A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery.

BACKGROUND: Temporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital. METHODS: A retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles. RESULTS: A total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3-3.8, p < 0.05). CONCLUSION: In patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.

Application and Potential of Artificial Intelligence in Heart Failure: Past, Present, and Future.

The prevalence of heart failure (HF) is increasing, necessitating accurate diagnosis and tailored treatment. The accumulation of clinical information from patients with HF generates big data, which poses challenges for traditional analytical methods. To address this, big data approaches and artificial intelligence (AI) have been developed that can effectively predict future observations and outcomes, enabling precise diagnoses and personalized treatments of patients with HF. Machine learning (ML) is a subfield of AI that allows computers to analyze data, find patterns, and make predictions without explicit instructions. ML can be supervised, unsupervised, or semi-supervised. Deep learning is a branch of ML that uses artificial neural networks with multiple layers to find complex patterns. These AI technologies have shown significant potential in various aspects of HF research, including diagnosis, outcome prediction, classification of HF phenotypes, and optimization of treatment strategies. In addition, integrating multiple data sources, such as electrocardiography, electronic health records, and imaging data, can enhance the diagnostic accuracy of AI algorithms. Currently, wearable devices and remote monitoring aided by AI enable the earlier detection of HF and improved patient care. This review focuses on the rationale behind utilizing AI in HF and explores its various applications.

Central pancreatectomy: A viable option for solid pseudopapillary neoplasm - A case report.

INTRODUCTION: Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors, comprising about 1 % of pancreatic tumors. They primarily affect females during their reproductive phase and have a favorable prognosis. SPNs are usually asymptomatic or present with mild symptoms. The exact histopathogenesis of SPNs remains unknown. Surgical resection is curative, and central pancreatectomy is a pancreas-sparing surgical technique. CASE PRESENTATION: A 33-year-old female presented with epigastric pain, vomiting, and infertility. Imaging revealed a mass in the pancreas. Exploration confirmed the mass, and central pancreatectomy was performed. Histopathology confirmed the diagnosis of SPN. The patient's recovery was uneventful, and follow-up CT scans showed no recurrence. DISCUSSION: This case involves a 33-year-old female presenting with epigastric pain and vomiting, revealing a cystic mass with a solid component in the pancreas. While generally benign, SPNs can become malignant in 15 % cases, with a favorable prognosis. Histopathologically, SPNs remain distinct, with CD99 and CD10 staining confirming the diagnosis. Diagnostic imaging, particularly CT scans, aids in identifying SPNs. Surgical resection, such as central pancreatectomy, is effective, preserving organ function. The case's positive outcome aligns with an overall 5-year survival rate of 95-97 %, highlighting the overall favorable prognosis of SPNs. The procedure's balance between tumor removal and organ preservation offers clinical advantages. CONCLUSION: This case underscores the successful management of an SPN using central pancreatectomy. It highlights the importance of early diagnosis and surgical intervention, as well as the favorable prognosis associated with SPNs, even in cases of metastasis. Central pancreatectomy offers organ preservation and reduces long-term complications. Continued reporting and research on such cases contribute to refining treatment strategies for SPNs.

From Recurrent Pain to a Life-Threatening Condition: A Case Report of Left Paraduodenal Hernia.

Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be life-threatening if not detected and treated promptly. Here, we present the case of a 36-year-old man who presented to the emergency department with an acute intestinal obstruction that had been developing for three days. The patient had a history of recurrent abdominal pain but had never undergone any abdominal surgery. Surgical exploration revealed a left internal PDH with a collection of incarcerated jejunal loops retrocolically encased within the hernial sac. Resection of the gangrenous jejunal loops was performed, followed by hernia reduction and neck closure. This case highlights the importance of timely and accurate diagnosis of left PDHs, particularly in patients with a history of recurrent abdominal pain and no prior abdominal surgeries. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.

Primary Closure vs T-Tube Drainage Following Open Choledochotomy for CBD (Common Bile Duct) Stones.

BACKGROUND: Choledocholithiasis affects 10%-15% of individuals with gallbladder stones. Approximately 7%-15% of cholecystectomy patients develop common bile duct (CBD) stones. It occurs more frequently in older age groups. It may result in a complete or partial blockage of the bile duct and present as pancreatitis or cholangitis due to gallstones. OBJECTIVE: The aim of this study was to compare the outcomes of primary closure of duct and T-tube drainage after open choledochotomy and to evaluate the effectiveness and safety of primary closure. MATERIAL AND METHODS: From January 2018 to December 2021, this descriptive study was carried out in the surgical department of the Hayatabad Medical Complex in Peshawar. In total, 60 patients who had open choledocholithotomy after a failed endoscopic extraction were included in this study. Of these, 30 (50%) patients got primary duct closure after choledochotomy, while 30 (50%) patients had T-tube insertion. RESULTS:  Among the total of 60 patients (primary closure: 30 and T-tube drainage: 30 patients), 10 (16%) were males, while 50 (84%) were female patients. The mean age was recorded as 45.9±13.9, and the mean hospital stay in days in both groups was 4.87±1.4 (T-tube: 5.24±1.50 and primary closure: 4.50±1.3). Complications developed in group A were a biliary leak in three (10%) patients, postoperative jaundice in two (6.5%) patients, wound infection in three (10%), intra-abdominal collection in three (10%) patients, and dislodgement of a tube in two (6.5%), while 17 (57%) patients had no complications developed. CONCLUSION:  If the duct is free of stones, as determined by preoperative choledochoscopy, primary closure of the common bile duct (CBD) is a safe, cost-effective procedure with less morbidity than regular T-tube drainage after open choledochotomy.

Endodermal sinus tumor with pancreatic origin: A case report.

Endodermal Sinus tumor is a rare malignant type of germ cell tumor (GCT). Primary endodermal sinus tumor, especially in the head of pancreas, is extremely rare. The case under consideration is of a 22 year old male who presented with pancreatic mass causing postprandial nausea and vomiting, and raised AFP levels. The biopsy of the mass revealed the endodermal sinus tumor, and the pancreatic origin was confirmed by a CT scan and a negative scrotal ultrasound. As the tumor was unresectable initially, a gastrojejunostomy was done to relieve the obstructive symptoms. Whipple procedure was performed two months after 4 cycles of BEP chemotherapy to remove the residual tumor in pancreas. It is crucial to highlight this uncommon case in order to increase surgeons' and oncologists' knowledge of the malignant extra-gonadal GCTs diagnosis and treatment.

Rationale design and efficacy of a smartphone application for improving self-awareness of adherence to edoxaban treatment: study protocol for a randomised controlled trial (adhere app).

INTRODUCTION: High adherence to oral anticoagulants is essential for stroke prevention in patients with atrial fibrillation (AF). We developed a smartphone application (app) that pushes alarms for taking medication and measuring blood pressure (BP) and heart rate (HR) at certain times of the day. In addition to drug alarms, the habit of measuring one's BP and HR may reinforce drug adherence by improving self-awareness of the disease. This pilot study aims to test the feasibility and efficacy of the smartphone app-based intervention for improving drug adherence in patients with AF. METHODS AND ANALYSIS: A total of 10 university hospitals in Korea will participate in this randomised control trial. Patients with AF, being treated with edoxaban for stroke prevention will be included in this study. Total of 500 patients will be included and the patients will be randomised to the conventional treatment group (250 patients) and the app conditional feedback group (250 patients). Patients in the app conditional feedback group will use the medication reminder app for medication and BP check alarms. The automatic BP machine will be linked to the smartphone via Bluetooth. The measured BP and HR will be updated automatically on the smartphone app. The primary endpoint is edoxaban adherence by pill count measurement at 3 and 6 months of follow-up. Secondary endpoints are clinical composite endpoints including stroke, systemic embolic event, major bleeding requiring hospitalisation or transfusion, or death during the 6 months. As of 24t November 2021, 80 patients were enrolled. ETHICS AND DISSEMINATION: This study was approved by the Seoul National University Bundang Hospital Institutional Review Board and will be conducted according to the principles of the Declaration of Helsinki. The study results will be published in a reputable journal. TRIAL REGISTRATION NUMBER: KCT0004754.

A practical approach towards causality mining in clinical text using active transfer learning.

OBJECTIVE: Causality mining is an active research area, which requires the application of state-of-the-art natural language processing techniques. In the healthcare domain, medical experts create clinical text to overcome the limitation of well-defined and schema driven information systems. The objective of this research work is to create a framework, which can convert clinical text into causal knowledge. METHODS: A practical approach based on term expansion, phrase generation, BERT based phrase embedding and semantic matching, semantic enrichment, expert verification, and model evolution has been used to construct a comprehensive causality mining framework. This active transfer learning based framework along with its supplementary services, is able to extract and enrich, causal relationships and their corresponding entities from clinical text. RESULTS: The multi-model transfer learning technique when applied over multiple iterations, gains substantial performance improvements. We also present a comparative analysis of the presented techniques with their common alternatives, which demonstrate the correctness of our approach and its ability to capture most causal relationships. CONCLUSION: The presented framework has provided cutting-edge results in the healthcare domain. However, the framework can be tweaked to provide causality detection in other domains, as well. SIGNIFICANCE: The presented framework is generic enough to be utilized in any domain, healthcare services can gain massive benefits due to the voluminous and various nature of its data. This causal knowledge extraction framework can be used to summarize clinical text, create personas, discover medical knowledge, and provide evidence to clinical decision making.

An Empirical Method of Automatic Pattern Extraction for Clinical Text Classification.

Clinical text classification is an indispensable and extensively studied problem in medical text processing. Existing research primarily employs machine learning and pattern based approaches to address the stated problem. In general, pattern based approaches perform better than other methods. However, these approaches commonly require human intervention for pattern identification, which diminish their benefits and restrain their applications. In this study, we present a novel pattern extraction algorithm, which identifies and extracts patterns from clinical textual resources, automatically. The algorithm identifies the candidate concepts in the clinical text, finds the context of the concepts by discovering their context windows, and finally transforms each context window to a pattern. We evaluate our proposed algorithm on Hypertension, Rhinosinusitis, and Asthma guidelines. 70% of the hypertension guideline was used for pattern extraction while the remaining 30% and the other two guidelines were used for evaluations. The algorithm extracts 21 patterns that classify Hypertension, Rhinosinusitis, and Asthma guidelines sentences to the recommendation and non-recommendation sentences with 84.53%, 80.03%, and 84.62% accuracy, respectively. The initial results reveal the benefits and applicability of the algorithm for clinical text classification.

Cognitive disturbance comparison among drug-naïve depressed cases and healthy controls.

OBJECTIVE: To assess and compare cognitive disturbances among newly diagnosed depressed and healthy control cases on the McNair and Kahn auto-evaluation scale. STUDY DESIGN: Comparative, cross-sectional study. PLACE AND DURATION OF STUDY: Out-patients Department of Psychiatry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from February to May, 2007. METHODOLOGY: All consecutive new cases reporting at the out patient department were screened for depressive illness. They were matched with healthy-controls aged between 18-40 years. Clinical assessment was carried out on the basis of detailed history, physical examination, mental state examination by psychiatrists. For diagnostic purpose, application of ICD-10 followed by administration of Scale for Cognitive Difficulties. RESULTS: Sixty subjects, 30 depressed patients (20 females and 10 males) and 30 healthy-controls (18 females and 12 males) were assessed. The age of cases with depressive disorder ranged 18-38 years. It was found that 63.3% (65% females and 60% males) depressed patients had cognitive difficulties compared to 3.3% of healthy-controls (p < 0.001). Proportions were compared using chi-square test with significance at p < 0.05. CONCLUSION: Depression is not merely an emotional (mood) disorder but has an impact on cognition domain as well. Attention/concentration was the most common domain of cognition affected, followed by memory disturbance among the drug-naïve depressed patients.

Psychiatric disorders in bone marrow transplant patients.

OBJECTIVE: To identify the psychiatric illnesses in patients with hematological/oncological disorders encountered during blood and bone marrow transplantation. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Bismillah Taqee Institute of Health Sciences and Blood Diseases Centre, Karachi from December 2002 to December 2005. PATIENTS AND METHODS: All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent blood and bone marrow transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE). The psychiatric diagnosis was made on the basis of International Classification of Diseases (ICD-10) system of classification devised by W.H.O. RESULTS: Eighty patients, who fulfilled the inclusion criteria, were inducted in this study. Thirty (37.5%) cases were found to have psychiatric disorders. Out of the total, 60 (75%) were males and 20 (25%) females. Adjustment disorder was the most frequent diagnosis (n=12), followed by major depression (n=7). Rest of the diagnoses made were generalized anxiety disorder, acute psychotic disorder, delirium and depressive psychosis. CONCLUSION: High psychiatric morbidity associated with blood and bone marrow transplantation was observed. It indicates the importance of psychiatric intervention during the isolation period of BMT as well as pre-transplant psychiatric assessment and counseling regarding procedure.

Clinical features of depressive disorder among patients below 18 years of age.

OBJECTIVE: To determine clinical manifestations of depressive disorder among cases below 18 years. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Carried out at NMI (Neurospinal Medical Institute), Karachi, over a period of 3 years (October 2001 to 2004). PATIENTS AND METHODS: Four hundred consecutive cases, below the age of 18 years, were evaluated. One hundred cases were inducted in this study based on detailed history and interview by psychiatrists. The diagnostic criteria of ICD-10 (International classification of diseases in its tenth revision) of WHO was used. Results based on clinical features were tabulated and analysed with SPSS-10. Fisher s exact test/Chi-square test were used for comparison between male and female cases. RESULTS: A total number of 400 consecutive cases, below the age of 18, who approached for psychiatric consultation, were evaluated. After applying the ICD-10 diagnostic criteria, a 100 (25%) of them were found to be suffering from depressive disorder. Among them, 54 were girls and 46 boys, giving a male to female ratio of 1:1.32 and statistically insignificant gender difference. Instead of mood disturbance, the most frequent presenting complaints included pain (55%), insomnia (33%), fear (16%), weakness (14%) and aggression (13%). CONCLUSION: Depression is a common psychiatric disorder among the pediatrics and adolescents. The clinical presentation was usually found to be atypical.