Introduction High-flow nasal oxygen (HFNO) has traditionally only been used in intensive care units (ICU) especially in acute respiratory distress syndrome (ARDS). Methods We studied the use of HFNO at Södersjukhuset, Stockholm, in patients with moderate to severe ARDS related to Covid-19 as well as its benefits both for patients and to offload the ICU. The patients were observed with frequent controls to assess the need of ICU in case of deterioration. Results We studied 41 patients with HFNO treatment either as primarily treatment (Step-Up) or after stabilizing in the ICU (Step-Down). The average duration for treatment with HFNO was 5.6 days. Of these patients 55% were discharged home or to geriatric rehabilitation and 10% avoided ICU completely. The usage of HFNO saved in total 229 days in the ICU. Mortality was higher among elderly patients, and patients with comorbidities (mainly hypertension and obesity). Discussion and conclusion HFNO treatment is feasible and efficient for patients with Covid-19, saving resources in the ICU and offering additional advantages as waken proning and fewer complications compared to traditional ICU care. It requires however frequent controls as deterioration is recurrent.
Local calibration of the punchout model in the Pavement ME software is a vital step in achieving performance predictability for the design of Continuously Reinforced Concrete (CRC) pavement. In Oklahoma, there was only limited performance data available in the General Pavement Studies (GPS) database for CRC pavement. This set of circumstances required a different approach as to the type of data used for calibration. The type of data originally utilized in NCHRP 1-37A essentially represented visually evident damage that is clearly observable at the surface of the pavement structure. Non-observable damage however is actually of greater value as a source of calibration data since it represents the deteriorative conditions that lead to the visual manifestation of the damage process. Since visually validated distress is the end result of the distress cycle the traffic level associated with it is often subject to a considerable amount of error. In this regard, non-observable data such as erosion damage is shown to be a good indicator of and a substitute for actual punchout data since it represents the deterioration of the slab subbase interface that has be found to closely aligned with the punchout process. The amount of erosion is evaluated based on FWD data and is shown it to be a reliable way to determine the calibration coefficients for the punchout model. This paper proposes an approach for calibrating local coefficients for CRC pavements based on non-observable performance data. The main process of this methodology requires estimating erosion percentage damage using Falling Weight Deflectometer data (FWD), determining the percentage of punchout from the Long-Term Performance Program (LTPP) records, and establishing the relationship between both components to estimate the existing punchout distresses. This relationship can be used to calculate the actual damage including erosion damage and to calibrate the local coefficients used in the pavement ME punchout model. This methodology was carried out on one section from Oklahoma and one section from Texas in order to validate its applicability and conclude on the pavement ME punchout model and its ability to predict punchout distress in the field.
The incidence of primary tracheobronchomalacia (TBM) in pediatric patients is 1/2100 and its prevalence in very premature infants with bronchopulmonary dysplasia is 10-46%. We report the case of a 26-week-old baby with recurrent infections and stunting. He was diagnosed for TBM.
Purpose The aim of this study was to explore the time-course of hospitalization due to hyponatremia associated with omeprazole and esomeprazole. Methods In this register-based case–control study, we compared patients hospitalized with a main diagnosis of hyponatremia (n = 11,213) to matched controls (n = 44,801). We used multiple regression to investigate time-related associations between omeprazole and esomeprazole and hospitalization because of hyponatremia. Results The overall adjusted OR (aOR) between proton pump inhibitor (PPI) exposure, regardless of treatment duration and hospitalization with a main diagnosis of hyponatremia, was 1.23 (95% confidence interval CI 1.15–1.32). Exposure to PPIs was associated with a prompt increase in risk of hospitalization for hyponatremia from the first week (aOR 6.87; 95% CI 4.83–9.86). The risk then gradually declined, reaching an aOR of 1.64 (0.96–2.75) the fifth week. The aOR of ongoing PPI treatment was 1.10 (1.03–1.18). Conclusion The present study shows a marked association between omeprazole and esomeprazole and hyponatremia related to recently initiated treatment. Consequently, newly initiated PPIs should be considered a potential culprit in any patient suffering from hyponatremia. However, if the patient has had this treatment for a longer time, the PPI should be considered a less likely cause.
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