A novel breakthrough in wrist-worn transdermal troponin-I-sensor assessment for acute myocardial infarction.

Aims: Clinical differentiation of acute myocardial infarction (MI) from unstable angina and other presentations mimicking acute coronary syndromes (ACS) is critical for implementing time-sensitive interventions and optimizing outcomes. However, the diagnostic steps are dependent on blood draws and laboratory turnaround times. We tested the clinical feasibility of a wrist-worn transdermal infrared spectrophotometric sensor (transdermal-ISS) in clinical practice and assessed the performance of a machine learning algorithm for identifying elevated high-sensitivity cardiac troponin-I (hs-cTnI) levels in patients hospitalized with ACS. Methods and results: We enrolled 238 patients hospitalized with ACS at five sites. The final diagnosis of MI (with or without ST elevation) and unstable angina was adjudicated using electrocardiography (ECG), cardiac troponin (cTn) test, echocardiography (regional wall motion abnormality), or coronary angiography. A transdermal-ISS-derived deep learning model was trained (three sites) and externally validated with hs-cTnI (one site) and echocardiography and angiography (two sites), respectively. The transdermal-ISS model predicted elevated hs-cTnI levels with areas under the receiver operator characteristics of 0.90 [95% confidence interval (CI), 0.84-0.94; sensitivity, 0.86; and specificity, 0.82] and 0.92 (95% CI, 0.80-0.98; sensitivity, 0.94; and specificity, 0.64), for internal and external validation cohorts, respectively. In addition, the model predictions were associated with regional wall motion abnormalities [odds ratio (OR), 3.37; CI, 1.02-11.15; P = 0.046] and significant coronary stenosis (OR, 4.69; CI, 1.27-17.26; P = 0.019). Conclusion: A wrist-worn transdermal-ISS is clinically feasible for rapid, bloodless prediction of elevated hs-cTnI levels in real-world settings. It may have a role in establishing a point-of-care biomarker diagnosis of MI and impact triaging patients with suspected ACS.

Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India.

OBJECTIVES: Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem. METHODS: This retrospective observational study reviewed patients presenting to Telangana's prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients' characteristics and prehospital intervention. RESULTS: There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned. CONCLUSION: This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.

A Comparison of Accuracy of Matrix Impression System with Putty Reline Technique and Multiple Mix Technique: An In Vitro Study.

BACKGROUND: The difficulty in obtaining an acceptable impression increases exponentially as the number of abutments increases. Accuracy of the impression material and the use of a suitable impression technique are of utmost importance in the fabrication of a fixed partial denture. This study compared the accuracy of the matrix impression system with conventional putty reline and multiple mix technique for individual dies by comparing the inter-abutment distance in the casts obtained from the impressions. MATERIALS AND METHODS: Three groups, 10 impressions each with three impression techniques (matrix impression system, putty reline technique and multiple mix technique) were made of a master die. Typodont teeth were embedded in a maxillary frasaco model base. The left first premolar was removed to create a three-unit fixed partial denture situation and the left canine and second premolar were prepared conservatively, and hatch marks were made on the abutment teeth. The final casts obtained from the impressions were examined under a profile projector and the inter-abutment distance was calculated for all the casts and compared. RESULTS: The results from this study showed that in the mesiodistal dimensions the percentage deviation from master model in Group I was 0.1 and 0.2, in Group II was 0.9 and 0.3, and Group III was 1.6 and 1.5, respectively. In the labio-palatal dimensions the percentage deviation from master model in Group I was 0.01 and 0.4, Group II was 1.9 and 1.3, and Group III was 2.2 and 2.0, respectively. In the cervico-incisal dimensions the percentage deviation from the master model in Group I was 1.1 and 0.2, Group II was 3.9 and 1.7, and Group III was 1.9 and 3.0, respectively. In the inter-abutment dimension of dies, percentage deviation from master model in Group I was 0.1, Group II was 0.6, and Group III was 1.0. CONCLUSION: The matrix impression system showed more accuracy of reproduction for individual dies when compared with putty reline technique and multiple mix technique in all the three directions, as well as the inter-abutment distance.