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Scientific Reports Jun 2024Leptospirosis is a global disease that impacts people worldwide, particularly in humid and tropical regions, and is associated with significant socio-economic...
Leptospirosis is a global disease that impacts people worldwide, particularly in humid and tropical regions, and is associated with significant socio-economic deficiencies. Its symptoms are often confused with other syndromes, which can compromise clinical diagnosis and the failure to carry out specific laboratory tests. In this respect, this paper presents a study of three algorithms (Decision Tree, Random Forest and Adaboost) for predicting the outcome (cure or death) of individuals with leptospirosis. Using the records contained in the government National System of Aggressions and Notification (SINAN, in portuguese) from 2007 to 2017, for the state of Pará, Brazil, where the temporal attributes of health care, symptoms (headache, vomiting, jaundice, calf pain) and clinical evolution (renal failure and respiratory changes) were used. In the performance evaluation of the selected models, it was observed that the Random Forest exhibited an accuracy of 90.81% for the training dataset, considering the attributes of experiment 8, and the Decision Tree presented an accuracy of 74.29 for the validation database. So, this result considers the best attributes pointed out by experiment 10: time first symptoms medical attention, time first symptoms ELISA sample collection, medical attention hospital admission time, headache, calf pain, vomiting, jaundice, renal insufficiency, and respiratory alterations. The contribution of this article is the confirmation that artificial intelligence, using the Decision Tree model algorithm, depicting the best choice as the final model to be used in future data for the prediction of human leptospirosis cases, helping in the diagnosis and course of the disease, aiming to avoid the evolution to death.
Topics: Leptospirosis; Humans; Machine Learning; Algorithms; Decision Trees; Brazil; Outcome Assessment, Health Care; Male; Female; Adult
PubMed: 38886357
DOI: 10.1038/s41598-024-62254-1 -
Journal of Investigative Medicine High... 2024Metastasis to the pancreas from malignant tumors is a rare event, representing only 1% to 2% of all pancreatic neoplasms. They occur in 2 different clinicopathological...
Metastasis to the pancreas from malignant tumors is a rare event, representing only 1% to 2% of all pancreatic neoplasms. They occur in 2 different clinicopathological settings: as a manifestation in widespread metastatic disease or as an isolated mass in the pancreas. We report the case of a 41-year-old woman who had a history of invasive lobular breast cancer treated with radical surgery, chemotherapy, and radiotherapy. After 21 years of total remission, she presented for severe lower back pain with jaundice, nausea, and loss of 9 kg in 3 months. Abdominal computed tomography demonstrated a hyper vascularized, irregular solid lesion of 2.6 cm × 2.1 cm in the head of the pancreas with discreet biliary duct dilatation and coelio-mesenteric enlarged lymph nodes measuring 2 cm. The diagnosis of pancreatic metastasis from a lobular breast carcinoma was made by percutaneous biopsy of pancreatic lesion. The multidisciplinary committee decided a palliative treatment. The patient received chemotherapy. The take home message from his case is that we should keep in mind the hypothesis of a solitary metastasis to the pancreas, when the pancreatic lesion develops in a patient who had a clinical history of previous neoplasm especially in those which is known to potentially metastasize to pancreas.
Topics: Humans; Female; Pancreatic Neoplasms; Adult; Breast Neoplasms; Tomography, X-Ray Computed; Neoplasm Recurrence, Local; Diagnosis, Differential; Carcinoma, Lobular; Pancreas
PubMed: 38884538
DOI: 10.1177/23247096241261511 -
Cureus May 2024Endoscopic ultrasound-guided hepaticogastrostomy is performed when transpapillary biliary drainage using endoscopic retrograde cholangiopancreatography is difficult due...
Stent Deployment Without Tract Dilation in Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Novel Partially Covered Metal Stent With a Super-Slim Stent Delivery System: A Case Report.
Endoscopic ultrasound-guided hepaticogastrostomy is performed when transpapillary biliary drainage using endoscopic retrograde cholangiopancreatography is difficult due to surgically altered anatomy, an inaccessible papilla, or difficult biliary cannulation. This procedure consists of puncturing the intrahepatic bile duct from the stomach, inserting a guidewire into the bile duct, dilating the puncture tract, and placing a stent. Recently, a novel partially covered self-expandable metal stent with a super-slim stent delivery system of 5.9 Fr has become available. With this stent, endoscopic ultrasound-guided hepaticogastrostomy can be performed without using a dilator to expand the puncture tract. Herein, we describe a technique for dilator-free stent deployment for endoscopic ultrasound-guided hepaticogastrostomy using this novel stent. We performed an endoscopic ultrasound-guided hepaticogastrostomy with this stent in a 65-year-old patient with obstructive jaundice due to pancreatic head cancer without adverse events and with satisfactory improvement in jaundice. This procedure is expected to reduce bile leakage into the abdominal cavity and shorten the procedure time.
PubMed: 38882994
DOI: 10.7759/cureus.60406 -
Acta Medica Philippina 2024Children with COVID-19 may present with gastrointestinal (GI) symptoms and liver dysfunction.
BACKGROUND
Children with COVID-19 may present with gastrointestinal (GI) symptoms and liver dysfunction.
OBJECTIVE
To determine the type and prevalence of gastrointestinal (GI) and hepatic manifestations of COVID-19 in children and its association with severity of illness.
METHODS
A systematic literature search was done from inception until January 4, 2021 using PubMed, Cochrane Library, Google Scholar and prepublication repositories with no language restrictions. Studies that reported the demographic and clinical features of children with COVID-19 and provided data on their GI and hepatic signs and symptoms were included. Prevalence of GI and hepatic manifestations were pooled using Stata14.
RESULTS
We included 58 studies with total of 4497 participants. Overall, one-third of children with COVID-19 presented with at least one GI symptom (33.8%; 95% confidence interval (CI) 23.0, 45.4; I 97.5%; 42 studies, 3327 participants) with abdominal pain, nausea or vomiting, and diarrhea each occurring in approximately 20%. Children with severe COVID-19 were more likely to present with GI symptoms (odds ratio 2.59; 95% CI 1.35, 4.99; I 24%; 4 studies, 773 participants). The pooled prevalence of elevated transaminases was 11% for both AST (11.3%, 95% CI 4.9, 19.3; I 74.7%; 11 studies, 447 participants) and ALT (11.2%, 95% CI 7.1, 16.0; I 40.8%; 15 studies, 513 participants). Hepatic findings such as jaundice (2-17%), hepatomegaly (2%) or behavioral changes (2%) from hepatic encephalopathy were variably reported by a few studies.The degree of heterogeneity was not improved on exclusion of studies with poor quality, but markedly improved on subgroup analysis according to geographical region and presence of MIS-C. Studies from China showed that children with COVID-19 had significantly lower pooled prevalence for any of the GI symptoms with low degree of heterogeneity, particularly for diarrhea, nausea/vomiting, and abdominal pain, all of which had I of 0%. Those with multisystem inflammatory syndrome in children (MIS-C) had significantly more common GI symptoms and increased transaminases than those without.
CONCLUSION
One-third of children with COVID-19 exhibit at least one GI symptom and more likely present in those with severe disease. Elevated transaminases were present in 10%. Prevalence of GI and hepatic manifestations were higher among children with MIS-C.
PubMed: 38882920
DOI: 10.47895/amp.v58i7.7054 -
Infection and Drug Resistance 2024Syphilis, a prevalent sexually transmitted infection, poses severe risks, especially during pregnancy. This study aimed to elucidate the trends and impacts of syphilis...
BACKGROUND
Syphilis, a prevalent sexually transmitted infection, poses severe risks, especially during pregnancy. This study aimed to elucidate the trends and impacts of syphilis in Guangxi, China, focusing on prevalence, clinical manifestations, and treatment outcomes in pregnant women and newborns. The objectives included understanding the demographic characteristics of affected pregnant women, analysing the clinical manifestations in newborns, and assessing the effectiveness of the treatment protocol.
METHODS
Conducted in adherence to ethical guidelines, a retrospective cohort study from January 2013 to December 2023 included 54,048 pregnant women tested for . Diagnosis involved a comprehensive approach, utilizing tests like the Toluidine Red Unheated Serum Test (TRUST) and the Particle Agglutination (TPPA) assay. Infant diagnosis and clinical manifestations were evaluated through a decade-long follow-up. Treatment protocols, including Benzathine penicillin, were implemented. Statistical analyses were conducted using SAS version 9.4.
RESULTS
Among 54,048 pregnant women, 0.10% were syphilis positive, correlating with a rise in hospitalizations. Newborns exhibited varied clinical manifestations, with neonatal pneumonia and jaundice being prevalent. The treatment protocol, especially with Benzathine penicillin, achieved a remarkable 100% cure success rate. The study noted a significant reduction in mother-to-child transmission. Syphilis in mothers and babies was diagnosed at different clinical stages, including primary, secondary, latent, and tertiary.
CONCLUSION
This study underscores the escalating impact of syphilis on pregnant women and newborns in Guangxi, China. The findings highlight the necessity for robust preventive measures, early diagnosis, and effective treatment strategies. The observed 100% cure success rate with Benzathine penicillin emphasizes the importance of strict treatment protocols in mitigating the adverse effects of congenital syphilis and reducing its transmission.
PubMed: 38882653
DOI: 10.2147/IDR.S467426 -
Radiology Case Reports Aug 2024We report a case of a 44-year-old male patient, who presented to the University Hospital of Salzburg, Austria with abdominal pain, persistent jaundice, and lack of...
We report a case of a 44-year-old male patient, who presented to the University Hospital of Salzburg, Austria with abdominal pain, persistent jaundice, and lack of appetite. Radiological work-up (CT, MRI, PET/CT) indicated a suspicious mass of the uncinate process of the pancreatic head with adjacent infiltration and regional lymphadenopathy. The differential diagnosis was between primary pancreatic cancer and focal autoimmune pancreatitis. Further laparoscopic biopsies from multiple areas, showed only fibrous scarring processes, with no malignancy. Treatment with steroids didn't give any benefits. After multiple follow-up CTs and MRs within 6 months-additional biopsies were done, which eventually demonstrated adenocarcinoma. Evidently the cancer diagnosis was much delayed and the patient started receiving chemotherapy, but radical surgery was not possible. Multiple articles and case reports can be found in the literature, that are reviewing the fact that pancreatic inflammatory processes are mimicking pancreatic tumor, but not many articles or case reports are available in the literature, where neoplastic processes are misinterpreted as inflammatory and incorrectly proven with histological examination. One of the main reasons for improper diagnosis is the desmoplastic reaction around the pancreatic malignancy. Another important aspect is the acceptance of histological diagnosis as conclusive, where no opposing arguments are specified, based on radiological criteria.
PubMed: 38881618
DOI: 10.1016/j.radcr.2024.05.025 -
Pediatrics and Neonatology Jun 2024Neonatal adrenal hemorrhage (NAH) is relatively uncommon in neonates and it is often noted accidently by abdominal ultrasonogram. Few studies discussed risk factors for...
BACKGROUND AND OBJECTIVES
Neonatal adrenal hemorrhage (NAH) is relatively uncommon in neonates and it is often noted accidently by abdominal ultrasonogram. Few studies discussed risk factors for and impacts of NAH. This study aimed to assess incidence, perinatal characteristics and follow-up outcomes in neonates with adrenal hemorrhage.
METHODS
This was a retrospective cohort study in a single institute from April 2008 to August 2018. All neonates who received abdominal ultrasonogram within seven days-of-life were recruited and divided in to 2 groups according to the presence of NAH. The perinatal characteristics and anthropometric measurements, the follow-up course and the clinical impact of NAH were reviewed in detail.
RESULTS
7217 neonates had received abdominal ultrasonogram within seven days-of-life and 29 of them (0.4%) were diagnosed with NAH. Mean gestation age was 38 ± 1.2 weeks and mean birth weight was 3406 ± 403 g. Most infants (96.6%) had unilateral hemorrhage over the right adrenal gland. Compared with the control group, infants with NAH were significantly heavier (3406 vs. 3094 gm, p < 0.001), longer in body length (50.1 vs. 48.8 cm, p < 0.001) and wider in chest girth (33.2 vs. 32.4 cm, p = 0.006). They also tended to be delivered via vaginal delivery with vacuum-extraction rather than cesarean section. The prevalence of nuchal cord, neonatal jaundice and subgaleal hemorrhage was higher in the NAH group. The hemorrhage area of adrenal gland had a positive correlation with the peak bilirubin level (r = 0.422, p < 0.001) and the days to resolution (r = 0.198, p = 0.033). All infants had resolution of AH before 7 months of age.
CONCLUSIONS
NAH occurred more frequently in heavier neonates that were delivered via vaginal delivery with vacuum extraction. The hemorrhage involved mostly over the right adrenal gland. Neonatal jaundice was the major comorbidity. All infants had spontaneous resolution of AH before 7 months of age.
PubMed: 38879430
DOI: 10.1016/j.pedneo.2023.11.013 -
BMC Pregnancy and Childbirth Jun 2024To investigate the prognosis of the remaining fetus in twin pregnancy after experiencing one fetal demise in the first trimester according to the location of the demised...
BACKGROUND
To investigate the prognosis of the remaining fetus in twin pregnancy after experiencing one fetal demise in the first trimester according to the location of the demised fetus.
METHODS
This was a retrospective study of twin pregnancies with one fetal demise after the first trimester (14 weeks of gestation) delivered between September 2004 and September 2022. The study population was divided into two groups based on the location of the demised fetus as determined by the last recorded ultrasonography results: Group 1 included twin pregnancies where the presenting fetus was demised (n = 36) and Group 2 included twin pregnancies where the non-presenting fetus was demised (n = 44). The obstetric and neonatal outcomes were also reviewed.
RESULTS
A total of 80 pregnant women were included. The median gestational age for the diagnosis of fetal demise was 24.1 weeks. The gestational age of the demised fetus was not different between Groups 1 and 2; however, the gestational age of the remaining fetus at delivery was significantly earlier in Group 1 than it was in Group 2 (33.8 vs. 37.3 weeks, P = .004). The rate of preterm birth before 28 weeks was almost five times higher in Group 1 than in Group 2 (22.2% vs. 4.5%, P = .037). Regression analysis demonstrated significant differences between Groups 1 and 2. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, and jaundice were more common in Group 1 than in Group 2; however, the association was not significant after adjusting for gestational age at delivery.
CONCLUSIONS
When the presenting fetus is demised in a twin pregnancy, the remaining fetus tends to be delivered earlier than when the non-presenting fetus is demised.
Topics: Humans; Female; Pregnancy; Pregnancy, Twin; Retrospective Studies; Adult; Fetal Death; Gestational Age; Prognosis; Infant, Newborn; Premature Birth; Pregnancy Outcome; Pregnancy Trimester, First; Ultrasonography, Prenatal; Fetus
PubMed: 38877391
DOI: 10.1186/s12884-024-06621-w -
Virchows Archiv : An International... Jun 2024Herein is reported a series of five patients with myeloid neoplasms presenting hepatic complications in whose liver biopsy revealed obstruction of sinusoids by platelet...
Herein is reported a series of five patients with myeloid neoplasms presenting hepatic complications in whose liver biopsy revealed obstruction of sinusoids by platelet aggregates associated to liver extramedullary haematopoiesis. Indication of liver biopsies was jaundice, unexplained hepatomegaly or portal hypertension. Haematological disorders were classified according to the World Health Organisation. Molecular profile was established in all cases as well as grade of liver extramedullary haematopoiesis and myelofibrosis. The patients were four men and one woman aged from 50 to 82 years. Two patients had myeloproliferative neoplasm (triple negative primary myelofibrosis and JAK2-mutated essential thrombocytopenia), two patients had unclassifiable myelodysplastic/myeloproliferative neoplasm and one patient had chronic myelomonocytic leukaemia type 1. Liver biopsies revealed platelet aggregates occluding sinusoids in association with extramedullary haematopoiesis grade 1 in one patient, grade 2 in two patients and grade 3 in two patients. Two of these patients presented co-existing liver fibrosis due to chronic alcoholic consumption and ischemic heart failure. These five patients died from 2 to 23 months after liver biopsy due to acute myeloblastic leukaemia (three patients), portal hypertension (one patient) or other causes (acute heart failure). Intrahepatic sinusoidal microthromboses through platelet aggregates might cause portal hypertension or liver deficiency in patients with myeloid neoplasms, independently of JAK2 mutational status and grade of extramedullary haematopoiesis.
PubMed: 38877359
DOI: 10.1007/s00428-024-03844-2 -
European Journal of Pediatrics Jun 2024Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in preterm infants. Oxidative stress plays a key role in the pathogenesis of ROP. Due to its...
Retinopathy of prematurity (ROP) is a vasoproliferative retinal disease in preterm infants. Oxidative stress plays a key role in the pathogenesis of ROP. Due to its antioxidant effects, bilirubin has been proposed to be protective against ROP. This study explored the association between hyperbilirubinemia and ROP. We analyzed a 10-year cohort from a neonatal intensive care unit in Milan, Italy, including 1606 infants born under 32 weeks and/or < 1500 g. Data from 1606 infants meeting specific inclusion criteria were reviewed. Eighty infants were excluded due to lack of data, 1526 were deemed eligible for analysis, and 1269 had hyperbilirubinemia requiring phototherapy. There was a higher incidence of ROP among infants with hyperbilirubinemia (13.8%) versus those without (7.8%, p<0.01). Infants with any ROP, non-severe or severe ROP, were exposed to hyperbilirubinemia for a significantly higher number of days compared with those without ROP. Each additional day of exposure increases the risk of developing any ROP by 5%, non-severe ROP by 4%, and severe ROP by 6%. However, this correlation was not observed in infants with gestational age less than 27 weeks and/or body weight less than 1000 g. Conclusion: Our data show that hyperbilirubinemia requiring phototherapy is associated with an increased risk of developing ROP. However, severe hyperbilirubinemia and ROP share many of their risk factors. Therefore, rather than being a risk factor itself, hyperbilirubinemia may be a surrogate for other risk factors for ROP. Clinical Trial Registration: NCT05806684. What is Known: • The development of retinopathy of prematurity (ROP) is influenced by several critical risk factors, including low gestational age, low birth weight, supplemental oxygen use, and increased oxidative stress. • In vitro, unconjugated bilirubin is an effective scavenger of harmful oxygen species and a reducing agent, highlighting its potential protective role against oxidative stress. What is New: • Hyperbilirubinemia requiring phototherapy was associated with an increased risk of developing ROP, but this association was not observed in the most vulnerable population of extremely preterm infants. • Every additional day of phototherapy for hyperbilirubinemia increases the risk of ROP by 5% for any ROP, 4% for non-severe ROP, and 6% for severe ROP.
PubMed: 38877325
DOI: 10.1007/s00431-024-05630-3