India ranks among the top countries experiencing worst traffic congestion in the world. According to the reports, in India it takes more than 400 minutes to reach a hospital for every second heart ...attack patient which is almost 13 times more than the ideal time of 30 minutes. The primary aim of this proposed solution is to minimize the response time of ambulances approaching the needy. Our proposed approach of the 'One-Tap-Button' emergency response app provides just one 'SOS' (Save Our Souls) button which sends the location of the user to the nearest hospital or medical center within a definite range set in the app via a library called socket.io. The location with the notification mentioning the details of the patient/victim is viewed in the integrated Google Maps app interface. A GPS (Global Positioning System) modem fitted in the ambulance which is responsible for keeping live track of their location by the servers i.e., the hospital's portal. WebRTC (Web Real-Time Communications) live video streaming feature enables direct patient-doctor communication during emergencies, facilitating real-time audio and video transmission. This seamless integration enhances emergency response and prompt healthcare communication.
Matched cohort comparison.
To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
There is a paucity of data ...on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF.
Patients who underwent 1-level MI-TLIF and received the ESP block (group E ) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups.
Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption ( P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 ( P = 0.016), and lower first pain scores postsurgery ( P < 0.001). Group E had lower intraoperative opioid requirements ( P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 ( P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively ( P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1.
In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF.
Level 3.
Supramolecular assembly of chromophores with inherent resistance to aggregation‐induced self‐quenching is significant to applications such as chemical sensing and organic light emitting diodes ...(OLEDs). In this work, molecular gels with aggregation‐induced emission (AIE) are constructed by simply coassembling AIE chromophores (electron donor or acceptor) with a nonfluorescent molecular gelator. The binary gels are fluorescent even at very low concentrations of the AIE chromophores, indicating that the rotation of their aromatic cores is restricted in the gel network. In tertiary gels, the fluorescence of the donor chromophore can be efficiently reduced by the acceptor chromophore through a combination of static and dynamic quenching process, via charge transfer from the donor to the acceptor. This work demonstrates a convenient approach to fabricate a supramolecular charge transfer system using an AIE donor and acceptor.
Supramolecular assembly of chromophores: Self‐quenching of chromophore molecules upon aggregation reduces energy conversion efficiency and performance of optoelectronic devices. In this work, supramolecular gels of chromophores with aggregation‐induced emission are constructed. The gels demonstrate efficient charge transfer from donor to acceptor chromophores (see figure).
During 2012-2013, at a public hospital in Pune, India, 26 (3.9%) cases of tuberculosis were reported among 662 medical trainees, representing an estimated incidence of 3,279 cases/100,000 ...person-years. Three of these infections were isoniazid-resistant, 1 was multidrug-resistant, and 1 occurred in a trainee who had fulminant hepatitis after starting treatment for TB.
This study aimed to describe the placental changes occurring in women with preexisting diabetes mellitus and to determine if elastography can detect placental changes in vivo.
PubMed, Embase, ...Medline, and Cochrane were searched to identify English language studies published until July 2020.
1) For key question 1, studies that described histopathologic changes in placentas from women with known diabetes mellitus and 2) for key question 2, those that described structural–placental changes detectable by elastography in high-risk pregnancies (eg, those complicated by preeclampsia and/or fetal growth restriction), were included.
For key question 1, we grouped placental pathologies using the Amsterdam International Consensus Group definitions. For key question 2, we conducted a metaanalysis including all data from studies reporting placental stiffness in meters per second (m/s) or kilopascals (kPa). The mean difference (95% confidence interval) was calculated using a random effects model.
Data were extracted from 14 studies of placental histopathology in women with known diabetes. In this group, a wide variety of placental histopathologic changes are described, though none are considered pathognomonic. The histopathologic changes including maternal vascular malperfusion, fetal vascular malperfusion, and/or infectious/inflammatory/other changes were divided into 3 broad categories on the basis of presumed etiology. A total of 15 studies reported the placental stiffness scores in women with a high-risk pregnancy vs those with a normal pregnancy. Only 1 reported stiffness scores for placentas in women with preexisting diabetes mellitus (N<10 women). Pooled analysis of 14 studies with available data included 478 “high-risk pregnancies” and 828 control or healthy pregnancies. Maternal-derived pathologies resulted in higher placental stiffness (mean difference 4.5 kPa 95% confidence interval, 3.16–5.87) compared with control or healthy pregnancies. Fetal-derived pathologies also resulted in higher placental stiffness (mean difference of 6.5 kPa 95% confidence interval, 1.08–11.86) compared with control or healthy pregnancies.
Shear wave elastography may provide an in vivo approximation of placental histopathology in women with certain kinds of high-risk pregnancies. A high-risk pregnancy may involve maternal- and fetal-derived pathologies. Further studies, particularly in women with preexisting diabetes, are needed to confirm this observation.
A supramolecular approach is used to assemble an electron donor and acceptor pair on the fibers of a molecular gelator. The donor and acceptor chromophores exhibit aggregation‐induced emission, a ...phenomenon which eliminates the self‐quenching problem. A high efficiency of charge transfer, which involves both static and dynamic processes, from donor to acceptor chromophore is perceived. This approach anticipates the design of optoelectronic materials that can achieve a high charge transfer efficiency for organic electronic applications. More information can be found in the Full Paper by J.‐L. Li, A. Gupta, S. V. Bhosale, et al. on page 14668.
To determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19.
Retrospective observational ...study.
Multicenter, international COVID-19 registry.
Adult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021.
None.
Data were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio OR = 1.28; 95% CI 1.19-1.38; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI 1.03-1.15; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI 0.81-0.94; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI 1.20-1.56; p < 0.0001).
Among patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.
Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients ...with COVID-19 and metabolic syndrome.
To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19.
This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as ≥3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021.
Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia.
The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS).
Among 46 441 patients hospitalized with COVID-19, 29 040 patients (mean SD age, 61.2 17.8 years; 13 059 45.0% women and 15713 54.1% men; 6797 Black patients 23.4%, 5325 Hispanic patients 18.3%, and 16 507 White patients 57.8%) met inclusion criteria. A total of 5069 patients (17.5%) with metabolic syndrome were compared with 23 971 control patients (82.5%) without metabolic syndrome. In adjusted analyses, metabolic syndrome was associated with increased risk of ICU admission (adjusted odds ratio aOR, 1.32 95% CI, 1.14-1.53), invasive mechanical ventilation (aOR, 1.45 95% CI, 1.28-1.65), ARDS (aOR, 1.36 95% CI, 1.12-1.66), and mortality (aOR, 1.19 95% CI, 1.08-1.31) and prolonged hospital LOS (median IQR, 8.0 4.2-15.8 days vs 6.8 3.4-13.0 days; P < .001) and ICU LOS (median IQR, 7.0 2.8-15.0 days vs 6.4 2.7-13.0 days; P < .001). Each additional metabolic syndrome criterion was associated with increased risk of ARDS in an additive fashion (1 criterion: 1147 patients with ARDS 10.4%; P = .83; 2 criteria: 1191 patients with ARDS 15.3%; P < .001; 3 criteria: 817 patients with ARDS 19.3%; P < .001; 4 criteria: 203 patients with ARDS 24.3%; P < .001).
These findings suggest that metabolic syndrome was associated with increased risks of ARDS and death in patients hospitalized with COVID-19. The association with ARDS was cumulative for each metabolic syndrome criteria present.
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