Reduce Mortality Rates Research Articles

Multimodal breast cancer hybrid explainable computer-aided diagnosis using medical mammograms and ultrasound Images

Breast cancer is a prevalent global disease where early detection is crucial for effective treatment and reducing mortality rates. To address this challenge, a novel Computer-Aided Diagnosis (CAD) framework leveraging Artificial Intelligence (AI) techniques has been developed. This framework integrates capabilities for the simultaneous detection and classification of breast lesions. The AI-based CAD framework is meticulously structured into two pipelines (Stage 1 and Stage 2). The first pipeline (Stage 1) focuses on detectable cases where lesions are identified during the detection task. The second pipeline (Stage 2) is dedicated to cases where lesions are not initially detected. Various experimental scenarios, including binary (benign vs. malignant) and multi-class classifications based on BI-RADS scores, were conducted for training and evaluation. Additionally, a verification and validation (V&V) scenario was implemented to assess the reliability of the framework using unseen multimodal datasets for both binary and multi-class tasks. For the detection tasks, the recent AI detectors like YOLO (You Only Look Once) variants were fine-tuned and optimized to localize breast lesions. For classification tasks, hybrid AI models incorporating ensemble convolutional neural networks (CNNs) and the attention mechanism of Vision Transformers were proposed to enhance prediction performance. The proposed AI-based CAD framework was trained and evaluated using various multimodal ultrasound datasets (BUSI and US2) and mammogram datasets (MIAS, INbreast, real private mammograms, KAU-BCMD, and CBIS-DDSM), either individually or in merged forms. Visual t-SNE techniques were applied to visually harmonize data distributions across ultrasound and mammogram datasets for effective various datasets merging. To generate visually explainable heatmaps in both pipelines (stages 1 and 2), Grad-CAM was utilized. These heatmaps assisted in finalizing detected boxes, especially in stage 2 when the AI detector failed to automatically detect breast lesions. The highest evaluation metrics achieved for merged dataset (BUSI, INbreast, and MIAS) were 97.73% accuracy and 97.27% mAP50 in the first pipeline. In the second pipeline, the proposed CAD achieved 91.66% accuracy with 95.65% mAP50 on MIAS and 95.65% accuracy with 96.10% mAP50 on the merged dataset (INbreast and MIAS). Meanwhile, exceptional performance was demonstrated using BI-RADS scores, achieving 87.29% accuracy, 91.68% AUC, 86.72% mAP50, and 64.75% mAP50-95 on a combined dataset of INbreast and CBIS-DDSM. These results underscore the practical significance of the proposed CAD framework in automatically annotating suspected lesions for radiologists.

The Impact of Dietary Unsaturated Fat or the Mediterranean Diet on Women Diagnosed With Breast Cancer: A Systematic Review.

This review explores the multifaceted relationship between dietary factors and breast cancer outcomes, focusing on unsaturated fats, the Mediterranean diet (MD), and other nutritional components. Breast cancer remains a significant global health concern, with lifestyle factors like diet playing a pivotal role in prevention and management. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Articles written in English and released between 2019 and 2024 were acceptable. We used pertinent search terms such as "unsaturated fats", "Mediterranean diet", "breast cancer", and "nutrition" to perform searches in PubMed, PubMed Central (PMC), EBSCOhost, and grey literature such as Google Scholar. After screening, 11 of the 479 original papers were chosen and included in the final review. These includecross-sectional analysis and systematic review, cohort study, narrative review, systematic review and meta-analysis, case-control study, randomized controlled trials (RCTs), and cross-sectional study. Key findings suggest that adherence to the MD correlates with improved quality of life measures and reduced mortality rates among women with breast cancer, particularly in older age groups. The diet's emphasis on antioxidant-rich foods, anti-inflammatory compounds, and healthy fats contributes to these observed benefits. Specific unsaturated fats, notably omega-3 polyunsaturated fatty acids (PUFAs) like docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), demonstrate anti-cancer properties by modulating cancer cell behavior and enhancing treatment responses.Biomarkers associated with the MD, such as β-carotene and lycopene, serve as indicators of dietary compliance and potential risk reduction. Furthermore, components found in olive oil, including polyphenols and monounsaturated fatty acids, exhibit promising effects in preventing breast cancer by exerting antioxidant and anti-proliferative actions. Other dietary factors like calcium, legumes, fruits, and vegetables also play a role in reducing breast cancer risk and improving survival rates.This review underscores the importance of dietary interventions in optimizing outcomes for breast cancer patients and highlights the need for further research to elucidate underlying mechanisms and refine dietary recommendations.

Effectiveness of Stroke Bundle Care in Emergency Unit on Acute Stroke Patient’s Outcome: Literature Review

Background: Stroke leads to death and disability with continuously increasing incidence rates. Immediate management of acute stroke plays a crucial role in minimizing its impact. Comprehensive management through effective stroke bundle care in emergency units has been recognized as an efficient approach and is a crucial step in determining accurate actions, with the potential to enhance patient independence and reduce morbidity and mortality. Objective: The aim of this theoretical study is to explore the impact of implementing a stroke care bundle in the emergency unit on the outcome of acute stroke patients. Method: This study employs a literature review method with 20 journals from three databases: PubMed, Semantic Scholar, and Google Scholar. Results: Stroke bundle care significantly improves patient outcomes, evident in increased Barthel Index and decreased mortality rates. Clinical factors, particularly NIHSS scores, significantly determine patient outcomes, and attention to nursing, time coordination, and clinical factor management can enhance stroke care effectiveness. Conclusion: This study reaffirms that the implementation of stroke bundle care significantly enhances outcomes for patients with acute stroke by reducing mortality rates, improving independence, and fostering effective coordination among the care team. Recommendation: Further integration of stroke bundle care into clinical practice is needed, with in-depth research on clinical factors and interdisciplinary collaboration to enhance acute stroke management.

Approaches and considerations in the endoscopic treatment of T1 colorectal cancer.

The detection of early colorectal cancer (CRC) is increasing through the implementation of screening programs. This increased detection enhances the likelihood of minimally invasive surgery and significantly lowers the risk of recurrence, thereby improving patient survival and reducing mortality rates. T1 CRC, the earliest stage, is treated endoscopically in cases with a low risk of lymph node metastasis (LNM). The advantages of endoscopic treatment compared with surgery include minimal invasiveness and limited tissue disruption, which reduce morbidity and mortality, preserve bowel function to avoid colectomy, accelerate recovery, and improve cost-effectiveness. However, T1 CRC has a risk of LNM. Thus, selection of the appropriate treatment between endoscopic treatment and surgery, while avoiding overtreatment, is challenging considering the potential for complete resection, LNM, and recurrence risk.

Validity of different scoring systems in prediction of intensive care unit admission and mortality in acute organophosphate poisoning.

Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients. A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC=0.983) and mortality (AUC=0.999). The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning.

Surgical Management of a Non-Obstetric Vulvar Hematoma

Purpose: To describe the successful management of a rare non-obstetric vulvar hematoma. Background: While vulvar hematomas are common in obstetric cases, vulvar hematomas due to non-obstetric trauma are rare, representing only 0.8% of all gynecological emergencies. The vulva is made primarily of loose connective tissue richly supplied by branches of the pudendal artery, so it is susceptible to injury by multiple different types of trauma. Because non-obstetric vulvar hematomas are so rare, there is no established consensus for management. In this article, we shall present a patient who, after sustaining multiple injuries from a motor vehicle collision, developed a large vulvar hematoma that was successfully treated with surgical evacuation. Case Description: A healthy 26-year-old female presented to the emergency department following a broadside motor vehicle collision. CT with contrast described multiple pelvic fractures as well as a small volume retroperitoneal hemorrhage anterior to the bladder. There was no evidence of bladder injury or other areas of extravasation. On hospital day 1, she underwent uncomplicated open reduction and internal fixation of pelvic and sacral ring fractures. On hospital day 3, the patient began noticing a painful, rapidly expanding labial hematoma, and OBGYN services were consulted. Despite conservative management with ice and analgesics, the patient described the pain as 10 out of 10. On physical exam the right vulva was found to have a 14 cm hematoma expanding down to the perineum and extending to include the labia majora and labia minora. The area was extremely edematous and tender to light palpation. Swelling distorted the anatomy, occluding the vaginal introitus and obscuring the left labia. A Foley catheter was draining clear urine from the bladder. The following morning, the hematoma had continued to expand and Hgb significantly decreased, so the decision was made to proceed with surgical management. Pre-operative antibiotics were given, and the patient was prepped and draped according to hospital protocol. Hart’s line was injected with a marcaine/lidocaine/epinephrine premixed solution for hemostasis. A 3 cm vertical incision was created along Hart’s line, and the space was bluntly entered using a hemostat. Clotted blood was evacuated from the labial space, and active bleeding was ligated with using Vicryl. Once hemostasis was noted, the incision was loosely closed with interrupted stitches placed widely apart to allow for drainage. The vagina and left labia were examined and found to be normal. The right labial space was packed using kerlix, and the patient was prescribed a 7-day course of oral antibiotics. The patient tolerated the procedure well and reported no vulvar pain on post-op day 1. The vulvar packing was removed without incident, and no bleeding was noted from the incision site. The patient was reevaluated by the OBGYN team on post-op day 8 and was healing very well. She reported very little pain and had no issues with spontaneous urination. On physical exam, the hematoma was nontender to palpation and measured approximately 10 x 5 x 2.5 cm with decreased bruising and areas of discoloration. The patient was discharged with no further issues. Despite multiple attempts to schedule an outpatient appointment, the patient was unfortunately lost to follow-up. Discussion: Non-obstetric vulvar hematomas due to non-obstetric trauma are rare, and with improper management, may lead to significant morbidity. However, there is no established consensus for management, and little literature is available for guidance. Some small studies have reported success with conservative management. Benrubi et al, however, observed that conservative management of vulvar hematomas may be associated with longer hospital stays and increased need for antibiotics and blood transfusions10. A recent retrospective analysis also suggests a preference for surgical management, as a significantly reduced mortality rate was observed in patients who underwent surgical intervention for non-obstetric vulvar trauma. The same study found that while the surgical cohort tended to require a slightly longer hospital stay, there were no differences in ICU days, ventilator days, or rates of UTI between cohorts who had undergone surgical management and those who had undergone conservative management1. Arterial embolization has also been described as an alternative to surgical intervention in select patients, but this approach requires equipment and specialized personnel that may not be readily available to all institutions. Some case studies suggest using rate of expansion or hemodynamic instability as indications for surgical management. Size of the hematoma may also be considered as evidence suggests vulvar hematomas with a diameter greater than 4 cm have a higher potential for skin necrosis. Even when surgical management is clearly indicated there is little data regarding an optimal surgical approach. Conclusion: In this article, we discuss the successful surgical management and short-term follow up of a very large non-obstetric vulvar hematoma. We hope that our surgical approach can add to the small pool of literature available on these rare gynecological cases and help guide future research into developing standardized management guidelines.

Multimodal breast cancer risk classifier based on biomaterial impedance analysis

Purpose of the research. Breast cancer is the most common malignant tumor among women in Europe and its early detection plays a leading role in reducing mortality rates. Currently, X-ray mammography is the standard screening method for detecting breast cancer. However, due to the morphological similarities between benign and malignant lesions, many of the positive screening mammograms are false positive (up to 40%). Therefore, automation and intellectualization of this process is an urgent task.Methods. The presented studies examine the problems of finding new, highly sensitive, prompt and non-invasive methods for detecting malignant tumors, based on the use of modern computer and telecommunication technologies, which make it possible not only to identify early manifestations of a pathological focus, but also to monitor the process of the effectiveness of therapy without significant harm to the patient’s health.Results. The presented model of a multi-channel classifier integrates the capabilities of multi-frequency bioimpedance measurements and matrix acquisition of information from the surface of human skin through multi-electrode matrix systems. To do this, based on a matrix of electrodes, 3D mapping of the skin surface in problem areas is carried out. Through multi-frequency scanning, we obtain a three-dimensional bioimpedance image, which is analyzed by a convolutional neural network and/or by a decision maker. The proposed solution allows simultaneous analysis of data by an expert (bioimpedance image) and a convolutional neural network (trained classifier), which leads to a reduction in false positive results.Conclusion. The possibilities of multichannel monitoring open up prospects for constructing impedance multidimensional "portraits" of malignant tumors. To classify “portraits” (diagnostics and preclinical diagnostics), methods and algorithms for image recognition and classification are used.

Association between new Life’s Essential 8 and the risk of all-cause and cardiovascular mortality in patients with hypertension: a cohort study

BackgroundThe American Heart Association recently introduced a new model for cardiovascular health (CVH) known as Life’s Essential 8 (LE8). The impact of LE8 on hypertensive individuals is currently unclear. In our study, we investigated the correlation between comprehensive and individual CVH indicators as defined by LE8, and the mortality rates in hypertension patients.MethodsWe analyzed a total of 8,448 hypertensive individuals aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2016. These participants were nonpregnant and noninstitutionalized. We identified their mortality by linking their data to the National Death Index until December 31, 2019. The overall cardiovascular health (CVH) was assessed using the LE8 score, which ranged from 0 to 100. Additionally, we evaluated the scores for each component of diet, physical activity, tobacco/nicotine exposure, sleep duration, body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure. The CVH were categorized into low (0–49), moderate (50–79), and high (80–100) CVH.ResultsOver an average follow-up period of 7.41 years, 1,482 (17.54%) of the participants died, among which 472 deaths were attributed to CVD. When compared to adults with lower total CVH scores, those with elevated total CVH scores displayed a 37% reduced risk of mortality from all causes (adjusted hazard ratio [aHR] = 0.63, 95% confidence interval [CI] = 0.45–0.88). In relation to CVD-specific mortality, the corresponding aHRs for moderate and high total CVH scores were 0.76 (0.60–0.97) and 0.54 (0.31–0.94), respectively. Furthermore, after adjusting for potential confounders, it was observed that higher scores on the LE8 index were associated with a reduced risk of both all-cause mortality (aHR for every 10-score increase, 0.91; 95% CI = 0.86–0.96) and CVD-specific mortality (aHR for every 10-score increase, 0.82; 95% CI = 0.75–0.90). Notably, a linear dose–response relationship was observed in this association. Similar patterns were identified in the relationship between health behavior and both all-cause and CVD-specific mortality.ConclusionsAchieving a higher CVH score, as per the new LE8 guidelines, has been found to be associated with a reduced risk of mortality from all causes and specifically from CVD in patients with hypertension. Therefore, public health and healthcare initiatives that focus on promoting higher CVH scores could potentially yield significant benefits in terms of reducing mortality rates among individuals with hypertension.

Surgical Management of a Non-Obstetric Vulvar Hematoma

Purpose: To describe the successful management of a rare non-obstetric vulvar hematoma. Background: While vulvar hematomas are common in obstetric cases, vulvar hematomas due to non-obstetric trauma are rare, representing only 0.8% of all gynecological emergencies. The vulva is made primarily of loose connective tissue richly supplied by branches of the pudendal artery, so it is susceptible to injury by multiple different types of trauma. Because non-obstetric vulvar hematomas are so rare, there is no established consensus for management. In this article, we shall present a patient who, after sustaining multiple injuries from a motor vehicle collision, developed a large vulvar hematoma that was successfully treated with surgical evacuation. Case Description: A healthy 26-year-old female presented to the emergency department following a broadside motor vehicle collision. CT with contrast described multiple pelvic fractures as well as a small volume retroperitoneal hemorrhage anterior to the bladder. There was no evidence of bladder injury or other areas of extravasation. On hospital day 1, she underwent uncomplicated open reduction and internal fixation of pelvic and sacral ring fractures. On hospital day 3, the patient began noticing a painful, rapidly expanding labial hematoma, and OBGYN services were consulted. Despite conservative management with ice and analgesics, the patient described the pain as 10 out of 10. On physical exam the right vulva was found to have a 14 cm hematoma expanding down to the perineum and extending to include the labia majora and labia minora. The area was extremely edematous and tender to light palpation. Swelling distorted the anatomy, occluding the vaginal introitus and obscuring the left labia. A Foley catheter was draining clear urine from the bladder. The following morning, the hematoma had continued to expand and Hgb significantly decreased, so the decision was made to proceed with surgical management. Pre-operative antibiotics were given, and the patient was prepped and draped according to hospital protocol. Hart’s line was injected with a marcaine/lidocaine/epinephrine premixed solution for hemostasis. A 3 cm vertical incision was created along Hart’s line, and the space was bluntly entered using a hemostat. Clotted blood was evacuated from the labial space, and active bleeding was ligated with using Vicryl. Once hemostasis was noted, the incision was loosely closed with interrupted stitches placed widely apart to allow for drainage. The vagina and left labia were examined and found to be normal. The right labial space was packed using kerlix, and the patient was prescribed a 7-day course of oral antibiotics. The patient tolerated the procedure well and reported no vulvar pain on post-op day 1. The vulvar packing was removed without incident, and no bleeding was noted from the incision site. The patient was reevaluated by the OBGYN team on post-op day 8 and was healing very well. She reported very little pain and had no issues with spontaneous urination. On physical exam, the hematoma was nontender to palpation and measured approximately 10 x 5 x 2.5 cm with decreased bruising and areas of discoloration. The patient was discharged with no further issues. Despite multiple attempts to schedule an outpatient appointment, the patient was unfortunately lost to follow-up. Discussion: Non-obstetric vulvar hematomas due to non-obstetric trauma are rare, and with improper management, may lead to significant morbidity. However, there is no established consensus for management, and little literature is available for guidance. Some small studies have reported success with conservative management. Benrubi et al, however, observed that conservative management of vulvar hematomas may be associated with longer hospital stays and increased need for antibiotics and blood transfusions10. A recent retrospective analysis also suggests a preference for surgical management, as a significantly reduced mortality rate was observed in patients who underwent surgical intervention for non-obstetric vulvar trauma. The same study found that while the surgical cohort tended to require a slightly longer hospital stay, there were no differences in ICU days, ventilator days, or rates of UTI between cohorts who had undergone surgical management and those who had undergone conservative management1. Arterial embolization has also been described as an alternative to surgical intervention in select patients, but this approach requires equipment and specialized personnel that may not be readily available to all institutions. Some case studies suggest using rate of expansion or hemodynamic instability as indications for surgical management. Size of the hematoma may also be considered as evidence suggests vulvar hematomas with a diameter greater than 4 cm have a higher potential for skin necrosis. Even when surgical management is clearly indicated there is little data regarding an optimal surgical approach. Conclusion: In this article, we discuss the successful surgical management and short-term follow up of a very large non-obstetric vulvar hematoma. We hope that our surgical approach can add to the small pool of literature available on these rare gynecological cases and help guide future research into developing standardized management guidelines.

Does higher education matter in mitigating chronic disease Mortality? evidence from MENA countries with consideration of Globalization, economic Growth, and environmental pollution

This study investigates the relationship between higher education and mortality rates from chronic and fatal diseases in MENA countries from 2000 to 2020. Utilizing a robust panel econometric framework with Generalized Least Square, Fully Modified Ordinary Least Squares (FMOLS), and Dynamic Ordinary Least Squares (DOLS), we analyze empirical data while controlling for globalization, CO2 emissions, and GDP per capita. Our findings reveal a significant negative correlation between education and mortality rates, paralleled by similar trends for globalization and GDP per capita. Conversely, CO2 emissions are found to increase mortality rates, highlighting the detrimental impact of environmental degradation on public health. This underscores the pivotal role of education, globalization, and economic development in reducing mortality rates associated with chronic and fatal diseases. The study advocates for increased investments in education and healthcare infrastructure to address disparities and enhance public health outcomes, alongside promoting responsible globalization practices to further improve health metrics.

Immobilisation protocols for wild giraffe (Giraffa spp.) - a review.

Immobilisation of wild giraffe (Giraffa spp.) is challenging due to their unique anatomy and physiology. Field immobilisations are required for numerous conservation, tourism, and veterinary purposes. Wild giraffe immobilisation techniques have evolved considerably from physical to chemical with ultrapotent drugs. To provide a detailed overview of historic and present protocols used for immobilising giraffe in the wild as a valuable resource tool for future research into best practices. A systematic review was undertaken of the published literature on wild giraffe capture and immobilisation techniques with no restrictions on publication date. The review detailed the evolution of capture techniques used for wild giraffe. The trend has moved from purely physical capture in the 1950s to the use of high dose ultrapotent opioids or a combination of opioids and alpha-2 agonists and/or tranquilisers. With a better understanding of giraffe physiology and wild giraffe capture, mortality rates have decreased significantly from ~ 35% to < 1%. The advent of ultrapotent opioids has caused a paradigm shift in wildlife immobilisation, especially for wild giraffe. While the use of these drugs, as sole immobilisation agents or in combination with alpha-2 agonists or tranquilisers, has greatly reduced mortality rates associated with wild giraffe immobilisations, there is a startling lack of physiological data evaluating the impact of these drugs on giraffe during and after immobilisation. Future research should focus on measuring physiological variables to determine the impact and best practice of these protocols on wild giraffe immobilisation.

Knowledge and Attitude of Adult Women Towards Early Prevention of Breast Cancer in a Local Government Area of a Southwestern State of Nigeria

This study investigates the knowledge, attitudes, and practices regarding breast self-examination (BSE) among adult women in Idanre Local Government Area of Ondo State, Nigeria. Breast cancer, a leading neoplasm among women, presents a significant global health challenge due to its high incidence and mortality rates. This descriptive cross-sectional study involved 400 adult women, employing a structured questionnaire to collect data. The findings reveal a high level of awareness about breast cancer, with 98.5% of participants demonstrating good knowledge and 93.5% exhibiting positive attitudes toward BSE. However, only 77.5% of respondents practiced BSE regularly. The study underscores the importance of early detection facilitated by BSE, particularly in resource-limited settings, as 86.3% of participants identified increasing age as a risk factor, and 100% recognized lumps in the breast as a symptom. Despite this awareness, many women do not practice BSE consistently due to misconceptions and lack of motivation. The research highlights the necessity of enhancing public awareness and education on BSE through mass media and healthcare providers to improve early breast cancer detection and reduce mortality rates. It recommends that healthcare workers promote BSE during interactions with female clients and serve as role models by adopting preventive screening measures themselves. This approach could significantly impact breast cancer control and improve health outcomes among women in the community. The study concludes that while knowledge and attitudes toward BSE are generally positive, consistent practice remains a challenge that must be addressed through targeted awareness and education initiatives.

Prediction of sepsis among patients with major trauma using artificial intelligence: a multicenter validated cohort study.

Sepsis remains a significant challenge in patients with major trauma in the ICU. Early detection and treatment are crucial for improving outcomes and reducing mortality rates. Nonetheless, clinical tools for predicting sepsis among patients with major trauma are limited. This study aimed to develop and validate an artificial intelligence (AI) platform for predicting the risk of sepsis among patients with major trauma. This study involved 961 patients, with prospective analysis of data from 244 patients with major trauma at our hospital and retrospective analysis of data from 717 patients extracted from a database in the United States. The patients from our hospital constituted the model development cohort, and the patients from the database constituted the external validation cohort. The patients in the model development cohort were randomly divided into a training cohort and an internal validation cohort at a ratio of 8:2. The machine learning algorithms used to train models included logistic regression (LR), decision tree (DT), extreme gradient boosting machine (eXGBM), neural network (NN), random forest (RF), and light gradient boosting machine (LightGBM). The incidence of sepsis for the model development cohort was 43.44%. Twelve predictors, including gender, abdominal trauma, open trauma, red blood cell count, heart rate, respiratory rate, injury severity score, sequential organ failure assessment score, Glasgow coma scale, smoking, total protein concentrations, and hematocrit, were used as features in the final model. Internal validation showed that the NN model had the highest area under the curve (AUC) of 0.932 (95% CI: 0.917-0.948), followed by the LightGBM and eXGBM models with AUCs of 0.913 (95% CI: 0.883-0.930) and 0.912 (95% CI: 0.880-0.935), respectively. In the external validation cohort, the eXGBM model (AUC: 0.891, 95% CI: 0.866-0.914) had the highest AUC value, followed by the LightGBM model (AUC: 0.886, 95% CI: 0.860-0.906), and the AUC value of the NN model was only 0.787 (95% CI: 0.751-0.829). Considering the predictive performance for both the internal and external validation cohorts, the LightGBM model had the highest score of 82, followed by the eXGBM (81) and NN (76) models. Thus, the LightGBM was emerged as the optimal model, and it was deployed online as an AI application. This study develops and validates an AI application to effectively assess the susceptibility of patients with major trauma to sepsis. The AI application equips healthcare professionals with a valuable tool to promptly identify individuals at high risk of developing sepsis. This will facilitate clinical decision-making and enable early intervention.

The moderating roles of healthcare expenditure in the fossil fuel consumption‐ mortality rate conflicts in fossil fuel‐dependent sub‐Saharan African countries

AbstractThis current study contributes to the extant literature by providing the first empirical evidence on the functional relationship between fossil fuel consumption, environmental pollution, and mortality rate in selected fossil fuels‐dependent nations in sub‐Saharan African countries with the moderating role of healthcare expenditures from 1982 to 2021. The empirical evidence relies on a battery of techniques comprising fully modified ordinary least squares, dynamic ordinary least squares, and panel quartile regression estimators. In order to establish sturdy empirical insights, fossil fuel is proxy by four indices including oil, coal, natural gas (at the disaggregated level), and fossil fuel (at the aggregated level). Mortality rate is also disaggregated into mortality rate, adult male, mortality rate, adult female, and infant mortality rate. Based on this disaggregation, the findings from the study reveal the following: First, the indicators for fossil fuel consumption have positive statistically significant impact on all three measures of mortality rate. Second, environmental pollution positively impacts the three indicators of mortality rate. Third, healthcare expenditure significantly reduces mortality rate, while its interaction with fossil fuel consumption moderates their unfavorable impacts on mortality rate. Fourth, with the exception of natural gas, the indicators of fossil fuel consumption and environmental pollution exert unfavorable impacts on mortality rate across all the quartiles. Emerging from these empirical findings, the study recommends promotion of cleaner sources of energy while at the same time improving healthcare expenditure as an interim measure pending full transition to renewable energy towards the attainment of a good health outcome in sub‐Saharan Africa countries.

Panorama da mortalidade por cardiopatia reumática crônica entre 2017 e 2021, no Rio Grande do Sul

Introduction: Chronic rheumatic heart disease is a complication of rheumatic fever (RF), a disease that results from pharyngotonsillitis, causing acquired heart disease in young people and can lead to valvular sequelae and death. The objective of the study is to evaluate mortality from rheumatic heart disease in Rio Grande do Sul, with emphasis on voluntary involvement, and to analyze a possible association between age group and sex. Material and Methods: This research consists of a cross-sectional study using the database of the Department of Information Technology’s Unified Health System (DataSUS). Deaths from rheumatic heart diseases were included, divided by sex and age, during the period from 2017 to 2021 in Rio Grande do Sul. For statistical analysis, the Chi-Square test (χ²) was used, using the software SPSS. Results: 321 deaths from rheumatic valve disease were found between 2017 and 2021, the majority of which were caused by mitral valve disease. Women had a higher number of deaths from mitral valve disease and men from other heart diseases. Regarding the age group, deaths due to mitral valve disease were more prevalent among those aged 40 to 49 years, while in tricuspid valve disease, there was a greater association with individuals aged 80 years or older. In other diseases, no association was demonstrated. Conclusion: From this, an association was established between sex and age group in the incidence of rheumatic heart disease among the studied population. Therefore, a more comprehensive therapeutic approach is needed, associated with the development of campaigns that publicize the importance of correct treatment in order to reduce mortality rates.

Introducing PneumNet—A Groundbreaking Dual Version Deep Learning Model for Pneumonia Disease Detection

ABSTRACTThe Internet of Medical Things (IoMT) has revolutionized healthcare, particularly in ambient assisted living (AAL). Deep learning has emerged as a powerful tool for identifying disorders and making health‐related decisions. Pneumonia, a dangerous and contagious disease, has a significant global impact. Prompt and accurate diagnosis is crucial, but traditional methods are time‐consuming and require specialized expertise. This research introduces PneumNet, a novel deep‐learning model. PneumNet consists of two versions: PneumNet v1.0 and PneumNet v2.0. The comparative analysis demonstrates PneumNet's exceptional performance. The top model achieves 99.84% accuracy, 99.87% F1‐score, 99.74% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 99.58% negative predictive value (NPV). PneumNet outperforms other methods, accurately diagnosing pneumonia and improving treatment outcomes. By leveraging deep convolutional neural networks (D‐CNNs), PneumNet provides an efficient and accurate solution for pneumonia detection. These findings highlight the significance of D‐CNNs, particularly the proposed PneumNet model, in enhancing pneumonia detection accuracy and reducing mortality rates. IoMT and deep learning pave the way for transformative advancements in healthcare.

Screening for Breast Cancer: A Comparative Review of Guidelines.

Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Updates on Management

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are dermatologic emergencies characterized by extensive epidermal necrolysis and sloughing. The incidence rates vary depending on location, with the UK experiencing an annual incidence of 5.76 cases per million individuals from 1995 to 2013. Females are more frequently afflicted than males, with mortality rates ranging from 4.8-9% to 14.8-48%. Nonpharmacologic treatment for SJS/TEN patients includes supportive care, fluid and electrolyte management, infection control, and wound care. The most critical component is the identification and cessation of the causative substance. Management of fluid, electrolytes, and nutrition is crucial for SJS/TEN patients, as they have lower fluid requirements than burn patients. Prophylactic antibiotics do not enhance outcomes, but infection prevention requires appropriate wound care and antiseptic handling. The role of surgical debridement has been a topic of controversy, and the decision to pursue this treatment option depends on the location of care. Anti-shear therapy, which involves aspiration of blister fluid and preservation of denuded epidermis, has been shown to be effective in reducing mortality rates. Pharmacologic treatment for SJS/TEN has been the subject of few prospective studies due to the disease's rarity. Various treatment regimens involving corticosteroids, IVIg, cyclosporine, and TNF-alpha inhibitors have been reported, but it is challenging to determine whether the disease's remission was due to a specific treatment or the natural course of the disease.

NURSE'S ROLE IN CARING FOR A PATIENT WITH FOURNIER'S GANGRENE

Fournier's gangrene is a life-threatening condition characterized by rapidly progressive necrotizing fasciitis, often leading to sepsis and multiple organ failure. While historically associated with males, the condition can affect both genders, with varying degrees of severity. This case report explores the complex management of a 59-year-old male patient with a history of alcohol abuse, diabetes, cirrhosis, and a long-term smoking habit, who presented with Fournier's gangrene. The patient's critical condition and complex medical history presented significant challenges for healthcare providers, particularly nurses, who played a pivotal role in his care. These cases occur rarely in practice and require specific care and compliance with surgical nursing techniques per protocol. This case report not only sheds light on the growing incidence of Fournier's gangrene among both genders but also underscores the indispensable role of nurses in the multidisciplinary care of patients with this challenging condition. Comprehensive nursing care, patient education, and meticulous attention to detail are essential in improving patient outcomes and reducing mortality rates associated with Fournier's gangrene.