Data System Research Articles

Design and implementation of the international news commentary Data Intelligent Processing System

In the digital media age, international news commentary has changed, creating challenges such as information overload and noise. Traditional platforms often need more data-driven analysis capabilities. This study presented a specialized intelligent system for processing international news commentary data. The system provided robust analysis tools, automated recommendations, and summarization capabilities. Its comprehensive modules included data crawling, processing, visualization, and retrieval. Experimental results demonstrated the system’s effectiveness in processing data and generating valuable insights. Users were able to gain objective insights into topics, emotions, and dissemination patterns. The system provided valuable resources for communication research, enhancing theoretical understanding and practical applications in the field.

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Performance of CO-RADS in the diagnosis of COVID-19 in hemodialysis patients.

Different data systems have been used to reach a common decision in the interpretation of chest computed tomography (CT) scans for the detection of COVID-19 infection. The aim of our study was to determine the usefulness of the COVID-19 Reporting and Data System (CO-RADS) for COVID-19 in patients undergoing hemodialysis. We included 90 hemodialysis patients who underwent chest CT and had samples available for real-time reverse transcription-polymerase chain reaction (RT-PCR). The files of the patients were retrospectively reviewed and the data were recorded. Image interpretation and CO-RADS staging were performed retrospectively by two radiologists experienced in COVID-19 patients, blinded to the RT-PCR results. The RT-PCR results were then compared with the CO-RADS stages obtained. The success of CO-RADS in diagnosing COVID-19 was evaluated according to its prediction of a positive RT-PCR result. At the same time, the relationship between CO-RADS stages and prognosis was also evaluated. Patients were divided into two groups according to the RT-PCR results, of which 38 (42.2%) had positive results. Validity tests of CO-RADS were performed according to the RT-PCR test. While 71.1% of patients with CO-RADS ≥4 were RT-PCR (+), 13.2% of patients with CO-RADS ≤2 were RT-PCR (+) (p < 0.001). CO-RADS ≥4 detected COVID-19 with 71.1% sensitivity and 51.9% specificity. ROC analysis confirmed the diagnostic performance of CO-RADS for predicting RT-PCR positivity with AUC = 0.73 (95% CI: 0.63-0.84). The relationship between CO-RADS stages and mortality was not significant (p = 0.21). CO-RADS is moderately sensitive and poorly specific for the diagnosis of COVID-19 in hemodialysis patients. In these patients, CO-RADS would be more useful to exclude other infections than to diagnose COVID-19.

Multiparameter magnetic resonance imaging features of prostatic malakoplakia.

To summarize the multiparameter magnetic resonance imaging (mpMRI) features of prostatic malakoplakia. Eleven patients (median age 62 years; IQR 59-71 years) with pathologically confirmed prostatic malakoplakia were included in this study. MpMRI features of the lesions were retrospectively reviewed and summarized. The Prostate Imaging-Reporting and Data System (PI-RADS) scores of the patients were 4 or 5, with a medium diameter of 3.7 cm (IQR 2.0-5.2 cm). All the lesions involved the peripheral zone, of which 3 cases (3/11, 27.3%) involved the transition zone simultaneously. A diffuse symmetrical distribution was found in 5 cases, a focal distribution in 5 cases, and a focal symmetrical distribution in 1 case. Both the surgical capsule and prostatic margin were bulged and compressed, but no signs of infiltration were found. Nearly all the lesions had moderate hypointensity on T2-weighted images and slightly higher signal intensity on T1-weighted images. Among the lesions, early enhancement occurred in all cases, prolonged enhancement occurred in 8 cases, and ring enhancement persisted in 1 case. All lesions displayed periprostatic enhancement in the delayed phase. Lesions distributed diffusely and symmetrically in the peripheral zone with preserved surgical capsule and margin are characteristic features of malakoplakia as opposed to cancer, especially in those with slightly high T1 signal intensity and delayed periprostatic enhancement. Those locally distributed lesions with the above signs should also be suspected. Prostatic malakoplakia are more likely to distribute diffusely and symmetrically, with slightly high T1 signal intensity and delayed periprostatic enhancement.

Enhancing radiologist's detection: an imaging-based grading system for differentiating Crohn's disease from ulcerative colitis

BackgroundDelayed diagnosis of inflammatory bowel disease (IBD) is common, there is still no effective imaging system to distinguish Crohn's Disease (CD) and Ulcerative Colitis (UC) patients.MethodsThis multicenter retrospective study included IBD patients at three centers between January 2012 and May 2022. The intestinal and perianal imaging signs were evaluated. Visceral fat information from CT images was extracted, including the ratio of visceral to subcutaneous fat volume (VSR), fat distribution, and attenuation values. The valuable indicators were screened out in the derivation cohort by binary logistic regression and receiver working curve (ROC) analysis to construct an imaging report and data system for IBD (IBD-RADS), which was tested in the validation cohort.ResultsThe derivation cohort included 606 patients (365 CD, 241 UC), and the validation cohort included 155 patients (97 CD, 58 UC). Asymmetric enhancement (AE) (OR = 87.75 [28.69, 268.4]; P < 0.001), perianal fistula (OR = 4.968 [1.807, 13.66]; P = 0.002) and VSR (OR = 1.571 [1.087, 2.280]; P = 0.04) were independent predictors of CD. VSR improved the efficiency of imaging signs (AUC: 0.929 vs. 0.901; P < 0.001), with a threshold greater than 0.97 defined as visceral fat predominance (VFP). In IBD-RADS, AE was the major criterion, VFP and perianal fistula were auxiliary criteria, and intestinal fistula, limited small bowel disease, and skip distribution were special favoring items as their 100% specificity. Grade 3 to 5 correctly classified most CD patients (derivation: 96.5% (352/365), validation: 98.0% (95/97)), and 98% of those were eventually diagnosed with CD (derivation: 97.8% (352/360), validation: 98.0% (95/97)).ConclusionsIBD-RADS can help radiologists distinguish between CD and UC in patients with suspected IBD.

Implementación de un sistema de gestión de la información para la Administración de Casa de Paz

This paper describes the implementation of an information management system for the Administration of Casas de Paz through the Access software with the aim of having better control with the data of this ministry. The program was developed together with the different diagrams that are a support for its development, in turn the data dictionary was made to facilitate the use of the program. By means of the Data System, better control will be obtained regarding attendance, where they are located, in turn to facilitate the location of a new member in the church and having the information of the leaders of each one of the Casas de Paz. ILIA: Investigaciones Latinoamericanas en Ingeniería y Arquitectura, No. 01, 2024: 46-51.

A clinical outcomes data archive for a comprehensive fetal diagnosis and treatment center.

Data on near and long-term outcomes are critical for the care of all maternal-fetal patients presenting to a fetal center. This is important since physiologic and neurodevelopmental attributes do not manifest until childhood when multi-level factors influence health outcomes. Electronic health records (EHR) documentation structures are not designed for acquisition of key attributes, and changes over time and between-clinician differences can affect resultant output. Therefore, EHR derived datasets have limited ability to accurately characterize the clinical presentation and care trajectory of patients with congenital anomalies. Moreover, the fetus lacks a digital identity and requires relinking attributes documented in the maternal chart to those in the pediatric EHR. This conundrum amplifies in the setting of multiple gestation, returning maternal patients, and pregnancies with fetal demise. Current data systems result in incomplete abstraction of variables that may confound, mediate, or moderate critical associations. Our objective was to develop and implement a prospective data capture platform to transform EHR data into an analytic-grade database for multi-purpose use. A unified platform for longitudinal follow-up of maternal-child dyads named the Clinical Outcomes Data Archive (CODA) was constructed. CODA was designed using a data dictionary based on multidisciplinary input, a relational identity for each patient, fetus, and pregnancy, and a process by which EHR-sourced and chart-abstracted data are validated. Descriptive analyses were performed for data acquired between July 2022 - July 2023, and a comparison of studies before and after implementation of CODA is presented. 5,394,106 data points were validated for 7,662 patients across 12 conditions. 2% of data points were found to be unreliable or undocumented. 91% of data points were sourced from the EHR. 85% of condition-specific variables required manual chart abstraction. The study conducted with CODA contributed to 18 studies. CODA successfully merges EHR-sourced and manually abstracted documentation for longitudinal study of the maternal-child dyad.

ProstateZones – Segmentations of the prostatic zones and urethra for the PROSTATEx dataset

Manual segmentations are considered the gold standard for ground truth in machine learning applications. Such tasks are tedious and time-consuming, albeit necessary to train reliable models. In this work, we present a dataset with expert segmentations of the prostatic zones and urethra for 200 randomly selected patients from the PROSTATEx dataset. Notably, independent duplicate segmentations were performed for 40 patients, providing inter-reader variability data. This results in a total of 240 segmentations. This dataset can be used to train machine learning models or serve as an external test set for evaluating models trained on private data, thereby addressing a current gap in the field. The delineated structures and terminology adhere to the latest Prostate Imaging Reporting and Data Systems v2.1 guidelines, ensuring consistency.

Diagnosis and management of Rosai–Dorfman disease of the breast: Case report and literature review

AbstractRosai–Dorfman disease (RDD) is a rare subtype of non–Langerhans cell histiocytosis. It is a benign disease with variable presentations, with breast involvement being an uncommon manifestation. In this paper, we present a case of breast RDD in a 59‐year‐old Chinese woman who presented with a painless, enlarging mass in her right breast, accompanied by skin changes and no palpable axillary lymph node. A mammogram and breast ultrasonography revealed a progressively enlarging lesion with a suspicious axillary lymph node, leading to an upgrade from Breast Imaging Reporting and Data System (BIRADS) score of 3 to 4A on interval imaging. Core biopsy of the breast mass and cytology of the right axillary lymph node confirmed extranodal RDD. After a 5‐year period of observation, excision was performed due to persistent symptoms. Local recurrence of RDD, with skin discolouration and thickening, was confirmed by skin biopsy 1 year and 9 months after the operation. To the best of our knowledge, this is the first reported case of breast RDD in Hong Kong.

8414 Utilization of Cell Free DNA Integrity Index to Differentiate Benign from Malignant Thyroid Nodules

Abstract Disclosure: S. Tarafdar: None. S. Dutta: None. P. Mukhopadhyay: None. N.P. Bhattacharya: None. S. Ghosh: None. Introduction: Recent advances in molecular genetics have evaluated a potential role for plasma cell-free DNA (cfDNA) integrity index as a non-invasive cancer marker. Data on cfDNA integrity in differentiated thyroid cancer is sparse and needs to be investigated further. Aim of the study: The purpose of this study is to investigate the hypothesis that longer DNA strands in plasma may serve as a marker for thyroid cancer. Methods: Patients presenting with thyroid nodules underwent ultrasonography with Thyroid Image Reporting and Data Systems (TIRADS) scoring and FNAC (Bethesda classification).Patients with Bethesda 3, 4, 5, and 6 had surgery and confirmation by histopathology. Patients with Bethesda 2 presenting with compressive symptoms and cosmetic concerns underwent surgery; the remaining patients were considered benign based on clinical follow-up, USG, and FNAC characteristics. Blood sample collected prior to FNAC was used to extract and quantify cfDNA. To assess the integrity index 180/67, 306/67, and 476/67 for the APP gene, we used a quantitative real-time PCR (qPCR) method based on the quantification of four amplicons of varying lengths (67, 180, 306, and 476 bp, respectively). Because culture cells had extremely intact genomic DNA, the genomic DNA obtained from the MDA-T32 papillary thyroid cancer cell line was utilised as a reference to estimate the relative DNA strand integrity in plasma DNA. To determine the (ΔCt) value for 67,180, 306, and 476 bp, the Ct value of the sample was subtracted from that of the MDA-T32 control. Results: A total of 161 subjects were recruited, of these 92 were benign and 69 had differentiated thyroid cancer(confirmed by histopathology). Using the 180/67 bp integrity index benign thyroid nodule patients had significant lower value (median 0.39, 95% CI: 0.33-0.46) compared to patients with differentiated thyroid cancer (median 0.62, 95% CI: 0.56-0.68). A cfDNA integrity index of 180/67 bp could significantly differentiate between benign and malignant thyroid nodules (P&amp;lt;0.001). However, there was no significant difference between malignant and benign thyroid nodules based on the cell free DNA integrity indexes of 306/67 and 476/67. Conclusions: The cfDNA integrity score of 180/67 exhibits potential as a circulating marker for the detection of thyroid nodules and as a means of monitoring cfDNA fragmentation in patients with thyroid cancer. However, further confirmation through prospective trials is necessary. Presentation: 6/3/2024

8414 Utilization Of Cell Free DNA Integrity Index To Differentiate Benign From Malignant Thyroid Nodules

Abstract Disclosure: S. Tarafdar: None. S. Dutta: None. P. Mukhopadhyay: None. N.P. Bhattacharya: None. S. Ghosh: None. Introduction: Recent advances in molecular genetics have evaluated a potential role for plasma cell-free DNA (cfDNA) integrity index as a non-invasive cancer marker. Data on cfDNA integrity in differentiated thyroid cancer is sparse and needs to be investigated further. Aim of the study: The purpose of this study is to investigate the hypothesis that longer DNA strands in plasma may serve as a marker for thyroid cancer. Methods: Patients presenting with thyroid nodules underwent ultrasonography with Thyroid Image Reporting and Data Systems (TIRADS) scoring and FNAC (Bethesda classification).Patients with Bethesda 3, 4, 5, and 6 had surgery and confirmation by histopathology. Patients with Bethesda 2 presenting with compressive symptoms and cosmetic concerns underwent surgery; the remaining patients were considered benign based on clinical follow-up, USG, and FNAC characteristics. Blood sample collected prior to FNAC was used to extract and quantify cfDNA. To assess the integrity index 180/67, 306/67, and 476/67 for the APP gene, we used a quantitative real-time PCR (qPCR) method based on the quantification of four amplicons of varying lengths (67, 180, 306, and 476 bp, respectively). Because culture cells had extremely intact genomic DNA, the genomic DNA obtained from the MDA-T32 papillary thyroid cancer cell line was utilised as a reference to estimate the relative DNA strand integrity in plasma DNA. To determine the (ΔCt) value for 67,180, 306, and 476 bp, the Ct value of the sample was subtracted from that of the MDA-T32 control. Results: A total of 161 subjects were recruited, of these 92 were benign and 69 had differentiated thyroid cancer(confirmed by histopathology). Using the 180/67 bp integrity index benign thyroid nodule patients had significant lower value (median 0.39, 95% CI: 0.33-0.46) compared to patients with differentiated thyroid cancer (median 0.62, 95% CI: 0.56-0.68). A cfDNA integrity index of 180/67 bp could significantly differentiate between benign and malignant thyroid nodules (P&amp;lt;0.001). However, there was no significant difference between malignant and benign thyroid nodules based on the cell free DNA integrity indexes of 306/67 and 476/67. Conclusions: The cfDNA integrity score of 180/67 exhibits potential as a circulating marker for the detection of thyroid nodules and as a means of monitoring cfDNA fragmentation in patients with thyroid cancer. However, further confirmation through prospective trials is necessary. Presentation: 6/3/2024

Epidemiologic and clinical features of cyanobacteria harmful algal bloom exposures reported to the National Poison Data System, United States, 2010–2022: a descriptive analysis

BackgroundHarmful algal bloom occurrences have been increasingly reported globally and over time. Exposure to the variety of toxins and co-contaminants that may be present in harmful algal blooms can cause illness and even death. Poison control data is a valuable public health information source that has been used to characterize many types of toxin exposures, including harmful algal blooms. Prior studies have been limited by location and time, and knowledge gaps remain regarding cyanobacteria harmful algal bloom (cyanoHAB) exposure circumstances, and the breadth and severity of associated clinical effect.MethodsThe objective of this study was to characterize epidemiologic and clinical features of cyanoHAB exposure cases reported to 55 US poison control centers and available in the National Poison Data System (NPDS). We identified 4260 NPDS cyanoHAB exposure cases reported from 2010 to 2022, including symptomatic exposure cases with and without clinical effects related to the exposure and asymptomatic exposure cases. We assessed demographics; exposure routes, locations, chronicity; clinical effects; and medical outcomes. We calculated case rates annually and 13-year case rates by US geographic division.ResultsOver half of cyanoHAB exposure cases were children < 20 years old (n = 2175). Most cyanoHABs exposures occurred in a “public area” (n = 2902, 68.1%); most were acute (≤ 8 h) (n = 3824, 89.8%). Dermal and ingestion routes and gastrointestinal effects predominated. 2% (n = 102) of cases experienced a moderate or major medical outcome; no deaths were reported. National rates increased from 0.4 cases/1 million (1 M) person-years in 2010 to 1.4 cases/1 M person-years in 2022. The Mountain division had the highest 13-year rate (7.8 cases/1 M person-years).ConclusionsCyanoHAB exposure case rates increased 2010–2022, despite a decrease in all-cause exposure cases during the same period. NPDS data provide valuable public health information for characterization of cyanoHAB exposures, an emerging public health challenge.

Using information and communication technology (ICT)-based data systems to support teacher data-driven decision-making: Insights from the literature (2013–2023)

Using information and communication technology (ICT)-based data systems to support teacher data-driven decision-making: Insights from the literature (2013–2023)

Spatiotemporal multilevel joint modeling of longitudinal and survival outcomes in end-stage kidney disease.

Individuals with end-stage kidney disease (ESKD) on dialysis experience high mortality and excessive burden of hospitalizations over time relative to comparable Medicare patient cohorts without kidney failure. A key interest in this population is to understand the time-dynamic effects of multilevel risk factors that contribute to the correlated outcomes of longitudinal hospitalization and mortality. For this we utilize multilevel data from the United States Renal Data System (USRDS), a national database that includes nearly all patients with ESKD, where repeated measurements/hospitalizations over time are nested in patients and patients are nested within (health service) regions across the contiguous U.S. We develop a novel spatiotemporal multilevel joint model (STM-JM) that accounts for the aforementioned hierarchical structure of the data while considering the spatiotemporal variations in both outcomes across regions. The proposed STM-JM includes time-varying effects of multilevel (patient- and region-level) risk factors on hospitalization trajectories and mortality and incorporates spatial correlations across the spatial regions via a multivariate conditional autoregressive correlation structure. Efficient estimation and inference are performed via a Bayesian framework, where multilevel varying coefficient functions are targeted via thin-plate splines. The finite sample performance of the proposed method is assessed through simulation studies. An application of the proposed method to the USRDS data highlights significant time-varying effects of patient- and region-level risk factors on hospitalization and mortality and identifies specific time periods on dialysis and spatial locations across the U.S. with elevated hospitalization and mortality risks.

Course-Skill Atlas: A national longitudinal dataset of skills taught in U.S. higher education curricula

Higher education plays a critical role in driving an innovative economy by equipping students with knowledge and skills demanded by the workforce. While researchers and practitioners have developed data systems to track detailed occupational skills, such as those established by the U.S. Department of Labor (DOL), much less effort has been made to document which of these skills are being developed in higher education at a similar granularity. Here, we fill this gap by presenting Course-Skill Atlas – a longitudinal dataset of skills inferred from over three million course syllabi taught at nearly three thousand U.S. higher education institutions. To construct Course-Skill Atlas, we apply natural language processing to quantify the alignment between course syllabi and detailed workplace activities (DWAs) used by the DOL to describe occupations. We then aggregate these alignment scores to create skill profiles for institutions and academic majors. Our dataset offers a large-scale representation of college education’s role in preparing students for the labor market. Overall, Course-Skill Atlas can enable new research on the source of skills in the context of workforce development and provide actionable insights for shaping the future of higher education to meet evolving labor demands, especially in the face of new technologies.

340B Participation and Safety Net Engagement Among Federally Qualified Health Centers

The 340B program provides discounts on outpatient drugs to certain hospitals and federally supported clinics (covered entities) that can be used to generate revenue to fund safety net care. While numerous studies have found no association between 340B and safety net care provision for most hospital covered entities, less is known about whether federally qualified health centers (FQHCs), the largest group of covered entities after hospitals, use the program to enhance safety net care. To assess whether a proxy for 340B revenue was associated with increased safety net care provision among FQHCs. This descriptive, retrospective cohort study examined care provided from 2005 to 2022 by 1468 FQHCs that submitted to the Health Resources and Services Administration Uniform Data System. FQHC and year-level fixed effects were included, as well as a control for differential Medicaid expansion over time. The data were analyzed between March and December 2023. One-year lagged number of locations registered to dispense or administer 340B-discounted drugs (registered locations), which included child sites, in-house pharmacies, and contract pharmacies in the 340B Outpatient Pharmacy Affairs Database. Natural logarithm of patient volume by payer, low-income status, and use of enabling services. Natural logarithm of visits in which low-profit preventive services were provided. An additional registered location was associated with increased patient volume, especially for uninsured (0.4%; 95% CI, 0.3%-0.5%) and privately insured (0.4%; 95% CI, 0.2%-0.5%) patients and low-income (0.4%; 95% CI, 0.2%-0.6%), unhoused (0.3%; 95% CI, 0.1%-0.5%), and non-English-speaking (0.3%; 95% CI, 0.1%-0.5%) patients. An additional registered location was associated with increased visits with an HIV test (0.7%; 95% CI, 0.4%-0.9%), serum lead test (0.8%; 95% CI, 0.6%-1.1%), seasonal influenza shot (0.4%; 95% CI, 0.3%-0.5%), Papanicolaou smear (0.5%; 95% CI, 0.4%-0.7%), and tobacco cessation counseling (1.0%; 95% CI, 0.5%-1.4%). Across the study period, the average annual increase in locations was 1.5. The results of this cohort study suggest that there are statistically significant increases in the provision of low-profit but high-value preventive services and care to safety net populations (those who lack insurance, have a low income, or require enabling services) and that, like public hospitals, FQHCs might use 340B revenues to enhance safety net care. This finding may inform debates on the 340B program by supporting differential 340B reforms across hospital and nonhospital covered entities.

Cerebral venous thrombosis in elderly patients.

We aimed to report the characteristics of cerebral venous thrombosis (CVT) in elderly people (aged ≥65 years). This multicenter retrospective cohort included elderly patients hospitalized for a first CVT in nine Paris-Ile-de-France hospitals between 2011 and 2021. The estimated incidence was compared to CVT recorded by the French health insurance data system. Lariboisière Hospital's CVT registry allowed comparisons of our elderly cohort with individuals younger than 65 years. One hundred fourteen patients were included in this study (mean age = 74.2 years, range = 65-93, 61% female). The CVT annual incidence in Ile-de-France was 5.9-7.1 per million elderly individuals versus 8.5 per million nationwide. Headaches and focal deficits were the most common initial clinical features (50% and 51%, respectively), followed by seizures and confusion (40% and 27%). Treatment included anticoagulation (93%) and, rarely, endovascular procedure (2%) or craniectomy (1%). Compared with adult patients aged <65 years (younger adults), elderly patients presented fewer headaches (50% vs. 96%, p < 0.01) and intracranial hypertension (7% vs. 22%, p < 0.01) but more seizures and focal deficits (40% vs. 27% and 51% vs. 38%, respectively, p < 0.01). Underlying cancer, hemopathy, and locoregional infections were more frequent in elderly patients than among younger adults (p < 0.01). The prognosis of patients from our elderly cohort was poorer than that of younger adults; 8% died in the acute phase, and 73% had a favorable outcome at 1 year (vs. 1.7% and 87%, respectively, p < 0.01). CVT in elderly patients has a specific clinical presentation, epidemiology, and risk factors such as cancer or hemopathy, justifying specialized management.

Association of Coprescribing of Gabapentinoid and Other Psychoactive Medications With Altered Mental Status and Falls in Adults Receiving Dialysis

Rationale & ObjectivePrescribing psychoactive medications for patients with kidney disease is common, but for patients receiving dialysis, some medications may be inappropriate. We evaluated the association of coprescribing gabapentinoids and other psychoactive potentially inappropriate medications (PPIMs) (e.g., sedatives, opioids) with altered mental status (AMS) and falls, and whether the associations are modified by frailty. Study DesignObservational cohort study. Setting& Participants: Adults receiving dialysis represented in the United States Renal Data System who had an active gabapentinoid prescription and no other PPIM prescriptions in the prior 6 months. ExposurePPIM coprescribing, or the presence of overlapping prescriptions of a gabapentinoid and ≥1 additional PPIM. OutcomesAcute care visits for AMS and injurious falls. Analytical ApproachPrentice-Williams-Petersen Gap Time models estimated the association between PPIM coprescribing and each outcome, adjusting for demographics, comorbidities, and frailty (assessed by a validated frailty index (FI)). Each model tested for interaction between PPIM coprescribing and frailty. ResultsOverall, PPIM coprescribing was associated with increased hazard of AMS (HR: 1.66 [95% CI 1.44, 1.92]) and falls (HR: 1.55 [95% CI 1.36, 1.77]). Frailty significantly modified the effect of PPIM coprescribing on the hazard of AMS (interaction p=0.01), but not falls. Among individuals with low frailty (FI=0.15), the hazard ratio for AMS with PPIM co-prescribing was 2.14 (95% CI: 1.69, 2.71); while for individuals with severe frailty (FI=0.34), the hazard ratio for AMS with PPIM coprescribing was 1.64 (95% CI: 1.42, 1.89). Individuals with PPIM coprescribing and severe frailty (FI =0.34) had the highest hazard of AMS [HR 4.04 (95% CI: 3.20, 5.10)] and falls [HR 2.77 (95% CI: 2.27, 3.38)] compared to non-frail individuals without PPIM coprescribing. LimitationsOutcome ascertainment bias; residual confounding. ConclusionsCompared to gabapentinoid prescriptions alone, PPIM coprescribing was associated with an increased risk of AMS and falls. Clinicians should consider these risks when coprescribing PPIMs to patients receiving dialysis.

Clinical Implication of the New AI-TIRADS Classification of Thyroid Nodules; Our Real Clinical Experience

Background: Ultrasound and fine needle aspiration biopsy (FNAB) play a primary role in determining the nature of nodules. Objectives: The aim of our study is to determine the diagnostic accuracy, sensitivity, and specificity of artificial intelligence-thyroid imaging reporting and data system (AI-TIRADS) in differentiating malignant from benign nodules to establish the treatment plan for patients and avoid unnecessary FNAB. Methods: This cross-sectional study was conducted between September 2020 and September 2021 (one year). Patients (n = 133) who had an indication for surgery due to nodular thyroid disease and were referred to the therapeutic training center of 5 Azar and Falsafi private section hospitals, Gorgan, Iran, were included. The diagnostic accuracy of FNAB and AI-TIRADS was calculated. Results: The mean age of patients with malignant pathology (39.65 ± 11.69) was lower than that of patients with benign pathology (44.14 ± 13.54), which was statistically significant (P = 0.042). Fifty-two out of 72 nodules less than 25 mm were malignant, demonstrating a higher prevalence of benign pathology in larger nodules. A pooled analysis of thyroid reporting (TR) = 2 and TR points ≥ 7 for their power in predicting the final pathology outcome showed figures of 0.97, 0.93, 0.97, and 0.97 for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively, with an overall pooled accuracy of 0.97 for these two groups of sonographic results. Conclusions: We concluded that AI-TIRADS has a high sensitivity and diagnostic accuracy in differentiating benign from suspicious nodules.

Correlative evaluation of findings between ultrasonography, fine needle aspiration cytology and histopathology in cases of goitre

Background: Thyroid imaging reporting and data system (TIRADS) criteria is followed in ultrasonography (USG), based on the risk of malignancy depending on the presence of suspicious ultrasound features. Patients in the high-risk category of TIRADS undergo fine needle aspiration cytology (FNAC), with the Bethesda classification used to determine the risk of malignancy. There is dearth of data comparing sonographic classification of thyroid nodule and its cytological association with respect to final histopathological diagnosis in India. Methods: Prospective observational study on correlation of USG, FNAC and HPE of thyroid swellings conducted in department of otolaryngology at Jaipur national university institute for medical science and research centre, Jaipur, Rajasthan from June 2022 to April 2024 on 50 patients with palpable thyroid lump. Results: In the present study, USG has a sensitivity of 63.63%, specificity of 97.44%, a positive predictive value (PPV) of 87.5%, a negative predictive value (NPV) of 90.4% and an overall accuracy of 84.00%. FNAC shows a sensitivity of 72.7%, specificity of 89.7%, PPV of 66.7%, NPV of 92%, and an overall accuracy of 86%. Conclusions: Benign lesions on both FNAC and USG were almost in concurrence with HPE in our study. The results of FNAC for diagnosing malignancy in our study were almost at par with the results of HPE and outweighed the results of USG. Surgical management should be based on FNAC finding even if USG shows benign features. It should be essential part of armamentarium of evaluation of thyroid swelling. This combined approach provides a robust framework and enhances the accuracy for distinguishing between benign and malignant thyroid lesions, ultimately contributing to improved patient care and outcomes. However, the histopathological examination will remain the gold standard.