rapid deterioration
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PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12579
Author(s):  
Joshua Hefler ◽  
Braulio A. Marfil-Garza ◽  
Rena L. Pawlick ◽  
Darren H. Freed ◽  
Constantine J. Karvellas ◽  
...  

Acute liver failure is marked by the rapid deterioration of liver function in a previously well patient over period of days to weeks. Though relatively rare, it is associated with high morbidity and mortality. This makes it a challenging disease to study clinically, necessitating reliance on preclinical models as means to explore pathophysiology and novel therapies. Preclinical models of acute liver failure are artificial by nature, and generally fall into one of three categories: surgical, pharmacologic or immunogenic. This article reviews preclinical models of acute liver failure and considers their relevance in modeling clinical disease.


Author(s):  
Vahid Mansouri ◽  
Samaneh Toutounchian ◽  
Fatemeh Arabi ◽  
Farid Kosari ◽  
Sahar Tavakoli shiraji

A 34-year-old woman with flank pain was referred for suspicious lymphadenopathy. PET/CT scan revealed disseminated lesions without apparent primary origin. Although she did not complain of any symptoms, after rapid deterioration, she died of respiratory distress and cardiac arrest. Her strong beliefs contribute to symptoms tolerance and late diagnosis.


Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1186
Author(s):  
Răzvan Socolov ◽  
Mona Akad ◽  
Maricica Păvăleanu ◽  
Diana Popovici ◽  
Mădălina Ciuhodaru ◽  
...  

Background and Objectives: The multiple pregnancies associated with COVID-19 is a new and difficult condition to manage. The prognosis for rapid deterioration after the cesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. Materials and Methods: We report the case of a 37-year-old primigesta primipara patient who was admitted to “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (triplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and currently is known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a cesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with triplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with COVID-19. The patient underwent a cesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation resulting in four newborns with weights between 1400 g and 1820 g and Apgar scores between 6–8. All newborns were transferred to a third-degree Neonatology ICU service due to their prematurity. The fourth newborn was not identified in any of the ultrasounds performed during pregnancy. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment. Discussions: Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists, and infectious disease doctors. Conclusion: Our case is the first to our knowledge in Romania to present an association of high-grade multiple pregancy with COVID19 moderate form, rapidly evolving postpartum, needing rapid intensive care admission, and specific treatment with Remdesivir, with good post-treatment evolution.


2021 ◽  
Vol 20 (2) ◽  
pp. 95-113 ◽  
Author(s):  
Vishvesh Prabhakar Kandolkar

Over the last century, monsoons in Goa have become more intense, with an increase of over 68% in rainfall (Goa State Biodiversity Board, 2019, p. 42). Such effects of climate change are devastating to architectural heritage, especially those structures built using materials like laterite, a weaker stone, vulnerable to rapid deterioration when it is left exposed. This is the precise problem concerning the Basilica of Bom Jesus, a sixteenth century building that is still in use. The monument which houses the relics of St. Francis Xavier is one of the most important cultural icons of Goa, as evidenced by its ongoing use and also its iconic representation in visual culture. While research may be available regarding the effects of climate change and architecture in the tropics generally, little pertains to the specificities of Indo-Portuguese architecture and especially heritage buildings. My article seeks to make an intervention in this regard, focusing on the effects of climate change with regard to the conservation of Bom Jesus. Considering the adverse effects of climate change on built heritage, architectural conservation in Goa cannot be merely about preserving cosmetic appearances, but rather must involve safeguarding monuments against major structural damage.  


2021 ◽  
Vol 11 (15) ◽  
pp. 6892
Author(s):  
Rina (Irena) Wasserman

The contemporary sea walls built in the pedestrian seashore zone in the City of Acre, Israel, were sided with porous calcarenite sandstone, so-called ‘kurkar’. Kurkar stone has been broadly used as a durable building material in Acre and Jaffa, the Eastern Mediterranean offshore cities, since ancient times. Therefore, the contemporary urban architectural plans obligate kurkar siding in the modern structures erected beside the Old City of Acre. However, a rapid deterioration of kurkar siding had occurred in the contemporary sea walls during only a few years. In contrast, the Historic walls built of kurkar dimensional stone have been still sound. The current study has evaluated the factors and causes of kurkar deterioration in the modern seawalls. It was revealed that the main reason for deterioration was adhering the kurkar siding with cement mortar and the next exposure of adhered siding to the humid and salt-enriched offshore environment with high air pollution.


2021 ◽  
Vol 11 (14) ◽  
pp. 6317
Author(s):  
Feng Jin ◽  
Hong Xiao ◽  
Mahantesh M Nadakatti ◽  
Huiting Yue ◽  
Wanting Liu

In this study, the rapid growth of corrugation caused by the bad quality of grinding works and their wavelength, depth, and evolution processes are captured through field measurements. The residual grinding marks left by poor grinding quality lead to further crack accumulation and corrugation deterioration by decreasing plastic resistance in rails. In this case, the average peak-to-peak values of corrugation grow extremely fast, reaching 1.4 μm per day. The finite element method (FEM) and fracture mechanics methodologies were used to analyze the development and trends in rail surface crack deterioration by considering rails with and without grinding marks. Crack propagation trends increase with residual grinding marks, and they are more severe in circular curve lines. To avoid the rapid deterioration of rail corrugation, intersections between grinding marks and fatigue cracks should be avoided.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anees ur Rehman ◽  
Shahid Shah ◽  
Ghulam Abbas ◽  
Sabariah Noor Harun ◽  
Sadia Shakeel ◽  
...  

AbstractCompromised lung function is a common feature of COPD patients, but certain factors increase the rate of lung function decline in COPD patients. The objective of the current study was to investigate the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year. COPD patients recruited from the chest clinic of Penang hospital were followed-up for one year from August 2018 to August 2019. Rapid deterioration of lung function was defined as greater than 60 ml/year decline in force expiratory volume in one second. Among 367 included patients 73.84% were male, with mean age 65.26 (9.6) years and % predicted FEV1 51.07 (11.84). 30.27% patients showed mean decline of ≥ 60 ml in FEV1. The regression analysis showed that current smoking relative risk (RR) = 2.38 (1.78–3.07), p < 0.001); GOLD Stage III& IV RR = 1.43 (1.27–1.97), p < 0.001); mMRC score 3 to 4 RR = 2.03 (1.74–2.70), p < 0.01); SGRQ-C score ≥ 10 points difference RR = 2.01 (1.58–2.73), p < 0.01); SGRQ-C symptoms Score ≥ 10 points difference RR = 1.48 (1.23–2.29), p < 0.001); 6MWT < 350 m RR = 2.29 (1.87–3.34), p < 0.01); ≥ 3 exacerbation in study year RR = 2.28 (1.58–2.42, p < 0.001); 8 or more hospital admission days (RR = 3.62 (2.66–4.20), p < 0.001); Charlson comorbidity index ≥ 3 RR = 3.18 (2.23–3.76), p < 0.01) and emphysema RR = 1.31 (1.15–1.79), p < 0.01) were significant risk factors for the rapid deterioration of lung function (FEV1 decline ≥ 60 ml). Among different factors CCI score ≥ 3, abrupt decline in health status, exacerbation frequency ≥ 3, hospital admission days ≥ 8 and emphysema were reported as risk factors for rapid deterioration of lung function.


2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
M Magee

Abstract Introduction During the first surge of COVID-19 it was well recognised that early identification of a plan for escalation in the event of deterioration for each patient was vital. If no decision is documented it results in junior staff frequently making decisions regarding escalation in the out of hours period. This leads to patients, or family members, having these conversations with a doctor they may never have met before. My aim was to improve the documentation of escalation plans in all patients within the first 24 hrs of admission. Method Baseline data was collected in September 2019 with further samples in April 2020 and August 2020. Patient medical notes were reviewed to identify if an escalation plan had been made during the period from admission to post take ward round. A COVID admission pathway document was introduced with a specific section on Clinical Frailty Score and Escalation plan between the baseline and April 2020 data. Results Baseline data showed that only 12.8% of medical patients had a documented escalation plan within the first 24 hrs of admission to hospital. During the first surge in April 2020 this number had improved to 47% following introduction of the COVID-19 admission pathway. This included 100% of patients admitted to respiratory wards. Unfortunately when reassessed in August 2020, this number had fallen to 16%. Conclusion Introduction of clinical frailty scoring and an area specifically to document escalation discussions resulted in a marked improvement. Heightened awareness of rapid deterioration of patients during the first surge almost certainly played a role in this. Unfortunately this was not sustained once staff discontinued the use of COVID-19 admission document. Moving forward we will incorporate these sections into the medical and surgical admissions pathways in the hope it produces similar results.


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