Medical Strategies Research Articles

Edge Computing for Smart-City Human Habitat: A Pandemic-Resilient, AI-Powered Framework

The COVID-19 pandemic has highlighted the need for a robust medical infrastructure and crisis management strategy as part of smart-city applications, with technology playing a crucial role. The Internet of Things (IoT) has emerged as a promising solution, leveraging sensor arrays, wireless communication networks, and artificial intelligence (AI)-driven decision-making. Advancements in edge computing (EC), deep learning (DL), and deep transfer learning (DTL) have made IoT more effective in healthcare and pandemic-resilient infrastructures. DL architectures are particularly suitable for integration into a pandemic-compliant medical infrastructures when combined with medically oriented IoT setups. The development of an intelligent pandemic-compliant infrastructure requires combining IoT, edge and cloud computing, image processing, and AI tools to monitor adherence to social distancing norms, mask-wearing protocols, and contact tracing. The proliferation of 4G and beyond systems including 5G wireless communication has enabled ultra-wide broadband data-transfer and efficient information processing, with high reliability and low latency, thereby enabling seamless medical support as part of smart-city applications. Such setups are designed to be ever-ready to deal with virus-triggered pandemic-like medical emergencies. This study presents a pandemic-compliant mechanism leveraging IoT optimized for healthcare applications, edge and cloud computing frameworks, and a suite of DL tools. The framework uses a composite attention-driven framework incorporating various DL pre-trained models (DPTMs) for protocol adherence and contact tracing, and can detect certain cyber-attacks when interfaced with public networks. The results confirm the effectiveness of the proposed methodologies.

Phenome-wide associations of human aging uncover sex-specific dynamics.

Aging varies significantly among individuals of the same chronological age, indicating that biological age (BA), estimated from molecular and physiological biomarkers, may better reflect aging. Prior research has often ignored sex-specific differences in aging patterns and mainly focused on aging biomarkers from a single data modality. Here we analyze a deeply phenotyped longitudinal cohort (10K project, Israel) of 10,000 healthy individuals aged 40-70 years that includes clinical, physiological, behavioral, environmental and multiomic parameters. Follow-up visits are scheduled every 2 years for a total of 25 years. We devised machine learning models of chronological age and computed biological aging scores that represented diverse physiological systems, revealing different aging patterns among sexes. Higher BA scores were associated with a higher prevalence of age-related medical conditions, highlighting the clinical relevance of these scores. Our analysis revealed system-specific aging dynamics and the potential of deeply phenotyped cohorts to accelerate improvements in our understanding of chronic diseases. Our findings present a more holistic view of the aging process, and lay the foundation for personalized medical prevention strategies.

Precision individualized medication strategies and challenges for cardiovascular diseases

Precision individualized medication strategies and challenges for cardiovascular diseases

Enhancing the Understanding of Abdominal Trauma During the COVID-19 Pandemic Through Co-Occurrence Analysis and Machine Learning

Background: This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018–26 February 2020) and pandemic periods (27 February 2020–7 March 2022). Methods: Analyzing data from 118 patients at the Emergency County Clinical Hospital of Craiova, we identified significant shifts in clinical practices affecting patient outcomes. Results: During the pandemic, a moderate increase in surgical interventions for specific abdominal traumas indicated the effective adaptation of the medical system. Prioritizing critical cases and deferring non-urgent procedures optimized limited resources. Demographic and clinical factors—including age, sex, body mass index (BMI), and red cell distribution width (RDW)—significantly influenced the hospitalization duration and recovery outcomes. Gender disparities in mortality lessened during the pandemic, possibly due to standardized interventions and the physiological effects of SARS-CoV-2. The link between occupation and obesity highlighted how work environments impact trauma severity, especially as lifestyle changes affect BMI. While age remained a major predictor of mortality, its influence slightly decreased, potentially due to improved protocols for elderly patients. RDW emerged as an important prognostic marker for disease severity and mortality risk. Conclusions: Employing advanced co-occurrence analysis enhanced with machine learning, we uncovered complex relationships between clinical and demographic variables often overlooked by traditional methods. This innovative approach provided deeper insights into the collective impact of various factors on patient outcomes. Our findings demonstrate the healthcare system’s rapid adaptations during the pandemic and offer critical insights for optimizing medical strategies and developing personalized interventions in global crises.

Clinical Management and Pathophysiology of Infective Endocarditis: An Updated Review of Diagnostic Challenges and Therapeutic Approaches

Infective endocarditis (IE) is a severe and life-threatening condition characterized by infection of the endocardial surface of the heart, primarily affecting the heart valves. Despite advances in diagnostic techniques and antimicrobial therapies, IE remains associated with significant morbidity and mortality due to its complex pathogenesis and clinical variability. This article reviews the most recent developments in the pathophysiology, diagnostic criteria, and management strategies of infective endocarditis. Key issues such as microbial etiology, including common pathogens like Staphylococcus aureus and Streptococcus species, are discussed alongside less frequent organisms and their association with specific patient populations. The article emphasizes the importance of early diagnosis using advanced imaging modalities, such as echocardiography and PET-CT, and laboratory findings, particularly blood cultures. We explore both medical and surgical management strategies, highlighting the role of antibiotic therapy and the indications for valve surgery. A focus is given to the management of complex cases, including prosthetic valve endocarditis and infections in immunocompromised patients. The article aims to provide clinicians with a comprehensive understanding of the evolving landscape of infective endocarditis and its implications for patient outcomes.

Non-surgical management of methicillin-sensitive Staphylococcus aureus bacteremia-related mediastinitis

Background: Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. Case presentation: In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. Conclusion: We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.

Targeted medical treatment of patients with chronic thromboembolic pulmonary hypertension who undergo balloon pulmonary angioplasty

Abstract Introduction In patients with chronic thromboembolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA), pre-treatment with PH-targeted medical therapy may be beneficial in improving clinical parameters and pulmonary hemodynamics. Purpose This study aims to describe the clinical results of PH-specific therapy prior to BPA. Methods Patients with CTEPH who underwent BPA treatment were selected from the St. Antonius CTEPH database. Medical treatment strategy, clinical parameters, and pulmonary hemodynamics at time of diagnosis and at the first BPA were collected from medical records. Results In total 93 BPA patients (62.4% women; age 60.4±14.1 years; NYHA FC III/IV 60.9%) were included; the majority of patients received dual PH targeted medical therapy (64.1%). Between diagnosis and the first BPA significant improvements were observed for both clinical parameters (6MWD: 26.8m [5.2 - 48.4], Log NTproBNP: -0.5 pg/ml [-0.8 to -0.2]) and pulmonary hemodynamic (mRAP: -2.2 mmHg [-3.7 to -0.8], mPAP: -6.4mmHg [-8.3 to -4.5], CO: 0.5L/min [0.2 - 0.9] and PVR: -2.6WU [-3.3 to -2]). Dual PH targeted medical therapy resulted in significantly greater improvements in PVR (p = 0.03) in comparison to patients without and mono PH targeted medical therapy (CO and mPAP both p-value: 0.01). Conclusion Between diagnosis and the initial BPA, substantial improvements were observed for 6MWD, NTproBNP and most pulmonary hemodynamics in CTEPH patients who underwent BPA. Patients who received dual PH targeted medical therapy had significantly greater improvements compared to patients without (PVR) and on mono PH targeted medical therapy (CO and mPAP).Clinical parameters: Baseline-1st BPAPH medication: ANOVA Post hoc analyses

Diplopia and Work: A Case Report

Diplopia is a frequent symptom in ophthalmology and has many causes. It may be binocular or monocular, the latter reflecting ocular damage. The study of the interaction between diplopia and the workstation is often neglected in therapeutic management; however, diplopia at work can have consequences for the health and safety of the worker concerned and therefore for clinical and socio-professional prognosis. We report a case of monocular diplopia due caused by a nuclear cataract in a radiologist. The purpose is to illustrate and explain the interaction between diplopia and work and the repercussions on fitness for work. This case underscores the need for effective, multidisciplinary medical and occupational strategies to manage diplopia in the workplace.

Treatment strategy for heart failure patients with guideline-directed medical therapy intolerance: a real-world prospective study

Abstract Background Guideline-directed medical therapy (GDMT) reduces the incidence of worsening events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, in actual clinical practice, a proportion of patients are unable to tolerate complete GDMT. Purpose This study aimed to assess the medication strategy for patients with HFrEF who are intolerant to GDMT. Methods A total of 110 patients admitted with acute HF were included in the study. The patients were non-randomly assigned to receive complete or incomplete GDMT after assessment by doctors before discharge from the hospital. All patients were followed up for 180 days. The primary composite endpoint was worsening HF-associated events, including death or rehospitalization due to HF, and the need for intravenous diuretic therapy. The secondary endpoints were the New York Heart Association functional class, blood pressure, and cardiac structure and function assessed by echocardiography. Results The main reasons for GDMT intolerance were renal insufficiency (41.8%) and hypotension (26.4%). GDMT-intolerant patients had lower eGFR (50.4 ml/min/1.73 m² vs. 70.9 ml/min/1.73 m²; p=0.002) compared with those who tolerated GDMT, and included more patients with chronic kidney disease (56.4% vs. 23.6%, p<0.001) and higher NT-proBNP levels (5340 pg/ml vs 8080 pg/ml, p=0.039) at baseline. While patient mortality was similar between the two groups, the rate of worsening HF events was lower in patients with GDMT (hazard ratio: 0.736; 95% confidence interval: 0.389−1.393) and vericiguat treatment (p<0.001). In terms of the secondary endpoint, patients who received GDMT showed greater improvements in cardiac structure and function although there was no statistical difference between the groups. In the prespecified subgroup analysis of the effects of vericiguat on the primary endpoint, the incidence of worsening HF events was reduced by vericiguat, regardless of whether the patient was comorbid with GDMT or not, or whether they had a previous history of HF (p-interaction= 0.519 and 0.227, respectively). Conclusions Patients with early in-hospital initiation of complete GDMT and continuous GDMT after discharge had better outcomes compared with patients who were intolerant to GDMT. Co-administration of vericiguat with or without GDMT may reduce the incidence of worsening HF events in HF patients within 180 days.Results of the primary endpoint

Evolving atrial fibrillation (AF) care in New Zealand (NZ): a nurse specialist-led clinic aiming to improve standardisation, equity, cost-effectiveness, and lifestyle modification in AF management

Abstract Background Management of atrial fibrillation (AF) in NZ is challenging and variable between regions. NZ has a diverse population with Māori and Pacific ethnic groups, in particular, facing significant difficulties with access to care and inequity in treatment. The integration of nurse specialists into the care of patients with AF is increasingly recognised and discussed in AF management, including the European Society of Cardiology (ESC) guidelines. This approach also allows emphasis on managing lifestyle factors, pivotal contributing factors in disease burden Objective This study assesses the efficacy of a nurse specialist-led AF clinic in a large regional centre in New Zealand. We look specifically at the standardisation of care, lifestyle management, the impact on health equity in managing AF, and the cost-effectiveness of these strategies. Methods A retrospective analysis of the first year of the clinic’s establishment was conducted reviewing the outcomes, attendance, and adherence to management guidelines. The clinic is running three days per week to follow up those presenting to the Emergency Department with a primary diagnosis of AF. After discharge, appointments are available within 48-72 hours of presentation. The clinics efficacy and ability to serve wider NZ populations will also be presented alongside a recently-published, similar initiative in Christchurch, NZ. Results Over the first year, 247 appointments were made (Median age 66, interquartile range 58-76, 48% male, 75% NZ European). 168 patients were established on a rhythm control strategy, with 20 directly referred for ablation, 26 receiving cardioversions, and the remainder established on anti-arrhythmic medication strategies. Lifestyle modifications were addressed with majority of these patients. Demographic data also highlighted once more, a need to focus on equity with only 17.4% of appointments attended by Māori and Pacific patients, lower than would be expected given population data and relative disease burden. Conclusions The Nurse Specialist-led AF clinic shows promising outcomes and is a positive step forward in AF management in this region of NZ. Incorporating ESC guidelines with emphasis on lifestyle factors and including rhythm control strategies to good effect. This clinic brings international standards to a local stage and throws a focus on our unique healthcare needs and an emphasis on equitable delivery of care. This clinic is scalable, effective, and an inclusive approach to AF care.

MaxEnt modeling of Klebsiella pneumoniae: predicting future distribution and evaluating the risk for public health

Klebsiella pneumoniae is a Gram-negative bacterium known for causing infections such as pneumonia, urinary tract infections, and bloodstream infections in humans. Its increasing drug resistance poses a significant threat. Understanding the effects of climate change on this bacterium is crucial to managing its impacts effectively. In this study, we employed MaxEnt modeling to explore the current and future distribution of K. pneumoniae under different climate change scenarios for 2050 and 2070. Our models utilized 280 valid occurrence points and 19 bioclimatic variables, with Mean Annual Temperature and Mean Annual Precipitation being the most influential variables. The models demonstrated high accuracy, with an AUC of 0.889. Our findings revealed that K. pneumoniae has a cosmopolitan distribution, with the highest suitability observed in Southeastern Asia, Central Africa, and Southern Europe. Future predictions indicated an apparent expansion of its range across almost all continents, particularly in the RCP 8.5 2070 scenario. Results have crucial implications for epidemiology, as they enable the identification of current and potential future disease hotspots and geographical patterns. This knowledge can inform the development of effective infection control strategies. Furthermore, it provides valuable insights for decision-makers and policymakers in allocating resources efficiently for medical control and prevention strategies.

Mitral valve regurgitation followed by blunt chest trauma in a paediatric patient: a case report.

We report a paediatric case where severe mitral valve regurgitation occurred led by blunt chest trauma. Medical treatment was undertaken, and surgical mitral valve repair was postponed until half a year after the initial injury, followed by an uneventful postoperative recovery. We highlight the importance of echocardiographic evaluation for traumatic valve insufficiency. The medical strategy and timing of surgical intervention should be individualised.

Malnutrition in patients with obesity: An overview perspective.

Malnutrition in patients with obesity presents a complex and often overlooked clinical challenge. Although obesity is traditionally associated with overnutrition and excessive caloric intake, it can also coincide with varying degrees of malnutrition. The etiopathogenesis of obesity is multifaceted and may arise from several factors such as poor diet quality, nutrient deficiencies despite excess calorie consumption, genetics, and metabolic abnormalities affecting nutrient absorption and utilization. Moreover, a chronic low-grade inflammatory state resulting from excess adipose tissue, commonly observed in obesity, can further exacerbate malnutrition by altering nutrient metabolism and increasing metabolic demands. The dual burden of obesity and malnutrition poses significant risks, including immune dysfunction, delayed wound healing, anemia, metabolic disturbances, and deficiencies in micronutrients such as vitamin D, iron, magnesium, and zinc, among others. Malnutrition is often neglected or not given enough attention in individuals with obesity undergoing rapid weight loss through aggressive caloric restriction, pharmacological therapies, and/or surgical interventions. These factors often exacerbate vulnerability to nutrition deficiencies. We advocate for healthcare practitioners to prioritize nutrition assessment and initiate medical intervention strategies tailored to address both excessive caloric intake and insufficient consumption of essential nutrients. Raising awareness among healthcare professionals and the general population about the critical role of adequate nutrition in caring for patients with obesity is vital for mitigating the adverse health effects associated with malnutrition in this population.

Learning from COVID-19: strengthening Australia's research capacity through preparedness and collaboration.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted that preparedness for and responsiveness to pandemics requires public health platforms and processes which are nimble and evidence-based and a research ecosystem which is rapidly responsive to the evolving needs of society and decision-makers. The national BEAT COVID-19 research consortium was funded in 2020 by the Snow Medical Research Foundation (Snow Medical). Its Expert Advisory Committee met with the consortium post-pandemic to summarise the research undertaken and to consider lessons learned through the research response to COVID-19 in Australia. The panel observed that philanthropy offered an important 'kick-starter' funding mechanism for urgent research, which facilitated leveraging of additional funds. It further agreed that research requirements for strengthening Australia's pandemic preparedness and response include: (1) development of a national health and medical research strategy for pandemic research; (2) long-term investment in pre-established research partnerships and networks; (3) systemic procedural improvements, e.g. in ethics, governance and resource allocation; (4) responsive funding mechanisms including philanthropy; and (5) integration of research outputs into health practice and decision-making, as illustrated in Figure 1.

Integration of Health Care Modules in Current Health Care Management Systems in India

Health care beyond worldwide boundaries is a critical problem, particularly when the population differs in terms of geographic position, culture, habits, socioeconomic background, medical strategy, and variations in disease burden over time. For countries like India, with a significant percentage of high-end medical experts as well as support and other health care systems, the development and integration of comprehensive and functionally versatile health care management systems are among the most important clinical problems addressed. The central dogma of a country that facilitates adopting a conglomeration will create a dedicated population to provide tailor-made health care in health shield, health protection, and health care delivery; a nation that takes care of a nation. Until now, it has given us E-Health, and offerings have been fine-tuned in research literature. In India, the health care domain is currently breaking the boundaries of knowledge workers in clinical and research domains working with the help of these workhorses (Fletcher-Brown et al. 2021). Many e-governance and public health reform programs in India are under consideration, and many of them are under implementation. This research focuses more on the integration of health care technology relevant to the paper topic within clinical setups, passive provision, and utilization of services for administrative purposes technologically implemented (Das et al. 2023).

Numerical simulation of impulse-induced surface acoustic waves for elastography purposes using k-Wave simulation toolbox

As elastography, an emerging medical imaging strategy, advances, surface acoustic waves have been utilized to examine superficial tissues quantitatively. So far, most studies are experimental, and a numerical method is needed to cost-effectively investigate surface acoustic wave generation and propagation for technical development and optimization purposes. This study aims to develop a reliable numerical method for simulating impulse-induced surface acoustic waves using the k-wave simulation toolbox. According to the physical process of surface acoustic wave based elastography, the proposed simulation method consists of two stages: compressional wave simulation and elastic wave simulation, which aim to generate acoustic radiation force impulse and elastic waves, respectively. The technical procedures were demonstrated by a wave simulation on a water–tissue model. Meanwhile, three acoustic radiation force modeling methods were adopted. The compressional wave simulation showed that the three force modeling methods could produce similar force distribution in space but largely different amplitudes. The elastic wave simulation confirmed the feasibility of numerically generating surface acoustic waves. The reliability of the simulated waves was verified by a quantitative comparison between the numerically acquired sound speeds and their theoretical expectations and by a qualitative comparison between the numerically generated waves and the experimental observations under similar conditions. In summary, this study confirms k-wave as an effective numerical method for simulating surface acoustic waves for elastography purposes. This study provides an immediate simulation platform for investigating Scholte waves, the surface acoustic wave at a liquid–solid interface, and also, a potential numerical framework to investigate other surface acoustic waves.

Nervonic acid as novel therapeutics initiates both neurogenesis and angiogenesis for comprehensive wound repair and healing.

Rapid tissue reconstruction in acute and chronic injuries are challengeable, the inefficient repair mainly due to the difficulty in simultaneous promoting the regeneration of peripheral nerves and vascular, which are closely related. Main clinical medication strategy of tissue repair depends on different cytokines to achieve nerves, blood vessels or granulation tissue regeneration, respectively. However, their effect is still limited to single aspect with biorisk exists upon long-time use. Herein, for the first time, we have demonstrated that NA isolated from Malania oleifera has potential to simultaneously promote both neurogenesis and angiogenesis in vitro and in vivo. First, NA was identified by NMR and FTIR structural characterization analysis. In a model of oxidative stress in neural cells induced by hydrogen peroxide, the cells viability of RSC96 and PC12 were protected from oxidative stress injury by NA. Similarly, based on the rat wound healing model, effective blood vessel formation and wound healing can be observed in tissue staining under NA treatment. In addition, according to the identification of nerve and vascular related markers in the wound tissue, the mechanism of NA promoting nerve regeneration lies in the upregulation of the secretion NGF, NF-200 and S100 protein, and NA treatment was also able to up-regulate VEGF and CD31 to directly promote angiogenesis during wound healing. This study provides an important candidate drug molecules for acute or chronic wound healing and nerve vascular synchronous regeneration.

The Effectiveness of Medical Engagement Strategies on Doctor’s Professional Development and Prescriptions Decisions

Pharmaceutical companies’ medical engagement is becoming a popular marketing technique where firms’ interact with doctors to influence their prescribing behaviour and personal growth. To this research, 500 doctors of all the specialties were included and data was collected and analysed quantitatively. Among all the engagement methods, in-person meetings and emails were considered as the most preferred and beneficial as an impact for the doctors’ knowledge and prescribing practices. Information sources describing clinical trial results and other physicians’ opinions were identified as important for prescription choices. This research study also shows the importance of medical representatives for influencing prescribing behaviours and argues that the improvement of engagement approaches will also improve doctor’s decisions and patient’s outcomes.

ULTRASOUND IMAGING OF COMLICATIONS IN COMBAT CHEST TRAUMA

Abstract. Objective. The aim is to evaluate the effectiveness of ultrasound diagnostics in combat chest trauma at the stage of specialized surgical care. Materials and Methods: 53 cases of complications from combat chest trauma were analyzed during patient evacuation at the stage of specialized surgical care to assess the specificity, accuracy, and sensitivity of the ultrasound method for early detection of complications and to guide further treatment tactics. Results. The ultrasound diagnostic method has advantages in detecting complications of gunshot wounds to the chest, not only during the qualified medical care stages but also where continuous monitoring of these complications is required during further medical evacuation and treatment strategy selection. Conclusions.Therefore, the monitoring of chest trauma complications should be informative at all stages of medical care, accessible, and effective in determining the subsequent treatment strategy.

Combined strategy of upfront CTCA and optimal treatment for stable chest pain: rationale and design of the CLEAR-CAD trial.

Patients with stable chest pain suspected of coronary artery disease (CAD) usually undergo multiple diagnostic tests to confirm or rule out obstructive CAD. Some tests may not effectively assess the presence of CAD, precluding optimal treatment. Adiagnostic strategy of upfront computed tomography coronary angiography (CTCA) combined with optimal medical therapy (OMT) tailored to the extent of CAD may be superior to standard care in preventing major adverse cardiac events. The CLEAR-CAD trial is aprospective, open-label, multicentre, randomised, superiority trial of an upfront CTCA-guided strategy in 6444 patients presenting in an outpatient setting with suspected CAD compared with standard care, in approximately 30participating centres in the Netherlands. The upfront CTCA-guided strategy consists of an initial CTCA which is assessed using the Coronary Artery Disease-Reporting and Data System (CAD-RADS2.0). In patients without CAD (CAD-RADS0) no specific cardiac medication is mandated. Patients with non-obstructive CAD (CAD-RADS 1-2) are treated with preventive OMT. Patients with obstructive CAD (CAD-RADS ≥ 3) are treated with preventive and anti-anginal OMT; in the presence of pharmacologically refractory symptoms patients undergo selective revascularisation after non-invasive functional imaging for myocardial ischaemia (≥ 10%). Patients with significant left main or proximal left anterior descending coronary artery stenosis on CTCA undergo direct invasive coronary angiography and subsequent revascularisation. The primary endpoint is the composite of all-cause death and myocardial infarction. The CLEAR-CAD trial is the first randomised study to investigate the efficacy of acombined upfront CTCA-guided medical and selective revascularisation strategy in an outpatient setting with suspected CAD compared with standard care.