Seeing the unseen: The low treatment rate of eye emergencies in Africa

BACKGROUND

Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.

AIM

To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.

METHODS

This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.

RESULTS

The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.

CONCLUSION

The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.

Impact of cognitive rehabilitation interventions on memory improvement in patients after stroke: A systematic review

BACKGROUND

Cognitive impairment is a major cause of disability in patients who have suffered from a stroke, and cognitive rehabilitation interventions show promise for improving memory.

AIM

To examine the effectiveness of virtual reality (VR) and non-VR (NVR) cognitive rehabilitation techniques for improving memory in patients after stroke.

METHODS

An extensive and thorough search was executed across five pertinent electronic databases: Cumulative Index to Nursing and Allied Health Literature; MEDLINE (PubMed); Scopus; ProQuest Central; and Google Scholar. This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Studies that recruited participants who experienced a stroke, utilized cognitive rehabilitation interventions, and published in the last 10 years were included in the review.

RESULTS

Thirty studies met the inclusion criteria. VR interventions significantly improved memory and cognitive function (mean difference: 4.2 ± 1.3, P < 0.05), whereas NVR (including cognitive training, music, and exercise) moderately improved memory. Compared with traditional methods, technology-driven VR approaches were particularly beneficial for enhancing daily cognitive tasks.

CONCLUSION

VR and NVR reality interventions are beneficial for post-stroke cognitive recovery, with VR providing enhanced immersive experiences. Both approaches hold transformative potential for post-stroke rehabilitation.

The remarkable effects of the ionized medical water Asea® in 3 boys with Duchenne dystrophy: Three case reports

BACKGROUND

Duchenne muscular dystrophy (DMD) is a severe lethal X-linked monogenic recessive congenital muscular dystrophy caused by various types of mutations in the dystrophin gene (DG). It is one of the most common human genetic diseases and the most common type of muscular dystrophy, in part because DG is one of the largest protein-coding genes in the human genome with a relatively high risk of being affected by a large palette of mutations. Long-term corticosteroid therapy (LTCT) with deflazacort started at age 4 is the most accessible and used pharmacological therapy for DMD in Romania. "Asea^® redox supplement" (ARS) is an approved dietary supplement in the European Union. Several studies have shown that it is a very potent selective NRF2 activator, and thus a very potent, albeit indirect, antioxidant, with no toxicity up to high doses, in contrast to LTCT.

CASE SUMMARY

This paper presents a 3-case series on the effects of ARS in a 4-year-old, 5-year-old and 3-year-old boy all with DMD from Bucharest or Slobozia (Romania). This is the first report of this type worldwide. The parents of these boys had refused LTCT. They were treated with relatively high doses of ARS (3-7 mL/kg/day). For two patients, ARS was administered in combination with medium doses of L-carnitine and omega-3 fatty acids for various intellectual disabilities. Periodic consults and assessments for rhabdomyolysis, medullar and liver toxicity markers (blood count, gamma-glutamyl transferase, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, creatine kinase, creatine kinase-MB and serum myoglobin) were performed. In vitro studies showed that ARS is a very potent and selective NRF2 activator, and thus a very potent indirect antioxidant. The in vivo studies also support this main pharmacological mechanism of ARS, with no toxicity at high doses, in contrast with much more toxic corticosteroids which are often refused by parents for their children with DMD. Although they were three distinct ages and carried three distinct DG mutations, from the first months of ARS-based treatment, the children responded similarly to ARS. The rhabdomyolysis markers, which were initially very high, significantly dropped, and there was no evidence for medullar and/or hepatic toxicity in any of the 3 patients.

CONCLUSIONS

ARS has significant indirect antioxidant effects via NRF2 and deserves extensive trials in children with DMD, as an adjuvant to corticoids or as a substitute in DMD patients who refuse corticoids. Future trials should also focus on ARS as an adjuvant in many types of acute/chronic infectious/non-infectious diseases where cellular oxidative stress is involved.

Selective procedure for the instant identification of cellular apoptosis induced by natural products

BACKGROUND

Recently, the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide. Traditionally, cell apoptosis is identified using morphological, biochemical, and cell cycle experiments, which is time consuming, and experimental materials are not from the same group, and it is very hard to ensure the identity and veracity of results of former and latter experiments.

AIM

To establish a selective, instant, and practical protocol to identify cell apoptosis induced by natural products.

METHODS

A one transient cell processing procedure (OTCPP) was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract (PMBE) at the morphological, biochemical, and cell cycle levels. The methods used included treatment with DNA gel electrophoresis, fluorescence microscopy, and flow cytometry.

RESULTS

In PMBE-treated LoVo cells, we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed "nuclear shrinkage, chromatin condensation or fragmentation". In addition, flow cytometry showed an "obvious apoptosis curve". Thus OTCPP achieved synchronous detection of the morphology, biochemistry, cell cycle, and the DNA content of the cells.

CONCLUSION

OTCPP can quickly identify apoptosis and measure the apoptosis rate, thereby unifying qualitative and quantitative analysis.

Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy

Third-space endoscopy (TSE) has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors. TSE is based on the concept of working in the submucosa using a mucosal flap valve technique, which is the underlying premise for all TSE procedures; thus, some complications are shared across the spectrum of TSE procedures. Despite the high safety profiles of most TSE procedures, studies have reported various adverse events, including insufflation-related complications, bleeding, perforation, and infection. Although the occurrence rate of those complications is not very high, they sometimes result in critical conditions. No reports of chylous effusion following TSE procedures, particularly per-oral endoscopic myotomy, have been documented previously. We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy. Additionally, we aim to present a comprehensive overview, discuss the existing data, and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures, especially TSE.

Gut virome and its emerging role in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a progressive multifactorial inflammatory disease of the gut. The cause of IBD is yet unknown. Some researchers have shown that genetic factors, environmental factors, and the gut microbiome are significant considerations. Our gut contains gut virome and gut bacteria, which vary among individuals due to some factors. The gut virome is a substantial component of the microbiome. This editorial explores the emerging role of gut virome in IBD.

Primary author contact for systematic reviews of randomized controlled trials: A systematic review

BACKGROUND

Systematic reviews (SRs) synthesize and evaluate data, mainly from randomized trials, which then guides the development of clinical recommendations in evidence-based medicine. However, the data and methodological information in the included papers can often be lacking or unclear, and reviewers usually need to contact the authors of included studies for clarifications. Contacting authors is recommended, but it is unclear how often SR teams do it, or what the level of response is.

AIM

To investigate how often reviewers undertake contact with the authors of included randomized controlled trials (RCTs) for clarification on data and risk of bias concerns, to explore the factors that influence whether SR authors contact or do not contact the authors, and the content and level of responses.

METHODS

We conducted a systematic electronic database search in MEDLINE using the search string “(systematic review)” AND “(RCT OR randomized OR trial)” for articles published between 1 January 2024 and 19 February 2024, without language restrictions. Screening and data extraction was done independently by two reviewers, and conflicts resolved by a senior author. Contact authors of included SRs were contacted for clarifications.

RESULTS

Of the 329 included SRs, 38% (n = 125) explicitly mentioned contact with the authors of included studies. The remaining 62% (n = 204) did not. We attempted contact with all SR teams for clarifications and received 90 responses (19.4%). Of the 50 respondents who did not explicitly mention contact in their SRs, 25 (50%) replied that they did make contact. We received a total of 64 responses on the level and content of information sought. The mean ± SD contacts SR teams made were 10 (10), replies received 5 (6.7), and response waiting time 10.1 (28.3) weeks. Resources, time, poor previous experience, perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.

CONCLUSION

The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors. However, SR teams reported that 50% of contacted primary authors respond. Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.

Multidisciplinary management of pituitary macroadenoma

BACKGROUND

Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.

AIM

To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.

METHODS

A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.

RESULTS

A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.

CONCLUSION

Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future

Evaluation of macular and peripapillary structure and microvasculature with optical coherence tomography angiography in migraine in the Indian population

BACKGROUND

Migraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve. Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins, alongside anterior and posterior ischemic optic neuropathy. With the advent of optical coherence tomography angiography (OCTA), it is easy to identify these macular subclinical microvascular and structural changes.

AIM

To evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura (MA), migraine without aura (MW), and healthy control (HC) participants using OCTA.

METHODS

In this observational cross-sectional study, we studied a total of 100 eyes: (1) 32 eyes of 16 patients with MA; (2) 36 eyes of 18 patients with MW, recruited based on the International Classification of Headache Disorders; and (3) 32 eyes of 16 age and sex-matched healthy participants. Foveal flux, foveal avascular zone (FAZ), peripapillary flux obtained from OCTA, and foveal and peripapillary ganglion cell layer (GCL) thickness calculated via optical coherence tomography were compared among the groups.

RESULTS

The mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants (P = 0.002). However, there was no significant difference between the FAZ of the MA and MW groups. Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW (P = 0.0018) and HCs (P = 0.002). There was also significant thinning of the GCL in patients with MA and MW (P = 0.001) compared to HCs. However, there was no significant difference in temporal GCL thickness between the MA and MW groups.

CONCLUSION

Significant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs. OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances, aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.

Artificial intelligence in revolutionizing orthodontic practice

This analytical research paper explores the transformative impact of artificial intelligence (AI) in orthodontics, with a focus on its objectives: Identifying current applications, evaluating benefits, addressing challenges, and projecting future developments. AI, a subset of computer science designed to simulate human intelligence, has seen rapid integration into orthodontic practice. The paper examines AI technologies such as machine learning, deep learning, natural language processing, computer vision, and robotics, which are increasingly used to analyze patient data, assist with diagnosis and treatment planning, automate routine tasks, and improve patient communication. AI systems offer precise malocclusion diagnoses, predict treatment outcomes, and customize treatment plans by leveraging dental imagery. They also streamline image analysis, improve diagnostic accuracy, and enhance patient engagement through personalized communication. The objectives include evaluating the benefits of AI in terms of efficiency, accuracy, and personalized care, while acknowledging the challenges like data quality, algorithm transparency, and practical implementation. Despite these hurdles, AI presents promising prospects in advanced imaging, predictive analytics, and clinical decision-making. In conclusion, AI holds the potential to revolutionize orthodontic practices by improving operational efficiency, diagnostic precision and patient outcomes. With collaborative efforts to overcome challenges, AI could play a pivotal role in advancing orthodontic care.

Interaction between gut virome and microbiota on inflammatory bowel disease

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic condition marked by recurring gastrointestinal inflammation. While immune, genetic, and environmental factors are well-studied, the gut virome has received less attention. This editorial highlights the work which investigates the gut virome’s role in IBD and its interactions with the bacterial microbiome and host immune system. The gut virome consists of bacteriophages, eukaryotic viruses, and endogenous retroviruses. Among these, Caudovirales bacteriophages are predominant and influence bacterial communities via lysogenic and lytic cycles. Eukaryotic viruses infect host cells directly, while endogenous retroviruses impact gene regulation and immune responses. In IBD, the virome shows distinct alterations, including an increased abundance of Caudovirales phages and reduced Microviridae diversity, suggesting a pro-inflammatory viral environment. Dysbiosis, chronic inflammation, and aberrant immune responses contribute to these changes by disrupting microbial communities and modifying virome composition. Phages affect bacterial dynamics through lysis, lysogeny, and horizontal gene transfer, shaping microbial adaptability and resilience. Understanding these interactions is crucial for identifying novel therapeutic targets and restoring microbial balance in IBD.

Fishing reviewing: A threat to research integrity and credibility

The rise of the “fishing reviewer” phenomenon presents a significant threat to the integrity of academic publishing, undermining the credibility of the peer review process and eroding trust in scientific journals. This editorial explores the risk factors contributing to this troubling trend and identifies key indicators to recognize such reviewers. To address this issue, we propose strategies, including enhanced reviewer vetting, comprehensive training, and transparent recognition policies to foster a culture of accountability and ethical conduct in scholarly review. By implementing these measures, we can safeguard the quality and credibility of academic research.

Sotatercept: A novel therapeutic approach for pulmonary arterial hypertension through transforming growth factor-β signaling modulation

Pulmonary arterial hypertension (PAH) is a progressive disease marked by degeneration of the lung’s blood vessels. As the disease progresses, the resistance to blood flow in the pulmonary arteries increases, putting a strain on the right side of the heart as it pumps blood through the lungs. PAH is characterized by changes in the structure of blood vessels and excessive cell growth. Untreated PAH leads to irreversible right-sided heart failure, often despite medical intervention. Patients experience a gradual decline in function until they are unable to perform daily activities. Advances in treatment have improved the prognosis for many PAH patients. Currently approved therapies target the prostacyclin, endothelin, nitric oxide, or phosphodiesterase pathways to slow the progression of the disease. To address the unmet need for effective PAH therapies, research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis. Among these, sotatercept, a fusion protein that targets the transforming growth factor-β superfamily signaling pathway, has emerged as a promising therapeutic option. In this review, we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.

Comparative evaluation of retentive capacity of three different attachment systems for implant retained overdentures: An in vitro study

BACKGROUND

The primary issue in managing edentulous patients is the severely resorbed mandibular ridge, particularly in older individuals with diminished adaptive capacities. This compromised situation leads to the fabrication of inadequate dentures that lack retention and stability, potentially causing psychosocial issues.

AIM

To determine the difference in retentive capacity between three attachment systems in implant-retained overdentures.

METHODS

Three edentulous mandibular models were fabricated using heat-cured polymethacrylate resin, with two implant replicas placed in the intra-foraminal region of each model. 30 acrylic resin mandibular overdentures were fabricated with provisions for three different overdenture attachment systems: A prefabricated ball/O-ring attachment, a locator attachment system, and an equator attachment system. Each model was subjected to 15000 pulls using a universal testing machine to remove the overdenture from the acrylic model and the force data were recorded.

RESULTS

The ball/O-ring attachment system demonstrated superior retentive capacity for 15 years, while the locator and equator attachment systems maintained excellent retentive capacity for 5 years.

CONCLUSION

The ball/O-ring attachment system outperformed better than the other two attachment systems regarding retentive capacity. The locator and equator attachment systems presented sufficient retentive abilities until 15000 cycles. After 7500 cycles, significant differences in retentive force between the systems evolved.

Innovative forecasting models for nurse demand in modern healthcare systems

Accurate prediction of nurse demand plays a crucial role in efficiently planning the healthcare workforce, ensuring appropriate staffing levels, and providing high-quality care to patients. The intricacy and variety of contemporary healthcare systems and a growing patient populace call for advanced forecasting models. Factors like technological advancements, novel treatment protocols, and the increasing prevalence of chronic illnesses have diminished the efficacy of traditional estimation approaches. Novel forecasting methodologies, including time-series analysis, machine learning, and simulation-based techniques, have been developed to tackle these challenges. Time-series analysis recognizes patterns from past data, whereas machine learning uses extensive datasets to uncover concealed trends. Simulation models are employed to assess diverse scenarios, assisting in proactive adjustments to staffing. These techniques offer distinct advantages, such as the identification of seasonal patterns, the management of large datasets, and the ability to test various assumptions. By integrating these sophisticated models into workforce planning, organizations can optimize staffing, reduce financial waste, and elevate the standard of patient care. As the healthcare field progresses, the utilization of these predictive models will be pivotal for fostering adaptable and resilient workforce management.

Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the most common modality for tissue acquisition from pancreatic masses. Despite high specificity, sensitivity remains less than 90%. Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically. However, data regarding the same have shown conflicting results.

AIM

To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.

METHODS

The electronic databases of MEDLINE, EMBASE, and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions. A bivariate hierarchical model was used to perform the meta-analysis.

RESULTS

A total of 10 studies were identified. The pooled sensitivity, specificity, and area under the receiver-operated curve (AUROC) for standard EUS-FNA/B were 0.82 (95%CI: 0.79-0.85), 1.00 (95%CI: 0.96-1.00), and 0.97 (95%CI: 0.95-0.98), respectively. The pooled sensitivity, specificity, and AUROC for EUS-FNA/B with auxiliary techniques were 0.86 (95%CI: 0.83-0.89), 1.00 (95%CI: 0.94-1.00), and 0.96 (95%CI: 0.94-0.98), respectively. Comparing the two diagnostic modalities, sensitivity [Risk ratio (RR): 1.04, 95%CI: 0.99-1.09], specificity (RR: 1.00, 95%CI: 0.99-1.01), and diagnostic accuracy (RR: 1.03, 95%CI: 0.98-1.09) were comparable.

CONCLUSION

Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B. Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.

Visual avatar to increase situational awareness in anaesthesia: Systematic review of recent evidence

BACKGROUND

Systematic review focuses on the visual patient avatar (VPA) technology, a tool designed to enhance situational awareness in anesthesia by transforming traditional numerical data into intuitive visual displays.

AIM

To explore how VPA can improve perceptual performance, reduce cognitive load, and increase user acceptance, potentially leading to better patient outcomes.

METHODS

The review is based on 14 studies conducted between 2018 and 2023 in five different hospitals across Europe.

RESULTS

These studies demonstrate that VPA allows clinicians to perceive and recall vital signs more efficiently than conventional monitoring methods. The technology’s intuitive design helps reduce cognitive workload, indicating less mental effort required for patient monitoring. Users’ feedback on VPA was generally positive, highlighting its potential to enhance monitoring and decision-making in high-stress environments. However, some users noted the need for further development, particularly in visualization design and data integration.

CONCLUSION

Review concludes that VPA technology represents a significant advancement in patient monitoring, promoting better situational awareness and potentially improving safety in perioperative care.

Biological and translational attributes of mitochondrial DNA copy number: Laboratory perspective to clinical relevance

The mitochondrial DNA copy number (mtDNAcn) plays a vital role in cellular energy metabolism and mitochondrial health. As mitochondria are responsible for adenosine triphosphate production through oxidative phosphorylation, maintaining an appropriate mtDNAcn level is vital for the overall cellular function. Alterations in mtDNAcn have been linked to various diseases, including neurodegenerative disorders, metabolic conditions, and cancers, making it an important biomarker for understanding the disease pathogenesis. The accurate estimation of mtDNAcn is essential for clinical applications. Quantitative polymerase chain reaction and next-generation sequencing are commonly employed techniques with distinct advantages and limitations. Clinically, mtDNAcn serves as a valuable indicator for early diagnosis, disease progression, and treatment response. For instance, in oncology, elevated mtDNAcn levels in blood samples are associated with tumor aggressiveness and can aid in monitoring treatment efficacy. In neurodegenerative diseases such as Alzheimer’s and Parkinson’s, altered mtDNAcn patterns provide insights into disease mechanisms and progression. Understanding and estimating mtDNAcn are critical for advancing diagnostic and therapeutic strategies in various medical fields. As research continues to uncover the implications of mtDNAcn alterations, its potential as a clinical biomarker is likely to expand, thereby enhancing our ability to diagnose and manage complex diseases.

Use of artificial intelligence in neurological disorders diagnosis: A scientometric study

BACKGROUND

Artificial intelligence (AI) has become significantly integrated into healthcare, particularly in the diagnosing of neurological disorders. This advancement has enabled neurologists and physicians to diagnose conditions more quickly and effectively, ultimately benefiting patients.

AIM

To explore the current status and key highlights of AI-related articles in diagnosing of neurological disorders.

METHODS

A systematic literature review was conducted in the Web of Science Core Collection database using the following strategy: TS = ("Artificial Intelligence" OR "Computational Intelligence" OR "Machine Learning" OR "AI") AND TS = ("Neurological disorders" OR "CNS disorder" AND "diagnosis"). The search was limited to articles and reviews. Microsoft Excel 2019 and VOSviewer were utilized to identify major contributors, including authors, institutions, countries, and journals. Additionally, VOSviewer was employed to analyze and visualize current trends and hot topics through network visualization maps.

RESULTS

A total of 276 publications from 2000 to 2024 were retrieved. The United States, India, and China emerged as the top contributors in this field. Major institutions included Johns Hopkins University, King's College London, and Harvard Medical School. The most prolific author was U. Rajendra Acharya from the University of Southern Queensland (Australia). Among journals, IEEE Access, Scientific Reports, and Sensors were the most productive, while Frontiers in Neuroscience led in total citations. Central topics in AI-related articles on neurological disorders diagnosis included Alzheimer's disease, Parkinson's disease, dementia, epilepsy, autism, attention deficit hyperactivity disorder, and their intersections with deep learning and AI.

CONCLUSION

Research on AI's role in diagnosing neurological disorders is becoming widely recognized for its growing importance. AI shows promise in diagnosing various neurological disorders, yet requires further improvement and extensive future research.

“Electronic Pediatrician”, a non-machine learning prototype artificial intelligence software for pediatric computer-assisted pathophysiologic diagnosis ― general presentation

BACKGROUND

Knowledge-based systems (KBS) are software applications based on a knowledge database and an inference engine. Various experimental KBS for computer-assisted medical diagnosis and treatment were started to be used since 70s (VisualDx, GIDEON, DXPlain, CADUCEUS, Internist-I, Mycin etc.).

AIM

To present in detail the “Electronic Pediatrician (EPed)”, a medical non-machine learning artificial intelligence (nml-AI) KBS in its prototype version created by the corresponding author (with database written in Romanian) that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.

METHODS

EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases. EPed has currently reached its prototype version 2.0, being able to diagnose 302 physiopathological macro-links (briefly named “clusters”) and 269 pediatric diseases: Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.

RESULTS

The prototype EPed can currently diagnose 269 pediatric infectious and non-infectious diseases (based on 302 clusters), including the most frequent respiratory/digestive/renal/central nervous system infections, but also many other non-infectious pediatric diseases like autoimmune, oncological, genetical diseases and even intoxications, plus some important surgical pathologies.

CONCLUSION

EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals. Furthermore, EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis, but also identifies possible physiopathological “clusters” that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically (until a final diagnosis is found), thus encouraging and developing the physiopathological reasoning of any clinician.

Interleukin 10 supplement to reduce episodes of recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is a very frequent condition in developed countries whose basic symptom is a lesion referred to as an aphthous ulcer. High levels of interleukin (IL)-1 and IL-6 and low salivary levels of IL-10 are the basis of RAS pathogenesis. Sublingual supplements based on IL-10 can be very useful in reducing the phenomenon of aphthous recurrence in patients with RAS. An observational clinical experience with a group of 5 patients with RAS receiving a commercially available IL-10-based supplement was reported by the authors. The findings revealed a subsequent reduction in the incidence of mouth ulcers.

Evidence-based approach for intraabdominal drainage in pancreatic surgery: A systematic review and meta-analysis

BACKGROUND

Historically intraoperative drains were employed after pancreatic surgery but over the last decade, there has been debate over the routine usage of drains.

AIM

To assess the necessity of intra-abdominal drain placement, identify the most effective drain type, and determine the optimal timing for drain removal.

METHODS

A systematic review of electronic databases, including PubMed, MEDLINE, PubMed Central, and Google Scholar, was conducted using Medical Subject Headings and keywords until December 2023. From an initial pool of 1910 articles, 48 were included after exclusion and screening. The primary outcomes analyzed were clinically relevant postoperative pancreatic fistula (CR-POPF), delayed gastric emptying (DGE), overall morbidity, and mortality. Subgroup analyses were performed for pancreaticoduodenectomy and distal pancreatectomy.

RESULTS

Routine use of drains is associated with a statistically significant increase in the risk of CR-POPF and DGE. Conversely, patients who did not have drains placed experienced a significant reduction in morbidity, readmission rates, and reoperations. No significant differences were observed between active and passive drain types. Early drain removal (< 3 days) yielded favorable outcomes compared to delayed removal.

CONCLUSION

Analysis of randomized controlled trials and cohort studies did not demonstrate an advantage of routine drain placement following pancreatic resection, potentially contributing to increased morbidity and mortality. The decision to use drains should be left to the discretion of the operating surgeon. However, early drain removal can substantially reduce morbidity.

Echo contrast medium: How the use of contrast echocardiography (ultrasound contrast agents) can improve patient care

Conventional echocardiography can sometimes pose a challenge to diagnosis due to sub-optimal images. Ultrasound contrast agents (UCAs) have been shown to drastically enhance imaging quality, particularly depicting the left ventricular endocardial borders. Their use during echocardiography has become a valuable tool in non-invasive diagnostics. UCAs provide higher-quality images that may ultimately reduce the length of hospital stays and improve patient care. The higher cost associated with UCAs in many situations has been an impediment to frequent use. However, when used as an initial diagnostic test, UCA during rest echocardiogram is more cost-effective than the traditional diagnostic approach, which frequently includes multiple tests and imaging studies to make an accurate diagnosis. They can be easily performed across multiple patient settings and provide optimal images that allow clinicians to make sound medical decisions. This consequently allows for better diagnostic accuracies and improvement in patient care.

Clinical inertia in sexual medicine practice

Clinical inertia (CI) is common in clinical practice. Sexual health issues are common in society, and CI is ubiquitous in sexual medicine practice. CI influences all aspects of healthcare, including prevention, diagnosis, and treatment. In this short review, we briefly describe the various aspects of CI in sexual medicine practice and ways to tackle them

Machine learning-based models for prediction of in-hospital mortality in patients with dengue shock syndrome

BACKGROUND

Severe dengue children with critical complications have been attributed to high mortality rates, varying from approximately 1% to over 20%. To date, there is a lack of data on machine-learning-based algorithms for predicting the risk of in-hospital mortality in children with dengue shock syndrome (DSS).

AIM

To develop machine-learning models to estimate the risk of death in hospitalized children with DSS.

METHODS

This single-center retrospective study was conducted at tertiary Children’s Hospital No. 2 in Viet Nam, between 2013 and 2022. The primary outcome was the in-hospital mortality rate in children with DSS admitted to the pediatric intensive care unit (PICU). Nine significant features were predetermined for further analysis using machine learning models. An oversampling method was used to enhance the model performance. Supervised models, including logistic regression, Naïve Bayes, Random Forest (RF), K-nearest neighbors, Decision Tree and Extreme Gradient Boosting (XGBoost), were employed to develop predictive models. The Shapley Additive Explanation was used to determine the degree of contribution of the features.

RESULTS

In total, 1278 PICU-admitted children with complete data were included in the analysis. The median patient age was 8.1 years (interquartile range: 5.4-10.7). Thirty-nine patients (3%) died. The RF and XGboost models demonstrated the highest performance. The Shapley Addictive Explanations model revealed that the most important predictive features included younger age, female patients, presence of underlying diseases, severe transaminitis, severe bleeding, low platelet counts requiring platelet transfusion, elevated levels of international normalized ratio, blood lactate and serum creatinine, large volume of resuscitation fluid and a high vasoactive inotropic score (> 30).

CONCLUSION

We developed robust machine learning-based models to estimate the risk of death in hospitalized children with DSS. The study findings are applicable to the design of management schemes to enhance survival outcomes of patients with DSS.