Medical Database System Research Articles

Mortality and Associated Factors Among HIV/TB Co-infected Patients Under ART Clinic in Dire Dawa, Ethiopia, 2023

<i>Background</i>: Tuberculosis (TB) remains a significant public health concern globally, especially among HIV-positive individuals. The study aimed to investigate the factors associated with mortality among HIV/TB co-infected patients receiving antiretroviral therapy (ART) in Dire Dawa, Ethiopia. <i>Methods</i>: A retrospective follow-up study was conducted at Dilchora Referral Hospital among 434 HIV/TB co-infected patients enrolled in ART from January 2008 to January 2023. Standardized checklist was used for data collection and taken from patient’s medical cards and database system. Binary logistic regression was used to identify baseline factors associated with mortality. <i>Results</i>: The study found a mortality rate of 31% among HIV/TB co-infected patients. Factors such as WHO clinical stage III (AOR: 9.3, 95% CI: 3.03, 28.34) and WHO clinical stage IV (AOR: 11.3, 95% CI: 3.5, 36.34) and underweight and overweight body mass index were (AOR: 2.6, 95% CI: 1.35, 4.83) and (AOR: 21.4, 95% CI: 8.24, 55.5), poor ART adherence (AOR: 4.24, 95% CI: 2.25, 7.98), alcohol consumption (AOR: 3.15, 95%: 1.69, 5.87), and smoking (AOR: 4.12, 95% CI: 2.32, 7.29) were associated with increased odds of mortality. <i>Conclusion</i>: The study underscores the importance of identifying and addressing baseline factors that contribute to mortality in HIV/TB co-infected patients. Interventions targeting factors like clinical staging, adherence to ART, and lifestyle habits could help reduce mortality rates in this population.

Pneumocystis pneumonia in French intensive care units in 2013-2019: mortality and immunocompromised conditions.

The recent epidemiology of Pneumocystis pneumonia (PCP) requiring intensive care unit (ICU) admission and the associated spectrum of immunocompromising conditions are poorly described. We analyzed all adult PCP cases admitted to French ICUs via the French medical database system (PMSI), over the period from 2013 to 2019. French ICUs admitted a total of 4055 adult patients with PCP. Among all hospitalized PCP cases, the proportion requiring ICU admission increased from 17.8 in 2014 to 21.3% in 2019 (P < 0.001). The incidence of severe PCP rose from 0.85 in 2013 to 1.32/100,000 adult inhabitants in 2019 (P < 0.0001), primarily due to the proportion of HIV-negative patients that increased from 60.6% to 74.4% (P < 0.0001). Meanwhile, the annual number of severe PCP cases among patients with HIV infection remained stable over the years. In-hospital mortality of severe PCP cases was 28.5% in patients with HIV infection and 49.7% in patients without. Multivariable logistic analysis showed that patients with HIV infection had a lower adjusted risk of death than patients without HIV infection (Odds Ratio [OR]: 0.30, 95% confidence interval [95CI]: 0.17-0.55). Comorbidities or conditions strongly associated with hospital mortality included the patient's age, Simplified Acute Physiologic Score II, congestive heart failure, coagulopathy, solid organ cancer, and cirrhosis. A vast array of autoimmune inflammatory diseases affected 19.9% of HIV-negative patients. The number of PCP cases requiring ICU admission in France has risen sharply. While the yearly count of severe PCP cases in HIV-infected patients has remained steady, this rise predominantly affects cancer patients, with a recent surge observed in patients with autoimmune inflammatory diseases, affecting one in five individuals.

Ethical Encrypted Search Scheme for Medical Database

E-medical records are highly sensitive and require secure storage, typically in encrypted form. However, encrypting the records can make them difficult to search and utilize within existing medical database systems. Additionally, managing access to these records, especially when multiple authorities are involved, presents challenges in ensuring security and scalability.To address these issues, we propose an authorized searchable encryption scheme designed for a multi-authority setting. This scheme utilizes the RSA (Rivest-Shamir-Adleman) function to enable each authority to control and limit search capabilities based on clients' privileges. Furthermore, to enhance scalability, we employ multi-authority attribute-based encryption, allowing the authorization process to be streamlined even across policies from multiple authorities.We have conducted thorough security and cost analyses, as well as experimental evaluations, demonstrating that our proposed scheme introduces only moderate overhead to existing searchable encrypted systems. Keywords--e-medical system, cloud storage, forward security.

Long-term efficacies of selective vasodilators in pulmonary arterial hypertension: a comprehensive comparison using a spontaneous reporting database.

There is no clinical evidence of differences in drugs associated with long-term survival in patients with pulmonary arterial hypertension (PAH) due to the small population and lack of information on death in Japanese medical database systems. This study evaluated whether patient data from a spontaneous reporting database could be used for comparing the effects of pulmonary vasodilators on long-term survival in PAH patients. PAH patient data reported in the Japanese Adverse Drug Event Report (JADER) database from April 2004 to July 2022 were extracted. Kaplan-Meier curves were used to compare survival times. Adjusted hazard ratios (aHRs) for all-cause mortality were determined using Cox proportional hazards models. Of 1969 PAH patients reported in the JADER database, 1208 were included in the survival analyses. The patient demographics were similar to those of the PAH population reported in the Japan Pulmonary Hypertension Registry. Among drugs targeting the prostacyclin pathway, epoprostenol was most associated with long-term survival (aHR, 0.38; 95% confidence interval (CI), 0.23-0.64). The PAH patients treated with endothelin receptor antagonists had improved survival, especially among the macitentan users (aHR, 0.30; 95% CI, 0.22-0.42). Sildenafil was associated with a poor prognosis in the PAH patients (aHR, 1.56; 95% CI, 1.19-2.04). Although our results must be interpreted with caution due to several limitations inherent to spontaneous reporting databases, our approach using the JADER database for survival analysis may provide useful information in limited situations such as the treatment of rare diseases including PAH.

Transvaginal sonography and surgical findings in the diagnosis of endometriosis individuals: A cross-sectional study.

Endometriosis is a challenging gynecological disease and a debilitating condition that profoundly affects the individual's quality of life. Besides pathological confirmation, diagnostic laparoscopy has been internationally accepted as the standard method to identify the accurate mapping of endometriosis. Transvaginal sonography (TVS) is the first non-invasive imaging modality to estimate the severity of endometriosis. This study aimed to evaluate the accuracy of TVS in affected women compared with surgical findings. This retrospective cross-sectional study surveyed 170 women with deep infiltrating endometriosis (DIE) referred to the endometriosis part of the Avicenna Infertility Center, Tehran, Iran and they underwent TVS followed by laparoscopy. Recorded data of individuals under study in the medical database system were reviewed. Finally, the agreement rate was calculated for ultrasound reports and intraoperative (IO) findings regarding ovarian endometrium, ovarian adhesion, involvement of cul-de-sac, rectovaginal septum, and bowel and ureter. 170 women with DIE entered the study. The agreement of TVS and IO findings were 86.76% for left ovarian endometriosis and 70.86% for right ovarian endometriosis, 93.90% for left ovarian adhesion, and 88.90% for right ovarian adhesion, 88.90% for a cul-de-sac, and 84.82% for bowel nodules. The findings, based on a laparoscopic assessment of the pelvic floor, were completely compatible with ultrasound reports (100%). TVS allows a preoperative evaluation in planning the surgical policy associated. TVS is beneficial for dedicated mapping of DIE; thus, an expert radiologist can aid the surgeon in preoperative evaluation and IO management.

Database System for Medical Record Keeping and Retrieval

The field of healthcare is producing a lot of information in the form of data and knowledge. Medical knowledge is increasing day by day. The data needs to be accessed for providing health services and for administrative, economic, and legal purposes. Most of the health sectors use a paper-based system, which due to its certain limitations can affect the quality of care. Modern medical systems observed the need for the use of medical databases. Medical Database System (MDS) is an advancing concept and is defined as a systematic collection of online-based health records in any health facility that helps to overcome the limitations of conventional paper-based systems. The problem remains in the existing methods of medical record keeping and retrieval, which are less efficient as well as accurate. Recent systems have problems in their systems, such as inaccuracies in data, inefficiencies in their workflows, and other potential security weaknesses. Thus, there is a need for a database system specifically designed for medical record keeping that can overcome these problems and can offer a reliable, secure, and efficient solution for storing and retrieving medical records. In this research, an online-based health record system is designed that can keep, manage, and retrieve medical health records. The system’s frontend, as well as backend, are designed on Microsoft Access 365. Microsoft Access 365 offers suitability in keeping medical records, cost-effectiveness, integration capabilities, user-friendly interface, and scalability which also support the objectives and requirements of our project. The system includes patient registration for reception, a questioner and data retrieval for cancer diagnosis, and a complete pharmacy system including multiple forms and ledgers as well as the reports to get the summary of data where desired. Furthermore, the system contains a login system to make it secure. Our proposed database system shows a very significant improvement over existing systems in terms of efficiency, scalability, security, retrieval capabilities, and societal impact in medical record keeping and retrieval with significant societal impacts. This system can further be improved in the future, expanding its design by including other hospital services, like laboratories, finance departments, and consultation appointments. Nowadays artificial intelligence is performing an excellent role in each domain. Implementing artificial intelligence in this database system can lead this database system to the next level.

Blockchain-driven authorized data access mechanism for digital healthcare

The existing traditional medical database system is a centralized system in which data manipulation is easy, privacy is critical, and there is a lack of easy information exchange and adequate data management. Although blockchain mechanisms have the potential to use and easily maintained on the distributed medical architecture around the globe to address the bottleneck situation. In this paper, we propose a blockchain-based authenticated access control framework. We use blockchain technology to defend patients’ rights to licensed medical material distribution systems. The proposed mechanism’s security has been demonstrated against adversary. The analysis of performance and comparative study is also performed, which shows that it is a reliable authenticated access control architecture for e-healthcare in terms of efficiency and security.

The impact of systematic assessment for adverse events on unscheduled hospital utilization in patients receiving neoadjuvant or adjuvant chemotherapy: A retrospective multicenter study.

BackgroundThis study was conducted to compare the reported adverse event (AE) profiles and unexpected use of medical services during chemotherapy between before and after the healthcare reimbursement of AE evaluation in patients with cancer.Patients and MethodsUsing the electronic medical record database system, extracted patients with breast, lung, gastric, and colorectal cancers receiving neoadjuvant or adjuvant chemotherapy between September 2013 and December 2016 at four centers in Korea were matched using the 1:1 greedy method: pre‐reimbursement group (n = 1084) and post‐reimbursement group (n = 1084). Unexpected outpatient department (OPD), emergency room (ER) visit, hospitalization rates, and chemotherapy completion rates were compared between the groups.ResultsThe baseline characteristics were well‐balanced between the groups. By chemotherapy cycle, hospitalization (1.8% vs. 2.3%; p = 0.039), and ER visit rates (3.3% vs. 3.9%; p = 0.064) were lower in the post‐reimbursement group than that in the pre‐reimbursement group. In particular, since cycle 2, ER visit and hospitalization rates were significantly lower in the post‐reimbursement group than those in the pre‐reimbursement group (2.6% vs. 3.3%; p = 0.020 and 1.4% vs. 2.0%; p = 0.007, respectively), although no significant differences were observed during cycle 1. The OPD visit rates were similar between both groups, regardless of cycles. The post‐reimbursement group had a higher proportion of patients who completed chemotherapy as planned than the pre‐reimbursement group (93.5% vs. 90.1%; p = 0.006). Post‐reimbursement group had more AEs reported, including alopecia, fatigue, diarrhea, anorexia, and peripheral neuropathy, during cycle 1 than the pre‐reimbursement group, which significantly decreased after cycle 2.ConclusionThe introduction of healthcare reimbursement for AE evaluation may help physicians capture and appropriately manage AEs, consequently, decreasing hospital utilization and increasing chemotherapy completion rates.

Efficiency of National Taskforce for Combating the Coronavirus (COVID-19) Protocol using real-time PCR testing in health facilities over a period of 8-weeks

BackgroundFollowing declaration of Corona Virus Disease 19 (COVID-19) as a global outbreak by the WHO with recommendation to do nasopharyngeal swabs for diagnosis. Many countries started to take different measures of precautions. The Kingdom of Bahrain COVID team (National Taskforce for Combating the Coronavirus) has introduced different protocols for different categories. ObjectiveThe aim of this study is to; determine the efficiency of the recent National Taskforce for Combating the Coronavirus (COVID-19) Protocol 5-day nasopharyngeal swab from diagnosis; by evaluating the period of time needed for a patient to retain a negative polymerase chain reaction result and to determine the number of patients who failed to retain a negative result. In addition to, evaluating the cycle threshold values of persistent positive and its relation to current evidence in literature. This study also aims to determine the number of patients that needed urgent medical care [i.e. shifting to an intensive care unit (ICU) facility] in that time frame. Materials & methodsData were collected from the daily index master sheets present in the facility from medical database systems; ALCARE by Royal Medical Services and ORACLE Reports by iSEHA. Search engines used were PubMed/MEDLINE, Oxford Academic Database, Cochrane Database system. The duration of study was from 1-July 2020 to 31-August 2020. ResultsThe sample included 7196 male patients from ages 18–65 years. Median age was 36. Out of 7196 patients, 3506 retained a negative result on 5th day from diagnosis, 1594 retained a negative result on 7th day from diagnosis, and 1343 retained negative result on 9th day from diagnosis. While 618 patients failed to retain a negative result. ConclusionThis study estimated the efficiency of testing protocol based on the current prevalence state of COVID-19. They found that the current protocol was not enough for the clinical data. In addition, 7-day nasopharyngeal swab was an effective testing method. Among the patients with Ct value >24, negative infected persons should be paid close attention.

Enabling Authorized Encrypted Search for Multi-Authority Medical Databases

E-medical records are sensitive and should be stored in a medical database in encrypted form. However, simply encrypting these records will eliminate data utility and interoperability of the existing medical database system because encrypted records are no longer searchable. Moreover, multiple authorities could be involved in controlling and sharing the private medical records of clients. However, authorizing different clients to search and access records originating from multiple authorities in a secure and scalable manner is a nontrivial matter. To address the above issues, we propose an authorized searchable encryption scheme under a multi-authority setting. Specifically, our proposed scheme leverages the RSA function to enable each authority to limit the search capability of different clients based on clients' privileges. To improve scalability, we utilize multi-authority attribute-based encryption to allow the authorization process to be performed only once even over policies from multiple authorities. We conduct rigorous security and cost analysis, and perform experimental evaluations to demonstrate that the proposed scheme introduces moderate overhead to existing searchable encryption schemes.

Everolimus-Related Pneumonitis in Patients with Metastatic Breast Cancer: Incidence, Radiographic Patterns, and Relevance to Clinical Outcome.

This study investigated the incidence, radiographic patterns, and relevance to clinical outcome of everolimus-related pneumonitis (ERP) in patients with metastatic breast cancer (MBC). Data of patients with MBC treated with everolimus who had baseline and at least one follow-up chest computed tomography (CT) were obtained from a medical electronic database system. An independent review of the CT scans of these patients was conducted by two radiologists (NCT03730428). Log-rank and Cox proportional hazard regression analyses were used for time-to-event analyses. ERP was radiographically detected in 45 of 86 patients (52.3%). In more than 80% of these patients, ERP occurred during the first 4 months of everolimus treatment. Only 14 of the 45 patients with ERP were symptomatic (31.1%). Symptoms included cough, fever, and shortness of breath. Bilateral and lower distribution of the pneumonitis was most common. In most of the cases, ground-glass opacities and reticular opacities were noticed. Elderly patients were more likely to develop ERP. Patients with ERP had significantly longer progression-free survival (PFS; 6.8 vs. 4.1 months, p = .024) and overall survival (OS; 42.8 vs. 21.3 months, p = .016). ERP was a predictor of OS improvement confirmed by multivariate Cox analysis (hazard ratio, 0.49; 95% confidence interval, 0.25-0.97; p = .040). ERP was noted in half of the patients with MBC treated with everolimus. Our data suggested that ERP was associated with improved prognosis and may be used as a biomarker for the efficacy of everolimus in MBC. Close monitoring, prompt diagnosis, and proper treatment for ERP are essential to maintain the quality of life of patients and achieve maximum treatment benefits. Everolimus-related pneumonitis (ERP) is one of the most worrying drug adverse events, especially in Asian patients. However, little has been known about the clinical and radiographic details of ERP in patients with metastatic breast cancers (MBCs) treated with everolimus. The present study investigated the clinical characteristics, radiographic patterns, and its correlation with treatment outcome in patients with MBC. ERP was identified in more than half of patients with MBC during everolimus therapy and was associated with improved outcome. Close monitoring and prompt diagnosis and appropriate treatment for ERP are critical for the preservation of patients' quality of life and achievement of maximal treatment benefits.

Efficiency of National Taskforce for Combating the Coronavirus [COVID-19] Protocol Using Real-Time PCR Testing in Health Facilities Over a Period of 8-Weeks

Background: Following declaration of Corona Virus Disease 19 [COVID-19] as a global outbreak by the WHO with recommendation to do nasopharyngeal swabs for diagnosis. Many countries started to take different measures of precautions. The Kingdom of Bahrain COVID team [National Taskforce for Combating the Coronavirus] has introduced different protocols for different categories. Objective: The aim of this study is to; determine the efficiency of the recent National Taskforce for Combating the Coronavirus [COVID-19] Protocol 5-day nasopharyngeal swab from diagnosis; by evaluating the period of time needed for a patient to retain a negative PCR result and to determine the number of patients who failed to retain a negative result. In addition to, evaluating the cycle threshold values of persistent positive and its relation to current evidence in literature. This study also aims to determine the number of patients that needed urgent medical care [i.e. shifting to an ICU facility] in that time frame. Materials & Methods: Data was collected from the daily index master sheets present in the facility from medical database systems; ALCARE by Royal Medical Services and ORACLE Reports by iSEHA. Surf engines used were PubMed/MEDLINE, Oxford Academic Database, Cochrane Database system. Results: The sample included 7196 male patients from ages 18-65 years. Median age was 36. Out of 7196 patients, 3506 retained a negative result on 5th day from diagnosis, 1594 retained a negative result on 7th day from diagnosis, and 1343 retained negative result on 9th day from diagnosis. While 618 patients failed to retain a negative result. Conclusion: Authors conclude that the protocol is non-efficient with current data and that a 7-day nasopharyngeal swab is intended to be a more effective testing method.Funding Statement: None to declare.Declaration of Interests: The authors have no conflicts of interest to declare.Ethics Approval Statement: This research has been approved by the Bahrain COVID-19 Research & Ethics Committee and has been approved by the Ethical & Research Committee in Bahrain Defence Force Hospital.

Predictive value of neutrophil/lymphocyte ratio on myocardial injury in severe COVID-19 patients

Objective: To explore the predictive value of neutrophil/lymphocyte ratio (NLR) on myocardial injury in severe COVID-19 patients. Methods: In this single-center retrospective cohort study, we collected and analyzed data form 133 severe COVID-19 patients admitted to Renmin Hospital of Wuhan University (Eastern District) from January 30 to February 18, 2020. Patients were divided into myocardial injury group (n=29) and non-myocardial injury group (n=104) according the presence or absence of myocardial injury. The general information of patients was collected by electronic medical record database system. All patients were followed up for 30 days, the organ injury and/or dysfunction were monitored, the in-hospital death was compared between the two groups, and the disease progression was reevaluated and classified at 14 days after initial hospitalization. Logistic regression analysis was performed to identify risk factors of myocardial injury in severe COVID-19 patients. The ROC of NLR was calculated, and the AUC was determined to estimate the optimal cut-off value of NLR for predicting myocardial injury in severe cases of COVID-19. Results: There was statistical significance in age, respiratory frequency, systolic blood pressure, symptoms of dyspnea, previous chronic obstructive pulmonary disease, coronary heart disease history, white blood cells, neutrophils, lymphocytes, platelets, C-reactive protein, platelet counting, aspartate transaminase, albumin, total bilirubin, direct bilirubin, urea, estimated glomerular filtration rate, total cholesterol, low-density lipoprotein cholesterol, D-dimer, CD3+, CD4+, partial pressure of oxygen, partial pressure of CO2, blood oxygen saturation, other organ injury, clinical outcome and prognosis between patients with myocardial injury and without myocardial injury (all P<0.05). Multivariate logistic regression analysis showed that NLR was a risk factor for myocardial injury (OR=1.066，95%CI 1.021-1.111，P=0.033). ROC curve showed that NLR predicting AUC of myocardial injury in severe COVID-19 patients was 0.774 (95%CI 0.694-0.842), the optimal cut-off value of NLR was 5.768, with a sensitivity of 82.8%, and specificity of 69.5%. Conclusion: NLR may be used to predict myocardial injury in severe COVID-19 patients.

Development of an Online Health Care Assessment for Preventive Medicine: A Machine Learning Approach.

BackgroundIn the era of information explosion, the use of the internet to assist with clinical practice and diagnosis has become a cutting-edge area of research. The application of medical informatics allows patients to be aware of their clinical conditions, which may contribute toward the prevention of several chronic diseases and disorders.ObjectiveIn this study, we applied machine learning techniques to construct a medical database system from electronic medical records (EMRs) of subjects who have undergone health examination. This system aims to provide online self-health evaluation to clinicians and patients worldwide, enabling personalized health and preventive health.MethodsWe built a medical database system based on the literature, and data preprocessing and cleaning were performed for the database. We utilized both supervised and unsupervised machine learning technology to analyze the EMR data to establish prediction models. The models with EMR databases were then applied to the internet platform.ResultsThe validation data were used to validate the online diagnosis prediction system. The accuracy of the prediction model for metabolic syndrome reached 91%, and the area under the receiver operating characteristic (ROC) curve was 0.904 in this system. For chronic kidney disease, the prediction accuracy of the model reached 94.7%, and the area under the ROC curve (AUC) was 0.982. In addition, the system also provided disease diagnosis visualization via clustering, allowing users to check their outcome compared with those in the medical database, enabling increased awareness for a healthier lifestyle.ConclusionsOur web-based health care machine learning system allowed users to access online diagnosis predictions and provided a health examination report. Users could understand and review their health status accordingly. In the future, we aim to connect hospitals worldwide with our platform, so that health care practitioners can make diagnoses or provide patient education to remote patients. This platform can increase the value of preventive medicine and telemedicine.

Oseltamivir Has No Benefit for Non-ICU Hospitalised Patients with Seasonal Influenza

Background: The effect of treatment with oseltamivir in hospitalised patients with seasonal influenza is unclear. Most available data are obtained from pandemic influenza or the ambulatory setting. Methods: We retrospectively reviewed medical records of two similar hospitals with different Influenza treatment policies. Hospital A had a liberal policy towards treatment with Oseltamivir, while hospital B was rather conservative in its approach. We compared the outcomes of patients treated in the two hospitals (treatment strategy) and the outcome of Oseltamivir vs. only symptomatic treatment (effect of Oseltamivir). Primary endpoints were length of stay (LOS) and duration of fever. Secondary endpoints were 30-day mortality, secondary bacterial pneumonia, secondary transfer to ICU and 30-day rehospitalisation. Patients were stratified for gender, age, DM, coronary heart disease, congestive heart failure, oxygen saturation on admission, COPD, renal failure, immunosuppression, malignancy and Charlson comorbidity Index. Patients directly admitted to ICU were excluded from the analysis. We compared Hospital A with Hospital B and Oseltamivir treated with symptomatically treated patients using a Mann Whitney-U-Test, students t-test and logistic regression. Results: 534 patients were analysed. 280/534 patients had Influenza A, 254/534 Influenza B. 304 were admitted to Hospital A and 230 to Hospital B. 298/534 patients presented within <48 hours of symptom onset. Overall, 199/534 patients received Oseltamivir. Baseline characteristics were not different between patients in Hospital A vs Hospital B, or Oseltamivir treated vs non-antiviral treated patients (p= n.s.). Significantly more patients in Hospital A received Oseltamivir (54.1 vs 15.3%, OR 3.57, CI 2.3-5.48; p<0.001). No differences were seen between the two hospitals in either primary (LOS: 6.5 vs 7.0 days, p=0.82/ fever days 0 vs 1 days, p=0.0.6) or in secondary endpoints. Mortality was 5.5 vs 3.5 % p=0.25. When comparing Oseltamivir treated vs non-antiviral treated patients, no differences in primary or secondary endpoints were observed. LOS was 7 vs 6 days, p=0.64, Duration of fever 1 vs 0 days, p=0.054, and mortality 4.5 vs 4.8 %, p=0.89. Conclusion: In this real life study with non-ICU patients hospitalised with seasonal influenza, treatment with Oseltamivir did not result in an improved outcome. Funding Statement: No funding. Declaration of Interests: All authors report no conflict. Ethics Approval Statement: After approval by the ethics committee (EKNZ 2019_00614) we conducted a retrospective study using the hospital based electronic medical database system (KISIM®) developed by Cistec™.

1168Role of 18FDG(fluorodeoxyglucose)-PET (positron emission tomography) for differential diagnosis of pericardial disease

Abstract Background Pericardial disease is frequently associated with systemic diseases. Diagnosis is often troublesome because pericardial fluid does not always give an answer and limited assessment for the acquisition of tissue in effusive-constrictive or constrictive pericarditis. Even after biopsy of pericardium, diagnostic yield is very low without further information for the underlying case. 18FDG-PET can visualize both the inflammation and malignancy through whole body assessment; therefore, it can visualize both pericardium and other organs to provide further insight to the systemic disease. Purpose To assess the role of 18FDG-PET for differential diagnosis of pericardial disease in real clinical practice. Methods Patients who admitted to our pericardial disease clinic who underwent 18FDG-PET for diagnostic methods were derived from electrical medical system database and reviewed. Exclusion criteria were known the advanced stage of malignancy, or already diagnosed from pericardial effusion analysis (positive for malignancy or bacterial culture) by pericardiocentesis. Results Forty patients were finally analyzed. Most common final diagnosis was Idiopathic (n=13, 33%) and tuberculosis (n=12, 28%). Malignancy was diagnosed in 6 patients (15%). Diagnosis of malignancy in all the patients was not confirmed in pericardial effusion. One patient was diagnosed by pericardial biopsy and one by pericardial effusion. Other four were diagnosed by biopsy of other organs. Post-radiation therapy associated pericarditis in two patients, post-operative pericarditis in 5 patients, and transudate, hematoma associated pericarditis, parasite infection in one patient each. Lymph node uptake was found in 28 cases, and four of them was “suggestive malignancy”, 18 was “suggestive benign” and other 6 was “need further evaluation”. All of the patients categorized as “suggestive malignancy” was helped by 18FDG-PET which indicated the optimal biopsy site and 3 of them finally diagnosed as malignancy and one as parasite infection. All of the patients who were categorized as “suggestive benign” were finally diagnosed as a non-malignant disease. Pericardial biopsy was performed in 19 cases (48%) and only 4 were diagnostic. Other 15 specimen showed “chronic inflammation”. Guiding the optimal biopsy site by 18FDG-PET was achieved in 6 patients. 19 cases had normal SUV in the pericardium and 7 patients had very high pericardial SUV more than 10. 6 patients with benign LV pattern was finally diagnosed as tuberculosis pericarditis and one patient with the malignant pattern was finally diagnosed as angiosarcoma Conclusion 18FDG-PET is helpful in the initial assessment of pericardial disease in the aspects of 1) presumptive diagnosis of malignancy in especially in nondiagnostic pericardial effusion or technically risky for pericardiocentesis, 2) Selection of optimal biopsy site with a higher yield of disease, and 3) possibly non-invasive diagnosis of tuberculosis pericarditis. Acknowledgement/Funding None

Executing Complexity-Increasing Queries in Relational (MySQL) and NoSQL (MongoDB and EXist) Size-Growing ISO/EN 13606 Standardized EHR Databases.

This research shows a protocol to assess the computational complexity of querying relational and non-relational (NoSQL (not only Structured Query Language)) standardized electronic health record (EHR) medical information database systems (DBMS). It uses a set of three doubling-sized databases, i.e. databases storing 5000, 10,000 and 20,000 realistic standardized EHR extracts, in three different database management systems (DBMS): relational MySQL object-relational mapping (ORM), document-based NoSQL MongoDB, and native extensible markup language (XML) NoSQL eXist.The average response times to six complexity-increasing queries were computed, and the results showed a linear behavior in the NoSQL cases. In the NoSQL field, MongoDB presents a much flatter linear slope than eXist.NoSQL systems may also be more appropriate to maintain standardized medical information systems due to the special nature of the updating policies of medical information, which should not affect the consistency and efficiency of the data stored in NoSQL databases.One limitation of this protocol is the lack of direct results of improved relational systems such as archetype relational mapping (ARM) with the same data. However, the interpolation of doubling-size database results to those presented in the literature and other published results suggests that NoSQL systems might be more appropriate in many specific scenarios and problems to be solved. For example, NoSQL may be appropriate for document-based tasks such as EHR extracts used in clinical practice, or edition and visualization, or situations where the aim is not only to query medical information, but also to restore the EHR in exactly its original form.

Chinese medicine for idiopathic Parkinson's disease: A meta analysis of randomized controlled trials.

To evaluate the efficacy of Chinese medicine (CM) adjunct to conventional medications for idiopathic Parkinson's disease (PD). Electronic English and Chinese databases including PubMed, Cochrane Library, Web of Science, Chinese Medical Current Contents, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Med Database, and Traditional Chinese Medical Database System were used for key words searching in a highly sensitive search strategy. The extracted data was analyzed by the Review Manager 5.0. Twelve trials involving 869 participants were included in the meta-analysis. Unified PD Rating Scale (UPDRS) I, II, III, IV scores and UPDRS V-IV total scores were used to be the primary outcomes, Parkinson Disease Question-39 (PDQ-39) and Scores of Chinese Medical Symptoms were the secondary outcomes. CM adjunct therapy had greater improvement in UPDRS I [2 trials; standardized mean difference (SMD)-0.40, 95% confidence interval (CI)-0.71 to-0.09; Z=2.49 (P=0.01)], II [5 trials; SMD-0.47, 95% CI-0.69 to-0.25; Z=4.20 (P<0.01)], III [5 trials; SMD-0.35, 95% CI-0.57 to-0.13; Z=3.16 (P=0.002)], IV scores [3 trials; SMD-0.32, 95% CI-0.60 to-0.03; Z=2.17 (P=0.03)], UPDRS I-IV total scores [7 trials; SMD-0.36, 95%CI-0.53 to-0.20; Z=4.24 (P<0.05)]. PDQ-39 and Chinese medical symptoms compared to the conventional medication only. CM adjunct therapy has potential therapeutic benefits by decreasing UPDRS scores and reducing adverse effect.

Xiaoke Pill () and anti-diabetic drugs: A review on clinical evidence of possible herb-drug interactions.

To critically analyze the clinically-based evidence of herb-drug interaction on Xiaoke Pill () and its concomitant use with anti-diabetic drugs. MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), International Pharmaceutical Abstracts (IPA), Chinese BioMedical Literature Database (CBM), Traditional Chinese Medical Database System (TCMDS), China National Knowledge Infrastructure Database (CNKI) and Wangfang Databases were searched. Levels of Evidence and Severity Level of Interaction were used to evaluate the quality of the included studies. A total of 27 studies published in Chinese, including 2 randomized controlled trials, 3 case series and 22 case reports, were included. Eighteen herbdrug interactions were reported involving Xiaoke Pill as monotherapy, while 6 herb-drug interactions occurred associated with Xiaoke Pill in combination with anti-diabetic drugs. The clinical results of herb-drug interaction of Xiaoke Pill were reported as additive blood glucose-lowering effects with anti-diabetic drugs, including benefifi cial and adverse hypoglycemic effects, anaphylactic shock and severe hair loss. Of these interactions 82.8% were reported to be associated with potential deterioration of the patients' conditions including hypoglycemic coma, stroke, mental disorder and even death. This review helped establish the clinically-based evidence about herb-drug interaction of Xiaoke Pill and its concomitant use with anti-diabetic drugs. The fifi ndings would help arouse the awareness of both health professionals and the general public to avoid the adverse herb-drug interactions of Xiaoke Pill in healthcare and community settings.

Lamivudine Therapy Exacerbates Bilirubinemia in Patients Underlying Severely Advanced Hepatitis

Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case reports on liver injuries after certain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database. A total of 1,321 patients taking lamivudine alone or with others were evaluated using laboratory hits in an electronic medical system at Seoul National University Hospital from 2005 through 2011. The patients were grouped according to prior ALT results: G#1, ALT lt; 40 IU/L; G#2, 40 IU/L ≤ ALT lt; 120 IU/L; G#3, 120 IU/L ≤ ALT lt; 240 IU/L; and G#4, ALT ≥ 240 IU/L. In G#1 and G#2 patients, lamivudine or adefovir treatment decreased ALT and TB compared to prior values. In G#3 and G#4 patients with three times the upper limit of normal (ULN) ≤ ALT lt; 15 times the ULN, both ALT and TB were decreased after treatment with lamivudine alone, or adefovir following lamivudine therapy, indicating that lamivudine therapy ameliorated liver functions. However, in G#4 patients who experienced severely advanced hepatitis (ALT ≥ 15 times the ULN, or ≥ 600 IU/L), lamivudine augmented TBmax (6.3 → 13.3 mg/dL) despite a slight improvement in ALT (839 → 783 IU/L), indicative of exacerbation of bilirubinemia. Patients who used adefovir after lamivudine also showed a high incidence of hyperbilirubinemia when they experienced severely advanced hepatitis. Treatment with adefovir alone did not show the effect. In conclusion, lamivudine may increase the risk of hyperbilirubinemia in patients with severely advanced hepatitis, implying that caution should be exercised when using lamivudine therapy in certain patient populations.