastic Age” and dealing with plastic waste has always been a challenging affair for Urban local bodies. Plastic roads are bituminous roads or pavement that have a waste plastic blended mix for their wearing courses. Plastic bituminous roads being a sustainable technology are becoming very popular nowadays as a substitute for conventional bituminous roads in India and other parts of the World. Evaluation of pavement is important to plan its maintenance strategy timely to avoid the complete deterioration of the pavement. In the present study, plastic bituminous roads and normal bituminous roads are evaluated for their various distress parameters and are compared based on distress parameters over the years. This paper tries to answer a basic question of whether Plastic Bituminous Roads are definitely sustainable but are they also better in handling the distresses. The study has also revealed that plastic bituminous roads perform better in early deterioration as compared to normal bituminous roads which will encourage field professionals and Urban Local bodies to use this sustainable technology.

Classical and myocardial deformation echocardiographic indices in chronic kidney disease patients; effects of aging and comparison to healthy controls

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease compared to the general population. Classic echocardiographic indices of left ventricular (LV) function may not be sensitive enough in detecting early myocardial deterioration in CKD patients while LV speckle tracking (2DSTE) analysis has shown promising results. Dipyridamole stress echocardiography (DIPSE), mostly used to measure coronary flow reserve (CFR), assesses coronary macrovascular and/or microvascular dysfunction in a non-invasive way. Purpose To investigate differences in classic, 2DSTE-related indices, CFR and other DIPSE-induced changes in various echocardiographic parameters between 1) healthy controls and age-matched (younger) CKD patients, 2) younger versus older CKD patients with similar clinical characteristics. Methods We prospectively evaluated 30 healthy controls and 60 consecutive CKD patients 40-75 years old who were followed-up at the CKD outpatient clinic of a University Hospital in Western Greece. A standard echocardiographic analysis including 2DSTE analysis was performed in all subjects before and after dipyridamole infusion. CFR in left anterior descending artery was also assessed. Results The median age of the CKD patients was 63 years and most of them were males (70%). Younger patients with CKD (i.e. &amp;lt;60 years old) had higher E/e" ratio (7.80 ± 2.71 vs 6.06 ± 1.37, p = 0.019), LVMI (114.7 ± 41.1 vs 89.6 ± 21.2, p = 0.017) and relative wall thickness (0.47 ± 0.08 vs 0.40 ± 0.06, p = 0.031) and lower E" (10.6 ± 2.6 vs 2.3 ± 2.9 cm/s, p = 0.045) compared to age and gender-matched healthy controls. Older CKD patients had lower E/A (0.80 ± 0.19 vs 1.03 ± 0.33, p = 0.007) and E" (8.5 ± 1.8 vs 10.6 ± 2.6 cm/s, p = 0.003) compared to younger CKD patients. CFR was higher in healthy controls compared to both younger (3.93 ± 1.25 versus 3.1 ± 0.75, p = 0.009) and older CKD patients (3.93 ± 1.25 versus 2.89 ± 0.88, p &amp;lt; 0.001); no significant difference in CFR was observed between younger and older CKD patients. Dipyridamole-induced changes in other studied echocardiographic indices did not differ significantly among groups. Conclusions In the current study, impaired coronary microcirculation, LV diastolic function and increased LV mass with concentric remodeling were shown to be the principal findings early in the process of CKD. These results may have pathophysiological implications for cardiorenal syndrome type 4 and targeted cardiac assessment in CKD patients. Future studies are needed to assess whether any therapeutic efforts aiming to delay or reverse these changes may have an impact on the cardiovascular prognosis in CKD patients.

Remote Monitoring of Patients With Hematologic Malignancies at High Risk of Febrile Neutropenia: Exploratory Study.

BackgroundFebrile neutropenia is one of the most common oncologic emergencies and is associated with significant, preventable morbidity and mortality. Most patients who experience a febrile neutropenia episode are hospitalized, resulting in significant economic cost.ObjectiveThis exploratory study implemented a remote monitoring system comprising a digital infrared thermometer and a pulse oximeter with the capability to notify providers in real time of abnormalities in vital signs that could suggest early clinical deterioration and thereby improve clinical outcomes.MethodsThe remote monitoring system was implemented and compared to standard-of-care vital signs monitoring in hospitalized patients with underlying hematologic malignancies complicated by a febrile neutropenia episode in order to assess the feasibility and validity of the system. Statistical analysis was performed using the intraclass correlation coefficient (ICC) to assess the consistency between the measurements taken using traditional methods and those taken with the remote monitoring system for each of the vital sign parameters (temperature, heart rate, and oxygen saturation). A linear mixed-effects model with a random subject effect was used to estimate the variance components. Bland-Altman plots were created for the parameters to further delineate the direction of any occurring bias.ResultsA total of 23 patients were enrolled in the study (mean age 56, SD 23-75 years; male patients: n=11, 47.8%). ICC analysis confirmed the high repeatability and accuracy of the heart rate assessment (ICC=0.856), acting as a supplement to remote temperature assessment. While the sensitivity and specificity for capturing tachycardia above a rate of 100 bpm were excellent (88% and 97%, respectively), the sensitivity of the remote monitoring system in capturing temperatures >37.8 °C and oxygen saturation <92% was 45% and 50%, respectively.ConclusionsOverall, this novel approach using temperature, heart rate, and oxygen saturation assessments successfully provided real-time, clinically valuable feedback to providers. While temperature and oxygen saturation assessments lagged in terms of sensitivity compared to a standard in-hospital system, the heart rate assessment provided highly accurate complementary data. As a whole, the system provided additional information that can be applied to a clinically vulnerable population. By transitioning its application to high-risk patients in the outpatient setting, this system can help prevent additional use of health care services through early provider intervention and potentially improve outcomes.

Two cases of catastrophic deterioration and multiple leaflet detachment in Trifecta valves

Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valve (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valve with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency, and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with the Trifecta valves; thus, necessitates long-term vigilance in aortic replacement patients.

Early Deterioration and Long-Term Prognosis of Patients With Intracerebral Hemorrhage Along With Hematoma Volume More Than 20 ml: Who Needs Surgery?

Background and Purpose: The treatment of patients with intracerebral hemorrhage along with moderate hematoma and without cerebral hernia is controversial. This study aimed to explore risk factors and establish prediction models for early deterioration and poor prognosis.Methods: We screened patients from the prospective intracerebral hemorrhage (ICH) registration database (RIS-MIS-ICH, ClinicalTrials.gov Identifier: NCT03862729). The enrolled patients had no brain hernia at admission, with a hematoma volume of more than 20 ml. All patients were initially treated by conservative methods and followed up ≥ 1 year. A decline of Glasgow Coma Scale (GCS) more than 2 or conversion to surgery within 72 h after admission was defined as early deterioration. Modified Rankin Scale (mRS) ≥ 4 at 1 year after stroke was defined as poor prognosis. The independent risk factors of early deterioration and poor prognosis were determined by univariate and multivariate regression analysis. The prediction models were established based on the weight of the independent risk factors. The accuracy and value of models were tested by the receiver operating characteristic (ROC) curve.Results: After screening 632 patients with ICH, a total of 123 legal patients were included. According to statistical analysis, admission GCS (OR, 1.43; 95% CI, 1.18–1.74; P < 0.001) and hematoma volume (OR, 0.9; 95% CI, 0.84–0.97; P = 0.003) were the independent risk factors for early deterioration. Hematoma location (OR, 0.027; 95% CI, 0.004–0.17; P < 0.001) and hematoma volume (OR, 1.09; 95% CI, 1.03–1.15; P < 0.001) were the independent risk factors for poor prognosis, and island sign had a trend toward significance (OR, 0.5; 95% CI, 0.16-1.57; P = 0.051). The admission GCS and hematoma volume score were combined for an early deterioration prediction model with a score from 2 to 5. ROC curve showed an area under the curve (AUC) was 0.778 and cut-off point was 3.5. Combining the score of hematoma volume, island sign, and hematoma location, a long-term prognosis prediction model was established with a score from 2 to 6. ROC curve showed AUC was 0.792 and cutoff point was 4.5.Conclusions: The novel early deterioration and long-term prognosis prediction models are simple, objective, and accurate for patients with ICH along with a hematoma volume of more than 20 ml.

Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review.

to map the early clinical deterioration technologies used in nurses' professional practice in the care of hospitalized adult patients. this is a scoping review, according to Joanna Briggs Institute Reviewer's Manual, which seeks to map the main technologies for detecting early clinical deterioration of hospitalized patients available for use by nurses, summarizing them and indicating gaps in knowledge to be investigated. twenty-seven studies were found. The most present variables in the technologies were vital signs, urinary output, awareness and risk scales, clinical examination and nurses' judgment. The main outcomes were activation of rapid response teams, death, cardiac arrest and admission to critical care units. the study emphasizes the most accurate variables in patient clinical assessment, so that indicative signs of potential severity can be prioritized to guide health conducts aiming to intervene early in the face of ongoing clinical deterioration.

Corrosion assessment in rebars of high-strength concrete using electromechanical impedance technique

The corrosion of steel rebar in reinforced concrete structures is one of the main reasons for early deterioration and premature failure of concrete structures, leading to enormous restoration costs worldwide infrastructure restoration. In the past, many sensors and techniques have been developed to monitor corrosion in steel rebar. However, the Electromechanical Impedance (EMI) technique using the piezoelectric Lead Zirconate Titanate (PZT) patches has been immersed as a promising technique to detect damages at an incipient level. This paper presents the corrosion assessment in embedded rebar in high-strength concrete using surface-bonded PZT patches through the EMI technique. The High Yield Strength Deformed (HYSD) rebars of Fe415 grade embedded in high-strength M60 grade concrete cylindrical specimens were used for the experimental work. The artificial corrosion in the embedded rebar was simulated through the accelerated corrosion test for 180 days. The conductance signatures were acquired through a surface-bonded PZT patch on embedded rebar. First, qualitative and quantitative corrosion assessment was carried out based on the conductance signature and the Root Mean Square Deviation (RMSD). Second, the effectiveness of extracted equivalent parameters was demonstrated for capturing the degradation of stiffness and mass due to corrosion. Finally, the corrosion rate is evaluated through equivalent parameters, and a comparison was made with the actual mass loss. The experimental study demonstrated that the EMI technique could be used very effectively through the statical index RMSD and equivalent parameters to identify corrosion phases and resulting losses in stiffness and mass of the structure.

Neural network model to predict compressive strength of steel fiber reinforced concrete elements incorporating supplementary cementitious materials

During the recent past,the problem of early deterioration of concrete structures and durability of concrete structures has remained major issue posed to engineers. we have reported here the incorporation of Metakaolin,fly ash,GGBS & silica fume at binary and ternary blended system with diverse Water binder ratio. Various concrete mixes with supplementary Cementitious material (SCM) and Normal Concrete of Grade M40 (NC40) has been prepared and Steel Fiber & plasticizer dosage has been varied. This Research Paper Explore the Neural Network Model comprising Compressive strength of various binary and ternary blended Supplementary Cementitious concrete elements. ANN model, then contrasted with MS-Excel, is created with R programming. The right algorithm and neuronal numbers have been determined for optimizing the model architecture via a responsive analysis,. It was found that the prediction of compressive strength with a neuron network was highly accurate. The relative mean squared error, coefficient of decision (R2) and mean absolute relative error is calculated for the experimental outcomes and model outputs. Levenberg Marquardt as algorithm employed for performance analysis. Paramount and Least Value of R2 is 97.2 % and 95.2 % for training data sets in the ANN model. Statistical performance demonstrate that proposed ANN models for compressive strength is accurate and extremely nearer to the experimental values. There is a close harmonization between actual data and ANN compressive strength outputs. The ANN model therefore seems to be a valuable tool to forecast compressive strength.

Performance of PSGWC-Bars and other rebars reinforced columns

In comparison to earlier concrete structures, recent decades' structures have experienced early deterioration. The majority of the time, this is due to the severe corrosion found in today's ribbed rebars. The adoption of PSGWC-bars, which have a plain surface and a gentle wave-type configuration, can extend the life of concrete structures by several times by reducing the rate of rebar corrosion. Beams strengthened with PSGWC-bars performed significantly better in tests conducted at several colleges. To establish its viability as a replacement for traditional rebars in columns, the load carrying capacity of PSGWC bars and other rebars must be tested. In this paper an attempt has been made to improve load carrying capacity of column with rebars. The impact of plain bars, epoxy coated plain bars, galvanised plain bars, PSGWC-bars of five different types, ribbed bars, epoxy coated ribbed bars, and ribbed bars with galvanising on the performance of sustainable columns was examined in this paper. It has been discovered that the use of PSGWC-bars increases load-carrying capacities in concrete columns as well.

Predictive Value of Early Warning Scores for Clinical Deterioration and Mortality in Hospitalised COVID-19 Pneumonia Patients

BACKGROUND AND AIM: The most important step in inpatient management to prevent mortality in COVID-19 patients is to diagnose clinical deterioration early and quickly. Early warning score (EWS) systems evaluate vital signs to detect early deterioration in a patient’s clinical status. The aim of this study was to see how accurate the EWS is at predicting the need for a transfer to the intensive care unit (ICU) and the mortality in COVID-19 pneumonia patients who are hospitalized. METHODS: A total of 471 confirmed COVID-19 pneumonia patients treated in our COVID-19 wards were included in the present study. RESULTS: ICU admission occurred in 95 (20.1%) of the cases during hospitalization, with a death rate of 11.9%. Compared with patients who were not admitted to the ICU, those who were admitted had higher National Early Warning Score (NEWS), NEWS2, Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA) score (p<0.001). NEWS was found to be superior to NEWS2, MEWS, and qSOFA in predicting patient clinical deterioration (p<0.001). NEWS outperformed NEWS2, MEWS, and the qSOFA score in predicting overall hospital mortality (p<0.05). ICU admission was substantially associated with high NEWS (≥7) and NEWS2 (≥7) (p=0.001, p=0.0028). CONCLUSIONS: NEWS and NEWS2 could be used routinely in pandemic wards to detect clinical worsening in COVID-19 pneumonia patients who are hospitalized.