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Cost Effectiveness and Resource... May 2024Deep learning (DL) is a new technology that can assist prenatal ultrasound (US) in the detection of congenital heart disease (CHD) at the prenatal stage. Hence, an...
BACKGROUND
Deep learning (DL) is a new technology that can assist prenatal ultrasound (US) in the detection of congenital heart disease (CHD) at the prenatal stage. Hence, an economic-epidemiologic evaluation (aka Cost-Utility Analysis) is required to assist policymakers in deciding whether to adopt the new technology.
METHODS
The incremental cost-utility ratios (CUR), of adding DL assisted ultrasound (DL-US) to the current provision of US plus pulse oximetry (POX), was calculated by building a spreadsheet model that integrated demographic, economic epidemiological, health service utilization, screening performance, survival and lifetime quality of life data based on the standard formula: US screening data were based on real-world operational routine reports (as opposed to research studies). The DL screening cost of 145 USD was based on Israeli US costs plus 20.54 USD for reading and recording screens.
RESULTS
The addition of DL assisted US, which is associated with increased sensitivity (95% vs 58.1%), resulted in far fewer undiagnosed infants (16 vs 102 [or 2.9% vs 15.4%] of the 560 and 659 births, respectively). Adoption of DL-US will add 1,204 QALYs. with increased screening costs 22.5 million USD largely offset by decreased treatment costs (20.4 million USD). Therefore, the new DL-US technology is considered "very cost-effective", costing only 1,720 USD per QALY. For most performance combinations (sensitivity > 80%, specificity > 90%), the adoption of DL-US is either cost effective or very cost effective. For specificities greater than 98% (with sensitivities above 94%), DL-US (& POX) is said to "dominate" US (& POX) by providing more QALYs at a lower cost.
CONCLUSION
Our exploratory CUA calculations indicate the feasibility of DL-US as being at least cost-effective.
PubMed: 38773527
DOI: 10.1186/s12962-024-00550-3 -
Burns : Journal of the International... Apr 2024Cyanide poisoning poses a significant threat to burn patients exposed to smoke in residential or workplace fires, leading to central nervous system dysfunction,...
Hydroxocobalamin is not associated with methemoglobinemia in patients with inhalation injury and suspected cyanide toxicity and a proposed algorithm for hydroxocobalamin administration.
BACKGROUND
Cyanide poisoning poses a significant threat to burn patients exposed to smoke in residential or workplace fires, leading to central nervous system dysfunction, hemodynamic instability, cardiovascular collapse, and death. Prompt administration of an effective antidote is critical. Hydroxocobalamin, a form of vitamin B12, is the gold standard treatment for cyanide toxicity, by binding to cyanide molecules and converting them into non-toxic cyanocobalamin that is eliminated by the kidneys. This mechanism is distinct from previous cyanide antidotes, which induce the formation of methemoglobin to bind to cyanide. Recent case studies have reported elevated methemoglobin levels after hydroxocobalamin administration, raising concerns regarding its safety. The current study investigates smoke inhalation patients treated with hydroxocobalamin at a single institution Burn Unit in hopes of enhancing our understanding of the complexities surrounding cyanide antidote therapy.
METHODS
After Institutional Board Approval, a retrospective cohort study was conducted. Our sample comprised burn patients with inhalation injury admitted to a single institution from 2013 to 2023 and treated with hydroxocobalamin for suspected cyanide toxicity. We also analyzed a matched control cohort of similar patients with inhalation injury not treated with hydroxocobalamin. We analyzed changes and peaks in methemoglobin levels, lactate levels, blood urea nitrogen (BUN) and creatinine, ventilator days, % total body surface area (TBSA), various types of medications and dressings, and mortality. Statistical analyses included t-tests, chi-square, linear and logistic regressions, and correlation analysis.
RESULTS
In the study, 36 patients with suspected inhalation injury were treated with hydroxocobalamin at the Los Angeles General (LAG) Burn Unit from 2013 to 2023, who were matched to 32 control patients with inhalation injury who were not treated with hydroxocobalamin. Demographic and baseline characteristics showed no statistically significant differences between the groups, including age, gender, BMI, and %TBSA. No significant differences were found in initial, final, peak, or change in methemoglobin levels. The study also revealed no significant disparities in initial lactate levels, mortality, kidney function tests, ventilator days, surgeries, or use of medications/treatments (e.g., Silvadene dressings, Vitamin C) between the two groups. When controlling for covariates, multiple linear regression analysis (age, gender, and %TBSA) indicated that hydroxocobalamin administration was not significantly associated with changes in methemoglobin or mortality. Increased %TBSA, however, was linked to elevated lactate levels.
CONCLUSIONS
Our investigation sought to assess the potential risks associated with hydroxocobalamin administration in burn patients with concomitant inhalation injury. Contrary to our initial hypothesis, we found no statistically significant differences in methemoglobinemia, lactate levels, mortality, or kidney function. The influence of other factors, such as methemoglobinemia-inducing drugs or hydroxocobalamin's interference with co-oximetry, adds complexity. Although elevated methemoglobin levels were observed in some cases, their clinical significance was limited. However, this study's limitations, particularly the rarity of inhalation injury cases with concern for cyanide toxicity, warrant consideration. Further research is required to comprehensively elucidate the impact of hydroxocobalamin administration on burn patients' outcomes.
PubMed: 38760187
DOI: 10.1016/j.burns.2024.04.007 -
Heliyon May 2024The COVID-19 pandemic in Latin America generated the need to develop low-cost, fast-manufacturing mechanical ventilators. The Universidad de La Sabana and the Fundacion...
BACKGROUND
The COVID-19 pandemic in Latin America generated the need to develop low-cost, fast-manufacturing mechanical ventilators. The Universidad de La Sabana and the Fundacion Neumologica Colombiana designed and manufactured the Unisabana-HERONS (USH) ventilator. Here, we present the preclinical and clinical study results to evaluate its effectiveness and safety characteristics in an animal model (Y and five patients with acute respiratory failure receiving mechanical ventilatory support for 24 h.
METHODS
The effectiveness and safety outcomes included maintaining arterial blood gases and pulse oximetry saturation (SpO2), respiratory pressures and volumes (during continuous monitoring) in the range of ARDS and lung-protective strategy goals, and the occurrence of barotrauma. A significance level of 0.05 was used for statistical tests. This clinical trial was registered on Clinicaltrials.gov (NCT04497623) and approved by the ethics committee.
RESULTS
Among patients treated with the Unisabana-HERONS, the most frequent causes of acute respiratory failure were pneumonia in 3/5 (60 %) and ARDS in 2/5 (40 %). During the treatment, the ventilatory parameters related to lung protection protocols were kept within the safety range, and vital signs and blood gas were stable. The percentage of time that the respiratory pressures or volumes were out of safety range were plateau pressure >30 cm H2O: 0.00 %; driving pressure >15 cm H2O: 0.06 %; mechanical power >15 J/min: 0.00 %; and Tidal volume >8 mL/kg: 0.00 %. There were no adverse events related to the ventilator. The usability questionnaire retrieved a median score for all items between 9 and 10 (best score: 10), indicating great ease of use.
CONCLUSION
The Unisabana-HERONS ventilator effectively provided adequate gas exchange and maintained the ventilatory parameters in the range of lung protection strategies in humans and an animal model. Furthermore, it is straightforward to use and is a low-cost medical device.
PubMed: 38756610
DOI: 10.1016/j.heliyon.2024.e30671 -
Cureus Apr 2024Background Pulse oximetry screening (POS) is acknowledged globally as a noninvasive method to detect critical congenital heart diseases (CCHDs) and respiratory...
Background Pulse oximetry screening (POS) is acknowledged globally as a noninvasive method to detect critical congenital heart diseases (CCHDs) and respiratory illnesses. However, its value for early diagnosis and treatment remains unrecognized in many hospitals with limited resources around the world. This study aimed to evaluate POS's application in CCHDs, persistent pulmonary hypertension (PPHN), and respiratory distress syndrome (RDS) for early diagnosis and its influence on clinical procedures in rural areas. Methods This prospective observational study included all eligible newborn infants in the regional neonatal unit of a community healthcare center. Their peripheral oxygen saturation was assessed at <24 hours and >24 hours after birth, in the right upper limb and either lower limb. An oxygen saturation of <95% or >3% difference between pre-ductal and post-ductal circulations was considered abnormal. All neonates with abnormal oxygen saturations at >24 hours after birth were subjected to another POS test within two hours of the last test. If the oxygen saturation was still abnormal, it was considered a positive POS test. The POS results were classified as oxygen saturation abnormal (<90%), abnormal (90-94%), and normal (≥95%). All neonates with a positive POS test were referred for echocardiography. Results Overall, 440 infants had documented POS results. A total of 65 (14.77%) infants had a positive POS test result, out of which 39 (8.86%) cases were diagnosed on further evaluation. Four neonates had CCHD (positive predictive value (PPV) = 6.15%), 26 had RDS (PPV = 40%), and nine had PPHN (PPV = 13.85%). Without any further delay, the doctor directed them all to a more advanced facility. Conclusion Our research showed that, in large-scale clinical settings, the addition of pulse oximetry to routine cardiac auscultation could be a reliable and feasible method to screen newborns for CCHD, PPHN, and RDS early on. Our research underscores the importance of implementing routine POS to detect CCHD, RDS, and PPHN in clinical practice.
PubMed: 38756257
DOI: 10.7759/cureus.58398 -
Veterinary Journal (London, England :... Jun 2024The postoperative period is critical for the development of complications, including hypoxemia. To detect hypoxemia early and provide appropriate care, continuous...
The postoperative period is critical for the development of complications, including hypoxemia. To detect hypoxemia early and provide appropriate care, continuous monitoring of saturation is necessary: pulse oximetry is an easily accessible and simple method for this purpose. However, a SpO cut-off value to detect hypoxemia in dogs recovering from general anesthesia is lacking in the veterinary literature. The objectives of this clinical study are to validate the room air SpO test (SpAT), to identify a cut-off value to discriminate hypoxemia (Phase 1), and to apply the SpAT to study the incidence of transient postoperative hypoxemia (TPH) (Phase 2) in dogs with healthy lungs recovering from general anesthesia. Phase 1: 87 dogs recovering from general anesthesia with an arterial line were included. After extubation, SpAT was performed simultaneously with arterial blood sampling. A PaO < 80 mmHg was considered hypoxemia. Phase 2: 654 dogs were enrolled. They underwent general anesthesia with different ventilation settings for different procedures. After extubation, dogs were classified as hypoxemic if the SpO was lower than the cut-off obtained in phase 1. Phase 1 showed that the SpO cut-off is < 95% (sensitivity 100%, specificity 97.4%; area under the curve, AUC = 0.996; 95% Confidence Interval = 0.944-1; P<0.0001). In Phase 2, 169 dogs were hypoxemic. Body Condition Score (BCS) > 3/5, dorsal recumbency, FiO 1, absence of Positive End-Expiratory Pressure (PEEP) had a significant odds ratio to induce TPH (5.8, 1.9, 3.7, 1.7, respectively). These results showed that SpO < 95% indicates PaO < 80 mmHg in dogs and TPH occurs in up to 28% of cases. Identification of associated risks could be useful to prevent and to increase awareness for monitoring and treatment.
Topics: Dogs; Animals; Hypoxia; Anesthesia, General; Oximetry; Dog Diseases; Male; Risk Factors; Female; Incidence; Postoperative Complications
PubMed: 38750813
DOI: 10.1016/j.tvjl.2024.106135 -
Physiological Measurement May 2024Diagnosis of incipient acute hypovolemia is challenging as vital signs are typically normal and patients remain asymptomatic at early stages. The early identification of...
Diagnosis of incipient acute hypovolemia is challenging as vital signs are typically normal and patients remain asymptomatic at early stages. The early identification of this entity would affect patients' outcome if physicians were able to treat it precociously. Thus, the development of a noninvasive, continuous bedside monitoring tool to detect occult hypovolemia before patients become hemodynamically unstable is clinically relevant. We hypothesize that pulse oximeter's alternant (AC) and continuous (DC) components of the infrared light are sensitive to acute and small changes in patient's volemia. We aimed to test this hypothesis in a cohort of healthy blood donors as a model of slight hypovolemia.We planned to prospectively study blood donor volunteers removing 450 ml of blood in supine position. Noninvasive arterial blood pressure, heart rate, and finger pulse oximetry were recorded. Data was analyzed before donation, after donation and during blood auto-transfusion generated by the passive leg-rising (PLR) maneuver.Sixty-six volunteers (44% women) accomplished the protocol successfully. No clinical symptoms of hypovolemia, arterial hypotension (systolic pressure < 90 mmHg), brady-tachycardia (heart rate <60 and >100 beats-per-minute) or hypoxemia (SpO< 90%) were observed during donation. The AC signal before donation (median 0.21 and interquartile range 0.17 a.u.) increased after donation [0.26(0.19) a.u;< 0.001]. The DC signal before donation [94.05(3.63) a.u] increased after blood extraction [94.65(3.49) a.u;< 0.001]. When the legs' blood was auto-transfused during the PLR, the AC [0.21(0.13) a.u.;= 0.54] and the DC [94.25(3.94) a.u.;= 0.19] returned to pre-donation levels.The AC and DC components of finger pulse oximetry changed during blood donation in asymptomatic volunteers. The continuous monitoring of these signals could be helpful in detecting occult acute hypovolemia. New pulse oximeters should be developed combining the AC/DC signals with a functional hemodynamic monitoring of fluid responsiveness to define which patient needs fluid administration.
Topics: Humans; Blood Donors; Pilot Projects; Female; Male; Adult; Photoplethysmography; Fingers; Hemorrhage; Middle Aged; Hypovolemia; Oximetry; Acute Disease; Young Adult; Heart Rate
PubMed: 38749458
DOI: 10.1088/1361-6579/ad4c54 -
Sleep & Breathing = Schlaf & Atmung May 2024The current study aims to assess the efficacy of the Stop-Bang Questionnaire (SBQ) in screening treatment-required sleep apnoea following Spinal Cord Injury (SCI)....
PURPOSE
The current study aims to assess the efficacy of the Stop-Bang Questionnaire (SBQ) in screening treatment-required sleep apnoea following Spinal Cord Injury (SCI). Additionally, we explore the performance of combined questionnaires and pulse oximetry to determine the most cost-effective method.
METHODS
The study employs a cross-sectional observational design. All patients admitted to in-hospital rehabilitation at the Spinal Cord Injury Centre of Western Denmark from September 2022 to February 2023 were continuously enrolled. Participating patients underwent SBQ screening, a standard sleep questionnaire, and cardiorespiratory monitoring, followed by an individual consultation with a physician.
RESULTS
During the study period, 35 SCI patients were admitted, with 24 providing informed consent. Among the 24 included patients, there was a 75% prevalence of mild to severe sleep apnoea, and 46% had treatment-required sleep apnoea. The SBQ missed only one patient with treatment-required sleep apnoea but misclassified eight patients. Combining SBQ with the pulse oximetry demonstrated the best performance in identifying patients with sleep apnoea.
CONCLUSION
The study indicates that SBQ alone is insufficient for screening treatment-required sleep apnoea. Exploratory analysis suggests that combining SBQ with a simple pulse oximetry measurement might enhance accuracy.
PubMed: 38748068
DOI: 10.1007/s11325-024-03062-9 -
The Journal of Trauma and Acute Care... May 2024The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and...
BACKGROUND
The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and cost-intensive nature of standard vital sign monitors or photoplethysmographic volume-clamp (PPGVC) devices used to measure arterial waveforms. In this regard, photoplethysmographic measurements obtained from pulse oximetry (PPGPO) may serve as a useful, portable alternative. This study aimed to validate CRM values obtained using PPGPO.
METHODS
Forty-nine healthy adults (25 females) underwent a graded lower body negative pressure (LBNP) protocol to simulate hemorrhage. Arterial waveforms were sampled using PPGPO and PPGVC. The CRM was calculated using a one-dimensional convolutional neural network. Cardiac output and stroke volume were measured using PPGVC. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. Log-rank analyses were used to examine differences in shock determination during LBNP between monitored hemodynamic parameters.
RESULTS
The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 47±12% reduction in stroke volume, 64±27% increase in heart rate, and 21±7% reduction in systolic blood pressure (P<0.001 for all). CRM values obtained with both PPGPO and PPGVC were associated with changes in heart rate (P<0.001), stroke volume (P<0.001), and pulse pressure (P<0.001). Furthermore, they provided an earlier detection of hemodynamic shock relative to the traditional metrics of shock index (P<0.001 for both), systolic blood pressure (P<0.001 for both), and heart rate (P=0.001 for both).
CONCLUSION
The CRM obtained from PPGPO provides a valid, time-sensitized prediction of hemodynamic decompensation, opening the door to provide military medical personnel noninvasive in-field advanced capability for early detection of hemorrhage and imminent onset of shock.
LEVEL OF EVIDENCE
Diagnostic Tests or Criteria, Level IV.
PubMed: 38745348
DOI: 10.1097/TA.0000000000004377 -
Stomatologiia 2024Increasing the effectiveness of treatment of chronic generalized periodontitis using PDT based on clinical and functional substantiation of the effects of a...
OBJECTIVE
Increasing the effectiveness of treatment of chronic generalized periodontitis using PDT based on clinical and functional substantiation of the effects of a photosensitizer.
MATERIALS AND METHODS
A clinical and functional study and treatment of moderate chronic generalized periodontitis was carried out in 62 people (26 men and 36 women) aged from 35 to 55 years without a somatic model with an orthognathic occlusion diagnosed according to ICD-10 - K05.3. Of these, 2 groups were divided depending on the type of treatment: Group 1 (main) - patients with moderate chronic generalized periodontitis - 32 people. (17 men and 15 women, average age of the group - 43.2±2.2 years); Group 2 (control) - patients with moderate chronic generalized periodontitis - 30 people. (14 men and 16 women, average age of the group - 44.0±3.3 years). Complex treatment consisted of sanitation of the mouth, removal of dental plaque and curettage of periodontal pockets in group 1, followed by PDT with Revixan gel using a special wired aligner REVIXAN DENTAL LED (16 r). The clinical condition of the periodontium was assessed using the Greene Vermillion Hygienic Index (OHI-S), the Mühlleman Bleeding Index (SBI) modified by Cowell, and the periodontal index PI. To study the state of microcirculation in the gum tissue, the laser Doppler flowmetry (LDF) method was used using the LAKK-M device (NPP «Lazma», Russia). The state of microcirculation was assessed by the microcirculation index (M), which characterizes the level of tissue blood flow; parameter - «σ», which determines the fluctuation of the erythrocyte flow. According to Wavelet analysis of LDF-grams, the shunt index (SH) of blood flow was determined. In the «LDF + spectrometry» mode, oxygenation in periodontal tissues was studied using optical tissue oximetry (OTO), based on the results of which the perfusion saturation index (Sm) and the specific oxygen consumption index (U, %) were determined.
RESULTS
According to LDF data, after PDT (group 1), normalization of clinical indices and the level of microcirculation in periodontal tissues was established, which was accompanied by an increase in the level of blood flow (M) and its activity (σ), which persisted after 3 and 6 months. after PDT. The perfusion saturation index (Sm) and specific oxygen consumption (U) increased more significantly after PDT, which persisted after 3 and 6 months. In the control group, the dynamics of indicators was less pronounced.
CONCLUSION
The use of PDT with Revixan gel normalizes the clinical condition of the periodontium, indicators of microhemodynamics and oxygen metabolism.
Topics: Humans; Female; Male; Adult; Microcirculation; Middle Aged; Chronic Periodontitis; Photochemotherapy; Photosensitizing Agents; Periodontium; Oxygen
PubMed: 38741530
DOI: 10.17116/stomat202410302118 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Diabetes mellitus (DM) causes different corneal changes that are associated with the severity of diabetic retinopathy. To identify the pathophysiological reasons for...
PURPOSE
Diabetes mellitus (DM) causes different corneal changes that are associated with the severity of diabetic retinopathy. To identify the pathophysiological reasons for this, corneal tomography and optical densitometry (COD) were combined with retinal oximetry.
METHODS
Patients with DM and healthy subjects were included in this pilot study. Spatially resolved corneal thickness and COD were assessed using the Pentacam HR (Oculus). The pachymetry difference (PAC) was calculated as an indicator of an increase in the peripheral corneal thickness. Oxygen saturation (SO) of the retinal vessels was measured using the Retinal Vessel Analyzer (Imedos Systems UG). Subsequently, the associations between corneal and retinal parameters were analyzed.
RESULTS
Data from 30 patients with DM were compared with those from 30 age-matched healthy subjects. In DM, arterial (P = 0.048) and venous (P < 0.001) SO levels were increased, and arteriovenous SO difference was decreased (P < 0.001). In patients, PAC was higher than that in healthy subjects (P < 0.05), indicating a stronger increase in peripheral corneal thickness. The COD was reduced in DM (P = 0.004). The PAC of concentric rings with a diameter of 4 mm (r = -0.404; P = 0.033) to 8 mm (r = -0.522; P = 0.004) was inversely correlated with the arteriovenous SO difference. Furthermore, PAC 4 mm was negatively associated with arterial SO (r = -0.389; P = 0.041), and the COD of the peripheral corneal areas correlated positive with arterial SO (COD total 10-12 mm: r = 0.408; P = 0.025).
CONCLUSION
These associations might indicate a common pathogenesis of corneal and retinal changes in DM, which could be caused by reduced oxygen supply, mitochondrial dysfunction, oxidative stress, and cytokine effects.
PubMed: 38737594
DOI: 10.2147/OPTH.S456020