ABSTRACT
BACKGROUND: Delirium, which is prevalent in critical care settings, remains underexplored in acute coronary syndrome (ACS) patients in the cardiac intensive care unit (CICU). AIMS: To investigate the prevalence and clinical significance of delirium in patients with ACS admitted to the CICU. STUDY DESIGN: A prospective study (n = 106, mean age 74.2 ± 5.7 years) assessed delirium using the confusion assessment method-intensive care unit (CAM-ICU) tool in 21.7% of ACS patients during their CICU stay. Baseline characteristics, geriatric conditions and clinical procedures were compared between delirious and nondelirious patients. The outcomes included in-hospital mortality, 30-day and 6-month mortality, acute adverse events and length of CICU stay and hospital stay (LOS). RESULTS: Delirious patients who were older and had a higher incidence of coronary artery disease underwent more complex procedures (e.g., pacemaker placement). Multivariate analysis identified central venous catheter insertion, urinary catheterization and benzodiazepine use as independent predictors of delirium. Delirium was correlated with prolonged LOS (p < .001) and increased in-hospital, 30-day and 6-month mortality (p < .001). CONCLUSIONS: Delirium in ACS patients in the CICU extends hospitalization and increases in-hospital, 30-day and 6-month mortality. Early recognition and targeted interventions are crucial for mitigating adverse outcomes in this high-risk population. RELEVANCE TO CLINICAL PRACTICE: This study highlights the critical impact of delirium on outcomes in hospitalized patients with ACS in the CICU. Delirium, often overlooked in ACS management, significantly extends hospitalization and increases mortality rates. Nurses and physicians must be vigilant in identifying delirium early, particularly in older ACS patients or those with comorbidities. Recognizing independent predictors such as catheterization and benzodiazepine use allows for targeted interventions to reduce delirium incidence. Integrating routine delirium assessments and preventive strategies into ACS management protocols can improve outcomes, optimize resource utilization and enhance overall patient care in the CICU setting.
ABSTRACT
SUMMARY: In modern microscopy, the field of view is often increased by obtaining an image mosaic, where multiple sub-images are taken side-by-side and combined post-acquisition. Mosaic imaging often leads to long imaging times that can increase the probability of sample deformation during the acquisition due to, e.g. changes in the environment, damage caused by the radiation used to probe the sample or biologically induced deterioration. Here we propose a technique, based on local phase correlation, to detect the deformations and construct an artifact-free image mosaic from deformed sub-images. The implementation of the method supports distributed computing and can be used to generate teravoxel-size mosaics. We demonstrate its capabilities by assembling a 5.6 teravoxel tomographic image mosaic of microvasculature in whole mouse brain. The method is compared to existing rigid stitching implementations designed for very large datasets, and observed to create artifact-free image mosaics in comparable runtime with the same hardware resources. AVAILABILITY AND IMPLEMENTATION: The stitching software and C++/Python source code are available at GitHub (https://github.com/arttumiettinen/pi2) along with an example dataset and user instructions.
Subject(s)
Algorithms , Software , Animals , Artifacts , Mice , Microscopy , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Patients suffering from Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) are found with no obstructive coronary artery disease on coronary arteriography. The Aim of this interesting case report is to present a patient with acute chest pain, temporal ST-segment elevation and MINOCA. CASE REPORT: A case of a young woman who presented with acute chest pain suggestive of angina, with temporal ST-segment elevation, accidentally recorded and not rising of myocardial necrosis biomarkers in blood tests is described. A coronary angiography via right radial artery was performed and revealed normal coronary arteries. She was defined suffering from Myocardial infarction with Non-Obstructive Coronary Arteries (MINOCA) which occurs in 1-14% of Myocardial Infarction cases. Treatment with nitrates calcium, calcium channel blockers and antiplatelet in the basis of ACS is highly indicated. CONCLUSION: Coronary artery spasm is not a rare cause of ACS. Coronary angiography is indicated in all cases to exclude severe coronary heart disease.
