Journal of Advances in Medical and Biomedical Research
Volume:31 Issue: 146, May-Jun 2023

Machine learning and artificial intelligence are useful tools to analyze data with multiple variables. It has been shown that the prediction models obtained by Machine learning have better performance than the conventional statistical methods. This study was aimed to assess the risk factors and determine the best machine learning prediction model/s for in-hospital mortality among patients who underwent prosthetic valve replacement surgery.

In this retrospective cross-sectional study, patient’s pre-operative, intra-operative and post-operative data underwent univariate analysis. Feature importance determination was carried out using algorithms including principal component analysis (PCA), support vector machine (SVM), random forest (RF) model-based, and recursive feature elimination (RFE). Then, 13 machine learning classifiers were implemented for in-hospital prediction model.

The In-hospital mortality rate was 6.36%. Data from 2455 patients underwent final analysis. The machine learning results revealed that among pre-operative features, Adaptive boost (AB) and RF classifiers (AUC: 0.82±0.033; 0.78±0.028, respectively); among intra-operative features, AB and K-nearest neighbors (KNN) classifiers (AUC: 0.68±0.014); among postoperative features, AB and RF classifiers (AUC: 0.9±0.1; 0.88±0.095, respectively); and among all features, AB and LR classifiers (AUC: 0.93±0.049; 0.93±0.055, respectively) had the best performance in prediction of in-hospital mortality.

The AB classifier was determined as the best model in prediction of in-hospital mortality in all 4 datasets.

Although the pain severity following laparoscopic cholecystectomy is generally lower compared to the open method, but some patients may still experience abdominal and shoulder pain for several days after the laparoscopic procedure. Based on recent evidences, pneumoperitoneum using low-pressure carbon dioxide gas can reduce the pain. This study evaluated the feedback on shoulder pain severity from laparoscopic cholecystectomy patients experiencing CO2-pneumoperitoneum.

80 laparoscopic cholecystectomy cases were allocated for intervention (n = 40) and control groups (n = 40) randomly. Pneumoperitoneum was done by a direct trocar. Patients’ pain feedback was assessed using the visual pain scale after the surgery. SPSS 21 was used to analyze the collected data.

Shoulder pain frequency significantly differed between the two groups at 12 hours (P = 0.048) and 24 hours (P = 0.001) after the surgery. Regarding average shoulder pain severity, the groups showed significant differences after 2, 6, and 24 hours of surgery (P < 0.05). Moreover, pneumoperitoneum duration was different in the groups (P = 0.001).

Based on these findings, low pressure of pneumoperitoneum with active evacuation compared to the standard pressure, efficiently reduced shoulder pain intensity. Thus, using low-pressure pneumoperitoneum in laparoscopic cholecystectomy is recommended to relieve postoperative pain.

The platelet-derived growth factor receptor (PDGFR) signaling pathway has a vital function as a regulator of glioma development. PDGFRA alterations have been observed in a variety of cancers and have been important clinical targets for tyrosine kinase inhibitors like Imatinib. The aim of this study was to evaluate the role of PDGFRA and PDGFA in the pathogenesis of GBM and to determine whether the constitutive activation of PDGFRA is driven by gene mutations or protein expression.

PDGFRA-activating gene mutations (exons 12, 18) were assessed in a subset of 75 samples, of which 65 were GBM and 10 were pilocytic astrocytoma, using PCR followed by direct sequencing. PDGFA expression was evaluated by immunohistochemistry in a series of 20 cases including 15 cases of glioblastoma multiforme and 5 cases of pilocytic astrocytoma.

No PDGFRA-activating mutations were found by Sanger sequencing. In addition, this study found polymorphism in PDGFRA exon 12, c.1701A> G, which was a silent mutation. Immunohistochemical analysis showed elevated PDGFA expression in 25% (5 out of 20) of glioma cases. PDGFA expression was not detected in any pilocytic astrocytoma; however, 33.33% (5 out of 15) of GBM samples showed increased PDGFA expression.

Consistent with previous studies, the findings of the present study underline the importance of PDGFA and PDGFRA alterations as a possible potential predictive biomarker and a therapeutic target in GBM. Further research is needed to better understand the underlying genetic mechanisms driving abnormal PDGFRA activity in gliomas.

 Chronic inflammation, dyspnea and activity limitation are common phenomena in patients with chronic obstructive lung disease.  Clinical studies suggest that Ubiquinone has anti-inflammatory and energetic properties. Here the beneficial effect of CoQ10 in patients with COPD will be studied.

 Baesd on the census method, 90 patients with moderate to severe COPD were divided into two identical placebo and CoQ10 groups. High sensitive-C-reactive protein (hs-CRP), Forced Expiratory Volume in 1 second, numerical rating breathlessness scale and "the time to get exhausted" were evaluated and recorded at baseline and the end of the study. The CoQ10 group received 120 mg of CoQ10 supplement per day versus the placebo group who also received a placebo (identical in look, size and taste to pharmaceutical sample) and were followed for 6 weeks. Data were analyzed using t-test, and nonparametric statistical tests. Qualitative variables were assessed by chi-square or Fisher exact tests. 

 The study included 49(53.6%) women and 41(46.4%) men, collectively 90 patients with moderate to severe COPD. The mean age was 66.97±12.59 years in the placebo and 64.21±11.78 years in the CoQ10 group (p=0.30). Breathlessness scale was improved in CoQ10 group (p<0.001). hs-CRP significantly declined after intervention in the CoQ10 compared to  the placebo group (p<0.001).No serious side effects were observed as a result of CoQ10 consumption.

 Daily administration of CoQ10 in COPD patients increases hs-CRP and improves dyspnea and "the time to get exhausted” without side effect.

 Chronic myeloid leukemia (CML) is a myeloproliferative disorder caused by an aberrant BCR-ABL fusion protein. Imatinib mesylate (IM) is a tyrosine kinase inhibitor that induces clinical remissions in chronic-phase CML patients. The T315I mutation at the gatekeeper residues of BCR-ABL confers resistance to both IM and second-generation TKIs, including dasatinib and nilotinib. Our objective was to determine the prevalence of T315I mutation between two groups of CML patients before and during Imatinib treatment in North-East of Iran.

 This study was conducted on 100 newly diagnosed cases of CML (before commencing IM treatment) and 25 IM-resistant CML patients. PCR-RFLP, ASO-PCR, and direct sequencing were performed to detect T315I mutations.

 The median age of newly-diagnosed and IM-resistant patients was 48±14 and 50±12.3 years, respectively. Males/Females ratio was 1 and 1.08 for newly diagnosed and IM-resistant patients, respectively. There was no significant difference regarding the age and sex between the two groups. During the study, T315I mutational analysis was performed for all 125 patients. The prevalence of T315I mutation was 0% and 4% for newly-diagnosed and IM-resistant patients, respectively. T315I mutation was not detected before IM administration, although it was detected in 1 (4%) among resistant patients who were at least 6-months on IM treatment.

 These observations suggest that T315I mutation may be categorized as secondary resistance and induce clonal expansion due to BCR/ABL instability. Hence, BCR-ABL mutations are less likely to appear before the onset of treatment, as presented in our study.

Given the importance of the benefits of natural childbirth and the complications of recurrent cesarean section, we have conducted the present study to determine the maternal and neonatal complications of natural childbirth after cesarean section.

In this case-control study, the obstetric complications of 84 women who had undergone a previous cesarean delivery referred to Baqiyatallah Hospital in 2018 for vaginal delivery after cesarean section (VBAC) delivery compared with 84 women with a previous vaginal delivery, who intended to give birth vaginally for the second delivery. Demographic, anthropometric, obstetric, and perinatal data of them were collected and registered in a researcher-developed form. Two groups were compared using the t-test and chi-square test.

The mean age in VBAC and control group was 30.49±6.83 and 32.08±7.28 years, respectively (P=0.15). There were not any occurrence of urinary rupture, bladder rupture, stool control disorder, uterine rupture, nephrotic infection, and ICU hospitalization of the mothers in the two groups. Regarding puerperal infection (3.57% in the VBAC group and 4.76% in the control group, P=0.69) and hospitalization of neonates in ICU (9.52% in the VBAC group and 5.95% in the control group, p=0.39), there was no significant difference between the two groups.

It seems that the overall incidence of obstetric complications in women attempting vaginal birth after cesarean delivery is low and not higher than those with prior vaginal delivery. Therefore, for the achievement of benefits of natural childbirth for both the mother and the fetus, women with a prior cesarean should be offered VBAC.

Breast cancer (BC) is the leading cause of cancer mortality among women in different countries around the world, including India. Monoclonal antibodies (MoAbs) have emerged as a promising targeted treatment for BC, improving the survival rate of these patients with minimum adverse effects. This study aimed to investigate the severity of the adverse effects of MoAbs in an Indian population.

This longitudinal descriptive study was conducted on 120 BC patients over six months in a tertiary care hospital in Bangalore, India, in 2020. A data collection form was used to gather relevant data. The collected data were analyzed by SPSS Version 21, using Chi-square and Fisher’s exact tests. A P-value less than 0.05 was considered statistically significant.

Among 97 patients evaluated in this study (including 29 patients in the non-exposed group), the adverse effects of BC were observed in all age groups. Most adverse effects were attributed to trastuzumab (37.50%; CI: 31.6-44) and bevacizumab (26.78%; CI: 20.9-31.8). The MoAbs were well tolerated by the patients, causing minimum adverse effects that were manageable by supportive therapy. Anemia was the most prevalent adverse effect. Evaluation of the null hypothesis indicated that the adverse effects of MoAbs depended on their amount and composition. The results of analysis using the Naranjo scale revealed that most of the adverse effects were probable (67%) and possible (32%), respectively. Also, according to the WHO scale, most of the adverse effects were under the categories of probable (61.20%) and possible (38.14%), respectively.

Based on the present results, the adverse effects of MoAbs were manageable by supportive care. Anemia was found to be the most prevalent adverse effect. Meanwhile, no potential adverse cardiovascular event was observed in patients on trastuzumab, except one case of dilated cardiomyopathy.

Due to the importance of the rapid diagnosis of SARS-COV-2, many studies have been performed on various diagnostic methods. In this vein, the aim of this study is to compare the diagnostic value of chest CT with RT-PCR in patients with suspected COVID-19.

This cross-sectional research was conducted at Shahid Sadoughi Hospital in Yazd. A total of 531 patients were randomly referred to the CT scan department for chest imaging (spiral or HRCT).Based on the PCR findings, they were divided into: positive and negative PCR groups. The CT scan findings were then recorded in a data collection form. Finally, the CT scan results of the two groups were compared.

In this study, 531 patients (306 males and 225 females with the mean age of 55.14 ± 19.7) were examined. The findings of reverse hallo (P = 0.000) and strict consolidation (P= 0.001) in CT scan were significantly different for the positive and negative PCR groups. Through the comparative analysis of the results, the sensitivity of CT scan and PCR findings emerged to be 97.42 and 55.75, respectively. However, the specificity of both diagnostic methods was 100%.

The results of this study show that, owing to the higher sensitivity of chest CT for the diagnosis of COVID-19 pneumonia, performing CT scan for quick diagnosis is recommended for COVID suspected people with negative RT-PCR test results.

 A variety of synthetic and chemical drugs have been established for the treatment of candidiasis, but each has some limitations and its probable side effects. This study attempts to touch upon the antifungal activity of different concentrations of hydroalcoholic extracts of Aloe vera against Candida albicans in in vitro conditions.

 Hydroalcoholic extract from Aloe vera leaves was tested for anti-fungal activity via an in vitro study. Anti-fungal activity and minimum inhibitory concentration (MIC) were determined by the disk diffusion method. Aloe vera hydroalcoholic extracts (75%, 50%, 25%, and 12.5%) were used as test groups. The data were analyzed by ANOVA using SPSS 23 software. The level of statistical significance was set at p≤ 0.05.

 The results revealed that Aloe vera contained substantial anti-fungal activity. There was a significant discrepancy in the mean diameter of the inhibition zone of C. albicans growth among different concentrations of Aloe vera (p-value=0.001). Also, there was a statistically significant difference between the average diameter of the inhibition zone of C. albicans growth at a concentration of 12.5% of Aloe vera extract compared to concentrations of 25%, 50%, and 75% Aloe vera, and concentration of 50% with 25% and 75% extracts. Aloe vera extract at 75% concentration effectively inhibited the growth of C. albicans compared with the positive control-nystatin. In this study, Aloe vera concentration of 20% was determined as the MIC for C. albicans.

 In adherence to the present results, it seems that Aloe vera extract, which is inexpensive and has no side effects, could be introduced as an alternative to nystatin.

 Among facial plastic surgical procedures, septorhinoplasty is deemed the most complex. A critical stage in this process is the effective handling of variations in the septum and turbinate. This research aimed to assess the differences and pathological irregularities in the septum and lateral nasal wall of patients scheduled for septorhinoplasty at a university-based hospital in northern Iran.

 This cross-sectional study focused on all septorhinoplasty candidates aged between 18-60 years. Observations during surgery, such as the location and category of septal abnormalities, and the location and type of lateral nasal wall abnormalities (including lower and middle turbinate hypertrophy, concha bullosa, and paradoxical turbinate) were meticulously documented and analyzed.

 Of the 672 participants, 469 patients (69.8%) presented with septum abnormalities, while 143 patients (21.3%) demonstrated disorders of the lateral nasal wall. The most frequent findings were spurred vomer (24.6%) and lower turbinate hypertrophy (46.9%).

 Given the broad range and high incidence of disorders in the septum and lateral nasal wall, it is reasonable to routinely incorporate radiological investigations into the preoperative assessment of surgical candidates. This approach can potentially identify pathological findings, minimize postoperative complications, and optimize the surgical outcomes.

 Pregnancy is a unique immunological condition in which the immune system is affected and therefore there is a greater risk of severe disease and mortality from COVID-19 disease. The present study aimed to evaluate the clinical manifestation, laboratory findings, and adverse outcomes among a population of pregnant women confirmed with COVID 19 infection.

 In present cross-sectional study, all pregnant women with COVID-19 referred to Mousavi Hospital in Zanjan City from February 2020 to August 2021 including 232 patients were examined. We used a researcher-made checklist to extract the required information, including socio-demographic data, potential risk factors, clinical manifestations, laboratory parameters, and fetal, and neonatal outcomes of the patients. Comparison of laboratory parameters in women with COVID-19 according to ICU admission was made using independent t-test and Mann-Whitney U test.

 47.4%, of women were 30 to 40 years old, 45.7% were illiterate. Weakness, myalgia, dry cough, and fatigue were the most common clinical symptoms (>90%). Patients had abnormal levels of ALT and AST, whereas the means of other laboratory parameters were in the normal range. Forty- one (17.6%) of patients were admitted to the ICU. The means of C - reactive protein (46.58 vs. 25.87), lactate dehydrogenase (586.31 vs. 480.97), Blood urea nitrogen (9.43 vs. 8.26), and erythrocyte sedimentation rate (62.40 vs. 46.11) were statistically higher in patients admitted to ICU than those who were not in the ICU (P <0.05). Mortality rates among women who had a vaginal delivery and C-section were 3% and 6.1%, respectively.

 The most common laboratory findings in COVID-19- infected mothers were lymphopenia and elevated CRP, ALT, D-Dimer, and LDH. An increased hospitalization in ICU and higher rates of mother and fetal death were complications of pregnancy and childbirth in COVID-19- infected women.

All age groups are at risk of contracting and dying of Coronavirus disease (COVID-19). However, older people and those with underlying conditions, comorbidities and disability levels are at higher risk of developing a serious illness, especially those living in enclosed spaces such as nursing homes and care centers, are more vulnerable to getting this disease, which can become fatal during this pandemic. Other reasons that make them more susceptible include population density, sharing equipment, poor public health measurements and infection controlling and close contact with roommates, which may all these factors increase the transmission rate and risk of infection. Therefore, we aimed to investigate the outbreak of COVID-19 in a chronic psychiatric rehabilitation center called Behboud center in Hamadan, west of Iran. It is a rehabilitation center with 85 women clients and 16 staff.