A two-stream deep model for automated ICD-9 code prediction in an intensive care unit.

Assigning medical codes for patients is essential for healthcare organizations, not only for billing purposes but also for maintaining accurate records of patients' medical histories and analyzing the outputs of certain procedures. Due to the abundance of disease codes, it can be laborious and time-consuming for medical specialists to manually assign these codes to each procedure. To address this problem, we discuss the automatic prediction of ICD-9 codes, the most popular and widely accepted system of medical coding. We introduce a two-stream deep learning framework specifically designed to analyze multi-modal data. This framework is applied to the extensive and publicly available MIMIC-III dataset, enabling us to leverage both numerical and text-based data for improved ICD-9 code prediction. Our system uses text representation models to understand the text-based medical records; the Gated Recurrent Unit (GRU) to model the numerical health records; and fuses these two streams to automatically predict the ICD-9 codes used in the intensive care unit. We discuss the preprocessing and classification methods and demonstrate that our proposed two-stream model outperforms other state-of-the-art studies in the literature.

Serum ferritin and vitamin D levels should be evaluated in patients with diffuse hair loss prior to treatment.

INTRODUCTION: Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients. AIM: We aimed to compare the serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and vitamin D in patients complaining of diffuse hair loss and in healthy individuals. MATERIAL AND METHODS: Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively. RESULTS: Serum concentrations of folate, vitamin B12, zinc and thyroid stimulating hormone were similar in the two groups. However, the mean serum ferritin and 25-hydroxyvitamin D levels were significantly lower in patients with hair loss than in healthy individuals. The mean serum ferritin levels of the patients and healthy individuals were 14.72 ±10.70 ng/ml and 25.30 ±14.41 ng/ml, respectively. The mean serum 25-hydroxyvitamin D levels of the patients and healthy individuals were 14.03 ±8.09 ng/ml and 17.01 ±8.59 ng/ml, respectively. Eleven (20.4%) patients had low serum ferritin levels, while 43 (79.6%) patients had low vitamin D levels. CONCLUSIONS: The results obtained from this study reveal that serum ferritin and 25-hydroxyvitamin D levels are generally low in patients complaining of hair loss. Therefore, serum ferritin and vitamin D levels should be evaluated and supplemented prior to treatment in all patients complaining of diffuse hair loss.

Colonoscopy in patients with psoriasis before the initiation of treatment with biological agents.

Psoriasis may lead to subsequent colorectal cancer, since chronic systemic inflammation is the common etiologic factor in both psoriasis and colorectal cancer. It is a matter of dispute whether biological agents used in the treatment of psoriasis cause predisposition to colorectal cancer as a result of their immunosuppressive effect. Medical records of psoriasis patients who underwent colonoscopy before biological agents were reviewed. Colonoscopy was performed in all patients who were aged 50 years and older and in patients younger than 50, if they had positive fecal occult blood test results. The study included 95 patients between the age of 34 to 84. Colonoscopy results revealed tubular adenoma in 16 (16.8%) patients, hyperplastic polyps in 7 (7.4%) patients, villous adenoma in 1 (1.1%) patient, and tubulovillous adenoma in 1 (1.1%) patient. Two patients were diagnosed with colon cancer detected by a former colonoscopy, which was recommended by their dermatologist before the biological agent treatment plan. These results revealed that adenomatous polyps which can evolve to colon adenocarcinoma were the most frequent polyp type in patients with psoriasis. We suggest that routine colonoscopy should be performed before the initiation of biological therapy in psoriasis patients who are aged 50 years old and over.

Pre-treatment vitamin B12, folate, ferritin, and vitamin D serum levels in patients with warts: a retrospective study.

AIM: To compare the serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone between patients with warts and healthy individuals. METHODS: This retrospective study enrolled 40 patients with warts and 40 healthy individuals treated at the Ufuk University Hospital, Ankara, between July and December 2017. Serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone status were evaluated retrospectively. RESULTS: Participants with and without warts had similar mean serum 25-hydroxyvitamin D, ferritin, folate, zinc, and thyroid stimulating hormone levels. However, patients with warts had significantly lower mean serum vitamin B12 level (P=0.010). Patients with warts non-significantly more frequently had decreased serum levels of 25-hydroxyvitamin D, ferritin, and folate (P=0.330, P=0.200, P=0.070, respectively). CONCLUSION: Patients with warts may require evaluation of serum levels of vitamin B12, folate, ferritin, and vitamin D.

Is mean platelet volume an inflammatory marker in acne patients treated with isotretinoin?

INTRODUCTION: Isotretinoin is a commonly used systemic retinoid for treating acne. However, isotretinoin may lead to elevated serum levels of triglycerides and cholesterol, and it may affect liver function tests. Moreover, the effect of isotretinoin on hematological parameters remains controversial. This study examines changes in the blood chemistry panel, hematological parameters, and inflammation biomarkers of patients diagnosed with acne and treated with isotretinoin. METHODS: The study included 70 patients (59 females and 11 males, between ages 18 and 37) with moderate to severe acne vulgaris treated with isotretinoin. The medical records and laboratory findings of the participants were reviewed retrospectively between March 2017 and September 2018. All the patients whose necessary laboratory test results could be obtained from the collected data were included in the study. RESULTS: Serum total cholesterol, HDL, LDL, triglyceride, mean corpuscular hemoglobin levels, and platelet/lymphocyte ratio increased, whereas white blood cell count and mean platelet volume (p = 0.036) decreased after isotretinoin treatment. CONCLUSIONS: The results of this study revealed that mean platelet volume decreased significantly 3 months after the initiation of isotretinoin treatment. Therefore, we suggest considering mean platelet volume as an inflammatory marker in patients with acne treated with isotretinoin. However, this research should be replicated under more randomized conditions in a prospective study to reach a definitive conclusion.

Estrogen receptor positive, progesterone receptor negative, leiomyoma of the areola of a male patient.

Leiomyoma of the nipple and areola is a rare subtype of genital leiomyoma. The etiology of the tumor is not well understood. However, sex hormones like estrogen and progesterone have been implicated in the tumorigenesis. Hereby, we report a 47-year-old man with an estrogen receptor positive, progesterone receptor negative, leiomyoma of the areola.

Staphylococcus aureus is the most common bacterial agent of the skin flora of patients with seborrheic dermatitis.

BACKGROUND: Seborrheic dermatitis is an inflammatory skin disease that affects 1-3% of the general population. The Malassezia species has been implicated as the main causative agent; however, the bacterial flora of the skin may also play role in the etiopathogenesis. Therefore, we investigated the most common bacterial agent of the skin flora of patients with seborrheic dermatitis. MATERIALS AND METHODS: Fifty-one patients with seborrheic dermatitis and 50 healthy individuals are included in this study. Sterile cotton swabs were rubbed on the scalp of the participants for bacterial culture. Colonial morphology was identified with gram stain and catalase test. RESULTS: Staphylococcus aureus was isolated from 25 (49%) patients with seborrheic dermatitis and 10 (20%) healthy individuals within the control group. Coagulase-negative staphylococci were isolated from 24 (47.1%) patients with seborrheic dermatitis and 17 (34%) healthy individuals within the control group. Diphtheroids were present in 2 (3.9%) patients and 1 (2%) subject within the control group. Gram-negative bacilli were present only in 1 (2%) patient. Hemolytic streptococci and bacilli were identified in 1 (2%) subject from each group. Colonization of coagulase-negative staphylococci, diphtheroids, gram-negative bacilli, hemolytic streptococci, and bacillus did not differ between patients and healthy controls. However, S. aureus colonization was significantly more common in patients with seborrheic dermatitis than in healthy controls. CONCLUSION: Within this study we revealed that S. aureus colonization was significantly higher among the patients. Therefore, we propose that, in addition to the Malassezia species, S. aureus may play a role in the etiopathogenesis of seborrheic dermatitis.

Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique.

INTRODUCTION: Pilonidal sinus disease can be treated with various surgical techniques. However, invasive surgical techniques harbor the risk of wound infection and require a long postoperative wound healing period. The treatment of pilonidal sinus disease with crystallized phenol is minimally invasive with a short postoperative recovery period. This article explains how to treat pilonidal sinus disease with crystallized phenol using a quick and easy three-step technique. METHODS: Between August 2014 and January 2016, 43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol. Hair was gently removed from the sinus openings with a mosquito clamp. Afterwards, the pilonidal sinus openings were gently filled with crystallized phenol. RESULTS: The closure of pilonidal sinus openings without any leakage after a single application of crystallized phenol was accepted as healing. The treatment failed in two of the female patients, who had had prior pilonidal sinus surgery, and in four of the male patients, who had a recurrence after wound site infection. The overall cure rate was 88%. CONCLUSIONS: Treatment of pilonidal sinus disease with crystallized phenol using the three-step technique is simple, fast, and comfortable. Therefore, crystallized phenol should be preferentially considered in the treatment of pilonidal sinus disease.