World Academy of Science, Engineering and Technology

Authors: Pechpailin Kortnoi, Tanitnun Paprad

Abstract:

Background: Myasthenia gravis (MG) is an autoimmune disorder characterized by impaired neuromuscular transmission due to antibodies against nicotinic receptors, leading to muscle weakness, ptosis, and respiratory issues. The incidence of MG has risen globally, emphasizing the need for effective diagnostics. Objective: This study evaluates the validity of a combined bedside test (the ice pack test and fatigability test) for diagnosing juvenile myasthenia gravis (JMG) in pediatric patients with ptosis. Methods: This cross-sectional study, conducted from January 2012 to May 2024 at King Chulalongkorn Memorial Hospital, Thailand, included pediatric patients (1 month to 18 years) with ptosis undergoing ice pack and fatigability tests. Data included demographics, clinical findings, and test results. Diagnostic efficacy was assessed using sensitivity, specificity, accuracy, PPV, NPV, Fagan Nomogram, Kappa Statistics, and McNemar’s Chi-Square. Results: Of 43 identified patients, 32 were included, with 47% male and a mean age of 7 years. The combined bedside test had high sensitivity (92.8%) and accuracy (87.5%) but moderate specificity (50%). It significantly outperformed the ice pack test (P = 0.0005), which showed low sensitivity (42.8%) and accuracy (43.8%). The fatigability test had 82% sensitivity and 92% PPV. Confirmatory tests (AChR-Ab, MuSK-Ab, neostigmine, repetitive nerve stimulation) supported most diagnoses. Conclusions: The combined bedside test, with high sensitivity (92.8%) and accuracy (87.5%), is an effective screening tool for juvenile myasthenia gravis, outperforming the ice pack test. Integrating it into clinical practice may improve diagnosis and enable timely treatment. The fatigability test (82% sensitivity) is also useful as an adjunct screening tool.

Keywords: myasthenia gravis (MG), the ice pack test, the fatigability test, the combined bedside test

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Authors: Fedor Semenov

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One of the most widespread facial bones’ malformations – the congenital palatoschisis – significant impact on drainage and ventilation of the middle ear through the incorrect work of soft palate muscles, which results in recurrent middle ear inflammation and subsequently leads to the hearing dysfunction. The purpose of this research is to evaluate the auditory tube function and hearing condition before the operative treatment (uranoplasty) and after 3 and 12 months. 42 patients aged from 6 months to 17 years who had soft and hard palate cleft and B and C type tympanogram were included in that study. The examination includes otoscopy, pure tone audiometry (for patients older than 8 years – 11 patients), tympanometry. According to the otoscopy results all the patients were divided into two groups: those who had a retracted eardrum and those who had a normal one. The results of pure tone audiometry showed that there were six patients with an air-bone gap of more than 10 dB and the five with normal audiograms. According to the results of this research, uranoplasty demonstrated strongly positive effects on the auditory tube function: normalization of eardrum view upon otoscopy was observed in 64% of children with a retracted eardrum three month after surgery and 85 % twelve months. The quantity of patients with A-type of tympanogram improved in 25 children out of 41 in 3 month and in 35 out of 41 in twelve months after operation. While before the operative treatment, six patients older than 8 years had had an air-bone gap of more than 10 dB; only two of them still had it in 12 months, and the others’ audiograms were normal. To sum it up, the uranoplasty showed a significant contribution in the restoration of auditory tube functioning. Some patients had signs of auditory dysfunction even after the operative treatment. That group of children needs further treatment by an otorhinolaryngologist.

Keywords: auditory tube dysfunction, palatoschisis, uranoplasy, otitis

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Authors: Hoorieh Darvishi, Rezaei

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Introduction: This study investigates the efficacy of computer-based interventions for children with Autism Spectrum Disorder , specifically targeting communication deficits and repetitive behaviors. The research evaluates novel software applications designed to enhance narrative capabilities and sensory integration through structured, progressive intervention protocols Method: The study evaluated two intervention software programs designed for children with autism, focusing on narrative speech and sensory integration. Twelve children aged 5-11 participated in the two-month intervention, attending three 45-minute weekly sessions, with pre- and post-tests measuring speech, communication, and behavioral outcomes. The narrative speech software incorporated 14 stories using the Cohen model. It progressively reduced software assistance as children improved their storytelling abilities, ultimately enabling independent narration. The process involved story comprehension questions and guided story completion exercises. The sensory integration software featured approximately 100 exercises progressing from basic classification to complex cognitive tasks. The program included attention exercises, auditory memory training (advancing from single to four-syllable words), problem-solving, decision-making, reasoning, working memory, and emotion recognition activities. Each module was accompanied by frequency and pitch-adjusted music that child enjoys it to enhance learning through multiple sensory channels (visual, auditory, and tactile). Conclusion: The results indicated that the use of these software programs significantly improved communication and narrative speech scores in children, while also reducing scores related to repetitive behaviors. Findings: These findings highlight the positive impact of computer-based interventions on enhancing communication skills and reducing repetitive behaviors in children with autism.

Keywords: autism, narrative speech, persian, SI, repetitive behaviors, communication

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Authors: Shirui Huang, Wei Chen, Chuanshu Huang

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Basal muscle-invasive bladder cancer (BMIBC) is considered one of the subtypes of BC with the highest metastatic rate and the poorest prognosis. Therefore, elucidating the mechanisms underlying BMIBC metastasis and identifying novel precision therapeutic targets are current research hotspots and challenges to cancer researchers. Through a series of in vitro and in vivo functional experiments, we have identified the crucial role of KRT14 in the high invasiveness and adverse prognosis of BMIBC. We found that the K294 site within the IGF2BP1-KH2 domain is responsible for reading the conserved genetic information carried by D226/E227 in the KRT14 nuclear export signal (NES). Activation of the KRT14-IGF2BP1 signaling axis is essential for IGF2BP1-mediated stabilization of SNAI1 mRNA through FTO modification. Additionally, IGF2BP1 forms a positive feedback loop by stabilizing its own mRNA, thereby accelerating the invasion and metastasis of BMIBC. Collectively, our study identifies the KRT14/IGF2BP1/FTO/Snail signaling axis as an essential regulatory mechanism associated with poor prognosis in BMIBC, providing a theoretical basis for KRT14 and its downstream regulated molecules as therapeutic targets for BMIBC and the development of corresponding targeted therapies.

Keywords: BMIBC, KRT4, IFGF2BP1, DNA methylation

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Authors: Aliakbar Hafezi, Jalal Taherian, Jamshid Abedi, Mahsa Elahi

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Background: Bones are commonly affected by renal cell carcinoma (RCC) (primarily or secondary), and this condition causes bone fragility. The aim of this study was to evaluate the diagnostic value of noninvasive methods for the diagnosis of ROD in RCC patients on hemodialysis (HD) in northern Iran. Methods: In this cross-sectional study, 50 RCC patients with ESRD referred to dialysis units in northern Iran during 2021-2024 were randomly selected and investigated. The biochemical and radiographic evaluation of ROD and its subtypes was performed, and then all patients underwent bone biopsy and histopathological study, and finally, the diagnostic value of the noninvasive methods was assessed. Results: The mean age of patients was 58.9 ± 11.7 years, and 27 cases (54.0%) were female. 38 (76.0%) of RCC patients with ESRD had ROD, and 12 patients (24.0%) had no evidence of bone disorders. The sensitivity, specificity, positive and predictive values and accuracy of the noninvasive methods for the diagnosis of ROD were 92%, 82%, 95%, 75% and 90%, respectively. Conclusion: This study showed that the frequency of ROD in RCC patients with ESRD in northern Iran was high and the biochemical and radiographic markers have a high diagnostic value for ROD as well as histopathological assessment.

Keywords: renal cell carcinoma, renal osteodystrophy, hemodialysis, non-metastatic

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Authors: Aliakbar Hafezi, Jalal Taherian, Mahsa Elahi, Jamshid Abedi

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Background: Patients with breast cancer with different molecular subtypes may have different pathological responses to neoadjuvant chemotherapy (NAC). The aim of this study was to evaluate the pathological response to NAC in patients with locally advanced breast cancer based on molecular subtypes. Method: In this retrospective cohort study, 210 female patients with breast cancer candidate for NAC referred to the radiation oncology departments in southern Iran between August 2019 and September 2024 were evaluated in terms of pathologic complete response (pCR) based on immunohistochemical molecular markers (estrogen and progesterone receptors, Her-2/neu and Ki-67), overall survival (OS) and disease-free survival (DFS). Results: The mean age of the patients was 38.22 ± 10.34 years, and 68 patients (32.4%) had a positive family history of breast cancer. The pCR rate was 17.6% (37 patients), which in the subtypes of luminal A, luminal B, Her-2/neu positive and triple negative was 7.7%, 16.9%, 26.5% and 21.05%, respectively. Patients with pCR had significantly better OS (78.4% vs. 49.1%, P = 0.014) and DFS (83.8% vs. 51.4%, P = 0.020) than patients with partial/no pathological response. Conclusion: It seems that the molecular subtype plays a decisive role in the clinical outcome and the pathological response to NAC in patients with locally advanced breast cancer.

Keywords: locally advanced breast cancer, neoadjuvant chemotherapy, pathologic complete response, clinical outcomes

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Authors: S. D. Zalepugin, A. E. Murzich, D. G. Satskevich, A. B. Palivanov

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Introduction. The incidence of spinal injuries in patients under 18 years of age has increased significantly in recent years, which represents a significant economic, social and medical problem. The most common method of surgical stabilization of spinal fractures in pediatric patients is transpedicular posterior spinal fusion, which is widely used by spinal neurosurgeons in adult patients. Purpose of the study: This study evaluates the results of treatment of thoracolumbar spine lesions in children using the transpedicular screw fixation method. Materials and methods. From 2019 to 2024, 35 children with injuries to the thoracic and lumbar spine underwent surgical treatment using the transpedicular screw fixation method. Among the injured, girls prevailed (21 cases, 60%). The age of the victims ranged from 9 to 17 years. The main causes of damage were: catatrauma (19 cases), road accident (5 cases), sports injury (6 cases), and other reasons - 5 cases. In 5 cases, suicidal attempts occurred. Co-injury was observed in most cases (20 patients, or 57%), which is natural for high-energy injury. Vertebral-spinal injury with neurological disorders was observed in 13 patients, the disorders ranged from mild inferior (4 children) to moderate/severe paraparesis (5 patients) and inferior paraplegia (4 children). 6 children had pelvic organ dysfunction in the form of urinary and fecal retention or incontinence. All thirty-five patients, within a period of 1 to 57 days after the injury, underwent several surgical interventions from the posterior surgical access using a screw fixation method (posterior decompression + spinal fusion). In 12 cases, it was necessary to perform the second stage of surgical treatment - anterior decompression of the spinal cord or its roots. Verticalization of patients was carried out within 1 to 5 days after surgery. Results. In all patients, the nearest, up to 1 year, results were evaluated. In children operated in 2019-2021, the results were studied in terms of 3 to 5 years. The procedures used, clinical results and the quality of the fixative installation were assessed. All patients managed to achieve positive results. The use of internal fixation made it possible to carry out early verticalization of children, eliminate pain syndrome and achieve a regression of neurological disorders in most patients (especially in cases when the operation was performed early after injury - from 1 to 3 days). Within the first month, the ability to self-care was fully restored. Bone fusion was observed within 6-12 months after surgery. There were no complications after surgery. The analysis of postoperative radiographs, CT and MRI images revealed the correct standing of the screws in all cases. Conclusion. The posterior spinal fusion using the new method of screw fixation in pediatric patients allows to achieve durable stabilization of damage, begins early rehabilitation of patients and reduces the duration of hospital treatment by 2-3 times. Thus, we recommend the use of a transpedicular fixator in children as a reliable, technically feasible method for restoring spinal stability with a low risk of intra- and postoperative complications.

Keywords: pediatric patients, spinal injuries, transpedicular stabilization, operative treatment

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Authors: Frank Dorrian, Aniket Adhikari

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The placenta accreta spectrum (PAS), which includes placenta accreta, increta, and percreta, is characterized by the abnormal implantation of placental chorionic villi beyond the decidua basalis. Key risk factors include placenta previa, prior cesarean sections, advanced maternal age, uterine surgeries, multiparity, pelvic radiation, and in vitro fertilization (IVF). The incidence of PAS has increased tenfold over the past 50 years, largely due to rising cesarean rates. PAS is associated with significant peripartum and postpartum hemorrhage. Magnetic resonance imaging (MRI) and ultrasound assist in the evaluation of PAS, enabling a multidisciplinary approach to mitigate morbidity and mortality. This study retrospectively analyzed PAS cases at Royal Prince Alfred Hospital, Sydney, Australia. Using the SAR-ESUR joint consensus statement, seven imaging signs were reassessed for their sensitivity and specificity in predicting PAS, with histopathological correlation. The standardized MRI protocols for PAS at the institution were also reviewed. Data were collected from the picture archiving and communication system (PACS) records from 2010 to July 2024, focusing on cases where MR imaging and confirmed histopathology or operative notes were available. This single-center, observational study provides insights into the reliability of MRI for PAS detection and the optimization of imaging protocols for accurate diagnosis. The findings demonstrate that intraplacental dark bands serve as highly sensitive markers for diagnosing PAS, achieving sensitivities of 88.9%, 85.7%, and 100% for placenta accreta, increta, and percreta, respectively, with a combined specificity of 42.9%. Sensitivity for abnormal vascularization was lower (33.3%, 28.6%, and 50%), with a specificity of 57.1%. The placenta bulge exhibited sensitivities of 55.5%, 57.1%, and 100%, with a specificity of 57.1%. Loss of the T2 hypointense interface had sensitivities of 66.6%, 85.7%, and 100%, with 42.9% specificity. Myometrial thinning showed high sensitivity across PAS conditions (88.9%, 71.4%, and 100%) and a specificity of 57.1%. Bladder wall thinning was sensitive only for placenta percreta (50%) but had a specificity of 100%. Focal exophytic mass displayed variable sensitivity (22.9%, 42.9%, and 100%) with a specificity of 85.7%. These results highlight the diagnostic variability among markers, with intraplacental dark bands and myometrial thinning being useful in detecting abnormal placentation, though they lack high specificity. The literature and the results of our study highlight that while no single feature can definitively diagnose PAS, the presence of multiple features -especially when combined with elevated clinical risk- significantly increases the likelihood of an underlying PAS. A thorough understanding of the range of MRI findings associated with PAS, along with awareness of the clinical significance of each sign, helps the radiologist more accurately diagnose the condition and assist in surgical planning, ultimately improving patient care.

Keywords: placenta, accreta, spectrum, MRI

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Authors: Chih-Rong Shyr, Chi-Ping Huang

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Intravesical BCG is the gold-standard therapy for high risk non-muscle invasive bladder cancer (NMIBC) after TURBT, but if not responsive to BCG, these BCG unresponsive patients face cystectomy that causes morbidity and comes with a morality risk. To provide the bladder sparing options for patients with BCG-unresponsive NMIBC, several new treatments have been developed to salvage the bladders and prevent progression to muscle invasive or metastatic, but however, most approved or developed treatments still fail in a significant proportion of patients without long term success. Thus more treatment options and the combination of different therapeutic modalities are urgently needed to change the outcomes. Xenogeneic rejection has been proposed to a mechanism of action to induce anti-tumor immunity for the treatment of cancers due to the similarities between rejection mechanism to xenoantigens (proteins, glycans and lipids) and anti-tumor immunities to tumor specific antigens (neoantigens, tumor associated carbohydrates and lipids). Xenogeneic urothelial cells (XUC) of porcine origin have been shown to induce anti-tumor immune responses to inhibit bladder tumor progression in mouse bladder cancer models. To further demonstrate the efficacy of the distinct intravesical XUC treatment in NMIBC, and the combined effects with chemotherapy and immune checkpoint inhibitors (ICIs) as a alternate therapeutic option, this study investigated the therapeutic effects and mechanisms of intravesical XUC immunotherapy in an orthotopic mouse immune competent model of NMIBC, generated from a mouse bladder cancer cell line. We found that the tumor progression was inhibited by intravescial XUC treatment and there was a synergy between intravesical XUC with intravesical chemotherapeutic agent, gemcitabine or systemic ICI, anti-PD1 antibody treatment. The cancer cell proliferation was decreased but the cell death was increased by the intravecisal XUC treatment. Most importantly, the mechanisms of action of intravesical XUC immunotherapy were found to be linked to enhanced infiltration of CD4+ and CD8+ T-cell as well as NK cells, but decreased presence of myeloid immunosuppressive cells in XUC treated tumors. The increased stimulation of immune cells of XUC treated mice to xenogeneic urothelial cells and mouse bladder cancer cells in immune cell proliferation and cytokine secretion were observed both as a monotherapy and in combination with intravesical gemcitabine or systemic anti PD-L1 treatment. In sum, we identified the effects of intravesical XUC treatment in monotherapy and combined therapy on tumor progression and its cellular and molecular events related to immune activation to understand the anti-tumoral mechanisms behind intravesical XUC immunotherapy for NMIBC. These results contribute to the understanding of the mechanisms behind successful xenogeneic cell immunotherapy against NMIBC and characterize a novel therapeutic approach with a new xenogeneic cell modality for BCG-unresponsive NMIBC.

Keywords: xenoantigen, neoantigen, rejection, immunity

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Authors: Malak Shawky

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Introduction: Colorectal cancer constitutes about 7% of al cancers. Abdominal perineal resection remains the standard operation against which the results of lesser procedures are measured Patients and methods : This study included 48 patients presented With pathologically proved carcinoma of the lower third of the rectum and scheduled for abdominal perineal resection With total excision of the mesorectum. They were randomized into two groups as regard the technique of colostomy after abdominal perineal resection. A study group of 24 patients underwent this new technique in which the rectus abdomnal muscle was used for wrapping the distal end of the colon in a 270 degrees and fixing the muscle to the anterior rectus sheath. A control group of 24 patients who underwent colostomy by the classical transrectal technique. Results : The use of a distal rectus muscle sling surrounding the stoma by 270 degrees achieved continence for solid stool in 12 patients of the study group compared to no patients In control group. 10 patients were able to avoid wearing colostomy appliance by day but still have to wear them by night, Patients have to wear the colostomy bags when they had diarrhea especially when they were receiving chemotherapy. One case had post post operative wound infection and gaping managed by debridment and secondary sutures without the need to remove the mesh. Manometrc studies for both control and study group showed : The average resting pressure was 40 mmHg in the study group compared to 15 mmHg in the control group. Conclusion : Continent Colostomy is a promising tool for quality of ife for abdomnal oerineal resection oatlents and a hooe of normal life for them.

Keywords: colostomy, rectum, resection, rectus

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Authors: Chris Cadman, Marcel Strauss

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Background: In 2020, the University Hospital Wishaw in the United Kingdom became the centre for trauma and orthopaedics within its health board. This resulted in the majority of patients with suspected cauda equina syndrome (CES) being assessed and imaged at this site, putting an increased demand on MR imaging and displacing other previous activity. Following this transition, imaging requests for CES did not always follow national guidelines and would often be missing important clinical and safety information. There also appeared to be a very low positive scan rate compared with previously reported studies. In an attempt to improve patient selection and reduce the burden of CES imaging at this site clinical audit was performed. Methods: A total of 250 consecutive patients imaged to assess for CES were evaluated. Patients had to have presented to either the emergency or orthopaedic department acutely with a presenting complaint of suspected CES. Patients were excluded if they were not admitted acutely or were assessed by other clinical specialities. In total, 233 patients were included. Requests were assessed for appropriate clinical history, accurate and complete clinical assessment and MRI safety information. Clinical assessment was allocated a score of 1-6 based on information relating to history of pain, level of pain, dermatomes/myotomes affected, peri-anal paraesthesia/anaesthesia, anal tone and post-void bladder volume with each element scoring one point. Images were assessed for positive findings of CES, acquired spinal stenosis or nerve root compression. Results: Overall, 73% of requests had a clear clinical history of CES. The urgency of the request for imaging was given in 23% of cases. The mean clinical assessment score was 3.7 out of a total of 6. Overall, 2% of scans were positive for CES, 29% had acquired spinal stenosis and 30% had nerve root compression. For patients with CES, 75% had acute neurological signs compared with 68% of the study population. CES patients had a mean clinical history score of 5.3 compared with 3.7 for the study population. Overall, 95% of requests had appropriate MRI safety information. Discussion: it study included 233 patients who underwent specialist assessment and referral for MR imaging for suspected CES. Despite the serious nature of this condition, a large proportion of imaging requests did not have a clear clinical query of CES and the level of urgency was not given, which could potentially lead to a delay in imaging and treatment. Clinical examination was often also incomplete, which can make triaging of patients presenting with similar symptoms challenging. The positive rate for CES was only 2%, much below other studies which had positive rates of 6–40% with a large meta-analysis finding a mean positive rate of 19%. These findings demonstrate an opportunity to improve the quality of imaging requests for suspected CES. This may help to improve patient selection for imaging and result in a positive rate for CES imaging that is more in line with other centres.

Keywords: cauda equina syndrome, acute back pain, MRI, spine

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Authors: Abuzar Baloach

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Spinal cord stimulators (SCS) are increasingly used for managing chronic pain, but their presence requires careful anesthetic planning. This review explores critical anesthetic considerations for patients with SCS, encompassing preoperative, intraoperative, and acute pain management, as well as specific considerations for obstetric and out-of-operating-room procedures. Preoperative Evaluation: Thorough assessment is essential, including a detailed medical history of the SCS device, such as type, manufacturer, and settings. Additionally, a complete pain history and a physical exam are necessary to understand the patient’s baseline neurological function and assess mobility, which can impact anesthesia management. Intraoperative Considerations: Electrocautery poses a risk for patients with SCS due to potential interference. Monopolar electrocautery is discouraged, but if needed, the grounding pad should be positioned away from the device, and the device itself should be turned off. The SCS device can introduce ECG artifacts and potentially interfere with pacemakers and defibrillators (ICD), which may result in inappropriate pacing or shocks. Precautions, including baseline ECG and interrogation, are recommended if both devices are present. Furthermore, lithotripsy, though generally avoided, can be performed under certain conditions with caution. Obstetric Anesthesia: While SCS devices are generally turned off during pregnancy, they have shown no interference with fetal cardiotocography, and epidural placement can be safely achieved with a sterile technique below the SCS leads. Acute Pain Considerations: SCS placement is taken into account in pain management plans, especially with neuraxial anesthesia, as potential risks include infection, limited spread due to fibrous sheaths, and damage to the SCS leads. Out-of-Operating Room Procedures: MRI, previously contraindicated, is now conditionally safe with SCS devices, depending on manufacturer specifications. CT scans are generally safe, though radiation should be minimized to prevent device malfunction. For radiation therapy, specific safety measures are recommended, such as keeping the beam at least 1 cm away from the device and limiting the dose to prevent damage. In conclusion, anesthetic management for SCS patients requires meticulous planning across all stages of care. By understanding the unique interactions and potential risks associated with SCS and other devices, healthcare providers can enhance patient safety and improve outcomes. Further research and the establishment of standardized guidelines are essential to optimize perioperative care for this growing patient population.

Keywords: anesthesia, chronic pain, spinal cord stimulator, SCS

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Authors: Melissa Nelson, Simran Jandu, Hana Jalal, Mia Ingram, Chrysi Stefanidou

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There is a significant overlap between autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD), with up to 90% of young people diagnosed with ASD having this co-morbidity. Distinguishing between the symptoms of the two leads to issues with accurate treatment, yet this is paramount in benefitting the young person. There are two distinct methods of treatment, psychological or pharmacological, with clinicians tending to choose one or the other, potentially due to the lack of research available. This report reviews the efficacy of psychological and pharmacological treatments for young people diagnosed with ASD and co-morbid OCD. A literature review was performed on papers from the last fifteen years, including “ASD,” “OCD,” and individuals under the age of 18. Eleven papers were selected as relevant. The report looks at the comparison between more traditional methods, such as selective serotonin reuptake inhibitors (SSRI) and cognitive behavior therapy (CBT), and newer therapies, such as modified or intensive ASD-focused psychotherapies and the use of other medication classes. On reviewing the data, it was identified that there was a distinct lack of information on this important topic. The most widely used treatment was medication such as Fluoxetine, an SSRI, which rarely showed an improvement in symptoms or outcomes. This is in contrast to modified forms of CBT, which often reduces symptoms or even results in OCD remission. With increased research into the non-traditional management of these co-morbid conditions, it is clear there is scope that modified CBT may become the future treatment of choice for OCD in young people with ASD.

Keywords: autism spectrum disorder, intensive or adapted cognitive behavioral therapy, obsessive compulsive disorder, pharmacological management

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Authors: Evgeny Pokushalov, Andrey Ponomarenko, John Smith, Michael Johnson, Claire Garcia, Inessa Pak, Evgenya Shrainer, Dmitry Kudlay, Sevda Bayramova, Richard Miller

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Background: Obesity is a complex, multifactorial chronic disease that poses significant health risks. Recent advancements in artificial intelligence (AI) offer the potential for more personalized and effective dietary supplement (DS) regimens to promote weight loss. This study aimed to evaluate the efficacy of AI-guided DS prescriptions compared to standard physician-guided DS prescriptions in obese patients. Methods: This randomized, parallel-group pilot study enrolled 60 individuals aged 40 to 60 years with a body mass index (BMI) of 25 or greater. Participants were randomized to receive either AI-guided DS prescriptions (n = 30) or physician-guided DS prescriptions (n = 30) for 180 days. The primary endpoints were the percentage change in body weight and the proportion of participants achieving a ≥5% weight reduction. Secondary endpoints included changes in BMI, fat mass, visceral fat rating, systolic and diastolic blood pressure, lipid profiles, fasting plasma glucose, hsCRP levels, and postprandial appetite ratings. Adverse events were monitored throughout the study. Results: Both groups were well balanced in terms of baseline characteristics. Significant weight loss was observed in the AI-guided group, with a mean reduction of -12.3% (95% CI: -13.1 to -11.5%) compared to -7.2% (95% CI: -8.1 to -6.3%) in the physician-guided group, resulting in a treatment difference of -5.1% (95% CI: -6.4 to -3.8%; p < 0.01). At day 180, 84.7% of the AI-guided group achieved a weight reduction of ≥5%, compared to 54.5% in the physician-guided group (Odds Ratio: 4.3; 95% CI: 3.1 to 5.9; p < 0.01). Significant improvements were also observed in BMI, fat mass, and visceral fat rating in the AI-guided group (p < 0.01 for all). Postprandial appetite suppression was greater in the AI-guided group, with significant reductions in hunger and prospective food consumption, and increases in fullness and satiety (p < 0.01 for all). Adverse events were generally mild-to-moderate, with higher incidences of gastrointestinal symptoms in the AI-guided group, but these were manageable and did not impact adherence. Conclusion: The AI-guided dietary supplement regimen was more effective in promoting weight loss, improving body composition, and suppressing appetite compared to the physician-guided regimen. These findings suggest that AI-guided, personalized supplement prescriptions could offer a more effective approach to managing obesity. Further research with larger sample sizes is warranted to confirm these results and optimize AI-based interventions for weight loss.

Keywords: obesity, AI-guided, dietary supplements, weight loss, personalized medicine, metabolic health, appetite suppression

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Authors: Evgeny Pokushalov, Claire Garcia, Andrey Ponomarenko, John Smith, Michael Johnson, Inessa Pak, Evgenya Shrainer, Dmitry Kudlay, Leila Kasimova, Richard Miller

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This study evaluated the efficacy of an AI-guided dietary supplement regimen compared to a standard physician-guided regimen in managing Type 2 diabetes (T2D). A total of 160 patients were randomly assigned to either the AI-guided group (n=80) or the physician-guided group (n=80) and followed over 90 days. The AI-guided group received 5.3 ± 1.2 supplements per patient, while the physician-guided group received 2.7 ± 0.6 supplements per patient. The AI system personalized supplement types and dosages based on individual genetic and metabolic profiles. The AI-guided group showed a significant reduction in HbA1c levels from 7.5 ± 0.8% to 7.1 ± 0.7%, compared to a reduction from 7.6 ± 0.9% to 7.4 ± 0.8% in the physician-guided group (mean difference: -0.3%, 95% CI: -0.5% to -0.1%; p < 0.01). Secondary outcomes, including fasting plasma glucose, HOMA-IR, and insulin levels, also improved more in the AI-guided group. Subgroup analyses revealed that the AI-guided regimen was particularly effective in patients with specific genetic polymorphisms and elevated metabolic markers. Safety profiles were comparable between both groups, with no serious adverse events reported. In conclusion, the AI-guided dietary supplement regimen significantly improved glycemic control and metabolic health in T2D patients compared to the standard physician-guided approach, demonstrating the potential of personalized AI-driven interventions in diabetes management.

Keywords: Type 2 diabetes, AI-guided supplementation, personalized medicine, glycemic control, metabolic health, genetic polymorphisms, dietary supplements, HbA1c, fasting plasma glucose, HOMA-IR, personalized nutrition

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Effective management of hypertension remains a critical public health challenge, particularly among racially and ethnically diverse populations. This study employs sophisticated statistical models to rigorously investigate the predictors of poor blood pressure (BP) control, with a specific focus on demographic, socioeconomic, and clinical risk factors. Leveraging a large sample of 19,253 adults drawn from the National Health and Nutrition Examination Survey (NHANES) across three distinct time periods (2013-2014, 2015-2016, and 2017-2020), we applied multivariable logistic regression and generalized estimating equations (GEE) to account for the clustered structure of the data and potential within-subject correlations. Our multivariable models identified significant associations between poor BP control and several key predictors, including race/ethnicity, age, gender, body mass index (BMI), prevalent diabetes, and chronic kidney disease (CKD). Non-Hispanic Black individuals consistently exhibited higher odds of poor BP control across all periods (OR = 1.99; 95% CI: 1.69, 2.36 for the overall sample; OR = 2.33; 95% CI: 1.79, 3.02 for 2017-2020). Younger age groups demonstrated substantially lower odds of poor BP control compared to individuals aged 75 and older (OR = 0.15; 95% CI: 0.11, 0.20 for ages 18-44). Men also had a higher likelihood of poor BP control relative to women (OR = 1.55; 95% CI: 1.31, 1.82), while BMI ≥35 kg/m² (OR = 1.76; 95% CI: 1.40, 2.20) and the presence of diabetes (OR = 2.20; 95% CI: 1.80, 2.68) were associated with increased odds of poor BP management. Further analysis using GEE models, accounting for temporal correlations and repeated measures, confirmed the robustness of these findings. Notably, individuals with chronic kidney disease displayed markedly elevated odds of poor BP control (OR = 3.72; 95% CI: 3.09, 4.48), with significant differences across the survey periods. Additionally, higher education levels and better self-reported diet quality were associated with improved BP control. College graduates exhibited a reduced likelihood of poor BP control (OR = 0.64; 95% CI: 0.46, 0.89), particularly in the 2015-2016 period (OR = 0.48; 95% CI: 0.28, 0.84). Similarly, excellent dietary habits were associated with significantly lower odds of poor BP control (OR = 0.64; 95% CI: 0.44, 0.94), underscoring the importance of lifestyle factors in hypertension management. In conclusion, our findings provide compelling evidence of the complex interplay between demographic, clinical, and socioeconomic factors in predicting poor BP control. The application of advanced statistical techniques such as GEE enhances the reliability of these results by addressing the correlated nature of repeated observations. This study highlights the need for targeted interventions that consider racial/ethnic disparities, clinical comorbidities, and lifestyle modifications in improving BP control outcomes.

Keywords: hypertension, blood pressure, NHANES, generalized estimating equations

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

Abstract:

To develop a machine learning model to predict diabetes (DM) prevalence in the U.S. population using demographic characteristics, physical indicators, and lifestyle habits, and to analyze how these factors contribute to the likelihood of diabetes. We analyzed data from 23,546 participants aged 20 and older, who were non-pregnant, from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). The dataset included key demographic (age, sex, ethnicity), physical (BMI, leg length, total cholesterol [TCHOL], fasting plasma glucose), and lifestyle indicators (smoking habits). A weighted sample was used to account for NHANES survey design features such as stratification and clustering. A classification machine learning model was trained to predict diabetes status. The target variable was binary (diabetes or non-diabetes) based on fasting plasma glucose measurements. The following models were evaluated: Logistic Regression (baseline), Random Forest Classifier, Gradient Boosting Machine (GBM), Support Vector Machine (SVM). Model performance was assessed using accuracy, F1-score, AUC-ROC, and precision-recall metrics. Feature importance was analyzed using SHAP values to interpret the contributions of variables such as age, BMI, ethnicity, and smoking status. The Gradient Boosting Machine (GBM) model outperformed other classifiers with an AUC-ROC score of 0.85. Feature importance analysis revealed the following key predictors: Age: The most significant predictor, with diabetes prevalence increasing with age, peaking around the 60s for males and 70s for females. BMI: Higher BMI was strongly associated with a higher risk of diabetes. Ethnicity: Black participants had the highest predicted prevalence of diabetes (14.6%), followed by Mexican-Americans (13.5%) and Whites (10.6%). TCHOL: Diabetics had lower total cholesterol levels, particularly among White participants (mean decline of 23.6 mg/dL). Smoking: Smoking showed a slight increase in diabetes risk among Whites (0.2%) but had a limited effect in other ethnic groups. Using machine learning models, we identified key demographic, physical, and lifestyle predictors of diabetes in the U.S. population. The results confirm that diabetes prevalence varies significantly across age, BMI, and ethnic groups, with lifestyle factors such as smoking contributing differently by ethnicity. These findings provide a basis for more targeted public health interventions and resource allocation for diabetes management.

Keywords: diabetes, NHANES, random forest, gradient boosting machine, support vector machine

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Background and Aims: This meta-analysis aimed to evaluate the effect of vitamin D supplementation on key metabolic and cardiovascular parameters, such as glycated hemoglobin (HbA1C), fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic blood pressure (SBP), and total vitamin D levels in patients with Type 2 diabetes mellitus (T2DM). Methods: A systematic search was performed across databases, including PubMed, Scopus, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov, from January 1990 to January 2024. A total of 4,177 relevant studies were initially identified. Using an unsupervised K-means clustering algorithm, publications were grouped based on common text features. Maximum entropy classification was then applied to filter studies that matched a pre-identified training set of 139 potentially relevant articles. These selected studies were manually screened for relevance. A parallel manual selection of all initially searched studies was conducted for validation. The final inclusion of studies was based on full-text evaluation, quality assessment, and meta-regression models using random effects. Sensitivity analysis and publication bias assessments were also performed to ensure robustness. Results: The unsupervised K-means clustering algorithm grouped the patients based on their responses to vitamin D supplementation, using key biomarkers such as HbA1C, FBS, LDL, HDL, SBP, and total vitamin D levels. Two primary clusters emerged: one representing patients who experienced significant improvements in these markers and another showing minimal or no change. Patients in the cluster associated with significant improvement exhibited lower HbA1C, FBS, and LDL levels after vitamin D supplementation, while HDL and total vitamin D levels increased. The analysis showed that vitamin D supplementation was particularly effective in reducing HbA1C, FBS, and LDL within this cluster. Furthermore, BMI, weight gain, and disease duration were identified as factors that influenced cluster assignment, with patients having lower BMI and shorter disease duration being more likely to belong to the improvement cluster. Conclusion: The findings of this machine learning-assisted meta-analysis confirm that vitamin D supplementation can significantly improve glycemic control and reduce the risk of cardiovascular complications in T2DM patients. The use of automated screening techniques streamlined the process, ensuring the comprehensive evaluation of a large body of evidence while maintaining the validity of traditional manual review processes.

Keywords: HbA1C, T2DM, SBP, FBS

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Limited research has examined the variations in dietary quality among U.S. adults diagnosed with chronic conditions like diabetes mellitus (DM), osteoarthritis (OA), and rheumatoid arthritis (RA), particularly across different age groups. Understanding how diet differs in relation to these conditions is crucial to developing targeted nutritional interventions. This cross-sectional study analyzed data from adult participants in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2021. Dietary quality was measured using the Healthy Eating Index (HEI)-2015 scores, encompassing both total and component scores for different dietary factors. Self-reported disease statuses for DM, OA, and RA were obtained, with age groups stratified into younger adults (20–59 years, n = 10,050) and older adults (60 years and older, n = 5,200). Logistic regression models, adjusted for demographic factors like sex, race/ethnicity, education, income, weight status, physical activity, and smoking, were used to examine the relationship between disease status and dietary quality, accounting for NHANES' complex survey design. Among younger adults, 8% had DM, 10% had OA, and 4% had RA. Among older adults, 22% had DM, 35% had OA, and 7% had RA. The results showed a consistent association between excess added sugar intake and DM in both age groups. In younger adults, excess sodium intake was also linked to DM, while low seafood and plant protein intake was associated with a higher prevalence of RA. Among older adults, a poor overall dietary pattern was strongly associated with RA, while OA showed varying associations depending on the intake of specific nutrients like fiber and saturated fats. The dietary quality of U.S. adults with DM, OA, and RA varies significantly by age group and disease type. Younger adults with these conditions demonstrated more specific dietary inadequacies, such as high sodium and low protein intake, while older adults exhibited a broader pattern of poor dietary quality, particularly in relation to RA. These findings suggest that personalized nutritional strategies are needed to address the unique dietary challenges faced by individuals with chronic conditions in different age groups.

Keywords: dietary, diabetes, osteoarthritis, rheumatoid arthritis, logistic regression

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Physiological changes during pregnancy, such as alterations in the circulatory, respiratory, and musculoskeletal systems, can negatively impact daily physical activity. This reduced activity is often associated with an increased risk of adverse maternal health outcomes, particularly gestational diabetes mellitus (GDM) and excessive weight gain. This meta-analysis aims to evaluate the effectiveness of structured physical exercise interventions during pregnancy in reducing the risk of GDM and managing maternal weight gain. A comprehensive search was conducted across six major databases: PubMed, Cochrane Library, EMBASE, Web of Science, ScienceDirect, and ClinicalTrials.gov, covering the period from database inception until 2023. Randomized controlled trials (RCTs) that explored the effects of physical exercise programs on pregnant women with low physical activity levels were included. The search was performed using EndNote and results were managed using RevMan (Review Manager) for meta-analysis. RCTs involving healthy pregnant women with low levels of physical activity or sedentary lifestyles were selected. These RCTs must have incorporated structured exercise programs during pregnancy and reported on outcomes related to GDM and maternal weight gain. From an initial pool of 5,112 articles, 65 RCTs (involving 11,400 pregnant women) met the inclusion criteria. Data extraction was performed, followed by a quality assessment of the selected studies using the Cochrane Risk of Bias tool. The meta-analysis was conducted using RevMan software, where pooled relative risks (RR) and weighted mean differences (WMD) were calculated using a random-effects model to address heterogeneity across studies. Sensitivity analyses, subgroup analyses (based on factors such as exercise intensity, duration, and pregnancy stage), and publication bias assessments were also conducted. Structured physical exercise during pregnancy led to a significant reduction in the risk of developing GDM (RR = 0.68; P < 0.001), particularly when the exercise program was performed throughout the pregnancy (RR = 0.62; P = 0.035). In addition, maternal weight gain was significantly reduced (WMD = −1.18 kg; 95% CI −1.54 to −0.85; P < 0.001). There were no significant adverse effects reported for either the mother or the neonate, confirming that exercise interventions are safe for both. This meta-analysis highlights the positive impact of regular moderate physical activity during pregnancy in reducing the risk of GDM and managing maternal weight gain. These findings suggest that physical exercise should be encouraged as a routine part of prenatal care. However, more research is required to refine exercise recommendations and determine the most effective interventions based on individual risk factors and pregnancy stages.

Keywords: gestational diabetes, maternal weight management, meta-analysis, randomized controlled trials

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Authors: Mjellma Rexhepi, Blerta Rexhepi Kelmendi, Blana Krasniqi, Shaip Krasniqi

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Rheumatoid arthritis is a chronic disease that causes inflammation of the joints which can be so severe that can cause not only deformities but also impairment of function that limits movement. This also contributes to the pain that accompanies this disease. This remains a problematic and challenging disease of modern medicine because treatment is still symptomatic. The main purpose of drug treatment is to reduce the activity of the disease, achieve remission, avoid disability and death. The etiology of the disease is idiopathic, but can also be linked to genetic, nongenetic factors such as hormonal, environmental or infectious. Current scientific evidence shows that vitamin D plays an important role in immune regulation mechanisms. Lack of this vitamin has been linked to loss of immune tolerance and the appearance of autoimmune processes, including rheumatoid arthritis. The purpose of the work was to define Vitamin D in patients hospitalized with rheumatoid arthritis in University Clinical Center of Kosova, as a basis of their connection with lifestyle and physical inactivity. The sample for the work was selected from patients with criteria met for rheumatoid arthritis who were hospitalized at the tertiary level of health care in Kosova. During the work have been investigated 100 consecutive patients fulfilling diagnostic criteria for rheumatoid arthritis, whereas in addition to the general characteristics are also determined the values of vitamin D at the beginning of hospitalization. The average age of the sample analyzed was 50.9±5.7 years old, with an average duration of rheumatoid arthritis disease 7.8±3.4 years. At the beginning of hospitalization, before treatment was initiated, the average value of vitamin D was 15.86±3.43, which according to current reference values is classified into the category of insufficient values. Correlating the duration of the disease, from the time of diagnosis to the day of hospitalization, on one side and the level of vitamin D on the other side, the negative correlation of a lower degree derived (r =-0.1). Physical activity affects the concentration of vitamin D in the blood through increased metabolism of fat and the release of vitamin D and its metabolites from adipose tissue. To now it is evident that physical activity is also accompanied by higher levels of vitamin D. In patients with rheumatoid arthritis, vitamin D levels were low compared to normal. Future works should be oriented toward investigating in detail the bone structure, quality of life and pain in patients with rheumatoid arthritis. More detailed scientific projects, with larger numbers of participants, should be designed for the future to clarify more possible mechanisms as factors related to this phenomenon such as inactivity, lifestyle and the duration of the disease, as well as the importance of keeping vitamin D values at normal limits.

Keywords: hospitalization, lifestyle, rheumatoid arthritis, vitamin D

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Authors: Andy Ho

Abstract:

Breast cancer is a common cancer in Australia. Early diagnosis is crucial for improving patient outcomes, as later-stage detection correlates with poorer prognoses. While multiparametric MRI offers superior sensitivity in detecting invasive and high-grade breast cancers compared to conventional mammography, its extended scan duration and high costs limit widespread application. As a result, full protocol MRI screening is typically reserved for patients at elevated risk. Recent advancements in imaging technology have facilitated the development of Abbreviated MRI protocols, which dramatically reduce scan times (<10 minutes compared to >30 minutes for full protocol). The potential for Abbreviated MRI to offer a more time- and cost-efficient alternative has implications for improving patient accessibility, reducing appointment durations, and enhancing compliance—especially relevant for individuals requiring regular annual screening over several decades. The purpose of this study is to assess the diagnostic efficacy of Abbreviated MRI for breast cancer screening among high-risk patients at the Royal Prince Alfred Hospital (RPA). This study aims to determine the sensitivity, specificity, and inter-reader variability of Abbreviated MRI protocols when interpreted by subspecialty-trained Breast Radiologists. A systematic review of the RPA’s electronic Picture Archive and Communication System identified high-risk patients, defined by Australian ‘Medicare Benefits Schedule’ criteria, who underwent Breast MRI from 2021 to 2022. Eligible participants included asymptomatic patients under 50 years old and referred by the High-Risk Clinic due to a high-risk genetic profile or relevant familial history. The MRIs were anonymized, randomized, and interpreted by four Breast Radiologists, each independently completing standardized proforma evaluations. Radiological findings were compared against histopathology as the gold standard or follow-up imaging if biopsies were unavailable. Statistical metrics, including sensitivity, specificity, and inter-reader variability, were assessed. The Fleiss-Kappa analysis demonstrated a fair inter-reader agreement (kappa = 0.25; 95% CI: 0.19–0.32; p < 0.0001). The sensitivity for detecting malignancies was 0.72, with a specificity of 0.92. For benign lesions, sensitivity and specificity were 0.844 and 0.73, respectively. These findings underline the potential of Abbreviated MRI as a reliable screening tool for malignancies with significant specificity, though reduced sensitivity highlights the importance of robust radiologist training and consistent evaluation standards. Abbreviated MRI protocols exhibit promise as a viable screening option for high-risk patients, combining reduced scan times and acceptable diagnostic accuracy. Further work to refine interpretation practices and optimize training is essential to maximize the protocol’s utility in routine clinical screening and facilitate broader accessibility.

Keywords: abbreviated, breast, cancer, MRI

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Authors: Pheeraphat Ussadamongkol, Suthasinee Sinawat

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Objective: The purpose of this study is to evaluate the anatomical and visual outcomes associated with the use of heavy silicone oil (HSO) during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). Materials and methods: A Total of 66 eyes of 66 patients with RRD patients who underwent PPV with HSO from 2018-2023 were included in this retrospective study. Risk factors of surgical outcomes were also investigated. Results: The mean age of the recruited patients was 55.26 ± 13.05 years. The most common diagnosis was recurrent RRD, with 43 patients (65.15%), and the majority of these patients (81.39%) had a history of multiple vitreoretinal surgeries. Inferior breaks and PVR grade ≧ C were present in 65.15% and 42.42% of cases, respectively. The mean duration of HSO tamponade was 7.77+5.19 months. The retinal attachment rate after surgery was 71.21%, with a final attachment rate of 87.88%. The mean final VA was 1.62 ± 1.11 logMAR. 54.54% of patients could achieve a final visual acuity (VA)  6/60. Multivariate analysis revealed that proliferative vitreoretinopathy (PVR) and multiple breaks were significantly associated with retinal redetachment, while initial good VA (  6/60) was associated with good visual outcome ( 6/60). The most common complications were glaucoma (30.3%) and epimacular membrane (7.58%). Conclusion: The use of heavy silicone oil in pars plana vitrectomy for rhegmatogenous retinal detachment yields favorable anatomical and visual outcomes. Factors associated with retinal redetachment are proliferative vitreoretinopathy and multiple breaks. Good initial VA can predict good visual outcomes.

Keywords: rhegmatogenous retinal detachment, heavy silicone oil, surgical outcome, visual outcome, risk factors

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Authors: Maierhaba Mijiti

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Objective：The aim is to understand the relationship between the expression level of the long-non-coding RNA LINC AC008063 and the clinicopathological parameters of patients with head and neck squamous cell carcinoma (HNSCC), and to clarify the biological function of LINC AC008063 in HNSCC cells. Moreover, it provides a potential biomarker for the diagnosis, treatment, and prognosis evaluation of HNSCC. Methods: The expression level of LINC AC008063 in the HNSCC was analyzed using transcriptome sequencing data from the TCGA (The cancer genome atlas) database. The expression levels of LINC AC008063 in human embryonic lung diploid cells 2BS, human immortalized keratinocytes HACAT, HNSCC cell lines CAL-27, Detroit562, AMC-HN-8, FD-LSC-1, FaDu and WSU-HN30 were determined by real-time quantitative PCR (qPCR). RNAi (RNA interference) was introduced for LINC AC008063 knockdown in HNSCC cell lines, the localization and abundance analysis of LINC AC008063 was determined by RT-qPCR, and the biological functions were examined by CCK-8, clone formation, flow cytometry, transwell invasion and migration assays, Seahorse assay. Results: LINC AC008063 was upregulated in HNSCC tissue (P<0.001), and verified b CCK-8, clone formation, flow cytometry, transwell invasion and migration assays, Seahorse assayy qPCR in HNSCC cell lines. The survival analysis revealed that the overall survival rate (OS) of patients with high LINC AC008063 expression group was significantly lower than that in the LINC AC008063 expression group, the median survival times for the two groups were 33.10 months and 61.27 months, respectively (P=0.002). The clinical correlation analysis revealed that its expression was positively correlated with the age of patients with HNSCC (P<0.001) and positively correlated with pathological state (T3+T4＞T1+T2, P=0.03). The RT-qPCR results showed that LINC AC008063 was mainly enriched in cytoplasm (P=0.01). Knockdown of LINC AC008063 inhibited proliferation, colony formation, migration and invasion; the glycolytic capacity was significantly decreased in HNSCC cell lines (P＜0.05). Conclusion: High level of LINC AC008063 was associated with the malignant progression of HNSCC as well as promoting the important biological functions of proliferation, colony formation, migration and invasion; in particular, the glycolytic capacity was decreased in HNSCC cells. Therefore, LINC AC008063 may serve as a potential biomarker for HNSCC and a distinct molecular target to inhibit glycolysis.

Keywords: head and neck squamous cell carcinoma, oncogene, long non-coding RNA, LINC AC008063, invasion and metastasis

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Authors: Philip Eappen, Narasimha Rao Vajjhala

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This chapter examines how healthcare organizations harnessed innovative healthcare informatics to navigate the challenges posed by the COVID-19 pan-demic, addressing critical needs and improving care delivery. The pandemic's un-precedented demands necessitated the adoption of new and advanced tools to manage healthcare operations more effectively. Informatics solutions played a crucial role in facilitating the smooth functioning of healthcare systems during this crisis and are anticipated to remain central to future healthcare management. Technologies such as telemedicine helped healthcare professionals minimize ex-posure to COVID-19 patients, thereby reducing infection risks within healthcare facilities. This chapter explores a range of informatics applications utilized worldwide, including telemedicine, AI-driven solutions, big data analytics, drones, robots, and digital platforms for drug delivery, all of which enabled re-mote patient care and enhanced healthcare accessibility and safety during the pan-demic.

Keywords: healthcare informatics, COVID-19 Pandemic, telemedicine, AI-driven healthcare, big data analytics, remote patient care, digital health platforms

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Diabetic nephropathy (DN) is a major complication of diabetes, with fibrosis and propionate metabolism playing critical roles in its progression. Identifying biomarkers linked to these pathways may provide novel insights into DN diagnosis and treatment. This study aims to identify biomarkers associated with fibrosis and propionate metabolism in DN. Analyze the biological pathways and regulatory mechanisms of these biomarkers. Develop a machine learning model to predict DN-related biomarkers and validate their functional roles. Publicly available transcriptome datasets related to DN (GSE96804 and GSE104948) were obtained from the GEO database (https://www.ncbi.nlm.nih.gov/gds), and 924 propionate metabolism-related genes (PMRGs) and 656 fibrosis-related genes (FRGs) were identified. The analysis began with the extraction of DN-differentially expressed genes (DN-DEGs) and propionate metabolism-related DEGs (PM-DEGs), followed by the intersection of these with fibrosis-related genes to identify key intersected genes. Instead of relying on traditional models, we employed a combination of deep neural networks (DNNs) and ensemble methods such as Gradient Boosting Machines (GBM) and XGBoost to enhance feature selection and biomarker discovery. Recursive feature elimination (RFE) was coupled with these advanced algorithms to refine the selection of the most critical biomarkers. Functional validation was conducted using convolutional neural networks (CNN) for gene set enrichment and immunoinfiltration analysis, revealing seven significant biomarkers—SLC37A4, ACOX2, GPD1, ACE2, SLC9A3, AGT, and PLG. These biomarkers are involved in critical biological processes such as fatty acid metabolism and glomerular development, providing a mechanistic link to DN progression. Furthermore, a TF–miRNA–mRNA regulatory network was constructed using natural language processing models to identify 8 transcription factors and 60 miRNAs that regulate these biomarkers, while a drug–gene interaction network revealed potential therapeutic targets such as UROKINASE–PLG and ATENOLOL–AGT. This integrative approach, leveraging deep learning and ensemble models, not only enhances the accuracy of biomarker discovery but also offers new perspectives on DN diagnosis and treatment, specifically targeting fibrosis and propionate metabolism pathways.

Keywords: diabetic nephropathy, deep neural networks, gradient boosting machines (GBM), XGBoost

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Controlling blood pressure is critical to reducing the risk of cardiovascular disease. However, BP control rates (systolic BP < 140 mm Hg and diastolic BP < 90 mm Hg) have declined since 2013, warranting further analysis to identify contributing factors and potential interventions. This study investigates the factors associated with the decline in blood pressure (BP) control among U.S. adults with hypertension over the past decade. Data from the U.S. National Health and Nutrition Examination Survey (NHANES) were used to assess BP control trends between 2013 and 2020. The analysis included 18,927 U.S. adults with hypertension aged 18 years and older who completed study interviews and examinations. The dataset, obtained from the cardioStatsUSA and RNHANES R packages, was merged based on survey IDs. Key variables analyzed included demographic factors, lifestyle behaviors, hypertension status, BMI, comorbidities, antihypertensive medication use, and cardiovascular disease history. The prevalence of BP control declined from 78.0% in 2013-2014 to 71.6% in 2017-2020. Non-Hispanic Whites had the highest BP control prevalence (33.6% in 2013-2014), but this declined to 26.5% by 2017-2020. In contrast, BP control among Non-Hispanic Blacks increased slightly. Younger adults (aged 18-44) exhibited better BP control, but control rates declined over time. Obesity prevalence increased, contributing to poorer BP control. Antihypertensive medication use rose from 26.1% to 29.2% across the study period. Lifestyle behaviors, such as smoking and diet, also affected BP control, with nonsmokers and those with better diets showing higher control rates. Key findings indicate significant disparities in blood pressure control across racial/ethnic groups. Non-Hispanic Black participants had consistently higher odds (OR ranging from 1.84 to 2.33) of poor blood pressure control compared to Non-Hispanic Whites, while odds among Non-Hispanic Asians varied by cycle. Younger age groups (18-44 and 45-64) showed significantly lower odds of poor blood pressure control compared to those aged 75+, highlighting better control in younger populations. Men had consistently higher odds of poor control compared to women, though this disparity slightly decreased in 2017-2020. Medical comorbidities such as diabetes and chronic kidney disease were associated with significantly higher odds of poor blood pressure control across all cycles. Participants with chronic kidney disease had particularly elevated odds (OR=5.54 in 2015-2016), underscoring the challenge of managing hypertension in these populations. Antihypertensive medication use was also linked with higher odds of poor control, suggesting potential difficulties in achieving target blood pressure despite treatment. Lifestyle factors such as alcohol consumption and physical activity showed no consistent association with blood pressure control. However, dietary quality appeared protective, with those reporting an excellent diet showing lower odds (OR=0.64) of poor control in the overall sample. Increased BMI was associated with higher odds of poor blood pressure control, particularly in the 30-35 and 35+ BMI categories during 2015-2016. The study highlights a significant decline in BP control among U.S. adults with hypertension, particularly among certain demographic groups and those with increasing obesity rates. Lifestyle behaviors, antihypertensive medication use, and socioeconomic factors all played a role in these trends.

Keywords: diabetes, blood pressure, obesity, logistic regression, odd ratio

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Authors: Prajwal Paudel, Shreeprasad Adhikari, Shailendra Bir Karmacharya, Kalpana Upadhyaya

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Background: Human milk banks have been recommended by the World Health Organization (WHO) for newborn and child nourishment in the provision of optimum nutrition as an alternative to breastfeeding in circumstances when direct breastfeeding is inaccessible. The vulnerable group of babies, mainly preterm, low birth weight, and sick newborns, are at a greater risk of mortality and possibly benefit from the safe use of donated human milk through milk banks. In this study, we aimed to shed light on the process involved during the setting up of the nation’s first milk bank and its vitality in small and sick newborn nutrition and care. Methods: The study was conducted in Paropakar Maternity and Women’s Hospital, where the first human milk (HMB) was established. The establishment involved a stepwise process of need assessment meeting, formation of the HMB committee, learning visit to HMB in India, studying the strengths and weaknesses of promoting breastfeeding and HMB system integration, procurement, installation, and setting up the infrastructure, and developing technical competency, launching of the HMB. After the initiation of HMB services, information regarding the recruited donor mothers and the volume of milk pasteurized and consumed by the needy recipient babies were recorded. Descriptive statistics with frequencies and percentages were used to describe the utilization of HMB services. Results: During the study period, a total of 506113 ml of milk was collected, while 49930 ml of milk was pasteurized. Of the pasteurized milk, 381248 ml of milk was dispensed. The total volume of milk received was from a total of 883 after proper routine screening tests. Similarly, the total number of babies who received the donated human milk (DHM) was 912 with different neonatal conditions. Among the babies who received DHM, 527(57.7%) were born via CS, and 385 (42.21%) were delivered normally. In the birth weight category,9 (1%) of the babies were less than 1000 grams, 75 (8.2%) were less than 1500 grams, 405 (44.4%) were between 1500 to less than 2500 grams whereas, 423 (46.4%) of the babies who received DHM were normal weight babies. Among the sick newborns, perinatal asphyxia accounted for 166 (18.2%), preterm with other complications 372 (40.7%), preterm 23 (2.02%), respiratory distress 140 (15.35%), neonatal jaundice 150 (16.44%), sepsis 94 (10.30%), meconium aspiration syndrome 9(1%), seizure disorder 28 (3.07%), congenital anomalies 13 (1.42%) and others 33(3. 61%). The neonatal mortality rate dropped to 6.2/1000 live births from 7.5/1000 live births in the first year of establishment as compared to the previous year. Conclusion: The establishment of the first HMB in Nepal involved a comprehensive approach to integrate a new system with the existing newborn care in the provision of safe DHM. Premature babies with complication, babies born via CS, perinatal asphyxia and babies with sepsis consumed the greater proportion of DHM. Rigorous research is warranted to assess the impact of DHM in small and sick newborn who otherwise would be fed formula milk.

Keywords: human milk bank, sick-newborn, mortality, neonatal nutrition

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Authors: Sharlene Fernandes

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Literature has shed light on the challenges of mothers of children with ASD, one of which involves sacrificing their professional jobs to fulfill the demands of their caregiving roles. However, the voices of the mothers who pursue employment along with caregiving roles have been overlooked. This study aimed to address this issue by exploring the narratives of Employed Mothers of Children with Autism Spectrum Disorder using the Narrative approach to inquiry. Through the view of Feminist Standpoint Theory, this study attempted to understand the role of sociocultural and systemic factors in shaping the lives of mothers. By employing the theoretical lens of Ethics of Care, this study explored how mothers balance care with their employment responsibilities, which are expected to be balanced seamlessly. Through narrative interviews, the study addressed the mothers' narratives on navigating work and caregiving, delving into their interpretations regarding expectations of care. The study gained valuable insights into the nuanced dynamics of employment, caregiving, and gender roles among mothers of children with Autism in the Indian context, implicating the urgent need for organizational policies, enhanced support systems, better quality therapeutic services, and inclusive school developments.

Keywords: Autism Spectrum Disorder, Caregivers, Employed Mothers, India, Narratives

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Authors: Mohammed Mustafa, Fatima Abusin, Mariam Abufatema

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Objective: This audit aims to evaluate the practices and outcomes of operative vaginal deliveries (OPVD) at Mayo University Hospital, focusing on identifying trends, complications, and adherence to clinical guidelines. Methods: A retrospective review was conducted on all cases of operative vaginal deliveries at Mayo University Hospital over one year. Data was collected from patient records, including demographics, OPVD indications, types of instruments used (forceps or vacuum), maternal and neonatal outcomes, and any associated complications. Statistical analyses were performed to assess the rates of successful and unsuccessful OPVDs and identify factors influencing outcomes. Results: The study included 159 [out of 174 total OPVD in 1 year] cases of operative vaginal deliveries. The indications predominantly consisted of the prolonged second stage of labor, fetal distress and suspicious CTG. The success rate of OVD was [97.5%]; maternal perineal tears [10 cases], hemorrhage[43 cases] and neonatal outcomes needed for SCBU admission[12 cases] were also assessed. Conclusion: This audit provides insights into the current practices and outcomes of operative vaginal deliveries at Mayo University Hospital. The findings underline the importance of adherence to clinical guidelines and highlight areas for potential improvement in practice

Keywords: OPVD operative vaginal delivery, GTG green top guidelines, PPH postpartum hemorrhage, SCBU special care baby unit

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