Hospital Database Research Articles

A novel method to monitor rheumatoid arthritis prevalence using hospital and medication databases

BackgroundMost estimates of rheumatoid arthritis (RA) prevalence, including all official figures in Australia and many other countries, are based on self-report. Self-report has been shown to overestimate RA, but the ‘gold standard’ of reviewing individual medical records is costly, time-consuming and impractical for large-scale research and population monitoring. This study provides an algorithm to estimate RA cases using administrative data that can be adjusted for use in multiple contexts to provide the first approximate RA cohort in Australia that does not rely on self-report.MethodsSurvey data on self-reported RA and medications from 25 467 respondents of the Australian Longitudinal Study on Women’s Health (ALSWH) were linked with data from the national medication reimbursement database, hospital and emergency department (ED) episodes, and Medicare Benefits codes. RA prevalence was calculated for self-reported RA, self-reported RA medications, dispensed RA medications, and hospital/ED RA presentations. Linked data were used to exclude individuals with confounding autoimmune conditions.ResultsOf 25 467 survey respondents, 1367 (5·4%) women self-reported disease. Of the 26 840 women with hospital or ED presentations, 292 (1·1%) received ICD-10 codes for RA. There were 1038 (2·8%) cases by the medication database definition, and 294 cases (1·5%) by the self-reported medication definition. After excluding individuals with other rheumatic conditions, prevalence was 3·9% for self-reported RA, 1·9% based on the medication database definition and 0·5% by self-reported medication definition. This confirms the overestimation of RA based on self-reporting.ConclusionsWe provide an algorithm for identifying individuals with RA, which could be used for population studies and monitoring RA in Australia and, with adjustments, internationally. Its balance of accuracy and practicality will be useful for health service planning using relatively easily accessible input data.

Intracranial Pressure Thresholds for Cerebral Autoregulation Impairment: Age-Stratified Analysis of Ultra-Low-Frequency Pressure Reactivity Index (UL-PRx) in Traumatic Brain Injury.

The study investigated the effectiveness of low-frequency sampling in detecting alterations in cerebrovascular reactivity (CVR) associated with changes in intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across different age groups. The primary objective was to investigate an ICP threshold that indicates a decrease in CVR as evidenced by a significant increase in the ultra-low-frequency pressure reactivity index (UL-PRx). Additionally, the study aimed to develop an age-based categorization method for patients with TBI to investigate the differences between these ICP thresholds in different age groups. In this retrospective analysis, data from 263 patients with TBI were prospectively collected. ICP and mean arterial pressure were extracted from the hospital database at 5-min intervals. Demographic details, clinical presentation, computed tomography scans, neurosurgical interventions, and 12-months outcome were recorded. ICP versus UL-PRx values were categorized into ICP bins and graphically represented with boxplots for each age group, illustrating how as ICP values rise, there is a bin (age-tailored ICP [AT-ICP]) beyond which UL-PRx shows a sudden increase, indicating CVR loss. Homogeneous age groups were established to obtain a consistent AT-ICP threshold. The discriminatory ability of the AT-ICP thresholds was compared with the guideline-recommended thresholds by calculating the area under the Receiver Operating Characteristic curve of the ICP-derived indices (dose above threshold, and the hourly dosage above threshold). Age groups 0-5, 6-20, 21-60, 61-70, and 71-85years were the best age subdivisions, corresponding to AT-ICP thresholds of 20, 30, 35, 25, and 30mmHg, respectively. The AT-ICP thresholds exhibited better discriminative ability compared with the guideline-recommended thresholds. The AT-ICP thresholds offer a novel approach for estimating CVR impairment and the developed method represents an alternative solution to address the age stratification issue in patients with TBI.

Validation of Database Autopsy for Review of Pregnancy-Associated Deaths in Canada

The database autopsy method was developed to determine probable causes of maternal deaths in the Canadian Institute for Health Information’s hospital discharge abstract database; however, the method has yet to be validated. Using immediate cause of death information from Québec’s hospitalization database as the gold standard, this study assessed the validity and reliability of the database autopsy method for pregnancy-associated deaths. The method had high sensitivity and specificity for identifying the most common causes of these deaths, as well as high interobserver agreement. We conclude that the database autopsy method is valid and reliable overall.

Metastatic onset of prostate carcinoma: A clinical and pathological challenge.

Prostate cancer is the second most common cancer, following lung cancer, and the fifth leading cause of cancer death in men worldwide. The onset of the disease, characterized by symptoms or changes caused by distant metastases, is rare and poses a challenge for clinicians and pathologists. We aimed to present a series of prostate carcinoma (PC) with unusual, histologically confirmed distant metastases (pM1) at the time of diagnosis, which raised suspicions of other types or origins of the primary tumor. Patients diagnosed with PC and distant metastases within a five-year timeframe (2017-2022) were extracted from the hospital database. The following data were collected: patient's age, imaging data, serum PSA level, and histopathological evaluation results. Patients with unusual distant metastases were selected and analyzed. We identified 10 patients in whom the diagnosis of PC was established following histopathological examination of tissue taken from distant metastatic sites (pM1). In three patients, the location of distant metastases was unusual: retroperitoneal, cranial/dural/epicranial and supradiaphragmatic lymph nodes which posed diagnostic challenges. Establishing the prostate origin of the tumor relied on immunohistochemical (IHC) investigation guided by clinical-imaging information. A metastasis of PC may rarely present as a cranial/dural tumor, retroperitoneal, or supradiaphragmatic lymphadenopathies in a man over the age of 50, but it should be taken into consideration. In the absence of correlated clinical, imaging, and histopathological/IHC data, diagnosing distant metastasis from PC is difficult, especially considering its potentially confusing IHC profile.

MRI analysis of and factors related to knee injuries in amateur marathon runners.

Marathons are the most challenging form of running, and amateur athletes may be more prone to injury due to a lack of professional knowledge and instruction in running. To analyze the MRI manifestations of and factors related to knee injuries in amateur marathon runners. Data were collected from a hospital database of 105 qualified amateur marathon athletes (65 males,40 females), between May 2018 and December 2021. 1.5T MR: sagittal fs-PDWI, sagittal T1WI and sagittal 3D-DESS sequence. The MRI manifestations of knee joint injury were analyzed and evaluated by two radiologists. The inter-observer agreement on MRI readings was analyzed using the kappa coefficient, and binary logistic regression analysis was employed to identify factors associated with knee injuries. The overall prevalence of knee cartilage lesions, meniscus lesions and bone marrow edema among amateur marathon runners was 45.7%, 72.4%, and 49.5% respectively. Our analysis revealed that older age (OR = 1.135, P<0.001), higher BMI (OR = 1.236, P = 0.044), and slower pace (OR = 2.305, P = 0.017) were associated with increased risk of articular cartilage disease. Furthermore, older age (OR = 1.425, P<0.001) was identified as a risk factor for meniscal lesions, while older age (OR = 1.088, P = 0.002) was bone marrow edema. Notably, no significant correlation was observed between knee joint injuries of amateur marathon athletes and gender or the monthly running distance (P>0.05). The occurrence of knee injuries among amateur marathon athletes was highly prevalent, with the patellofemoral joint cartilage and posterior horn of medial meniscus being frequently affected areas. Moreover, age, BMI, running years and pace were significant risk factors of knee joint injury.

Development and validation of a nomogram to predict mortality of patients with DIC in ICU.

Disseminated intravascular coagulation (DIC) is a devastating condition, which always cause poor outcome of critically ill patients in intensive care unit. Studies concerning short-term mortality prediction in DIC patients is scarce. This study aimed to identify risk factors contributing to DIC mortality and construct a predictive nomogram. A total of 676 overt DIC patients were included. A Cox proportional hazards regression model was developed based on covariates identified using least absolute shrinkage and selection operator (LASSO) regression. The prediction performance was independently evaluated in the MIMIC-III and MIMIC-IV Clinical Database, as well as the 908th Hospital Database (908thH). Model performance was independently assessed using MIMIC-III, MIMIC-IV, and the 908th Hospital Clinical Database. The Cox model incorporated variables identified by Lasso regression including heart failure, sepsis, height, SBP, lactate levels, HCT, PLT, INR, AST, and norepinephrine use. The model effectively stratified patients into different mortality risk groups, with a C-index of >0.65 across the MIMIC-III, MIMIC-IV, and 908th Hospital databases. The calibration curves of the model at 7 and 28 days demonstrated that the prediction performance was good. And then, a nomogram was developed to facilitate result visualization. Decision curve analysis indicated superior net benefits of the nomogram. This study provides a predictive nomogram for short-term overt DIC mortality risk based on a Lasso-Cox regression model, offering individualized and reliable mortality risk predictions.

Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020.

To improve firearm injury encounter classification (new vs follow-up) using machine learning (ML) and compare our ML model to other common approaches. This retrospective study used data from the St Louis region-wide hospital-based violence intervention program data repository (2010-2020). We randomly selected 500 patients with a firearm injury diagnosis for inclusion, with 808 total firearm injury encounters split (70/30) for training and testing. We trained a least absolute shrinkage and selection operator (LASSO) regression model with the following predictors: admission type, time between firearm injury visits, number of prior firearm injury emergency department (ED) visits, encounter type (ED or other), and diagnostic codes. Our gold standard for new firearm injury encounter classification was manual chart review. We then used our test data to compare the performance of our ML model to other commonly used approaches (proxy measures of ED visits and time between firearm injury encounters, and diagnostic code encounter type designation [initial vs subsequent or sequela]). Performance metrics included area under the curve (AUC), sensitivity, and specificity with 95% confidence intervals (CIs). The ML model had excellent discrimination (0.92, 0.88-0.96) with high sensitivity (0.95, 0.90-0.98) and specificity (0.89, 0.81-0.95). AUC was significantly higher than time-based outcomes, sensitivity was slightly (but not significantly) lower than other approaches, and specificity was higher than all other methods. ML successfully delineated new firearm injury encounters, outperforming other approaches in ruling out encounters for follow-up. ML can be used to identify new firearm injury encounters and may be particularly useful in studies assessing re-injuries.

Myelodysplastic/Myeloproliferative Neoplasms with Features Intermediate between Primary Myelofibrosis and Chronic Myelomonocytic Leukemia: Case Series and Review of the Entity

Diagnosis of myeloid neoplasm is currently performed according to the presence of a predetermined set of clinical, morphological, and molecular diagnostic criteria agreed upon by a consensus of experts. Even strictly adhering to these criteria, it is possible to encounter patients who present features that are not easily ascribable to a single disease category. This is the case, e.g., of patients with de novo myeloid neoplasms with features intermediate between primary myelofibrosis (PMF) and chronic myelomonocytic leukemia (CMML). In this study, we retrospectively searched the pathological database of IRCCS Humanitas Research Hospital to identify cases of chronic myeloid neoplasm with monocytosis with a driver mutation of classic myeloproliferative neoplasms (MPN) and showing morphological MPN features. For each case, we assessed all epidemiological, clinical, histopathological, and molecular data. Then, we carried out a literature review, searching for cases with features similar to those of our patients. We retrieved a total of 13 cases presenting such criteria (9 from the literature review and 4 from our institution); in all of them, there was a coexistence of clinical, histopathological, and molecular myelodysplastic and myeloproliferative features. To date, according to current classifications (World Health Organization and International Consensus Classification), given the presence/absence of essential features for PMF or CMML, these patients should be formally diagnosed as myelodysplastic/myeloproliferative neoplasm unclassified/not otherwise specified (U/NOS). This review aims to summarize the features of these difficult cases and discuss their differential diagnosis and their classification according to the novel classifications and the existing literature on overlapping myeloid neoplasms.

Severe neutropenia unrelated to clozapine in patients receiving clozapine.

Clozapine is known to cause agranulocytosis. Mandatory monitoring schemes are aimed at reducing the risk of agranulocytosis and of the consequences of agranulocytosis. All cases of agranulocytosis occurring in people prescribed clozapine are assumed to be caused by clozapine. In a previous study, we examined a cohort of patients listed on our hospital database as having had clozapine-induced agranulocytosis and applied specific criteria to identify those with confirmed clozapine-related, life-threatening agranulocytosis. In this study, we examine the cases not meeting these specific criteria. In the original study, 9 of 23 cases met the criteria for clozapine-induced, life-threatening agranulocytosis. Of the 13 remaining cases for whom data were available, 5 were probably caused by clozapine but were not life-threatening. Three cases were the result of concomitant cancer chemotherapy. Three were anomalous results probably related to measurement error. For the remaining two cases, the cause was not identified. Not all cases of agranulocytosis occurring in people taking clozapine are caused by clozapine. The widely used threshold criterion-based diagnosis overestimates the risk of agranulocytosis. True clozapine-related agranulocytosis is best identified by pattern-based criteria: rapid fall in neutrophil counts over around 2 weeks to below 0.5 × 109/L for two consecutive days (unless clozapine is stopped very early or granulocyte colony stimulating factor is given) where other possible causes (benign ethnic neutropenia, cancer chemotherapy) can be ruled out.

Potential Role of Generative Adversarial Networks in Enhancing Brain Tumors.

Contrast enhancement is necessary for visualizing, diagnosing, and treating brain tumors. Through this study, we aimed to examine the potential role of general adversarial neural networks in generating artificial intelligence-based enhancement of tumors using a lightweight model. A retrospective study was conducted on magnetic resonance imaging scans of patients diagnosed with brain tumors between 2020 and 2023. A generative adversarial neural network was built to generate images that would mimic the real contrast enhancement of these tumors. The performance of the neural network was evaluated quantitatively by VGG-16, ResNet, binary cross-entropy loss, mean absolute error, mean squared error, and structural similarity index measures. Regarding the qualitative evaluation, nine cases were randomly selected from the test set and were used to build a short satisfaction survey for experienced medical professionals. One hundred twenty-nine patients with 156 scans were identified from the hospital database. The data were randomly split into a training set and validation set (90%) and a test set (10%). The VGG loss function for training, validation, and test sets were 2,049.8, 2,632.6, and 4,276.9, respectively. Additionally, the structural similarity index measured 0.366, 0.356, and 0.3192, respectively. At the time of submitting the article, 23 medical professionals responded to the survey. The median overall satisfaction score was 7 of 10. Our network would open the door for using lightweight models in performing artificial contrast enhancement. Further research is necessary in this field to reach the point of clinical practicality.

Evaluation of post cardiopulmonary resuscitation patıents followed in intensive care unit: A one-year retrospective analysis.

Aim: Post Cardiopulmonary Resuscitation (CPR) patients are a critical patient group. Despite the development of treatment options and guidelines, mortality and morbidity rates in these patients are still high. We aimed to obtain a descriptive data for post CPR patients admitted to Intensive Care Unit (ICU). Material and Methods: This single-center, retrospective observational study was conducted in the mix ICU’s at the Karabuk University Hospital in Karabuk, Turkey, from Jan 2023 to Jan 2024. Demographic data of the post-CPR patients, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Glasgow coma scores (GCS), length of stay in the ICU and mortality were recorded through our hospital database. Results: During the study period,78 patients were evaluated. The mean age of the patients was 75.01 ± 9.6 years, and 42 of them were female (53.84%). The mean APACHE II scores on ICU admission was 21.15 ± 7.2, and mean GKS was 8.29 ± 2.4. Comorbid disease was present in 96.15% of the patients, and 35 patients had 3 or more comorbid diseases. Twenty-six patients survived whereas 52 died in ICU. APACHE II scores and. the lactate level were higher, whereas GCS score was lower in nonsurvivors. Conclusion: High mortality rates have been reported for post CPR patients. There are many factors that have been suggested to be prognostic for these patients. In our died patients, the lactate level and their APACHE II score were higher and their GCS scores were lower.

Assessment of Organ-at-risk Sparing in Esophageal Cancer: A Comparative Dosimetric Evaluation of Hybrid, Noncoplanar, and Coplanar RapidArc Plans.

The purpose of this study is to improve the precision of radiation treatment and sparing of organ-at-risk (OAR) in patients with thoracic esophageal cancer (EC) affecting the heart, lung, and spinal cord. To improve and personalize cancer treatment plans, it assesses the dosimetric benefits of coplanar RapidArc (RAc), hybrid arc (RAHyb), and noncoplanar RapidArc (RAnc). Fourteen patients with EC were chosen for our investigation from our hospital's database. RapidArc (RA) plan patients had already received treatment. Retrospectively, additional RAnc and RAHyb plans were made with a prescription dose of 50.4 Gy in 28 fractions for the planning target volume (PTV). A prescription dose of 95% of PTV was used, so that three different treatment planning procedures could be compared. The cumulative dose-volume histogram was used to analyze the plan quality indices homogeneity index (HI), conformity index (CI), conformation number (CN) as well as the OARs doses to the lung, heart, and spinal cord. In comparison to RAc and RAnc techniques, the study indicated that RAHyb plans significantly increased D95%, CI and HI; Dmax and CN did not differ substantially. In addition, compared to RAc (lung: 16.15 ± 0.03 Gy and heart: 23.91 ± 4.67 Gy) and RAnc (lung: 15.24 ± 0.03 Gy and heart 23.82 ± 5.10 Gy) plans, RAHyb resulted in significantly lower mean lung doses (15.10 ± 0.03 Gy) and heart doses (21.33 ± 6.99 Gy). Moreover, the RAHyb strategy showed a statistically significant (P < 0.05) lower average MU (452.7) than both the RAc (517.5) and RAnc (566.2) plans. The D95%, conformity, and homogeneity indices were better for hybrid arc plans compared to RAc and RAnc plans. They also successfully managed to reduce the lung and heart doses as well as the mean MU per fraction.

Description of outcome and adverse events in 21 cats with locally advanced nasal planum squamous cell carcinoma treated with electrochemotherapy.

Squamous cell carcinoma (SCC) is the most common tumour in the nasal planum of cats. Surgery has traditionally been the treatment of choice but might not be feasible in locally advanced scenarios. Electrochemotherapy (ECT) has shown good control in superficial tumours, but there is a lack of robust information about efficacy in locally advanced cases. The aim of this study was to assess the safety and efficacy of ECT in the treatment of locally advanced stage nasal planum SCC in cats. The clinical database of a veterinary referral hospital was searched retrospectively for cats diagnosed with a locally advanced nasal planum SCC (T3N0M0 or T4N0M0) that had received ECT. Local response, adverse events and outcome were documented. The data were evaluated by inferential statistics and correlations between response, recurrence, feline immunodeficiency virus/feline leukaemia virus status, number of treatments, voltage and severity of adverse events, with Kaplan-Meier curves and log-rank tests. Statistical significance was set at P <0.05. In total, 21 cats were enrolled over a 4-year period. Nineteen cats achieved a complete response (CR) and two cats a partial response (PR) for an overall response rate of 100%. Cats achieving a CR had a median disease-free interval of 182 days (range 128-327) and those with a PR had a median progression-free survival of 156.5 days (range 122-191). The median time to progression was not reached. The overall survival was 453 days for a median follow-up of 341 days (range 191-989). Of the cats, 62% had grade 3 or 4 toxicities, but no deaths due to the treatment were documented. Only voltage was correlated with longer survival (P = 0.001). ECT appears to be an effective treatment for feline nasal planum SCC and could be considered a first-line therapy for locally advanced cases. Toxicities reported can be severe in the short term and these could be secondary to more invasive lesions and equipment used.

Acute kidney injury in children with lymphoma.

To analyze the epidemiology of acute kidney injury (AKI) in children with lymphoma and to assess the incidence, risk profile of AKI, and effects on renal function in children with lymphoma during their first 30 days of hospitalization. This was a retrospective screen of electronic hospital and laboratory databases to select hospitalized children who were first diagnosed and treated for lymphoma at Beijing Children's Hospital between 2020 and 2021. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. We analyzed the incidence and risk factors for AKI in children with lymphoma during their first 30 days of hospitalization. We also analyzed mortality rate and the incidence of kidney recovery over a 1-year follow-up period. Of the 295 children with lymphoma (which were all non-Hodgkin lymphoma), 42 (16.5%) experienced AKI events during the first their 30 days of hospitalization. The proportion of patients with lymphoma clinical stage 4 was higher in the AKI group than in the non-AKI group (66.7 vs. 43.7%, p<0.05). Tumor lysis syndrome (TLS), lung infection, and lymphoma clinical stage were identified as independent risk factors for AKI in children with lymphoma. Severe AKI was associated with TLS, sepsis, and a higher need for intensive care. Over 1-year of follow-up, none of the survivors developed impaired renal function or proteinuria. However, the mortality of children in the AKI group was significantly higher than that in the non-AKI group (p<0.05). TLS, lung infection, and lymphoma clinical stage were identified as independent risk factors for AKI in children with lymphoma during the first 30 days of hospitalization. Clinicians should increase their awareness of AKI in hospitalized patients with lymphoma.

Descriptive epidemiology of prostate cancer in India, 2012-2019: Insights from the National Cancer Registry Programme.

This study describes the epidemiology, clinical extent at diagnosis, and treatment modalities for prostate cancer in India. This study is a secondary analysis of primary prostate cancer data sourced from the National Cancer Registry Programme. Data from population-based cancer registry for the period 2012-2016 were used to estimate the incidence rates, including crude incidence rate (CR), age-adjusted incidence rate (AAR), age-specific rate, and cumulative risk. Trends in the AAR were assessed using join-point regression. Hospital-Based Cancer Registry data from 2012 to 2019 were used to describe the clinical extent of the cancer at diagnosis and the treatment modalities. The incidence of prostate cancers was higher in urban registries such as Delhi, Kamrup Urban, and Mumbai (AAR of 11.8 per 100,000, 10.9 per 100,000, and 9.7 per 100,000, respectively). Prostate cancer incidence showed a rise after the age of 50, with a notable acceleration after age 64. The overall annual percentage change for prostate cancer incidence from 1982 to 2016 was 2.6. Around 43.0% of all prostate cancers were diagnosed at the distant metastatic stage. Surgery and radiotherapy, either as standalone treatments or in combination with other modalities, contributed to the treatment of 78.5% of localized cancer, 74.2% of locoregional cancer, and 57.2% of distant metastatic stage of prostate cancer. There is heterogeneity in the incidence of prostate cancer, as evidenced by urban registries. Additionally, there is a need for downstaging the disease, without risking overdiagnosis.

Magnitude and patterns of cancers in North Malabar region of Kerala, India, from 2010-2019: Update from a retrospective hospital-based cancer registry data

Magnitude and patterns of cancers in North Malabar region of Kerala, India, from 2010-2019: Update from a retrospective hospital-based cancer registry data

Pregnancy Characteristics and Delivery Outcomes of Individual Mother Hospitalized at Jalalabad, Kyrgyzstan

Background: Maternal morbidity is a silent struggle, echoing the untold stories of resilience and strength in the face of adversity. Women of childbearing age are faced with extreme uncertainties; hence the purpose of this study was to analyze fertility trend and maternal complications including the possible high-risk factors connected to maternal morbidity. Maternal morbidity could be prevented through early detection, including the period preceding pregnancy. Methods and methodology: This is a retrospective cross-sectional study using data from hospital database describes trends of fertility and with immediate post-delivery maternal complication. The data was collected just from month January in 2023 from a Regional Maternity Hospital in Jalalabad, Kyrgyzstan. Total of 260 sample were drawn from the data base for the study. Objective: The study intended to find the different pregnancy characteristics and the outcomes of delivery of Individual mother who were Hospitalized at Jalalabad, Kyrgyzstan. We settled for this topic because it is one of the significant causes of death among reproductive age group women around the world. Result: Among 260 delivery cases, majority 56.2% of them were from age group 21 - 25 years. Majority of them have more than one child and 22.7% cases had more than 3 children. Common complications associated during pregnancy were anemia (17.3%) &amp; Pre-eclampsia (16.1%) whereas most common postpartum complication was PPH associated with atony (17.3%). Obesity (10%) and Pre-existing hypertension (9.6%) were the most common comorbidity associated with pregnancy. Conclusion: The research population appears to have high fertility trends. The main causes of obstetric complications were anemia, hypertension, and postpartum hemorrhage. Two prevalent comorbidities linked to pregnancy were obesity and underlying hypertension. To reduce pregnancy-related problems, it is imperative that interventions be implemented that support early ANC attendance, lower obesity, increase access to blood pressure monitoring, and provide family planning information and services.

Initial Experience of Robot-Assisted Surgeries.

To present initial experience with the first 100 cases of robotic-assisted surgery by the Department of General Surgery. Descriptive study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to August 2023. Demographic and postoperative details of the first 100 patients to undergo robotic-assisted surgery by the Department of General Surgery were reviewed. Prospective data were collected from the hospital information database as well as the CMR database. The data collected in the hospital database included the patients' age, diagnoses, genders, complications during hospital stay as well as 90-day readmission, morbidity, and mortality. Data collected by CMR via Versius robotic surgery console or internal databases included operative minutes using the console. The average age of patients undergoing robotic surgery was 44.26 ± 14.08 years. Cholecystectomy (78%) was the most commonly performed robotic-assisted procedure. Only one patient had blood loss of more than 100ml. There was no postoperative complication, readmission or mortality during the study period. With proper patient selection, robotic-assisted surgery is safe and feasible even in low-middle-income countries (LMICs). Robotic-assisted surgery, Pakistan, Initial experience, Outcomes, Versius.

Incidence of Persistence and Recurrence of Differentiated Thyroid Cancer in Post-surgical Cases From a Tertiary Care Hospital in Dubai, United Arab Emirates.

Background Despite the excellent prognosis of differentiated thyroid carcinoma, recurrence remains a major concern. However, the persistence of thyroid cancer post-thyroidectomy is not uncommon. We aimed to characterise patients who underwent re-operative surgery for differentiated thyroid carcinoma and analyse the percentage of re-operations that truly were for "recurrent" disease versus the management of persistent disease. Methods We conducted a retrospective review of the hospital database, analysing patients who visited the nuclear medicine department at Mediclinic City Hospital, a tertiary care hospital in Dubai, United Arab Emirates, between 2015 and 2022. The study included patients with differentiated thyroid carcinoma who underwent re-operations after total thyroidectomy. Recurrence was defined as the development of disease after a patient had undetectable thyroglobulin and negative radiological scans within one year of the first surgery. Cases were categorised as "recurrent", "persistent", or "unable to classify" in the event of missing data. Results Out of 836 patients diagnosed with differentiated thyroid carcinoma who visited the nuclear medicine department, 71 underwent re-operations. The mean age of these patients was 44.4 years (CI 41.7-47.0), of whom 78.9% were females. Almost half (46.5%) underwent re-operations within the first year, and 98.6% were diagnosed with papillary thyroid carcinoma. We were able to classify 63.4% of cases (n=45) as persistent disease, while 24 cases were categorised as "unable to classify". Only two cases met the criteria for recurrent disease. Conclusion The majority of cases previously classified as "recurrent" in differentiated thyroid carcinoma were found to be a persistent disease, possibly indicating inadequate therapy. Further research may be required to explore the reasons behind this eye-opening rate of disease persistence. This highlights an area for improvement in the management and future outcomes of differentiated thyroid carcinoma patients.

The prognostic value of lymph node response to neoadjuvant therapy among breast cancer subtypes

Objectives. The aim of this study was to assess the prognostic value of persistent node involvement after neoadjuvant chemotherapy among breast cancer subtypes. Materials and methods. A total of 258 patients with T1-T4 and N0-N3 breast cancer treated by neoadjuvant chemotherapy followed by tumor excision and axillary lymph-node dissection between January 2015 and December 2019 were selected from the Coltea Clinical Hospital database and retrospectively evaluated. Association between nodal involvement (ypN) binned into four classes (0, 1-3, 4-9 and &gt;10), relapse free-survival and overall survival among the whole population and according to breast cancer subtypes was analyzed using Statistical Package for Social Science Version 29.0.2.0. Outcomes. After a median follow-up of 20.7 months (range 1-97 months) post neoadjuvant chemotherapy nodal involvement was significantly associated with disease free survival in the whole population (X2(3)= 23.161, p &lt;.001) and between breast cancer subgroups (X2(3) = 27.871, p= &lt;.001). After univariate cox regression analyses by breast cancer subtypes nodal involvement was statistically significant only in the Luminal B(HER-) (X2(3)=14.867, p=.002) and triple-negative breast cancer (X2(3)= 9.867, p=.020). In Luminal B(HER2-) breast cancers all nodal involvement subgroups were associated with impaired relapse free survival compared to ypN0 tumors (1-3 nodes, HR= 4.871, 95%CI [1.32-17.94], p=.017; 4-9 nodes, HR=5.126, 95%CI [1.341-19.59], p=.017; &gt;10 nodes, HR=8.744, 95%CI [2.379-32.13], p=.001). In triple negative breast cancers, relapse-free survival was associated with an adverse prognosis in patients with more than 10 nodes involved when compared with ypN0 (HR=16.57, 95%CI [3.25-84.30], p=&lt;.001). There was no statistically significant association in the univariate cox regression analyze between post neoadjuvant chemotherapy nodal involvement and overall survival neither in the whole population (X2(3)=.992, p=.803) nor among breast subtypes (X2(3)=1.191, p= .779). Kaplan Meier analyze of RFS adjusted for BC subtype showed a statistically significant relapse rate in all groups (1-3 (p=.035), 4-9(p=&lt;.001), &gt;10 (p=&lt;.001)) compared with ypN0 group. Kaplan Meier overall survival analyze showed no statistical difference in survival among node groups. Conclusions. Post neoadjuvant chemotherapy lymph node status in breast cancer subtypes represents an important prognostic factor of relapse-free survival and the prognostic value of residual axillary disease should be interpreted according to breast cancer subtype.