Acta Informatica Medica最新文献

Background: Amblyopia affects 1-3% of the population, leading to irreversible vision loss in children and adults. Treatment options include refractive correction, occlusion therapy, and atropine penalization. Anisometropic amblyopia, caused by a difference in refractive status between the eyes, can be treated using contact lenses, glasses, ICL implantation, or cataract surgery with intraocular lens implantation. Tecnis Eyhance IOL is a superior solution, improving vision after eye surgery with a low incidence of halo, glare, or starburst.

Objective: The aim is to present the case of a patient with anisometropic amblyopia, in whom Eyhance IOL was implanted in both eyes as a solution to refractive error and initial cataract due to intolerance for contact lenses.

Case report: A 58-year-old female patient presented to our clinic complaining of blurry vision in her left eye that had persisted for a year. The patient reported intolerance to contact lenses and a history of amblyopia in her right eye. CDVA was 0.20 with -9.00/-1.50 x 25◦ in her right and 0.80 with +4.00 sphere correction in her left eye, while her CNVA was J9 with +2.50 and J1 with +2.50. Slit-lamp examination revealed early cataracts in both eyes, with otherwise normal findings. A dilated fundus examination showed vitreous liquefaction and myopic macula in the right eye but normal results in both eyes' posterior segments. The IOP was within normal limits, and the eye's axial length was measured. Considering the patient's intolerance to contact lenses, cataract surgery with intraocular lens implantation was deemed appropriate. Given the anisometropic amblyopia, the Eyhance lens was selected to optimize the patient's visual acuity. Following the procedure, the patient's visual acuity improved significantly, with her best CDVA at 0.35 in the right eye and 0.95 in the left eye. With +1.50 sphere correction, the CNVA was also enhanced, with the patient reading at J4 and J1 for her right and left eye, respectively. These improvements may have positively impacted the patient's quality of life and ability to perform daily activities.

Conclusion: Anisometropic amblyopia in 58-year-old women was treated successfully with cataract surgery and implantation of Eyhance IOL.

Background: Assessment of thyroid nodules histopathology using AI is crucial for an accurate diagnosis. This systematic review analyzes recent works employing deep learning approaches for classifying thyroid nodules based on histopathology images, evaluating their performance, and identifying limitations.

Methods: Eligibility criteria focused on peer-reviewed English papers published in the last 5 years, applying deep learning to categorize thyroid histopathology images. The PubMed database was searched using relevant keyword combinations.

Results: Out of 103 articles, 11 studies met inclusion criteria. They used convolutional neural networks to classify thyroid neoplasm. Most studies aimed for basic tumor subtyping; however, 3 studies targeted the prediction of tumor-associated mutation. Accuracy ranged from 77% to 100%, with most over 90%.

Discussion: The findings from our analysis reveal the effectiveness of deep learning in identifying discriminative morphological patterns from histopathology images, thus enhancing the accuracy of thyroid nodule histopathological classification. Key limitations were small sample sizes, subjective annotation, and limited dataset diversity. Further research with larger diverse datasets, model optimization, and real-world validation is essential to translate these tools into clinical practice.

Background: COVID-19 is a virulent viral infection by SARS-CoV-2 which caused pandemic and high mortality. One of the numerous risk factors for worse clinical outcomes in COVID-19 patients is the presence of comorbidity. Diabetes Mellitus is a chronic metabolic disease frequently in COVID-19 patients. Insulin resistance, causes chronic inflammation in the body, may aggravate the clinical outcome COVID-19 patients.

Objective: The aim of the study was to examine factors that impact clinical outcomes in COVID-19 T2DM patients.

Methods: The method used an analytical method with cross sectional design. Population is inpatients in Haji Adam Malik Hospital diagnosed with COVID-19 and Diabetes Mellitus Type 2 with 99 inpatients as sample. The data used are secondary data obtained through medical records from a hospital covering patients characteristics and laboratory result The data was analyzed using t-independent and chi square test with SPSS program.

Results: Clinical outcomes for 99 patients are 60 patients are cured and 39 patients are dead. analytical study found a significant correlation between factors impacting clinical outcomes on COVID-19 patients with T2DM that are HbA1c level, D-dimer, cholesterol total and COVID-19 degree of severity and the clinical outcomes (p<0,05).

Conclusion: HbA1c level, D-dimer, total cholesterol and the infection degree of severity affects the clinical outcomes on COVID-19 with T2DM (p<0,05).

Background: Anemia is one of the major global problems that continues to this day. According to World Health Organization (WHO) data, anemia is found in 1.62 billion people or equivalent to 24.8% of the world's population while, the prevalence of anemia in children under 6 years of age in Indonesia reached 38.4%. Anemia, if undiagnosed or untreated for a long period of time can lead to multiorgan failure. The cardiovascular system is the most commonly affected system in chronic anemia. Between one-third and two-thirds of patients with severe anemia have cardiomegaly and this will return to normal within a few weeks after the anemia is well managed. This abnormality can be evaluated on chest radiograph or echocardiography.

Objective: This study aims to evaluate the association between anemia and cardiomegaly.

Methods: This was a cross-sectional which was carried out in the pediatric ward and pediatric cardiology outpatient clinic in the year 2022. The research subjects were children diagnosed with anemia, then they would undergo chest radiograph and echocardiography to assess whether there is cardiomegaly or not.

Results: Eighty one children were included in this study. The majority of them were girl, with a total of 43 people (53.1%). The median age of patients in this study was 7.75 years old. In addition, this study also found that the median of patients' body weight and height were 18.3 kg and 116 cm. In this study, the median hemoglobin level was 10.3 g/dL. For the echocardiography parameters in this study, the median of LA/Ao, EF and FS were 1.24, 65% and 35% respectively.Conclusion There is no association beteween anemia and cardiomegaly based on chest radiograph or echocardiography.

Background: The electrocardiograph (ECG) is efficient method for the accurate assessment of fetal heart rate. The barriers for accurate assessment are maternal heart rate, uterine contractions and abdominal muscles. Although previous monitoring methods have struggled to overcome these barriers, recent advances have led to a greater degree of success for listening and recording pulse-by-pulse fetal heart rate.

Objectives: A prospective cohort study evaluating the use, reliability and safety of non-invasive electrocardiography, in conjunction with Fetal Heart Rate parameters such as, Short Term Variability (STV) together with umbilical cord PH and Apgar score, during the active phase of childbirth.

Methods: A total of 41 women with single, normal, full-term pregnancies had systematic obstetric monitoring with Monica AN24. 20 had only monitoring and 21 also had and arterial blood flow measurements. pH was measured and correlated with neonatal Apgar score at 1 and 5 min. The study also included a questionnaire about the safety and usability of obstetric monitoring. Statistical analysis was done using IBM SPSS v. 26.0.

Results: Mean age was 28.8 years, (SD ± 6.153). Electrocardiogram recordings (ECG) were classified as normal (71%) and suspicious (29%). Baseline between ECGs was different (p = 0.025) similarly for Short term variability (STV) (p <0.0001). BMI did not differentiate SVT rates. Only high acceleration (p <0.029) and small slowdowns had a statistically significant difference between normal and suspected cardiographs (p <0.029). APGAR score did not differ, whereas the umbilical cord pH was different in normal ECGs compared to the suspect (p = 0.012) and STV was also differentiated. A usability and safety survey was conducted after recording with MONIKA AN24, and the response to whether they would accept recording with the device again, was positive for 96% of the 30 responders.

Conclusion: The present study shows that the use of electrocardiography in obstetrics allows to draw conclusions about the fetal hematopoiesis and oxygenation status. This method could be clinically applied and be an important tool for further screening in embryos that may be hypoxic and to decide whether to continue with a vaginal or cesarean delivery, thereby achieving the goal of reducing perinatal morbidity and mortality.

Background: Tamoxifen has been successfully administered as adjunctive therapy for breast cancer. However, the effect of tamoxifen as an estrogen agonist and antagonist can cause pathological changes in the uterus. The agonist effect may stimulate endometrial proliferation leading to endometrial polyps, hyperplasia, and, rarely, endometrial cancer.

Objective: We present the case of tamoxifen-treated breast cancer case to better understand one of the most serious consequences, endometrial cancer.

Case presentation: A 37-year-old woman came to our centre with complaints of abnormal vaginal bleeding. She has diagnosed with grade I infiltrative ductal carcinoma in 2018, with primary complaints of right breast mass and axillary lymphadenopathy. During this period, adjuvant chemotherapy was given tamoxifen 20 mg once daily. There were no complaints or relapses at a six-month follow-up over three years. In the fourth year, the patient complained of vaginal bleeding. A vaginal biopsy was performed, and the results showed low-grade endometrioid-type endometrial carcinoma. Total hysterectomy and bilateral salpingo-oophorectomy were performed with the resultant mass of up to half of the myometrial lining with metastatic negative parallax lymph nodes.

Conclusion: Following tamoxifen therapy, endometrial cancer is more likely to occur in patients. Patients who experience irregular vaginal hemorrhage should have hysteroscopy or uterine ultrasound performed, and if the cause is unknown, a biopsy should be performed.

Background: Thyroid eye disease (TED; also known as thyroid - associated orbitopathy, Graves ophthalmopathy) is an autoimmune inflammatory disease which presents in typical signs and symptoms such as deep orbital pain, chemosis with or without caruncular edema, unilateral or bilateral proptosis, eyelid retraction, eyelid edema or erythema, restrictive strabismus and compressive optic neuropathy.

Objective: The aim of this study was to investigate the role of thermal camera in the assessment of thyroid eye disease (TED) activity compared to the Clinical Activity Score (CAS) scale, exophthalmometry values, and thyroid hormone and antibody levels.

Methods: A total of 50 patients participated in this cross-sectional study of whom 29 were in the active phase of TED according to the sum on CAS scale and 21 patients in the inactive phase. The Flir E8® thermal camera was used to measure the temperature of the orbital area and the values were compared with the CAS scale, exophthalmometry values and thyroid hormone and antibody levels.

Results: Higher values of temperature (p>0.0001), CAS score (p>0.0001), exophthalmometry (p=0.022), FT4 (p=0.0176) and TRAb (p=0.0091) were found in patients in the active phase of TED. Temperature of orbital area showed statistically significant positive correlation with CAS scale (p=0.0001), exophthalmometry values (p=0.0022) and anti-TPO levels (p=0.019).

Conclusion: Thermal camera showed higher values of the temperature of the orbital area in patients in the active phase of the disease and positively correlated with the CAS scale, exophthalmometry findings and anti-TPO levels.

Background: Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients.

Objective: The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece.

Methods: Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage.

Results: The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence.

Conclusion: CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.

Background: Cardiovascular complications are the leading cause of death in diabetic patients. Speckle tracking echocardiography can early detect left ventricular systolic dysfunction even when normal ejection fraction.

Objective: The study aims to evaluate left ventricular systolic function by Speckle tracking echocardiography and its relation with cardiovascular risk factors in type 2 diabetic patients.

Methods: A controlled cross-sectional descriptive study was conducted on 150 patients (75 type 2 diabetic patients and 75 controls).

Results: Type 2 diabetic patients had global longitudinal strain (-17.02±3.06%), global circumferential strain (-29.04±6.39%) were lower than the control group (p<0.05). Global longitudinal strain was correlated with systolic blood pressure (r=0.3), diastolic blood pressure (r=0.2), fasting plasma glucose (r=0.5), HbA1c (r=0.2), total cholesterol (r=-0.25), (p<0.05). Global circumferential strain was correlated with systolic blood pressure (r=0.2), diastolic blood pressure (r=0.2), HDL (r=-0.3), (p<0.05).

Conclusion: Type 2 diabetic patients have reduced global longitudinal strain and global circumferential strain. The reduction of global longitudinal strain, global circumferential strain was correlated with cardiovascular risk factors (hypertension, not good glycemia control, increasing BMI, dyslipidemia).

Background: Metabolic syndrome (MetS) denotes a cluster of co-occurring medical conditions associated with regulating hyperglycemia and acute cardiovascular events and complications. The escalating frequency of MetS among individuals afflicted with type 2 diabetes mellitus (T2DM) underscores its burgeoning significance as a critical public health concern and a complex clinical conundrum. Timely identification is imperative to avert the expedited progression of diabetic complications.

Objective: To investigate the role of CRP/HDL-C and Monocyte/HDL ratios in predicting MetS in T2DM individuals.

Methods: The study was designed as a two-year prospective study and included 80 T2DM patients divided into MetS and non-MetS groups based on MetS development over two years. The patients' serums were analyzed for complete blood count parameters, lipid profile, and C-reactive protein (CRP). Based on the laboratory test results, Monocyte/HDL-C and CRP/HDL-C ratios were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy.

Results: Monocyte/HDL-C ratio and CRP/HDL-C ratio were significantly higher in MetS-T2DM2 than in nonMetS-T2DM (p=0.003 and p=0.029, respectively). The results of ROC curve analysis have shown that the CRP/HDL-C ratio (AUC of 0.695) and Monocytes/HDL-C ratio (AUC of 0.645) can serve as good predictors of MetS in T2DM patients.

Conclusion: This study confirms the reliability of the Monocytes/HDL-C and CRP/HDL-C ratios as novel, simple, low-cost, and valuable predictors of MetS development in T2DM.