Methamphetamine-Induced Cardiomyopathy (MACM) in a Middle-Aged Man; a Case Report

The development of methamphetamine-associated cardiomyopathy (MACM) represents a severe complication of chronic methamphetamine abuse. MACM-induced irreversible structural and functional changes in the heart can eventually lead to decompensated heart failure, ultimately requiring heart transplantation. In this case report we present a 47-year old male with a previous history of chronic amphetamine abuse who presented to the emergency room with severe dyspnea at rest associated with mild substernal non-radiating chest pain. He denied any previous cardiac history but had a positive urinary toxicology for methamphetamine. A complete cardiac workup ruled out all other etiologies. The patient required a 3-week intensive pharmacotherapy intervention to stabilize acute heart failure symptoms. At discharge he was classified as having New York Association Class III (NYHA-III) heart failure. His medical symptoms did not improve and he was considered for heart transplantation. With the increase in availability and abuse of methamphetamine, case of MACM such as ours are more frequently being encountered in the emergency departments. In addition to raising awareness, our case provides an outline of how MACM patients likely may present and the subsequent morbid sequela. Clinicians should maintain a high degree of suspicion when assessing all patients with a history of methamphetamine abuse. Early cardiac evaluation can help identify ventricular compromise in asymptomatic patients providing an opportunity to intervene prior to the development of irreversible MACM

Classification of Melanoma and Nevus in Digital Images for Diagnosis of Skin Cancer

Melanoma is considered a fatal type of skin cancer. However, it is sometimes hard to distinguish it from nevus due to their identical visual appearance and symptoms. The mortality rate because of this disease is higher than all other skin-related consolidated malignancies. The number of cases is growing among young people, but if it is diagnosed at an earlier stage, then the survival rates become very high. The cost and time required for the doctors to diagnose all patients for melanoma are very high. In this paper, we propose an intelligent system to detect and distinguish melanoma from nevus by using the state-of-the-art image processing techniques. At first, the Gaussian filter is used for removing noise from the skin lesion of the acquired images followed by the use of improved K-mean clustering to segment out the lesion. A distinctive hybrid superfeature vector is formed by the extraction of textural and color features from the lesion. Support vector machine (SVM) is utilized for the classification of skin cancer into melanoma and nevus. Our aim is to test the effectiveness of the proposed segmentation technique, extract the most suitable features, and compare the classification results with the other techniques present in the literature. The proposed methodology is tested on the DERMIS dataset having a total number of 397 skin cancer images: 146 are melanoma and 251 are nevus skin lesions. Our proposed methodology archives encouraging results having 96% accuracy

Leveraging Ethereum platform for development of efficient tractability system in pharmaceutical supply chain

Consumer knowledge of the goods produced or processed by the numerous suppliers and processors is still relatively low due to the growing complexity of the structure of pharmaceutical supply chains. Information asymmetry in the pharmaceutical sector has an effect on welfare, sustainability, and health. (1) Background: In this respect, we wanted to develop a productive structure for a pharmaceutical supply chain that satisfies the consumer information needs and fosters consumer confidence in the pharmacy goods they buy. By using blockchain technology, the main goals were to develop and implement a pharmaceutical supply chain. (2) Objectives: The main objectives of this work were to leverage an Ethereum platform for the development of a tractability system in a pharmaceutical supply chain environment and to analyze the efficiency of MSMAChain with respect to the cost and execution of transactions based on our designed smart contracts. (3) Results: This research looked into a variety of issues related to the value, viability, and effects of blockchain technology for use in supply chain applications. The methods and creations in this environment were monitored and researched. It is vital to identify a number of crucial subjects including future research areas, in order to achieve the widespread acceptance of the supply chain traceability provided by blockchain technology. (4) Conclusions: MSMAChain, an Ethereum blockchain-based approach, leverages smart contracts and decentralized off-chain storage for efficient product traceability in terms of the cost and execution of transaction for a health care supply chain

Can Different Salt Formulations Revert the Depressing Effect of Salinity on Maize by Modulating Plant Biochemical Attributes and Activating Stress Regulators through Improved N Supply?

Salinity is a major constraint in improving agricultural productivity due to its adverse impact on various physiological and biochemical attributes of plants, and its effect on reducing nitrogen (N) use efficiency due to ion toxicity. To understand the relationship between sodium chloride (NaCl) and increased N application rates, a pot study was performed in which the ammonical (NH4+) form of N was applied as urea to maize crops at different rates (control, 160, 186, 240, 267, 293, and 320 kg N ha−1) using two salinity levels (control and 10 dS m−1 NaCl). The results indicate that all biochemical and physiological attributes of the maize plant improved with increased concentration of N up to 293 kg ha−1, compared to those in the control treatment. Similarly, the optimal N concentration regulated the activities of antioxidant enzymes, i.e., catalase activity (CAT), peroxidase activity (POD), and superoxide dismutases (SOD), and also increased the N use efficiencies of the maize crop up to 293 kg N ha−1. Overall, our results show that the optimum level of N (293 kg ha−1) improved the salinity tolerance in the maize plant by activating stress coping physiological and biochemical mechanisms. This may have been due to the major role of N in the metabolic activity of plants and N assimilation enzymes activity such as nitrate reductase (NR) and nitrite reductase (NiR)

A Machine Learning Approach for Expression Detection in Healthcare Monitoring Systems

Expression detection plays a vital role to determine the patient’s condition in healthcare systems. It helps the monitoring teams to respond swiftly in case of emergency. Due to the lack of suitable methods, results are often compromised in an unconstrained environment because of pose, scale, occlusion and illumination variations in the image of the face of the patient. A novel patch-based multiple local binary patterns (LBP) feature extraction technique is proposed for analyzing human behavior using facial expression recognition. It consists of three-patch [TPLBP] and four-patch LBPs [FPLBP] based feature engineering respectively. Image representation is encoded from local patch statistics using these descriptors. TPLBP and FPLBP capture information that is encoded to find likenesses between adjacent patches of pixels by using short bit strings contrary to pixel-based methods. Coded images are transformed into the frequency domain using a discrete cosine transform (DCT). Most discriminant features extracted from coded DCT images are combined to generate a feature vector. Support vector machine (SVM), k-nearest neighbor (KNN), and Naïve Bayes (NB) are used for the classification of facial expressions using selected features. Extensive experimentation is performed to analyze human behavior by considering standard extended Cohn Kanade (CK+) and Oulu–CASIA datasets. Results demonstrate that the proposed methodology outperforms the other techniques used for comparison

An Adequate Approach to Image Retrieval Based on Local Level Feature Extraction

ABSTRAC

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

IntroductionSeveral single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).Methods160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.ResultsThe total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).ConclusionsThis multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.Trial registrationClinicalTrial.gov, NCT01401283

ИНВАЗИВНЫЙ МОНИТОРИНГ СЕРДЕЧНОГО ВЫБРОСА ПО ВРЕМЕНИ ТРАНЗИТА ПУЛЬСОВОЙ ВОЛНЫ ПОСЛЕ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ НА РАБОТАЮЩЕМ СЕРДЦЕ

Goal of the study: to evaluate the accuracy of invasive measurement of cardiac output (CO) by pulse wave transit time (PWTT) (esCCO, Japan) compared to transpulmonary thermodilution (TPTD) (PiCCO2 , Germany) after aortocoronary bypass (ACB) without cardiopulmonary bypass (ACB without CPB). Methods. 21 patients with ACB without CPB were enrolled into the study. During early post-operative period CO was simultaneously registered at eight stages basing on PWTT (COPWTT) and TPTD (COTPTD). Statistic analysis included evaluation of congruence of CO absolute values and capability to follow-up changes in CO. Results. In accordance with Bland-Altman analysis the average difference between two methods made 0.3 l/min. with consistency limits of ± 2.1 l/min. and percent error of 40%. Polar chart analysis showed the angular difference of 2.6°, radial consistency limits ± 53.3° and polar concordance of 69%. Conclusion: Lower repeatability of CO measurement by PWTT and insufficient capability to follow the changes in CO after ACB without CPB don not allow recommending this method in its invasive variant for routine practice as an alternative to thermodilution methods.  Цель исследования: оценка точности инвазивного измерения сердечного выброса (СВ) по времени транзита пульсовой волны (ВТПВ) (esCCO, Япония) в сравнении с методом транспульмональной термодилюции (ТПТД) (PiCCO2 , Германия) после аортокоронарного шунтирования (АКШ) без искусственного кровообращения (АКШ без ИК). Методы. В исследование включен 21 пациент после АКШ без ИК. В раннем послеоперационном периоде на восьми этапах выполняли параллельную регистрацию СВ, определенного на основе оценки ВТПВ (СВВТПВ) и ТПТД (СВТПТД). Статистический анализ включал оценку согласованности абсолютных значений СВ и способности отслеживать динамику СВ. Результаты. Согласно анализу Бланда – Альтмана, средняя разница между методами составила 0,3 л/мин с границами согласованности ± 2,1 л/мин и процентной ошибкой 40%. Анализ полярной диаграммы показал угловую разницу 2,6°, радиальные границы согласованности ± 53,3° и полярную конкордантность 69%. Вывод. Низкая воспроизводимость измерения СВ на основе оценки ВТПВ и недостаточная способность отслеживать динамику СВ после АКШ без ИК не позволяют рекомендовать рутинное использование данного метода в его инвазивном варианте в качестве альтернативы термодилюционным методикам.

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700