Deep Learning Applied to Intracranial Hemorrhage Detection

Intracranial hemorrhage is a serious health problem requiring rapid and often intensive medical care. Identifying the location and type of any hemorrhage present is a critical step in treating the patient. Diagnosis requires an urgent procedure and the detection of the hemorrhage is a hard and time-consuming process for human experts. In this paper, we propose a novel method based on Deep Learning techniques which can be useful as decision support system. Our proposal is two-folded. On the one hand, the proposed technique classifies slices of computed tomography scans for hemorrhage existence or not, achieving 92.7% accuracy and 0.978 ROC-AUC. On the other hand, our method provides visual explanation to the chosen classification by using the so-called Grad-CAM method. TRANSLATE with x English ArabicHebrewPolish BulgarianHindiPortuguese CatalanHmong DawRomanian Chinese SimplifiedHungarianRussian Chinese TraditionalIndonesianSlovak CzechItalianSlovenian DanishJapaneseSpanish DutchKlingonSwedish EnglishKoreanThai EstonianLatvianTurkish FinnishLithuanianUkrainian FrenchMalayUrdu GermanMalteseVietnamese GreekNorwegianWelsh Haitian CreolePersian TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back TRANSLATE with x English ArabicHebrewPolish BulgarianHindiPortuguese CatalanHmong DawRomanian Chinese SimplifiedHungarianRussian Chinese TraditionalIndonesianSlovak CzechItalianSlovenian DanishJapaneseSpanish DutchKlingonSwedish EnglishKoreanThai EstonianLatvianTurkish FinnishLithuanianUkrainian FrenchMalayUrdu GermanMalteseVietnamese GreekNorwegianWelsh Haitian CreolePersian TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster Portal Back

Retrospective analysis of the effectiveness of a reduced dose of idarucizumab in dabigatran reversal

Background The recommended dose of idarucizumab, the specific reversal agent for dabigatran etexilate, is 5g. However, published data showed biochemical reversal after an initial 2.5g dose. Objectives This study aims to retrospectively compare the clinical effectiveness of 2.5g and 5g doses of idarucizumab used in dabigatran reversal in three hospitals in Auckland, New Zealand. Methods All patients receiving idarucizumab for dabigatran reversal between 1st April 2016 and 31st December 2018 were included. The primary outcome was the likelihood of receiving a second dose of idarucizumab during the same admission. Secondary outcomes included normalisation of coagulation profiles; and 30-day thrombotic, bleeding and mortality rates. Results Of 329 patients included, 206 received an upfront 2.5g dose and 123 received a 5g dose. The median age was 78 years and median creatinine clearance was 50mL/min. Most patients (62.6%) required idarucizumab for an urgent procedure, while 37.4% presented with bleeding. A 2.5g dose was not associated with an increased rate of receiving a second dose (OR 0.686, 95% CI 0.225-2.090). A similar proportion of patients in each group achieved a normal APTT (73.8% vs 80.0%, p=0.464) and dTCT (95.9% vs 91.4%, p=0.379) following idarucizumab infusion. There was no increase in the rate of death (OR 0.602, 95% CI 0.292-1.239), thrombosis (OR 0.386, 95% CI 0.107-1.396) or bleeding (OR 0.96, 95% CI 0.27-3.33) in the 2.5g dose group compared to the 5g dose group. Conclusions An initial 2.5g dose of idarucizumab appears effective for dabigatran reversal in the real-world setting.

Association Between Intoxication and Urgent Neurosurgical Procedures in Severe Traumatic Brain Injury: Results From the American College of Surgeons Trauma Quality Improvement Program

Background: The probability of undergoing surgery after severe traumatic brain injury (TBI) varies significantly across studies and centers. However, causes of this variability are poorly understood. We hypothesized that intoxication may impact the probability of receiving an urgent neurosurgical procedure among patients with severe TBI. Methods: We performed a retrospective cohort study of adult patients admitted to a Level I or II trauma center in the United States or Canada with an isolated severe TBI.2012-2016 Data were derived from the Trauma Quality Improvement Program dataset. An urgent neurosurgical procedure was defined as a procedure that occurred within 24 hrs of admission. Multivariable logistic regression was utilized to examine the independent effect of intoxication on a patient’s likelihood of undergoing an urgent procedure, as well as the timing of the procedure. Results: Of 33,646 patients with an isolated severe TBI, 11,313 (33.6%) were intoxicated. An urgent neurosurgical procedure was performed in 8,255 (24.5%) cases. Overall, there was no difference in the probability of undergoing an urgent procedure between patients who were and were not intoxicated (OR 0.99; 95% CI 0.94–1.06). While intoxication status had no impact on the probability of surgery among patients with the most severe TBI (head AIS 5: OR 1.06 [95% CI 0.98–1.15]), intoxicated patients on the lower spectrum of injury had lower odds of undergoing an urgent procedure (AIS 3: OR 0.80 [95% CI 0.66–0.97]). Among patients who underwent an urgent procedure, intoxication had no impact on timing. Conclusion: Intoxication status was not associated with differences in the probability of undergoing an urgent neurosurgical procedure among all patients with a severe TBI. However, in patients with less severe TBI, intoxication status was associated with decreased likelihood of receiving an urgent intervention. This finding underscores the challenge in the management of intoxicated patients with TBI.

A Branch-to-Branch Through-and-Through Wire Technique to Redirect a Branch Malposition in Multibranched Endovascular Aortic Aneurysm Repair

Objective To describe a novel technique to redirect a malrotated branch when treating a symptomatic juxtarenal aortic aneurysm using an off-the-shelf multibranched endograft. Technique A 75-year-old patient was admitted because of a symptomatic juxtarenal aortic aneurysm with a maximum diameter of 9.2 cm. The aneurysm showed no infrarenal neck. Because of his comorbidities, an endovascular repair using off-the-shelf multibranched endograft was considered as urgent procedure. During the deployment, the devise malrotated clockwise. The incorporation of the renal branches was performed successfully; however, the superior mesenteric artery (SMA) branch was malpositioned, so that the SMA could not be cannulated. Both celiac and SMA branches were simultaneously cannulated and snared outside of the endograft redirecting the malrotated SMA branch (a branch-to-branch through-and-through wire technique). Leaving the through-and-through wire in situ, the SMA could be intubated using parallel wire through the SMA branch. The final angiogram showed a good perfusion of the renovisceral vessels. The aneurysm was completely excluded. The patient was discharged into a rehabilitation facility 8 days later without complications. The 12-month follow-up period was uneventful. Conclusion A branch-to-branch through-and-through wire technique for branch repositioning is feasible and may present a bailout tool.

Specialist shortage in developing countries: comprehending delays in care

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing ‘catastrophic healthcare expenditure’, an economic global health quandary much ignored.

How COVID-19 pandemic has changed haematological care

Background : Datas from China suggest that patients with cancer have more severe outcome in case of covid-19 infection. Patients with haematological disease have often immunosuppression, due to the underlying disease and to their treatment. Methods: We recorded the consecutive patients usually treated in our haematology department diagnosed with COVID-19 infection between March 10th to April 30th. To evaluate the impact of the pandemic, we compare the activity of our department during two twenty working-days periods: March 20th to April 17th (“Covid month”) and February 18th to March 16th 2020 (“Covid-free month”). Results: Fifty patients treated in our haematology department had a COVID-19 infection, diagnosed with PCR or CT-scanner. Half of them were still on chemotherapy treatment, 30% were on survey after treatment and 20% were on a “watch and wait” strategy. Sixteen patients ( 30%) evolved to an acute respiratory syndrome with a fatal outcome in ten cases. (20%). The severity of the disease prompted us to change the organization of our department to protect our patients. We followed international recommendation and delayed non urgent procedure. this allowed a reduction of 10% of our activity. Moreover, we managed to treat 25% of our patients coming usually in outpatient clinic with tele-health. Thanks to hospital-at-home, these patients could receive their treatment and stay safe at home. Conclusion: This retrospective study give an insight of how covid-19 outbreak will change cancer care.

Global Use of Idarucizumab in Clinical Practice: Outcomes of the RE-VECTO Surveillance Program

Idarucizumab was approved for the reversal of dabigatran in 2015. We investigated whether postapproval usage patterns of idarucizumab in a real-world setting reflect those observed in the pivotal trials. No safety or efficacy data were collected in this medical record-based observational study. RE-VECTO, a global postapproval, international, surveillance program, involved hospital pharmacies in countries where idarucizumab was licensed and dispensed (August 2016–June 2018). Characteristics of sites prescribing idarucizumab and of eligible patients (≥ 18 years old and receiving idarucizumab regardless of prior oral anticoagulant use), as well as idarucizumab utilization data, were collected and analyzed descriptively. Sixty-one sites enrolled 359 patients. Most pharmacies (85.2%) were centralized, and the median idarucizumab units stocked per hospital was 2.0 (interquartile range, 1.0–3.0). Almost three-quarters of patients were elderly (74.9% aged > 70 years), and only four (1.1%) had received idarucizumab before. Nearly all patients were treated with dabigatran (97.5%). There was a low frequency of unapproved dabigatran dosage regimens (3.3%). Life-threatening or uncontrolled bleeding was the most frequent indication for idarucizumab (57.7%), followed by emergency surgery/urgent procedure (35.9%). Of the life-threatening bleeding events, the most frequent were gastrointestinal tract (44.4%) and intracranial (38.6%). Most patients (95.0%) were given the full dose of two vials (2 × 2.5 g) of idarucizumab initially, and very few (1.7%) received a second dose. Of those patients requiring emergency or scheduled/planned surgery/procedures, 25.5% underwent gastrointestinal and/or abdominal surgery/procedures. Real-world usage patterns of idarucizumab provide valuable insights into emergency reversal strategies. Off-label use was minimal.

La tramitación de la reforma constitucional mediante procedimientos legislativos abreviados: un problema de límites procedimentales

¿Pueden las Cámaras tramitar las iniciativas de reforma constitucional aplicando simultáneamente los procedimientos parlamentarios de reforma constitucional y procedimientos legislativos abreviados? Más específicamente, ¿puede considerarse que los métodos de lectura única y urgencia son procedimientos adecuados para tramitar la revisión de la Constitución? En el Auto 9/2012 el Tribunal Constitucional parece haberse decantado por la tesis de la simultaneidad procedimental, conforme a la cual los procedimientos de reforma constitucional podrían aplicarse transversalmente junto a las técnicas procedimentales de lectura única y de urgencia. Sin embargo, haciendo una interpretación sistemática de las normas constitucionales y parlamentarias que regulan el modo de producción legislativa, es posible deducir que dichas modalidades abreviadas actúan como límites procedimentales en la tramitación parlamentaria de la revisión de la Constitución.Can the Parliament process constitutional reform initiatives applying the procedures of constitutional reform and abbreviated legislative procedures simultaneously? More specifically, can it be considered that the method of single reading and the urgent procedure are adequate for processing the revision of the Constitution? In the decision ATC 9/2012 the Constitutional Court seems to have embraced the thesis of procedural simultaneity, according to which the procedures of constitutional reform could be applied transversally along with the legislative techniques of single reading and urgency. However, making a systematic interpretation of constitutional and parliamentary rules governing the lawmaking process, it might be argued that these kind of abbreviates procedures act as procedural limits in the parliamentary processing of the constitutional revision.