Management Of Patients Research Articles

Assessment of Computer-Controlled Starpen Device and Conventional Aspirating Cartridge on Pain Perception in Paediatric Dental Patients – A Split-Mouth Crossover Study

Abstract Background: Local anaesthesia (LA) is the cornerstone for pain management of invasive dental procedures, but the process of delivering it may itself induce anxiety, especially in paediatric patients that can affect the pain perception. Advances such as the computer-controlled LA delivery system have expanded the horizons of LA and can serve as an alternative for painless injections. Objective: To examine the pain perception and anxiety reduction along with patient preference between computer-controlled Starpen device and conventional aspirating cartridge in LA administration for inferior alveolar nerve block. Materials and Methods: The patients were randomly allotted into two groups: Starpen and Septodont syringe where the LA injections were given using both the methods in the 1st week. After a washout period of 1 week, the crossover was performed and the other mode of LA administration was performed in the 2nd week. Pain scores were objectively recorded by the observer using the Face, Legs, Activity, Cry and Consolability (FLACC) scale during LA administration and extraction. Patients were asked to record the pain scores using the Visual Analogue Scale at three phases: (a) mucosa perforation, (b) needle insertion and (c) solution injection. The effect of pain perception on the vital parameters and the preference between the two techniques were assessed. Statistical Package for the Social Sciences (SPSS) version 23.0, Armonk, NY, USA: IBM Corp was used for statistical analysis, and Mann–Whitney U-test and unpaired t-test were utilised to compare the mean difference of two groups at significance level of 0.05. Results and Observations: Intergroup differences among the Starpen and Septodont syringe groups were found to be statistically significant (P < 0.001) during both LA and extraction when pain was objectively assessed using FLACC. Conclusion: Computerised devices such as Starpen offer controlled release of local anaesthetics, effectively decreasing pain perception in paediatric patients and can form a mainstay for the behaviour management of young patients.

Application of Alfalfa App in the management of oral anticoagulation in patients with atrial fibrillation: a multicenter randomized controlled trial

BackgroundIn recent years, mobile medical technology has made great progress in chronic disease management, but its application in patients with atrial fibrillation (AF) still needs to be clarified.ObjectiveThis study aims to determine whether the newly developed smartphone app for patients with AF (Alfalfa App) can improve anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients.MethodsAlfalfa App integrates the functions of patient education, remote consultation, and medication reminder through a simple user interface. From June 2020 to December 2020, patients with AF were recruited in five large tertiary hospitals in China. Patients were randomly divided into the Alfalfa App or routine nursing groups. Patients’ knowledge, medication adherence, and satisfaction with anticoagulation were assessed using validated questionnaires at baseline, 1 month, and 3 months.ResultsIn this randomized controlled trial, 113 patients with AF were included, 57 patients were randomly assigned to the Alfalfa App group, and 56 patients were randomly assigned to the routine nursing group. Forty-eight patients in the Alfalfa App group completed a three-month follow-up, and 48 patients in the routine nursing group completed a three-month follow-up. Basic demographic data were comparable between the two groups. The average age of AF patients was 61.65 ± 11.01 years old, and 61.5% of them were male. With time (baseline to 3 months), the knowledge scores of the Alfalfa App group (P<.001) and the routine nursing group (P = .002) were significantly improved, the compliance scores of the routine nursing group(P<.001) and Alfalfa App group(P<.001) significantly improved. Compared with the routine nursing group, patients’ knowledge level and medication compliance using the Alfalfa App at 1 month and 3 months were significantly higher (all P < .05). There were significant differences in knowledge and compliance scores between the two groups with time (all P < .05). The satisfaction degree of drug treatment in the Alfalfa App group was significantly better than that in the routine nursing group (all P < .05).ConclusionsAlfalfa App significantly improved the anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients. In oral anticoagulation management for AF patients, mobile medical technology that integrates the functions of patient education, remote consultation, and medication reminder may be helpful.Trial registrationRegistration number, ChiCTR1900024455. Registered on July 12, 2019.

Managing Cancer Pain in Hospitalized Patients with Comorbid Opioid Use Disorder with Buprenorphine: A Case Series.

Data indicate that one in five patients with cancer might be at risk for nonmedical opioid use and its extreme form, opioid use disorder (OUD). Buprenorphine is one of the few medications available for the management of patients with co-occurring OUD and chronic pain. Care for these patients can be challenging and require the expertise of specialist clinicians with a deep understanding of addiction and cancer pain. Regrettably, these specialist clinicians may not always be available and accessible when patients are admitted to the hospital. Reports on how primary non-specialist clinicians without access to specialist addiction services navigate the care of such patients in the inpatient setting are limited. We hereby describe the care of three patients with OUD receiving buprenorphine who were hospitalized for cancer pain.

Multiomics-Based Outcome Prediction in Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR)

Objectives: This retrospective study aims to develop a multiomics approach that integrates radiomics, dosiomics, and delta features to predict treatment responses in brain metastasis (BM) patients undergoing PULSAR. Methods: A retrospective study encompassing 39 BM patients with 69 lesions treated with PULSAR was undertaken. Radiomics, dosiomics, and delta features were extracted from both pre-treatment and intra-treatment MRI scans alongside dose distributions. Six individual models, alongside an ensemble feature selection (EFS) model, were evaluated. The classification task focused on distinguishing between two lesion groups based on whether they exhibited a volume reduction of more than 20% at follow-up. Performance metrics, including sensitivity, specificity, accuracy, precision, F1 score, and the area under the receiver operating characteristic (ROC) curve (AUC), were assessed. Results: The EFS model integrated the features from pre-treatment radiomics, pre-treatment dosiomics, intra-treatment radiomics, and delta radiomics. It outperformed six individual models, achieving an AUC of 0.979, accuracy of 0.917, and F1 score of 0.821. Among the top nine features of the EFS model, six features came from post-wavelet transformation and three from original images. Conclusions: The study demonstrated the feasibility of employing a data-driven multiomics approach to predict treatment outcomes in BM patients receiving PULSAR treatment. Integrating multiomics with intra-treatment decision support in PULSAR shows promise for optimizing patient management and reducing the risks of under- or over-treatment.

Attitudes towards digital health technology for the care of people with chronic kidney disease: A technology acceptance model exploration.

Chronic Kidney Disease (CKD) is a long-term condition and a major health problem, which affects over 3.5 million adults in the UK. Use of digital technology has been proposed as a means of improving patient management. It is important to understand the factors that affect the acceptability of this technology to people living with chronic kidney disease. This study used the Technology Acceptance Model 3 (TAM) to investigate whether perceived ease of use and perceived usefulness could predict intention behaviour. It then investigated if intention to use digital technology predicted actual use. This was a cross-sectional study whereby the TAM3 questionnaire was sent online to people known to have chronic kidney disease via Kidney Care UK. The characteristics of the respondents (age, sex, CKD stage) were recorded. The questionnaire was sent to 12,399 people, of which 229 (39% drop out) completed it. The respondents' age ranged from 24-90 years and 45% (n = 102) were male. Thirty-five percent of participants had advanced kidney care, 33% (n = 76) had kidney transplant and 22% (n = 51) had CKD. A multiple regression analysis showed a perceived ease of use and perceived usefulness of the technology predicted behaviour intention to use digital health technology. Behaviour intention did not significantly predict actual use behaviour. Perceived usefulness and perceived ease of use are important factors in determining the intention of people with CKD to use digital healthcare. However, a gap exists between this intention and readiness to actually use the technology. This needs to be overcome if digital healthcare is to gain future traction in the clinical scenario.

Cluster analysis identifies long COVID subtypes in belgian patients

Abstract SARS CoV-2 infection presents complications known as long COVID, a multisystemic organ disease which allow multidimensional analysis. Objectives This study aims to uncover clusters of long COVID cases and establish their correlation with the clinical classification developed at the Clinical Research Unit of Brugmann University Hospital, Brussels. Such an endeavour is instrumental in customizing patient management strategies tailored to the unique needs of each distinct group. Method A two-stage multidimensional exploratory analysis was performed on a retrospective cohort of 205 Long COVID patients, involving a Factorial Analysis of Mixed Data (FAMD), and then Hierarchical Clustering Post Component Analysis (HCPC). Results The study's sample comprised 76% women, with an average age of 44.5 years. Three clinical forms were identified: long, persistent, and post-viral syndrome. Multidimensional analysis using demographic, clinical and biological variables identified three clusters of patients. Biological data did not provide sufficient differentiation between clusters. This emphasizes the importance of identifying or classifying long COVID patients according to their predominant clinical syndrome. Conclusion long COVID phenotypes, as well as clinical forms, appear to be associated with distinct pathophysiological mechanisms or genetic predispositions. This underscores the need for further research.

Perioperative Pain Management in Hemophilic Patient Undergoing Orthopedic Surgery: A Narrative Review

Background: Hemophilia type A and B is associated with spontaneous bleeding in muscle tissues and joints. Acute hemarthrosis, representing 70–80% of all bleedings in severe hemophilia patients, is extremely painful. When surgical procedures are needed in hemophiliac patients, perioperative management should be planned with a multidisciplinary team. Our narrative review, through a rigorous analysis of the current literature, focuses on pain management in hemophiliac patients. Methods: The report synthesizes a literature review on hemophilia, adapting PRISMA guidelines. It identifies a research question on surgical procedures and perioperative pain management. Various sources, including electronic databases, are utilized. Study inclusion criteria are defined based on the research question. Forty studies are included. A detailed study selection is illustrated. Results: Guidelines for managing acute postoperative pain in the general population advocate for a multimodal analgesic administration to enhance synergistic benefits, reduce opioid requirements, and minimize side effects. Recent recommendations from the World Federation of Hemophilia (WFH) for postoperative pain management in hemophilia patients suggest tailoring treatment based on pain levels, in coordination with anesthesiologists. Conclusions: Pain management in hemophiliac patients undergoing orthopedic interventions requires a multidisciplinary approach, with further research needed to define a reliable global standard of treatment.

Papillary carcinoma arising from de novo ectopic thyroid tissue within thyroglossal duct cyst: A rare case report

The most common congenital anomaly of thyroglossal duct is a thyroglossal duct cyst, but carcinoma arising from a thyroglossal duct cyst is a rare phenomenon. Carcinomas involving thyroglossal duct cysts are mostly papillary carcinomas. Definitive diagnosis of carcinomas involving thyroglossal duct cysts is done through surgical excision and subsequent histopathological examination. Most carcinomas arise de novo from ectopic thyroid tissue within thyroglossal duct cysts, but the direct spread of papillary carcinomas arising from the thyroid gland can also present themselves as carcinomas involving thyroglossal duct cysts in a minority of patients. Clinical presentation in most of the patients with carcinoma of thyroglossal duct cyst is quite similar to that of the patients with histopathologically diagnosed thyroglossal duct cyst, i.e., a painless anterior midline neck swelling with cosmetic concern and no other significant symptom(s). Careful clinical examination, imaging techniques, fine needle aspiration cytology, etc., can be helpful in indicating the presence of carcinoma preoperatively. Management of patients with thyroglossal duct cyst carcinoma involves only the Sistrunk procedure in the majority of cases. However, in a minority of patients, management by Sis trunk procedure with additional total thyroidectomy (with or without dissection of lymph nodes of the neck) and adjuvant chemo and radio-ablation therapies are needed. Here, we report a case of a 17-year-old female with papillary carcinoma involving thyroglossal duct cyst who presented with a submental swelling and was eventually managed by Sis trunk procedure, total thyroidectomy, and adjuvant therapies for optical cure. Decisions for the management of her cancer were taken through multidisciplinary interactions at tumor board meetings and by judging her surgical and therapeutic needs based on her clinical, radiological, and pathological findings.

Areas of uncertainty on the diagnosis, treatment, and follow-up of hypophosphatemia in adults: an Italian Delphi consensus.

The study aimed to present the results of a Delphi consensus involving Italian experts focusing on the management of hypophosphatemia in adults. A multidisciplinary advisory board of nine physicians, experts in hypophosphatemia management, was established. Next, a literature search was performed to identify international guidelines, consensus, and clinical pathways, which were later presented to the advisory board. Collaboratively, the advisory board and authoring team selected key statements for the consensus process and focused on areas of uncertainty related to the management of hypophosphatemia. The advisory board also indicated the experts to be invited to participate in the consensus process. The Delphi method was employed to reach a consensus. The literature search yielded one guideline, five consensus documents, and one clinical pathway. While our search strategy aimed to identify documents on the management of all types of hypophosphatemia, most of the guidelines and consensus documents retrieved focused on X-linked hypophosphatemia. The consensus process focused on 11 key issues, achieving strong convergence (over 70% consensus) in the first Delphi round for 8 out of the 11 statements. Three statements proceeded to the second round, with strong agreement reached for two. Notably, consensus was not reached for the statement concerning the measurement of fibroblast growth factor 23 for diagnostic purposes. The study revealed that the community of clinical experts is well-informed and in agreement regarding hypophosphatemia management. It emphasized the importance of developing clear national guidance documents to support clinicians and multidisciplinary teams in patient management. These documents are crucial not only for healthcare professionals but also for those responsible for defining pathways and services, facilitating a more accurate management of hypophosphatemic patients.

Prone position applied to COVID-19 patients: Systematic review-meta-analysis.

Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position. This systematic review and meta-analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit. This systematic review-meta-analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID-19 patients. Twenty-three studies were included. This meta-analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID-19 and severe hypoxemic. The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation. The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID-19 patients.

The role of artificial intelligence in optimizing management of atrial fibrillation in acute ischemic stroke.

Atrial fibrillation (AF) is a severe condition associated with high morbidity and mortality, including an increased risk of stroke and poor outcomes poststroke. Our understanding of the prognosis in AF remains poor. Machine learning (ML) has been applied to the diagnosis, management, and prognosis of AF in the context of stroke but remains suboptimal for clinical use. This article endeavors to provide a comprehensive overview of current ML applications to AF patients at risk of stroke, as well as poststroke patients without AF. Strategies to develop effective ML involve the validation of a variety of ML algorithms across internal and external datasets as well as exploring their predictive powers in hypothetical and realistic settings. Recent literature of this rapidly evolving field has displayed much promise. However, further testing and innovation of medical artificial intelligence are required before its imminent introduction to ensure complete patient trust within the community. Prioritizing this research is imperative for advancing the optimization of ongoing care for AF patients, as well as the management of stroke patients with AF.

Optimizing Touchless Fingerprint Identification: A Machine Learning Approach to Modelling and Performance Evaluation

This paper explored the modelling and performance analysis of a smartphone-based fingerprint identification system using Convolutional Neural Networks (CNN). The research developed a theoretical framework to validate picture-based fingerprint identification as a feasible alternative to traditional touch-based methods. A modified Automated Fingerprint Identification System (AFIS) model served as the study's foundation. To enhance the model's capabilities, data from two databases, IIT India and SOCOFing, were utilized. The evaluation of the CNN architecture focused on mobile device fingerprint recognition. It emphasized key processes such as data pre-processing, model training, and the optimization of the CNN through a Siamese-CNN approach to boost accuracy and efficiency. Python scripts developed for this purpose were converted to Android code using TensorFlow for deployment on Android devices. Performance metrics, including identification accuracy, processing speed, and resource utilization, were analysed to determine the system's feasibility. The results demonstrated that CNN-based fingerprint identification systems hold significant promise for delivering robust and reliable biometric authentication on smartphones, highlighting both their practical applications and limitations. decrease medical as well as financial burden, hence improving the management of cirrhotic patients. These predictors, however, need further work to validate reliability.

The Critical Role of Regulatory T Cells in Immune Tolerance and Rejection Following Liver Transplantation: Interactions With the Gut Microbiome.

Liver transplantation (LT) is the ultimate treatment for patients with end-stage liver disease or early hepatocellular carcinoma. In the context of LT, because of the unique immunological characteristics of human liver allograft, 5%-20% of selected LT recipients can achieve operational tolerance. Nonetheless, there remains a risk of rejection in LT patients. Maintaining immune homeostasis is thus crucial for improving clinical outcomes in these patients. In mechanism, several immune cells, including dendritic cells, Kupffer cells, myeloid-derived suppressor cells, hepatic stellate cells, regulatory B cells, and CD4+ regulatory T cells (Treg), contribute to achieving tolerance following LT. In terms of Treg, it plays a role in successfully minimizing immunosuppression or achieving tolerance post-LT while also reducing the risk of rejection. Furthermore, the gut microbiome modulates systemic immune functions along the gut-liver axis. Recent studies have explored changes in the microbiome and its metabolites under various conditions, including post-LT, acute rejection, and tolerance. Certain functional microbiomes and metabolites exhibit immunomodulatory functions, such as the augmentation of Treg, influencing immune homeostasis. Therefore, understanding the mechanisms of tolerance in LT, the role of Treg in tolerance and rejection, as well as their interactions with gut microbiome, is vital for the management of LT patients.

Monitoring the efficiency of reversal on anti-Xa direct oral anticoagulants using point-of-care viscoelastic testing

Bleeding events in patients receiving direct oral anticoagulation (DOAC) can be life-threatening even at therapeutic DOAC plasma concentrations, as anticoagulation impairs hemostasis and should therefore be identified immediately after hospital admission. The anticoagulatory effects of DOAC are typically not measurable in standard coagulation tests, such as PT or aPTT. Specific calibrated anti-FXa-tests allow specific drug monitoring, but they are too time-consuming for critical bleeding events and are commonly not available for 24 h/7 days in routine care. However, recent advances in point-of-care (POC) viscoelastic testing (VET) have shown a promising approach for rapid and quantitative detection of DOAC plasma concentrations using the Russell viper venom factor V activator (RVV for FXa-inhibitors) test or the ecarin clotting time (thrombin inhibitors). In acute bleeding situations, direct FXa inhibitors can be reversed by specific antidote andexanet alfa or hemostasis can be improved by prothrombin complex factor concentrates (PCCs). After reversal, confirmation of reversal efficacy is often requested, but no routine assays are currently available. Thus, the emergency management of bleeding DOAC patients is usually “blinded” with regard to reversal efficacy. POC VET laboratory assays might therefore also be helpful for measuring DOAC effects after reversal. We present a case series demonstrating the usefulness of RVV-clotting time post-DOAC reversal with andexanet alfa.

ABLE-SCORE, a simplified risk score for major adverse cardiovascular outcomes in left ventricular hypertrabeculation: a multicenter longitudinal cohort study.

Left ventricular hypertrabeculation (LVHT) is a heterogeneous entity with life-threatening complications and variable prognosis. However, there are limited prediction models available to identify individuals at high risk of adverse outcomes, and the current risk score in LVHT is comparatively complex for clinical practice. This study aimed to develop and validate a simplified risk score to predict major adverse cardiovascular events (MACE) in LVHT. This multicenter longitudinal cohort study consecutively enrolled morphologically diagnosed LVHT patients between January 2009 and December 2020 at Fuwai Hospital (derivation cohort, n = 300; internal validation cohort, n = 129), and between January 2014 and December 2022 at two national-level medical centers (external validation cohort, n = 95). The derivation/internal validation cohorts and the external validation cohort were followed annually until December 2022 and December 2023, respectively. MACE was defined as a composite of all-cause mortality, heart transplantation/left ventricular assist device implantation, cardiac resynchronization therapy, malignant ventricular arrhythmia, and thromboembolism. A simplified risk score, the ABLE-SCORE, was developed based on independent risk factors in the multivariable Cox regression predictive model for MACE, and underwent both internal and external validations to confirm its discrimination, calibration, and clinical applicability. A total of 524 LVHT patients (43.5 ± 16.6years, 65.8% male) were included in the study. The ABLE-SCORE was established using four easily accessible clinical variables: age at diagnosis, N-terminal pro-brain natriuretic peptide levels, left atrium enlargement, and left ventricular ejection fraction ≤ 40% measured by echocardiography. The risk score showed excellent performance in discrimination, with Harrell's C-index of 0.821 [95% confidence interval (CI), 0.772-0.869], 0.786 (95%CI, 0.703-0.869), and 0.750 (95%CI, 0.644-0.856) in the derivation, internal validation, and external validation cohort, respectively. Calibration plots of the three datasets suggested accurate agreement between the predicted and observed 5-year risk of MACE in LVHT. According to decision curve analysis, the ABLE-SCORE displayed greater net benefits than the existing risk score for LVHT, indicating its strength in clinical applicability. A simplified and efficient risk score for MACE was developed and validated using a large LVHT cohort, making it a reliable and convenient tool for the risk stratification and clinical management of patients with LVHT.

Antioxidant status in patients with hyperplasia and prostate cancer

This review aims to briefly describe and summarize data from various studies on the role and the link between serum Total Antioxidant Status (TAS) levels in patients with BPH and PC, as well as other more widely available endogenous antioxidants, the levels of markers of inflammation (CRP, Leuc.), as well as the link between the values of endogenous antioxidants and various harmful factors. Their levels and adequate assessment could help in the proper management of patients with BPH and PC, as well as in reducing morbidity.

Impact of pharmacist-led intervention in medication adherence and inhaler usage on asthma and chronic obstructive pulmonary disease control: a quasi-experimental study.

Despite recent advances in the management of asthma and chronic obstructive pulmonary disease (COPD), patients still experience suboptimal disease control largely due to medication non-adherence and inappropriate use of inhaler. This study evaluates the impact of pharmacist-led intervention in medication adherence and inhaler usage on asthma and COPD control among out-patients attending the premier tertiary hospital in Nigeria. A quasi-experimental study carried-out among eligible out-patients attending pulmonology clinic of University College Hospital, Ibadan. Baseline questionnaire explored medication adherence using a comprehensive-medication-adherence-assessment-scale (CMAAS-12) developed by the study co-investigators, use of pressurized-metered-dose (pMDI) and Diskus inhalers, as well as asthma/COPD control using validated asthma control test (ACT) and COPD assessment test (CAT). Subsequently, patients were allocated into control (n = 65) or intervention group (n = 65) using odd or even number. Intervention group received 2-month follow-up educational and/or cognitive-behavioural interventions to resolve identified adherence barriers, while control group continued with traditional care. Descriptive statistics, Chi-square and Wilcoxon-signed-ranked tests were used for analysis at p < 0.05. Overall, patients with optimal adherence were 11(18.6%) and 16(27.1%), p = 0.132 (control), but 20(33.3%) and 38(63.3%), p < 0.001 (intervention) at baseline and post-baseline, respectively. Specifically, in the intervention group, the identified adherence barriers at baseline were summarized into knowledge (120;40.4%), practical (115;38.7%) and attitudinal (62;20.9%). Patients with correct use of pMDI were 11(21.6%) baseline and 19(36.5%) post-baseline, p = 0.011 (control), but 13(22.8%) and 46(80.7%) respectively, p < 0.001 (intervention). Correct use of Diskus inhaler were 5(50.0%) and 4(40.0%), p = 0.157 (control), but 7(35.0%) and 14(70.0%), p = 0.025 (intervention) at baseline and post-baseline, respectively. Patients with 'well-controlled asthma' were 25(44.6%) and 26 (47.3%), p = 0.025 (control), but 18(35.3%) and 32(60.4%), p < 0.001 (intervention) at baseline and post-baseline, respectively. The COPD-specific health status indicated that 0(0.0%) and 1(14.3%), p = 0.059 (control), but 0(0.0%) and 7(50.0%), p < 0.001 (intervention) at baseline and post-baseline, respectively, belonged to 'low COPD impact'. Pharmacist-led intervention significantly enhanced medication adherence and appropriate use of inhaler among the intervention cohort, with subsequent significant improvement in asthma control and reduced COPD impact compared with the control group. This underscores the need for active involvement of pharmacists in collaborative management of patients with chronic respiratory diseases in clinical practice. ClinicalTrials.gov identifier: NCT06417931. Retrospectively-registered.

Bridging early life trauma to difficult-to-treat depression: scoping review.

Accumulating evidence suggests that early life trauma (ELT) initiates and perpetuates a cycle of depression, leading to challenges in management and achieving remission. This scoping review aimed to examine the intricate relationship between ELT and difficult-to-treat depression (DTD). An extensive literature search from 1 January 2013 to 21 October 2023 was conducted using the Cochrane Library, PubMed, Scopus, PsycINFO and OpenGrey. Our review identified scientific literature illustrating the multifaceted link between ELT and DTD, highlighting the dual impact of ELT on therapeutic resistance and clinical complexity. This complexity hampers management of patients with DTD, who are characterised by limited pharmacological responsiveness and heightened relapse risk. While exploring the ELT-DTD nexus, the review revealed a paucity of literature on the impact of ELT within DTD. Findings underscore the profound link between ELT and DTD, which is essential for comprehensive understanding and effective management. Tailoring treatments to address ELT could enhance therapeutic outcomes for patients with DTD. Future studies should use larger samples and well-defined diagnostic criteria and explore varied therapeutic approaches.

Machine Learning Approaches for the Prediction of Postoperative Major Complications in Patients Undergoing Surgery for Bowel Obstruction

Background: Performing emergency surgery for bowel obstruction continues to place a significant strain on the healthcare system. Conventional assessment methods for outcomes in bowel obstruction cases often concentrate on isolated factors, and the evaluation of results for individuals with bowel obstruction remains poorly studied. This study aimed to examine the risk factors associated with major postoperative complications. Methods: We retrospectively analyzed 99 patients undergoing surgery from 2015 to 2022. We divided the patients into two groups: (1) benign-related obstruction (n = 68) and (2) cancer-related obstruction (n = 31). We used logistic regression, KNN, and XGBOOST. We calculated the receiver operating characteristic curve and accuracy of the model. Results: Colon obstructions were more frequent in the cancer group (p = 0.005). Operative time, intestinal resection, and stoma were significantly more frequent in the cancer group. Major complications were at 41% for the cancer group vs. 20% in the benign group (p = 0.03). Uni- and multivariate analysis showed that the significant risk factors for major complications were cancer-related obstruction and CRP. The best model was KNN, with an accuracy of 0.82. Conclusions: Colonic obstruction is associated with tumor-related blockage. Malignant cancer and an increase in C-reactive protein (CRP) are significant risk factors for patients who have undergone emergency surgery due to major complications. KNN could improve the process of counseling and the perioperative management of patients with intestinal obstruction in emergency settings.

Interplay between Lung Diseases and Viral Infections: A Comprehensive Review

The intricate relationship between chronic lung diseases and viral infections is a significant concern in respiratory medicine. We explore how pre-existing lung conditions, including chronic obstructive pulmonary disease, asthma, and interstitial lung diseases, influence susceptibility, severity, and outcomes of viral infections. We also examine how viral infections exacerbate and accelerate the progression of lung disease by disrupting immune responses and triggering inflammatory pathways. By summarizing current evidence, this review highlights the bidirectional nature of these interactions, where underlying lung diseasesincrease vulnerability to viral infections, while these infections, in turn, worsen the clinical course. This review underscores the importance of preventive measures, such as vaccination, early detection, and targeted therapies, to mitigate adverse outcomes in patients with chronic lung conditions. The insights provided aim to inform clinical strategies that can improve patient management and reduce the burden of chronic lung diseases exacerbated by viral infections.