Escala de alerta precoce na identificação de pacientes com risco de deterioração clínica / Early warning scale for identifying patients at risk of clinical deterioration / Escala de alerta temprana en la identificación de pacientes con riesgo de deterioro clínico

Objetivo: avaliar pontuação da National Early Warning Score (NEWS) em relação ao tipo de desfecho e perfil dos pacientes da enfermaria clínica médica de um hospital em Teresina, Piauí, Brasil. Método: estudo quantitativo realizado num hospital público, em Teresina, com 150 prontuários de pacientes internados no setor clínica médica de fevereiro de 2022 a dezembro de 2022, a partir de registros demográficos, clínicos e valores da escala na admissão e desfecho. Resultados: houve associação dos valores da escala com a faixa etária (p=0,029), tempo de internação (p=0,023) e tipo de desfecho (p < 0,001). Alto risco clínico prevaleceu entre pacientes do sexo masculino (13%), na faixa etária de 60 a 94 anos (13%), com permanência de 21 a 57 dias (19,2%) e óbito como desfecho (100%). Conclusão: implementação da referida escala evidenciou ser fundamental para prever agravos clínicos e melhorar qualidade da assistência.

Objective: to evaluate the National Early Warning Score (NEWS) in relation to the type of outcome and profile of patients in the medical clinical ward of a hospital in Teresina, Piauí, Brazil. Method: a quantitative study conducted in a public hospital in Teresina, with 150 medical records of patients admitted to the medical clinic sector from February 2022 to December 2022, based on demographic and clinical records and scale values at admission and outcome. Results: there was an association between the scale values and the age group (p=0.029), length of stay (p=0.023) and type of outcome (p < 0.001). High clinical risk prevailed among male patients (13%), aged between 60 and 94 years (13%), with a stay of 21 to 57 days (19.2%), and death as an outcome (100%). Conclusion: implementation of the aforementioned scale proved to be fundamental for predicting clinical problems and improving care quality.

Objetivo: evaluar el puntaje de la National Early Warning Score (NEWS) con respecto al tipo de desenlace y el perfil de los pacientes de la enfermería clínica médica de un hospital en Teresina, Piauí, Brasil. Método: estudio cuantitativo realizado en un hospital público en Teresina, con 150 historiales médicos de pacientes internados en el sector de clínica médica desde febrero de 2022 hasta diciembre de 2022, a partir de registros demográficos, clínicos y valores de la escala en la admisión y desenlace. Resultados: hubo asociación de los valores de la escala con la edad (p=0,029), tiempo de internación (p=0,023) y tipo de desenlace (p < 0,001). El alto riesgo clínico prevaleció entre los pacientes del sexo masculino (13%), en la franja de edad entre 60 y 94 años (13%), con una estancia de 21 a 57 días (19,2%) y fallecimiento como desenlace (100%). Conclusión: la implementación de dicha escala demostró ser fundamental para prever agravios clínicos y mejorar la calidad de la asistencia.

Caracterización clínica de dengue con signos de alarma y dengue grave en adultos. Hospital Roosevelt, Guatemala

Introducción: El dengue es uno de los arbovirus de mayor importancia clínica y epidemiológica a nivel mundial. En Guatemala, durante el 2023 se registró el número más alto de casos en los últimos 10 años y un incremento de 135% en el número de casos comparado con el 2022. Objetivo: Caracterización clínica de dengue con signos de alarma y dengue grave. Metodología: Estudio descriptivo transversal retrospectivo, incluyó registros de 206 pacientes con signos de alarma de dengue que acudieron a la Emergencia de Adultos del Hospital Roosevelt de Guatemala, del 26 de septiembre al 26 de noviembre del 2023. Resultados: Predominó el sexo femenino en 54,4% y el grupo etario de 12-22 años en 51,0%. El principal signo de alarma fue el sangrado en 63,6%. Las mayores complicaciones fueron hepatopatía en 9,2%, choque en 5,8% y alteración neurológica en 2,9%. Respecto a los parámetros hematológicos, predominaron la trombocitopenia en 93,2%, leucopenia en 53,9% y linfocitosis en 71,4%. Las transaminasas AST y ALT presentaron elevación en 97,0% (96/99) y 91,0% (142/156), respectivamente. Los tiempos de coagulación se mostraron prolongados en 55,9% (104/186) para TPT y en 22,6% (42/186) para TP. Hubo 78,7% de positividad (148/188) para dengue. El 8,3% (17/206) de los pacientes fue referido al área crítica por clasificación de dengue grave. Conclusión: Estos datos aportan una mejora en el reconocimiento y el manejo clínico adecuado de casos con signos de alarma y dengue grave, que pueden contribuir para disminuir la carga de morbimortalidad de esta enfermedad en el país.

Introduction: Dengue is one of the most clinically and epidemiologically important arboviruses worldwide. In Guatemala, the highest number of cases in the last 10 years was recorded in 2023 and an increase of 135% in the number of cases compared to 2022. Objective: Clinical characterization of dengue with warning signs and severe dengue. Methodology: Retrospective cross-sectional descriptive study, included records of 206 patients with warning signs of dengue who attended the Adult Emergency of the Roosevelt Hospital in Guatemala, from September 26 to November 26, 2023. Results: The female sex predominated in 54,4% and the age group of 12-22 years in 51,0%. The main warning sign was bleeding in 63,6%. The major complications were liver disease in 9,2%, shock in 5,8% and neurological alterations in 2,9%. Regarding hematological parameters, thrombocytopenia predominated in 93,2%, leukopenia in 53,9% and lymphocytosis in 71,4%. The transaminases AST and ALT were elevated in 97,0% (96/99) and 91,0% (142/156), respectively. Coagulation times were prolonged in 55,9% (104/186) for TPT and in 22,6% (42/186) for TP. There was 78,7% positivity (148/188) for dengue. The 8,3% (17/206) of patients were referred to the critical area for classification of severe dengue. Conclusion: These data provide an improvement in the recognition and adequate clinical management of cases with warning signs and severe dengue, which can contribute to reducing the burden of morbidity and mortality from this disease in the country.

Introdução: A dengue é uma das arboviroses de maior importância clínica e epidemiológica em todo o mundo. Na Guatemala, durante 2023 foi registrado o maior número de casos dos últimos 10 anos e um aumento de 135% no número de casos em relação a 2022. Objetivo: Caracterização clínica da dengue com sinais de alerta e dengue grave. Metodologia: Estudo descritivo transversal que incluiu registros de 206 pacientes com sinais de alerta de dengue atendidos na Emergência Adulto do Hospital Roosevelt, na Guatemala, no período de 26 de setembro a 26 de novembro de 2023. Resultados: O sexo feminino predominou em 54,4% e na faixa etária de 12 a 22 anos em 51,0%. O principal sinal de alerta foi sangramento em 63,6%. As principais complicações foram doença hepática em 9,2%, choque em 5,8% e alteração neurológica em 2,9%. Em relação aos parâmetros hematológicos, houve predomínio de trombocitopenia em 93,2%, leucopenia em 53,9% e linfocitose em 71,4%. As transaminases AST e ALT foram elevadas em 97,0% (96/99) e 91,0% (142/156), respectivamente. Os tempos de coagulação foram prolongados em 55,9% (104/186) para TPT e em 22,6% (42/186) para TP. Houve 78,7% de positividade (148/188) para dengue. 8,3% (17/206) dos pacientes foram encaminhados para a área crítica devido à classificação de dengue grave. Conclusão: Esses dados proporcionam uma melhoria no reconhecimento e manejo clínico adequado dos casos com sinais de alerta e dengue grave, o que pode contribuir para a redução da carga de morbidade e mortalidade dessa doença no país.

Recent Advances in the Wearable Devices for Monitoring and Management of Heart Failure.

Heart failure (HF) is an acute and degenerative condition with high morbidity and mortality rates. Early diagnosis and treatment of HF can significantly enhance patient outcomes through admission and readmission reduction and improve quality of life. Being a progressive condition, the continuous monitoring of vital signs and symptoms of HF patients to identify any deterioration and to customize treatment regimens can be beneficial to the management of this disease. Recent breakthroughs in wearable technology have revolutionized the landscape of HF management. Despite the potential benefits, the integration of wearable devices into HF management requires careful consideration of technical, clinical, and ethical challenges, such as performance, regulatory requirements and data privacy. This review summarizes the current evidence on the role of wearable devices in heart failure monitoring and management, and discusses the challenges and opportunities in the field.

Latent factors underlying the symptoms of adult-onset myotonic dystrophy type 1 during the clinical course.

BACKGROUND: Myotonic dystrophy type 1 (DM1) is a multisystem genetic disorder that classically presents with symptoms associated with myotonia, early onset cataracts, and muscular weakness, although the presentation and pattern of disease progression is quite varied. Presenting symptoms are well documented among adults with DM1. However, less is known about the co-occurrence of symptoms over time. We aimed to use factor analysis to explore the correlation pattern of signs and symptoms (S/S) that emerged during the clinical course. RESULTS: Clinical records of 228 individuals with adult onset DM1 were abstracted using the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) from a six-site cohort in the United States during an eight-year study period. Factor analysis was used to group the correlated S/S into latent factors. Three factors were identified. Group 1: 'Facial Weakness/Myotonia' includes the two most common S/S, as indicated by its name. Group 2: 'Skeletal Muscle Weakness' includes eight muscular S/S and is more frequently reported by males and those with older age at onset. Group 3: 'Gastrointestinal distress/Sleepiness' includes four non-muscular S/S and hand stiffness. The abstracted medical records reported that over 63% of individuals had S/S from all three groups. Associations of covariates with factor scores were also examined using linear regression. CTG repeat length was significantly positively associated with higher factor scores for all three factors. CONCLUSIONS: This study identified three latent factors of S/S which accumulated during the clinical course of adult onset DM1.

UNVEILING THE LINK BETWEEN PHYSICAL PARAMETERS AND SAFETY IN CARDIAC REHABILITATION: LONGITUDINAL OBSERVATIONAL STUDY: physical parameters and cardiac adverse events.

OBJECTIVE: To identify the associations between cardiorespiratory fitness and quadriceps muscle strength and the occurrence of minor adverse events in a cardiac rehabilitation (CR) program. DESIGN: Prospective cohort study. SETTING: Output of a CR programme for primary or secondary prevention of cardiovascular disease (CVD). PATIENTS: Seventy individuals who were diagnosed with CVD and/or risk factors and 7 who were excluded due to a low adherence rate in exercise sessions (less than 70%), 4 due to errors in oxygen consumption recorded during the cardiopulmonary exercise test (CPET) and 11 because they decided to withdraw from the study. The data of 38 participants were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Quadriceps muscle strength was assessed by an isokinetic dynamometer and by a manual dynamometer. Functional capacity was assessed by the CPET and by a six-minute walk test (6MWT). Participants were monitored by a physiotherapist during 24 exercise sessions to identify and register adverse events. RESULTS: Significant associations were detected between adverse events and quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-2.0(-2.0;0.0), p=0.047), between functional capacity assessed by the CPET (peak torque, B=-0.3(-2.4;0.0), p=0.019), between fatigue and functional capacity assessed by the CPET (VO2max, B=-1.3(-2.9;0.0), p=0.005) and between quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-10.0(-2.7;0.0); p=0.010). CONCLUSIONS: Lower functional capacity and quadriceps muscle strength seem to be associated with a greater incidence of adverse events during exercise sessions.

Emerging innovations in neonatal monitoring: a comprehensive review of progress and potential for non-contact technologies.

Continuous monitoring of high-risk neonates is essential for the timely management of medical conditions. However, the current reliance on wearable or contact sensor technologies for vital sign monitoring often leads to complications including discomfort, skin damage, and infections which can impede medical management, nursing care, and parental bonding. Moreover, the dependence on multiple devices is problematic since they are not interconnected or time-synchronized, use a variety of different wires and probes/sensors, and are designed based on adult specifications. Therefore, there is an urgent unmet need to enable development of wireless, non- or minimal-contact, and non-adhesive technologies capable of integrating multiple signals into a single platform, specifically designed for neonates. This paper summarizes the limitations of existing wearable devices for neonates, discusses advancements in non-contact sensor technologies, and proposes directions for future research and development.

Striatal Cholinergic Interneurons Control Physical Nicotine Withdrawal via Muscarinic Receptor Signaling.

Striatal cholinergic interneurons (ChIs) provide acetylcholine tone to the striatum and govern motor functions. Nicotine withdrawal elicits physical symptoms that dysregulate motor behavior. Here, the role of striatal ChIs in physical nicotine withdrawal is investigated. Mice under RNAi-dependent genetic inhibition of striatal ChIs (ChIGI) by suppressing the sodium channel subunit NaV1.1, lessening action potential generation and activity-dependent acetylcholine release is first generated. ChIGI markedly reduced the somatic signs of nicotine withdrawal without affecting other nicotine-dependent or striatum-associated behaviors. Multielectrode array (MEA) recording revealed that ChIGI reversed ex vivo nicotine-induced alterations in the number of neural population spikes in the dorsal striatum. Notably, the drug repurposing strategy revealed that a clinically-approved antimuscarinic drug, procyclidine, fully mimicked the therapeutic electrophysiological effects of ChIGI. Furthermore, both ChIGI and procyclidine prevented the nicotine withdrawal-induced reduction in striatal dopamine release in vivo. Lastly, therapeutic intervention with procyclidine dose-dependently diminished the physical signs of nicotine withdrawal. The data demonstrated that the striatal ChIs are a critical substrate of physical nicotine withdrawal and that muscarinic antagonism holds therapeutic potential against nicotine withdrawal.

Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures.

BACKGROUND: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers. METHODS: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function. KEY RESULTS: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers. CONCLUSIONS & INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

The dataset of multi-target vital signs monitored by FMCW radar.

The dataset presents the raw data of respiration and heartbeat of two human subjects monitored by 60GHz Frequency-Modulated Continuous Wave (FMCW) radar and the validation data obtained by the electrocardiogram (ECG) front-end. During the radar-based vital signs monitoring, the subjects were simultaneously equipped with the ECG front-end, integrated with an Arduino board, to collect muscle electric signal waveforms, which enabled the estimation of the actual number of respirations and heartbeats of the subjects during the radar monitoring. To assess the impact of radar parameters, as well as the angle and distance between the subjects and the radar, on monitoring accuracy, the dataset classifies the positions of the human subjects within the scene into symmetric and asymmetric cases. Monitoring was conducted using various radar modulation bandwidths across different angles and distances in an open environment where only the human subjects were present. The objective of this dataset is to facilitate the development of a reliable system for monitoring multiple subjects' respiration and heartbeat using a single-view FMCW radar, emphasizing enhancing the radar's ability to distinguish between different targets and improving the accuracy of respiratory and heartbeat rate monitoring.

Male partners' involvement in antenatal care and its associated factors in West-central Ethiopia.

BACKGROUND: Male partner involvement in antenatal care is a key factor that cannot be ignored in the quest for improvement in maternal health and is recommended as an essential intervention to improve maternal and neonatal health outcomes. However, little attention has been given to male partners' involvement in maternity care, particularly in developing countries. OBJECTIVE: This study aimed to assess male partners' involvement in antenatal care and its associated factors among male partners whose wives gave birth within the last one-year in Bichena town, Westcentral, Ethiopia, 2019. METHODS: A community-based cross-sectional study design was conducted from October 1/2018 to June 15/2019, in Bichena town, among 406 male partners. The data was collected by a simple random sampling technique and analyzed using the Statistical Package of the Social Science 23.0 version. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of < 0.05 considered statistically significant. RESULTS: In this study, 53.4% [95% CI: 48.3- 58.1%] of male partners had high involvement in antenatal care. The age group of 20-29 years [AOR = 2.14, 95% CI = 1.04-4.38], having primary, secondary, and diploma and above educational level [AOR = 2.04, 95% CI = 1.02-4.07], [AOR = 3.02, 95% CI = 1.49-6.11] and [AOR = 4.03, 95% CI = 2.06-7.89] respectively, ≤ 10 years marriage length [AOR = 2.92, 95% CI = 1.46-5.87], good knowledge of the services provided in antenatal care [AOR = 2.68, 95%, CI = 1.62-4.42], good awareness of the danger signs of pregnancy [AOR = 1.77, 95 CI = 1.10-2.85], favorable attitude towards antenatal care [AOR = 2.62, 95% CI = 1.64-4.19], travel less than 15 min to reach a nearby health facility [AOR = 3.43, 95% CI = 1.54-7.65] and making decision together to seek care in health facility [AOR = 2.44, 95% CI = 1.19-5.03] were associated with male partners involvement in antenatal care. CONCLUSIONS: Male partners' involvement in antenatal care was encouraging in the study area compared to previous studies done in Ethiopia. We suggest strengthening awareness among male partners about their shared responsibility during pregnancy. Male partners should be invited to attend the antenatal care. Policymakers and healthcare planners should design programs and plans that will encourage male partners' involvement in maternal healthcare services utilization.

Improving Clinical Preparedness: Community Health Nurses and Early Hypoglycemia Prediction in Type 2 Diabetes Using Hybrid Machine Learning Techniques.

OBJECTIVES: The aim of the study was to analyze the data of diabetic patients regarding warning signs of hypoglycemia to predict it at an early stage using various novel machine learning (ML) algorithms. Individual interviews with diabetic patients were conducted over 6 months to acquire information regarding their experience with hypoglycemic episodes. DESIGN: This information included warning signs of hypoglycemia, such as incoherent speech, exhaustion, weakness, and other clinically relevant cases of low blood sugar. Researchers used supervised, unsupervised, and hybrid techniques. In supervised techniques, researchers applied regression, while in hybrid classification ML techniques were used. In a 5-fold cross-validation approach, the prediction performance of seven models was examined using the area under the receiver operating characteristic curve (AUROC). We analyzed the data of 290 diabetic patients with low blood sugar episodes. RESULTS: Our investigation discovered that gradient boosting and neural networks performed better in regression, with accuracies of 0.416 and 0.417, respectively. In classification models, gradient boosting, AdaBoost, and random forest performed better overall, with AUC scores of 0.821, 0.814, and 0.821, individually. Precision values were 0.779, 0.775, and 0.776 for gradient boosting, AdaBoost, and random forest, respectively. CONCLUSION: AdaBoost and Gradient Boosting models, in particular, outperformed all others in predicting the probability of clinically severe hypoglycemia. These techniques enable community health nurses to predict hypoglycemia at an early stage and provide the necessary therapies to patients to prevent complications resulting from hypoglycemia.

Neurodevelopmental predictors of treatment response in schizophrenia and bipolar disorder.

BACKGROUND: Treatment resistance is a major challenge in psychiatric disorders. Early detection of potential future resistance would improve prognosis by reducing the delay to appropriate treatment adjustment and recovery. Here, we sought to determine whether neurodevelopmental markers can predict therapeutic response. METHODS: Healthy controls (N = 236), patients with schizophrenia (N = 280) or bipolar disorder (N = 78) with a known therapeutic outcome, were retrospectively included. Age, sex, education, early developmental abnormalities (obstetric complications, height, weight, and head circumference at birth, hyperactivity, dyslexia, epilepsy, enuresis, encopresis), neurological soft signs (NSS), and ages at first subjective impairment, clinical symptoms, treatment, and hospitalization, were recorded. A supervised algorithm leveraged NSS and age at first clinical signs to classify between resistance and response in schizophrenia. RESULTS: Developmental abnormalities were more frequent in schizophrenia and bipolar disorder than in controls. NSS significantly differed between controls, responsive, and resistant participants with schizophrenia (5.5 ± 3.0, 7.0 ± 4.0, 15.0 ± 6.0 respectively, p = 3 × 10-10) and bipolar disorder (5.5 ± 3.0, 8.3 ± 3.0, 12.5 ± 6.0 respectively, p < 1 × 10-10). In schizophrenia, but not in bipolar disorder, age at first subjective impairment was three years lower, and age at first clinical signs two years lower, in resistant than responsive subjects (p = 2 × 10-4 and p = 9 × 10-3, respectively). Age at first clinical signs and NSS accurately predicted treatment response in schizophrenia (area-under-curve: 77 ± 8%, p = 1 × 10-14). CONCLUSIONS: Neurodevelopmental features such as NSS and age of clinical onset provide a means to identify patients who may require rapid treatment adaptation.

Correlation Between Anxiety, Depression and Hemodynamic Changes in Office-Based Laryngeal Surgery.

OBJECTIVE: To investigate the correlation between anxiety, depression, and hemodynamic changes during office-based laryngeal surgery (OBLS). METHODS: All patients undergoing OBLS between February 2024 until July 2024 were invited to participate in the study. Participants had their vital signs recorded throughout the procedure at a 5-min interval. They also had to fill the Generalized Anxiety Disorder scale-7 (GAD-7) to assess anxiety severity and the Patient Health Questionnaire-9 (PHQ-9) to assess depression severity. Demographic data included age, gender, history of smoking, history of reflux disease, history of cardiovascular diseases, type and duration of procedure. RESULTS: A total of 45 patients were recruited in the study. During OBLS, 35.5% of patients developed hypertension and 28.9% developed tachycardia. There was a significant increase in mean systolic blood pressure (SBP) by 30.16 mmHg (p < 0.001), in mean diastolic blood pressure (DBP) by 31.44 mmHg (p < 0.001), and in mean heart rate (HR) by 14.2 beats per minute (p < 0.001). There was also a significant decrease in the mean O2 saturation by 0.4% (p = 0.001). There was no correlation between anxiety and SBP, DBP, HR, and O2 (r < 0.1). There was also no correlation between depression levels and SBP, DBP, HR, O2 (r < 0.1). CONCLUSION: There was a significant increase in the mean SBP, DP, and HR and a significant decrease in the O2 saturation in patients undergoing OBLS. However, there was no correlation between anxiety, depression and the changes in these vital signs. Future investigations are needed to understand the causes of hemodynamic instability in OBLS. LEVEL OF EVIDENCE: 2 Laryngoscope, 2024.

Validity and Reliability of Wearable Sensors for Continuous Postoperative Vital Signs Monitoring in Patients Recovering from Trauma Surgery.

(1) Background: Wearable sensors support healthcare professionals in clinical decision-making by measuring vital parameters such as heart rate (HR), respiration rate (RR), and blood oxygenation saturation (SpO2). This study assessed the validity and reliability of two types of wearable sensors, based on electrocardiogram or photoplethysmography, compared with continuous monitoring of patients recovering from trauma surgery at the postanesthesia care unit. (2) Methods: In a prospective observational study, HR, RR, SpO2, and temperature of patients were simultaneously recorded with the VitalPatch and Radius PPG and compared with reference monitoring. Outcome measures were formulated as correlation coefficient for validity and mean difference with 95% limits of agreement for reliability for four random data pairs and 30-min pairs per vital sign per patient. (3) Results: Included were 60 patients. Correlation coefficients for VitalPatch were 0.57 to 0.85 for HR and 0.08 to 0.16 for RR, and for Radius PPG, correlation coefficients were 0.60 to 0.83 for HR, 0.20 to 0.12 for RR, and 0.57 to 0.61 for SpO2. Both sensors presented mean differences within the cutoff values of acceptable difference. (4) Conclusions: Moderate to strong correlations for HR and SpO2 were demonstrated. Although mean differences were within acceptable cutoff values for all vital signs, only limits of agreement for HR measured by electrocardiography were considered clinically acceptable.

Exploring perceptions and attitudes towards pregnancy danger signs among childbearing age women in the Al-Baha Region, Saudi Arabia.

The World Health Organization (WHO) estimates that complications related to pregnancy and childbirth affect approximately 300 million women in developing countries, causing both acute and chronic illnesses. Direct obstetric complications such as hemorrhage, sepsis, hypertensive disorders during pregnancy, obstructed and prolonged labor, and unsafe abortion account for approximately 75% of maternal deaths. This study aimed to assess the perceptions and attitudes towards pregnancy danger signs among women of childbearing age in the Al-Baha Region, Saudi Arabia. A descriptive cross-sectional hospital-based study was conducted using simple random sampling to select 446 pregnant women. After outlining the study's goal and ensuring confidentiality, data were gathered through a pre-tested, well-designed questionnaire. Data were analyzed using Excel and SPSS version 28. The assessment of the study participants about perceptions of pregnancy danger signs revealed that many were aware of signs such as bleeding, abdominal pain, and lack of fetal movement, indicating a comprehensive understanding of potential pregnancy complications. The study participants exhibited good knowledge and relatively positive attitudes towards pregnancy danger signs. However, a significant fraction showed negative attitudes and insufficient knowledge, suggesting room for improvement in maternal health literacy. The study also found a significant relationship between sociodemographic characteristics and knowledge.Most participants had good knowledge and perceptions about pregnancy danger signs, and their attitudes were relatively positive. However, there is a need to increase awareness and improve attitudes towards pregnancy danger signs among women in the Al-Baha Region.

L'Organisation mondiale de la santé (OMS) estime que les complications liées à la grossesse et à l'accouchement touchent environ 300 millions de femmes dans les pays en développement, provoquant des maladies aiguës et chroniques. Les complications obstétricales directes telles que l'hémorragie, la septicémie, les troubles hypertensifs pendant la grossesse, le travail dystocique et prolongé et l'avortement à risque représentent environ 75 % des décès maternels. Cette étude visait à évaluer les perceptions et les attitudes à l'égard des signes de danger de grossesse chez les femmes en âge de procréer dans la région d'Al-Baha, en Arabie Saoudite. Une étude descriptive transversale en milieu hospitalier a été menée en utilisant un échantillonnage aléatoire simple pour sélectionner 446 femmes enceintes. Après avoir défini l'objectif de l'étude et assuré la confidentialité, les données ont été recueillies au moyen d'un questionnaire pré-testé et bien conçu. Les données ont été analysées à l'aide d'Excel et de SPSS version 28. L'évaluation des participantes à l'étude sur la perception des signes de danger de grossesse a révélé que beaucoup d'entre elles étaient conscientes de signes tels que des saignements, des douleurs abdominales et un manque de mouvement du fœtus, ce qui indique une compréhension globale des complications potentielles de la grossesse. . Les participantes à l'étude ont fait preuve de bonnes connaissances et d'attitudes relativement positives à l'égard des signes de danger de grossesse. Cependant, une fraction significative a montré des attitudes négatives et des connaissances insuffisantes, ce qui suggère qu'il y a place à l'amélioration des connaissances en matière de santé maternelle. L'étude a également révélé une relation significative entre les caractéristiques sociodémographiques et les connaissances. La plupart des participantes avaient de bonnes connaissances et perceptions des signes de danger de la grossesse, et leurs attitudes étaient relativement positives. Cependant, il est nécessaire de sensibiliser davantage les femmes de la région d'Al-Baha à l'égard des signes de danger de grossesse et d'améliorer leurs attitudes à l'égard des signes de danger de grossesse.

Inter-rater Reliability of the Reflux Sign Assessment-10 (RSA-10).

OBJECTIVE: To evaluate the inter-rater reliability and internal consistency of the Reflux Sign Assessment-10 (RSA-10) among otolaryngologists and speech therapists with various experiences. METHODS: Six experts (2 otolaryngologists, 2 speech-therapists, and 2 speech-therapist students) rated 300 clinical images of oral, laryngeal, and pharyngeal signs from patients with laryngopharyngeal reflux disease diagnosis at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Inter-rater reliability and internal consistency were evaluated with Intraclass Correlation (ICC) and Cronbach-α. The severity of scores was compared between judges. The intra-rater (test-retest) reliability was evaluated with the Spearman correlation coefficient. RESULTS: The pictures of 40 patients were included. There were 18 females and 22 males. The mean age was 52.6 ± 13.9 years. The Cronbach-α was 0.854, which indicates a high internal consistency between judges. The overall ICC was 0.787 (95% CI: 0.715-0.845; P = 0.001). The ICC varied among judges with the highest value for students (ICC = 0.960) and SLP seniors versus students (ICC = 0.805). The severity of RSA-10 rating scores was influenced by the number of reflux patients seen (rs =-0.941; P = 0.001) and the number of fiberscope examinations performed (rs =-0.812; P = 0.049). The RSA-10 was more severely scored by speech therapists with the least experience compared to otolaryngologists with the most experience in fiberscope/reflux patient assessment. CONCLUSION: The RSA-10 demonstrated adequate global ICC and internal consistency among otolaryngologists and speech therapists with various degrees of experience. The assessment of RSA was influenced by the fibroscopy experience, and the number of reflux patients seen.

A retrospective evaluation of SwePEWS use in paediatric patients with COVID-19 and RSV infection.

AIM: As early detection of deterioration is a challenge in children, the Swedish Paediatric Early Warning Score (SwePEWS) is used to systematically assess paediatric patients' clinical state. Here, we aimed to evaluate the use and predictive ability of SwePEWS. METHODS: Electronic health records of paediatric patients admitted due to respiratory syncytial virus infection or COVID-19 were reviewed retrospectively. Registered vital signs were compared to the assigned SwePEWS score and monitored vital sign values to identify discrepancies. Additionally, SwePEWS's ability to predict transfer to the paediatric intensive care unit (PICU) was assessed. RESULTS: Among 1374 SwePEWS assessments, one-third were either incomplete or contained errors. Incomplete SwePEWS assessments were more frequent during night-time. Single measurements of oxygen saturation presented lower values compared to average saturation from continuous monitoring. SwePEWS's ability to predict PICU transfer was low. CONCLUSION: There was a surprisingly high occurrence of underestimated SwePEWS scores. This study provides new insights into pitfalls when developing and implementing paediatric early warning scores for systematic re-evaluations in paediatric patients.

Clinical Findings, Laboratory Results, Electrocardiography and Echocardiography Findings in Dairy Buffaloes with Theileriosis.

PURPOSE: Tropical theileriosis is a tick-borne haemoprotozoan disease, and cardiac function assessment in buffaloes with theileriosis was poorly documented. METHODS: The Present study was carried out from April 2022 to December 2022. Theileriosis was confirmed by microscopic examination of stained blood smears and lymphnode smears further confirmed by PCR assay. Electrocardiography was performed by using the base apex lead system, and echocardiography was performed by using the right parasternal view. RESULTS: The incidence of theileriosis was 16.25% by examination of stained blood smears, and 30.42% by PCR examination in 240 buffaloes. Repeatedly noted clinical signs were the absence of rumination, anorexia, loss of milk yield, depressed demeanour, emaciation, hyperthermia, lymphadenopathy, tick infestation, tachycardia, cardiac arrhythmia, and increased intensity of heartbeat. Haematological findings disclosed decreased haemoglobin, packed cell volume, total erythrocyte count, and neutrophils; increased eosinophils and monocytes. Serum biochemical findings revealed decreased albumin, albumin/globulin ratio, glucose, calcium, phosphorous, sodium, potassium, and chloride; increased globulin, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, cholesterol, lactate dehydrogenase, gamma-glutamyl transferase, and creatine kinase myocardial band isoenzymes. Electrocardiography explorations were sinus tachycardia, broad T wave, and sinus arrhythmia. Echocardiography examination showed ventricular wall thickening, cardiac chamber dilatation, valvular defects/valvular regurgitation, and pericarditis/cardiac tamponade. CONCLUSION: The present research proposes the changes in the electrocardiography and echocardiography findings in buffaloes with theileriosis, which are essential in clinics to identify the secondary complications during theileriosis and formulate therapeutics.

Motif discovery in hospital ward vital signs observation networks.

Vital signs observations are regular measurements used by healthcare staff to track a patient's overall health status on hospital wards. We look at the potential in re-purposing aggregated and anonymised hospital data sources surrounding vital signs recording to provide new insights into how care is managed and delivered on wards. In this paper, we conduct a retrospective longitudinal observational study of 770,720 individual vital signs recordings across 20 hospital wards in South Wales (UK) and present a network modelling framework to explore and extract behavioural patterns via analysis of the resulting network structures at a global and local level. Self-loop edges, dyad, triad, and tetrad subgraphs were extracted and evaluated against a null model to determine individual statistical significance, and then combined into ward-level feature vectors to provide the means for determining notable behaviours across wards. Modelling data as a static network, by aggregating all vital sign observation data points, resulted in high uniformity but with the loss of important information which was better captured when modelling the static-temporal network, highlighting time's crucial role as a network element. Wards mostly followed expected patterns, with chains or stand-alone supplementary observations by clinical staff. However, observation sequences that deviate from this are revealed in five identified motif subgraphs and 6 anti-motif subgraphs. External ward characteristics also showed minimal impact on the relative abundance of subgraphs, indicating a 'superfamily' phenomena that has been similarly seen in complex networks in other domains. Overall, the results show that network modelling effectively captured and exposed behaviours within vital signs observation data, and demonstrated uniformity across hospital wards in managing this practice.

Derived Amharic alphabet sign language recognition using machine learning methods.

Hearing-impaired people use sign language as a means of communication with those with no hearing disability. It is therefore difficult to communicate with hearing impaired people without the expertise of a signer or knowledge of sign language. As a result, technologies that understands sign language are required to bridge the communication gap between those that have hearing impairments and those that dont. Ethiopian Amharic alphabets sign language (EAMASL) is different from other countries sign languages because Amharic Language is spoken in Ethiopia and has a number of complex alphabets. Presently in Ethiopia, just a few studies on AMASL have been conducted. Previous works, on the other hand, only worked on basic and a few derived Amharic alphabet signs. To solve this challenge, in this paper, we propose Machine Learning techniques such as Support Vector Machine (SVM) with Convolutional Neural Network (CNN), Histogram of Oriented Gradients (HOG), and their hybrid features to recognize the remaining derived Amharic alphabet signs. Because CNN is good for rotation and translation of signs, and HOG works well for low quality data under strong illumination variation and a small quantity of training data, the two have been combined for feature extraction. CNN (Softmax) was utilized as a classifier for normalized hybrid features in addition to SVM. SVM model using CNN, HOG, normalized, and non-normalized hybrid feature vectors achieved an accuracy of 89.02%, 95.42%, 97.40%, and 93.61% using 10-fold cross validation, respectively. With the normalized hybrid features, the other classifier, CNN (sofmax), produced a 93.55% accuracy.