RESUMEN
BACKGROUND: Post-COVID conditions encompass a range of long-term symptoms after SARS-CoV-2 infection. The potential clinical and economic burden in the United States is unclear. We evaluated diagnoses, medications, healthcare use, and medical costs before and after acute COVID-19 illness in US patients at high risk of severe COVID-19. METHODS: Eligible adults were diagnosed with COVID-19 from April 1 to May 31, 2020, had ≥ 1 condition placing them at risk of severe COVID-19, and were enrolled in Optum's de-identified Clinformatics® Data Mart Database for ≥ 12 months before and ≥ 13 months after COVID-19 diagnosis. Percentages of diagnoses, medications, resource use, and costs were calculated during baseline (12 months preceding diagnosis) and the post-acute phase (12 months after the 30-day acute phase of COVID-19). Data were stratified by age and COVID-19 severity. RESULTS: The cohort included 19,558 patients (aged 18-64 y, n = 9381; aged ≥ 65 y, n = 10,177). Compared with baseline, patients during the post-acute phase had increased percentages of blood disorders (16.3%), nervous system disorders (11.1%), and mental and behavioral disorders (7.7%), along with increases in related prescriptions. Overall, there were substantial increases in inpatient and outpatient healthcare utilization, along with a 23.0% increase in medical costs. Changes were greatest among older patients and those admitted to the intensive care unit for acute COVID-19 but were also observed in younger patients and those who did not require COVID-19 hospitalization. CONCLUSIONS: There is a significant clinical and economic burden of post-COVID conditions among US individuals at high risk for severe COVID-19.
Asunto(s)
COVID-19 , Adulto , Humanos , Estados Unidos/epidemiología , COVID-19/epidemiología , Síndrome Post Agudo de COVID-19 , Estrés Financiero , Enfermedad Aguda , Prueba de COVID-19 , SARS-CoV-2 , Estudios RetrospectivosRESUMEN
Recently, there has been an increasing fascination for employing radio frequency (RF) energy harvesting techniques to energize various low-power devices by harnessing the ambient RF energy in the surroundings. This work outlines a novel advancement in RF energy harvesting (RFEH) technology, intending to power portable gadgets with minimal operating power demands. A high-gain receiver microstrip patch antenna was designed and tested to capture ambient RF residue, operating at 2450 MHz. Similarly, a two-stage Dickson voltage booster was developed and employed with the RFEH to transform the received RF signals into useful DC voltage signals. Additionally, an LC series circuit was utilized to ensure impedance matching between the antenna and rectifier, facilitating the extraction of maximum power from the developed prototype. The findings indicate that the developed rectifier attained a peak power conversion efficiency (PCE) of 64% when operating at an input power level of 0 dBm. During experimentation, the voltage booster demonstrated its capability to rectify a minimum input AC signal of only 50 mV, yielding a corresponding 180 mV output DC signal. Moreover, the maximum power of 4.60 µW was achieved when subjected to an input AC signal of 1500 mV with a load resistance of 470 kΩ. Finally, the devised RFEH was also tested in an open environment, receiving signals from Wi-Fi modems positioned at varying distances for evaluation.
RESUMEN
Staphylococcus aureus is one of the major pathogens responsible for causing food poisoning worldwide. The emergence of antibiotic resistance in this bacterium is influenced by various factors. Among them, bacterial acquired defense systems described as clustered regularly interspaced short palindromic repeats (CRISPR)-cas system might be involved in antibiotic resistance development in bacteria. The current study was designed to assess the prevalence of S. aureus and its antibiotic resistance profile and identify the relationship of the CRISPR-cas system with antimicrobial resistance, followed by phylogenetic analysis. Total samples (n = 188) of poultry meat were collected from the poultry bird market of Lahore, Punjab, Pakistan. We used both phenotypic (antibiotic disc diffusion) and genotypic methods (PCR) to identify multi-drug resistant (MDR) strains of S. aureus. Additionally, the role of the CRISPR-Cas system in the isolated MDR S. aureus was also assessed. In addition, real-time quantitative PCR (qRT-PCR) was used to evaluate the association of the CRISPR-cas system with antimicrobial resistance. All of the S. aureus isolates showed 100% resistance against erythromycin, 97.5% were resistant to tetracycline, and 75% were resistant to methicillin. Eleven isolates were MDR in the current study. The CRISPR system was found in all MDR isolates, and fifteen spacers were identified within the CRISPR locus. Furthermore, MDR S. aureus isolates and the standard strain showed higher expression levels of CRISPR-associated genes. The correlation of said system with MDR isolates points to foreign gene acquisition by horizontal transfer. Current knowledge could be utilized to tackle antibiotic-resistant bacteria, mainly S. aureus.
Asunto(s)
Infecciones Estafilocócicas , Staphylococcus aureus , Humanos , Animales , Pakistán , Staphylococcus aureus/genética , Sistemas CRISPR-Cas/genética , Filogenia , Aves de Corral , Antibacterianos/farmacología , Farmacorresistencia Microbiana/genéticaRESUMEN
The power consumption of portable gadgets, implantable medical devices (IMDs) and wireless sensor nodes (WSNs) has reduced significantly with the ongoing progression in low-power electronics and the swift advancement in nano and microfabrication. Energy harvesting techniques that extract and convert ambient energy into electrical power have been favored to operate such low-power devices as an alternative to batteries. Due to the expanded availability of radio frequency (RF) energy residue in the surroundings, radio frequency energy harvesters (RFEHs) for low-power devices have garnered notable attention in recent times. This work establishes a review study of RFEHs developed for the utilization of low-power devices. From the modest single band to the complex multiband circuitry, the work reviews state of the art of required circuitry for RFEH that contains a receiving antenna, impedance matching circuit, and an AC-DC rectifier. Furthermore, the advantages and disadvantages associated with various circuit architectures are comprehensively discussed. Moreover, the reported receiving antenna, impedance matching circuit, and an AC-DC rectifier are also compared to draw conclusions towards their implementations in RFEHs for sensors and biomedical devices applications.
Asunto(s)
Suministros de Energía Eléctrica , Ondas de Radio , Tecnología Inalámbrica , Diseño de Equipo , Tecnología Inalámbrica/instrumentaciónRESUMEN
BACKGROUND: Reconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction process. A procedure that has gained interest of the patients is reconstruction of breast using the autologous form. Main objective of this study is to determine the outcomes of modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction. METHODOLOGY: This is a retrospective case series which was conducted at the Department of Plastic Surgery, SIMS/Services Hospital, Lahore, from January 2020 till December 2022. 184 patients age 25-60 years and Females with a history of mastectomy, who had to undergo creation of breast shape using a tissue flap from another part of the body at the site of breast following mastectomy were included. All patients were subjected to standard procedure of breast reconstruction with latissimus dorsi flap using modified fleur-de-lis technique and postoperatively weekly assessment in the first month and then monthly until 3 months was carried out and outcome of the study was analysed. RESULTS: The mean age and VAS score of the patients was 49.7 ± 9.17 and 6 ± 2.21, respectively. 57.1 % patients have DCIS, benign in 38 % patients and other tumours were present in 4.9 % patients. Immediate versus delayed reconstruction was done in 63.6 % versus 36.4 % patients respectively. Good aesthetic outcome was achieved in 80.3 % patients CONCLUSION: Modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction yielded a good aesthetic outcome in the majority of the patients.
Asunto(s)
Neoplasias de la Mama , Mamoplastia , Mastectomía , Colgajo Miocutáneo , Músculos Superficiales de la Espalda , Humanos , Mamoplastia/métodos , Femenino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Músculos Superficiales de la Espalda/trasplante , Mastectomía/métodos , Neoplasias de la Mama/cirugía , Resultado del Tratamiento , Colgajo Miocutáneo/trasplanteRESUMEN
OBJECTIVE: To create a data-driven definition of post-COVID conditions (PCC) by directly measure changes in symptomatology before and after a first COVID episode. MATERIALS AND METHODS: Retrospective cohort study using Optum® de-identified Electronic Health Record (EHR) dataset from the United States of persons of any age April 2020-September 2021. For each person with COVID (ICD-10-CM U07.1 "COVID-19" or positive test result), we selected up to 3 comparators. The final COVID symptom score was computed as the sum of new diagnoses weighted by each diagnosis' ratio of incidence in COVID group relative to comparator group. For the subset of COVID cases diagnosed in September 2021, we compared the incidence of PCC using our data-driven definition with ICD-10-CM code U09.9 "Post-COVID Conditions", first available in the US October 2021. RESULTS: The final cohort contained 588,611 people with COVID, with mean age of 48 years and 38% male. Our definition identified 20% of persons developed PCC in follow-up. PCC incidence increased with age: (7.8% of persons aged 0-17, 17.3% aged 18-64, and 33.3% aged 65+) and did not change over time (20.0% among persons diagnosed with COVID in 2020 versus 20.3% in 2021). For cases diagnosed in September 2021, our definition identified 19.0% with PCC in follow-up as compared to 2.9% with U09.9 code in follow-up. CONCLUSION: Symptom and U09.9 code-based definitions alone captured different populations. Maximal capture may consider a combined approach, particularly before the availability and routine utilization of specific ICD-10 codes and with the lack consensus-based definitions on the syndrome.
Asunto(s)
COVID-19 , Humanos , Masculino , Estados Unidos/epidemiología , Persona de Mediana Edad , Femenino , COVID-19/epidemiología , Registros Electrónicos de Salud , Síndrome Post Agudo de COVID-19 , Estudios Retrospectivos , Clasificación Internacional de EnfermedadesRESUMEN
INTRODUCTION: Although real-world studies demonstrate that those prescribed nirmatrelvir/ritonavir (and particularly within 5 days of symptom onset) are less likely to experience severe COVID-19 outcomes, prior studies show that only a small fraction of patients with COVID-19 who are eligible for nirmatrelvir/ritonavir receive a prescription. Studies calculating the proportion of nirmatrelvir/ritonavir prescriptions filled and identifying individual- and pharmacy-level correlates of filling nirmatrelvir/ritonavir are lacking. METHODS: This retrospective cohort study included individuals aged ≥ 12 years with a nirmatrelvir/ritonavir prescription ordered at a large national retail pharmacy (December 22, 2021-August 12, 2023). Those taking contraindicated medications were excluded. For those with only one nirmatrelvir/ritonavir prescription ordered, the outcome was whether the prescription was filled (yes/no). In a subanalysis of these individuals, the outcome was whether the prescription was filled within 5 days of symptom onset (yes/no). For those with multiple prescriptions ordered, the outcome was whether > 1 (vs. 0 or 1) prescriptions were filled. A log-binomial regression with generalized estimating equations was used to identify individual (clinical and demographic) and pharmacy-level (percentage of trade area that is non-Hispanic white, urbanicity, US Census region, and tract-level area deprivation index) correlates. RESULTS: A total of 2,103,570 unique nirmatrelvir/ritonavir prescriptions were ordered for 1,985,990 individuals. Among the 95% of individuals prescribed only one nirmatrelvir/ritonavir course, 88% filled their prescription. Among those with > 1 prescription ordered, 77% (82,993/108,411) filled one and 13% (13,662/108,411) filled > 1. Patients ≥ 50 years of age and those with documented high-risk conditions were slightly more likely to fill prescriptions, regardless of whether one or multiple courses were ordered. Individuals with cancer, asthma, or taking corticosteroids or immunosuppressive medications were more likely to fill multiple prescriptions. CONCLUSIONS: Most patients filled their nirmatrelvir/ritonavir prescriptions. Interventions to improve uptake should focus on increasing patient and provider awareness, reducing nirmatrelvir/ritonavir prescribing disparities, and ensuring treatment initiation within 5 days.
RESUMEN
PURPOSE: To report a case of primary vitreoretinal lymphoma masquerading as infectious retinitis that was diagnosed via a retinal biopsy. OBSERVATIONS: A 72-year-old female patient was referred to our ophthalmology clinic for evaluation of retinitis and vasculitis in the right eye (OD). On examination, best-corrected visual acuities (BCVAs) were hand motions OD and 20/20 in the left eye (OS). Fundus examination revealed optic disc edema and diffuse retinal whitening superior to the superotemporal arcade OD. Given the high suspicion of infectious retinitis, the patient was treated with intravitreal foscarnet, systemic acyclovir, and oral prednisone and underwent a comprehensive uveitis workup, which was unremarkable for viral and autoimmune entities. Given the patient's history of diffuse large B cell lymphoma with cutaneous involvement, vitreoretinal lymphoma was suspected, prompting pars plana vitrectomy with a retinal biopsy. Biopsy and immunohistochemistry results were consistent with B-cell lymphoma, and the patient was treated with high-dose methotrexate and rituximab. At 5-month follow-up, BCVAs were hand motions OD and 20/30 OS, and fundus examination demonstrated disc edema with resolution of retinal whitening OD. She responded well to the treatment with regression of vitreoretinal lymphoma on examination and is being monitored closely for lymphoma recurrence. CONCLUSIONS AND IMPORTANCE: Although uncommon, patients with vitreoretinal lymphoma may masquerade as infectious retinitis, and vitreoretinal lymphoma should be suspected when refractory to antiviral therapy and in the setting of a negative workup for viral etiologies. Vitrectomy with retinal biopsy may be considered to aid the diagnosis of vitreoretinal lymphoma although careful consideration of the risks and benefits is warranted.
RESUMEN
BACKGROUND: This study was carried out to introduce a new technique of excision arteriotomy and to compare it with standard excision arteriotomy in terms of achieving desired size, shape and margins with minimal technical problems. METHODS: This was a comparative study carried out at the Vascular Surgery Unit of Combined Military Hospital Peshawar between January and September 2022. A total of 150 patients of chronic renal failure undergoing Arteriovenous access fulfilling the inclusion criteria were enrolled in our study. The patients were randomized into two groups, 75 in each group: Group A consisted of patients who underwent Conventional excision arteriotomy and Group B underwent Double Stab excision Arteriotomy. The endpoint of the study was to achieve an appropriate arteriotomy of the desired size and shape by having regular margins without intimal dissection during its formation or otherwise inappropriate arteriotomy if any of the criteria is not met. RESULTS: Among the total 150 patients included in our study, Ages ranged between 30-60 years and a mean age of 52.5 years. There were 82 (54.66%) males and 68 (45.33%) females with a male-to-female ratio of 1.2:1. In group A (Conventional Excision arteriotomy) there were 30 (40%) inappropriate arteriotomies and 45 (60%) appropriate arteriotomies. Among the total 30(40%) inappropriate arteriotomies in group A, larger than desired size arteriotomies were 10 cases (33.33%) followed by smaller than desired size arteriotomies; 6 (20%), irregular margins 9 (30%), intimal dissection 3(10%) & lateral tear 2 (6.66%) respectively. In group B of double stab excision arteriotomies, appropriate arteriotomies were achieved in 69 (92%) while the rest had inappropriate arteriotomies in 6 (8%). Among the total 6 (8%) inappropriate arteriotomies in group B, larger than desired size arteriotomies were 2 (33.33%), smaller than desired size arteriotomy; 1 (16.66%), irregular margins 1 (16.66%), intimal dissection;2 (33.33%) & no lateral tear respectively. CONCLUSIONS: This study concluded that the Double stab excision arteriotomy technique is superior to the conventional excision arteriotomy technique. The advantages of our technique are; its reliability with a short learning curve and can be performed precisely and safely.
Asunto(s)
Procedimientos Quirúrgicos Vasculares , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Reproducibilidad de los Resultados , Procedimientos Quirúrgicos Vasculares/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Injection sclerotherapy administration is known to cause a decreased recurrence of varicose vein disease. This research aimed to investigate the recurrence of varicose vein disease after giving booster doses of injection sclerotherapy. The booster doses were given at 3rd and 6th months. METHODS: One hundred and fifty patients participated and all patient's included ages 30-70 in the category of 'low risk' patients. The patients were both males and females. Patients participating in the study were counselled appropriately and written consent was taken from them. Moreover, the patients selected were volunteers and agreed to be part of the study. Patients who were above 70 years of age, those who were at a high-risk due to some co-morbidities (high-risk patients), patients not willing to be part of the study, those allergic to drugs being used including sclerosant and people with any known psychiatric illness or cardiac arrhythmias, deep venous thrombosis patients, patients having arteriovenous malformation/venous ulcers were all excluded. If the patient was pregnant, the gynaecology team was taken on board and the procedure was carried out. Every procedure was carried out under the direct supervision of the supervisor. Booster dose sessions of Foam Sclerotherapy were held at 3rd and 6th months of the study time. Their effectiveness was observed and documentation was carried out. RESULTS: Since it was a procedure that could be done in the OPD, there was no need for specialized anaesthesia care. It is of significant notice that when a patient of varicose veins was given a booster intravenous sclerosant injection at 3rd and 6th month of treatment, chances of recurrence decreased to 50%.