Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA.</p> <p>Case presentation</p> <p>A 59-year-old Caucasian man with septic shock secondary to community-acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital.</p> <p>Conclusion</p> <p>In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study.</p

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Енергооптимізовані інформаційні системи для мобільної робототехніки у фізичних процесах

У цій статті досліджується інтеграція автономних мобільних роботів (AMR) у промислові умови, що революціонізує планування завдань. Орієнтований на мінімізацію часу завершення операцій, він заглиблюється у фізичні процеси в інформаційних системах. Дослідження наголошує на перетині апаратного, програмного та робототехнічного забезпечення, надаючи огляд ключових компонентів AMR та їх ролі у виконанні завдань. Мобільність, можливості зондування та взаємодія з навколишнім середовищем є вирішальними факторами для ефективних алгоритмів планування. Збір даних у режимі реального часу за допомогою встановлених датчиків AMR інформує алгоритми планування, підкреслюючи важливість точної інформації. Підкреслюється ключова роль зберігання даних у підтримці ефективності, наголошується на швидкому пошуку для швидкого прийняття рішень. Дослідження розглядає роль центральних процесорів (CPU) і арифметико-логічних пристроїв (ALU) в алгоритмах планування обробки, підкреслюючи потребу в обчислювальній потужності. Комунікаційні процеси, мережевий зв’язок і надійність передачі даних є найважливішими для координації кількох AMR. Досліджено значення систем живлення та охолодження в підтримці інфраструктури AMR, звертаючись до забезпечення електроенергією та контролю навколишнього середовища. Фізичні заходи безпеки та процеси обслуговування, включаючи оновлення апаратного та програмного забезпечення, забезпечують максимальну ефективність AMR. У підсумку, це дослідження висвітлює інтегральні фізичні процеси в інформаційних системах для планування завдань на основі AMR, пропонуючи ідеї для підвищення ефективності в різноманітних промислових умовах.This paper explores the integration of Autonomous Mobile Robots (AMRs) in industrial settings, revolutionizing task scheduling. Focused on minimizing operational completion time, it delves into the physical processes within information systems. The study emphasizes the hardware, software, and robotics intersection, providing an overview of key AMR components and their role in task execution. Mobility, sensing capabilities, and interaction with the environment are crucial considerations for effective scheduling algorithms. Real-time data acquisition through AMR-mounted sensors informs scheduling algorithms, emphasizing the importance of accurate information. Data storage's pivotal role in maintaining efficiency is highlighted, stressing quick retrieval for rapid decision-making. The study examines central processing units (CPU) and arithmetic logic units (ALU) roles in processing scheduling algorithms, emphasizing the need for computational power. Communication processes, network communication, and data transmission reliability are paramount for coordinating multiple AMRs. Power supply and cooling systems' significance in sustaining AMR infrastructure is explored, addressing electrical power provision and environmental controls. Physical security measures and maintenance processes, including hardware and software updates, ensure peak AMR efficiency. In conclusion, this research illuminates the integral physical processes within information systems for AMR-based task scheduling, offering insights for enhanced efficiency in diverse industrial settings

Atypical antipsychotic poisoning in young children: a multicentre analysis of poisons centres data

Although paediatric patients frequently suffer from intoxications with atypical antipsychotics, the number of studies in young children, which have assessed the effects of acute exposure to this class of drugs, is very limited. The aim of this study was to achieve a better characterization of the acute toxicity profile in young children of the atypical antipsychotics clozapine, olanzapine, quetiapine, and risperidone. We performed a multicentre retrospective analysis of cases with atypical antipsychotics intoxication in children younger than 6 years, reported by physicians to German, Austrian, and Swiss Poisons Centres for the 9-year period between January 1, 2001 and December 31, 2009. One hundred and six cases (31 clozapine, 29 olanzapine, 12 quetiapine, and 34 risperidone) were available for analysis. Forty-seven of the children showed minor, 28 moderate, and 2 severe symptoms. Twenty-nine cases were asymptomatic. No fatalities were recorded. Symptoms predominantly involved the central nervous and cardiovascular systems. Minor reduction in vigilance (Glasgow Coma Scale score >9) (62 %) was the most frequently reported symptom, followed by miosis (12 %) and mild tachycardia (10 %). Extrapyramidal motor symptoms were observed in one case (1 %) after ingestion of risperidone. In most cases, surveillance and supportive care were sufficient to achieve a good outcome, and all children made full recovery. Conclusions: Paediatric antipsychotic exposure can result in significant poisoning; however, in most cases only minor or moderate symptoms occurred and were followed by complete recovery. Symptomatic patients should be monitored for central nervous system depression and an electrocardiogram should be obtained