Multicenter validation of an artificial intelligence (AI)-based platform for the diagnosis of acute appendicitis.

BACKGROUND: The current scores used to help diagnose acute appendicitis have a "gray" zone in which the diagnosis is usually inconclusive. Furthermore, the universal use of CT scanning is limited because of the radiation hazards and/or limited resources. Hence, it is imperative to have an accurate diagnostic tool to avoid unnecessary, negative appendectomies. METHODS: This was an international, multicenter, retrospective cohort study. The diagnostic accuracy of the artificial intelligence platform was assessed by sensitivity, specificity, negative predictive value, the area under the receiver curve, precision curve, F1 score, and Matthews correlation coefficient. Moreover, calibration curve, decision curve analysis, and clinical impact curve analysis were used to assess the clinical utility of the artificial intelligence platform. The accuracy of the artificial intelligence platform was also compared to that of CT scanning. RESULTS: Two data sets were used to assess the artificial intelligence platform: a multicenter real data set (n = 2,579) and a well-qualified synthetic data set (n = 9736). The platform showed a sensitivity of 92.2%, specificity of 97.2%, and negative predictive value of 98.7%. The artificial intelligence had good area under the receiver curve, precision, F1 score, and Matthews correlation coefficient (0.97, 86.7, 0.89, 0.88, respectively). Compared to CT scanning, the artificial intelligence platform had a better area under the receiver curve (0.92 vs 0.76), specificity (90.9 vs 53.3), precision (99.8 vs 98.9), and Matthews correlation coefficient (0.77 vs 0.72), comparable sensitivity (99.2 vs 100), and lower negative predictive value (67.6 vs 99.5). Decision curve analysis and clinical impact curve analysis intuitively revealed that the platform had a substantial net benefit within a realistic probability range from 6% to 96%. CONCLUSION: The current artificial intelligence platform had excellent sensitivity, specificity, and accuracy exceeding 90% and may help clinicians in decision making on patients with suspected acute appendicitis, particularly when access to CT scanning is limited.

Deep Neural Network for the Prediction of KRAS Genotype in Rectal Cancer.

BACKGROUND: KRAS mutation can alter the treatment plan after resection of colorectal cancer. Despite its importance, the KRAS status of several patients remains unchecked because of the high cost and limited resources. This study developed a deep neural network (DNN) to predict the KRAS genotype using hematoxylin and eosin (H&E)-stained histopathological images. STUDY DESIGN: Three DNNs were created (KRAS_Mob, KRAS_Shuff, and KRAS_Ince) using the structural backbone of the MobileNet, ShuffleNet, and Inception networks, respectively. The Cancer Genome Atlas was screened to extract 49,684 image tiles that were used for deep learning and internal validation. An independent cohort of 43,032 image tiles was used for external validation. The performance was compared with humans, and a virtual cost-saving analysis was done. RESULTS: The KRAS_Mob network (area under the receiver operating curve [AUC] 0.8, 95% CI 0.71 to 0.89) was the best-performing model for predicting the KRAS genotype, followed by the KRAS_Shuff (AUC 0.73, 95% CI 0.62 to 0.84) and KRAS_Ince (AUC 0.71, 95% CI 0.6 to 0.82) networks. Combing the KRAS_Mob and KRAS_Shuff networks as a double prediction approach showed improved performance. KRAS_Mob network accuracy surpassed that of two independent pathologists (AUC 0.79 [95% CI 0.64 to 0.93], 0.51 [95% CI 0.34 to 0.69], and 0.51 (95% CI 0.34 to 0.69]; p < 0.001 for all comparisons). CONCLUSION: The DNN has the potential to predict the KRAS genotype directly from H&E-stained histopathological slide images. As an algorithmic screening method to prioritize patients for laboratory confirmation, such a model might possibly reduce the number of patients screened, resulting in significant test-related time and economic savings.

Outcome and quality of life in obese patients underwent laparoscopic vs. open appendectomy.

BACKGROUND: Although obesity is a popular reason for choosing laparoscopic appendectomy (LA) versus open appendectomy (OA), however, the question of whether there is a difference remains. Our goal is to investigate if there is a difference between OA and LA in obese patients. METHODS: Fifty-eight obese patients diagnosed with acute appendicitis according to ALVARDO score at department of surgery at Suez Canal university hospitals from March 2020 till August 2021 were included. The study participants were assigned in two groups LA and OA. This study aimed to comparing between LA and OA regarding intraoperative complications, length of hospital stays, post -operative pain, and rate of post-operative complications. Meanwhile, using SF-36 scoring questionnaire, the quality of life was compared between both groups. RESULTS: A total of 58 patients were included in the present study (LG = 29 patients and OG = 29 patients). The early post-operative complications (within 30 days after surgery) were significantly lower in the LA group (5 patients out of 29) than the OA (11 patients out of 29). Additionally, lower incidence of complications was noticed in the LA group (2 out of 29 patients) compared to OA (6 patients out of 29) beyond 30 days after operation. Patients with laparoscopic surgery had statistically significant higher overall quality of life scores (SF-36) (72 ± 32) compared to open surgery patients (66 ± 35) 2 weeks after operation. CONCLUSION: The laparoscopic procedure was associated with lower incidence of post operative complications. However, open appendectomy was superior for a shorter operative time. Laparoscopic approach is not only used for therapeutic purposes, but also it has a diagnostic role.

The role of the surgical resection distance from the pylorus after laparoscopic sleeve gastrectomy: a prospective cohort study from an academic medical center in Egypt.

BACKGROUND: Laparoscopic sleeve gastrectomy was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus. We conducted this study to elucidate any potential differences in the short-term outcomes between 2 and 6 cm distance from the pylorus in laparoscopic sleeve gastrectomy. METHODS: A prospective observational cohort study in a selected cohort of 96 patients was conducted from January 2018 to March 2019 in morbidly obese patients who had laparoscopic sleeve gastrectomy performed at Suez Canal University Hospital. Outcome was expressed by excess weight loss percentage, resolution of comorbidities, improvement of quality of life, and incidence of complications after laparoscopic sleeve gastrectomy. The morbidly obese patients (body mass index [BMI] > 40 kg/m2 or > 35 kg/m2 with obesity-related comorbidities) in the study were divided into two equal groups: (1) Group 1 (48 patients) underwent laparoscopic sleeve gastrectomy with a 2 cm distance from the pylorus resection distance and (2) Group 2 (48 patients) underwent laparoscopic sleeve gastrectomy with a 6 cm distance from the pylorus resection distance. Body weight, BMI, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and post-operatively for a duration of 12 months. RESULTS: Statistically, no significant differences between the two study groups regarding the excess weight loss percentage, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 versus 25% in Group 2, p > 0.05) were found. CONCLUSION: Laparoscopic sleeve gastrectomy was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The distance from the pylorus resection distance did not affect the short-term effects of laparoscopic sleeve gastrectomy regarding excess weight loss percentage, resolution of comorbidities, change in quality of life, or occurrence of complications.

Factors influencing the degree of physician-pharmacist collaboration within Iraqi public healthcare settings.

OBJECTIVES: Medication safety and effectiveness can be improved through interprofessional collaboration. The goals of this study were to measure the degree of physician-pharmacist collaboration within Iraqi governmental healthcare settings and to investigate factors influencing this collaboration. METHODS: This cross-sectional study was conducted in Al-Najaf Province using the Collaborative Working Relationship Model and Physician-Pharmacist Collaborative Instrument (PPCI). Four pharmacists distributed paper surveys with a 7-point Likert scale to a convenience sample of physicians and pharmacists working in seven public hospitals and two outpatient clinics. The questionnaire (in English) covered individual (demographics, practising years and academic affiliation), context (practice setting) and PPCI characteristics (trustworthiness, role specification and relationship initiation) in addition to collaborative care items: one for pharmacists and one for physicians. Separate multiple regressions were used to assess the association of the factors with collaborative care for physicians and for pharmacists. KEY FINDINGS: Seventy-seven physicians and 86 pharmacists returned usable surveys (81.5% response rate). The majority of physicians were male (84%), while the majority of pharmacists were female (58%). The mean age of the physicians was (37.99 years) older than that of the pharmacists (30.35 years). The physicians had a longer period of practice (11.32 years) than pharmacists (5.45 years). Most (90%) of the providers were practising in hospitals. Pharmacist academic affiliation was significantly associated with collaborative care. The pharmacist and physician regressions indicated significant (P < 0.05) associations between collaborative care and two PPCI domains (role specification and relationship initiation for physicians; role specification and trustworthiness for pharmacists). CONCLUSIONS: This study focused on physician-pharmacist collaboration within hospitals, and it was the first study measuring interprofessional collaboration in Iraq. The results showed there is physician-pharmacist collaboration within Iraqi hospitals and exchange characteristics had significant influence on this collaboration.

Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost.

PURPOSE: The aims were to calculate total systemic antibiotic consumption and cost in both public and private sectors in all care settings in Al-Najaf province, Iraq, during 2012, recognize the percentage of each pharmacological class for the dispensed antibiotics and identify oral and parenteral antibiotic percentages dispensed and the portions manufactured nationally and imported. METHODS: Cross-sectional study was conducted in Al-Najaf to calculate the total cost and quantities of antibiotics consumed during 2012 using World Health Organization Guidelines for Defined Daily Dose (DDD). KEY FINDINGS: The results showed more than 21 million DDDs were dispensed in Al-Najaf in one year, and more than half (54.2%) were dispensed by governmental healthcare institutions. A thousand inhabitants in the province consumed 45.26 DDDs per day. Extended-spectrum (34.49%) and combined penicillins (26.08%) were the most frequently consumed while meropenem was the least frequently consumed (0.02%). Ninety-five per cent of the consumed antibiotics were oral dosage forms, and five per cent were parenteral dosage forms. The total cost of antibiotic consumed was more than nine million U.S dollars. CONCLUSIONS: The antibiotic consumption ratio in this province was comparable to neighbouring countries, but far higher compared to European countries. Penicillins, cephalosporins and quinolones were the most popular antibiotics. Around half of the antibiotics consumed were made by national pharmaceutical companies that mainly produce oral antibiotics. The public sector consumed a higher portion, but spent a lower amount compared to private sectors. This is the first time report of antibiotic consumption in Iraq. More studies evaluating antibiotic consumption can improve utilization.

Evaluation of medical waste incinerators in Alexandria.

Medical establishments play important roles in different activities by using of modern technology to serve the humans and the environment through different departments in the establishment and its firms. Medical wastes are considered as a hazardous waste because they contain toxic materials, infectious, or non-infectious wastes and they are considered as a hazard to millions of patients, health care workers, and visitors. Treatment processes for medical wastes comprise autoclaving, microwaving, chemical disinfection, irradiation, plasma system, and incineration. Incineration is a thermal process, which destroys most of the waste including microorganisms. Combustion process must be under controlled conditions to convert wastes containing hazardous materials into mineral residues and gases. Hospital waste incinerators may emit a number of pollutants depending on the waste being incinerated. These pollutants include particulate matter, acid gases, toxic metals, and toxic organic compounds products of incomplete combustion, e.g., dioxins, furans, and carbon monoxide, as well as sulfur oxides and nitrogen oxides. So, there should be a reduction of emissions of most of these pollutants by air pollution control devices. This study was conducted in 51 medical establishments (ME) in Alexandria. To evaluate its incinerators. It was found that only 31.4% of total ME have their own incinerators to treat their medical waste. Also, the incinerators conditions were poor with incomplete combustion. So, the study recommend handling of all medical wastes of ME in Alexandria by the company which is responsible now for management of domestic solid wastes of the city.

Assessment of combustion products of medical waste incinerators in Alexandria.

The emissions and ashes from medical waste incinerators might perform a threat to the environment and the public health. The aim of the present work is to evaluate the emissions and ashes of six medical wastes incinerators in six hospitals in Alexandria. Five air pollutants were sampled and analyzed in the emissions comprising smoke, lead, carbon monoxide, sulphur dioxide and nitrogen dioxide . Ash samples were analyzed for bacterial count, volatile substances, lead and cadmium. Shape and color of ash were observed visually. The results of the present study have revealed that all the average values of gases in the six incinerators were within the limits stated in Egyptian environmental law, where as carbonaceous particulate (smoke) averages of the six incinerators have exceeded the maximum allowable limit in the law. On the other hand, lead concentration in emissions were far below the maximum allowable limit in the law. Incinerator No 6 emissions have been significantly higher in CO, NO2, SO2 and smoke concentration than the other five incinerators P<0.001, P<0.0006, P<0.0001, and P<0.002 respectively. There was no significant variation in bacterial count of ash samples at 20 degrees C and 37 degrees C between the six studied incinerators. Volatile substance percentage of ash samples in the six incinerators were much higher than the recommended percentage. There was a highly significant variation between the six incinerators (p<0.005). Lead and cadmium concentrations in ash samples were much higher than those in developed countries, meanwhile, more or less as those in developing countries. It is recommended to state specific realistic emissions limits for medical waste incinerators and to substitute sporadic incinerators in hospitals by two central incinerators in proper places outside the city.

Evaluating the indoor and outdoor environment: using a simple method.

Housing is the conjunction of the dwelling, the home, the immediate environment and the community. Between 1960 and 1980, the urban population in developing countries more than doubled and is expected to reach 56% of the total population by the year 2025. In many cities, the development of squatter settlements and shanty towns had grown rapidly causing the destruction of green areas. The number of people living in urban slums and shanty towns is an indicator of conditions in the cities and the United Nations had estimated that about one-third of urban dwellers in developing countries live in such settlements. Poverty is highly prevalent among the residents of these areas. Outdoor environmental degradation, together with the social degradation affects the health of the urban population especially the poor causing a burden of ill-health, disability, poor indoor housing, and high maternal and infant mortality. The aim of the present study is to evaluate the indoor and outdoor environment using a simple method and to assess its reliability and validity. The scoring system, which was developed for the assessment of the indoor and outdoor environmental levels included 36 items (18 for the indoor and 18 for the outdoor) using a questionnaire. Results revealed that the proposed scoring system was able to reveal significance difference between served (water, electricity, and sewerage system were available) and unserved areas when using t-test, z-test, and chi-square testing. The proposed scoring system was reliable and valid especially in indoor assessment. Outdoor scores might need more modifications to improve its reliability.

Quality monitoring of composting processes of wastewater sludge in Alexandria.

There are two wastewater primary treatment plants in Alexandria (west and east). The produced primary sludge is mechanically dewatered and transported to sludge disposal site 9N where composting is carried out. However, prior to 1970, composting played a very minor role in sludge or solid wastes treatment because of greatly unfavorable balance between its economics and those of the principal competing option, namely landfill disposal. This study aims at monitoring and evaluating the composting process of demitted sludge produced from Alexandria wastewater treatment plants. Ten batches of sludge were composted. During the composting process the batches were been investigated and followed up to 3 months. Representative samples (10 for each batch) were taken from these batches at the start of windrowing and after each turning (4-15 days) and were analyzed for physical; chemical; bacteriological; and parasitological characteristics, heavy metals, and plant nutrients. Results revealed that C/N ratio of the final compost product comply with the decree of the Minister of Agriculture No. 100 11967, while moisture, C%, and TKN did not. Heavy metals, faecal coliforms, and helminthes complied with the decree No. 222/2002 for the Minister of Housing, Utilities, and Urban Communities. Moisture had positive correlation with both C and VS and negative correlation with pH. Temperature had negative correlation with TKN. Both total and faecal coliforms had negative correlation with temperature and positive correlation with C, N, and VS. It is recommended to optimize the quality of the produced sludge compost by use bulking agent rich in carbon and nitrogen as Hay or Rice straw, instead of the matured sludge compost.