Test Images Research Articles

A Case of Acute Necrotizing Encephalitis Misdiagnosed as Opium Poisoning: A Case Report

Introduction: The coronavirus has been associated with significant neurologic complications, including encephalopathy, seizures, ataxia, and motor or sensory deficits. Among these complications, acute necrotizing encephalopathy (ANE) is a rare condition linked to viral infections such as influenza, HHV-6, and COVID-19. This study presents a unique case of ANE in a COVID-19 patient, initially misdiagnosed as opium poisoning. Despite the reduction in pandemic cases, COVID-19 continues to present serious side effects, emphasizing the need to recognize potential neurological manifestations of the virus. Increased awareness and accurate diagnosis are essential for managing these complex cases. Case Presentation: This case study involves a 29-year-old female patient presenting with loss of consciousness and other symptoms that led to a diagnosis of COVID-19-related acute necrotizing encephalitis. Initial suspicions of opium poisoning were ruled out, and imaging tests revealed bilateral ground-glass opacities (GGO) and consolidation in the chest, along with abnormal findings in the brain. The patient was treated with glucocorticoid pulse therapy and IVIG, resulting in symptom improvement, though some neurological deficits persisted at discharge. This case underscores the importance of considering COVID-19 in cases of acute encephalitis and highlights the neurological complications associated with the virus. Conclusions: This study explores ANE as a severe manifestation of COVID-19 infection, focusing on the diverse neurological presentations associated with ANE in COVID-19 patients and a case initially misdiagnosed as opium poisoning. Through a case study of a patient with ANE, characterized by loss of consciousness and meiotic pupils, the research emphasizes the need for early detection and appropriate treatment. Findings suggest that ANE in COVID-19 patients can present with varied symptoms, posing diagnostic challenges. The study underscores the value of timely intervention with glucocorticoid pulse therapy and gamma globulin injection to improve patient outcomes. These findings highlight the necessity for increased awareness among healthcare providers to promptly recognize ANE in COVID-19 patients, aiding in timely and effective intervention.

Effect of Collagen Fiber Tortuosity Distribution on the Mechanical Response of Arterial Tissues.

This study investigated the effect of collagen fiber tortuosity distribution on the biomechanical failure and prefailure properties of arterial wall tissue. An in-silico model of the arterial wall was developed using data obtained from combined multiphoton microscopy imaging and uniaxial tensile testing. Layer dependent properties were prescribed for collagen, elastin, and ground substance. Collagen fibers were modeled as discrete anisotropic elements, while elastin and ground substance were modeled as homogeneous isotropic components. Our parametric analysis, using a finite element approach, revealed that different parameters of collagen fibers tortuosity distribution significantly influence both pre-failure and failure biomechanical properties. Increased fiber tortuosity improved the tissue strength whereas the dispersion in the tortuosity distribution reduced it. This study provides novel insights into the structural-mechanical interdependencies in arterial walls, offering potential targets for clinical assessments and therapeutic interventions aimed at mitigating rupture risks.

Epileptic encephalopathy, autism and cognitive deficit caused by the SYNGAP1 gene mutation

The paper analyzes data from scientific publications and presents a clinical case study of a rare genetic epileptic encephalopathy caused by a mutation in the SYNGAP1 gene. The case study focuses on a 4-year-old girl who has been diagnosed with epileptic encephalopathy due to the mutation. The paper describes the anamnesis of the child’s illness, including family history, neurological, neuropsychological, and speech assessments, as well as the results of genetic testing, electroencephalography, and magnetic resonance imaging (MRI). The findings indicate that the main symptoms of the condition are typically epilepsy, autism spectrum disorder, difficulty with phrasal speech, and mental retardation. Common types of seizures include atypical absence seizures, myoclonic seizures, atonic seizures, and eyelid myoclonia with absences. On the electroencephalogram, there is a slowdown in occipital activity and diffuse, prolonged «peak-polypic-slow-wave» complexes. Pathognomonic neuroimaging changes in the brain are typically absent. Valproic acid, levetiracetam, and ethosuximide have been shown to be the most effective treatments for controlling epileptic seizures. Due to the rarity of this syndrome, the authors have provided a detailed clinical case report from their practice.Conclusion. SYNGAP1-related epileptic encephalopathy has a specific clinical presentation, including characteristic EEG findings and a particular pattern of seizures. The diagnostic approach for children with this condition, autism spectrum disorder, and delayed language development should include video electroencephalography with sleep deprivation, as well as genetic testing if necessary, using next-generation sequencing, to ensure early detection and appropriate treatment planning.

NAFLD No More: A Review of Current Guidelines in the Diagnosis and Evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).

Provide a concise update on metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), as well as a practical approach to screening and initial evaluation. Nomenclature changes have placed a greater focus on cardiometabolic risk factors in the definition of MASLD. Screening for MASLD is by stepwise noninvasive serum and imaging tests which can identify patients at risk for advanced fibrosis and liver-related complications. MASLD has been increasing in prevalence and disease burden but is underrecognized in primary care and endocrinology clinics. Multiple society guidelines, synthesized here, provide a framework for the initial approach in the diagnosis and evaluation of MASLD. Recent advances in pharmacologic treatment underline the importance of screening for patients who are at risk for advanced fibrosis as they are most likely to benefit from new drug classes, such as the liver-directed thyroid receptor agonist resmiterom.

Abstract 4115801: Assessing Prevalence of Cardiac Amyloidosis at the Time of Spinal Laminectomy for Spinal Stenosis

Introduction: Cardiac amyloidosis (CA) involves deposition of amyloid fibrils within cardiac myocardium, resulting in heart failure. Recent studies have shown an association between amyloid deposition in the ligamentum flavum (LF) and development of CA. Our study aims to investigate the prevalence of CA in patients identified with amyloid deposition in their LF at the time of spinal laminectomy for spinal stenosis, employing a comprehensive approach integrating multi-modality imaging and laboratory testing. Methods: This is a retrospective study of patients age >50 years old who underwent spinal laminectomy for non-congenital spinal stenosis or spondyloarthropathy. LF tissue samples obtained during surgery were examined histologically for amyloid deposition. Patients with positive findings underwent testing, including serum markers, echocardiography, and 99mtechnetium pyrophosphate (99mTcPYP) scintigraphy. Additionally, cardiac magnetic resonance imaging (cMRI) was obtained when clinically appropriate to assess for CA. Results: Among the 197 enrolled patients, 39 (19.3%) exhibited amyloid deposition in LF tissue. Patient demographics and clinical characteristics did not significantly differ between the positive and negative groups (Table 1). Of the 39 amyloid positive specimens, subtyping using mass spectrometry identified 1 (3%) light-chain, 28 (72%) transthyretin (TTR), and 10 (25%) were unable to be subtyped. Of the 28 TTR positive patients, 8 were of the wild type genotype. Furthermore, 18 of the 28 TTR patients underwent 99mTcPYP scintigraphy, of which none had cardiac uptake consistent with TTR amyloidosis; the other 10 declined work up. Of the 10 untyped patients, 6 had 99mTcPYP scintigraphy with none of the patients having cardiac uptake. Adjunctive cMRI in select positive patients showed findings inconsistent with amyloid deposition. Serum NT-proBNP, Troponin T, and serum pre-albumin levels were similar between groups. Conclusion: Amyloid deposition in LF tissue did not correlate with cardiac manifestations of amyloidosis at the time of surgery. Longitudinal investigation is ongoing to better understand the relationship between amyloid deposition in LF tissue and the development of CA over time.

Visfatin and VEGF levels are not increased in adolescent girls with polycystic ovary syndrome

IntroductionPCOS is one of the most commonly occurring endocrinopathies among women and increasingly affects adolescent populations. The connection between PCOS and various endocrinological, psychological, and CVD is increasingly recognized. Some studies have shown elevated levels of visfatin and VEGF among patients with PCOS, which are markers of vascular endothelial dysfunction. In our study, we evaluated the concentration of these parameters, focusing solely on a group of adolescents with PCOS, to assess whether these early markers of CVD are present at an early stage of diagnosis.Material and methodsIn total, 80 adolescent girls participated in the study. 47 adolescents diagnosed with PCOS were included in the study group (mean age 15.68 ± 1.18 years, BMI 26.66 ± 6.41 kg/m2), while the remaining 33 regularly menstruating individuals (mean age 15.79 ± 1.22 years, BMI 25.44 ± 7.24 kg/m2) were assigned to the control group. Each participant underwent imaging, biochemical, and hormonal tests. Additionally, markers of endothelial dysfunction: VEGF and visfatin, were measured in all adolescents.ResultsBoth VEGF and visfatin levels did not differ significantly between PCOS and control group (p=0.30 and p=0.15, respectively). In the group of adolescent girls with PCOS, visfatin was significantly correlated with HDL, FSH, cortisol, and testosterone levels >55 ng/dl. VEGF was significantly correlated with fasting glucose, glucose levels after OGTT, estradiol, and waist circumference >80 cm.ConclusionIt can be indirectly inferred that both visfatin and VEGF should not be used as early markers for cardiometabolic complications among adolescent patients with PCOS. On the other hand, low visfatin levels, through their negative correlation with HDL, may have a protective effect on cardiovascular complications, while low VEGF levels, through their positive correlation with glucose levels, may have a protective influence on carbohydrate metabolism disorders.

Abstract 4141469: Left Ventricular Septum Displacement Implications in the Limited Cardiac Reserve, RV to Pc Uncoupling and Oxygen Uptake During Exercise in Heart Failure

Background: Dyspnea on exertion is cardinal symptom in heart failure (HF) and may be caused by an unfavorable dynamic of ventricular interaction. This concept has been poorly addressed over time and we hypothesized that a careful study of the interventricular septum adaptations during maximal exercise in HF might be implicated in the limited cardiac reserve and uncoupling of right ventricular (RV) to pulmonary circulation (Pc), both yielding to a limited O2 uptake. Aim: To study the pathophysiology behind biventricular interaction during exercise in HF, evaluating the role of septum displacement during exercise and how and whether it would affect peak exercise oxygen consumption (VO 2 peak) through a limited cardiac output (CO) increase and some degrees of RV to PC uncoupling assessed by TAPSE/PASP. Methods: 22 HF performed a combined cardiopulmonary exercise testing imaging (CPET imaging) with RV 3D-imaging analysis and were compared with a control population. 3D imaging of the RV chamber was examined off-line using the 4D RV TomTec software and obtained 3D mesh of the RV model using custom software to obtain the mean curvature value of IVS in 4 regions of: inflow tract (RVIT), outflow tract (RVOT), apical and body. We acquired measurements of curvature during end-diastole (ED) and at end systole (ES) phases and obtained a parametric curvature map. Results: HF patients (mean age 72±12, 27% female) typically showed an abnormal septal curve, with a more leftward configuration either at rest and under exercise (rest =−0.01±0.007 at ED, and −0.01±0.009 at ES; peak exercise= −0.01±0.006 at ED, and −0.01±0.007 at ES) compared to controls (rest=−0.02±0.002 at ED, and −0.02±0.006 at ES; peak exercise −0.02±0.0.006 at ED, and −0.02±0.01 at ES, Figure). Notably, the degree of the IVS curvature showed a linear correlation with an impaired gas exchange performance as indicated by a lower peak VO 2 , a limited CO and impairment of TAPSE/PASP in HF (respectively, r=0.64, p<0.001, r=0.5, p<0.001, r=0.53, p<0.001 at ED during exercise; r=0.61, p<0.001 at ES during exercise; Figure). Conclusions: In HF, the evidence of right to left IVS displacement appears worth of investigation, by intervening strictly to a reduced CO response, and RV-PA uncoupling during exercise. These findings clearly point to the utility of assessing how new and current therapeutic strategies may modulate the negative septum displacement and overall cardiac mechanics.

PERFIL CLÍNICO-RADIOLÓGICO DE PACIENTES PEDIÁTRICOS DIAGNOSTICADOS COM PNEUMONIA COMUNITÁRIA COMPLICADA ATENDIDOS NO PRONTO SOCORRO DO HOSPITAL REGIONAL DE TAGUATINGA

Complicated community-acquired pneumonia (CACP) results from localized complications - pleural effusion and/or empyema, necrotizing pneumonia or lung abscess - or systemic complications. A British report states that 3% of pneumonias in children progress to CACP. Diagnosis requires imaging tests - chest X-ray (X-ray), chest ultrasound (USG) and chest tomography (CT). Treatment is based on empirical antibiotic therapy, with Streptococcus pneumoniae (SP) as the most frequent agent. The objective of the study is to identify patients treated at the Pediatric Emergency Room of the Taguatinga Regional Hospital (HRT), Federal District, diagnosed with CACP between March 1, 2022 and March 1, 2024. The total sample consisted of 51 patients with CACP. It can be inferred that the profile of patients is healthy, male children under five years of age. The characteristic symptoms - cough, tachypnea and fever - were present in most cases at admission. Persistent fever beyond 48-72h after the start of treatment or its reappearance after an afebrile period, persistent and/or onset of tachypnea and/or cough, decreased and/or abolished breath soun ds on auscultation and hypoxemia provided the most frequent clinical pattern of evolution. Chest X-ray was the most frequently performed imaging exam, with the predominant radiological presentation being isolated consolidation and radiological signs of the complications presented. Two cases with PS as the etiological agent were identified. The therapeutic definition was variable and the outcome was favorable in all cases. The clinical and radiological profile of the patients was compatible with the data in the literature. However, there is a lack of strategies regarding uniform management of the institution for the care of patients with CCAP.

A contribution to the study of phosphate’s effects on calcareous soils to be stabilized with lime and natural pozzolana

When investigating the potential use of lime and natural pozzolana for subgrade soils containing phosphate, especially on agricultural lands, the effectiveness of these traditional binders needs to be assessed because of the possible deleterious effect of phosphates anions. This paper addresses this question using the problematic marly soil of Medea which was deliberately contaminated with a common fertilizer mono ammonium phosphate (0, 2, 4 and 6% by dry weight) and then stabilized with lime and/or natural pozzolana (0, 8%),(0, 20%) by dry weight respectively. Micro and macrostructural changes of these mixtures were studied under X-Ray diffraction test and Scanning electron microscope imaging. Variations of pH levels on a 90 days period, Atterberg limits between 1 to 30 days of curing, normal Proctor parameters, immediate bearing index at optimum moisture were also carried out. Overall, the results indicate that the uncontaminated marly clay soil wasn’t very reactive to lime stabilization even with 8% lime and it required the addition of natural pozzolana with lime to exhibit some improvements. Aside from that, phosphates proved to be deleterious for stabilizing marly clay of Medea producing considerable impact on all the results. It was also shown that calcite present in the soil can interfere with the employed stabilization technique.

A Comprehensive Quality Evaluation for Gentiana Rigescens Franch. by Fingerprinting Combined with Chemometrics and Network Pharmacology.

Gentiana rigescens Franch. (G. rigescens) is a unique traditional medicinal herb from southwestern China, and its clinical mechanism for the treatment of hepatitis and the quality differences between different origins are not clear. The research aims to analyze the mechanisms for the treatment of hepatitis and differences in inter-origin differences using analytical techniques, chemometrics, and network pharmacology. Through infrared spectroscopy, spectral images, and high-performance liquid chromatography (HPLC) analysis, it was found that there were differences in absorbance intensity and significant differences in compound content among the samples' origin. G. rigescens iridoids and flavonoids exert therapeutic effects on hepatitis through multiple targets (GAPDH, EGFR, and MMP9, etc.) and multiple pathways (non-small cell lung cancer, hepatitis C, etc.). The above HPLC, chemometrics, and network pharmacology results revealed that gentiopicroside, and swertiamarine was the best quality marker among origins. The accuracy of the ResNet model train, test, and external validation sets for synchronous spectral images were 100 %, which could be utilized as an effective tool for tracing G. rigescens's origins. The R2 of the calibration and validation sets of the PLSR model was higher than 0.70. This model had excellent predictive performance in determining the content of gentiopicroside and swertiamarine, and could quickly, accurately, and effectively predict these two compounds. The research investigates the differences in G. rigescens origins from multiple perspectives, establishes image recognition models and prediction models, and provides new methods and theoretical basis for quality control of G. rigescens.

Diagnosis and management of hypertrophic cardiomyopathy: European vs. American guidelines.

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, affecting 1:200 to 1:500 individuals worldwide. Guidelines on the diagnosis and management of HCM have been recently published by the European Society of Cardiology (ESC) and American societies. The ESC guidelines cover a broad range of cardiomyopathies, including HCM, with 119 recommendations, whereas the American guidelines focus exclusively on HCM with 141 specific recommendations. Both guidelines emphasize a comprehensive diagnostic approach, including imaging and genetic testing, but differ in some specific aspects. For example, sudden cardiac death (SCD) risk assessment is a primary point of divergence. The ESC guidelines advocate for the use of a validated Risk-SCD calculator, while the American guidelines rely on specific risk markers for individualized risk evaluation. Management strategies also vary: both guidelines prioritize beta-blockers and calcium channel blockers in patients with resting or provocable left ventricular outflow tract (LVOT) obstruction. If beta-blockers (or verapamil/diltiazem) are ineffective, either disopyramide or the myosin inhibitor mavacamten may be an option with slightly different indications among the two guidelines. Septal reduction therapy is recommended in ESC guidelines for symptomatic patients with significant LVOT gradients, while American guidelines suggest earlier myectomy for certain clinical factors and emphasize shared decision-making. The ESC guidelines recommend sequential atrioventricular pacing and dual-chamber defibrillators for reducing LVOT gradients. The American guidelines focus on genetic testing for risk assessment and suggest periodic cardiac magnetic resonance imaging. This paper provides a detailed comparison of these guidelines, highlighting key differences and areas needing further research and expert debate.

Automatic Segmentation and Evaluation of Mitral Regurgitation Using Doppler Echocardiographic Images

Background: Mitral Regurgitation (MR) is a common heart valve disease. Severe MR can lead to pulmonary hypertension, cardiac arrhythmia, and even death. Therefore, early diagnosis and assessment of MR severity are crucial. In this study, we propose a deep learning-based method for segmenting MR regions, aiming to improve the efficiency of MR severity classification and diagnosis. Methods: We enhanced the Efficient Multi-Scale Attention (EMA) module to capture multi-scale features more effectively, thereby improving its segmentation performance on MR regions, which vary widely in size. A total of 367 color Doppler echocardiography images were acquired, with 293 images used for model training and 74 images for testing. To fully validate the capability of the improved EMA module, we use ResUNet as the backbone, partially integrating the enhanced EMA module into the decoder’s upsampling process. The proposed model is then compared with classic models like Deeplabv3+ and PSPNet, as well as UNet, ResUNet, ResUNet with the original EMA module added, and UNet with the improved EMA module added. Results: The experimental results demonstrate that the model proposed in this study achieved the best performance for the segmentation of the MR region on the test dataset: Jaccard (84.37%), MPA (92.39%), Recall (90.91%), and Precision (91.9%). In addition, the classification of MR severity based on the segmentation mask generated by our proposed model also achieved acceptable performance: Accuracy (95.27%), Precision (88.52%), Recall (91.13%), and F1-score (90.30%). Conclusion: The model proposed in this study achieved accurate segmentation of MR regions, and based on its segmentation mask, automatic and accurate assessment of MR severity can be realized, potentially assisting radiologists and cardiologists in making decisions about MR.

Eagles’ syndrome: is it the longest styloid process length to date? A case report and an overview of the literature

Eagle syndrome is a rare condition that occurs when the styloid process, a bony projection in the skull, becomes elongated and causes pain in the head, neck, and face. The causes of Eagle syndrome are not entirely clear, but it is believed to be related to a genetic predisposition or trauma to the head or neck. The most common symptoms of Eagle syndrome include a sharp pain in the throat or ear, difficulty swallowing, and a feeling of a foreign object in the throat. Other symptoms may include headaches, facial pain, and neck pain. Diagnosis of Eagle syndrome can be challenging as symptoms can be mistaken for other conditions such as myofascial pain syndromes, glossopharyngeal or trigeminal neuralgias, migraine and cervical arthritis. However, proper diagnosis can be established by performing adequate physical examination, taking clear medical history, and full workup including imaging tests such as X-rays, CT scans, or MRIs to confirm the diagnosis.

KI-gestützte Atemgasanalyse (E-Nose) zur Früherkennung von Lungenkarzinomen

Volatile organic compounds (VOCs) are an increasingly meaningful method for the early detection of various types of cancers, including lung cancer, through non-invasive methods. Traditional cancer detection techniques such as biopsies, imaging, and blood tests, though effective, often involve invasive procedures or are costly, time consuming, and painful. Recent advancements in technology have led to the exploration of VOC detection as a promising non-invasive and comfortable alternative. VOCs are organic chemicals that have a high vapor pressure at room temperature, making them readily detectable in breath, urine, and skin. The present study leverages artificial intelligence (AI) and machine learning algorithms to enhance classification accuracy and efficiency in detecting lung cancer through VOC analysis collected from exhaled breath air. Unlike other studies that primarily focus on identifying specific compounds, this study takes an agnostic approach, maximizing detection efficiency over the identification of specific compounds focusing on the overall compositional profiles and their differences across groups of patients. The results reported hereby uphold the potential of AI-driven techniques in revolutionizing early cancer detection methodologies towards their implementation in a clinical setting.

Study on the Development Rule of Mudstone Cracks in Open-Pit Mine Dumps Improved with Xanthan Gum

The stability of open-pit mine slopes is crucial for safety, especially for spoil dump slopes, which are prone to cracks leading to landslides. This study investigates the use of xanthan gum (XG) to enhance the stability of mudstone in spoil dumps. Various concentrations of xanthan gum were mixed with mudstone and subjected to dry–wet cycle tests to assess the impact on crack development. Pore and crack analysis system (PCAS) was utilized for image recognition and crack analysis, comparing the efficiency of crack rate and length modification. The study found that xanthan gum addition significantly improved mudstone’s resistance to crack development post-drying shrinkage. A 2% xanthan gum content reduced the mudstone crack rate by 45% on average, while 1.5% xanthan gum reduced crack length by 46.2% and crack width by 26.3%. Xanthan gum also influenced the fractal dimension and water retention of mudstone cracks. The optimal xanthan gum content for mudstone modification was identified as between 1.5% and 2%. Scanning electron microscopy imaging and X-ray diffraction tests supported the findings, indicating that xanthan gum modifies mudstone by encapsulation and penetration in wet conditions and matrix concentration and connection in dry conditions. These results are expected to aid in the development of crack prevention methods and engineering applications for open-pit mine spoil dump slopes.

Knee pain in primary care medicine : diagnostic and therapeutic approach

Knee pain is one of the most common musculoskeletal complaints in primary care medicine. The leading causes of knee pain are osteoarthritis and musculoskeletal disorders. A careful history and a rigorous clinical examination usually enable a diagnosis to be made without the need for further investigations. A systematic search for red flags helps identify patients requiring urgent and specialized care. When necessary, X-rays and ultrasound are the first-line imaging tests to perform. The latter can be used to guide a joint puncture for diagnostic and therapeutic purposes. This article reviews the diagnostic approach and summarizes the management of the main pathologies encountered in the general practitioner's office.

Septo-optic dysplasia plus: A case report for reviewing and recognizing this condition

Septo-optic dysplasia is a congenital neurological condition with multifactorial etiology, characterized by septum pellucidum agenesis and/or corpus callosum dysgenesis, hypoplasia of the chiasm or optic nerves, and hormonal dysfunction with pituitary or hypothalamic alterations. Diagnosis requires two of these criteria and magnetic resonance is the imaging test of choice. Most cases present with abnormalities of cortical development in the form known as septo-optic dysplasia plus. While seizures and neurodevelopmental disorders are the dominant neurological manifestations, this entity is highly heterogeneous and has multiple clinical and radiological findings to consider. We present the case of a 35-year-old man with a history of cranioencephalic trauma in childhood and remission for refractory focal epilepsy associated with cognitive deficit. During the initial examination, the simple cranial tomography showed septum pellucidum agenesis and corpus callosum dysgenesis. Brain magnetic resonance imaging revealed agenesis of the septum pellucidum, irregularity and anomalous thickening of the cerebral cortex in frontal lobes and perisylvian region, heterotopic gray matter in frontal lobes and left fronto-insular region, mild supratentorial ventriculomegaly, atypical appearance of the corpus callosum rostrum, and hypoplasia of the chiasm and optic nerves. Although agenesis of the septum pellucidum was the key finding in this case, it is not present in all patients. The relevance of magnetic resonance imaging for the detailed evaluation of other involved structures, highlighting optic nerve hypoplasia, is fundamental in the radiologist’s diagnostic workup and this entity recognition.

Prediction of Severe Acute Pancreatitis at a Very Early Stage of the Disease Using Artificial Intelligence Techniques, Without Laboratory Data or Imaging Tests: The PANCREATIA Study.

To evaluate machine learning models' performance in predicting acute pancreatitis severity using early-stage variables while excluding laboratory and imaging tests. Severe acute pancreatitis (SAP) affects approximately 20% of acute pancreatitis (AP) patients and is associated with high mortality rates. Accurate early prediction of SAP and in-hospital mortality is crucial for effective management. Traditional scores such as APACHE-II and BISAP are complex and require laboratory tests, while early predictive models are lacking. Machine learning (ML) has shown promising results in predictive modelling, potentially outperforming traditional methods. We analysed data from a prospective database of AP patients admitted to Vall d'Hebron Hospital from November 2015 to January 2022. Inclusion criteria were adults diagnosed with AP according to the 2012 Atlanta classification. Data included basal characteristics, current medication, and vital signs. We developed machine learning models to predict SAP, in-hospital mortality, and intensive care unit (ICU) admission. The modelling process included two stages: Stage 0, which used basal characteristics and medication, and Stage 1, which included data from Stage 0 and vital signs. Out of 634 cases, 594 were analysed. The Stage 0 model showed AUC values of 0.698 for mortality, 0.721 for ICU admission, and 0.707 for persistent organ failure. The Stage 1 model improved performance with AUC values of 0.849 for mortality, 0.786 for ICU admission, and 0.783 for persistent organ failure. The models demonstrated comparable or superior performance to APACHE-II and BISAP scores. The ML models showed good predictive capacity for SAP, ICU admission, and mortality using early-stage data without laboratory or imaging tests. This approach could revolutionise AP patients' initial triage and management, providing a personalised prediction method based on early clinical data.

Variation in batch ordering of imaging tests in the emergency department and the impact on care delivery.

To examine heterogeneity in physician batch ordering practices and measure the associations between a physician's tendency to batch order imaging tests on patient outcomes and resource utilization. In this retrospective study, we used comprehensive EMR data from patients who visited the Mayo Clinic of Arizona Emergency Department (ED) between October 6, 2018 and December 31, 2019. Primary outcomes are patient length of stay (LOS) in the ED, number of diagnostic imaging tests ordered during a patient encounter, and patients' return with admission to the ED within 72 h. The association between outcomes and physician batch tendency was measured using a multivariable linear regression controlling for various covariates. The Mayo Clinic of Arizona Emergency Department recorded approximately 50,836 visits, all randomly assigned to physicians during the study period. After excluding rare complaints, we were left with an analytical sample of 43,299 patient encounters. Findings show that having a physician with a batch tendency 1 standard deviation (SD) greater than the average physician was associated with a 4.5% increase in ED LOS (p < 0.001). It was also associated with a 14.8% (0.2 percentage points) decrease in the probability of a 72-h return with admission (p < 0.001), implying that batching may lead to more comprehensive evaluations, reducing the need for short-term revisits. A batch tendency 1SD greater than that of the average physician was also associated with an additional 8 imaging tests ordered per 100 patient encounters (p < 0.001), suggesting that batch ordering may be leading to tests that would not have been otherwise ordered had the physician waited for the results from one test before placing their next order. This study highlights the considerable impact of physicians' diagnostic test ordering strategies on ED efficiency and patient care. The results also highlight the need to develop guidelines to optimize ED test ordering practices.

Magnetic resonance imaging in patients with cardiac implantable electronic devices: the RESONANCE Spanish registry.

Despite increasing evidence demonstrating the safety of magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs), this procedure is often neglected in this population. This Spanish registry aimed to determine the proportion of MRI referrals and performance among patients with pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). This prospective, multicenter, open-label registry involved 21 Spanish centers. Data were collected upon implant of PMs or ICDs from BIOTRONIK and one year after, and included the number of MRIs and computed tomography scans prescribed, performed and denied, and reasons for denial. Data from 1105 patients (mean age: 74.2 years) were analyzed and 982 completed the follow-up. Of them, 82.2% had a PM and 17.8% an ICD. A total of 351 imaging tests were prescribed in 220 patients (19.9%), including 52 MRIs in 39 patients (3.5%) and 299 computed tomography scans in 196 patients (17.8%). Among the MRIs, 44 (84.6%) were performed, five (9.6%) were not performed, and three (5.8%) were replaced by an alternative test. Most of the indicated computed tomography scans were performed (97.7%). The proportion of patients with an MRI scan referral was 4.6% during the pre-COVID-19 period and 2.6% during the COVID-19 period. No MRI-related arrhythmic ventricular event was reported. This registry revealed that only 3.5% of patients with CIEDs had an MRI referral over the study, with rates decreasing to 2.6% during the COVID-19 period. These rates contrast with the 85 MRIs conducted per 1000 inhabitants in Spain in 2020.