3 research outputs found
Hoffmann's syndrome: delayed onset and progression in the elderly - a case report
No full textHoffmann's syndrome (HS) is typically characterized by myopathy and linked to hypothyroidism. It is distinguished by hypothyroidism, muscle weakness, and pseudohypertrophy of particular muscles. In the present case report, a 70-year-old man was brought to the hospital with major complaints of hematuria and swelling in both legs, and a small wound on his right leg. He had a known history of type 2 diabetes mellitus with irregular medication. The hematological investigation reveals abnormalities, including an irregular Q-wave, an inverted T-wave, and low voltage in the limb leads, as identified by electrocardiography (ECG). Troponin I was negative, cardiac indicators were aberrant, and the creatine kinase myocardial band (CK-MB) level was 132 U/l. To manage the symptoms and stabilize the patient’s condition, he was treated initially with antibiotics, metformin, metoprolol, furosemide, aspirin, and clopidogrel. Contrarily, the leg swelling did not improve. Later, the hematological investigation revealed that abnormal thyroxine levels (T3-0.26 ng/ml, T4-0.5 ng/ml, and TSH-60.0 mIU/l) and prominent right leg swelling were associated with chronic kidney disease (CKD) and Hypothyroidism. The swelling and cellulitis gradually reduced after intravenous meropenem and oral thyroxine treatment. He was continuously monitored, and signs and symptoms steadily improved. In this instance, it is crucial to stress that, particularly in the absence of obvious signs of hypothyroidism, a differential diagnosis of musculoskeletal problems should be taken into consideration when a patient presents with leg swelling, and early detection of Hoffman’s disorder leads to a more effective treatment outcome
Nonlinear Reconstruction of Images from Patterns Generated by Deterministic or Random Optical Masks—Concepts and Review of Research
No full textIndirect-imaging methods involve at least two steps, namely optical recording and computational reconstruction. The optical-recording process uses an optical modulator that transforms the light from the object into a typical intensity distribution. This distribution is numerically processed to reconstruct the object’s image corresponding to different spatial and spectral dimensions. There have been numerous optical-modulation functions and reconstruction methods developed in the past few years for different applications. In most cases, a compatible pair of the optical-modulation function and reconstruction method gives optimal performance. A new reconstruction method, termed nonlinear reconstruction (NLR), was developed in 2017 to reconstruct the object image in the case of optical-scattering modulators. Over the years, it has been revealed that the NLR can reconstruct an object’s image modulated by an axicons, bifocal lenses and even exotic spiral diffractive elements, which generate deterministic optical fields. Apparently, NLR seems to be a universal reconstruction method for indirect imaging. In this review, the performance of NLR isinvestigated for many deterministic and stochastic optical fields. Simulation and experimental results for different cases are presented and discussed
Effect of transcatheter aortic valve implantation vs surgical aortic valve replacement on all-cause mortality in patients with aortic stenosis
No full textImportance: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear.
Objective: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk.
Design, Setting, and Participants: In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019.
Interventions: TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455).
Main Outcomes and Measures: The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation.
Results: Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of −2.0% (1-sided 97.5% CI, −∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]).
Conclusions and Relevance: Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year.
Trial Registration: isrctn.com Identifier: ISRCTN57819173
