The Effect of an Informative Video upon Anxiety and Stress in Patients Requiring an Oral Biopsy: A Randomized Controlled Study

Objective: The use of multimedia tools improves patient understanding of surgical procedures, reduces anxiety and increases satisfaction. The present study evaluates the impact of an audiovisual intervention (video) upon anxiety and stress in patients requiring an oral biopsy. Material and methods: A prospective randomized clinical trial was carried out in patients requiring an oral biopsy. The control group (n = 60) received verbal standard information while the experimental group (n = 60) received information in the form of a video. The following data were recorded: gender, age, educational level and hemodynamic parameters (blood pressure, heart rate and blood oxygen saturation). The following questionnaires were used to assess anxiety and stress before and after the biopsy procedure: Corah’s Modified Dental Anxiety Scale (MDAS), the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS). Results: The final study sample consisted of 120 patients, of which 65.8% were women and 34.2% men, with a mean age of 40.5 ± 15.3 years. At the end of the study, the experimental group presented a significantly lower MDAS score than the control group (p = 0.041). The STAI score also showed a significant decrease with respect to the control group at the end of the study (p = 0.012). There were no statistically significant changes in the hemodynamic parameters in either group. Conclusions: The video constituted a useful and easy tool for reducing anxiety among patients requiring an oral biopsy.

Internet of Things Concept in the Context of the COVID-19 Pandemic: A Multi-Sensor Application Design

In this paper, we present the design, development and implementation of an integrated system for the management of COVID-19 patient, using the LoRaWAN communication infrastructure. Our system offers certain advantages when compared to other similar solutions, allowing remote symptom and health monitoring that can be applied to isolated or quarantined people, without any external interaction with the patient. The IoT wearable device can monitor parameters of health condition like pulse, blood oxygen saturation, and body temperature, as well as the current location. To test the performance of the proposed system, two persons under quarantine were monitored, for a complete 14-day standard quarantine time interval. Based on the data transmitted to the monitoring center, the medical staff decided, after several days of monitoring, when the measured values were outside of the normal parameters, to do an RT-PCR test for one of the two persons, confirming the SARS-CoV2 virus infection. We have to emphasize the high degree of scalability of the proposed solution that can oversee a large number of patients at the same time, thanks to the LoRaWAN communication protocol used. This solution can be successfully implemented by local authorities to increase monitoring capabilities, also saving lives.

Predictors of Mortality in Hemodialyzed Patients after SARS-CoV-2 Infection

Introduction: The determinants of COVID-19 mortality are well-characterized in the general population. Less numerous and inconsistent data are among the maintenance hemodialysis (HD) patients, who are the population most at risk of an unfavorable prognosis. Methods: In this retrospective cohort study we included all adult HD patients from the Pomeranian Voivodeship, Poland, with laboratory-confirmed SARS-CoV-2 infection hospitalized between 6 October 2020 and 28 February 2021, both those who survived, and also those who died. Demographic, clinical, treatment, and laboratory data on admission, were extracted from the electronic medical records of the dedicated hospital and patients’ dialysis unit, and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with 3-month all-cause mortality. Results: The 133 patients (53.38% males) aged 73.0 (67–79) years, with a median duration of hemodialysis of 42.0 (17–86) months, were included in this study. At diagnosis, the majority were considered to have a mild course (34 of 133 patients were asymptomatic, another 63 subjects presented mild symptoms), while 36 (27.07%) patients had low blood oxygen saturation and required oxygen supplementation. Three-month mortality was 39.08% including an in-hospital case fatality rate of 33.08%. Multivariable logistic regression showed that the frailty clinical index of 4 or greater (OR 8.36, 95%CI 1.81–38.6; p < 0.01), D-Dimer of 1500 ng/mL or greater (6.00, 1.94–18.53; p < 0.01), and CRP of >118 mg/L at admission (3.77 1.09–13.01; p = 0.04) were found to be predictive of mortality. Conclusion: Very high 3-month all-cause mortality in hospitalized HD patients was determined mainly by frailty. High CRP and D-dimer levels upon admission further confer mortality risk.

Embedded AI-Based Digi-Healthcare

Healthcare is an indispensable part of human life and chronic illnesses like cardiovascular diseases (CVD) have a deeply negative impact on the healthcare sector. Since the ever-growing population of chronic patients cannot be managed at hospitals, therefore, there is an urgent need for periodic monitoring of vital parameters and apposite treatment of these patients. In this paper, an Internet of Medical Things (IoMT) -based remote patient monitoring system is proposed which is based on Artificial Intelligence (AI) and edge computing. The primary focus of this paper is to develop an embedded prototype that can be used for remote monitoring of cardiovascular patients. The system will continuously monitor physiological parameters like body temperature, heart rate, and blood oxygen saturation, and then report the health status to the authenticated users. The system employs edge computing to perform multiple functionalities including health status inference using a Machine Learning (ML) model which makes predictions on real-time data, alert notifications in case of an emergency, and transferring data between the sensor network and the cloud. A web-based application is developed for the depiction of raw data and ML results and to provide a direct communication channel between the patient and the doctor. The ML module achieved an accuracy of 96.26% on the test set using the K-Nearest Neighbors (KNNs) algorithm. This solution aims to address the sense of emergency due to the alarming statistics that highlight the mortality rate of cardiovascular patients. The project will enable a smart option based on IoT and ML to improve standards of living and prove crucial in saving human lives.

Treatment of COVID-19 pneumonia and acute respiratory distress with ramatroban, a thromboxane A2 and prostaglandin D2 receptor antagonist: A 4-Patient Case Series Report

Importance Hypoxemia in COVID-19 pneumonia is dispositive for hospitalization and mechanical ventilation and contributes to mortality. Other than oxygen supplementation, there is no treatment that resolves hypoxemia in COVID-19 pneumonia. Objective COVID-19 pneumonia sustains a massive increase in lipid mediators, especially thromboxane A2 >> PGE2 > PGD2. Thromboxane A2 induces pulmonary venoconstriction, increases pulmonary capillary pressure and contributes to pulmonary edema. High thromboxane A2 metabolite levels are strongly associated with respiratory failure and mortality in hospitalized COVID-19 patients. Ramatroban (Baynas®, Bayer Yakuhin Ltd., Japan) is an inexpensive, orally bioavailable, thromboxane A2 receptor antagonist. Ramatroban was administered to patients with COVID-19 pneumonia and hypoxemia to explore the effect of thromboxane A2 antagonism on clinical symptoms and outcomes. Design, Setting, and Participants A retrospective case series comprising 4 consecutive outpatients, 22 to 87 years of age, with COVID-19 pneumonia and hypoxemia treated with ramatroban between April and July 2021 in India. Main Outcomes and Measures The primary outcome measure was blood oxygen saturation using pulse oximetry (SpO2). Secondary outcome measures were respiratory distress and need for hospitalization. Results Four COVID-19 outpatients had developed progressive respiratory distress and hypoxemia. Within 12-36 hours of the first dose of ramatroban, all four patients experienced increase in SpO2 and decrease in respiratory distress, which obviated hospitalization. Continued treatment for 5 days was associated with complete resolution of respiratory distress and hypoxemia. Conclusions and Relevance There is an unmet medical need for drugs that target the hemodynamic, prothrombotic, and maladaptive immune responses that lead to pneumonia and respiratory failure following SARS-CoV-2 infection. As an anti-vasospastic, broncho-relaxant, anti-thrombotic and immunomodulatory agent, ramatroban addresses the fundamental host response mechanisms underlying respiratory and critical organ failure in COVID-19. Ramatroban merits study in randomized clinical trials that might offer hope for a cost-effective pandemic treatment.

Treatment of COVID-19 pneumonia and acute respiratory distress with ramatroban, a thromboxane A2 and prostaglandin D2 receptor antagonist: A 4-Patient Case Series Report

Importance Hypoxemia in COVID-19 pneumonia is dispositive for hospitalization and mechanical ventilation and contributes to mortality. Other than oxygen supplementation, there is no treatment that resolves hypoxemia in COVID-19 pneumonia. Objective COVID-19 pneumonia sustains a massive increase in lipid mediators, especially thromboxane A2 >> PGE2 > PGD2. Thromboxane A2 induces pulmonary venoconstriction, increases pulmonary capillary pressure and contributes to pulmonary edema. High thromboxane A2 metabolite levels are strongly associated with respiratory failure and mortality in hospitalized COVID-19 patients. Ramatroban (Baynas®, Bayer Yakuhin Ltd., Japan) is an inexpensive, orally bioavailable, thromboxane A2 receptor antagonist. Ramatroban was administered to patients with COVID-19 pneumonia and hypoxemia to explore the effect of thromboxane A2 antagonism on clinical symptoms and outcomes. Design, Setting, and Participants A retrospective case series comprising 4 consecutive outpatients, 22 to 87 years of age, with COVID-19 pneumonia and hypoxemia treated with ramatroban between April and July 2021 in India. Main Outcomes and Measures The primary outcome measure was blood oxygen saturation using pulse oximetry (SpO2). Secondary outcome measures were respiratory distress and need for hospitalization. Results Four COVID-19 outpatients had developed progressive respiratory distress and hypoxemia. Within 12-36 hours of the first dose of ramatroban, all four patients experienced increase in SpO2 and decrease in respiratory distress, which obviated hospitalization. Continued treatment for 5 days was associated with complete resolution of respiratory distress and hypoxemia. Conclusions and Relevance There is an unmet medical need for drugs that target the hemodynamic, prothrombotic, and maladaptive immune responses that lead to pneumonia and respiratory failure following SARS-CoV-2 infection. As an anti-vasospastic, broncho-relaxant, anti-thrombotic and immunomodulatory agent, ramatroban addresses the fundamental host response mechanisms underlying respiratory and critical organ failure in COVID-19. Ramatroban merits study in randomized clinical trials that might offer hope for a cost-effective pandemic treatment.

Bước đầu đánh giá hiệu quả hệ thống theo dõi SpO2 từ xa ở bệnh nhân Covid-19 mức độ nhẹ - trung bình

TÓM TẮT Đặt vấn đề: Đại dịch COVID-19 (coronavirus disease of 2019) do chủng vi rút Corona mới SARS-CoV-2 vẫn đang bùng phát trên toàn thế giới, gây gia tăng gánh nặng lên Hệ thống chăm sóc Y Tế các quốc gia. Chính vì vậy, việc phát triển hệ thống giúp hỗ trợ chẩn đoán và theo dõi bệnh nhân COVID-19 từ xa được xem là vấn đề cấp thiết hiện nay. Trong đó, chỉ số SpO2 có vai trò quan trọng đối với bệnh COVID-19 và được lựa chọn để theo dõi bệnh nhân tại các Cơ sở Y tế cũng như tại nhà. Nghiên cứu này được chúng tôi thực hiện với mục đích đánh giá hiệu quả ban đầu của hệ thống theo dõi SpO2từ xa trên các bệnh nhân COVID-19 mức độ nhẹ - trung bình. Đối tượng, phương pháp: Nghiên cứu cắt ngang, theo dõi dọc ngắn hạn các bệnh nhân COVID-19 mức độ nhẹ - trung bình điều trị tại Trung tâm Hồi sức Tích cực điều trị bệnh nhân COVID-19 trực thuộc Bệnh viện Trung Ương Huế tại TP. Hồ Chí Minh. Kết quả: Trong giai đoạn từ 8/2021 - 10/2021, 32 bệnh nhân COVID-19 được gắn thiết bị theo dõi chỉ số SpO2, trung bình là 34,2 ± 12,0 tuổi. Các yếu tố nguy cơ bao gồm: BMI xếp loại béo phì 25%, hút thuốc lá (18,8%), tăng huyết áp (15,6%) và đái tháo đường (12,5%). Phần lớn bệnh nhân vào viện do khó thở (71,9%) và chuyển từ tuyến dưới (62,5%). Triệu chứng lâm sàng chủ yếu là ho, hắt hơi, chảy mũi nước (40,6%), theo sau đó là giảm hoặc mất khứu giác, vị giác (25%). 81,3% có D-Dimer ≤ 500ng/mL. 62,5% bệnh nhân được phân độ COVID-19 mức trung bình. Tổng cộng 3.161 lượt đo SpO2, trong đó có 8 lượt cảnh báo SpO2 < 93%. SpO2 trung bình 98,1 ± 0,2 %. Tất cả bệnh nhân xuất viện thành công. Kết luận: Hệ thống theo dõi SpO2 từ xa bước đầu có hiệu quả giúp theo dõi các bệnh nhân COVID-19 mức độ nhẹ - trung bình. ABSTRACT INITIAL EFFECTIVENESS EVALUATION OF THE REMOTE SPO2 MONITORING SYSTEM IN PATIENTS WITH MILD - TO - MODERATE COVID-19 DISEASE Background: The COVID-19 pandemic affected by the new Coronavirus SARS-CoV-2 continues to spread globally, increasing the burden on countries’ Health Care systems. Therefore, generating a platform to help diagnose and monitor COVID-19 patients remotely is considered an essential issue today. In particular, the SpO2 index plays a vital role in COVID-19 disease and is selected to monitor patients at health facilities and homes. This study aimed to evaluate the initial effectiveness of the remote SpO2 monitoring system in patients with mild - to - moderate COVID-19 diseases. Methods: This cross - section study was conducted on mild - to - moderate COVID-19 patients treated at the COVID-19 Intensive Care Center operated by Hue Central Hospital in Ho Chi Minh City, Vietnam Results: From August 2021 to October 2021, 32 COVID-19 patients were applied with SpO2 monitoring smartwatches. The mean age was 34.2 ± 12.0. Risk factors including obesity (25%), smoking (18.8%), hypertension (15.6%), and diabetes (12.5%). Most patients were admitted to the center due to shortness of breath (71.9%) and transferred from lower - level hospitals (62.5%). The main clinical symptoms are coughing, sneezing, runny nose (40.6%), followed by a decrease or loss of smell and taste (25%). 81.3% of patients had D-Dimer ≤ 500 ng/mL. 62.5% of patients had moderate COVID-19 grades. A total of 3,161 SpO2 measurements, including 8 alarms < 93%. The average SpO2 was 98.1 ± 0.2 %. All patients were discharged successfully. Conclusion: A remote SpO2 monitoring system is considered to have preliminary effectiveness in monitoring mild - to - moderate COVID-19 patients. Keywords: COVID-19, blood oxygen saturation, smartwatch, health monitoring system.

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

Background: Dilatation and curettage (D & C) is one of the relatively common surgeries among women. Familiarity with the analgesics, along with their different uses and specific characteristics, can help to determine the best and most appropriate drug to control pain in the patients. Objectives: This study aimed to compare the effects of ketofol, dexmedetomidine, and isofol in anesthesia of candidates for D & C. Methods: In this double-blind clinical trial, 150 candidates for D & C surgeries with ASA class 1 and 2 were included. Patients were randomly divided into three groups. The first group received ketamine + propofol, the second group received dexmedetomidine, and the third group received isofol (isoflurane + propofol). Any hemodynamic changes or respiratory disorders, including apnea or hypoventilation, drop in the level of blood oxygen saturation, and the need for respiratory support, were recorded and compared. Results: Hypoventilation was observed in 47 patients in isofol group, 18 in the dexmedetomidine group, and 42 in ketofol group. Also, 48 patients in the isofol group, eight in the dexmedetomidine group, and 33 in the ketofol group experienced apnea. Moreover, 17 patients in the dexmedetomidine group, 35 in the ketofol group, and eight in the isofol group experienced bradycardia. The rate of bradycardia was significantly higher in the dexmedetomidine group (70%) compared to the other two groups, and the rate of hypotension was significantly higher in the isofol group (P = 0.001). Conclusions: According to the results, dexmedetomidine was associated with fewer complications during general anesthesia in D & C surgery.

Dexmedetomidine - Oxycodone Combination for Conscious Sedation During Colonoscopy in Obese Patients: A Randomised Controlled Trial

Background: The objective of this trial was to investigate the effectiveness and safety of dexmedetomidine plus oxycodone for conscious sedation during colonoscopy in obese patients. Methods: A total of 138 patients undergoing colonoscopy were randomly assigned into one of two groups: group Dex+oxy received sedation with dexmedetomidine plus oxycodone; while group Pro+suf received anaesthesia with propofol plus sufentanil. Parameters including blood pressure, heart rate, respiration, blood oxygen saturation, injection pain, and recovery were recorded for both groups. Results: The incidence of hypoxaemia was significantly reduced in group Dex+oxy compared with group Pro+suf (4.9% vs 20.3%, P = 0.011). Blood pressure was significantly increased, and heart rate was reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Moreover, the caecal insertion time, recovery time to orientation, and recovery time to walking were significantly reduced in group Dex+oxy compared with group Pro+suf (P < 0.05). Endoscopist satisfaction scores were significantly higher in group Dex+oxy compared with group Pro+suf (P = 0.042). Conclusion: Dexmedetomidine plus oxycodone provides effective sedation with minimal adverse effects for obese patients, while also reducing colonoscopy operation difficulty by allowing obese patients to reposition. Thus, dexmedetomidine plus oxycodone could be used safely as a conscious sedation method for colonoscopy in obese patients.Trial registration The protocol was registered at www.chictr.org.cn (ChiCTR1800017283, 21/07/2018)