Comprehensive Medical History Research Articles

Predictive Modeling for Diabetic Management: A Machine Learning Approach

Effective diabetic management is crucial for improving patient outcomes and reducing healthcare costs. This study investigates the application of machine learning techniques to develop predictive models for diabetic management. By leveraging comprehensive patient data, including demographics, medical history, and lifestyle factors, various algorithms such as decision trees, random forests, support vector machines, and neural networks were evaluated. The models demonstrated high accuracy in predicting blood glucose levels, potential complications, and the effectiveness of different treatment regimens. These predictive insights facilitate personalized treatment plans and timely interventions, enhancing patient care. The approach aims to empower healthcare providers with data-driven tools to optimize diabetic management strategies, ultimately improving the quality of life for diabetic patients and minimizing the risk of severe complications

AI-Driven Rehabilitation: Personalizing Cardiac Care Post-Diagnosis

The integration of Artificial Intelligence (AI) into cardiac rehabilitation diagnosis goes beyond advancement; it marks a notable stride, towards personalized medical treatment. This groundbreaking approach harnesses AIs potential to develop custom rehabilitation plans designed to cater to the requirements of each patient. By utilizing a range of data sets that include detailed physiological parameters, comprehensive medical histories and real time monitoring results AI driven algorithms and machine learning methods carefully design treatment plans that greatly improve the effectiveness of rehabilitative treatment. Additionally, this approach does not enhance patient outcomes by optimizing therapeutic interventions but also significantly boosts the efficiency of resources within healthcare systems. This article explores the applications of AI in cardiac rehabilitation addressing complex issues offering sophisticated solutions showcasing its versatility highlighting its profound impact on patient care and outlining opportunities for future integration into standard clinical practices. Through an in-depth examination the review emphasizes AIs role, in enhancing the accuracy of cardiac care and promoting a proactive healthcare environment that prioritizes individualized patient well-being and preventive measures establishing a new benchmark in the field of cardiac rehabilitation. Keywords: Artificial Intelligence, Cardiac Rehabilitation, Personalized Medicine, Machine Learning, Real-time Monitoring, Patient Outcomes.

COMPARATIVE ANALYSIS OF LIPID PROFILE IN PATIENTS WITH HEMORRHAGIC VERSUS ISCHEMIC STROKE: A CROSS-SECTIONAL STUDY

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies. Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p<0.05. Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696). Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

Clinical characteristics of Behçet's disease in an Egyptian cohort

Background: Behçet's disease is a multi-systemic vasculitis characterized by recurring lesions in the skin mucosa and sight-threatening uveitis. The aim of the research: This research aimed to investigate the clinical features of Behçet's disease (BD) in individuals residing in Egypt. Patients and methods: 150 individuals with BD were recruited, examined, and put through a skin allergy test, musculoskeletal assessment, laboratory tests, and comprehensive medical history. The disease's activity was evaluated using the Behçet Disease Current Activity Form (BDCAF). Complete ophthalmological evaluation and imaging studies were performed according to the organ involved. Results: Cases were 116 men (77.3%) and 34 women (22.7%) (M: F 3.4:1). Their mean age was 34.05 ± 9.28 years, and the disease duration range was 1–20 years. Oral and genital aphthosis were reported in 86.7% and 82.0%, respectively. Eye affection was observed in 68.7%, mainly in anterior uveitis (35.3%). Vascular manifestations occurred in 58.7%, affecting primarily the venous side (31.3%) in the form of deep venous thrombosis (DVT). 32.7% had joint affection, and the pathergy test was positive for 28%. Central nervous system (CNS), skin lesions, and gastrointestinal tract involvement were the slightest common manifestations observed in 26%, 25.3%, and 7.3%, respectively. Articular manifestations were markedly linked to skin lesions (P = 0.002), and there was a significant predominance of articular manifestations among females (P = 0.042). BDCAF score was significantly related to male gender (P = 0.037), smokers (P < 0.000), those with older age (P = 0.028), delayed age of disease onset (P = 0.025), and additionally those with the eye (P = 0.000) and CNS involvement (P = 0.003). Conclusion: The clinical features of Egyptian Behçet's patients were significantly dominated by mucocutaneous involvement, followed by ocular affection. Articular manifestations were markedly more significant in women. The disease activity score was more remarkable in males, smokers, those of older age, and those with a delayed age of disease onset.

Leveraging explainable artificial intelligence for early prediction of bloodstream infections using historical electronic health records.

Bloodstream infections (BSIs) are a severe public health threat due to their rapid progression into critical conditions like sepsis. This study presents a novel eXplainable Artificial Intelligence (XAI) framework to predict BSIs using historical electronic health records (EHRs). Leveraging a dataset from St. Olavs Hospital in Trondheim, Norway, encompassing 35,591 patients, the framework integrates demographic, laboratory, and comprehensive medical history data to classify patients into high-risk and low-risk BSI groups. By avoiding reliance on real-time clinical data, our model allows for enhanced scalability across various healthcare settings, including resource-limited environments. The XAI framework significantly outperformed traditional models, particularly with tree-based algorithms, demonstrating superior specificity and sensitivity in BSI prediction. This approach promises to optimize resource allocation and potentially reduce healthcare costs while providing interpretability for clinical decision-making, making it a valuable tool in hospital systems for early intervention and improved patient outcomes.

Protocolo diagnóstico de las anemias hemolíticas

Hemolytic anemias are defined by the premature destruction of circulating red blood cells. They can be classified as congenital or acquired and most are of immune origin. Diagnosis requires a comprehensive medical history, including a personal and family history; use of drugs or toxins; and a series of laboratory tests. Test findings predominantly show a marked decrease in hemoglobin; an increase in reticulocytes, bilirubin (indirect fraction), and lactate dehydrogenase; and a decrease in haptoglobin. Finally, a direct antiglobulin test (direct Coombs test) and a peripheral blood smear can be very useful in indicating the possible cause of hemolytic anemia.

Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.

A case report of acute myocardial infarction with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by epistaxis, gastrointestinal bleeding, iron deficiency anemia, and arteriovenous malformations (AVMs) affecting the lungs, liver, and brain. Owing to its rarity and diagnostic challenges, early identification is often elusive. Underdiagnosis and prolonged diagnostic delays are prevalent. Here, we present the case of a 63-year-old male who presented with chest pain and was diagnosed with an ST-elevation myocardial infarction (STEMI). Subsequently, he underwent placement of a drug-eluting stent in the right coronary artery (RCA). However, recurrent postoperative epistaxis resulted in severe anemia, prompting further investigation leading to the diagnosis of hereditary hemorrhagic telangiectasia through comprehensive medical history and genetic testing. Future studies are warranted to evaluate reperfusion strategies in HHT patients presenting with myocardial infarction.

Nutritional screening in children with cerebral palsy in Tanta University Hospitals

Background Cerebral palsy (CP) in children can lead to malnutrition due to growth hormone dysregulation, muscle spasticity, and feeding difficulties, which can worsen CP limitations and lead to multiple negative impacts on general health. Aim To screen the nutritional status of children with CP at the University Hospitals. Patients and methods This cross-sectional observational study included 100 CP children of both sexes, aged less than 17 years old, who attended the Pediatric Clinical Nutrition and Neurology Clinics at the University Hospitals. They underwent a comprehensive medical history, which included a detailed feeding history, a thorough clinical examination, and an assessment of their anthropometric measurements. Results Lack of weight gain for 2–3 months was the most common indicator of feeding and swallowing difficulties (74%), followed by stressful mealtimes with caregivers (61%). The main gastrointestinal tract comorbidity was dysphagia (40%). The median daily water, energy, carbohydrate, protein, fat, and fiber intakes as percentages of the recommended dietary allowance were 45, 66, 76, 67, 78, and 19%, respectively. The prevalence of malnutrition was 24% for wasting (6% severe) based on the Gomez classification and 93% for stunting (57% severe) based on the Waterlow classification. Conclusion Most of the studied CP patients had red flags indicating feeding and swallowing difficulties. They consumed less water, calories, and macronutrients than the recommended dietary allowances for their ages. In addition, they had varied degrees of malnutrition.

Rates of Visual Field Progression Before and After the Onset of Atrial Fibrillation.

This case-control study investigated the effect of atrial fibrillation (AF) on the progression of glaucoma. The presence of AF and related microvascular damage were associated with a slightly faster visual field loss in glaucoma patients. To investigate the effect of atrial fibrillation (AF) on glaucoma progression. In this longitudinal case-control study, a total of 144 eyes from 105 patients with primary open angle glaucoma were included. 48 eyes of case developed AF during the follow-up followed for 15.6 years. 96 eyes of control that did not have AF at baseline or during follow-up matched for age, baseline glaucoma severity and follow-up period were followed for an average of 14.7 years. Mixed-effects linear models were used to calculate the difference in the VF MD slopes before and after the AF. CHADS2 and CHA2DS2-VASc scores were used to evaluate the risk of thrombosis event, and related microvascular damage was assessed based on these scores. The rate of VF MD change was -0.20 (-0.42 to 0.02) dB/y before AF and -0.28 (-0.47 to -0.09) dB/y after AF for the patients with AF, and -0.21 (-0.25 to -0.17) dB/y for the control. In the multivariable models, the VF slope difference before and after the onset of AF (-0.10 (-0.14 to -0.05) dB/y, P<0.001), higher CHADS2 score (-0.07 (-0.13 to 0.00) dB/y per 1 unit, P=0.040), and higher CHA2DS2-VASc score (-0.05 (-0.10 to 0.00) dB/y per 1 unit, P=0.039) were associated with faster VF MD loss. The presence of atrial fibrillation and related microvascular damage might accelerate visual field loss. This underscores the need for a comprehensive medical history and management of cardiovascular risk factors to mitigate increase VF loss in glaucoma.

Intramuscular lipomas posing diagnostic and pre-operative counselling challenges in a low-resource setting: A case series

IntroductionIntramuscular lipomas (IMLs) are uncommon primary adipose tissue tumours deep within the muscle. A high likelihood of misdiagnosing them as other benign and malignant masses necessitates imaging studies to confirm the diagnosis and plan treatment. Ultrasonography is useful but CT and MRI provide a more accurate diagnosis. While diagnostic tests are suitable, they may not always be accessible or affordable in low-resource settings. We present three cases of IMLs that emphasise the difficulties posed by limited resources and the significance of a comprehensive medical history and physical examination in low-resource settings. Presentation of casesThe patients included a 57-year-old male with a distal right thigh mass, a 65-year-old female with a proximal right thigh mass, and a 60-year-old female with a mass at the left scapular area. The three patients underwent surgical excision and had an uneventful postoperative course, with no reported recurrence during their ongoing follow-up. DiscussionThe management of IMLs is not complicated if the requisite resources are available. Conversely, in low-resource settings with limited diagnostic facilities and human expertise, management may take a challenging path. Patient 1, despite undergoing diagnostic tests confirming IML, initially declined treatment due to challenges with pre-operative counselling. Patients 2 and 3 lacked health insurance and could not afford diagnostic imaging tests. ConclusionHealthcare professionals in low-resource settings should familiarise themselves with the clinical characteristics and pathology of IMLs to minimise misdiagnosis and ensure appropriate counselling is provided to patients. IMLs are slow-growing mostly asymptomatic benign swelling. On physical examination, they are usually non-tender, soft, masses, not fixed to the bed or overlying tissue. The overlying skin is normal and lymphadenopathy is absent.

Ophthalmic manifestations of NAA10-related and NAA15-related neurodevelopmental syndromes: Analysis of cortical visual impairment and refractive errors.

NAA10-related (Ogden syndrome) and NAA15-related neurodevelopmental syndrome are known to present with varying degrees of intellectual disability, hypotonia, congenital cardiac abnormalities, seizures, and delayed speech and motor development. However, the ophthalmic manifestations of NAA10 and NAA15 variants are not yet fully characterized or understood. This study analyzed the prevalence of six ophthalmic conditions (cortical visual impairment, myopia, hyperopia, strabismus, nystagmus, and astigmatism) in 67 patients with pathogenic (P) or likely pathogenic (LP) variants in the NAA10 cohort (54 inherited, 10 de novo; 65 missense, 2 frameshift) and 19 patients with (L)P variants in the NAA15 cohort (18 de novo; 8 frameshift, 4 missense, 4 nonsense, and 1 splice site). Patients were interviewed virtually or in-person to collect a comprehensive medical history verified by medical records. These records were then analyzed to calculate the prevalence of these ophthalmic manifestations in each cohort. Analysis revealed a higher prevalence of ophthalmic conditions in our NAA10 cohort compared to existing literature (myopia 25.4% vs. 4.7%; astigmatism 37.3% vs. 13.2%; strabismus 28.4% vs. 3.8%; CVI 22.4% vs. 8.5%, respectively). No statistically significant differences were identified in the prevalence of these conditions between the NAA10 and NAA15 variants. Our study includes novel neuroimaging of 13 NAA10 and 5 NAA15 probands, which provides no clear correlation between globe size and severity of comorbid ophthalmic disease. Finally, anecdotal evidence was compiled to underscore the importance of early ophthalmologic evaluations and therapeutic interventions.

Pattern of eye trauma among pediatric ophthalmic patients in upper and lower Egypt: A prospective two-center medicolegal study.

Ocular trauma is the leading cause of monocular blindness in children. This study aimed to identify and compare pediatric ocular injuries at two national university hospitals: Benha University Hospital (BUH) and South Valley University Hospital (SVUH) while evaluating the predictive utility of the Ocular Trauma Score (OTS) for post-traumatic permanent visual infirmity. This multicenter observational study enrolled children under 18 years at BUH and SVUH Ophthalmology Departments from May 31 to December 31, 2022. Comprehensive medical histories and detailed data on eye trauma were obtained, with each undergoing thorough eye examinations at the initial presentation and during the 6-month follow-up period. The final visual outcome was permanent visual infirmity that was defined as the Best Corrected Visual Acuity in the better eye worse than 3/60 or near vision worse than N6 according to the International Classification of Diseases 11. The study included 120 cases evenly distributed between the two hospitals, with a mean age of 10.03 (±3.30) years, 74.17% male and 51.67% urban residents. Blunt, sharp, and foreign objects were the most common causes (39.17%, 33.33%, and 11.67%, respectively). Closed-globe injuries prevailed at BUH (83.33%) than SVUH (40.0%). Most injuries were accidental and outdoors, with an average interval of 9.93 (±23.57) hours to seek medical care. Lack of education, open-globe injuries, poor initial visual acuity, longer intervals from admission to intervention, and lower OTS were associated with visual impairment.

Predictors of hemorrhagic transformation in patients of first ever acute ischemic stroke receiving recombinant tissue plasminogen activator (rTPA)

Abstract Background Hemorrhagic transformation (HT) represents a serious complication of acute ischemic stroke (AIS). Aim To detect predictive factors linked to HT among patients having a first-ever AIS who received recombinant tissue plasminogen activator (rTPA), for better preselection of patients eligible for thrombolytic therapy. Patients and methods This research took place at the Neuropsychiatry Department and Centre of Psychiatry, Neurology, and Neurosurgery, Tanta University Hospitals over 12 months. The total number of patients included was 460, with 115 who received rTPA and 345 who did not receive rTPA. All participants underwent a comprehensive medical history, clinical and neurological assessments, radiological evaluation (ASPECT score), cardiac investigation, and were followed-up for two weeks to detect any HT. Results Patients with HT represented 21.7% of all rTPA patients, with symptomatic intracranial hemorrhage representing 6.9%, while non-rTPA patients with HT represented 13.9% and symptomatic intracranial hemorrhage represented 4.3%. HT patients in the rTPA group had significantly higher rates of smoking, respiratory rate, and lower platelet count, low density lipoprotein and cholesterol levels, while HT patients in the non-rTPA group exhibited significantly higher blood pressure, random blood sugar, as well as lower ASPECT scores. Conclusion There was an association between HT and five predictors (higher smoking rate, higher respiratory rate, lower platelet count, and lower low density lipoprotein and cholesterol levels) in first ever acute ischemic stroke patients receiving rTPA. In patients who did not receive rTPA, HT was associated with lower ASPECT scores, higher blood pressure, and random blood sugar.

The Morbid Impact of Environmental Toxins on the Human Nervous System: Peripheral Neuropathy Nexus with Organic Solvents, Pesticides, and Heavy Metals

Peripheral neuropathy is a complex disorder characterized by damage to the peripheral nerves, resulting in various sensory, motor, and autonomic symptoms. This review offers a detailed examination of peripheral neuropathy, covering its prevalence, effects on individuals and society, causes, diagnosis, mechanisms, treatment, and management, focusing on its association with environmental toxins. The etiology of peripheral neuropathy is multifactorial, encompassing diverse causes such as diabetes mellitus, autoimmune diseases, infections, vitamin deficiencies, toxic exposures, and genetic factors. Notably, environmental toxins, including organic solvents, pesticides, and heavy metals, have been implicated in the pathogenesis of peripheral neuropathy. Environmental toxins exert their neurotoxic effects through various mechanisms, including disruption of neuronal membrane integrity, interference with neurotransmission, induction of oxidative stress, and promotion of inflammatory responses. Accurate diagnosis of peripheral neuropathy involves a comprehensive medical history, neurological examination, electrophysiological studies, imaging tests, and laboratory investigations to identify underlying causes, including environmental toxin exposure. Treatment strategies for environmental toxin-induced peripheral neuropathy focus on eliminating exposure, managing symptoms, and preventing further nerve damage. Pharmacological interventions, adjunctive therapies, nutritional support, regular monitoring, and patient education are integral to management. A multidisciplinary approach is fundamental for diagnosing and managing peripheral neuropathy effectively, emphasizing identifying and mitigating environmental toxin exposure to alleviate symptoms and improve quality of life.

Late-Onset Reactions after Hyaluronic Acid Dermal Fillers: A Consensus Recommendation on Etiology, Prevention and Management.

Hyaluronic acid (HA) dermal fillers, generally considered low-risk, can lead to rare late-onset reactions (LORs) manifesting between 3 and 4 months postinjection, occasionally even as early as 24h postinjection. The Complication Assessment and Risk Evaluation (CARE) board was established to review these reactions. In this publication, the authors aims to explore the etiological hypotheses underlying LORs, associated risk factors, prevention, and management approaches suggested by the CARE board. The CARE board identified three etiological hypotheses contributing to LORs. Firstly, the physicochemical structure of the filler, particularly low molecular weight HA, which may trigger an immune response. Secondly, infection, potentially introduced during injection or by dormant biofilm activation. Lastly, an imbalance in the host immune system, caused by factors like autoimmune diseases or viral infections, may lead to extended foreign body reactions, delayed type IV hypersensitivity, or adjuvant-based reactions. Based on these hypotheses, the board categorized various risk factors as patient-related (e.g., recent dental treatment, current medical status, active autoimmune disease), product-related (e.g., molecular weight), and procedure-related (e.g., aseptic technique and trauma). To reduce the risk of LORs, the CARE board recommends diligent patient selection, including comprehensive medical history assessment and informed consent. Practitioners should maintain an effective aseptic technique, and choose an appropriate product and injection depth for the anatomical location. Post-procedure, patients should receive education on proper filler care. Management of LORs depends on the suspected etiology, and the CARE board has proposed an algorithm to determine the most appropriate treatment. Hyaluronidase is recommended for noninflammatory reactions in the absence of active infection, while watchful waiting and/or steroid treatment may be preferred for inflammatory reactions. Hyaluronidase is not recommended as a first-line treatment for infections, which require drainage, bacterial culture, and antibiotic treatment. However, the board emphasizes the need for individualized evaluation and treatment in all cases.

Impact of Pulmonary Rehabilitation on Fatigue and Quality of Life in Patients of Interstitial Lung Disease

Individuals with interstitial lung diseases (ILDs) often experience debilitating fatigue, impacting their quality of life. Pulmonary rehabilitation (PR), comprising tailored exercise, education, and behaviour change, aims to improve physical and psychological conditions in ILD patients. Evaluating fatigue and quality of life pre- and post-pulmonary rehabilitation provides insights into its effectiveness in enhancing patient outcomes. Following ethical approval, an exploratory cross-sectional study was conducted at the Department of Respiratory Medicine, Chettinad Hospital and Research Institute. The study enrolled 73 ILD patients admitted between August 2022 and August 2023. Comprehensive pulmonary function assessments and medical histories were obtained from reliable sources and were assessed with questionnaires like the Fatigue Assessment Scale (FAS) for fatigue and St. George Respiratory Questionnaire (SGRQ) for quality of life before and after a 6-month individualized home-based pulmonary rehabilitation program. Seventy-three (73) patients were enrolled in the study. The age group with the highest number of patients was between 50 – 60 years (40%), with a male predominance of 60 % (44). Independent samples of different tools in the research and their mean values were compared using the T-test. This study illustrates the considerable link between the ILD cases for FAS and SGRQ with statistically significant differences in FAS and SGRQ between time durations, at 3 and 6 months duration, indicating improvement in fatigue and quality of life in those patients at a 3 and 6-month duration (p &lt;0.001). The assessment showed a significant decline in fatigue levels (p&lt;0.001) and a marked betterment in the overall quality of life (p&lt;0.0066) among patients after participating in Pulmonary Rehabilitation when compared with FVC severity. These findings underscore the importance of integrating rehabilitation programs into the comprehensive care of these patients to improve their overall health and well-being.

Causal Effects of Inflammatory Bowel Diseases on the Risk of Kidney Stone Disease.

Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, have been increasingly associated with kidney stone disease, posing significant health challenges globally. This research sought to determine the causal relationship between kidney stone disease risk and inflammatory bowel disorders. This retrospective cohort study included patients with IBDs, such as ulcerative colitis or Crohn's disease, who were diagnosed at least 18 years of age. Information was gathered with an emphasis on patients having comprehensive medical histories and confirmed cases of kidney stone disease from Januaryto December 2022. Medical records were retrospectively evaluated by trained staff to extract treatment information and clinical, radiological, and demographic data. To evaluate relationships, statistical analysis was carried out in SPSS software version 23 using Chi-square tests and descriptive statistics. The study included 320 patients diagnosed with IBDs, among which 198 (61.87%) had Crohn's disease, and 122 (38.13%) were diagnosed with ulcerative colitis. The cohort consisted of 140 females (43.75%) and 180 men (56.25%), with a mean age of 45.5 years. Regarding smoking, 113 people (35.31%) reported being smokers, whereas 207 people (64.69%) did not smoke. Additionally, 18 (5.62%) of the population had an underweight BMI, 136 (42.50%) had a normal BMI, 119 (37.19%) had an overweight BMI, and 47 (14.69%) had an obese BMI. Of the patients, 86 (26.88%) had a prior history of kidney stone disease, while 194 (60.62%) did not. Aminosalicylates were the most often used therapy modality for IBDin 189 (58.97%) of cases, followed by corticosteroids in 117 (36.56%) and immunomodulators in 93 (28.94%). Radiological examinations showed that renal calculi were present in 60 (18.75%) of patients, and kidney stones occurred in 40 (12.50%) of patients throughout the research period. The smoking status (p=0.006) and prior history of kidney stones (p<0.001) were the corresponding p-values for the significant results. The study highlights an increased risk of kidney stone disease in IBD patients, particularly among smokers and those with a recurrent history of kidney stones. Of the 320 patients, 198 (61.87%) had Crohn's disease and 122 (38.13%) had ulcerative colitis, with a significant relationship found between kidney stones and both smoking (113 patients, 35.31%, p=0.006) and a prior history of kidney stones (86 patients, 26.88%, p<0.001). The findings emphasize the need for targeted preventive measures and close monitoring of these high-risk groups.

ANALYSIS OF TRANEXAMIC ACID USAGE IN ADULT SPINAL DEFORMITY PATIENTS WITH RELATIVE CONTRAINDICATIONS IN PAKISTAN

Patients who require complex spinal surgery require a huge amount of blood transfusion perioperatively. The anemia, the formation of hematoma, and increased coagulation properties, which are consequences of massive blood loss itself can negatively affect the postoperative clinical results.Objectives: The main objective of the study is to find the tranexamic acid usage in adult spinal deformity patients with relative contraindications in Pakistan. Methodology of the study: This prospective observational study was conducted at Pakistan institute of medical sciences from 2016-2020. Data were collected from 185 patients of spine deformity.Data were collected through a combination of medical record reviews and direct patient interviews. Demographic details, including age, gender, weight, and height, were recorded for each of the 185 patients. Comprehensive medical histories were obtained to identify comorbid conditions and relative contraindications for tranexamic acid (TXA) use, such as a history of thromboembolic events, renal impairment, and concurrent anticoagulant therapy. Results: Data were collected from 185 patients according to criteria of the study. Mean age of the patients were 58.4 ± 12.3 years. Out of 185, there were 112 (60.5%) females and 73 (39.5%) male patients. Mean BMI was 28.1 ± 5.4 kg/m2. 49.7% were also suffering from hypertension, 24.3% from DM and 20% from osteoporosis.The regression coefficient (β) for total blood loss was -250 mL, with a 95% confidence interval (CI) of [-300, -200], and a p-value of &lt; 0.001. Similarly, the regression coefficient for the number of blood transfusions was -1.2 units, with a 95% confidence interval of [-1.5, -0.9], and a p-value of &lt; 0.001.Conclusion: Tranexamic acid effectively reduces blood loss and transfusion requirements in adult spinal deformity surgeries, even among patients with relative contraindications. The associated complication rates are manageable with careful patient selection and monitoring.

Comparative observational study on diagnostic utility of impulse oscillometry vs spirometry in obstructive airway diseases

Background Obstructive airway diseases, including chronic obstructive pulmonary disease (COPD) and asthma, pose significant global health challenges. Early and accurate diagnosis is crucial for effective management. Although Spirometry has traditionally been the cornerstone of diagnostics, Impulse Oscillometry (IOS) has emerged as a promising alternative. This study aims to compare the diagnostic performance of Spirometry and IOS in patients attending the Respiratory Medicine Department at the Acharya Vinoba Bhave Rural Hospital, Sawangi, India. Methods A Comparative Observational Study was conducted between August 2022 and August 2024, enrolling patients who met specific inclusion criteria. Data were collected through a comprehensive medical history, clinical examination, routine blood tests, chest radiography, High-resolution computed tomography (HRCT), spirometry, and IOS. Key parameters, including Forced expiratory volume in the first second FEV1, FEV1/FVC (Forced Expiratory Volume), (Forced Expiratory Volume) FVC, (Forced Expiratory Flow) FEF 25-75 for Spirometry, and R5, R20, fres, X5, and AX for IOS, were analyzed using the Chi-Square Test and Student’s t-test with SPSS 27.0 and GraphPad Prism 7.0. Expected outcome The study included 130 participants with the primary objective of evaluating IOS’s diagnostic advantages of IOS over spirometry. Our findings demonstrate that IOS offers enhanced sensitivity for diagnosing early small airway diseases, which is a crucial factor for early diagnosis in both pediatric and adult populations.