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1.
Acta Neurol Belg ; 124(2): 407-417, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38457005

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory, immune-mediated disease affecting the central nervous system. Natalizumab, an FDA-approved monoclonal antibody for MS, has been explored for its off-label extended interval dosing (EID), suggesting a potential reduction in the risk of progressive multifocal leukoencephalopathy (PML) compared to standard interval dosing (SID). Our objective was to assess the efficacy and safety of EID in comparison to SID for natalizumab treatment in patients with MS. METHODS: We searched PubMed, Embase, WOS, Scopus, Ovid, Science Direct, Clinical trials.gov, and Cochrane Library. Our assessed outcomes were clinical relapses, MRI activity, change in expanded disability status scale [EDSS], and the risk of PML. The EID group was defined as 5 to 8 weeks [EID (Q5-8W)]. The analysis was conducted using RevMan ver. 5.4. The effect estimates were presented as a risk ratio [RR] or mean difference with 95% confidence intervals [CI] using SID group as the reference for comparisons. RESULTS: Fourteen studies met our inclusion criteria: 2 RCTs, 1 switched single-arm trial, and 12 observational studies. No significant differences were found in all efficacy outcomes of interest. Risk of clinical relapses [RR = 0.90, (95%CI 0.80, 1.02)], risk of new or newly enlarging T2 hyperintense MRI lesions [RR = 0.78, (95%CI 0.59, 1.04)], risk gadolinium enhancing lesions [RR = 1.30, (95%CI 0.98, 1.72)], change in EDSS [MD = 0.09 (95%CI - 0.57, 0.76)], risk of PML [RR = 1.09, 95%CI (0.24, 4.94)]. CONCLUSION: In summary, our meta-analysis indicates that natalizumab maintains its effectiveness under extended interval dosing [up to 8 weeks], presenting comparable risks for clinical relapses, MRI lesions, EDSS, and PML. Caution is advised given study limitations and heterogeneity. Robust conclusions necessitate well-designed high-quality prospective studies.


Assuntos
Leucoencefalopatia Multifocal Progressiva , Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Humanos , Natalizumab/efeitos adversos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico , Estudos Prospectivos , Anticorpos Monoclonais/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Recidiva , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Fatores Imunológicos/efeitos adversos , Estudos Observacionais como Assunto
2.
Sci Rep ; 14(1): 2020, 2024 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-38263441

RESUMO

Deep neural networks (DNNs) have demonstrated higher performance results when compared to traditional approaches for implementing robust myoelectric control (MEC) systems. However, the delay induced by optimising a MEC remains a concern for real-time applications. As a result, an optimised DNN architecture based on fine-tuned hyperparameters is required. This study investigates the optimal configuration of convolutional neural network (CNN)-based MEC by proposing an effective data segmentation technique and a generalised set of hyperparameters. Firstly, two segmentation strategies (disjoint and overlap) and various segment and overlap sizes were studied to optimise segmentation parameters. Secondly, to address the challenge of optimising the hyperparameters of a DNN-based MEC system, the problem has been abstracted as an optimisation problem, and Bayesian optimisation has been used to solve it. From 20 healthy people, ten surface electromyography (sEMG) grasping movements abstracted from daily life were chosen as the target gesture set. With an ideal segment size of 200 ms and an overlap size of 80%, the results show that the overlap segmentation technique outperforms the disjoint segmentation technique (p-value < 0.05). In comparison to manual (12.76 ± 4.66), grid (0.10 ± 0.03), and random (0.12 ± 0.05) search hyperparameters optimisation strategies, the proposed optimisation technique resulted in a mean classification error rate (CER) of 0.08 ± 0.03 across all subjects. In addition, a generalised CNN architecture with an optimal set of hyperparameters is proposed. When tested separately on all individuals, the single generalised CNN architecture produced an overall CER of 0.09 ± 0.03. This study's significance lies in its contribution to the field of EMG signal processing by demonstrating the superiority of the overlap segmentation technique, optimizing CNN hyperparameters through Bayesian optimization, and offering practical insights for improving prosthetic control and human-computer interfaces.


Assuntos
Sistemas Computacionais , Gestos , Humanos , Teorema de Bayes , Eletromiografia , Redes Neurais de Computação
3.
Curr Org Synth ; 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38174438

RESUMO

A novel series of chromen-3-yl-pyridine moieties were synthesized. IR, NMR, and MS spectroscopy were used to confirm the structure of these novel compounds and study antitumor activity of these compounds. The structure-activity relationship investigation demonstrated that 2,4-diamino-5-(3- methoxyphenyl)-7-(2-oxo-2H-chromen-3-yl)-1,8-naphthyridine-3-carbonitrile (16), naphthyridine-3- carbonitrile derivatives 17, 18 and pyrido[2,3-d]pyrimidine derivative 12 were found to be more effective, while compounds 5a,b, 9c, 11, 13 and 14 showed moderate activity for antitumor activities. OBJECTIVES: The objective was to design a series of new chromen-3-yl-pyridine and pyrido[2,3-d]pyrimidine derivatives and study the antitumor of these compounds. MATERIALS AND METHODS: The condensation reaction of 3-acetyl-2H-chromen-2-one with 3-methoxy benzaldehyde and malononitrile or ethyl cyanoacetate in the presence of ammonium acetate and acetic acid under reflux to give the corresponding chromen-3-yl pyridine-3-carbonitrile derivatives. RESULTS: In this study, the antitumor activity of the synthesized compounds chromen-3-yl-pyridine derivatives has been determined for the broad spectrum of cytotoxic activity toward the investigated three cell lines and 5-Fluorouracil, as reference drugs. CONCLUSION: A series of new chromen-3-yl-pyridine and pyrido[2,3-d]pyrimidine derivatives were synthesized in this work. All compounds were evaluated for cytotoxic activity.

4.
Cureus ; 15(5): e39610, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37388602

RESUMO

We present a unique case of a type I peri-operative myocardial infarction during an extensive abdominal aortic aneurysm repair occurring due to the occlusion of a severe stable ostial plaque stenosis by a small overlying thrombus. During coronary angiography, the thrombus was dislodged by the diagnostic catheter which restored normal flow without stent placement. We demonstrate a care approach that was carefully arrived upon through multidisciplinary management with vascular surgery and anesthesiology colleagues.

5.
Curr Org Synth ; 2023 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-37102479

RESUMO

BACKGROUND: Multi-component reactions for the preparation of pyrazolophthalazine derivatives under microwave irradiation from different aromatic aldehydes with a mixture malononitrile and phthalhydrazide derivatives were established. The antimicrobial activity of the target compounds was evaluated against four bacteria and two fungi using standard antibiotics Ampicillin and mycostatine as reference drugs. The structure-activity relationship studies reported that the substitution at 2,4, and 2,5-positions in the 1H-pyrazolo nucleus with the specific halogen atom increases the ability of the molecule against the antimicrobial activity. The structures of the synthesized compounds were established based on spectral data, IR, 1H NMR, 13C NMR and MS data. OBJECTIVES: Design a series of new pyrazolophthalazine moieties and study the antimicrobial activity of these compounds Materials and Methods: pyrazolophthalazine derivatives 4a-j were synthesized by reaction of phthalhydrazide (1) with malononitrile (2), and various halogen aromatic aldehydes 3a-j in and EtOH/ Pip. Solution under microwave irradiation settings for two minutes at 140 °C Results: In this study, the antimicrobial activity of the synthesized compounds 4a-j was examined for their in vitro antimicrobial activity by using the agar diffusion method using Mueller-Hinton agar medium for bacteria and Sabouraud's agar medium for fungi. Ampicillin and mycostatine were included in the experiments as reference drugs. CONCLUSION: A series of new pyrazolophthalazine derivatives were synthesized in this work. All compounds were evaluated for antimicrobial activity.

6.
Am J Cardiol ; 192: 166-173, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36807133

RESUMO

Mitral transcatheter edge-to-edge repair (TEER) in patients with rheumatic heart disease (RHD) is challenging owing to leaflet thickening and calcification but is performed in select cases. Limited data exist on its outcomes. The aim of this analysis was to investigate the safety and efficacy of mitral TEER in patients with severe symptomatic rheumatic mitral regurgitation. We queried the Nationwide Readmissions Database for hospitalizations for mitral TEER between 2016 and 2018. Propensity score-weighted regression analysis was conducted to evaluate the association of RHD with in-hospital outcomes and 90-day readmissions after mitral TEER. A total of 18,240 procedures were included in the analysis, including 1,779 in patients with RHD. Mitral TEER in patients with RHD was associated with similar in-hospital mortality to that in patients without RHD (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.94 to 2.30, p = 0.089). However, RHD was associated with higher acute myocardial infarction (OR 1.65, 95% CI 1.07 to 2.56), acute kidney injury (OR 1.58, 95% CI 1.30 to 1.94), ventricular arrhythmia (OR 1.50, 95% CI 1.12 to 2.01), high-degree heart block (OR 1.67, 95% CI 1.25 to 2.23), and conversion to open surgical repair/replacement (OR 2.53, 95% CI 1.02 to 6.30). Mitral TEER in RHD was also associated with higher 90-day all-cause readmission (hazard ratio [HR] 1.19, 95% CI 1.04 to 1.47, p = 0.012). In conclusion, mitral TEER in patients with RHD is associated with higher rates of hospital complications, crossover to surgery, and readmissions but could be performed selectively in patients at high surgical risk who have favorable anatomy.


Assuntos
Cardiopatia Reumática , Humanos , Injúria Renal Aguda , Calcinose , Bases de Dados Factuais , Bloqueio Cardíaco , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
7.
Curr Org Synth ; 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36654464

RESUMO

BACKGROUND: A series of novel naphthopyrane moieties have been synthesized. Their structures were characterized by IR, NMR, and MS spectroscopy, and the corresponding antitumor properties also were studied Objectives: Design a series of new naphthopyrane moieties and study of antitumor properties of these compounds Materials and Methods: 4-(halophenyl)-4H-naphthopyran derivatives (4a-h) were synthesized by reaction of 6-methoxy-ß-naphthol (1) with _various _halogen aromatic aldehydes (2a-h) and malononitrile (3) in an EtOH/ Pip. solution under microwave irradiation settings for two minutes at 140 °C. RESULTS: In this study, Three human cancer cell lines were used as in vitro test subjects for compounds 4a - h. HepG-2 cells (Hepatocellular carcinoma in humans), HCT-116 cells (colon carcinoma), and MCF-7 cells (breast carcinoma), with 5-fluorouracil as a standard reference medication. CONCLUSION: A series of new 4-(halophenyl)-4H-naphthopyran derivatives were synthesized in this work. All compounds were evaluated in antitumor activities.

8.
Ocul Immunol Inflamm ; 31(10): 1978-1983, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36094930

RESUMO

PURPOSE: To report the causes of childhood-onset uveitis in a tertiary pediatric ophthalmology hospital in Egypt. METHODS: Retrospective study of the medical records of all uveitis patients following up at a tertiary pediatric ophthalmology hospital in Egypt from January 2017 to December 2020. RESULTS: The present study included 388 patients. The most common anatomical category was intermediate uveitis (30.4%), and around half of these children had pars planitis. This was followed by panuveitis (25.5%), posterior uveitis (23.5%), and anterior uveitis (20.6%), in decreasing frequency. Juvenile idiopathic arthritis, toxoplasmosis, and Vogt-Koyanagi-Harada syndrome were the most common causes of anterior uveitis, posterior uveitis, and panuveitis respectively. Cataract (40.5%), glaucoma (33.8%), and cystoid macular edema (31.6%) were the most frequent ocular complications. CONCLUSION: The present report provides the relative prevalence of the different anatomical types of uveitis, as well as their main causes in a cohort of Egyptian patients with childhood-onset uveitis.


Assuntos
Pan-Uveíte , Uveíte Anterior , Uveíte Posterior , Uveíte , Humanos , Criança , Egito/epidemiologia , Estudos Retrospectivos , Uveíte/diagnóstico , Uveíte/epidemiologia , Uveíte/etiologia , Pan-Uveíte/complicações , Uveíte Posterior/complicações , Centros de Atenção Terciária , Uveíte Anterior/complicações , Doença Aguda
9.
Sci Rep ; 12(1): 3948, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35273282

RESUMO

In a computer-aided diagnostic (CAD) system for skin lesion segmentation, variations in shape and size of the skin lesion makes the segmentation task more challenging. Lesion segmentation is an initial step in CAD schemes as it leads to low error rates in quantification of the structure, boundary, and scale of the skin lesion. Subjective clinical assessment of the skin lesion segmentation results provided by current state-of-the-art deep learning segmentation techniques does not offer the required results as per the inter-observer agreement of expert dermatologists. This study proposes a novel deep learning-based, fully automated approach to skin lesion segmentation, including sophisticated pre and postprocessing approaches. We use three deep learning models, including UNet, deep residual U-Net (ResUNet), and improved ResUNet (ResUNet++). The preprocessing phase combines morphological filters with an inpainting algorithm to eliminate unnecessary hair structures from the dermoscopic images. Finally, we used test time augmentation (TTA) and conditional random field (CRF) in the postprocessing stage to improve segmentation accuracy. The proposed method was trained and evaluated on ISIC-2016 and ISIC-2017 skin lesion datasets. It achieved an average Jaccard Index of 85.96% and 80.05% for ISIC-2016 and ISIC-2017 datasets, when trained individually. When trained on combined dataset (ISIC-2016 and ISIC-2017), the proposed method achieved an average Jaccard Index of 80.73% and 90.02% on ISIC-2017 and ISIC-2016 testing datasets. The proposed methodological framework can be used to design a fully automated computer-aided skin lesion diagnostic system due to its high scalability and robustness.


Assuntos
Aprendizado Profundo , Melanoma , Dermatopatias , Neoplasias Cutâneas , Dermoscopia/métodos , Humanos , Melanoma/diagnóstico por imagem , Redes Neurais de Computação , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
11.
Am Heart J Plus ; 18: 100185, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38559418

RESUMO

Study objective: Reduce inappropriate transthoracic echocardiograms (TTEs) using a series of Plan-Do-Study-Act (PDSA) quality improvement cycles. Design: Three PDSA cycles were designed with the first integrating a previously published decision support tool (DST) into the electronic TTE order, the second tailoring the DST to reflect the most common inappropriately ordered TTEs at our institution, and the third integrating direct clinician education. Setting: Malcom Randall Veterans Administration Medical Center, Gainesville, Florida, USA. Participants: Consecutive patients were studied using the database of all TTEs performed at our institution without regard for specific patient characteristics. Interventions: Three PDSA Cycles as described above. Main outcome measure: Reduction in inappropriate TTEs at our institution. Results: After implementing our DST during the first cycle, no difference in inappropriate TTEs was observed (relative risk [RR] 0.71, p = 0.12, 95 % confidence interval [CI] 0.46-1.09). After the second cycle, we observed a reduction in the proportion of inappropriate TTEs (RR = 0.69, p = 0.014, 95 % CI 0.5-0.94), however two of the four inappropriate TTEs targeted by the DST increased. Feedback gathered from clinicians in the third cycle showed significant knowledge gaps regarding appropriate use criteria for TTE. Conclusions: At our facility, implementation of a DST failed to substantially reduce inappropriate TTEs, even when adapted to facility-specific ordering patterns. Gaps in clinician knowledge about TTEs may have contributed to the inefficacy of our DST.

12.
Crit Pathw Cardiol ; 20(3): 115-118, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34238793

RESUMO

Cardiac rehabilitation is a class 1 recommendation for acute coronary syndrome (ACS) patients according to the American College of Cardiology/American Heart Association. However, only 1 in 5 ACS patients are referred for cardiac rehabilitation nationally, and even fewer at our institution. We sought to improve the number of referrals to cardiac rehabilitation for post-ACS patients admitted to our inpatient cardiology service, and ultimately their participation in the program. We designed a quality improvement initiative that included education of patients and house staff, automated referral order, and participation of cardiac rehabilitation staff members on multidisciplinary rounds. We compared the number of patients who received a referral to cardiac rehabilitation, had the first appointment scheduled before hospital discharge, and attended the program before and after our intervention. Six months after initiation of the project, the proportion of ACS patients referred to cardiac rehabilitation before hospital discharge increased from 10% to 43% (P < 0.001). The mean number of patients with a cardiac rehabilitation appointment scheduled before discharge was 2 before and 5 after the intervention (P < 0.001), and the mean number of patients who attended their scheduled appointment was 1 before and 3 after the intervention (P = 0.001). Run charts demonstrated that the number of referrals and the number of scheduled appointments remained above the median following the intervention. In conclusion, an initiative that included education, automated referrals, and direct one-on-one contact with cardiac rehabilitation staff before discharge increased the number of cardiac rehabilitation referrals, and appointments scheduled and attended in post-ACS patients.


Assuntos
Síndrome Coronariana Aguda , Reabilitação Cardíaca , Humanos , Alta do Paciente , Melhoria de Qualidade , Encaminhamento e Consulta
13.
PLoS One ; 16(6): e0251159, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34115768

RESUMO

OBJECTIVES: To quantify SARS-CoV2 IgG antibody titers over time and assess the longevity of the immune response in a multi-ethnic population setting. SETTING: This prospective study was conducted in a tertiary hospital in Abu Dhabi city, UAE, among COVID-19 confirmed patients. The virus-specific IgG were measured quantitatively in serum samples from the patients during three visits over a period of 6 months. Serum IgG levels ≥15 AU/ml was used to define a positive response. PARTICIPANTS: 113 patients were analyzed at first visit, with a mean (SD) age of participants of 45.9 (11.8) years 87.5% of the patients were men. 63 and 27 participants had data available for visits 2 and 3, respectively. PRIMARY OUTCOME: Change in SARS-CoV2 IgG antibody titers over the visits. RESULTS: No mortality or re-infection were reported. 69% of the patients developed positive IgG response within the first month after the onset of symptoms. The levels of IgG showed a consistent increase during the first three months with a peak level during the third month. Increasing trend in the levels of IgG were observed in 82.5%, 55.6% and 70.4% of patients between visit 1 to visit 2, visit 2 to visit 3, and from visit 1 to visit 3, respectively. Furthermore, about 64.3% of the patients showed sustained increase in IgG response for more than 120 days. CONCLUSIONS: Our study indicates a sustained and prolonged positive immune response in COVID-19 recovered patients. The consistent rise in antibody and positive levels of IgG titers within the first 5 months suggest that immunization is possible, and the chances of reinfection minimal.


Assuntos
Anticorpos Antivirais/sangue , COVID-19/sangue , COVID-19/epidemiologia , Imunoglobulina G/sangue , SARS-CoV-2/imunologia , Adulto , COVID-19/virologia , Feminino , Seguimentos , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Viral/genética , RNA Viral/isolamento & purificação , SARS-CoV-2/genética , Centros de Atenção Terciária , Emirados Árabes Unidos/epidemiologia , Adulto Jovem
14.
Cardiovasc Revasc Med ; 28S: 166-168, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33965335

RESUMO

Patients with end-stage heart failure with reduced ejection fraction requiring mechanical support while awaiting heart transplant present a clinical dilemma. Intra-aortic balloon pump (IABPs) provide a modest improvement in hemodynamics and are easy to implant. Left axillary IABP implantation allows patients to engage in daily physical activity pre-transplant. We present a case of a patient awaiting heart transplant with a left axillary IABP that prolapsed above the aortic valve in the ascending aortic root requiring immediate removal. We describe our multi-modal imaging evaluation, and technique to safely remove the IABP and replace a new one into the same left axillary access while preserving vascular access.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Aorta/diagnóstico por imagem , Aorta/cirurgia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Humanos , Balão Intra-Aórtico , Estudos Retrospectivos
15.
Cureus ; 13(1): e12915, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33654598

RESUMO

Cardiac amyloid is an uncommon cause of diastolic dysfunction the recognition of which requires the internist to have clinical suspicion to guide diagnosis and treatment. Cardiac amyloid is an infiltrative cardiomyopathy with significant morbidity and mortality. Appropriate diagnosis is important because management of cardiac amyloid differs from typical heart failure with preserved ejection fraction. An astute internist must be able to recognize common findings of cardiac amyloidosis. Here we present a case of a patient presenting with diastolic heart failure and the steps leading towards diagnosis and subsequent treatment.

16.
Int Ophthalmol ; 41(4): 1167-1177, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33398508

RESUMO

PURPOSE: The objective of this study is to compare the endothelial safety of femtosecond laser (FSL) energy at two different dissection depths in FSL-assisted deep anterior lamellar keratoplasty (FSDALK) for keratoconus. METHODS: This prospective double-armed interventional study included 25 eyes from 21 patients with advanced keratoconus who underwent FSDALK (big bubble technique) at a trephination depth of 110 µm in group I (11 eyes) and 80 µm in group II (14 eyes)-all of which were anterior to the Descemet's membrane (DM). Visual acuity measurement, anterior and posterior segment examination, corneal tomography, and specular microscopy were performed preoperatively and at 3, 6, and 12 months, postoperatively. Endothelial cell density, coefficient of variation, percentage of cell hexagonality, and pachymetry were used to evaluate endothelial safety. RESULTS: No statistically significant difference in any of the endothelial safety parameters was found between the two groups. The mean 12-month postoperative endothelial cell loss rate was 17.46% and 12.91% in group I and II, respectively (P = 0.345). Most of the endothelial cell loss occurred during the first 3 months after surgery. Group II showed statistically greater improvement in the mean keratometry values at all follow-up visits. CONCLUSION: The endothelial safety profiles of lamellar FSL cuts at 110 µm and 80 µm anterior to the DM are comparable. Cuts as deep as 80 µm anterior to the DM can be safely applied without causing significant injury to the endothelium. Further studies are needed to compare the endothelial safety profiles of different FSL platforms available in the market. Trial registration PACTR201901615323963. Registered 24 November 2018-retrospectively registered.


Assuntos
Transplante de Córnea , Ceratocone , Dissecação , Endotélio Corneano , Humanos , Ceratocone/diagnóstico , Ceratocone/cirurgia , Lasers , Estudos Prospectivos
17.
Crit Pathw Cardiol ; 20(2): 71-74, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32657972

RESUMO

Medication nonadherence is a strong predictor of adverse events and unplanned 30-day readmissions in post-myocardial infarction (MI) patients. Nonadherence with dual antiplatelet therapy (DAPT) is of particular concern in post-MI patients, given the high rate of percutaneous coronary intervention in this population. Review of post-MI quality measures revealed that compared to national benchmarks, our safety net hospital had lower DAPT adherence rates and higher unplanned 30-day readmission rates. The aim was to improve these important quality measures by creating a transition of care pathway primarily focused on medication accessibility and affordability of DAPT and early follow-up. A multidisciplinary task force created a transition of care pathway that included bedside medication delivery, patient assistance program enrollment for medications, and follow-up within 10 days of discharge in a dedicated post-MI clinic. Resources for the pathway (personnel and hospital) were already available and repurposed. We compared quality measures of DAPT adherence, proportion of patients evaluated early after hospital discharge, and unplanned 30-day readmissions before and after the initiative. Following initiation of the transition of care pathway, DAPT adherence increased from 56% pre-intervention to 92% post-intervention (P < 0.0001). The proportion of patients scheduled for early clinic follow-up after discharge increased and unplanned 30-day readmissions decreased following initiation of the pathway. A transition of care pathway for post-MI patients using readily available resources was associated with increased DAPT adherence and decreased 30-day unplanned readmissions.


Assuntos
Infarto do Miocárdio , Readmissão do Paciente , Seguimentos , Humanos , Adesão à Medicação , Infarto do Miocárdio/tratamento farmacológico , Melhoria de Qualidade , Provedores de Redes de Segurança
18.
J Neural Eng ; 18(1)2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33217750

RESUMO

Objective.Intramuscular electromyography (iEMG) signals, invasively recorded, directly from the muscles are used to diagnose various neuromuscular disorders/diseases and to control rehabilitative and assistive robotic devices. iEMG signals are potentially being used in neurology, kinesiology, rehabilitation and ergonomics, to detect/diagnose various diseases/disorders. Electromyography-based classification and analysis systems are being designed and tested for the classification of various neuromuscular disorders and to control rehabilitative and assistive robotic devices. Many studies have explored parameters such as the pre-processing, feature extraction and selection of classifiers that can affect the performance and efficacy of iEMG-based classification systems. The pre-processing stage includes the removal of any unwanted noise from the original signal and windowing of the signal.Approach.This study investigated and presented the optimum windowing configurations for robust control and better performance results of an iEMG-based analysis system based on the stationarity rate (SR) and classification accuracy. Both disjoint and overlap, windowing techniques with varying window and overlap sizes have been investigated using a machine learning-based classification algorithm called linear discriminant analysis.Main results.The optimum window size ranges are from 200-300 ms for the disjoint and 225-300 ms for the overlap windowing technique, respectively. The inferred results show that for the overlap windowing technique the optimum range of overlap size is from 10%-30% of the length of window size. The mean classification accuracy (MCA) and mean stationarity rate (MSR) were found to be lower in the disjoint windowing technique compared to overlap windowing at all investigated overlap sizes. Statistical analysis (two-way analysis of variance test) showed that the MSR and MCA of the overlap windowing technique was significantly different at overlap sizes of 10%-30% (p-values < 0.05).Significance.The presented results can be used to achieve the best possible classification results and SR for any iEMG-based real-time diagnosis, detection and control system, which can enhance the performance of the system significantly.


Assuntos
Algoritmos , Tecnologia Assistiva , Análise Discriminante , Eletromiografia/métodos , Aprendizado de Máquina
19.
Am Heart J Plus ; 6: 100032, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38560555

RESUMO

Standard cardiology practice often defers preventive strategies to primary care providers. We aimed to evaluate the effectiveness of a preventive cardiology clinic focused on lifestyle and nutrition counseling combined with guideline-directed medical therapy on reducing cardiovascular disease (CVD) risk. We queried the University of Florida-Health database for patients enrolled in the preventive cardiology clinic, and a general and interventional cardiology clinic from January 2016 to October 2019. Mean change in weight and blood cholesterol including LDL cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) were compared in the three clinics in the initial cohort and stratified into primary and secondary prevention. A propensity score-matched analysis was done to adjust for CVD risk factors and statin use. Among a cohort of 239 patients, enrollment in the preventive clinic (n = 99) was associated with greater weight loss at 6 months compared to other clinics (n = 140) (mean -1.7 vs +0.1 kg, p 0.007). Preventive clinic was also associated with greater mean reduction in LDL-C (-24.8 vs -7.1 mg/dl, p 0.021), TC (-29.3 vs -2.0, p 0.003) and TG (-19.7 vs +13.3, p 0.002) at both initial and last follow-up (median time 6 and 16 months). The association with reduction in TG was observed in both primary and secondary prevention, but reduction in LDL-C and TC was only significant in secondary prevention. In a propensity-matched linear regression analysis, preventive clinic was independently associated with LDL-C reduction (b -14.7, r -0.3, p 0.038). A preventive cardiology clinic focused on patient education can be effective in reducing CVD risk.

20.
Sensors (Basel) ; 20(6)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32183473

RESUMO

Electromyography (EMG) is a measure of electrical activity generated by the contraction of muscles. Non-invasive surface EMG (sEMG)-based pattern recognition methods have shown the potential for upper limb prosthesis control. However, it is still insufficient for natural control. Recent advancements in deep learning have shown tremendous progress in biosignal processing. Multiple architectures have been proposed yielding high accuracies (>95%) for offline analysis, yet the delay caused due to optimization of the system remains a challenge for its real-time application. From this arises a need for optimized deep learning architecture based on fine-tuned hyper-parameters. Although the chance of achieving convergence is random, however, it is important to observe that the performance gain made is significant enough to justify extra computation. In this study, the convolutional neural network (CNN) was implemented to decode hand gestures from the sEMG data recorded from 18 subjects to investigate the effect of hyper-parameters on each hand gesture. Results showed that the learning rate set to either 0.0001 or 0.001 with 80-100 epochs significantly outperformed (p < 0.05) other considerations. In addition, it was observed that regardless of network configuration some motions (close hand, flex hand, extend the hand and fine grip) performed better (83.7% ± 13.5%, 71.2% ± 20.2%, 82.6% ± 13.9% and 74.6% ± 15%, respectively) throughout the course of study. So, a robust and stable myoelectric control can be designed on the basis of the best performing hand motions. With improved recognition and uniform gain in performance, the deep learning-based approach has the potential to be a more robust alternative to traditional machine learning algorithms.


Assuntos
Membros Artificiais , Eletromiografia/métodos , Gestos , Redes Neurais de Computação , Processamento de Sinais Assistido por Computador , Adulto , Algoritmos , Mãos/fisiologia , Humanos , Masculino , Adulto Jovem
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