Identification Of Failure Research Articles

Identification of Pre-Heart Failure in Early Stages: The Role of Six Stages of Heart Failure

Identification of Pre-Heart Failure in Early Stages: The Role of Six Stages of Heart Failure

Evidence-based approach for the generation of a multivariate logistic regression model that predicts instrument failure.

Identification of instrument failure (IF) represents a point to improve the quality of services provided by medical laboratories. Here, a logistic regression model was created to define the relationship between instrument downtime and laboratory quality management systems. Interval-level quality control (QC) and categorical quality assurance data from 3 identical chemistry analyzers was utilized to generate a logistic regression model able to predict IF. A case-control approach and the forward stepwise likelihood-ratio method was used to develop the logistic regression model. The model was tested using a case-control dataset and again using the complete sample. A total of 650 downtime events were identified. A total of 22,880 QC data points, 187 calibrations, 24 proficiency testing events, and 107 maintenance records were analyzed. The regression model was able to correctly predict 59.2% of no instrument downtime events and 69.2% of instrument downtime events using the case-control data. Using the entire data set, the sensitivity of the model was 69.2% and the specificity was 58.2%. A logistic regression model can predict instrument downtime nearly 70% of the time. This study acts as a proof of concept using a limited data set collected by the chemistry laboratory.

Surgical and non-surgical risk factors affecting the insufficiency of ileocolic anastomosis after first-time surgery in Crohn's disease patients.

Crohn's disease (CD) often necessitates surgical intervention, particularly when it manifests in the terminal ileum and ileocecal valve. Despite undergoing radical surgery, a subset of patients experiences recurrent inflammation at the anastomotic site, necessitating further medical attention. To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients. This study enrolled 77 patients who underwent open ileocolic resection with primary stapled anastomosis. Patients were stratified into two groups: Group I comprised individuals without anastomotic insufficiency, while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period. Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts. Anastomotic insufficiency was detected in 12 patients (15.6%), with a mean time interval of 30 months between the initial surgery and recurrence. The predominant reasons for re-intervention included stenosis and excessive perianastomotic lesions. Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction, anastomotic bleeding, and clinically confirmed micro-leakage. Additionally, patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD. Successful surgical outcomes hinge on the attainment of a fully functional anastomosis, optimal metabolic status, and clinical remission of the underlying disease. Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure, thereby enabling noninvasive interventions.

To Evaluate Structured Competency-Based Curriculum for Health Programs among Community Medicine Postgraduates: Mixed Method Approach

Background: The postgraduate curriculum needs to be given a definite shape so as to make health programs more intensive and integrative. In the present scenario, most of the information is unclear and infrequent. A structured public health competency-based education is an important aspect to consider for integrative health care. Evaluate the structured competency-based curriculum (SCBC) prepared on health program matters. Methods: Mixed method model involving postgraduate students, faculties in community medicine departments of selected medical colleges and stakeholders from district administration. The SCBC was piloted and validated for use. The evaluation was then done based on pre- and posttest performance analysis, satisfaction survey, and questionnaires for reaction and learning components. Results: For a complete understanding of the program, students had to invest 52 hours of stipulated time. CBC assessment mean scores for a) problems in PHC and programmatic evaluation (78.9%) and b) identification of success and failure of programs (78.2%) were more than 75% mean score; whereas, assessment scores for topics on a) resource allocation and b) evaluation of program as write-up was 65% and 52%, respectively. As compared to the conventional method, the SCBC showed a critical evaluation score of 70% with a 0.001 significance level. Discussion and Conclusion: Students’ narratives were that they could understand as well as integrate them better on the field. There was enhanced satisfaction and encouragement. Structured curriculum will also help in making learning more student-centric and go a long way in boosting their creativity.

Recommendations for early identification of heart failure in patients with diabetes: Consensus statement of the Swiss Society of Endocrinology and Diabetology and the Heart Failure Working Group of the Swiss Society of Cardiology.

Diabetes is a well-recognised risk factor for the development of heart failure, with a prevalence higher than 30% in patients with diabetes aged over 60 years. Heart failure often emerges as the primary cardiovascular manifestation in patients with type 2 diabetes and appears to be even more prevalent in type 1 diabetes. In Switzerland, there are approximately 500,000 individuals with diabetes, and the number of affected people has been steadily rising in recent years. Therefore, the consequences of heart failure will affect an increasing number of patients, further straining the Swiss healthcare system. Early lifestyle modification and initiation of appropriate treatment can prevent or at least significantly delay the onset of symptomatic heart failure by several years. These facts underscore the urgent need for early detection of individuals with subclinical heart failure, which often remains undiagnosed until the first episode of acute heart failure requiring hospital admission occurs. To address this issue, the European Society of Cardiology, the American Diabetes Association (ADA) and other international professional societies have published recommendations on heart failure screening, diagnosis and management. To address this issue in Switzerland, experts from the Swiss Society of Endocrinology and Diabetology, the Swiss Society of Cardiology and the General Internal Medicine specialty met and prepared a consensus report including a simple diagnostic algorithm for use in everyday practice.

Early diagnosis and revision repair of lesser tuberosity osteotomy failure after anatomic total shoulder arthroplasty

BackgroundLesser tuberosity osteotomy (LTO) in total shoulder arthroplasty (TSA) has a relatively high success rate owing to bone-to-bone healing and modern repair techniques. Failure of the LTO repair has been associated with poorer outcomes, decreased patient satisfaction, and the potential need for revision arthroplasty. Despite this, few studies closely examined outcomes for revision LTO repair in the setting of prior TSA. MethodsA retrospective review of all TSAs performed by a single surgeon from 2016 until 2023 was performed to identify all cases with LTO failure who underwent acute revision LTO repair. Baseline characteristics, postoperative complications including infection, need for revision surgery, and time to revision surgery were collected and reported on all TSA patients. All patients were followed for a minimum of 1 year after their TSA and revision LTO fixation if required. Subgroup analysis was performed on the LTO revision cohort to evaluate for potential risk factors. ResultsA total of 166 patients underwent TSA with LTO. Of these, eight patients were diagnosed with an acute LTO failure at a mean of 5.7 weeks after surgery and underwent revision LTO fixation at a mean of 6.3 weeks after surgery. At a mean follow-up of 147.9 weeks (standard deviation: 90.3; range: 52.1-284.9), seven of eight patients (87.5%) demonstrated healing of their LTO and had no complaints, complications, or reoperations at the latest follow-up. One patient developed a periprosthetic infection requiring two-stage revision. No patients in the overall cohort underwent revision shoulder arthroplasty due to subscapularis failure. ConclusionEarly identification of subscapularis failure is important to optimize outcomes of revision fixation. Use of LTO for subscapularis repair is beneficial by allowing early radiographic detection of subscapularis failure. Revision LTO repair can be successful when performed acutely and appears to minimize the need for revision shoulder arthroplasty due to subscapularis failure.

Cutaneous larva migrans: is dermoscopy useful for the treatment?

Cutaneous larva migrans (CLM) is a zoonotic disease endemic in tropical regions. CLM diagnosis mainly relies on the morphology of the skin lesions, however dermoscopy can improve diagnostic accuracy. In this paper, we report two cases of CLM to highlight the importance of dermoscopic follow-up in early identification of treatment failure, as well as the effectiveness of topical ivermectin as a combined medication.

Prognostic Role of Lymphocyte-to-Monocyte Ratio (LMR) in Patients with Intermediate-Stage Hepatocellular Carcinoma (HCC) Undergoing Chemoembolizations (DEM-TACE or cTACE) of the Liver: Exploring the Link between Tumor Microenvironment and Interventional Radiology.

Inflammation-based scores are biomarkers of the crosstalk between the tumor microenvironment and the immune response. Investigating the intricate relationship between the tumor stromal microenvironment, biomarkers, and the response to transcatheter arterial chemoembolization (TACE) is essential for early identification of TACE refractoriness or failure, providing insights into tumor biology and facilitating personalized therapeutic interventions. This study addresses a dearth of recent literature exploring the prognostic significance of the preoperative LMR in individuals from western countries diagnosed with stage B hepatocellular carcinoma (HCC) undergoing drug eluting microspheres TACE (DEM-TACE) or conventional TACE (cTACE). This international multi-center retrospective analysis included consecutive patients with stage B HCC who underwent TACE from January 2017 to June 2023. The study evaluated the ability of the preoperative LMR to predict complete response (CR), objective response (OR), sustained response duration (SRD) exceeding 6 months, successful downstaging at 6 months, progression-free survival (PFS) at 6 months, and overall survival (OS) at 6 months. The study population included 109 HCC patients and it was divided into low LMR (LMR < 2.24) and high LMR (LMR ≥ 2.24) groups, according to ROC curve analysis to select the optimal LMR cut-off value. High LMR was associated with lower Hepatitis C prevalence, higher absolute lymphocyte count, and a trend toward lower alpha-fetoprotein. The group with high LMRs exhibited superior CR rates (14.9% vs. 0%), overall OR (43.2% vs. 14.3%), and better PFS at 6 months (75.7% vs. 45.7%). The LMR, specifically categorized as <2.24 and ≥2.24, emerged as a robust predictor for treatment response and short-term outcomes in patients with stage B HCC undergoing DEM- or c-TACE.

Identification and impact of failure of pelvic compensation in patients with adult spinal deformity

BACKGROUND CONTEXTPrevious research has identified a specific subtype known as failure of pelvic compensation (FPC) in patients with adult spinal deformity (ASD). However, the criteria for assessing FPC remain inconsistent, and its impacts on spinal sagittal alignment and health-related quality-of-life (HRQoL) scores remain unclear. PURPOSETo propose a novel criterion for identifying FPC based on variations in spinopelvic alignment during the transition from the supine to upright position and to evaluate the effects of FPC on patients' spinal sagittal alignment and HRQoL scores. STUDY DESIGN/SETTINGRetrospective cross-sectional study. PATIENT SAMPLEPatients with ASD from a monocenter database. OUTCOME MEASURESRadiographic measures, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt, pelvic incidence (PI), and sagittal vertical axis (SVA), were measured on lateral whole-spine radiographs. LL and SS were also measured on reconstructed lumbar computed tomography images in the sagittal view taken in the supine position. The relative functional cross-sectional area (rFCSA) of paraspinal muscles was evaluated via lumbar magnetic resonance imaging. HRQoL measures, encompassing visual analog scale for back pain (VAS-BP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R), were collected. METHODSA total of 154 patients were enrolled. Based on the calculated minimum detectable change of SS, FPC was defined as the change in SS of less than 3.4° between supine and upright positions. Patients were divided into 3 groups: sagittal balance with pelvic compensation (SI-PC), sagittal imbalance with pelvic compensation (SI-PC), and sagittal imbalance with failure of pelvic compensation (SI-FPC). Radiographic parameters and HRQoL scores were compared among the groups. RESULTSThirty-six patients were categorized into the SB-PC group, 87 into the SI-PC group, and 31 into the SI-FPC group. Patients with low PI and small paraspinal muscles rFCSA were more prone to experiencing FPC accompanied by severe sagittal imbalance. The SI-FPC group exhibited less TK and a larger SS than the SI-PC group exhibited and had a similar SVA as that of the SI-PC group. Additionally, they displayed worse VAS-BP, ODI, SRS-function, and SRS-22 total scores than the SB-PC group displayed. CONCLUSIONSIn patients with ASD, an inherently low pelvic compensatory reserve and a high fatty infiltration in paraspinal muscles are pivotal factors contributing to FPC. Compared with SI-PC patients, SI-FPC patients demonstrate a thoracic-dominant compensatory pattern for sagittal malalignment. In addition, these patients experienced more severe pain and functional decline than the SB-PC patients experienced.

Electrical aging of a piezoelectric MEMS fast steering mirror and its impact on reliability

Reliability is a critical characteristic of aerospace-grade components, particularly fast steering mirror (FSM), which is one of the key devices in Free-Space laser communication terminals. The previous long-term work of FSM exposes noteworthy reliability issues about degradation of this device. This paper first demonstrates the electrical aging effect that occurs in piezoelectric-driven micro electro mechanical system (MEMS) FSM during prolonged operation. This is a significant reliability issue as it causes the decay of mechanical angle of MEMS FSM, ultimately resulting in functional failure. In order to study the electrical aging effect, firstly, a mechanical angle monitoring system is developed for the rapid and accurate identification of electrical aging failure. Secondly, we performed failure analysis by using scanning electron microscope - focused ion beam (FIB - SEM) and conducted thermal analysis experiments to confirm heat accumulation within the MEMS FSM actuator, where the electrical aging effect takes place. Thirdly, by setting up a finite element simulations (FEM) model of the step region in the actuator, the electrical aging effect resulting from heat accumulation caused by high current density under a significant electric field at the lower step is confirmed. Finally, the critical reliability issue of electrical aging, which affects the lifetime of piezoelectric-driven MEMS FSM, is improved by adjusting the layout to eliminate large electric field intensity in local region.

A framework to identify fatigue failure of asphalt binders under multiple aging levels using linear amplitude and time sweep testing

ABSTRACT The identification of fatigue failure can significantly affect the determination and prediction of fatigue life for a given asphalt binder. In this work, different approaches for identifying the fatigue failure on linear amplitude sweep (LAS) and time sweep (TS) are compared, especially for highly-aged asphalt binders. The candidate methods include traditional 50% or 80% reduction in pseudo-stiffness parameter (denoted as C0.5 and C0.2), peak stored pseudo-strain energy (PSE), peak C × N and peak phase angle. For asphalt binder at multiple aging levels, peak C × N is found to be effective in defining fatigue failure of TS testing. Meanwhile, peak stored PSE is suitable as the failure definition of LAS because it can capture the benefit of polymer modification and has a high accuracy for fatigue life prediction. Nf in strain-control TS test determined by different failure definitions shows that aging can increase the fatigue resistance at early-aged levels and then decrease the fatigue resistance at highly-aged levels. In general, the selected failure definitions have little influence on the trend of Nf with age levels. The purpose of this work is to select the logical failure definitions of asphalt binder under multiple aging levels.

Cohesive failure analysis of carbon-fiber composite patch repair in perforated steel tubular elements

The use of composite materials to repair corroded steel structural components has expanded in the offshore oil and gas sector. The effective use of composites requires a meticulous process for choosing appropriate constituent elements. In this regard, numerical modeling is an efficient tool to better understand the impact of associated variables and enables the identification of failure causes and simulation of failure propagation. This study aims to assess the mechanical behavior of the adhesive layer at the steel - composite material interface in the repair of perforated tubular structures under bending, compression, and bending-compression. A numerical model is developed simplifying the examination and characterization of the cohesive failure mechanisms and modes occurring between the laminate patch repair and the perforated steel tubular element. The stress distribution and cohesive failure at the interface are then thoroughly investigated. The impacts of the inclusion of fillets at the patch repair ends to smoothen the transition between the composite material and the tube and the repair length are also evaluated. A Python subroutine is developed to identify the failure mode mechanisms to characterize the adhesive areas subjected to peel, shear, or mixed modes. Results suggest that pure shear mode is predominant in most of the repair locations across the three types of loading. For bending loads, the cohesive failure close to the cutout shows prominent shear mode. In the other loading conditions, the adhesive nearly fails in the vicinity of the cutouts (i.e., damage values are close to 1) in a predominant near pure shear failure mechanism. The use of fillets displaces the failure location for bending load, hence increasing the failure load level. Repairs were more extensive under Bending Moment load conditions compared to other load types. The mode ratio analysis and methodology presented in this work offer valuable tools for understanding the causes of failure modes.

Analyzing Potential Failures and Effects in a Pilot-Scale Biomass Preprocessing Facility for Improved Reliability

This study demonstrates a failure identification methodology applied to a preprocessing facility generating conversion-ready feedstocks from biomass meeting conversion process critical quality attribute (CQA) specifications. Failure Modes and Effects Analysis (FMEA) was used as an industrially relevant risk analysis approach to evaluate a logging residue preprocessing system to prepare feedstock for pyrolysis conversion. Risk evaluations considered both system-level and operation unit-level assessments considering process efficiency, product quality, cost, sustainability, and safety. Key outputs included estimations of semi-quantitative risk scores for each failure, identification of the failure impacts, identification of failure causes associated with material attributes and process parameters, ranking success rates of failure detection methods, and speculation of potential mitigation strategies for decreasing failure risk scores. Results showed that deviations from moisture specifications had cascading consequences for other CQAs along with process safety implications. Failures linked to fixed carbon specifications carried the highest risk scores for product quality and process efficiency impacts. As increased throughput can be inversely related to meeting product quality specifications; achieving throughput and other material-based CQAs simultaneously will likely require system optimization or prioritization based on system economics. Ultimately, this work successfully demonstrates FMEA as a risk analysis approach for other bioenergy process systems.

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Circulating tumour DNA detects somatic variants contributing to spatial and temporal intra-tumoural heterogeneity in head and neck squamous cell carcinoma

BackgroundAs circulating tumour DNA (ctDNA) liquid biopsy analysis is increasingly incorporated into modern oncological practice, establishing the impact of genomic intra-tumoural heterogeneity (ITH) upon data output is paramount. Despite advances in other cancer types the evidence base in head and neck squamous cell carcinoma (HNSCC) remains poor. We sought to investigate the utility of ctDNA to detect ITH in HNSCC.MethodsIn a pilot cohort of 9 treatment-naïve HNSCC patients, DNA from two intra-tumoural sites (core and margin) was whole-exome sequenced. A 9-gene panel was designed to perform targeted sequencing on pre-treatment plasma cell-free DNA and selected post-treatment samples.ResultsRates of genomic ITH among the 9 patients was high. COSMIC variants from 19 TCGA HNSCC genes demonstrated an 86.9% heterogeneity rate (present in one tumour sub-site only). Across all patients, cell-free DNA (ctDNA) identified 12.9% (range 7.5-19.8%) of tumour-specific variants, of which 55.6% were specific to a single tumour sub-site only. CtDNA identified 79.0% (range: 55.6-90.9%) of high-frequency variants (tumour VAF&amp;gt;5%). Analysis of ctDNA in serial post-treatment blood samples in patients who suffered recurrence demonstrated dynamic changes in both tumour-specific and acquired variants that predicted recurrence ahead of clinical detection.ConclusionWe demonstrate that a ctDNA liquid biopsy identified spatial genomic ITH in HNSCC and reliably detected high-frequency driver mutations. Serial sampling allowed post-treatment surveillance and early identification of treatment failure.

Accurate detection of lead malfunction from ECG-derived bipolar pacing stimulus amplitude

BackgroundOne common mode of lead failure is insulation breach, which may result in myopotential noise and device malfunction. “Pseudo-unipolarization” of bipolar pacing stimuli, as observed from a routine 12-lead electrocardiogram (ECG) due to stimulus current leak, has been observed with insulation breaches. ObjectiveWe sought to characterize this electrocardiographic finding to detect this type of lead malfunction. MethodsA total of 138 transvenous leads were analyzed, including 88 with known malfunction and 50 normal leads. The amplitude of a bipolar pacing stimulus on the ECG was recorded and compared with a control data set of newly implanted leads with bipolar stimuli normalized for output. ResultsThe malfunction group consisted of 61% right atrium and 39% right ventricle leads with mean pacing output of 2.74 V at 0.5 ms. There was a significant difference in ECG bipolar stimulus amplitudes at time of identification of failure (7.89 ± 7.56 mm/V; P < .001) compared with those of normal leads (0.86 ± 0.41 mm/V). Receiver operating characteristic curve for the prediction of lead malfunction based on absolute ECG amplitude displayed an area under the curve of 0.93 (95% CI, 0.891–0.969). When normalized for programmed stimulus output, a cutoff of 5 mm/V demonstrated a sensitivity of 91% and a specificity of 92% (area under the curve, 0.967; 95% CI, 0.938–0.996). ConclusionThe maximum amplitude of a bipolar pacing stimulus on the ECG is significantly lower in normal functioning leads compared with those with known malfunction. This simply derived variable demonstrated good accuracy at identifying lead failure due to insulation breach.

Research on Image Detection Algorithm for Failure of Key Parts of Railway Freight Wagon Based on Deep Learning

The parts failure of railway freight wagon is one of the main causes of wagon accidents. Currently, train inspection work mostly uses "human eye recognition" to determine the part failures, which cannot realize the automatic fault identification. For the problem of automatic identification of key parts failure, an image detection algorithm based on is proposed based on the combination of deep learning and image processing technology according to the idea of "first locate, then identify". First, the parts detection data set and parts fault identification data set are constructed. Then, the Small-Target-Detect-Layer and CBAM YOLOv5s (SC-YOLOv5s) are integrated with the small target detection layer and Convolutional Block Attention Module to realize the localization, classification and cropping of multi-scale key parts. Finally, an algorithm based on object detection results and prior knowledge is proposed to directly determine the type of loss fault, and the improved MobileNetV3 classification algorithm is proposed to realize the automatic identification of three kinds of faults: oil dumping of rolling bearing, loosening of locking plate, and breakage of rocking pillow spring, as well as the image processing method to realize the automatic identification of two kinds of faults: bending of crossover rod and breakage of front cover of rolling bearing. The results show that SC-YOLOv5s mAP@0. 5 and mAP@0. 5: 0. 95 can reach 99. 3% and 74. 9% and the detection speed can reach 36. 09 FPS; the improved MobileNetV3 algorithm can reach 98. 63%, 99. 34%, and 90. 21% of the recognition accuracy of bearing oil dumping, locking plate loosening, and rocking pillow spring breakage; the recognition accuracy of the image processing method for crossbar bending and rolling bearing front cover breakage can reach 95. 32% and 82. 88%, respectively.

Assessment of growth monitoring among children younger than 5 years at early childhood development centres in Nelson Mandela Bay, South Africa

AbstractIntroductionEarly childhood development (ECD) centres are important community hubs in South Africa and act as sites for community detection of childhood nutrition problems. This study aimed to assess the ability of trained ECD practitioners with optimal support to correctly classify the nutritional status of infants and young children at ECD centres in the Nelson Mandela Bay.MethodsA descriptive, cross‐sectional study was used to collect data from 1645 infants and children at 88 ECD centres. Anthropometric measurements were taken by trained fieldworkers and growth monitoring and promotion infrastructure was audited at ECD centres.ResultsOf the sample, 4.4% (n = 72) were underweight by weight for age Z‐score (WAZ &lt; −2) and 0.8% (n = 13) were severely underweight (WAZ &lt; −3). Results showed that 13.1% (n = 214) were stunted by height for age Z‐score (HAZ &lt; −2) and 4.5% (n = 74) were severely stunted (HAZ &lt; −3). The prevalence of moderate acute malnutrition was 1.2% and severe acute malnutrition was 0.5%, while the prevalence of overweight was 9.2% and the prevalence of obesity was 4%. A significant level of agreement between the correct interpretation and the ECD practitioners' interpretation was observed across all the anthropometric indicators investigated. The true positive wasting cases had a mean mid‐upper arm circumference (MUAC) of 14.6 cm, which may explain the high false negative rate found in terms of children identified with wasting, where ECD practitioners fail to use the weight for height Z‐score (WHZ) interpretation for screening.ConclusionBy using ECD centres as hub to screen for malnutrition, it may contribute to the early identification of failure to thrive among young children. Although it was concerning that trained ECD practitioners are missing some children with an unacceptably high false negative rate, it may have been due to the fact that wasting in older children cannot be identified with MUAC alone and that accurate WFH plotting is needed. Onsite mentorship by governmental health workers may provide ECD practitioners with more confidence to screen children for growth failure based on regular WFH measurements. Moreover, ECD practitioners will be more confident to monitor the Road to Health booklets for missed vaccinations, vitamin A and deworming opportunities.

Delayed identification of treatment failure causes high levels of acquired drug resistance and less future drug options among HIV-1-infected South Indians

PurposeHIV-1 Drug Resistance Mutations (DRMs) among Immunological failure (IF) on NRTI based first-line regimens, Thymidine analogue (TA) - AZT & D4T and Non-Thymidine Analogue (NTA) -TDF; and predict viral drug susceptibility to gain vision about optimal treatment strategies for second-line. MethodsCross-sectionally, 300 HIV-1 infected patients, failing first-line HAART were included. HIV-1 pol gene spanning 20–240 codons of RT was genotyped and mutation pattern was examined, (IAS-USA 2014 and Stanford HIV drug resistance database v7.0). ResultsThe median age of the participants was 35 years (IQR 29–40), CD4 T cell count of TDF failures was low at 172 cells/μL (IQR 80–252), and treatment duration was low among TDF failures (24 months vs. 61 months) (p < 0.0001). Majority of the TDF failures were on EFV based first-line (89 % vs 45 %) (p < 0.0001). Level of resistance for TDF and AZT shows, that resistance to TDF was about one-third (37 %) of TDF participants and onefourth (23 %) of AZT participants; resistance to AZT was 17 % among TDF participants and 47 % among AZT participants; resistance to both AZT and TDF was significantly high among AZT participants [21 % vs. 8 %, OR 3.057 (95 % CI 1.4–6.8), p < 0.0001]. ConclusionAlthough delayed identification of treatment failure caused high levels of acquired drug resistance in our study. Thus, we must include measures to regularize virological monitoring with integrated resistance testing in LMIC (Low and Middle Income Countries) like in India; this will help to preserve the effectiveness of ARV and ensure the success of ending AIDS as public health by 2030.

Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.

Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.