Acta Informatica Medica最新文献

Background: Spigelian hernia, also known as spontaneous lateral ventral hernia, is defined as a protrusion of abdominal contents through an abdominal wall defect within the transversus aponeurosis. The entity was first reported in 1742 and named after Adrian van der Spieghel. It is recognized as a rare condition, accounting for 1 to 2% of all abdominal wall hernias. Cirrhotic patients, in particular, are more predisposed to hernias of all types. When Spigelian hernia is accompanied by hepatic cirrhosis, the decision to repair gets into a controversial aspect. Herein, we present the emergency management of an incarcerated spigelian hernia in a cirrhotic patient, highlighting the challenges in managing similar cases.

Case presentation: A 65-year-old lady, presented to our emergency department complaining of a left lower quadrant (LLQ) abdominal pain associated with a painful swelling for 9 hours duration. Upon assessment, the patient was jaundiced and haemodynamically stable. Abdominal examination revealed a soft and lax but distended abdomen, with irreducible tender swelling over the LLQ, measuring around 3x2 cm. Laboratory investigations showed anemia, hypoalbuminemia, hyperbilirubinemia, lactic acidosis and prolonged coagulation profile. A contrast-enhanced computed tomography (CT) scan of the abdomen showed evidence of incarcerated left spigelian hernia. Moreover, advanced cirrhosis of the liver was detected with hypertrophy of the caudate lobe, extensive ascites and splenomegaly. After establishing the diagnosis of incarcerated spigelian hernia, with a picture of advanced liver cirrhosis, Child-Pugh-Turcotte (CPT) score of C and a Model for End-Stage Liver Disease (MELD) score of 19 and Mayo score for post-operative mortality of 16% in 7 days and 53% in 30 days. Given the patient's condition which necessitates urgent operative intervention beside the risk of decompensation of pre-existing liver disease and high mortality. Decision was made to proceed with laparoscopic hernia repair. Intraoperatively, ischemic small bowel segment was resected with creation of end ileostomy. Conventional anatomical repair of the hernia defect was performed. Postoperatively, the patient was managed and resuscitated in critical care unit and then discharged home in a satisfactory condition on post-operative day 15. She passed away prior to liver transplantation, thirty-two days post-operatively in a different institution.

Conclusion: The surgical management of complicated hernias in an emergency setting comprise a notable number of cases encountered by surgeons. It always needs special attention. Moreover, cirrhotic patients with their predicted high morbidity and mortality require even further vigilance. Therefore, a patient-tailored approach is always recommended when managing similar cases to provide optimal outcomes.

Background: Gastric cancer is one of the most common cancers. We can use AI for predictive models and help us in early detection and diagnosis.

Objective: This study examines the use of a neural network model to classify gastric cancer based on clinical, demographic and genetic data.

Methods: The data from the participants were divided into two subsets. 70% training data and 30% testing data. The neural network model has 12 input variables. Factors influencing a disease can be age, sex, family history, smoking, alcohol, Helicobacter pylori infection, food habits, diseases, endoscopic images, biopsy, CT scan, gene variants (TP53, KRAS, CDH1). The hyperbolic tangent activation function has four units in the hidden layer of a model. The output layer used a Softmax activation function and cross-entropy error function which predicted the presence of gastric cancer. The assessment was done on the predictors.

Results: The training and testing datasets showed 100% accuracy predicting gastric cancer in the model outputs. Age, gender, family history, infection with Helicobacter pylori, smoking, and drinking alcohol are the biggest predictors. Information from clinical diagnosis like endoscopic images, biopsy and CT scans helped the predictive model.

Conclusion: The neural network was able to perform well for gastric cancer predictions using multiple clinical and demographic factors, showing great utility. The outcomes for AI-based diagnostic tools look promising in cancer, however generalization needs to be confirmed using external datasets. The study shows how artificial intelligence can better precision medicine and cancer diagnosis.

Background: Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) can occur after herpes simplex encephalitis (HSE) and Japanese encephalitis (JE). We describe the clinical features of children with anti-NMDARE after viral encephalitis.

Objective: This study aims to describe the clinical characteristics, laboratory findings, and treatment outcomes of these patients.

Methods: We describe the clinical characteristics of 14 children of anti-NMDARE following viral encephalitis treated at National Children's Hospital from January 2021 to December 2022. Patients with evidence of viral reactivation or other antibodies were excluded.

Results: There are 12 children with anti-NMDARE after HSE and 2 children after JE. The median age was 2.1 years (range 0.6-12.9), with 8 male patients. All patients (100%) had fever and seizures, while 50% exhibited focal neurological signs. No patients experienced movement disorders, psychiatric symptoms, or sleep disturbances during the viral encephalitis phase. In contrast, the most common symptoms during the anti-NMDARE phase were as follows: movement disorders in 92.9% (13/14), recurrent or prolonged fever in 71.4% (10/14), sleep disturbances in 64.3% (9/14), seizures in 50% (7/14), and psychiatric symptoms in 50% (7/14). The median cerebrospinal fluid (CSF) white blood cell count in the viral encephalitis and anti-NMDARE phases was 57 (4-410) and 13 (2-48), respectively. The mean CSF protein concentration was 0.43 ± 0.16 g/L and 0.85 ± 0.63 g/L, respectively. Brain MRI was performed in both encephalitis phases for 10/14 patients, with 8/10 showing no new lesions.

Conclusion: There were differences in clinical symptoms and CSF findings between the two phases of encephalitis; however, most patients did not develop new lesions on brain MRI.

Background: Carotid atherosclerosis is often mentioned as one of the main causes of stroke. Currently, embolization is considered the most common mechanism that causes ischemic strokes due to atherosclerotic lesions in the carotid artery. Transcranial Doppler (TCD) ultrasound provides relatively inexpensive, noninvasive, real-time measurement of blood flow characteristics and cerebrovascular hemodynamics within brain arteries. The pulsatile index measured by transcranial Doppler is a parameter that indicates the degree of elasticity of the blood vessels of the brain.

Objective: The aim of this study is to determine the relationship between the value of the pulsatile index of the middle cerebral artery and the basilar artery in patients with carotid stenosis using transcranial Doppler and the value of the pulsatile index in relation to the degree of carotid stenosis.

Methods: The study involved a total of 140 patients examined at the Color Doppler and Transcranial Doppler Department of the Neurology Department of the General Hospital "Prim Dr. Abdulah Nakas" Sarajevo The patients were divided into two groups. The research was conducted in the General Hospital "Prim. dr. Abdulah Nakas" in Sarajevo at the Department for Color Doppler and Transcranial Doppler of the Department of Neurology and included patients examined in the period from February 2022 to December 2022. All patients underwent extracranial Doppler of the carotid arteries and transcranial Doppler of the middle cerebral artery and basilar artery.

Results: The mean values of PI in ACM in the total sample were statistically significantly lower in patients with stenosis up to 50% compared to the average in patients with stenosis over 50%. Average values of PI in AB in the total sample were statistically significantly lower in patients with stenosis up to 50% compared to the mean values in patients with stenosis over 50%.

Conclusion: Transcranial Doppler findings showed an increased pulsatile index in patients who had carotid stenosis greater than 50% compared to patients with mild carotid stenosis. The study showed that in clinical work it would be necessary to introduce the pulsatile index as an indispensable neurosonological parameter that would be included in the findings of the transcranial Doppler and thus objectify the potential risk of a cerebrovascular ischemic event.

Background: Perianal manifestations of Crohn's disease (CD) are common, with fistulas being the most prevalent and challenging to manage.

Objective: The aim of this articles was to describe and explain how Perianal fistulizing Crohn's disease significantly impacts patients' quality of life and poses a therapeutic challenge for clinicians.

Methods: The author used published papers deposited in index databases PubMed Central, Scopus, HINARY etc. rergarding Surgical Management of Perianal Crohn's Disease: Current Management requires a multidisciplinary and multimodal approach, integrating both medical and surgical interventions tailored to disease severity and fistula complexity.

Results and discussion: Despite advancements in therapy, the majority of patients require multiple interventions due to high rates of primary non-healing, surgical morbidity, and recurrence..Medical treatment primarily includes biologics, particularly anti-TNF agents such as infliximab and adalimumab, which have demonstrated efficacy in fistula closure and symptom control. Surgical approaches remain critical with various degrees of success.

Conslusion: Despite the availability of multiple therapeutic options, Perianal fistulizing Crohn's disease remains a complex condition with ongoing challenges in achieving sustained remission. Future research should focus on novel treatment strategies and optimizing individualized patient care.

Background: Benign prostatic hyperplasia (BHP) is a common disease in the urinary system and often appears in old male patients with the incidence increasing proportionally to age.

Objective: The study aimed to describe the anatomy and imaging findings of the prostatic artery (PAs) on 3D rendering dual-energy multi-sequence computed tomography (DECT) in patients with symptomatic benign prostatic hypertrophy (BPH) treated by prostatic artery embolisation (PAE).

Methods: The study was conducted on 64 patients with BPH who underwent DECT scans with 3D rendering of the pelvic artery before intervention from August 2022 to November 2023. The PAs were independently evaluated for each side, focusing on the number of branches, origin, tortuosity, atherosclerotic plaque, and anastomoses with adjacent arteries.

Results: Among 128 pelvic sides where the PAs can be observed, the rate of finding 01 prostate artery on each side was high (96.1%), and the rate of 02 prostate arteries on each side was rare (3.9%). In 133 prostatic arteries, the most common type of prostatic artery according to origin is type I (29.6%), followed by type III (24.6%). The atherosclerotic prostatic artery rate is 24.6%, and the average diameter is 1.5±0.4 mm. The tortuosity prostate artery accounted for 74.6%. The anastomosis to the contralateral prostatic artery rate is 48.4%, followed by the penis and rectum anastomoses.

Conclusion: PAs have abundant original varies between the left and right sides and between patient to patient. The most common form arises from the internal pudendal artery.

Background: The COVID-19 was declared no longer a global health emergency. The mental health of healthcare workers has become a critical concern, highly impacted by the COVID-19 pandemic.

Objective: This study aimed to determine the prevalence of mental disorders among healthcare workers in Vietnam and the associated factors in the post-pandemic era.

Methods: A cross-sectional descriptive study was conducted at Hung Vuong Hospital, Vietnam. A self-administered questionnaire was distributed to 660 healthcare workers, and the outcomes were assessed using the DASS-21 scale.

Results: The participants' ages ranged from 22 to 62 years, with 66.2% female. The majority were nurses (48.9%) and doctors (25.8%). A significant proportion worked in clinical sectors (77.9%) and had less than 10 years of work experience (84.4%). Overall, 39.5% of participants had at least one mental disorder, specifically, 31.7% had anxiety, 16.2% had stress, and 18.9% had depression. Significant associated factors included pressure from administrative duties (aOR = 2.15, 95% CI 1.39-3.35), intensive work (aOR = 1.69, 95% CI 1.13-2.55), relationships with colleagues (aOR = 1.59, 95% CI 1.10-2.29), and perceived fairness in work-performance evaluations (aOR = 1.88, 95% CI 1.22-2.91).

Conclusion: The mental disorders among healthcare workers in Vietnam remained relatively high after the pandemic. Interventions should prioritize work-environmental factors including pressure from administrative duties, intensive working, the absence of good relationships with colleagues, and the fairness in work-performance evaluation.

Background: T Congenital diaphragmatic hernia (Bochdalek hernia), which occurs in 1/2,200 live births, is typically diagnosed in the prenatal or immediate postnatal period. Diaphragmatic hernia is rare in older children and adults and can be presented with acute respiratory failure, incarcerated hernia, acute pancreatitis, or rare conditions such as left portal hypertension and hypersplenism.

Objective: The aim of this case report was to present 15-year-old male with vomiting and mild upper abdominal pain who had mild epigastric tenderness with no guard and an IV grade splenomegaly caused by Congenital Diaphragmatic Hernia. Case presentation: We report a case of left portal hypertension and hypersplenism in an adolescent with congenital diaphragmatic hernia. Typical clinical presentations include abdominal pain, respiratory symptoms, or intestinal obstruction in incarcerated diaphragmatic hernia. Additionally, some uncommon symptoms reported in literature include gastrointestinal bleeding as a result of portal hypertension, thrombocytopenia due to hypersplenism, and acute pancreatitis.

Conclusion: The treatment has released the obstruction in the splenic vein and reduce returned collateral gastric blood flow. Splenectomy should be considered based on many factors, such as anatomic anomalies or the degree of hypersplenism and portal hypertension. This is a rare clinical entity with only a few cases that have been reported in the literature.