Acta Informatica Medica最新文献

Background: Hip fractures among the elderly stem from low-energy trauma and frequently coincide with osteoporosis or low bone mass, along with other related medical conditions that heighten, the risk of falls with the majority of hip fractures manifest in women aged over 65 years, with an estimated global annual incidence of approximately 1.7 million. The incidence is expected to rise in tandem with increasing life expectancy and the expanding population of elderly individuals and those grappling with chronic health conditions.

Objective: The aim of this study was to assess the impact of surgical timing on mortality and functional outcomes in elderly hip fracture patients and identify systemic factors contributing to delays.

Methods: This retrospective cohort study analyzed 236 patients aged ≥50 years with surgically treated hip fractures at King Abdullah University Hospital, Jordan (2019-2022). Patients were stratified into early (≤3 days post-admission) and delayed (>3 days) surgery groups. Data on demographics, comorbidities, surgical variables, and outcomes were extracted from electronic health records. Statistical analyses included Wilcoxon rank sum, Chi-squared tests, and logistic regression to evaluate associations between surgical delay and mortality.

Results: Delayed patients (31.8%) exhibited significantly higher 1-year mortality (31% vs. 12%, p<0.001), longer hospital stays (11.2 vs. 5.9 days, p<0.001), and reduced ambulation at 3 months (36% vs. 16% non-ambulatory, p<0.001). Logistic regression identified surgical delay as an independent mortality predictor: delayed patients with ≥3 comorbidities had 9.02-fold higher odds of death (95% CI: 1.67-167.85, p=0.038), while those with <2 comorbidities had a 13.18-fold increase (95% CI: 2.27-251.18, p=0.017). Systemic barriers included preoperative ICU admissions (12% vs. 1.2%, p<0.001) and lower preoperative hemoglobin levels (11.26 vs. 11.87 g/dL, p=0.012).

Conclusion: Surgical delay beyond three days independently elevates mortality and disability risks in hip fracture patients, irrespective of comorbidities. Timely intervention mitigates comorbidity-related risks, underscoring the need for multidisciplinary pathways and policy reforms to reduce delays.

Background: MitoWizz is an advanced bioinformatics tool designed for the analysis of the human mitochondrial genome, offering precise and efficient data interpretation. It enables comparisons of sequencing results obtained from various instrumental methods with the reference Andersen genome (rCRS), aiding in the identification of alterations. This capability is particularly valuable in forensic and clinical mitochondrial DNA analysis.

Objective: The primary goal of developing MitoWizz is to automate and streamline mitochondrial DNA analysis, providing researchers and forensic experts with a fast, reliable, and comprehensive tool for sequence comparison, variation detection, and data validation.

Methods: MitoWizz compares query sequences in opposed to the reference genome and allows direct comparison of two sequences to identify genetic variations. To ensure accuracy, the results are validated through the Clustal Omega W by aligning sequences with the human mitochondrial DNA reference from GenBank (NC_012920.1).

Results: The software detected genetic variations and generated a visual report, as demonstrated in an analysis where 11 mutations were identified in various genes, with an 88% sequence identity to the reference genome. The accuracy of the detected alterations was further validated using the Omega Clustal W program.

Conslusion: MitoWizz significantly reduces analysis time and enhances result reliability by integrating multiple analytical steps into a single platform. By automating mtDNA comparisons and validation, it provides forensic and research laboratories with a high-throughput, efficient solution for precise mitochondrial genome analysis.

Background: Keratoconus is a progressive condition that weakens the cornea and affects vision. Symptoms typically emerge in the second or third decade of life, though rare cases in young children occur. Early diagnosis is crucial to prevent vision deterioration.

Objective: The aim of this study was to evaluate the effectiveness of the accelerated crosslinking treatment for keratoconus in the pediatric population.

Methods: This prospective study evaluated 20 eyes in 13 patients with keratoconus who underwent accelerated crosslinking procedures at Eye Clinic Svjetlost Sarajevo with a one-year follow-up. Participants aged 12 to 18 had a confirmed keratoconus diagnosis and corneal thickness over 400 microns. Preoperative examinations included visual acuity (LogMAR scale), keratometry measurements, central corneal thickness, and keratoconus grading using the ABCD system on a Pentacam.

Results: Postoperative results showed stability and postoperative improvement of uncorrected and corrected visual acuity (P < 0.001). Postoperative keratometries, specifically Km and Kmax, showed a statistically significant decrease, flattening by approximately 1 diopter (D) and 1.5 diopters (D), respectively. Results of postoperative ABCD score showed stability, without postoperative deviation from the mean value and standard deviation. Central corneal thickness values decreased to 456.48 ± 27.2 μm at the one-year examination, and were statisticaly significant compared to preoperative values (P < 0.001).

Conslusion: Stopping progression with crosslinking is the single most important part of management of the pediatric keratoconus patient, thus early diagnosis is imperative. Crosslinking is a safe procedure and the only treatment for pediatric keratoconus that has been proven to halt the progression of the disease and prevent prolonged reduction in a child's visual acuity.

Background: Tuberous Sclerosis Complex (TSC) is an autosomal dominant genetic disorder and involves multiple organs, intellectual disability and epilepsy. Mutations in TSC1 and TSC2 genes are responsible for the molecular disease mechanism.

Objective: The aim is to determine molecular background of a patient with a suspicion of TSC.

Case presentation: In this case report, we describe a seven year old patient with the clinical manifestation of TSC that includes supratentorial changes, subependymal hamartomas and angifibromas in the facial area. Besides the brain and skin changes, no other TSC characteristics were observed. The patient was referred to molecular genetic testing using Next Generation Sequencing (NGS). Results: Clinical exome sequencing revealed intronic TSC2 c.4849+2T>G variant. The variant was confirmed using Sanger sequencing on the subject. However, the variant was not detected in the parents, which indicated that it arose de-novo. The RegSNP-intron, Mutation Taster and Human Splicing Finder were used as a bioinformatic tools to predict the possible effect on protein. Using bioinformatic tools, it was determined that the variant is possibly damaging to protein.

Conclusion: This data suggest that observed splicing intronic variant could be the cause of TSC in this pediatric patient.

Background: Amniotic fluid embolism (AFE) is a rare and catastrophic obstetric complication that can lead to sudden cardiac arrest, respiratory distress, and disseminated intravascular coagulation. Recognizing and managing this condition promptly is crucial for improving maternal and neonatal outcomes.

Objective: This report includes two case studies describing the timely detection, prompt delivery of medical treatment, and the interdisciplinary approach essential for achieving better outcomes for mothers and children confronting with this catastrophic condition.

Case presentation: Case 1: A 39-year-old pregnant woman at 36 weeks and 5 days of gestation with central placenta previa was admitted due to antepartum hemorrhage. She developed convulsions and cardiac arrest during a cesarean section, requiring cardiopulmonary resuscitation. Laboratory tests revealed severe anemia, thrombocytopenia, coagulopathy, severe acidosis, and myocardial injury. Bedside echocardiography and CT scan identified high-risk pulmonary embolisms. Intensive care included VA-ECMO, CRRT, transcatheter arterial embolization, and mechanical thrombectomy. Histopathology confirmed amniotic fluid components making up the emboli. Case 2: A 31-year-old female was transferred following a cesarean section for central placenta previa complicated by severe hemorrhage, cardiac arrest, and pulmonary embolism. Laboratory results showed severe anemia, thrombocytopenia, significant coagulopathy, myocardial injury, and hepatic injury. Histopathology confirmed amniotic components in the embolism. Management involved extensive blood transfusions, and pulmonary thromboendarterectomy. She was discharged in improved condition.

Conclusion: Early diagnosis and prompt intervention are crucial to optimizing outcomes for patients with amniotic fluid embolism, utilizing a comprehensive multidisciplinary approach.

Background: Chronic hepatitis B virus (HBV) infection is a global health issue with a significant impact on pregnant women, mainly due to the interplay between liver function and hematological changes. The liver plays a key role in erythropoiesis and systemic hemostasis. In HBeAg-positive pregnant women, platelet dynamics may be uniquely influenced by the interaction of HBV, immune modulation in pregnancy, and liver function. This area remains underexplored.

Objective: Our study aimed to analyze the interaction between HbeAg status with others preclinical factors by using the matrix correlation and multidimensional statistics methods.

Methods: We used SEM (Structural Equation Modeling) to demonstrate and quantify the direct reciprocal interaction between platelet count and HBeAg status in HBsAg-positive pregnant women.

Results: We found the quantity of platelet, with the optimal threshold is 201x10^3cells/ml, directly relates with HBeAg status (R =0.24) and negatively correlates with ratio of AST on ALT (R=-0.139). In case of HbeAg positive, the risk ratio having a high quantity of platelet (>201x103cells/ml) and high AST/ALT ratio (>1.42) is 2.16[1.23,3.80] (p<0.05). SEM model shows that platelet count has a direct impact on HBeAg (p<0.05, Coefficient =0.24) and indirectly through the AST/ALT ratio. This impact is greater than the direct impact from HBeAg on platelet count (p < 0.05, coefficient = 0.23).

Conclusion: Research results show a complex relationship between platelet count, AST/ALT ratio and HBeAg in patients with chronic hepatitis B. The direct interaction between platelet count, HBeAg status, and AST/ALT ratio suggests intriguing complex immuno-biochemical responses to chronic hepatitis B virus (HBV) infection.

Background: Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), presents significant morbidity and mortality risks post-bariatric surgery. Despite the recognized need for thromboprophylaxis, optimal strategies, particularly regarding the duration and dosing of chemoprophylaxis, remain under debate.

Objective: This study evaluates the efficacy of standard versus extended chemoprophylaxis with enoxaparin in preventing VTE following laparoscopic sleeve gastrectomy (LSG) at King Abdullah University Hospital in Irbid, Jordan.

Methods: A prospective cohort study included patients undergoing LSG from January to July 2023. Excluding high-risk individuals based on specific criteria, participants were randomized into two groups: standard prophylaxis (Group A) and extended prophylaxis with enoxaparin for 14 days post-discharge (Group B). Both groups were assessed preoperatively and followed up to one month postoperatively for signs of DVT via venous Doppler ultrasound and for any complications related to enoxaparin use.

Results: Of the 116 patients studied, no DVT incidents were reported across both groups. Preoperative and postoperative assessments showed significant weight loss, with no complications associated with enoxaparin. Statistical analysis indicated no significant difference in DVT prevention between groups. The study's findings align with existing literature, underscoring the safety of enoxaparin but questioning its impact on DVT incidence post-LSG.

Conclusion: The study concludes that extended chemoprophylaxis with enoxaparin post-LSG is safe, with no reported adverse effects. However, its efficacy in significantly reducing postoperative DVT incidence remains uncertain. These outcomes suggest the need for further research with larger sample sizes to optimize thromboprophylaxis strategies, considering patient-specific factors and potential risks.

Background: The scientific researchers have the role of interacting through published articles in scientific journals or presentations at scientific and professional conferences where they can affect the practices that can make achievements to society and country. or worldwide.

Objective: The aim of this article was to describe bibliometric indexes and explained its importance for its evaluation and measuring quality assessment of published papers in scientific journals and advantages and disadvantages of current bibliometric portals for creating the list of universities and its academic staff by counts of deposited articles in databases and number of its citations.

Methods: The author searched the most influential online databases and analyzed deposited papers by bibliometric indexes, and used a descriptive method to review important facts about bibliometrics experiences in scientific and academic practice. The author used facts deposited on the main international portals for analyzing number of citations of deposited scientific papers on Scopus and Google Scholar platform-h-Index and i10-Index and number of citations as basic data for created top list of most citated scientists in almost of all countries in the world.

Results and discussion: Bibliometric methods are used for quantitative analysis of written materials. Citation is influenced by: article quality, understanding of the article, language in which the article is written, loyalty to a group of researchers, article type, etc. Some indicators used in evaluating scientific work are Impact factor (IF); Citation of the article; Journal citations; Number and order of authors, etc. The index factor of influence depends on the quality of the journal, the language in which it was printed, the area it covers, and the journal distribution system. The portals and its platforms: Webometrics, "AD Scientific Index" and Stanford Bibliometric List are not fully relevant for measuring quality assessment of universities and its academic staff.

Conclusion: Current academies and academicians can propose criteria how improve indexing scientific papers with the consultation of scientific bodies and experts at universities in one country, selected regions, or worldwide. These criteria should be necessary for quality assessment of the scientific curriculum of scientists and their published papers in scientific journals.

Background: Radiotherapy is one of the primary treatment options in cancer management, together with surgery and chemotherapy. Radiation therapy is technologically complex discipline involving professionals with various specialties, and using high energy radiation in treatment of wide range of different cancer types. Technical complexity, increasing number of patients, large workload, and delivery of radiation therapy treatment with lack of human, technical and financial resources in low and middle income countries creates environment with great potential to develop incidents. Emerging need of modern radiation therapy is to develop preventive approach to risk management i to improve the patient safety.

Objective: The objective of this research is to identify and assess risk associated with radiation therapy practice in Bosnia and Herzegovina.

Methods: An anonymous, voluntary electronic on-line radiation therapy incident reporting system (IRS) was created. IRS consists of four sections containing questions about working environment, incident occurrence, root causes and contributing factors, and incident severity assessment. Data collected using IRS were used to create taxonomy of incidents in radiation therapy. Risk assessment was made using Risk Matrix method. Research was made using the data collected from first 60 incidents reported to IRS.

Results: Based on probability and frequency of incident occurrence and severity of consequences, it was assessed that 41.7% of incidents had low risk level (L), 50% of incidents had moderate risk level (M), and 8.3% of incidents had high risk level (H). Radiation therapy risk profile based on risk assessment results clearly shows that incidents with low frequency, low occurrence probability, but high consequences severity level have highest level of risk.

Conclusion: The results of this research confirm that the electronic on-line radiation therapy IRS allows the identification and classification of the most significant risk factors in radiotherapy and prevention of serious incidents occurrence.