Quantitative evaluation of CT scan images to determinate the prognosis of COVID-19 patient using deep learning.

The purpose of this research is to evaluate the accuracy of AI-assisted quantification in comparison to conventional CT parameters reviewed by a radiologist in predicting the severity, progression, and clinical outcome of disease. The current study is a cross-sectional study that was conducted on patients with the diagnosis of COVID-19 and underwent a pulmonary CT scan between August 23th, 2021 to December 21th, 2022. The initial CT scan on admission was used for imaging analysis. The presence of ground glass opacity (GGO), and consolidation were visually evaluated. CT severity score was calculated according to a semi-quantitative method. In addition, AI based quantification of GGO and consolidation volume were also performed. 291 patients (mean age: 64.7 ± 7; 129 males) were included. GGO + consolidation was more frequently revealed in progress-to-severe group whereas pure GGO was more likely to be found in non-severe group. Compared to non-severe group, patients in progress-to-severe group had larger GGO volume percentage (40.6%± 11.9%versus 21.7%± 8.8%, p ˂0.001) as well as consolidation volume percentage (4.8% ± 2% versus 1.9% ± 1%, p < 0.001). Among imaging parameters, consolidation volume percentage and the largest area under curve (AUC) in discriminating non-severe from progress-to-severe group (AUC = 0.91, p < 0.001). According to multivariate regression, consolidation volume was the strongest predictor for disease progression. In conclusion, the consolidation volume measured on the initial chest CT was the most accurate predictor of disease progression, and a larger consolidation volume was associated with a poor clinical outcome. In patients with COVID-19, AI-assisted lesion quantification was useful for risk stratification and prognosis evaluation.

Evaluation the accuracy and cost effectiveness of using the Bernese and Ottawa rules in ankle Sprain.

INTRODUCTION: Ankle sprain is one of the most common musculoskeletal injuries that occur most commonly in the active and working population. Ottawa and Burns Laws are tools for physicians to determine the need for a radiograph of an ankle injury. The purpose of this study was to evaluate the accuracy of the Ottawa and Bernese criteria in patients with torsion of the foot and the economical savings resulting from the application of these two criteria. METHODS: This prospective study was designed to evaluate the two rules burns of Bernese and Ottawa and their economic savings were designed in two phases. They were referred to Poursina Medical Center, Rasht, Iran from September 2019 to the achieved sample size. Data were analyzed by SPSS software version 24 (Statistical Package for Social Science (SPSS) 21, Chicago, IL, USA). RESULTS: A total of 800 patients were included in this study to determine the accuracy of bronze and Ottawa criteria in ankle torsion and the economic cost of using them. Of the 800 patients studied, 430 (53.7%) were male and 370 (46.3%) were female, with a mean age of 35.77±16.42 years. The diagnostic accuracy of the Ottawa criteria is 90% and the diagnostic accuracy of the Bernese criteria is 90.75%. The sensitivity of the Ottawa evaluation method was 97.6% and the specificity was 88%. The sensitivity of Bernese evaluation method was 91% and specificity was 90.7%. CONCLUSION: Because of the higher sensitivity of the Ottawa criterion than the Bernese criteria, it is preferred to determine the probability of fracture for emergency unit personnel. Using these two methods can reduce the time, energy and cost of treatment for the patient during the treatment period.

Comparative study of the neck shaft angle in femoral neck and intertrochanteric fractures in north part of Iran.

BACKGROUND: A femur fracture is accounted for as one of the most common fractures in the population. The femoral neck has had an angle with the longitudinal axis of the bone shaft, which is defined as neck- shaft angle (NSA). Regional epidemiologic information about NSA might be useful for orthopedic surgeons. In the present study, we aimed conduct a comparative study of NSA in patients with femoral neck or intertrochanteric fractures in Rasht, Iran. METHODS: The study population consisted of all patients with hip fractures. Patients with femoral fractures (neck and intertrochanteric) were examined by an emergency medicine specialist at the time of admission. An Anterior-Posterior X-ray image was taken at the time of admission. Patients NSA was measured by expert orthopedic surgeons and was compared between patients. RESULTS: In the present study, we evaluated the data of 80 patients with femoral fractures and 40 healthy individuals as control group. Patients were divided into two groups of femoral neck fractures (40 patients) and intertrochanteric fractures (40 patients). Analysis of the NSA showed no significant differences between the NSA of patients with neck and intertrochanteric fractures and also control group (P>0.05). Our data showed that the mean NSA in patients with femoral neck fractures were 131.04±3.7° degrees while the NSA of patients with intertrochanteric fractures were 132.07±4.1°. The NSA of controls were also 132.8±6.9°. We also found no significant differences between the NSA of different age groups or between male and female patients. CONCLUSION: The results of this study showed that no significant differences could be indicated between NSA of healthy subjects and patients with femoral fractures. We believe that paradoxical results of former reports could be due to population and regional factors.

Comparison of opponensplasty techniques in isolated low median nerve palsy.

BACKGROUND: Thumb opposition is a critical operation of thumb. Median nerve palsy interferes with a large number of ordinary activities such as opposition. Opponensplasty for low median nerve injury is performed with various techniques. The purpose of this study is to compare tendon transfer techniques of Riordan and Burckhalter. METHODS: This study was a clinical trial performed on 120 patients who underwent Opponensplasty. Patients with traumatic low nerve palsy were divided into two equal groups of Riordan and Burckhalter operation. Demographic information, functional status, Kapandji score, and Pulp pinching method were recorded and compared for all patients 3 months and 8 months after surgery. FINDINGS: Performance status, Kapandji score and Pulp pinching tests showed significant improvements in both groups after surgeries. The changes in pressure between the thumb and fifth finger were significantly greater in the Burckhalter method compared with Riordan method (P<0.05). The incidence of complications was significantly higher in the Riordan group (P=0.01). CONCLUSION: According to the present study, there was no differences between Burckhalter and Riordan methods in terms of opposition recovery, although Burckhalter's opponensplasty had better therapeutic results. Postoperative complications were also less in the Burckhalter method.

Treatment of unstable extra-articular distal radius fractures using locked volar plating and percutaneous pinning without external fixation.

INTRODUCTION: One of the most common fractions is distal radius fracture, and various treatments have been suggested for this. The purpose of this study, is comparison of Open reduction and internal fixation by using a locked volar plating compared to percutaneous pinning by cast immobilization under the elbow in patients less than 60 years with good bone density that had unstable extra-articular distal radius fracture or UDRF. METHODS: This study was clinical trial. 88 patients with closed UDRF who were referred for surgical treatment entered the study. Patients were randomized into two groups: group 1 had open reduction and internal fixation by using a locked volar plating and the other group had percutaneous pinning by cast immobilization surgeries. Amount of pain [by using Visual analog scale or VAS] and functional results of two methods were compared 3 and 12 month after surgeries. FINDINGS: The intensity of pain was higher in the pinning group 3 and 12 month after treatment (P=0.001 and P=0.390 respectively). The range of motions in the plating group was significantly better (P<0.001). There was a significant difference in performing daily activities 3 month after treatment between the two groups, but a significant limitation in daily activities, observed 12 months after surgery in pinning group (P=0.004). CONCLUSION: Bone fixation, using locked volar plating, can be a better modality with regard to postsurgical pain and also the wrist range of motion than percutaneous pinning with cast immobilization in patients younger than 60 years sustaining unstable, closed extra-articular, distal radius fracture.

Does intravenous tranexamic acid reduce bleeding during mastoidectomy?

Mastoidectomy is one of the important head and neck surgeries which is mostly performed due to complications of otitis media. This procedure is performed under microscopic surgery and as a result, a clean visual field is required for surgeons. Bleeding is one of the important issues during microscopic surgeries which reduces visualization. In this clinical trial, we aimed to examine effects of tranexamic acid in reducing bleeding during mastoidectomy. Here we investigated 69 patients who were candidates of mastoidectomy. Patients were randomized into two groups. In group 1, patients received tranexamic acid (10 mg/kg) at the beginning of surgeries along with other anesthetic drugs. In group 2, patients received normal saline as placebo with the same volume. Data regarding to bleeding, duration of surgeries, heart rate and blood pressure of patients were collected and analyzed. We indicated that administration of tranexamic acid is associated with significant reduced bleeding and also reduced blood pressure during surgeries (P<0.001). Taken together, we suggest that otolaryngologists should administer tranexamic acid during microscopic surgeries in order to reduce bleeding and provide a better visual field.

Effects of fingolimod treatments on alanine transaminase and aspartate transaminase levels in patients with multiple sclerosis.

INTRODUCTION: Multiple Sclerosis (MS) is a chronic neurological disorder with no known cause or cure. Fingolimod (FTY720) is an oral medication recently approved for the treatment of MS as well as other diseases with autoimmune aspects. However, the drug is not without side effects. The severity and prevalence of these side effects are not completely understood. One of the most common causes for the patient cessation of fingolimod is an increase in liver enzymes, indicating possible inflammation or damage to liver cells. Alanine transaminase (ALT) and aspartate transaminase (AST) are the most common liver enzymes used as indicators of hepatic health. OBJECTIVES: This three-month prospective cohort study selected patients who were diagnosed with relapsing-remitting MS (RRMS) and who were not taking fingolimod oral treatment. ALT and AST levels were determined for these patients at baseline and then after three months of taking FTY720 to determine if these liver enzymes were changed. METHODS: 36 RRMS patients completed this study, which lasted three months. They were started on 0.5 oral FTY720 after approval from a physician and completion of an AST/ALT blood test. Baseline levels were determined and then taken again three months later. Statistical analysis of these values was performed using P<0.05 as a significance threshold. RESULTS: In this sample of patients, only ALT levels were significantly increased after fingolimod treatment in the general cohort (P=0.00). The general cohort showed an insignificant increase in AST levels. In male and female populations separately, AST was not significantly increased. ALT was only significantly increased in men (P=0.00) and insignificantly increased in women. CONCLUSION: This study further confirms our concerns about fingolimod's possible effects on the liver. While these numbers do support the claim that the drug does on average increase ALT in patient populations, it is important to note that most of these patients have no real hepatic side effects. In addition, previous studies have cited a return to normal ALT and AST levels after cessation of fingolimod, suggesting its effects are temporary and not severely damaged in the usual patient.