Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus.

BACKGROUND: Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit. METHODS: Clinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge. RESULTS: Age, temperature, heart rate, lower peripheral oxygen saturation (SpO2) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Heart rate, SpO2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively). Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95-41.57, 53.0 [41.6-56.3] and 54.8 [51.6-57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO2, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge. CONCLUSIONS: MV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome

Empagliflozin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

BackgroundEmpagliflozin has been proposed as a treatment for COVID-19 on the basis of its anti-inflammatory, metabolic, and haemodynamic effects. The RECOVERY trial aimed to assess its safety and efficacy in patients admitted to hospital with COVID-19.MethodsIn the randomised, controlled, open-label RECOVERY trial, several possible treatments are compared with usual care in patients hospitalised with COVID-19. In this analysis, we assess eligible and consenting adults who were randomly allocated in a 1:1 ratio to either usual standard of care alone or usual standard of care plus oral empagliflozin 10 mg once daily for 28 days or until discharge (whichever came first) using web-based simple (unstratified) randomisation with allocation concealment. The primary outcome was 28-day mortality; secondary outcomes were duration of hospitalisation and (among participants not on invasive mechanical ventilation at baseline) the composite of invasive mechanical ventilation or death. On March 3, 2023 the independent data monitoring committee recommended that the investigators review the data and recruitment was consequently stopped on March 7, 2023. The ongoing RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov(NCT04381936)FindingsBetween July 28, 2021 and March 6, 2023, 4271 patients were randomly allocated to receive either empagliflozin (2113 patients) or usual care alone (2158 patients). Primary and secondary outcome data were known for greater than 99% of randomly assigned patients. Overall, 289 (14%) of 2113 patients allocated to empagliflozin and 307 (14%) of 2158 patients allocated to usual care died within 28 days (rate ratio 0·96 [95% CI 0·82–1·13]; p=0·64). There was no evidence of significant differences in duration of hospitalisation (median 8 days for both groups) or the proportion of patients discharged from hospital alive within 28 days (1678 [79%] in the empagliflozin group vs 1677 [78%] in the usual care group; rate ratio 1·03 [95% CI 0·96–1·10]; p=0·44). Among those not on invasive mechanical ventilation at baseline, there was no evidence of a significant difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (338 [16%] of 2084 vs 371 [17%] of 2143; risk ratio 0·95 [95% CI 0·84–1·08]; p=0·44). Two serious adverse events believed to be related to empagliflozin were reported: both were ketosis without acidosis.InterpretationIn adults hospitalised with COVID-19, empagliflozin was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death so is not indicated for the treatment of such patients unless there is an established indication due to a different condition such as diabetes

How Far Removed Are You? Scalable Privacy-Preserving Estimation of Social Path Length with Social PaL

International law-making in the field of coastal State jurisdiction over ships in peril and shipwrecks is of incremental nature. Various legal issues concerning the matter at stake have emerged at different stages over the last fifty years, and have been triggered by a number of maritime accidents, the 1967 Torrey Canyon incident marking the critical point in this respect. The current legal regime on coastal State jurisdiction over ships in peril and shipwrecks is determined by a combination of a number of different instruments adopted under the auspices of the International Maritime Organization, in particular the 1969 Intervention Convention, the 1973 Intervention Protocol, the 1989 Salvage Convention, the 2003 Guidelines on Places of Refuge and the 2007 Nairobi Wreck Removal Convention. Moreover, the 1982 United Nations Convention on the Law of the Sea serves as an underlying ‘constitutional’ framework. All these instruments intend to function within the same legal regime, providing coastal States with certain decision-making powers to combat risks posed by ships in peril and shipwrecks. However, much of the language used in the relevant provisions is vague and subject to varying interpretations. As a result, considerable ambiguity characterizes not only each of the key instruments in place, but also their relationship and the way the legal regime actually works. Of additional concern is the generality of application of certain rules, in particular, the question of opposability. Against this backdrop, the thesis seeks to explore and explain what are the rights and obligations of coastal States over foreign ships in peril and shipwrecks under international law, and how have these evolved since the 1967 Torrey Canyon disaster

Multiresponse Optimization for a Novel Compliant Z-Stage by a Hybridization of Response Surface Method and Whale Optimization Algorithm

A novel compliant z-stage is applied for positioning and indenting a specimen in nano/microindentation testing system. For an excellent operation, the proposed z-stage can concurrently satisfy multicriteria comprising high safety factor, small parasitic motion, and large output displacement. The key aims of this article are to present a novel design of the compliant z-stage as well as an effective integration methodology of Taguchi method, response surface method, weight factor calculation based on signal to noise, and the whale optimization algorithm to resolve a design optimal problem so as to enrich the quality performances of the proposed stage. Primarily, the z-stage is designed based on four-lever amplifier, compliant hinge shifted arrangement mechanism, zigzag-based flexure spring guiding mechanism, and symmetric six leaf hinges-based parallel guiding mechanism. Secondly, the number experiment data are achieved by the Taguchi method and finite element analysis. Subsequently, the regression functions among input variables and quality characteristics are formed by exploiting response surface method. In addition, the weight factors for every characteristic are defined. Additionally, the sensitivity analysis is accomplished for determining influences of input variables on quality responses. Ultimately, based on regression equations, the whale optimization algorithm is executed to define the optimal factors. The consequences indicated that the output deformation is about 454.55 μm and the safety factor is around 2.38. Furthermore, the errors among the optimal consequences and the confirmations for the safety factor and output deformation are 7.12% and 4.25%, correspondingly. By using Wilcoxon and Friedman methods, the results revealed that the proposed algorithm is better than the cuckoo search algorithm. Based on the quality convergence characteristics of hybrid approach, the proposed method is proficient for resolving complicated multiobjective optimization

Typology of houses and ventilation characteristics: a case study in Ho Chi Minh City (Vietnam)

FLWNOinfo:eu-repo/semantics/publishe

The natural history and transmission potential of asymptomatic severe acute respiratory syndrome coronavirus 2 infection

Background Little is known about the natural history of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods We conducted a prospective study at a quarantine center for coronavirus disease 2019 in Ho Chi Minh City, Vietnam. We enrolled quarantined people with reverse-transcription polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 infection, collecting clinical data, travel and contact history, and saliva at enrollment and daily nasopharyngeal/throat swabs (NTSs) for RT-PCR testing. We compared the natural history and transmission potential of asymptomatic and symptomatic individuals. Results Between 10 March and 4 April 2020, 14 000 quarantined people were tested for SARS-CoV-2; 49 were positive. Of these, 30 participated in the study: 13 (43%) never had symptoms and 17 (57%) were symptomatic. Seventeen (57%) participants imported cases. Compared with symptomatic individuals, asymptomatic people were less likely to have detectable SARS-CoV-2 in NTS collected at enrollment (8/13 [62%] vs 17/17 [100%]; P = .02). SARS-CoV-2 RNA was detected in 20 of 27 (74%) available saliva samples (7 of 11 [64%] in the asymptomatic group and 13 of 16 [81%] in the symptomatic group; P = .56). Analysis of RT-PCR positivity probability showed that asymptomatic participants had faster viral clearance than symptomatic participants (P  Conclusions Asymptomatic SARS-CoV-2 infection is common and can be detected by analysis of saliva or NTSs. The NTS viral loads fall faster in asymptomatic individuals, but these individuals appear able to transmit the virus to others.</p