Pertinent Clinical Information Research Articles

The Psychosocial Burden Of Psoriasis: Understanding The Impact On Mental Health And Well-Being

Psoriasis is a chronic, systemic inflammatory skin condition that is distinguished by scaly, red lesions that can be uncomfortable, itchy, and disfiguring. Psoriasis can influence aspects of one’s life beyond distressful physical symptoms, such as mood and quality of life. Patients diagnosed with psoriasis are 39% more likely to suffer from concomitant depression and 31% of patients are diagnosed with anxiety [1]. Due to physical manifestations, individuals with psoriasis are at increased risk of developing issues of poor social perception and body image stress [2]. Research states that psoriasis flare-ups are sometimes directly linked with bouts of anxiety and depression; conversely, physical symptoms of psoriasis may be attributed to psychosocial issues. For example, depression may cause a lack of proper adherence to treatment and lead to exacerbated inflammation. Understanding the psychosocial aspects of psoriasis may provide pertinent clinical information; thereby, allowing seamless integration of psychiatric treatments for the overall treatment protocol for psoriasis. This project delves into understanding how decreased emotional and social well-being can challenge the proper maintenance and treatment of psoriasis. Further, this paper highlights adaptive coping strategies and social support networks that are key in enhancing treatment viability. Oliver C, Robert PD, Daihung D, et al. The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis. Arch Dermatol. 2010;146(8) Hepat A, Chakole S, Rannaware A. Psychological Well-Being of Adult Psoriasis Patients: A Narrative Review. Cureus. 2023

Predicting stroke risk: An effective stroke prediction model based on neural networks

BackgroundStroke is the leading worldwide cause of disability and death. Effective stroke prevention and management depend on early identification of stroke risk. MethodsEight machine learning algorithms are applied to predict stroke risk using a well-curated dataset with pertinent clinical information. This paper describes a thorough investigation of stroke prediction using various machine learning methods. ResultsThe empirical evaluation yields encouraging results, with the logistic regression, support vector machine, and K-nearest neighbors models achieving an impressive accuracy of 95.04%, and the random forest and neural network models scoring even better, with accuracies of 95.10% and 95.16%, respectively. The neural network exhibits slightly superior performance, indicating its potential as a reliable model for stroke risk assessment. ConclusionsThe empirical evaluation underscores the ability of neural networks to discern intricate data relationships. These findings offer valuable insights for healthcare professionals and researchers, aiding in the development of improved stroke prevention strategies and timely interventions, ultimately enhancing patient outcomes.

Microbial etiology of vertebral osteomyelitis/discitis amid the opioid epidemic.

The primary goal of this study was to establish the current microbial trends in vertebral osteomyelitis/discitis (VOD) amid the opioid epidemic and to determine if intravenous drug use (IVDU) predisposes one to a unique microbial profile of infection. The authors performed a retrospective cohort study consisting of 1175 adult patients diagnosed with VOD between 2011 and 2022 at a single quaternary center. Data were acquired through retrospective chart review, with pertinent demographic and clinical information collected. Staphylococcus aureus was the most cultured organism in both the IVDU and non-IVDU groups at 56.1% and 40.7%, respectively. In the IVDU cohort, Serratia marcescens was the next most prevalently cultured organism at 13.9%. The present study demonstrates that in the IVDU population S. marcescens is an organism of high concern. The potential for Serratia spp. infection should be accounted for when selecting empirical antimicrobial therapy in VOD patients.

Transcending Language Barriers: Can ChatGPT Be the Key to Enhancing Multilingual Accessibility in Health Care?

ObjectiveTo explore the capabilities of Chat Generative Pre-trained Transformer (ChatGPT) for the purpose of simplifying and translating radiology reports into Spanish, Hindi, and Russian languages, with comparisons to its performance in simplifying to the English language. MethodsFifty deidentified abdomen-pelvis CT reports were fed to ChatGPT (4.0), instructing it to simplify and translate the report. The processed reports were rated on factual correctness (category 1), potential harmful errors (category 2), completeness (category 3), and explanation of medical terms (category 4). The translated versions were also rated on the quality of translation (category 5). The scores in each category were compared between the translated versions and each translated version was compared with the English version in the first four categories. The original reports and the simplified English reports were rated on the Flesch Reading Ease Score and the Flesch Kincaid Grade Level. ResultsThe Spanish translation outperformed the Hindi and Russian version significantly in categories 1 and 3 (P < .05). All translated versions performed significantly worse compared with the English version in category 4 (P < .001). Notably, the Hindi translated version performed significantly worse in all four categories (P < .05). The Russian translated version was also significantly worse in category 3 (P < .05). In the first three categories, the Spanish translation, and in the first two categories, the Russian translation demonstrated no statistically significant difference from the English version. No statistically significant difference was observed in the Flesch Reading Ease Score and Flesch Kincaid Grade Level of the simplified English reports. Typographical errors in the original reports negatively affected the translation. ConclusionChatGPT demonstrates potential ability in translating reports and communicating pertinent clinical information with limited errors. More training and tailoring are required for languages that are not as commonly used in medical literature. Large language models can be used for translating and simplifying radiology reports, potentially improving access to health care and helping reduce health care costs.

Characteristic morphology and immunohistochemical patterns of clear cell papillary renal cell tumours may be observed in renal cell carcinomas, a critical pitfall in renal biopsy cytopathology.

Clear cell papillary renal cell tumour (CCPRCT) was renamed from previous clear cell papillary renal cell carcinoma (CCPRCC) in the latest WHO Classification of Tumours. It is essential to differentiate RCC from CCPRCT in renal mass biopsies (RMB). RMB cases with subsequent resections were reviewed. The pathology reports and pertinent clinical information were recorded. Fifteen cases displaying either CCPRCT morphology (20% diffuse, 67% focal) or immunohistochemical patterns (cup-like CA9: 20% diffuse, 47% focal; CK7: 33% diffuse, 40% focal) were identified. One case was positive for TFE3. TSC mutation was identified in one case. Both cases exhibited both CCPRCT morphology and immunohistochemical patterns for CA9 and CK7, with focal high-grade nuclei. RMB diagnoses were as follows: 6 (40%) as CCRCC, 2 (13%) as CCPRCT, 2 (13%) as CCRCC versus CCPRCT, 2 (13%) as CCRCC versus PRCC, 1 (7%) as RCC with TSC mutation versus CCPRCT, 1 (7%) as TFE3-rearranged RCC versus PRCC, and 1 (7%) as cyst with low-grade atypia. 71% of patients underwent nephrectomy, 21% received systemic treatment for stage 4 RCCs, and 7% with ablation for small renal mass (1.6 cm) with low-grade CCRCC. Our study highlights that morphologic and immunochemical features of CCPRCT may be present in RCCs, including RCC-TFE3 expression and TSC-associated RCC, a critical pitfall to misdiagnose aggressive RCC as indolent CCPRCT and result in undertreatment. Careful examination of morphology and immunostains for CA9, CK7, and TFE3, as well as molecular tests, is crucial for distinguishing aggressive RCC from indolent CCPRCT.

Triglyceride-glucose index: A surrogate marker of homeostasis model assessment of insulin resistance to predict diabetic nephropathy.

To determine the association of triglyceride-glucose index with homeostasis model assessment of insulin resistance in type 2 diabetes mellitus patients, and to determine the association of triglyceride-glucose index with urinary albumin-to-creatinine ratio for predicting diabetic nephropathy. The observational, cross-sectional study was conducted from September 2021 to September 2022 at the Department of Chemical Pathology, Pakistan Railway Hospital, Rawalpindi, Pakistan and comprised recently-diagnosed type 2 diabetes mellitus patients. Recorded data included age, gender, vitals, diabetes duration, body mass index and other pertinent demographic and clinical information. Measurements included spot urine albumin-to-creatinine ratio, triglycerideglucose index, homeostasis model assesment of insulin resistance as well as fasting serum insulin, fasting plasma glucose, glycosylated haemoglobin, triglycerides, total cholesterol and serum creatinine. On the basis of triglyceride-glucose index scores, the participants were divided into 4 quartiles; Q1=4.5-5, Q2=5.1-5.5, Q3=5.6-6, and Q4=>6. Data was analysed using SPSS 26. Of the 218 patients, 141(64.7%) were females and 77(35.3%) were males. The overall mean age was 49.22±11.46 years. There were 102(46.8%) overweight patients, 33(15.1%) obese and 82(37.2%) had normal weight. There were 58(26.6%) patients in Q1, 86(39.4%) in Q2, 46(21.1%) in Q3 and 28(12.8%) in Q4. Those in Q4 showed elevated fasting plasma glucose, glycated haemoglobin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance and urine albumin-to-creatinine ratio (p<0.05), as well as low values for high-density lipoprotein cholesterol and estimated glomerular filtration rate(p<0.05). Fasting serum insulin was negatively linked to glycated haemoglobin (r=-0.12, p=0.07). Triglyceride-glucose index (r=0.76, p<0.001), homeostasis model assessment of insulin resistance (r=0.48, p<0.001), and urine albumin-to-creatinine ratio (r=0.10,p=0.05) positively correlated with glycated haemoglobin. Fasting serum insulin (r=-0.13, p=0.05), negatively correlated with triglyceride-glucose index, while homeostasis model assessment of insulin resistance (r= 0.32, p<0.001) and urine albumin-to-creatinine ratio (r=0.28, p=0.05) had a positive correlation. The estimated glomerular filtration rate was significantly positively linked with fasting serum insulin (r=0.05, p=0.05), and correlated significantly negatively with triglyceride-glucose index (r=-0.35, p=0.01), homeostasis model assessment of insulin resistance (r=-0.01, p=0.86) and urine albumin-to-creatinine ratio (r=-0.02, p=0.8). The triglyceride-glucose index showed a strong association with homeostasis model assessment of insulin resistance, and surpassed it in terms of predicting diabetic nephropathy in type 2 diabetes mellitus patients.

Enhanced Skin Assessment Methodology to Detect Early Tissue Damage and Prevent Pressure Injuries.

The purpose of this study was to evaluate a skin assessment technique, subepidermal moisture (SEM) assessment, to assess, identify, and prevent pressure injuries (PIs) in critically ill adults. This was a retrospective, descriptive, comparative research study. The sample comprised 69 critically ill adults; their mean age was 58.8years (SD 18.1years). The majority were male (n=40, 58%), 29 (42%) were African American (AA), and 36 (52%) were White. The study setting was a surgical trauma intensive care unit (STICU) in a southern US Gulf Coast academic level I trauma hospital. Data were collected from September to November 2021. We conducted a retrospective medical record review of subjects who had undergone SEM assessment. We also collected demographic and pertinent clinical information, including Braden Scale cumulative scores and subscale scores, documented PI prevention interventions, and PI occurrence and characteristics if developed within 7days of SEM measurement. We also evaluated whether PI prevention interventions were appropriate. To examine nurse perception of the SEM device, we conducted a web-based survey of nurses providing care in our facility's STICU. Comparison of responses was done using Fisher's test or Chi-square test, and the mean responses from groups were compared using t test. Thirty-five (57%) subjects had a sacral SEM delta ≥0.6; 14 (40%) were AA; 20 (57%) were White; and 11 (31%) had a hospital-acquired PI (HAPI) or present-on-admission (POA) PI. Among the 14 HAPI and POA PI subjects with sacral SEM delta, 11 (79%) had sacral SEM delta ≥0.6. Among 26 AA subjects with sacral SEM delta, 5 had a HAPI or POA PI, and of those, 4 (80%) had sacral SEM delta ≥0.6. A significant and negative correlation was observed between cumulative Braden Scale scores on day 2 and sacral SEM delta (r =-0.28, P =.03) and R heel delta (r =-0.29, P =.03) scores, indicating higher PI risk. Of the 35 patients with a sacral SEM delta ≥0.6, 24 (69%) subjects did not have appropriate PI prevention interventions. Nurses (n=13) indicated that the SEM device was easy to use and helped them perform an accurate skin assessment on patients with darker skin tones. This study demonstrates that SEM technology is beneficial to address racial disparities in skin assessment, enhance skin assessment accuracy beyond existing PI care, improve the accuracy of risk assessment, and promote appropriate location-specific PI prevention interventions.

Cysts of the jaws and how to make their diagnoses under a microscope: a need for a better communication between clinicians and pathologists

Introduction: Cysts of the jaws constitute an heterogenous group of lesions occurring in the maxillofacial region. Their diagnosis is challenging and necessitating a meticulous correlation of clinical, radiological, and pathological features. Pathologists often face numerous difficulties stemming from inadequate clinical and radiological information, along with limited samples. Nevertheless, clinicians are not always aware of the pathologist's concerns, making difficult to know exactly which pertinent clinical information they should deliver in their request form. The objective of this article is to illustrate the microscopic diagnostic pitfalls associated with cystic lesions of the jaws and enhance communication between oral surgeons and oral pathologist. Corpus: This section starts by examining the essential clinical and radiological data necessary for a precise pathological diagnosis. Subsequently, we discuss about the differential diagnosis of jaw cystic lesions, categorizing them into five distinct subsets based on their microscopic features, particularly their histological lining. For each subset, we engage in a detailed discussion concerning the primary diagnostic challenges and their implications for treatment decisions. Conclusion: Pathologist and clinicians are not irreconcilables: improved communication, rooted in a mutual understanding of each other's concerns, leads to optimizing the diagnosis and subsequently the treatment of jaw cysts.

C3+ and C3- Warm Autoimmune Hemolytic Anemias: A Comparison of Clinical Characteristics and Treatment Outcomes

Background: Warm autoimmune hemolytic anemia (WAIHA) is mostly IgG mediated (IgG+C3-), which may at times fix complement (IgG+C3+). Whether the clinical outcome of complement-fixing (C3+) WAIHA is different from that of non-complement fixing (C3-) WAIHA remains unclear. The goal of this retrospective study was to describe and compare the clinical characteristics and treatment outcomes of patients with C3+ and C3- WAIHA. Methods: We included adult WAIHA patients seen at our institution from 2001-2023 who met all of the following criteria: A) age &amp;gt;18 years; B) direct antiglobulin test [DAT] IgG+ + C3+ with no cold agglutinin; and C) biochemical evidence of hemolysis. Response to treatment was based on the international consensus criteria: complete (CR; normal Hb or Hb ≥12 g/dL, with resolution of hemolysis); partial (PR; Hb &amp;gt;10 but &amp;lt;12 g/dL or Hgb &amp;gt;12 g/dL without resolution of hemolysis); or no response (neither CR nor PR). 223 WAIHA patients were found, and 132 patients were ultimately included. The most common reason for exclusion was a lack of complete DAT that included C3 testing. Results: There were 59 patients with C3- WAIHA and 73 patients with C3+ WAIHA, reflecting 44.7% and 55.3% of total patients respectively. Pertinent demographic, clinical, and treatment information are shown in Table 1. Slightly over half (52.3%) were males and the mean age (SD) was 63.9 years (18.1). Concomitant lymphoproliferative disease was present in 34.1% of the patients. The 3 most common treatments were steroids (97%), rituximab (66.7%), and splenectomy (18.2%). The median follow-up from diagnosis was 20.0 months (range, 1.0-251.8 months), and 14.4% of patients had died at the time of this analysis with no difference between the groups (P=0.82). There was no significant difference in the demographic composition, clinical findings, and treatment received in both groups. The number of treatments received were similar between C3- and C3+ WAIHA groups (Table 1). After first line of treatment, response was achieved in 86.4% and 94.4% of the C3- and C3+ groups (P=0.12), respectively. Additionally, 62.7% of the C3- group and 80.8% of the C3+ group were in PR or CR by their most recent CBC (P=0.02). 33.9% and 43.8% of the C3- and C3+ groups relapsed at least once (P=0.25). In those who relapsed, there was an average of 2.6 relapse events in the C3- WAIHA group compared to 1.8 relapse events in the C3+ WAIHA group (P=0.03). However, there was no difference in time to first relapse between the groups (P=0.51), shown in Figure 1. Conclusion: There have been retrospective descriptions of multiple AIHA subtypes and response rates to different therapies; however, this is one of the first studies to our knowledge to focus specifically on outcomes between complement subgroups. In our large group of patients with C3- and C3+ WAIHA, the clinical presentation, treatments utilized, and response to treatment were similar. Our data suggest that C3- and C3+ WAIHA can be approached and treated similarly.

2197. Impact of an INtake FOrm for Restricted Medications to (INFORM) better antibiotic use within a long-term acute care hospital system

Abstract Background Long-term Acute Care Hospitals (LTACHs) are uniquely positioned to treat patients with a high severity of illness for a long period of time. Despite this, there are substantial barriers to providing antimicrobial stewardship in this setting including limited resources and lack of patient data from transferring facilities. Methods This multi-center retrospective, quasi-experimental study evaluated the use of broad-spectrum antibiotics (BSAbx) over 3 timeframes in 43 LTACHs and rehabs within the Post Acute Medical System. Despite implementation of a restriction policy in June 2018, use remained high for ceftolozane/tazobactam (C/T), ceftazidime/avibactam (CZA), and meropenem/vaborbactam (MEV). In July 2020, the system antimicrobial stewardship committee created an INtake FOrm for Restricted Medications (INFORM) that required submission of pertinent clinical information for each patient receiving one of the target antibiotics as well as systematic review by an ID pharmacist. An electronic version of the INFORM was implemented in April 2022. Study timeframes included baseline (BL: July 2019-June 2020), phase 1 (P1: July 2020-March 2022), and phase 2 (P2: April 2022-March 2023). The primary objective was to determine if there was a difference in the combined use of C/T, CZA, and MEV measured as cost/acute patient day (APD) across the three timeframes. Secondary analyses included post-hoc analyses between these groups, and an evaluation of C/T, CZA, MEV with the addition of imipenem/cilastatin/relebactam (I/C/R). Results There was a significant reduction in antimicrobial use across intervention periods (mean cost/APD BL=2.5, P1=1.3, P2=0.8, p=0.045 using ANOVA, Figure 1). Sub-hoc analyses showed a significant difference for BL:P1 (p=0.02) and BL:P2 (p&amp;lt; 0.01), but not for P1:P2 (p=0.6). Even when adding I/C/R to control for any shifts in utilization to this agent after it was approved by the FDA, there was a statistically significant reduction across the intervention periods (p&amp;lt; 0.01 using ANOVA, Figure 2). Figure 2: Cost/Acute Patient Day for C/T, CZA, MEV vs. I/C/R over time C/T = ceftolozane/tazobactam, CZA = ceftazidime/avibactam, MEV = meropenem/vaborbactam, I/C/R = imipenem/cilastatin/relebactam Conclusion Completion of both the paper and electronic INFORM reduced C/T, CZA, and MEV use from baseline, showing that the systematic collection and review of patient data by an ID pharmacist reduced use of these BSAbx in a system of LTACHs and rehabs. Disclosures All Authors: No reported disclosures

Predictors of Transthoracic Impedance in Patients Who Underwent Elective Electrical Cardioversion

Successful synchronized direct current cardioversion (DCCV) requires adequate current delivery to the heart. However, adequate current for successful DCCV is not yet established. Trans-myocardial current depends on two factors: input energy and transthoracic impedance (TTI). While factors affecting TTI have been studied in animal models, factors affecting TTI in humans have not been well established. Here we explored the potential factors that affect TTI in humans. Retrospective review of patients undergoing DCCV at a large quaternary medical center between October 2019 and August 2021 was conducted. Pertinent clinical information, including demographics, echocardiography findings, laboratory findings and body characteristics were collected. Cardioversion details including joules delivered and TTI were recorded by the defibrillator for each patient's first shock. Predictors of thoracic impedance were assessed using regression analysis. A total of 220 patients (29% female) were included in the analysis. 143 (65%) of the patients underwent DCCV for atrial fibrillation, 77 (35%) underwent DCCV for atrial flutter. Mean impedance in our population was 73 ± 18 ohms. In a regression model with high impedance defined as the upper quartile of our cohort, BMI, female sex, obstructive sleep apnea and chronic kidney disease (All p values <0.05) were significantly associated with high impedance. According to an ROC analysis, BMI has a high predictive value for high impedance, with an AUC of 0.76. In conclusion, our study reveals that elevated BMI, female sex, sleep apnea and chronic kidney disease were predictors of higher TTI. These factors may help in determining the appropriate initial shocking energy in patients undergoing DCCV for atrial fibrillation and flutter.

Understanding inpatient mortality and 30-day mortality at a comprehensive cancer center.

59 Background: Inpatient mortality quality metric for hospital settings. We sought to review instances of inpatient mortality as part of continuing quality improvement (QI) in our pursuit of the Triple Aim of Health care to improve individual and population health, while reducing unnecessary physical harm, psychological harm, and costs. Methods: An interdisciplinary institutional mortality review committee (MRC) was assembled to review all instances of inpatient mortality or 30-day hospital mortality (hospital mortalities). Individual team members reviewed pertinent clinical information, and appropriate instances were discussed during monthly meetings. The purpose is to review the details of the hospitalization and make determinations if any learning opportunities or process improvements were present. Study data were collected and managed using REDCap electronic data capture tools. Approval from the IRB was obtained to conduct this retrospective analysis. Results: Between January 2022 and April 2023, a total of 430 instances of hospital mortalities were identified and reviewed. Of the 421 patients for which data was available, 294 deaths were classified as “Anticipated” while 127 were classified as “Unanticipated”. Out of the 421 patients, 189 (44.9%) were classified as having an improvement opportunity. There was no association between anticipated vs unanticipated death and opportunity for improvement χ2,(1, n=421) =0, p=.998. However, we noted a significant inverse association with prior goals of care conversation and learning opportunity χ2,(3, n=421) =77.2, p&lt;0.001. During the period of this initiative, we have noted an upward trend in the percentage of patients who had a GOC conversation from 83% to 96%. Improvement opportunities and hospital mortalities related to hospital acquired infections, direct surgical complications, and misdiagnosis were rare. Conclusions: Regarding hospital mortality, opportunities for improvement were largely centered around goals of care conversations and advanced care planning. There is a suggestion that MRC may have contributed to the increase in documented Goals of Care conversations. We believe that an MRC can contribute towards a cultural shift to promote Advanced Care Planning. Initiatives to improve goals of care conservations early in a patient’s disease course may have the potential to reduce inpatient mortality and reduce the physical, psychological, and financial toll of disease.

Bone Flap Resorption After Cranioplasty: Risk Factors and Proposal of the Flap Integrity Score

BackgroundBone flap resorption is a known complication of post-decompressive autologous cranioplasty. Although several potential etiopathogenetic factors have been investigated, their role is still under discussion. To further complicate things, resorption is not an all-or-nothing event, patients frequently presenting with different degrees of flap remodeling. Focus of this paper was to describe the elaboration of a score quantifying bone resorption according to a set of clinical and radiological criteria, hopefully allowing prompt identification of patients needing re-surgery before the development of adverse events. MethodsIn a 10-years-time, 281 autologous cranioplasties were performed at our Institution following decompressive craniectomy. Pertinent clinical and radiological information was registered. A set of 3 clinical and 3 radiological parameters was established to score the degree of resorption, identified under the acronym FIS (Flap Integrity Score). Three groups of patients emerged, respectively showing no (208), partial (32) and advanced (41) resorption. ResultsAn overall 14.6% incidence of advanced bone resorption was found in our series. Younger age, bone multifragmentation, higher post-cranioplasty GOS scores, < 2 cm distance of medial craniectomy border from the midline, and cause leading to decompressive craniectomy were associated to a statistically significant higher risk of developing a relevant bone flap resorption. The first three variables confirmed as risk factors at multivariate analysis. FIS well discriminated the 3 different groups. ConclusionsAutologous bone repositioning is still a valuable, low-cost, cosmetically and functionally satisfactory procedure. Nonetheless, although resorption affects a minor percentage of patients, its early identification and treatment can improve long term results.

REPORTING HIGH RISK HISTOPATHOLOGICAL FEATURES IN OPHTHALMIC PATHOLOGY

Background: There can be a wide variety of space-occupying lesions in and around the orbit. These include congenital lesions, benign vascular lesions, inflammatory and infectious diseases and malignant neoplasms. In surgical pathology, the idea of a critical diagnosis in ophthalmic pathology entails a determination of the gravity of an anatomic finding and whether or not it was clinically predicted.If pertinent clinical information is included with the specimen before it is sent to the lab, pathologists are less likely to wrongly label a diagnosis as unexpected. Objective: The aim of this study was to determine critical diagnosis in different neoplastic and non-neoplastic lesions in ophthalmic pathology. Materials and methods: Eighty-six cases of different lesions in the orbit were collected from Mayo Hospital, Lahore. Results: For 29 benign lesions, the ages of the patients ranged from 1-60 years with a mean of 31.48 years ±14.43 SD. Cystic lesions were most common benign lesions. There were 27 malignant lesions of orbit. Basal cell carcinoma and squamous cell carcinoma were the most frequent malignancies in adults whereas retinoblastoma was the most common tumor of children. Age ranged from 3-82 with a mean of 51.54 years ±24.58 SD. The lesions were more frequent in females. Conclusion: In this study of 86 cases of lesions in orbit, it was concluded that non-neoplastic cystic lesions including epidermal inclusion cyst and dermoid cysts were most common. Among the malignant tumors, basal cell carcinoma is the most common malignant tumor followed by squamous cell carcinoma.

Association between clinical history in the radiographic request and diagnostic accuracy of thorax radiographs in dogs: A retrospective case-control study.

The effect of clinical history on the interpretation of radiographs has been widely researched in human medicine. There is, however, no data on this topic in veterinary medicine. Diagnostic accuracy would improve when history was supplied. Thirty client-owned dogs with abnormal findings on thoracic radiographs and confirmation of the disease, and 30 healthy client-owned controls were drawn retrospectively. Retrospective case-control study. Sixty radiographic studies of the thorax were randomized and interpreted by 6 radiologists; first, with no access to the clinical information; and a second time with access to all pertinent clinical information and signalment. A significant increase in diagnostic accuracy was noted when clinical information was provided (64.4% without and 75.2% with clinical information; P = .002). There was no significant difference in agreement between radiologists when comparing no clinical information and with clinical information (Kappa 0.313 and 0.300, respectively). The addition of pertinent clinical information to the radiographic request significantly improves the diagnostic accuracy of thorax radiographs of dogs and is recommended as standard practice.

Incisional hernias post renal transplant: a systematic review and meta-analysis.

Incisional hernia (IH) post renal transplant (RT) is relatively uncommon and can be challenging to manage clinically due to the presence of the kidney graft and patient immunosuppression. This systematic review and meta-analysis synthesises the current literature in relation to IH rates, risk factors and outcomes post RT. PubMed, EMBASE, and Cochrane Central Registry of Controlled Trials (CENTRAL) were searched up to July 2023. The most up to date Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed. Pertinent clinical information was synthesised. A meta-analysis of the pooled proportions of IH rates, the rates of patients requiring surgical repair and the rates of recurrence post RT are reported. Twenty studies comprising 16,018 patients were included in this analysis. The pooled rate of IH occurrence post RT was 4% (CI 3-5%). The pooled rate of IH repair post RT was 61% (CI 14-100%). The pooled rate of IH recurrence after repair was 16% (CI 9-23%). Risk factors identified for IH development post RT are BMI, immunosuppression, age, smoking, incision type, reoperation, concurrent abdominal wall hernia, lymphocele formation and pulmonary disease. IH post RT is uncommon and the majority of IH post RT are repaired surgically on an elective basis.

Clinico-pathological Spectrum of Pyogenic Granuloma in Patients Presenting at Ayub Teaching Hospital, Abbottabad

Background: Oral Pyogenic Granuloma (OPG) is a type of oral mucosal lesion that is distinguished by its rapid development, friable nature, and vascular proliferation. Aim: To examine the demographic and histopathological features of patients diagnosed with oral pyogenic granuloma. Study design: The cross-sectional study. Methodology: This study was conducted in the Dentistry Department of Ayub Medical College, Abbottabad following the acquisition of a comprehensive medical history through a pre-established form, pertinent clinical information pertaining to the patients, including age and lesion location, was collected. All excisional biopsy specimens were collected. Following preservation in 10% neutral buffered formalin, the gathered specimens underwent preparation for paraffin embedding. The histopathological findings that were assessed and documented included the observation of ulceration, inflammatory cell infiltration, vascular proliferation, fibrosis, and epithelial alterations. Data was analyzed in SPSS. Results: The 51 patients who were a part of the research had a mean age of 31.14+SD and were all female. The bulk of the patients were between the ages of 26 and 35. Lesion diameters varied from 0.5 to 3 cm, with 1.1 to 2 cm being the most common size range. 78% of the cases involved pregnant females. The most common site was the gum mucosa, lips, tongue, and palate were the next most typical locations for OPG. The majority of patients had pseudoepitheliomatous hyperplasia, mild chronic inflammation, and fibrosis, in addition to lobules of capillary sized blood vessels according to histopathological examination. Conclusion: Oral Pyogenic Granuloma is predominantly seen in young females, and is mostly associated with pregnancy and most common site is gum mucosa. The histopathological findings demonstrate characteristic features such as pseudoepitheliomatous hyperplasia, chronic inflammation, and fibrosis. Understanding these features contributes to accurate diagnosis and management of this lesion. Keywords: Oral Pyogenic Granuloma, lobular capillary hemangioma, pseudoepitheliomatous hyperplasia.

Predicting diabetes with multivariate analysis an innovative KNN-based classifier approach

Diabetes seems to be a severe protracted disease or combination of biochemical disorders. A person's blood glucose (BG) levels remain elevated for an extended period because tissues lack and non-reaction to hormones. Such conditions are also causing longer-term obstacles or serious health issues. The medical field handles a large amount of very delicate data that must be handled properly. K-Nearest Neighbourhood (KNN) seems to be a common and straightforward ML method for creating illness threat prognosis models based on pertinent clinical information. We provide an adaptable neuro-fuzzy inference K-Nearest Neighbourhood (AF-KNN) learning-dependent forecasting system relying on patients' behavioural traits in several aspects to obtain our aim. That method identifies the best proportion of neighborhoods having a reduced inaccuracy risk to improve the predicting performance of the final system.

A “High-Reliability Organization” Approach to Improve Trauma Imaging Performance

PurposeCT is the gold standard for triaging critically ill patients, including in trauma, and its use has increased over time. CT turnaround times (TATs) are frequently targeted for improvement. As opposed to linear reductionist processes such as Lean and Six Sigma, a high-reliability organization (HRO) approach focuses on culture and teams to enable rapid problem solving. The authors evaluated the HRO model to rapidly generate, trial, select, and implement improvement interventions to improve trauma patient CT performance. MethodsAll trauma patients presenting to a single institution’s emergency department during a 5-month period were included. Project periods included 2-month preintervention, 1-month wash-in, and 2-month postintervention. Each initial trauma CT encounter during the wash-in and postintervention periods created job briefs in which the radiologist ensured that all involved had the pertinent clinical information and agreed on the imaging needed, thereby creating a shared mental model as well as an opportunity to raise concerns and provide ideas for improvement. ResultsA total of 447 patients were included: 145 preintervention, 68 wash-in, and 234 postintervention. The seven selected interventions were trauma text alert; scripted CT technologist-radiologist communication; modification of CT acquisition, processing, sending, and interpretation; and trauma mobile phones. The seven selected interventions reduced trauma patient CT median TATs by 60% (78 vs 31 min, P < .001), demonstrating the effectiveness of an HRO approach to improvement. ConclusionsAn HRO-based approach was rapid in generating, trialing, selecting, and implementing improvement interventions, and the interventions were effective at substantially decreasing trauma patient CT TATs.

Expression profiles of MUC5AC glycoforms in neoplastic and non-neoplastic pancreatic tissue.

e16008 Background: MUC5AC, secretory mucin, exists in two major glycoforms, heavily-glycosylated mature (MM) and less-glycosylated immature (IM) isoforms. Prior IM-based tissue expression studies could not establish the clinical significance of MUC5AC in pancreatic ductal adenocarcinoma (PDA). Despite having strong pre-clinical evidence of MM’s role in local invasion, metastasis, and drug (gemcitabine) resistance, its impact on PDA outcomes is unclear. In this study, for the first time, we examined the differential expression of MM and IM by immunohistochemistry in primary PDA (pPDA), metastatic PDA (mPDA), normal pancreatic tissue adjacent to tumor (NAJ), neuroendocrine tumors (NET), Pancreatitis (P), normal pancreas (N) using tissue microarrays (TMA). Methods: Commercially available TMA (PA2081c, tissuearray.com, Derwood, MD) constructed from 96 patients, including 38 pPDA (14-stage 1, 22-Stage 2, and 2-stage 3), 5 mPDA, 24 NAJ, 11 NET, 8 P and 10 N was used in this study. Two separate 1 mm cores represented each case. Immunohistochemistry for MUC5AC was performed using CHL2 clone (ab77576, abcam, Boston, MA) for the IM isoform and 45M1 clone (ab369, abcam, Boston, MA) for the MM isoform. The immunostains were optimized as per the manufacturer's recommendations using appropriate controls. The sections are evaluated for the intensity of expression (0-3) and the percentage of reactive cells, and an H-score is derived from the product of these measurements. Cases are categorized as having negative/weak (score &lt;10) or positive (score &gt;10) expression. For every positive case, the pattern of expression in terms of Apical (Ap), cytoplasmic (Cy), and extracellular (EC) expression was recorded. Results: MUC5AC (MM and IM) is not expressed in N, NAJ, and P. MM expression is only noted in 44% of PDAs (19/43; 18 pPDA and 1 omental mPDA lesion). Three different expression patterns were noted, including Ap (63%), Cy (84%), and EC (47%). IM expression was detected in 60% of PDAs (26/43, 25 pPDA and omental mPDA lesion) and 18% NET (2/11). IM expression was noted in cases with EC MM expression (9/43, 21%), suggesting that IM was further glycosylated to MM and expressed extracellularly in some patients. MM and MM were co-expressed in 40% of PDA (17/43). Liver and abdomen metastatic lesions in the TMA did not express IM or MM. Pertinent clinical information was not available to study the impact of MM’s expression on PDA outcomes. Conclusions: Our study shows that MUC5AC is primarily expressed in PDAs and can be a useful biomarker. Larger studies are ongoing to correlate tissue expression patterns in PDAs for evidence of any association with early recurrence or treatment failure. Preliminary data suggests that only MM isoform is expressed extracellularly and could be detected in patient serum and serve as a potential non-invasive biomarker for treatment selection (for gemcitabine resistance) and monitor the response in certain cases.