bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Proposal for Utilization of Vaults as Floor-slab Structures in Contemporary Architecture
Authors: Badik-Szabó Daniel 
Published: June 2024

Abstract
Vaults are among the oldest known engineering structures, and have escorted the history of architecture through thousands of years. Nowadays, construction industry rarely uses them, and doesn’t consider them as a general option to be used for floorslab structures, although they offer several opportunities. The presentation aims to re-introduce vaults into everyday usage, emphasizing their efficient shape, building technology and aesthetic values.
The following aspects are featured in the paper:

-mathematical definition of vaults,

-main technical terms considering vault constructions,

-main features of the statics of vaults,

-connection of the force-trajectory and the central core,

-importance of shape for ideal material distribution,

-a proposal for a contemporary floorslab structure featuring beams and narrow vaultzones,

-pros and cons of the proposed floorslab structure
Sudden Deterioration of a Young Patient During Elective Cesarean Section. Amniotic Fluid Embolism… or Else? – A Case Report
Authors: Codru Ioana Roxana , Codru Marian Valeriu , Vintilă Bogdan Ioan , Gherman Ioana , Popescu Dragoș 
Published: June 2024

Abstract
Sudden respiratory and circulatory collapse during or immediately after delivery, vaginal or surgical, can have many causes that can lead to poor maternal outcomes. A pregnancy-induced amniotic fluid embolism and anaphylaxis are two distinct medical conditions that appear similar clinically but have very different underlying mechanisms and treatment approaches. Amniotic fluid embolism is a rare but life-threatening obstetric emergency that leads to a systemic inflammatory response that can be easily confounded with an anaphylactic reaction. We report the case of a patient with no comorbidities or allergies before the current pregnancy that was proposed for delivery by C-Section under spinal anesthesia. After delivery of the placenta and administering the test dose of antibiotic, the patient developed sudden circulatory collapse, altered neurological status, and critical respiratory distress. At that point, the two presumed diagnoses were amniotic fluid embolism and anaphylaxis. Concurrently with the diagnostic pathway, supportive measures (intubation, mechanical ventilation, hemodynamic support) were taken. The clinical evolution was favorable, and after day three, the patient was discharged from the hospital. Our case highlights the significance of promptly distinguishing between anaphylaxis and amniotic fluid embolism to facilitate the timely management of the critical situation.
Comparison of Critical Illness Score in Patients Admitted to Intermediate Care Units of a Tertiary Care Hospital: A Comparative Cross-Sectional Study from Karachi, Pakistan
Authors: Ahmed Amber Sabeen , Iqbal Madiha , Sethi Sher Muhammad , Sabir Sania , Almas Aysha 
Published: June 2024

Abstract

Introduction
Intermediate care units (IMCUs) serve as step-up units for emergency department patients and as step-down units for critically ill patients transferred from intensive care units. This study compares four critical illness scores for assessment of acutely ill patients and their accuracy in predicting mortality in patients admitted to IMCU.

Methods
A comparative cross-sectional study on patients aged ≥18 admitted to IMCU of Aga Khan University Hospital from 2017 to 2019. All patients admitted to IMCU from the emergency room were included in the study. Patient’s record were reviewed for demographic data, physiological and laboratory parameters. Critical illness scores were calculated from these variables for each patient.

Results
A total of 1192 patients were admitted to the IMCU, of which 923 (77.4%) medical records were finally analyzed. The mean (SD) age of participants was 62 years (± 16.5) and 469 (50.8%) were women. The overall hospital mortality rate of patients managed in IMCU was 6.4% (59/923 patients). The median scores of APACHE II, SOFA, SAPS II and MEWS were 16 (IQR 11–21), 4 (IQR 2–6), 36 (IQR 30–53) and 3 (IQR 2–4) points respectively. AUC for SAPS II was 0.763 (95% CI: 0.71–0.81), SOFA score was 0.735 (95% CI: 0.68–0.79) and MEWS score was 0.714 (95% CI: 0.66–0.77). The lowest ROC curve was 0.584 (95% CI: 0.52–0.64) for APACHE II.

Conclusion
In conclusion, our study found that SAPS II, followed by SOFA and MEWS scores, provided better discrimination in stratifying critical illness in patients admitted to IMCU of a tertiary care hospital in Pakistan.
Posterior Reversible Encephalopathy Syndrome, not so Uncommon in Pediatric Patients with Renal Involvement: A Case Series
Authors: Koller Ana-Maria Roxana , Man Alexandra , Muntean Carmen 
Published: June 2024

Abstract

Introduction
Posterior reversible encephalopathy syndrome (PRES) primarily shows neurological symptoms and is more frequent in males, often occurring in oncological patients. It can also be associated with renal conditions like post-streptococcal glomerulonephritis, a common cause of pediatric hypertension. Management involves blood pressure and seizure treatment. In some cases, it may lead to irreversible and severe complications. Early treatment is essential for prevention.

Presentation of case series
In the past six months, we have documented the cases of two patients, aged 15 and 10, both of whom presented with PRES and renal disease. These patients were admitted because of general malaise, headaches, nausea, vomiting, visual disturbances, and elevated blood pressure. Subsequently, both patients experienced epileptic episodes. Only the first patient required transfer to the Pediatric Intensive Care Unit (PICU). Cerebral magnetic resonance imaging (MRI) scans revealed distinct PRES lesions in both cases. Following comprehensive investigations, both cases were diagnosed with PRES in the context of acute post-streptococcal glomerulonephritis.

Conclusions
The patients showed improvement following the administration of antihypertensive and anticonvulsant medications, along with treatment for the underlying renal condition.
Simplified Diagnosis of Urosepsis by Emergency Ultrasound Combined with Clinical Scores and Biomarkers
Authors: Dragoescu Alice Nicoleta , Dragoescu Petru Octavian , Stanculescu Andreea Doriana , Padureanu Vlad , Dop Dalia , Radu Mihai Alexandru , Florescu Mirela Marinela , Maria Daniela Teodora , Florescu Dan Nicolae , Mitroi George 
Published: June 2024

Abstract

Background
Urosepsis is a life-threatening medical condition due to a systemic infection that originates in the urinary tract. Early diagnosis and treatment of urosepsis are critical to reducing mortality rates and preventing complications. Our study was aimed at identifying a fast and reliable method for early urosepsis diagnosis and severity assessment by combining prognostic scores such as SOFA and NEWS with ultrasound examination and serum markers PCT and NLR.

Methods
We performed a single-center prospective observational study in the Craiova Clinical Emergency Hospital. It initially analysed 204 patients admitted for sepsis of various origins in our hospital between June and October 2023. Those with urological conditions that were suspected to have urosepsis have been selected for the study so that finally 76 patients were included as follows: the severe cases with persistent hypotension requiring vasopressor were enrolled in the septic shock group (15 patients - 19.7%), while the rest were included in the sepsis group (61 patients - 80.3%). Mortality rate in our study was 10.5% (8/76 deaths due to sepsis).

Results
Both prognostic scores SOFA and NEWS were significantly elevated in the septic shock group, as were the sepsis markers PCT and NLR. We identified a strong significant positive correlation between the NEWS and SOFA scores (r = 0.793) as well as PCT and NLR (r=0.417). Ultrasound emergency evaluation proved to be similar to CT scan in the diagnosis of urosepsis (RR = 0.944, p=0.264). ROC analysis showed similar diagnostic performance for both scores (AUC = 0.874 for SOFA and 0.791 for NEWS), PCT and NLR (AUC = 0.743 and 0.717).

Conclusion
Our results indicate that an accurate and fast diagnosis of urosepsis and its severity may be accomplished by combining the use of simpler tools like emergency ultrasound, the NEWS score and NLR which provide a similar diagnosis performance as other more complex evaluations.
Feeding Intolerance in Critically Ill Patients with Enteral Nutrition: A Meta-Analysis and Systematic Review
Authors: Xu Jing , Shi Wenyu , Xie Liying , Xu Jing , Bian Lanzheng 
Published: June 2024

Abstract

Background
Feeding intolerance is a common yet serious complication in critically ill patients undergoing enteral nutrition. We aimed to conduct a meta-analysis to evaluate the risk factors of feeding intolerance in critically ill patients undergoing enteral nutrition, to provide insights to the clinical enteral nutrition treatment and care.

Methods
Two researchers systematically searched PubMed, Medline, Web of Science, Cochrane Library, Chinanews. com, Wanfang and Weipu databases about the studies on the risk factors of feeding intolerance in severe patients with enteral nutrition up to August 15, 2023. Literature screening, data extraction and quality evaluation were carried out independently by two researchers, and Meta analysis was carried out with RevMan 5.3 software and Stata 15.0 software.

Results
18 studies involving 5564 enteral nutrition patients were included. The results of meta-analyses showed that age < 2 years old, age > 60 years old, APACHE II score ≥ 20, Hypokalemia, starting time of enteral nutrition > 72 hours, no dietary fiber, intra-abdominal pressure > 15mmHg, central venous pressure > 10cmH2O and mechanical ventilation were the risk factors of feeding intolerance in critically ill patients undergoing EN (all P<0.05). No publication biases were found amongst the included studies.

Conclusion
The incidence of feeding intolerance in critically ill patients undergoing enteral nutrition is high, and there are many influencing factors. Clinical medical workers should take effective preventive measures according to the risk and protective factors of patients to reduce the incidence of feeding intolerance and improve the prognosis of patients.
Weaning Outcome is Associated with ELWI and Impaired Diastolic Function
Authors: Bagka Dimitra , Zakynthynos George , Tsolaki Vasiliki , Papanikolaou Jonh , Vazgiourakis Vasilis , Baka Maria , Pratsas Konstantinos , Makris Demosthenes 
Published: June 2024

Abstract

Objectives
To evaluate hemodynamic profiles of critical care patients undergoing spontaneous t-piece trial (SBT) and present weaning failure.

Methods
Prospective observational study conducted in ready-to-wean non-cardiac ICU patients. Clinical, echocardiographic and thermodilution-derived variables were recorded before and after a 2-hour SBT. Weaning from mechanical ventilation was defined as preservation of spontaneous breathing for 48 hours following successful SBT.

Results
Fourteen patients succeeded weaning, five manifested T-trial-failure and six late-failure. Weaning outcome was significantly associated with ELWI(Extravascular lung-water index), global-end-diastolic index and impaired diastolic function, as indicated by pre-T Doppler early wave velocities (E/Em); Fifty-six percent of participants presented ELWI≥7mL/kg when fulfilling predetermined criteria for weaning. ELWI, impaired pulmonary permeability and left ventricular diastolic dysfunction were independent determinants of ELWI.

Conclusions
ELWI before SBT and impaired diastolic function (as indicated by pre-T E/Em) might be weaning outcome determinants and their assessment may allow better risk stratification in weaning decision making.
Retrospective Study of the Use of Heparins in Pregnant Women and in vitro Testing on the HCT 116 Colorectal Carcinoma Cell Line
Authors: Fiat Felicia , Arnautu Diana-Aurora , Bernad Brenda Cristina , Anton Alina , Marcovici Iasmina , Semenescu Alexandra-Denisa , Bernad Elena Silvia 
Published: June 2024

Abstract

Introduction
Pregnant women manifest an increased risk of developing coagulation disorders. Unfractionated heparin (HEP) and low-molecular-weight heparin (LMWHep) are considered as selective medication in the case of pregnancy which needs anticoagulant treatment. In addition to anticoagulant properties, HEP and its derivatives manifest other properties including anti-cancer potential. According to Globocan’s latest data, colorectal cancer (CRC) is the second most encountered form of malignancy in the case of women, manifesting some special particularities, as confusion of symptoms from cancer with symptoms encountered normally in pregnant women (such as constipation or rectal bleeding), delayed diagnosis because of limitations imposed both for the fetus and for the mother, and the need for special treatment.

Aim
The aim of the present work is to follow the incidence and safety of consumption of HEP and LMWHep in the case of pregnant women and to analyze their potential on the HCT 116 colorectal carcinoma cells.

Results
Analyzing the consumption of heparins in case of pregnant women hospitalized from 01.01.2022 to 31.12.2022 at the Pius Brînzeu” Emergency Clinical Hospital from Timisoara, Obstetrics and Gynecology Clinic I, it was observed that 44,6% of the patients were administered the following medication and no administration risks were observed. When tested on HCT 116 cells, heparins manifested a significant anti-migratory effect (with wound healing rates of 2,6%, when tested with HEP 100 UI concentration and 14.52% wound healing rates in case of fraxiparine 100 UI). In addition, different signs of apoptosis were observed, suggesting the pro-apoptotic potential of the tested substances.

Conclusions
Heparins remain the preferred medication to be administered to pregnant women with the potential for coagulation disorders, showing a high safety profile. Testing on the cancerous line of colorectal carcinoma highlights important properties that stimulate future studies, to establish the anti-tumor potential and the exact mechanism of action.
Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS)
Authors: Cucerea Manuela , Simon Marta , Stoicescu Silvia Maria , Blaga Ligia Daniela , Galiș Radu , Stamatin Maria , Olariu Gabriela , Ognean Maria Livia 
Published: June 2024

Abstract

Introduction
This study is part of a European survey on delivery room practices endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Romanian Association of Neonatology (ANR). The aim of our study was to evaluate the current neonatal resuscitation practices in Romanian maternity hospitals and to compare the results between level III and level II centers.

Material and Methods
The questionnaire was distributed through ANR by email link to heads of neonatal departments of 53 Romanian maternity hospitals with more than one thousand of births per year between October 2019 and September 2020, having 2018 as the reference year for data collection.

Results
The overall response rate to the questionnaire was 62.26% (33/53), 83.33% (15/18) for level-III centers and 51.43% (18/35) for level-II centers. Of the responding centers, 18 (54,54%) were academic hospitals, 15 (83,33%) were level III and 3 (16,67%) level II hospitals. In 2018, responding centers reported 81.139 births representing 42.66% of all Romanian births (190.170). There were significant differences between level-III and level-II maternity hospitals regarding the number of births in 2018 (3028.73±1258.38 vs 1983.78±769.99; P=0.006), lowest GA of routinely assisted infants in delivery room (25.07±3.03 weeks vs 30.44±3.28, P<0.001), inborn infants with BW<1500 admitted to neonatal intensive care unit (NICU) in 2018 (66.86±39.14 g vs 22.87±31.50 g; P=0.002), and antenatal counseling of parents before the delivery of a very preterm infant or an infant with expected problems (60% vs 22.2%; P=0.027). There were no significant differences of thermal and umbilical cord management, positive pressure delivery, heart rate assessment between responding centers.

Conclusion
The adherence to new guidelines was high among responding centers regarding thermal and umbilical cord management, initial FiO2, but aspects like antenatal counseling, EKG monitoring, laryngeal mask, and heated/humidified gases availability and administration, and simulation-based training require further implementation.
User’s Search for Information: A Multi-Language Cross-Sectional Assessment of Websites about Healthcare-Associated Infections
Authors: Nădășan Valentin , Kasza Dalma , Kiss Konrád-Ottó , Maior David , Mărușteri Marius 
Published: June 2024

Abstract

Introduction
Healthcare-associated infections have a significant impact on public health, and many patients and their next-of-kin are seeking information on the internet. The study aimed to assess the quality of online written content about healthcare-associated infections available in English, Romanian, and Hungarian languages.

Materials and methods
The study sample included 75 websites, 25 for each language subgroup. The assessment involved examining the general characteristics, adherence to established credibility criteria, and the completeness and accuracy of informational content. The evaluation was conducted using a topic-specific, evidence-based benchmark. Two evaluators independently graded completeness and accuracy; scores were recorded on a scale from 0 to 10. A comparative analysis of websites was performed, considering pertinent characteristics, and potential factors influencing information quality were subjected to testing. The statistical significance was set at 0.05.

Results
For the overall study sample, the average credibility, completeness, and accuracy scores were 5.1 (SD 1.7), 2.4 (SD 1.5), and 5.9 (SD 1.0), respectively. Pairwise comparison tests revealed that English websites rated significantly higher than Romanian and Hungarian websites on all three quality measures (P<0.05). Website specialization, ownership, and main goal were not associated with credibility or content ratings. However, conventional medicine websites consistently scored higher than alternative medicine and other websites across all three information quality measures (P<0.05). Credibility scores were positively but weakly correlated with completeness (rho=0.273; P=0.0176) and accuracy scores (rho=0.365; P=0.0016).

Conclusions
The overall quality ratings of information about healthcare-associated infections on English, Romanian, and Hungarian websites ranged from intermediate to low. The description of information regarding the symptoms and prevention of healthcare-associated infections was notably unsatisfactory. The study identified website characteristics possibly associated with higher-quality online sources about healthcare-associated infections, but additional research is needed to establish robust evidence.
Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia
Authors: Anand Abhijeet , Kodamanchili Sai Teja , Joshi Ankur , Joshi Rajnish , Sharma Jai Prakash , Abhishek Goyal , Pakhare Abhijit P , Niwariya Yogesh , Panda Rajesh , Karna Sunaina T , Khurana Alkesh K , Saigal Saurabh 
Published: June 2024

Abstract

Introduction
NIV (Non-invasive ventilation) and HFNC (High Flow nasal cannula) are being used in patients with acute respiratory failure. HACOR score has been exclusively calculated for patients on NIV, on other hand ROX index is being used for patients on HFNC. This is first study where ROX index has been used in patients on NIV to predict failure.

Aim of the study
This study investigates the comparative diagnostic performance of HACOR score and ROX index to predict NIV failure.

Methods
We performed a retrospective cohort study of non-invasively ventilated COVID-19 patients admitted between 1st April 2020 to 15th June 2021 to ICU of a tertiary care teaching hospital located in Central India. We assessed factors responsible for NIV failure, and whether these scores HACOR/ROX index have discriminative capacity to predict risk of invasive mechanical ventilation.

Results
Of the 441 patients included in the current study, 179 (40.5%) recovered, while remaining 262 (59.4%) had NIV failure. On multivariable analysis, ROX index > 4.47 was found protective for NIV-failure (OR 0.15 (95% CI 0.03–0.23; p<0.001). Age > 60 years and SOFA score were other significant independent predictors of NIV-failure. The AUC for prediction of failure rises from 0.84 to 0.94 from day 1 to day 3 for ROX index and from 0.79 to 0.92 for HACOR score in the same period, hence ROX score was non-inferior to HACOR score in current study. DeLong's test for two correlated ROC curves had insignificant difference expect day-1 (D1: 0.03 to 0.08; p=3.191e-05, D2: −0.002 to 0.02; p = 0.2671, D3: −0.003 to 0.04; p= 0.1065).

Conclusion
ROX score of 4.47 at day-3 consists of good discriminatory capacity to predict NIV failure. Considering its non-inferiority to HACOR score, the ROX score can be used in patients with acute respiratory failure who are on NIV.
Weekend Effect and Mortality Outcomes in Aortic Dissection: A Prospective Analysis
Authors: Banceu Cosmin Marian , Harpa Marius , Brinzaniuc Klara , Neagu Nicolae , Szabo Dan Alexandru , Banceu Diana Mariana , Al Hussein Hussam , Cristutiu Daiana , Puscas Alexandra , Stan Alexandru , Oprean Marvin , Popentiu Adrian , Halic Marius Neamtu , Suciu Horatiu 
Published: June 2024

Abstract

Background
Aortic dissection (AD) is a critical heart condition with potentially severe outcomes. Our study aimed to investigate the existence of a “weekend effect” in AD by examining the correlation between patient outcomes and whether their treatment occurred on weekdays versus weekends.

Methods
Specifically, we prospectively analysed the effect of weekday and weekend treatment on acute AD patient outcomes, both before surgical intervention and during hospitalization, for 124 patients treated from 2019–2021, as well as during 6 months of follow-up.

Results
The mean age of the study population was 62.5 years, and patient age exhibited a high degree of variability. We recorded a mortality rate before surgery of 8.65% for the weekend group and 15% for the weekday group, but this difference was not statistically significant. During hospitalization, mortality was 50% in the weekend group and 25% in the weekday group, but this difference was not statistically significant. Discharge mortality was 9.61% in the weekend group and 5% in the weekday group.

Conclusions
Our findings suggest that there was no significant difference in mortality rates between patients admitted to the hospital on weekends versus weekdays. Therefore, the period of the week when a patient presents to the hospital with AD appears not to affect their mortality.