Aetiological Spectrum and Predictors of Mortality in Hospitalised Adults with Community-Acquired Pneumonia: A Cross-Sectional Observational Study at a Tertiary Care Hospital
Background: Pneumonia is one of the major causes of morbidity and mortality due to infection worldwide and is known as community-acquired pneumonia (CAP). The aetiological spectrum of CAP in Indian tertiary care hospitals is different from Western countries, Klebsiella pneumoniae was predominant and high percentage of antibiotic-resistant pathogens. Empirical antibiotic guidance is dependent upon knowledge of local microbiology and mortality predictors. Methods: This was a cross sectional observational study involving 250 hospitalised adults with CAP (IDSA/ATS 2019 criteria) at a tertiary care hospital in 12 months. Comprehensive microbiological sampling, CURB-65 and PSI scoring, treatment outcome documentation, and multivariable mortality analysis were performed. Results: A causative pathogen was identified in 47.2% of cases. Streptococcus pneumoniae was most common (22.0%), followed by Klebsiella pneumoniae (14.0%), atypicals (8.0%), and viral co-infection (11.0%). Severe CAP (CURB-65 ≥3) was present in 22.4%; ICU admission in 18.0%; 30-day in-hospital mortality 9.2%. Independent mortality predictors included septic shock (aOR 5.6), CURB-65 ≥3 (aOR 4.5), inappropriate empirical antibiotic therapy (aOR 2.7), and diabetes (aOR 1.8). Conclusion: The CAP pathogen spectrum in this Indian tertiary care hospital combines classical pneumococcal disease with significant Gram-negative and atypical pathogen contribution. Inappropriate empirical therapy is a major modifiable mortality predictor. Local antibiogram-guided empirical protocols and early severity stratification by CURB-65 are essential for improving outcomes.
Community-acquired pneumonia; CAP; CURB-65; Streptococcus pneumoniae; Klebsiella pneumoniae; atypical pathogens; empirical antibiotic therapy; 30-day mortality; India.
Dr. VVSDS Ratnasagar, Dr. P Prudhvi Chandra
Clinical-Operative Outcomes of Laparoscopic Versus Open Appendicectomy in Adults with Complicated and Uncomplicated Acute Appendicitis: A Cross-Sectional Observational Study at a Tertiary Care Hospital
Background: The laparoscopic appendicectomy (LA) is the preferred method of dealing with uncomplicated acute appendicitis in high-income nations, whereas a comparison of its outcomes with surgical appendicectomy (SA) is scarce in the Indian tertiary care setting, especially with the complicated appendicitis. Real World Outcomes inform institutional surgical practice and training. Methods: Two groups were compared: LA (n=140) and OA (n=80) in 220 adults in a cross sectional observational study over 18 months in a tertiary care hospital. Operative parameters, total cost, length of stay, complication status (perforated/gangrenous/abscess), AIR score, and Alvarado score were documented. Results: Mean operative time was longer in LA (64.2±18.4 vs 46.8±14.2 minutes, p<0.001). SSI was significantly lower in LA (4.3% vs 16.3%, p=0.004). Postoperative ileus (3.6% vs 11.3%, p=0.034), mean LOS (2.8 vs 5.2 days, p<0.001), and opioid requirement were also significantly lower in LA. Multivariable predictors of SSI: open approach (aOR 3.6), complicated appendicitis (aOR 2.9), diabetes (aOR 1.9), and delayed presentation >48 hours (aOR 1.7). Conclusion: Laparoscopic appendicectomy is associated with significantly lower SSI, shorter LOS, and reduced ileus compared to open approach, including in complicated appendicitis. Expansion of LA capability and training at tertiary care hospitals is recommended.
Appendicectomy; laparoscopic appendicectomy; acute appendicitis; complicated appendicitis; surgical-site infection; Alvarado score; length of stay; India.
Dr. K. Cheruvu Nataraj Navya, Dr. Haritha Oruganti
Hemodynamic Stability During Airway Instrumentation: Comparison of Direct Laryngoscopy, Videolaryngoscopy, and Laryngeal Mask Airway Techniques
Airway instrumentation during the induction of general anesthesia is well known to provoke a sympathetic-mediated cardiovascular response characterized by transient increases in heart rate and arterial blood pressure. These hemodynamic changes may be clinically insignificant in healthy individuals but can pose substantial risks in patients with cardiovascular, cerebrovascular, or other systemic comorbidities. Therefore, selecting an airway management technique that minimizes the pressor response is of considerable clinical importance. This randomized controlled trial was conducted to compare the hemodynamic responses associated with direct laryngoscopy (DL), videolaryngoscopy (VL), and laryngeal mask airway (LMA) insertion in adult patients undergoing elective surgical procedures under general anesthesia. A total of 150 patients were enrolled and randomly assigned into three equal groups (n = 50 each) according to the airway management technique used. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, during airway instrumentation, and at 1, 3, and 5 minutes following the procedure. The collected data were analyzed using repeated-measures analysis of variance (ANOVA) to evaluate differences in hemodynamic responses over time among the study groups. The results demonstrated that all three airway management techniques produced a transient increase in HR and MAP following instrumentation. However, the magnitude of the response differed significantly among the groups, with direct laryngoscopy producing the greatest increase and LMA insertion resulting in the smallest hemodynamic disturbance (p < 0.001). Videolaryngoscopy showed an intermediate response, significantly attenuating the cardiovascular changes compared with direct laryngoscopy. These findings suggest that LMA insertion is associated with superior hemodynamic stability, while videolaryngoscopy offers a less pronounced pressor response than conventional direct laryngoscopy, supporting their use in patients vulnerable to adverse cardiovascular effects during airway management.
Airway management; Laryngoscopy; Videolaryngoscopy; Laryngeal mask airway; Hemodynamic response; Intubation.
Dr. Hery Prabhu Alfred, Dr. Pilli Bhavani
Clinical Profile and Outcomes of Acute Organophosphorus Poisoning Correlated with Serum Cholinesterase Levels And Peradeniya Organophosphorus Poisoning Score: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Acute organophosphorus (OP) compound poisoning continues to be an important public health emergency in agricultural India accounting for a large proportion of poisoning deaths. The Peradeniya Organophosphorus Poisoning (POP) score and serum pseudocholinesterase (PChE) are the two indices developed to assess severity of OP poisoning but need to be systematically evaluated for combining the two and predicting the need for mechanical ventilation, intermediate syndrome and death. Methods: This is a cross-sectional observational study that recruited 180 adults with acute OP poisoning who were admitted to a tertiary care hospital during 18-month period. At admission, the POP score, the serum PChE, clinical features, treatment parameters (atropine dose, pralidoxime use), the need for mechanical ventilation, the presence of intermediate syndrome, the length of stay in the ICUs and in-hospital mortality were recorded. Results: The most prevalent compound was chlorpyrifos which accounted for 38.3%. Thirty-two.2% had severe POP score (≥8). Intermediate (14.4%) and mechanical ventilation (36.1%) required and in hospital mortality (9.4%). A negative correlation was shown between serum PChE and severity of POPs (r=−0.62; p<0.001). Independent predictors of mortality were delayed presentation >6 hours, delayed PChE <400 U/L, mechanical ventilation, and POP score ≥8 (all aOR>2.0). Conclusion: The use of the combination of both the POP score and serum PChE at admission in acute OP poisoning allows for good severity stratification. Early intensive care, appropriate atropinisation and oxime therapy, where applicable, are the mainstay of management. There is an emergency need for policy-level regulation of highly toxic OP compounds.
Organophosphorus poisoning; POP score; serum pseudocholinesterase; cholinergic toxidrome; intermediate syndrome; atropine; mechanical ventilation; India.
Dr. Kota Rahul Krishna, Dr. Sridhar Pilla
Functional Outcomes and Patient-Reported Measures After Primary Total Knee Arthroplasty For Advanced Osteoarthritis: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Advanced knee osteoarthritis is treated by total knee arthroplasty (TKA), which provides pain relief and function. Patient-reported outcomes (PROs) have emerged as a vital component of the assessment of TKA success but population-specific predictors of patient dissatisfaction have yet to be well described in the Indian context. This study compares functional outcomes, PROs and factors associated with dissatisfaction following primary TKA in a tertiary care center. Methods: One hundred adults who underwent unilateral primary cemented TKA for advanced primary knee OA (Kellgren-Lawrence ≥3) at a tertiary care hospital with 6–24 months’ follow-up were enrolled in this cross-sectional observational study. Outcome measures included Oxford Knee Score (OKS), Knee Society Score (KSS), WOMAC pain subscale, range of motion (ROM), and patient satisfaction (5-point Likert scale). Multivariable logistic regression identified predictors of dissatisfaction. Results: Mean OKS improved from 18 to 38 at 12 months (p<0.001); KSS-Knee from 42 to 86 (p<0.001); WOMAC pain subscale from 16 to 4 (p<0.001); ROM from 102° to 116° (p<0.001). Complication rates: SSI 3%, DVT 4%, per prosthetic infection 1%, stiffness requiring MUA 2%. Transfusion rate 14%. 86% patients were satisfied/very satisfied. Independent predictors of dissatisfaction: residual flexion <100° at 6 months (aOR 4.0), pre-operative depression (aOR 3.1), BMI ≥30 (aOR 2.2), and pre-operative flexion contracture ≥10° (aOR 2.0). Conclusion: Primary TKA achieves significant improvements in pain, function, and quality of life in the majority of patients. Pre-operative psychological optimisation, weight management, aggressive physiotherapy for post-operative ROM, and targeted patient expectation management are crucial to minimising dissatisfaction. Depression screening and rehabilitation should be incorporated into all TKA pre-operative assessment pathways.
Total knee arthroplasty, Patient-reported outcomes, Oxford Knee Score, WOMAC, Knee Society Score, Patient satisfaction, Predictors of dissatisfaction, Osteoarthritis.
Histopathological Profile and Clinical Correlates of Lymphadenopathy in A Tertiary Care Centre
In the present cross-sectional study, a total of 200 lymph node biopsy specimens were evaluated histopathologically to determine the spectrum of lymph node lesions and their clinicopathological correlations. Reactive hyperplasia was the most common diagnosis, accounting for 68 cases (34%), followed by granulomatous lymphadenitis, predominantly tuberculous in nature, observed in 56 cases (28%). Malignant lesions constituted a substantial proportion of cases, with metastatic deposits identified in 44 biopsies (22%) and lymphomas diagnosed in 32 cases (16%). Analysis of age distribution revealed that benign lesions, particularly reactive hyperplasia and granulomatous lymphadenitis, were more frequently encountered in younger individuals, whereas malignant lesions were significantly more common among older patients. Cervical lymph nodes represented the most frequent site of involvement overall, especially in reactive and granulomatous lesions. In contrast, supraclavicular lymphadenopathy demonstrated a strong association with malignancy, particularly metastatic disease. Node size also showed significant correlation with histopathological diagnosis, with larger lymph nodes more frequently harboring malignant pathology. Similarly, lymph nodes with a longer duration of enlargement prior to presentation were significantly associated with metastatic and lymphomatous lesions compared with reactive and infective conditions. Statistical analysis using chi-square testing demonstrated significant associations between histological diagnosis and clinical variables including patient age, lymph node site, node size, and duration of lymphadenopathy (p < 0.05). The findings highlight the diverse pathological spectrum of lymphadenopathy and emphasize the importance of integrating clinical characteristics with histopathological examination. Histopathology proved invaluable in distinguishing benign from malignant conditions and provided definitive diagnostic information necessary for appropriate patient management and therapeutic decision-making.
Lymph node; Histopathology; Lymphadenopathy; Tuberculosis; Metastasis; Lymphoma.
Incidental Thyroid Nodules Detected on CT and MRI: Frequency, Ultrasound Risk Stratification, and Clinical Outcomes in a Cross-Sectional Study
Background: Incidental thyroid nodules (ITNs) are increasingly detected on computed tomography (CT) and magnetic resonance imaging (MRI) performed for non-thyroid indications. Although most incidental nodules are benign, a small proportion may represent thyroid malignancy, creating challenges regarding appropriate evaluation and management. Understanding the frequency, imaging characteristics, and outcomes of ITNs is important for developing evidence-based diagnostic pathways. Objective: To determine the frequency of incidental thyroid nodules detected on CT and MRI examinations and to evaluate their ultrasound characteristics, cytological findings, and malignancy outcomes. Methods: This cross-sectional study reviewed 1,500 CT and MRI examinations that included visualization of the thyroid gland and were performed for non-thyroid clinical indications. Incidental thyroid nodules were identified and characterized according to size, multiplicity, and imaging features. Nodules meeting established criteria underwent dedicated thyroid ultrasonography and were classified using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Fine-needle aspiration cytology (FNAC) and histopathological findings were reviewed where available. Data were analyzed descriptively using frequencies, percentages, and summary statistics. Results: Incidental thyroid nodules were identified in 225 of 1,500 examinations, yielding an overall frequency of 15%. The prevalence was 16% on CT and 13% on MRI. The median nodule size was 9 mm (interquartile range: 6–14 mm), and multiple nodules were present in 68 patients (30%). Ninety patients (40%) underwent dedicated thyroid ultrasonography, while 27 patients (12%) underwent FNAC. Among evaluated nodules, 41 (46%) were classified as ACR TI-RADS TR1–TR2, 27 (30%) as TR3, 16 (18%) as TR4, and 6 (6%) as TR5. Only two nodules (2%) were confirmed as malignant on cytological or histopathological examination. The majority of incidental nodules therefore demonstrated low-risk ultrasound characteristics and did not require invasive intervention. Conclusion: Incidental thyroid nodules are common findings on CT and MRI examinations performed for non-thyroid indications; however, the prevalence of malignancy is low. Most nodules exhibit low-risk ultrasound features and can be managed conservatively. A selective, guideline-based approach incorporating ultrasound risk stratification and targeted FNAC appears effective for identifying clinically significant lesions while minimizing unnecessary investigations and interventions.
Incidental thyroid nodule, thyroid incidentaloma, computed tomography, magnetic resonance imaging, ultrasonography, ACR TI-RADS, fine-needle aspiration cytology, thyroid cancer.
Clinical Spectrum, Severity Indicators, and Outcomes of Hospitalised Adults with Dengue: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Dengue is the fastest growing vector borne viral disease in the world. Dengue is one of the highest burden diseases in the Southeast Asian region and hospitalised adult dengue is a wide spectrum disease ranging from febrile illness to severe dengue with plasma leakage, severe bleeding and organ failure. Predictors of progression to severity are important in terms of triage and resource allocation. Methods: The cross sectional observational study involved 350 hospitalised adults who were positive for NS1 antigen and/or IgM antibody of dengue (WHO 2009 classification) during one monsoon season in a tertiary care hospital. Clinical features, sequential laboratory parameters, and outcomes were recorded. Results: Warning signs: 41.1% and severe dengue: 12.3% occurred. Thrombocytopenia <20,000/µL occurred in 24.0%; AST >3× ULN in 28.3%; transfusion requirement in 9.1%; ICU admission in 14.3%; mortality 1.4%. AST >500 U/L, serum albumin <3 g/dL, age >45 years and presence of diabetes were independent multivariable predictors of severe dengue with aORs of 4.2, 3.6, 2.1, and 1.9, respectively. Conclusion: Dengue with warning signs and severe dengue affect a substantial proportion of hospitalised adults. Elevated AST and hypoalbuminaemia are strong independent severity predictors that can guide triage decisions. Judicious fluid management and vigilance for plasma leakage are cornerstones of effective clinical management.
Dengue; severe dengue; NS1; thrombocytopenia; plasma leakage; WHO 2009 classification; warning signs; dengue haemorrhagic fever.
Dr. Duggirala Pujitha Chowdary, Dr. Nirmal Kumar
Three-Dimensional Segmental Stability of Multi-Piece Le Fort I Osteotomies vs. Single-Piece Maxillary Advancements in Cleft Lip and Palate Patients
Background and Objective: Cleft lip and palate (CLP) patients frequently develop mid-facial hypoplasia necessitating orthognathic surgical intervention. The optimal approach—multi-piece Le Fort I osteotomy (MP-LFI) versus single-piece maxillary advancement (SP-MA)—remains contested, particularly regarding three-dimensional (3D) skeletal stability. This study prospectively compared 3D segmental stability, occlusal outcomes, and patient-reported quality of life at 24 months between the two techniques. Methods: A prospective cohort study enrolled 100 skeletally mature CLP patients (52 MP-LFI; 48 SP-MA) at a tertiary craniofacial centre between January 2022 and December 2023. Cone-beam computed tomography (CBCT) with 3D cephalometric analysis was performed preoperatively, and at 1, 3, 6, 12, and 24 months postoperatively. Primary outcomes included 3D skeletal relapse vectors across the anteroposterior (X), vertical (Y), and transverse (Z) axes. Secondary outcomes comprised occlusal stability indices, patient-reported outcomes (PROs) using a 100-mm Visual Analogue Scale, and complication rates. Results: At 24 months, the MP-LFI group demonstrated significantly lower total 3D relapse (3.1 ± 1.0 mm vs. 6.2 ± 1.7 mm; p < 0.001) and superior retention of planned movement (65.1% vs. 38.4%; p < 0.001). Stable occlusal outcomes (≤2 mm relapse) were achieved in 74.0% of MP-LFI patients versus 52.1% of SP-MA patients (p = 0.023). Quality of life scores were significantly higher in the MP-LFI cohort across all domains (p < 0.05). Complication rates were lower in the MP-LFI group (11.5% vs. 18.8%). Conclusion: Multi-piece Le Fort I osteotomy provides superior three-dimensional skeletal stability over single-piece maxillary advancement in CLP patients at 24-month follow-up. The MP-LFI technique should be considered the approach of choice in patients with moderate-to-severe maxillary hypoplasia, transverse discrepancies, and arch constriction.
Cleft lip and palate; Le Fort I osteotomy; orthognathic surgery; skeletal stability; three-dimensional cephalometry; maxillary advancement; CBCT; mid-facial hypoplasia; multi-segment osteotomy.
Self-Improving Frontier Agents for Insurance Operations: A Governed Architecture for Autonomous Claims Reasoning And Workflow Adaptation
Frontier artificial intelligence models have demonstrated unprecedented advancements in multi-hop reasoning, tool-use, and interpretive capabilities across complex domains. Despite these advances, regulated industries such as insurance remain constrained by static automation, brittle rule systems, and manual adjudication processes. Current large language model (LLM) deployments in enterprise settings utilize retrieval-augmented generation or simple tool-routing frameworks but lack the ability to improve autonomously over time, restricting operational scalability and consistency. Here we introduce Self-Improving Frontier Agents (SIFA)—a governed, autonomous agentic architecture integrating frontier models (e.g., GPT-o3, Claude 3.5 Opus, Nova Pro) with continuous self-improvement loops, synthetic data generation, human-in-the-loop corrections, and auditable reasoning traces. SIFA dynamically refines claims reasoning, policy interpretation, and workflow steps through governed adaptation pipelines while maintaining compliance and transparency required for regulated enterprise environments. To our knowledge, this is the first documented application of self-improving frontier agents in the insurance domain, bridging a gap between frontier reasoning capabilities and real-world adjudication workflows. We establish the conceptual framework, architecture, implementation methodology, metrics, and governance model necessary for such deployments, and outline implications for broader regulated industries.
Self-Improving Agents, Frontier AI Models, Insurance Claims Adjudication, Governed Adaptation, Retrieval-Augmented Generation.
Venkata Harikishan Koppuravuri, Abhishek Kumar, Karthik Budige
Explainable Federated Deep Learning for Low-Cost and Privacy-Preserving Early Breast Cancer Screening to Reduce U.S. Healthcare Burden
Breast cancer, which overall has an established survival rate of 74% - compared to a progressively increasing 99% within the last 30 years, making early detection essential in improving prognoses - is both sensitive and difficult for clinicians. To overcome the above challenges, in this paper, we propose FedXAI-DP: a novel framework for privacy-preserving breast cancer classification that synergistically combines Federated Learning (FL), Explainable Artificial Intelligence (XAI), and Differential Privacy (DP). FedXAI-DP performs a SHAP-importance-weighted aggregation, where more important clients are given higher or lower weights proportionally in constructing the global model, as compared to existing FL strategies that aggregate model parameters uniformly for each client. This allows more discriminative feature information to rule the global update in the heterogeneous and non-IID client data. Surprisingly, we find under IID data conditions by experimenting on the Wisconsin Breast Cancer Dataset (WBCD, n=569) that FedXAI-DP achieves 98.25% accuracy and AUC-ROC =0.9950, exactly matches centralized training performance while assuring zero access to raw data. Even under realistic non-IID scenarios, the federated model only costs a 1.76% overhead compared to the centralized upper bound whilst achieving an accuracy of 96.49%. We perform a detailed privacy-utility tradeoff analysis across epsilon 2.0, 5.0, 10.0, and 20.0 that quantifies the cost in accuracy from formal privacy guarantees. SHAP analysis ranks radius_mean, area_worst and concave_points_worst as the clinical features most impactful, offering actionable explainability from a pathologist's perspective.
Federated Learning; Explainable AI; SHAP; Differential Privacy; Breast Cancer Detection; Non-IID; Privacy-Preserving Machine Learning; FedAvg.
Md Ismail Hossain Siddiqui, Kanchon Kumar Bishnu, Mohd Abdullah Al Mamun, Mohon Raihan, Araf Islam, Sonia Akter, Iftekhar Hossain
Comparison of Early Versus Delayed Rehabilitation Following ACL Reconstruction
Background: Anterior cruciate ligament (ACL) injury is a common orthopedic condition affecting physically active individuals and often results in knee instability, reduced functional capacity and impaired quality of life. Postoperative rehabilitation plays a crucial role in recovery following ACL reconstruction. However, the optimal timing of rehabilitation initiation remains controversial, particularly in resource-limited settings such as Bangladesh. This study aimed to compare the functional outcomes and postoperative complications between early and delayed rehabilitation following ACL reconstruction. Methods: This comparative observational study was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January to December 2021. A total of 60 patients undergoing primary unilateral arthroscopic ACL reconstruction were enrolled and divided equally into early rehabilitation (n=30) and delayed rehabilitation (n=30) groups. Functional outcomes were assessed using IKDC, Lysholm, Tegner activity, VAS pain scores, knee range of motion and postoperative stability tests. Statistical analysis was performed using SPSS version 25.0. Results: Baseline characteristics were comparable between the groups. At six months, the early rehabilitation group demonstrated significantly higher IKDC scores (84.6±6.8 vs 78.2±7.5; p=0.001), Lysholm scores (89.1±5.9 vs 82.7±6.7; p<0.001), Tegner activity scores (6.2±1.1 vs 5.4±1.0; p=0.006) and greater knee flexion range of motion (132.4±7.1° vs 125.8±8.3°; p=0.002). Lower VAS pain scores and fewer postoperative complications were also observed in the early rehabilitation group. Conclusion: Early rehabilitation following ACL reconstruction resulted in better functional recovery and lower complication rates than delayed rehabilitation.
ACL reconstruction, rehabilitation, early mobilization, knee function.
Dr. Md. Imamur Rashid, Prof. Dr. M.A. Shakoor, Dr. Nadia Rahman, Dr. Mohammad Golam Nobi, Dr. Mohammadullah
Predictors of Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates with high death and morbidity. Aim: This study aimed to recognize demographic, laboratory, and clinical predictors related to the need for surgical management in neonates with NEC. Methods: This retrospective observational study was conducted on 200 patients over a three-year period in a tertiary neonatal intensive care unit. Neonates diagnosed with NEC (Bell’s stage II or III) were included and divided into surgical and conservative management groups. Results: A total of 200 neonates with NEC have been involved; 45 required surgical intervention, and 155 were managed conservatively. Neonates in the surgical group had significantly lower gestational age and birth weight (p under 0.001). Severe clinical features, including abdominal distension, abdominal rigidity, weak bowel sounds, poor mental reaction, tachycardia, and advanced Bell’s stage, were significantly more prevalent in the surgical group (p below 0.05). Multivariate analysis recognized CRP and lactate as independent predictors of surgical intervention, while higher gestational age, absolute lymphocyte count, and white blood cell count were protective. ROC analysis showed good predictive accuracy for CRP (AUC = 0.792). Conclusion: Prematurity, low birth weight, severe clinical presentation, and elevated inflammatory and metabolic markers are strongly associated with surgical NEC. CRP, in particular, is a reliable predictor and can aid in early recognition of high-risk neonates, facilitating timely surgical decision-making and improved outcomes.
Necrotizing enterocolitis; Surgical intervention; C-reactive protein; Neonates.
Hatem W Alsherbiny, Tharwat Hussein, Hasan A Adly, Alsayed M Othman MD, Taha Sobhy Taha, Reda Alkady
Workplace Violence Against Nurses and Its Association With Job Satisfaction and Turnover Intention
Workplace violence (WPV) directed towards nurses is one of the most serious health issues worldwide, having far-reaching consequences for healthcare provision, nurses’ well-being, and organizations’ internal functioning. This literature review presents a state-of-the-art research in terms of current evidence obtained in recent years (2020–2024) regarding prevalence, causes, and outcomes of workplace violence directed toward nurses, especially concerning its connection with nurses' job satisfaction and turnover intention. Based on systematic reviews, meta-analysis, and large cross-sectional studies conducted in different geographical regions such as Ethiopia, China, USA, and the UK, this paper shows that workplace violence affects from 43.4% to 89.6% of nurses according to the type and settings. In addition, the presented results show that job satisfaction acts as an important mediating variable explaining the link between workplace psychological violence and turnover intention, accounting for 43.97% of the total effect. According to hierarchical regression analysis, workplace violence contributes 32.5% of turnover intention variance when controlling demographic variables. The obtained results emphasize the necessity to implement evidence-based organizational changes, policy reforms, and culture changes in order to prevent nurses’ violence-related injuries and improve their satisfaction, thereby alleviating the problem of worldwide nursing shortage due to nurse turnover.
Workplace Violence, Nurses, Job Satisfaction, Turnover Intention, Healthcare, Occupational Safety, Nursing Retention.
Deema Fuad Abdullah Haneef, Jebreen Omayrah Almarashi, Razaz Hussain Bajal, Ghazal Ahmed farajallh Al- thalabi ,Alaa Abdullah Al Subhi, Tariq Ahmed Abdullah Alzahrani, Khalid Abdulrahman alzahrani
Large Language Models for Automated Healthcare Data Dictionary Generation and Maintenance
Data dictionaries enable consistent and reliable communication within and between healthcare organizations but are often incomplete, inconsistent, outdated, or poorly maintained. A methodology harnessing large language models (LLMs) facilitates the automated inception, augmentation, and upkeep of data dictionaries and associated artifacts throughout their lifecycle. Experimental results on an end-to-end data dictionary generation pipeline highlight considerable improvements in artifact quality, with specific categories prepared at least an order of magnitude faster than by human expert contributors. The approach addresses two crucial yet largely neglected aspects of data dictionary governance: the identification of new attributes within hospital information systems and the assessment of impact from proposed changes. In healthcare, data dictionaries describe the information content supported by a system. These dictionaries help facilitate interoperability and data-sharing by formally documenting core knowledge (such as metadata about entities and attributes), by enabling data sharing in an external dataset against which new datasets can be validated, and by providing domain knowledge about external datasets for data fusion, data integration, and machine learning. Nevertheless, many platforms do not have data dictionaries of any kind, and the quality of those that do is often poor. Poor-quality data dictionaries suffer from a range of problems, including incompleteness, inconsistency, outdated content, and lack of audit trails for historical queries. Poor-quality (and missing) data dictionaries also impact data governance by slowing down and increasing the risk in aspects such as the identification of privacy-sensitive fields, the preparation of new data-sharing contracts, and impact assessments for schema changes.
Healthcare Data Dictionaries, LLM-Based Data Governance, Automated Metadata Management, Data Dictionary Automation, Healthcare Data Interoperability, Metadata Quality Improvement, Schema Change Impact Analysis, Data Governance Frameworks, Clinical Data Standardization, Intelligent Data Documentation
Bindu Madhavi Mangalampalli, Sasi Kumar Kolla
Deep Vein Thrombosis and Pulmonary Embolism: A Shared Postoperative Concern in Prolonged Immobilised Patients
Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a major preventable cause of morbidity and mortality among postoperative and prolonged immobilized patients. Despite advances in surgical care, anesthesia, and anticoagulant therapy, VTE continues to be a significant global health challenge. Postoperative immobility, endothelial injury, and hypercoagulability—collectively known as Virchow’s triad—remain the cornerstone mechanisms driving thrombus formation. Surgical stress, tissue trauma, and prolonged bed rest further exacerbate venous stasis and clot propagation. Clinically, DVT often presents with unilateral leg swelling and pain, while PE manifests with dyspnea, chest pain, or hemodynamic instability, although many cases remain asymptomatic until complications arise. Early diagnosis through clinical scoring systems, D-dimer assays, ultrasonography, and computed tomography pulmonary angiography is crucial to prevent fatal outcomes. Preventive strategies, including pharmacologic prophylaxis with heparins or direct oral anticoagulants, mechanical compression, and early mobilization, have proven highly effective. However, variations in clinical practice, underdiagnosis, and inadequate adherence to prophylactic protocols persist, particularly in resource-limited settings. Future research should emphasize risk-based individualized prevention, development of national guidelines, and incorporation of artificial intelligence for improved prediction and early detection. A multidisciplinary approach integrating clinicians, nurses, and physiotherapists is essential to minimize postoperative VTE burden and improve patient outcomes.
Venous thromboembolism, Deep vein thrombosis, Pulmonary embolism, Postoperative immobility, Prophylaxis.
Dr Prithvansh Malhotra, Dr RK Shinde, Dr Pooja Batra, Dr Muskaan Singhal, Dr Jaideep Reddy R
Role of Barbed Sutures in Gynaecological Laparoscopic Surgery - Evidence and Implementation
Barbed sutures have emerged as a significant advancement in gynecological laparoscopic surgery, offering a knotless and efficient alternative to conventional suturing techniques. Their unique self-anchoring mechanism ensures continuous tension distribution, eliminates the need for intracorporeal knots, and simplifies suturing in confined pelvic spaces. Over the past decade, numerous clinical and comparative studies have demonstrated that barbed sutures reduce operative and suturing times, minimize blood loss, and improve surgical ergonomics without increasing complication rates. Their use has been widely adopted in procedures such as total laparoscopic hysterectomy, laparoscopic myomectomy, and pelvic organ prolapse repair, where consistent tissue approximation and hemostasis are critical. The safety profile of barbed sutures is well established, with reported complications such as bowel obstruction or suture extrusion being rare and largely preventable through proper surgical technique. Additionally, barbed sutures contribute to improved cost-effectiveness by reducing operative duration, anesthesia time, and hospital resource utilization. In India, adoption is steadily increasing, driven by favorable outcomes and growing surgeon familiarity, though barriers such as cost and limited training remain. Despite strong evidence supporting their clinical utility, research gaps persist regarding long-term fertility outcomes, uterine scar integrity, and region-specific cost analyses. Future studies should focus on multicentric, randomized trials and standardized training protocols to optimize safety and implementation. Overall, barbed sutures represent a practical, safe, and efficient innovation that aligns with the goals of modern minimally invasive gynecologic surgery.
Barbed sutures, Gynecological laparoscopy, Hysterectomy, Myomectomy, Surgical efficiency.
Dr Muskaan Singhal, Dr Poonam Bhojwani, Dr Karuna Puri
Unexplained Iron‑Deficiency Anemia Attributable To Hookworm Infection: A Decade of Case Reports In Asia
Iron-deficiency anemia (IDA) remains a major public health concern, with hookworm infection a significant yet often overlooked contributor, particularly in Asia. Hookworms (Ancylostoma duodenale, Necator americanus, and Ancylostoma ceylanicum) cause chronic intestinal blood loss, leading to progressive microcytic anemia, fatigue, and pallor. Susceptible populations include children, the elderly, and individuals with comorbidities or nutritional deficiencies. Diagnosis is challenging due to nonspecific symptoms and low sensitivity of routine stool microscopy, often resulting in misdiagnosis as nutritional anemia or other chronic conditions. Case reports highlight the utility of endoscopy and molecular assays in detecting low-burden or occult infections. Treatment with anthelmintics, iron supplementation, transfusion, and nutritional support results in favorable hematological recovery. This scoping review maps published case reports in Asia (2015–2025), summarizing patient characteristics, diagnostic approaches, species identified, and treatment outcomes. Findings emphasize the need for heightened clinical awareness, comprehensive diagnostic strategies, and preventive measures to reduce the burden of hookworm-associated anemia.
Hookworm, Iron-Deficiency Anemia, Ancylostoma, Necator, Asia.
Mark Ericson B. Baladad, Josephine C. Milan
Crystal Engineering of Pharmaceutical Cocrystals: Emerging Strategies for Drug Solubility, Stability and Bioavailability Enhancement
Pharmaceutical cocrystals have emerged as a promising crystal engineering strategy for improving the physicochemical and biopharmaceutical limitations of active pharmaceutical ingredients (APIs). In recent years, cocrystallization has gained significant attention in pharmaceutical research due to its ability to enhance solubility, dissolution rate, stability, permeability, bioavailability, and mechanical properties without altering the pharmacological activity of the drug molecule. This review comprehensively discusses the fundamental principles, classification, and preparation techniques of pharmaceutical cocrystals, including solvent evaporation, grinding, slurry conversion, hot melt extrusion, and supercritical fluid methods. The article further highlights the role of intermolecular interactions such as hydrogen bonding, π–π stacking, and van der Waals forces in cocrystal formation and stabilization. Various characterization techniques including Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), and nuclear magnetic resonance (NMR) are also summarized. Special emphasis is placed on the recent advancements of pharmaceutical cocrystals in improving therapeutic performance in oncology, antimicrobial therapy, and poorly water-soluble drugs. Additionally, regulatory perspectives, patent opportunities, industrial challenges, and future prospects associated with cocrystal-based formulations are critically analyzed. Overall, pharmaceutical cocrystals represent a versatile and innovative platform for modern drug development and offer substantial potential for enhancing drug efficacy, patient compliance, and formulation performance in advanced pharmaceutical applications.
Isoflavone, Cocrystal, Daidzein, Solvent Evaporation, Solubility Enhancement.
Preet Kaur, Dr. Manju Pandey, Dr. Brijesh Singh
Early Postoperative Outcomes of De Vega Versus Ring Tricuspid Annuloplasty in Patients Undergoing Mitral Valve Replacement
Background: Patients having mitral valve replacement (MVR) frequently have functional tricuspid regurgitation (TR), which is linked to poor postoperative results if treatment is not received. The relative effectiveness and safety of two popular surgical methods for tricuspid annuloplasty, De Vega semicircular suture annuloplasty and prosthetic ring annuloplasty, are still being compared. Objectives: This study aimed to compare the early clinical and echocardiographic outcomes of De Vega suture annuloplasty versus prosthetic ring annuloplasty in patients with moderate-to-severe functional TR undergoing concomitant MVR. Methods: A prospective comparative cohort study was conducted at Shebein Elkom Teaching Hospital and the National Heart Institute. Sixty adult patients with moderate-to-severe functional TR scheduled for MVR were enrolled and equally divided into two groups: Group A (De Vega group, n = 30) underwent De Vega semicircular suture annuloplasty, and Group B (Ring group, n = 30) underwent prosthetic rigid or semi-rigid ring annuloplasty. Results: Intraoperative characteristics — including CPB time (p = 0.742), aortic cross-clamp time (71.8 ± 10.4 vs. 68.3 ± 9.7 min; p = 0.186), and total procedure time (p = 0.553) — were comparable between groups. Both groups demonstrated significant improvements in EF (p = 0.003) and significant reductions in PAP postoperatively, with no statistically significant difference between groups (p = 0.248 and p = 0.368, respectively). Postoperative TR severity distribution was similar between groups (mild TR: 56.7% vs. 60.0%; p = 0.807). ICU stay was comparable (4.8 ± 1.7 vs. 4.1 ± 1.2 days; p = 0.085). No statistically significant differences were observed in postoperative complications, including prolonged intubation, tracheostomy, IABP use, ECMO requirement, or need for dialysis. Thirty-day mortality was 6.7% in the De Vega group and 10.0% in the ring group (p = 1.0). Conclusion: Both De Vega suture annuloplasty and prosthetic ring annuloplasty yielded comparable early postoperative outcomes in patients with functional TR undergoing MVR, including equivalent improvements in EF and PAP, similar TR severity grades, and comparable complication and mortality rates. While ring annuloplasty demonstrated a numerical trend toward greater hemodynamic improvement, the differences did not reach statistical significance in this early follow-up period. Long-term studies are warranted to determine whether differences in TR recurrence and durability emerge between the two techniques over time.
Tricuspid regurgitation; De Vega annuloplasty; ring annuloplasty; mitral valve replacement; functional tricuspid regurgitation; tricuspid valve repair; pulmonary artery pressure; ejection fraction..
Mohamed Abdallah, Islam Ebeid, Mazin Essam Eldin Ali, Eslam Elshafey, Sarah Mubarak Ibrahim
Leadership Styles and Their Influence on Healthcare Staff Performance and Patient Outcomes: A Comprehensive Analysis
The role of proper leadership in the healthcare environment has become a highly important factor of clinical performance, organizational success, and employee health. The paper is a comprehensive review of how different leadership styles, namely transformational, transactional, servant, autocratic, and laissez-faire, relate to the direct impact on healthcare workers performance, morale, and patient outcomes. Based on recent empirical research and systematic reviews and meta-analyses published in 2020-2026, the current paper will synthesize both quantitative and qualitative data to assess the efficacy of leadership. The results show that transformational and servant leadership styles are most likely to be linked to increased job satisfaction, decreased burnout, and high-quality patient safety cultures. On the other hand, autocratic and laissez-faire are associated with high medical errors, employee turnover and psychological distress. Transactional leadership is contextually useful, especially in highly risky, protocol-based units such as intensive care units. The article concludes that healthcare organizations should move beyond traditional, clinical based, and expertise based promotions to developed leadership development initiatives to promote adaptive, transformational, and servant leadership abilities to help them navigate the maze of modern healthcare delivery.
Leadership Styles, Healthcare Management, Transformational Leadership, Servant Leadership, Patient Outcomes, Staff Burnout, Job Satisfaction.
Amani Mohammed M Bujud, Ghadah Abdulhadi Ahmed, Maram Yousef Shalabi
Bayan Saleh Binmahfouz, Abrar Khalid Hambishi
Diagnostic Approaches for Detecting Metallo-β-Lactamase–Producing Gram-Negative Bacteria: A Review of MALDI-TOF Mass Spectrometry, Culture Methods, and Emerging Machine Learning Applications
Metallo-β-lactamase (MBL)–producing Gram-negative bacteria represent a major challenge to global healthcare due to their ability to confer resistance to carbapenems, often leaving limited therapeutic options. Early and accurate detection of these organisms is essential for appropriate antimicrobial therapy, infection control, and antimicrobial stewardship. Conventional culture-based and phenotypic methods remain widely used but are limited by prolonged turnaround times, subjective interpretation, and variable diagnostic performance. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) has emerged as a rapid tool for bacterial identification and has recently been adapted for functional detection of antimicrobial resistance through modified carbapenem hydrolysis assays. In parallel, machine learning approaches applied to MALDI-TOF spectral data have shown promising results in automating and enhancing resistance detection. This review critically summarizes current diagnostic approaches for MBL detection, compares their diagnostic performance, and discusses the evolving role of machine learning–assisted MALDI-TOF MS in routine clinical microbiology. Key challenges, standardization issues, and future research directions are also highlighted to support clinical translation.
Metallo-β-lactamase; MALDI-TOF MS; Gram-negative bacteria; Carbapenem resistance; Machine learning; Diagnostic accuracy.
A Comprehensive Systematic Review of Effect of Extracorporeal Shockwave Therapy on the Pain, Functional Capacity and Quality of Life in Patients with Chronic Low Back Pain
Introduction: Chronic low back pain (CLBP) is a prevalent and debilitating condition with significant socioeconomic impact, often refractory to conventional treatments. Extracorporeal shockwave therapy (ESWT) has emerged as a promising non-invasive modality, but its overall efficacy, optimal protocols, and comparative effectiveness for CLBP require comprehensive synthesis (Çelik, Altan & Ökmen, 2019; Yue et al., 2021). Methods: A systematic review of 67 studies, including randomized controlled trials (RCTs) was conducted. Studies involving adult patients with CLBP (≥12 weeks) receiving ESWT as a primary intervention were included. Data on pain (VAS, NRS), functional capacity (ODI, Roland-Morris), quality of life (SF-36, HADS), safety, and protocol parameters (type, energy, pulses) were extracted and synthesized (Liu et al., 2023; Wu et al., 2023). Results: ESWT demonstrated statistically and clinically significant reductions in pain intensity (e.g., VAS MD = -1.14 to -2.37) and improvements in functional disability (e.g., ODI MD = -6.01 to -14.10), with benefits sustained up to 12 months in some studies (Nedelka et al., 2025; Rajfur et al., 2022). Quality of life, particularly physical domains and depression scores, also improved (Çelik, Altan & Ökmen, 2019; Han et al., 2015). ESWT showed a favorable safety profile with mostly minor, transient adverse events. Comparative effectiveness varied: ESWT was superior to conventional physical therapy and sham, comparable to laser therapy, but sometimes less effective than manual therapies like Maitland mobilization or mechanical traction in specific contexts (Ejaz et al., 2024; Kızıltaş et al., 2022). Discussion: The therapeutic effects of ESWT are mediated by biological mechanisms including neovascularization, tissue regeneration, and pain gate modulation. Outcome heterogeneity is explained by variations in ESWT protocols (focused vs. radial, energy density), patient selection (specific vs. non-specific CLBP), and the presence of co-interventions like exercise. Focused ESWT with moderate energy (0.15-0.35 mJ/mm²) targeting identifiable pain generators (e.g., myofascial trigger points, facet joints) within a multimodal rehabilitation framework appears most effective (Sun et al., 2022; Ferdinandov, 2024). Conclusion: ESWT is an effective, safe, and non-invasive therapeutic option for CLBP, providing meaningful relief in pain, function, and quality of life. It is best applied as part of a multimodal strategy for patients with identifiable musculoskeletal pain generators who have not responded to first-line treatments. Future research should standardize protocols and focus on long-term outcomes and cost-effectiveness.
Extracorporeal Shockwave Therapy, Chronic Low Back Pain, Pain Management, Functional Capacity, Rehabilitation, Non-invasive Treatment.
Tivalen Dwirara Anggraini, Rene Rizaldi Pradnasurya
Explainable Machine Learning Framework for Early Heart Disease Detection Using SMOTE and SHAP
Cardiovascular diseases (CVDs) remain the leading cause of death globally, creating a persistent need for early screening tools that are both accurate and clinically interpretable.1 This study presents an end-to-end, explainable machine learning framework for binary heart disease prediction using a structured clinical dataset derived from the UCI Heart Disease benchmark, where published experiments commonly use a 14-variable subset and focus on distinguishing presence versus absence of disease.2 To strengthen reliability and reduce bias, the pipeline integrates stratified train–test splitting, feature scaling for scale-sensitive learners, and Synthetic Minority Over-sampling Technique (SMOTE) to address potential class imbalance in the training split.3 Multiple models are compared, including Logistic Regression, Naïve Bayes, KNN, SVM, Decision Tree, Random Forest, Gradient Boosting, AdaBoost, Extra Trees, XGBoost, and MLP. Performance is evaluated using accuracy, precision, recall, F1-score, and ROC-AUC, with 5-fold cross-validation to estimate generalization stability. On the held-out test set, Extra Trees achieved the highest ROC-AUC (90.80%), while SVM obtained the highest accuracy (83.61%). Cross-validation ranked Random Forest (mean ROC-AUC ≈ 90.06%) and AdaBoost (≈ 89.95%) as top performers, and GridSearchCV further optimized Extra Trees to a best cross-validated ROC-AUC of 0.912. Finally, explainability is provided through SHAP, which attributes predictions to clinically meaningful features, supporting transparent decision support rather than black-box output.4
Heart Disease Prediction, Machine Learning, Explainable AI, SHAP, SMOTE, Classification Models, Healthcare Analytics, Cross-Validation, Hyperparameter Tuning, Clinical Decision Support.
Mahfuz Islam Khan Jabed, Muhammad Imran, Abdul Ali Khan, Mohiuddin Mehedi, Ashraful Islam, Rahat Pervez
Peri-Coronary Epicardial Adipose Tissue and Coronary Artery Calcification as Markers of Atherosclerotic Burden in Postmenopausal Women
Background: Peri-coronary epicardial adipose tissue (EAT) may play a role in coronary atherosclerosis via localized inflammatory and paracrine mechanisms. This study sought to evaluate the correlation between peri-coronary epicardial adipose tissue, coronary artery calcification, coronary atherosclerotic lesions, and cardiovascular risk factors in post-menopausal women. Method: This study involved 200 post-menopausal women with suspected coronary artery disease. All participants underwent clinical evaluation, laboratory tests, coronary artery calcium (CAC) scoring, and multislice computed tomography coronary angiography. The thickness of peri-coronary EAT was assessed surrounding the left main, LAD, LCX, and RCA. Based on MSCT results, patients were put into two groups: a coronary lesion group and a control group. Result: There were coronary lesions in 140 women. Cases with coronary lesions had CAC scores that were much higher than those of the controls (219.64±345.55 vs. 111.5±301.33; p=0.028). There was a big difference between the patient group and the control group in peri-coronary EAT around LAD, LCX, and RCA. However, there was no big difference in LM EAT. EAT around LAD, LCX, and RCA was strongly linked to significant CAC, dyslipidemia, and a positive family history, but not to age, obesity, smoking, high blood pressure, or diabetes. Conclusion: In post-menopausal women, peri-coronary EAT had a positive correlation with CAC and coronary atherosclerotic lesions. It was also linked to certain cardiovascular risk factors, especially dyslipidemia and family history. This suggests that peri-coronary EAT could be a useful imaging marker for the burden of coronary atherosclerosis.
Epicardial adipose tissue; coronary artery calcification; multislice computed tomography; coronary artery disease; post-menopausal women.
Mohamed R Badran, Islam Ebeid, Rehab Mahmoud Al-Ashry
Delay in Diagnosis and Treatment of Breast Cancer among the Patients Attending a Public and Private Hospital
Background: Breast cancer is the most common malignancy and the leading cause of cancer-related mortality among women worldwide. Delay in diagnosis and treatment is associated with advanced stage at presentation and poor prognosis. Methods: A cross-sectional study was conducted among 236 women with diagnosed breast cancer attending a public hospital (National Institute of Cancer Research and Hospital, NICRH) and a private hospital (Ahsania Mission Cancer Hospital). Participants were selected using purposive sampling. Data were collected through face‑to‑face interviews using a pretested semi‑structured questionnaire. Delays were categorized as patient delay, diagnosis delay, treatment delay, system delay, and total delay. Associations were assessed using Pearson's chi‑square test. Results: Mean age of participants was 45.42±8.52 years; 41.5% had primary education, 89.8% were housewives, and 22.5% had a monthly family income of 6000–10,000 BDT. Most (66.5%) resided in urban areas. More than half of the respondents experienced patient delay (mean 4.5 months). Mean treatment delay was 2.10±2.30 months (nearly half of respondents), diagnosis delay 1.6±1.96 months (nearly half), system delay 3.80±4.00 months (nearly two‑thirds), and total delay 7.58±6.65 months (nearly two‑thirds). When comparing public vs. private hospital, statistically significant differences were observed for treatment delay (p=0.004), diagnosis delay (p=0.004), and system delay (p<0.001); all delays were longer in the public hospital. Multiple factors contributed to delays, and total delay showed a highly significant association with the responsible factors. Conclusion: Delays in breast cancer diagnosis and treatment are substantial, particularly in public hospital settings. Public health education, reliable referral pathways, health system strengthening, and screening programs are needed to reduce the burden of delayed presentation.
Breast Cancer, Diagnostic Delay, Treatment Delay, Public Hospital, Private Hospital, Bangladesh.
Afsana Zerin Shakila, Most Sultana Afroz, Md. Ahashan Habib, Nadiya Pasha, Nusrat Ahmed, Nayma Sharoary Jahan, Sayda Tanjina Pervin, Anaya Nur Mou
Impact of Postoperative Cognitive Dysfunction after Cardiac Surgery on Midterm Outcomes and Mortality
Background: Postoperative cognitive dysfunction (POCD) that is a common neurological side effect after cardiac surgery, is becoming more widely acknowledged as a possible marker of adverse outcomes. But its effect on mortality and midterm results is still unclear, especially in developing countries. Aim of the Study: To investigate the impact of POCD on midterm clinical outcomes and mortality following cardiac surgery. Patients and Methods: This prospective observational cohort study was conducted on 200 adult patients undergoing cardiac surgery at the National Heart Institute, Cairo, Egypt, and Shebein Elkom Teaching Hospital, Menoufia. Patients were categorized into POCD and non-POCD groups based on postoperative cognitive assessment using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Results: Postoperatively, MMSE scores were significantly lower in the POCD group compared to the non-POCD group. Patients with POCD had significantly prolonged ICU stays and total hospital stays. The incidence of postoperative complications was significantly higher in the POCD group. Functional dependence, as assessed by Activities of Daily Living (ADL), was also significantly more prevalent among POCD patients. Regarding mortality outcomes, although mortality at 1 week and 1 month were higher in the POCD group, it did not reach statistically significant difference. While at 1 year the POCD group showed a significantly higher mortality rate (9.0% vs 1.0%, p = 0.019). Conclusion: POCD is associated with adverse postoperative outcomes following cardiac surgery, including increased complications, prolonged hospitalization, greater functional dependence, and higher midterm mortality. Early identification and targeted management of POCD may improve patient outcomes and reduce postoperative morbidity and mortality.
Cognitive dysfunction; POCD; cardiac surgery; mortality.
Mohamed Abdallah, Sarah Mubarak Ibrahim, Shymaa Mamdouh Mohamed Abdu, Eslam Elshafey, Mazin Essam Eldin Ali
Secure Multi-Party Computation for Medical Data Protection
The growing digitization of healthcare systems has greatly enhanced the accessibility and efficiency of medical data and diagnosis. Nevertheless, it has also posed significant issues concerning the privacy of data, its security, and compliance with regulations. When stored or processed in centralized systems, sensitive patient data, such as clinical history and diagnostic history, is extremely susceptible to breaches. Historical healthcare machine learning models typically involve combining data from several institutions, which is a serious privacy concern. Secure Multi-Party Computation (SMPC) has become one of the promising cryptographic paradigms that help to cooperatively compute functions on the data of multiple parties without disclosing the sensitive information. This paper introduces a privacy-preserving machine learning model with SMPC to predict heart diseases. The suggested system enables the distributed healthcare institutions to collaboratively train predictive models without providing raw patient information. To test the framework, a heart disease dataset with more than 1000 records of patients was used. Random Forest and Gradient Boosting machine learning models were tested in a simulated SMPC setting. The findings show that the suggested solution has high predictive accuracy and guarantees high levels of data confidentiality. Gradient Boosting attained 88% accuracy, which is better than random forest. The results indicate that SMPC combined with machine learning is able to resolve privacy issues in healthcare analytics without drastically deteriorating the performance of the model. This study serves as part of the expanding body of privacy-sensitive AI and emphasizes the promise of SMPC in privacy-sensitive medical data sharing and collaborative medical research.
Secure Multi-Party Computation, Healthcare Data Privacy, Machine Learning, Heart Disease Prediction, Cryptography, Privacy-Preserving Systems
K M Nazmul Hasan, Md Mahbubur Rahman Akash, Md Mashfiqur Rahman, Shimanto Haque, Imamul Haque Suhag, Md Ismail Jobi Ullah, Dr Sifat Sanjida Basher
Machine-Learning–Based Prediction of Drug Resistance Genes in Human Cancer Cell Lines
Background: The problem of drug resistance has continued to be a formidable issue in the treatment of cancer, and in most instances, the patient turns out to fail in therapy and subsequently dies. The latest achievements in machine learning (ML) and high-throughput data in the biological realm have created new opportunities in predicting the drug resistance genes in human cancer cell lines. The combination of computational needs and cancer genomics and multi-omics data will have the potential to improve prediction accuracy and facilitate personalized cancer treatment. Objective: The overall aim of the conducted research was to investigate the effectiveness of machine learning-based methods in predicting drug resistance genes in human cancer cell lines and study how machine learning familiarity, cancer genomics background, and multi-omics combination impact the predictive results. Methodology: The research design employed was quantitative, which relied on the use of questionnaire-based data in finding the answer to the research question that involved 210 participants with background data in bioinformatics, computer science, biotechnology, and molecular biology. The statistical tests included a normality test, a reliability and validity test, an Independent Samples t -test, a One-Way ANOVA, a Kruskal-Wallis test, a Chi-Square Test of Independence, a Pearson correlation, and a multiple linear regression test. The data analysis was done to identify relationships, group variations, and predictive effects among major study variables. Results: The findings were that the data were distributed normally, reliable, and valid. The statistical tests were used to provide an inference that found significant variations in machine learning familiarity between genders, the level of education, and the field of study. The use of human cancer cell line datasets was also significantly related to machine learning familiarity. The results of Pearson correlation showed moderate to strong positive correlations between machine learning familiarity, cancer genomics knowledge, multi-omics integration, and the impact of personalized therapy. The use of regression analysis revealed that all of the independent variables significantly and positively impacted the prediction of drug resistance, with the largest impact being observed in multi-omics integration. Conclusion: The results of the research paper prove that machine learning-based strategies, to which specialized skills in cancer genomics are added, and multi-omics information sets are integrated, contribute to predicting drug resistance genes in human cancer cells a great deal. Such findings emphasize the relevance of cross-functional learning and elevated computational analysis to promote accuracy in oncology and individualized treatment of cancer.
Machine Learning, Drug Resistance Genes, Cancer Cell Lines, Cancer Genomics, Multi-omics Integration, Personalized Cancer Therapy, Bioinformatics.
Elton Bicalho do Carmo, Lincoln Junior Bicalho, Saima Akter Shikha, Tania Yeasmin, Daniel Benniah John, Mehedi Hasan Pritom, Momtaz Akter Mitu, Nure Alam Howlader, Md Refat Hossain, Md. Maniruzzaman
Free LIMA Graft with Proximal Aortic Anastomosis for Intraoperative Proximal LIMA Injury: Short- and Mid-Term Outcomes of a Conduit-Preserving Salvage Strategy
Background: The left internal mammary artery (LIMA) is the gold-standard conduit for left anterior descending (LAD) coronary revascularization. Proximal LIMA injury during harvest is a rare but technically challenging complication that may result in loss of the optimal arterial conduit. We evaluated the feasibility, safety, and short- to mid-term outcomes of a conduit-preserving salvage strategy using free LIMA grafting with proximal anastomosis to the ascending aorta. Methods: A retrospective analysis of a prospectively maintained multicenter registry was conducted across four high-volume cardiac centers between January 2018 and December 2021. Patients undergoing coronary artery bypass grafting (CABG) complicated by intraoperative proximal LIMA injury (≥50% transection, critical stenosis, or pedicle avulsion) were included. Salvage was performed by converting the LIMA into a free graft, with proximal anastomosis to the ascending aorta and distal anastomosis to the LAD. Intraoperative graft flow was assessed using transit-time flowmetry (TTFM). Primary endpoints were 30-day major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, myocardial infarction, stroke, or repeat revascularization) and graft patency at follow-up. Graft patency was assessed using MSCT coronary angiography at 12 months or during follow-up when feasible and graded according to the Fitzgibbon classification (A: excellent; B: <50% stenosis; O: occlusion or ≥50% stenosis). Outcomes were compared with a 1:1 propensity-matched cohort (n=52) undergoing standard in-situ LIMA-to-LAD grafting, matched for age, sex, LVEF, diabetes, redo status, and graft number. Kaplan–Meier survival analysis and Cox proportional hazards regression were used for comparative outcomes. Results: Fifty-two patients underwent attempted LIMA salvage. Technical success, defined as satisfactory intraoperative flow by TTFM, was achieved in 50 patients (96.2%). Mean age was 64.2 ± 8.1 years, and 78.8% were male. The 30-day MACCE rate was 9.6% (5/52), including mortality in 3.8% (n=2), non-fatal myocardial infarction in 3.8% (n=2), and stroke in 1.9% (n=1); no repeat revascularization occurred within 30 days. MSCT coronary angiography follow-up was available in 48 of 50 successfully treated patients (96.0%) at a mean follow-up of 26.4 ± 4.2 months (range 18–38); the remaining two patients were excluded due to pre-existing renal dysfunction precluding contrast administration. Overall graft patency (Fitzgibbon grade A or B) was 93.4% (45/48), with perfect patency (grade A) in 89.6% (43/48). Compared with the propensity-matched in-situ LIMA cohort, all-cause mortality did not differ significantly (adjusted hazard ratio 1.07, 95% CI 0.89–1.29; p = 0.51). The study was not powered to demonstrate equivalence between groups. Conclusions: Conversion of an injured LIMA to a free graft with proximal anastomosis to the ascending aorta is a feasible and effective conduit-preserving salvage strategy. It provides favorable short- to mid-term patency and acceptable clinical outcomes compared with standard in-situ LIMA grafting. This technique may be considered in selected intraoperative injury scenarios when anatomically feasible to preserve arterial revascularization options.
Coronary artery bypass grafting; left internal mammary artery; conduit injury; free LIMA graft; MSCT coronary angiography; surgical salvage technique.
Mahmoud Zayed, Mohammed Farahat Helmey, Tarek Mohamed Afifi, Badr Fayed