After-Stroke Arm Paresis Detection using Kinematic Data

This paper presents an approach for detecting unilateral arm paralysis/weakness using kinematic data. Our method employs temporal convolution networks and recurrent neural networks, guided by knowledge distillation, where we use inertial measurement units attached to the body to capture kinematic information such as acceleration, rotation, and flexion of body joints during an action. This information is then analyzed to recognize body actions and patterns. Our proposed network achieves a high paretic detection accuracy of 97.99\%, with an action classification accuracy of 77.69\%, through knowledge sharing. Furthermore, by incorporating causal reasoning, we can gain additional insights into the patient's condition, such as their Fugl-Meyer assessment score or impairment level based on the machine learning result. Overall, our approach demonstrates the potential of using kinematic data and machine learning for detecting arm paralysis/weakness. The results suggest that our method could be a useful tool for clinicians and healthcare professionals working with patients with this condition.Comment: submitted to IEEE Symposium Series on Computational Intelligenc

Risk Factors Associated with Periodontal Diseases among Yemeni Adult Patients

Objectives: This study aimed to investigate the possible risk factors associated with periodontal diseases among adult dental patients in Yemen. Methods: The study population comprised of 805 patients attending the teaching dental hospital in Dhamar city, Yemen. The first part of investigation was interview including age, gender, systemic diseases, pregnancy (for women), as well as tooth brushing, smoking, and Qat chewing habits and dentist interval visits. The second part was clinical examination including the periodontal parameters. Data were analyzed and presented in terms frequencies and percentages or means and standard deviations, as appropriate. Chi-squared test was used for associations and Mann-Whitney U test was used for differences. Regression analysis was utilized for the determinants of the periodontal disease. A P-value < 0.05 was considered significant. Results: The bivariate analyses revealed significant differences (P< 0.05) between the independent variables (proposed risk factors) groups in relation to the periodontal parameters except for systemic disease in relation to GI and BI, visiting dentist in relation to CI, BI, and GR, and pregnancy in relation to PI, GI, CI, and BI (P> 0.05). The regression analyses revealed that the age, smoking, and brushing teeth are significant (P< 0.05) determinants for all periodontal parameters. Whereas, systemic disease was a significant determinant for GR, and sex for BI. Conclusions: Age, brushing teeth and smoking are the significant determinants of periodontal health. Education about the side effects of bad habits as well as maintaining good oral hygiene should be implemented

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients

Rapid alteplase administration improves functional outcomes in patients with stroke due to large vessel occlusions

Background and Purpose: We report the relation of onset-to-treatment time and door-to-needle time with functional outcomes and mortality among patients with ischemic stroke with imaging-proven large vessel occlusion treated with intravenous alteplase. Methods: Individual patient-level data from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration were pooled from 7 trials that randomized patients to mechanical thrombectomy added to best medical therapy versus best medical therapy alone. Analysis was restricted to patients who received alteplase directly at the endovascular hospital. The primary outcome was disability defined on the modified Rankin Scale at 3 months. Results: Among 601 patients, mean age was 66.0 years (SD, 13.9), 50% were women, and median National Institutes of Health Stroke Scale score was 17. Onset-to-treatment time was median 125 minutes (interquartile range, 90–170). Door-to-treatment time was median 38 minutes (interquartile range, 26–55). Each 60-minute onset-to-treatment time delay was associated with greater disability at 90 days; the odds of functional independence (modified Rankin Scale, 0–2) at 90 days was 0.82 (95% CI, 0.66–1.03). With each 60-minute delay in door-to-needle time; the odds of functional independence was 0.55 (95% CI, 0.37–0.81) at 90 days. The absolute decline in the rate of excellent outcome (modified Rankin Scale, 0–1 at 90 days) was 20.3 per 1000 patients treated per 15-minute delay in door-to-needle time. The adjusted absolute risk difference for a door-to-needle time <30 minutes versus 30 to 60 minutes was 19.3% for independent outcome (number-needed-to-treat ≈5 to gain 1 additional good outcome). Symptomatic intracranial hemorrhage occurred in 3.4% of patients, without a significant time dependency: odds ratio, 0.74 (95% CI, 0.43–1.28). Conclusions: Faster intravenous thrombolysis delivery is associated with less disability at 3 months among patients with large vessel occlusion

Public Health and Cost Benefits of Successful Reperfusion After Thrombectomy for Stroke

Background and Purpose- The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society. Methods- A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy-treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence. Results- Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and$20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy-treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and$36.8 million for the healthcare system and society, respectively. Conclusions- Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate

Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke: a pooled-data meta-analysis

Background and Purpose: Hyperglycemia is a negative prognostic factor following acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy in patients with large vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of endovascular thrombectomy in acute stroke. Methods: Seven randomized trials compared endovascular thrombectomy with standard care between 2010 and 2017 (HERMES Collaboration). 1764 patients with large vessel stroke were allocated to endovascular thrombectomy (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome [modified Rankin Scale (mRS) range: 0-6; lower scores indicating less disability] at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level. Results: Median (IQR) serum glucose on admission was 120 (104-140) mg/dl [6.6mmol/l (5.7-7.7) mmol/l]. Endovascular thrombectomy (EVT) was better than standard care in the overall pooled-data analysis [common odds ratio (acOR), 2.00 (95% CI 1.69–2.38); however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose < or > 90mg/dl (5.0mmol/l) [(p=0.019 for interaction, acOR 3.81 (95% CI 1.73–8.41) for patients < 90 mg/dl vs 1.83 (95% CI 1.53–2.19) for patients > 90 mg/dl], and glucose < or > 100mg/dl (5.5mmol/l) [(p=0.004 for interaction, acOR 3.17 (95% CI 2.04–4.93) vs acOR 1.72 (95% CI 1.42–2.08)], but not between subgroups above these levels of glucose. Conclusions: Endovascular thrombectomy improved stroke outcomes compared to standard treatment regardless of glucose levels but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100mg/dl (5.0-5.5mmol/l). Whether tight control of glucose improves the efficacy of endovascular thrombectomy following large vessel stroke warrants appropriate testing

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

The effect of palm oil clinker powder & cockle shell powder as cement replacement to concrete mechanical properties

Concrete materials have been of a significant concern through the past years and there has been a huge research on finding alternatives to the traditional materials. Among the most common materials to be substituted are palm oil clinker waste on form of powder due to a presence of silica (pozzolanic material) which helps uphold the strength of concrete and is available in Malaysia also cockle shell powder which consists of calcium carbonate in the form of aragonite and calcite. The objective of this research is to examine the concrete compressive strength and flexural using cockleshell and palm oil clinker as cement replacement with different proportion. For this research, there are six different percentages of palm oil clinker and cockleshell replacement in concrete mixture. For compressive strength test and flexural test, the concrete is tested on 7, and 28 days. The concrete mixture was designed according to ASTM C 109/C 109M standard with water cement ratio of 0.485. For compressive strength test, 36 cubes size 50mm x 50mm x 50mm were tested on 7, and 28 days each. Moreover, for flexural test, 36 concrete beam size 160mm x 40mm x 40mm were tested on 7 and 28 days for each test. This study found that the compressive and flexural strength were decrease by increasing palm oil clinker powder and cockle shell powder percentage as cement replacement