DNA damage and ALAD polymorphism in high blood lead (Pb) levels of pregnant women attending a tertiary care teaching hospital.

Background: Pregnant women are particularly vulnerable to lead toxicity due to increased absorption and decreased elimination of lead from their bodies. The δ-aminolevulinic acid dehydratase (ALAD) gene plays a crucial role in lead metabolism, and its polymorphisms have been implicated in modifying the susceptibility to lead toxicity. Methods: A cross-sectional study was conducted involving 90 pregnant women and blood samples were collected to measure blood lead levels (BLL) and assessed DNA damage using the comet assay. ALAD polymorphisms were genotyped using PCR-RFLP analysis with MspI restriction enzyme. Statistical analysis, including chi-square tests, logistic regression, and correlation analysis, was performed to determine associations between ALAD polymorphisms, BLL, and DNA damage. Results: From 90 pregnant women the participants, 16 had high BLL (≥5 µg/dL), while the remaining 74 had normal levels (<5 µg/dL). The ALAD 1-2 genotype was found to be significantly associated with high BLL (p < 0.001). Pregnant women with the ALAD 1-2 genotype exhibited higher levels of DNA damage compared to those with other genotypes (p < 0.001). Furthermore, a positive correlation was observed between the transfer of lead concentration from mother to infant and DNA damage severity (r = 0.511, p < 0.001). Conclusions: The combination of comet assay and polymorphism analysis offers a comprehensive approach to understanding the impact of lead exposure during pregnancy. These findings underscore the urgent need for effective regulatory measures to reduce lead exposure in the environment and mitigate its adverse effects of lead on maternal and child health.

A Case-Control Study Utilizing Red Cell Distribution Width as a Bio-Inflammatory Marker in Pre-eclampsia.

INTRODUCTION: This research was conducted to assess the effectiveness of red cell distribution width (RDW) as an indicator for pre-eclampsia (PE), a condition characterized by elevated blood pressure and the presence of protein in the urine occurring beyond the 20th week of pregnancy. METHODOLOGY: The case-control investigation spanned 10 months, following the acquisition of informed consent and the receipt of ethical clearance. The study sample comprised a total of 70 pregnant women, evenly divided into two groups: 35 cases of PE and 35 normotensive pregnant controls. Both the cases and controls provided 3 ml venous blood samples. The study employed a semi-automated three-part hematological analyzer to establish the baseline RDW for all individuals. RESULTS: This study showed that the individuals with pre-eclampsia had a greater RDW compared to the healthy pregnant women. The observed difference was found to be statistically significant, with a p-value of 0.004. The receiver operating curve (ROC) analysis showed that RDW exhibited significant diagnostic accuracy in differentiating between cases and controls (area under the curve [AUC] = 0.71, P = 0.004) when employing a cut-off value of >= 18.25. The sensitivity was 80% and the specificity was 71.4%. CONCLUSION: In contrast to other indicators of inflammation, RDW is a cost-effective and easily accessible biomarker that can be acquired from routine complete blood counts. It has the potential to be valuable in predicting and diagnosing pre-eclampsia.

Comparison of cosmesis, mydriasis, fundus visibility, and anterior chamber depth following single-pass four-throw pupilloplasty in congenital and traumatic iris defects.

PURPOSE: To compare postoperative cosmesis, mydriasis, fundus visibility, and anterior chamber depth (ACD) in congenital and traumatic iris defects after single-pass four-throw pupilloplasty (SFTP). SETTINGS AND DESIGN: Hospital-based non-randomized interventional study. METHODS: SFTP was done along with phacoemulsification in six patients each with congenital and traumatic iris defects, and the patients were followed for a minimum period of 3 months. The postoperative pupil shape, size, mydriasis, and ACD were compared between the two groups. RESULTS: Tissue approximation was successful in 11 out of 12 patients (91.7%), whereas it failed to do so in one patient with traumatic iris tear (8.3%). A central round pupil was attained in all six patients with congenital defects (group 1), whereas in the traumatic group (group 2), a central round pupil was attained in four cases. Group 1 did not show a significant reduction in horizontal pupil diameter, but group 2 had a significant reduction in pupil diameter postoperatively. Mydriasis and fundus visibility were satisfactory in all cases. There was a significant deepening of ACD in both groups. CONCLUSION: Traumatic mydriasis usually requires SFTP at two opposite poles to achieve a central pupil with a significant reduction in pupil size, whereas congenital coloboma requires SFTP to be done at the site of coloboma with occasional enlargement at the opposite pole if the pupil is eccentric.

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

BACKGROUND: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. AIM: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. METHODS: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. RESULTS: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. CONCLUSION: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Luteal Phase Stimulation in the Same Cycle Is an Effective Strategy to Rescue POSEIDON Poor Responders with No Embryos after the First Follicular Stimulation.

Background: Poor responders may benefit from recruiting a 'second wave' of antral follicles within the same cycle. This concept forms the basis of double stimulation which has been named as 'DuoStim'. This protocol involves ovarian stimulation in both follicular and luteal phases with egg retrieval in each phase, respectively, to increase the number of oocytes and embryos in one menstrual cycle. This can be considered a potentially valuable option for women with poor ovarian reserve/response to maximise the number of oocytes retrieved in a single ovarian cycle in the shortest possible time. Aims: The aim of this study was to evaluate the efficacy of the DuoStim protocol in women classified as POSEIDON poor responders undergoing in vitro fertilization by comparing the embryological outcomes between the follicular and luteal phase stimulations in the same menstrual cycle. Settings and Design: This was a retrospective cohort study of 131 patients who enrolled to undergo DuoStim cycles from January 2021 to Sept. 2022, at a IVF center in a tertiary care hospital. Materials and Methods: The follicular phase stimulation used a standard antagonist protocol for the first oocyte retrieval. Thereafter, the luteal phase stimulation was started 3 days after the first retrieval, with the same dose of gonadotropin along with a daily 10 mg medroxyprogesterone acetate tablet, followed by a second oocyte retrieval. Blastocysts produced in both the phases were subsequently vitrified. Statistical Analysis Used: The paired t-test was used for comparing means and 95% confidence intervals (CIs) for different parameters. McNemar's test was used to compare paired proportions. The analysis was conducted using R statistical environment 4.2. Results: The mean number of oocytes retrieved and the mean number of utilizable blastocysts frozen per stimulation cycle were found to be significantly higher in the luteal phase as compared to the follicular phase (5.71 ± 3.95 vs. 4.87 ± 2.79, P = 0.02, and 1.43 ± 1.22 vs. 0.95 ± 1, P = 0.001, respectively). However, the mean fertilization rate and the mean blastocyst utilization rate were found to be similar between both the phases. The length of stimulation was found to be approximately 3 days longer in the luteal phase (12.63 ± 2.43 vs. 9.75 ± 1.85, P = 0.001). Overall, the odds of obtaining a usable blastocyst in the luteal phase was found to be significantly higher than in the paired follicular phase (73.9% vs. 57.7%, P = 0.012, odds ratio: 2.286 [95% CI: 1.186-4.636]). Also importantly, the luteal phase stimulation was able to rescue 68% (32/47) of patients where no blastocysts were formed in the follicular phase. Conclusion: Our data demonstrate that in women with poor reserve, the addition of luteal stimulation could increase the chances of achieving a pregnancy by significantly increasing the number of eggs and transferable embryos per menstrual cycle compared to follicular stimulation alone. Furthermore, luteal phase stimulation in the same cycle proved to be an effective strategy to rescue POSEIDON poor responders with no embryos after the first stimulation.

An Insight Into Tuberculosis Patients in the Chest Clinic of North India: Epidemiological Profile and Treatment Outcomes in the Wake of COVID-19.

Objectives Our study aims to re-evaluate the epidemiological profile and treatment outcomes of TB patients enrolled at the chest clinic of a tertiary care center after the third wave of COVID-19 in New Delhi. Patients and methods We have conducted an observational analytical study after taking the IEC approval from October 2022 to February 2022 on the TB patients enrolled from March 2022 to August 2022. The total data of 1114 TB patients was analyzed. The association between various factors and treatment outcomes was assessed using the chi-square test. To identify the independent effects of these factors on treatment outcomes, we did a multiple logistic regression analysis. Results We found that the treatment outcomes were mostly successful (83.9%, n=935), while a few patients lost to follow-up (11.7%, n=130) and died (4.4%, n=49). Deaths were significantly higher among geriatrics (19%, n=15), PTB (4.9%, n=30), and MDR TB (15%, n=3). The treatment success was highest among the new category of patients (85.1%, n=807), followed by retreatment patients (80.1%, n=117) and MDR TB patients (55%, n=11). Adults and geriatrics had a significantly higher risk of death (4.45 times and 27.93 times, respectively) compared to pediatrics. In addition, death risks were higher among males (1.6 times for females), MDR TB patients (17 times for new patients), and HIV-reactive patients (3.05 times for HIV non-reactive patients). Conclusion We found that males, HIV-TB co-infection, the geriatric population, pulmonary TB patients, and MDR TB were at a higher risk of death. By identifying high-risk groups, policymakers can prioritize targeted interventions and allocate resources effectively to address the specific needs of these vulnerable populations.

Platelet factors are induced by longevity factor klotho and enhance cognition in young and aging mice.

Platelet factors regulate wound healing and can signal from the blood to the brain1,2. However, whether platelet factors modulate cognition, a highly valued and central manifestation of brain function, is unknown. Here we show that systemic platelet factor 4 (PF4) permeates the brain and enhances cognition. We found that, in mice, peripheral administration of klotho, a longevity and cognition-enhancing protein3-7, increased the levels of multiple platelet factors in plasma, including PF4. A pharmacologic intervention that inhibits platelet activation blocked klotho-mediated cognitive enhancement, indicating that klotho may require platelets to enhance cognition. To directly test the effects of platelet factors on the brain, we treated mice with vehicle or systemic PF4. In young mice, PF4 enhanced synaptic plasticity and cognition. In old mice, PF4 decreased cognitive deficits and restored aging-induced increases of select factors associated with cognitive performance in the hippocampus. The effects of klotho on cognition were still present in mice lacking PF4, suggesting this platelet factor is sufficient to enhance cognition but not necessary for the effects of klotho-and that other unidentified factors probably contribute. Augmenting platelet factors, possible messengers of klotho, may enhance cognition in the young brain and decrease cognitive deficits in the aging brain.

Longevity factor klotho enhances cognition in aged nonhuman primates.

Cognitive dysfunction in aging is a major biomedical challenge. Whether treatment with klotho, a longevity factor, could enhance cognition in human-relevant models such as in nonhuman primates is unknown and represents a major knowledge gap in the path to therapeutics. We validated the rhesus form of the klotho protein in mice showing it increased synaptic plasticity and cognition. We then found that a single administration of low-dose, but not high-dose, klotho enhanced memory in aged nonhuman primates. Systemic low-dose klotho treatment may prove therapeutic in aging humans.

Association of Autonomic Balance With Phone Call Duration in Healthy Individuals.

Background This study aimed to estimate the association of autonomic balance with the duration of phone calls in healthy individuals. Methodology A total of 30 subjects aged between 18 and 30 years without any established systemic disease and using mobile phones for more than five years with minimum daily usage of 30 minutes were included in this analytical study. Heart rate variability (HRV) was recorded using a three-channel physiograph (AD Instruments South Asia (India) Pvt. Ltd., New Delhi, India) with the software LabChart PROV8.1.8 with HRV Module version 2.0.3 for 10 minutes. Time domain parameters were recorded in terms of the standard deviation of normal to normal interval (SDNN), root mean square of successive differences between normal heartbeats (RMSSD), R-R intervals greater than 50 ms (pRR50), and mean heart rate (MHR), and frequency domain parameters were total power, low-frequency power (LF), high-frequency power (HF), and the ratio of low-frequency to high-frequency power (LF/HF). HRV was recorded three times in each subject that included baseline HRV, HRV during the use of a mobile phone, and HRV after the use of a mobile phone. Results A total of 30 subjects (14 males and 16 females) participated in this study. The mean age of participants was 31.93 ± 8.59 years (32.07 ± 9.87 years for males, and 31.81 ± 7.64 years for females). There were no findings of significant arrhythmia in any of the participants. There was a significant difference in pRR50 on comparing all three phases (p = 0.036). However, there was no significant variation in other parameters such as very low frequency (VLF, ms2), VLF (%), LF (ms2), LF (%), HF (ms2), HF (%), LF/HF, SDNN (ms), RMSSD (ms), Poincare plot standard deviation perpendicular to the line of identity (ms), Poincare plot standard deviation along the line of identity (ms), systolic blood pressure (mmHg), and diabolic blood pressure (mmHg) during, before, and after exposure to mobile phone calls. There was no significant difference in the value of all parameters between males and females (p < 0.05). Conclusions Mobile phone calls may influence HRV and autonomic balance. This change may be affected by the electromagnetic field and by speaking as well.

Salt stress resilience in plants mediated through osmolyte accumulation and its crosstalk mechanism with phytohormones.

Salinity stress is one of the significant abiotic stresses that influence critical metabolic processes in the plant. Salinity stress limits plant growth and development by adversely affecting various physiological and biochemical processes. Enhanced generation of reactive oxygen species (ROS) induced via salinity stress subsequently alters macromolecules such as lipids, proteins, and nucleic acids, and thus constrains crop productivity. Due to which, a decreasing trend in cultivable land and a rising world population raises a question of global food security. In response to salt stress signals, plants adapt defensive mechanisms by orchestrating the synthesis, signaling, and regulation of various osmolytes and phytohormones. Under salinity stress, osmolytes have been investigated to stabilize the osmotic differences between the surrounding of cells and cytosol. They also help in the regulation of protein folding to facilitate protein functioning and stress signaling. Phytohormones play critical roles in eliciting a salinity stress adaptation response in plants. These responses enable the plants to acclimatize to adverse soil conditions. Phytohormones and osmolytes are helpful in minimizing salinity stress-related detrimental effects on plants. These phytohormones modulate the level of osmolytes through alteration in the gene expression pattern of key biosynthetic enzymes and antioxidative enzymes along with their role as signaling molecules. Thus, it becomes vital to understand the roles of these phytohormones on osmolyte accumulation and regulation to conclude the adaptive roles played by plants to avoid salinity stress.

Demographic profile, management, and survival of primary Gastrointestinal Kaposi Sarcoma: A USA Nationwide SEER-based study.

Kaposi Sarcoma (KS) is a Human Herpes Virus-8 (HHV-8) associated angio-proliferative disorder commonly seen in patients with HIV. It most commonly involves the skin as classic purple lesions but occasionally involves the gastrointestinal (GI) tract. To date, published data is scarce on primary GI KS. Using a national database, this study analyzes the incidence, demographics, and survival of primary GI KS. We conducted a retrospective analysis (1975-2019) on biopsy-proven primary GI KS cases from 17 registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. A total of 685 patients with GI KS were identified. Female gender, Non-Hispanic Asian or Pacific Islander (NHAPI), married marital status, and large bowel site-specific primary KS to have better overall survival. Luminal gastrointestinal KS was more frequent (84.96%) than solid organ involvement (3.07% of all cases). This study is the most extensive population-based study about the epidemiological and survival data of patients with primary GI KS, revealing GI KS to be a young male disease with best outcomes in the large bowel and anal canal KS while inferior outcomes in extraintestinal GI KS.

Exosomes as diagnostic tools.

Exosomes have evolved into novel candidates as diagnostic tools due to their composition of proteins and nucleic acids and ability to cross hypoxic regions, the systemic circulation and blood vessel barriers. Exosomes are nano-sized extracellular vesicles that contain information from their source cells and are found in almost all body fluids. In this chapter, we have focused on basic biogenesis, contents, and functions of these unique particles, and provide a comprehensive discussion on their usefulness as novel diagnostic tools in various diseases. In addition, these unique features make them potential candidates for development of advanced therapeutics and monitoring thereof.

Social Risk Adjustment In The Hospital Readmissions Reduction Program: A Systematic Review And Implications For Policy.

Value-based payment programs adjust payments to providers based on spending, quality, or health outcomes. Concern that these programs penalize providers disproportionately serving vulnerable patients prompted calls to adjust performance measures for social risk factors. We reviewed fourteen studies of social risk adjustment in Medicare's Hospital Readmissions Reduction Program (HRRP), a value-based payment model that initially did not adjust for social risk factors but subsequently began to do so. Seven studies found that adding social risk factors to the program's base risk-adjustment model (which adjusts only for age, sex, and comorbidities) reduced differences in risk-adjusted readmissions and penalties between safety-net hospitals and other hospitals. Three studies found that peer grouping, the HRRP's current approach to social risk adjustment, reduced penalties among safety-net hospitals. Two studies found that differences in risk-adjusted readmissions and penalties were further narrowed when augmentation of the base model was combined with peer grouping. Two studies showed that it is possible to adjust for social risk factors without obscuring quality differences between hospitals. These findings support the use of social risk adjustment to improve provider payment equity and highlight opportunities to enhance social risk adjustment in value-based payment programs.

CBCT Analysis of Maxillary First Molar in Indian Population.

Aim: This study aimed to assess the variations in root canal morphology of permanent maxillary first molar with the use of cone-beam computed tomography (CBCT). Materials and methods: One hundred extracted teeth were cleaned and arranged in U shape template mimicking natural arch in set of five teeth. These arches were scanned in CBCT and were analyzed by expert radiologist for number of roots, number of canals per root, and Vertucci classification. Result: A maximum number of permanent maxillary first molars had three roots, and only 2% had two roots. All the palatal roots and 99% of distobuccal roots had one canal, but one of the distobuccal roots had two canals. Incidence of two canals in MB root is more frequent (60%) than incidence of one canal. The most common type of Vertucci's classification for MB root is a type I, followed by type IV, type II, type VI, type V, type VII. How to cite this article: Sharma M, Gupta S, Bhayya DP, et al. CBCT Analysis of Maxillary First Molar in Indian Population. Int J Clin Pediatr Dent 2022;15(3):258-262.

Comparison between Different Combinations of Alendronate, Platelet-rich Fibrin, Hydroxyapatite in Bone Regeneration in Endodontic Surgeries Using Cone-beam Computed Tomography.

AIM: To compare different combinations of alendronate, platelet-rich fibrin (PRF), and hydroxyapatite in bone regeneration in endodontic surgeries using cone-beam computed tomography (CBCT). METHODS AND SUBJECTS: During this study, 28 patients were selected who were found to have pathology in the periapical area in the anterior region, The study subjects were categorized into four categories, each consisting of seven subjects, Category one-there was no placement of any material; category two-PRF; category three-hydroxyapatite along with PRF; category four-alendronate along with PRF, Root canal treatment followed by endodontic surgery in each patient was carried out, Volumetric analysis of the lesions was carried out before surgery and 12 months after surgery using CBCT, Analysis of variance (ANOVA) test and Tukey post-hoc test were used for statistical analysis. RESULTS: There was a maximum change in the volume of lesions in the study subjects in which PRF was used along with hydroxyapatite in comparison to other combination of materials, There was no significant difference when PRF was placed along with alendronate in comparison to study subjects when PRF was placed alone, The difference was not significant when PRF was placed in defects of bone in comparison to study subjects when no materials were placed in the defects of bone. CONCLUSION: It can be concluded from the current research that PRF along with hydroxyapatite is a better option for the healing of defects of bone in surgeries performed in the area around the root apex in endodontic patients, But further studies should be carried out with a large sample size and for a longer duration. CLINICAL SIGNIFICANCE: It is a very important consideration that there should be healing of the lesion after surgery around the root apex by actual bone regeneration, The healing of the larger lesions does not take place easily as compared with the lesions having a small size, This is because there is healing by secondary intention where there is formation of scar instead of actual healing by formation of bone, There are several methods by which proper bone regeneration can be obtained.

Challenges and Road Map towards Starting a New COVID Hospital.

Background and Aim: With advent of the Coronavirus Disease 2019 (covid-19) pandemic, need for a dedicated government hospital was felt. Following directions after a cabinet decision, a dedicated Covid hospital was made functional within a month in Central district of Delhi. This manuscript briefs the journey and challenges experienced during this mission. Method: As per decision of the state health ministry, bed allocation was planned along with provision for diagnosis, treatment and prevention of Covid -19. Various trainings were simultaneously conducted, licences were obtained and manpower and material were arranged starting with procurement to service provision and waste management. Result: Concerted efforts resulted in initiation of clinical and diagnostic services within one month of initiation of teamwork. Government supported in all the licencing requirements and material management. The hospital became functional during the first wave; and by the start of second wave, 20-bedded fully equipped Intensive Care Unit (ICU) was ready with pressure swing adsorber (PSA) oxygen generator in premises. Conclusion: A well-coordinated action in the right direction with administrative support can help in achieving difficult targets. Opening a new hospital amidst lockdown and resource constraints in an emergency situation was a rewarding achievement.

Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels: A systematic review and meta-analysis.

Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7 %. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test time intervals and cut-off values. The aim of this meta-analysis was to present pooled data from available studies to compare the predictive accuracies of serum amylase and lipase for PEP. Patients and methods A total of 18 studies were identified after a comprehensive search of various databases until June 2021 that reported the use of pancreatic enzymes for PEP. Results The sample size consisted of 11,790 ERCPs, of which PEP occurred in 764 (6.48 %). Subgroups for serum lipase and amylase were created based on the cut-off used for diagnosing PEP, and meta-analysis was done for each subgroup. Results showed that serum lipase more than three to four times the upper limit of normal (ULN) performed within 2 to 4 hours of ERCP had the highest pooled sensitivity (92 %) for PEP. Amylase level more than five to six times the ULN was the most specific serum marker with a pooled specificity of 93 %. Conclusions Our analysis indicates that a lipase level less than three times the ULN within 2 to 4 hours of ERCP can be used as a good predictor to rule out PEP when used as an adjunct to patient clinical presentation. Multicenter randomized controlled trials using lipase and amylase are warranted to further evaluate their PEP predictive accuracy, especially in high-risk patients.

In-hospital prognosis of malignancy-related pulmonary embolism: an analysis of the national inpatient sample 2016-2018.

A substantial proportion of patients with malignancy develop pulmonary embolism (PE), which significantly worsens the prognosis and ranks as one of the leading causes of mortality in these patients. This retrospective study aimed to examine prognosis of PE in 17 different types of malignancies. All hospitalizations for a primary diagnosis of PE, were identified from the National Inpatient Sample from 2016 to 2018 and divided into those with and without malignancies. Propensity score matching was performed with malignancy as the dependent variable and 23 clinically relevant covariates. Malignancy was stratified into 17 different types of cancer, for which the odds of in-hospital mortality were calculated. After propensity score matching, 82,970 hospitalizations for PE each were allocated into those with and without malignancy groups. PE in all types of malignancies had significantly higher odds of in-hospital mortality compared to PE without malignancy (OR 2.27, 95% CI 2.03-2.54). When stratified to types, esophageal cancer (OR 4.05, 95% CI 2.77-5.92) was associated with the highest odds of in-hospital mortality, followed by gastric (OR 3.41, 95% CI 2.25-5.16) and ovarian cancer (OR 2.95, 95% CI 2.12-4.13). On sensitivity analysis, only PE in esophageal and lung cancer was associated with higher odds of in-hospital mortality compared to PE in all other malignancies combined. Hospitalizations for PE in patients with malignancy were associated with higher odds of in-hospital mortality than those without malignancy. Esophageal cancer had the highest odds of in-hospital mortality, followed by gastric, ovarian, and lung cancer.

Application of artificial intelligence in diagnosis of pancreatic malignancies by endoscopic ultrasound: a systemic review.

Background: Pancreatic cancer (PC) is a highly fatal malignancy with a global overall 5-year survival of under 10%. Screening of PC is not recommended outside of clinical trials. Endoscopic ultrasonography (EUS) is a very sensitive test to identify PC but lacks specificity and is operator-dependent, especially in the presence of chronic pancreatitis (CP). Artificial Intelligence (AI) is a growing field with a wide range of applications to augment the currently available modalities. This study was undertaken to study the effectiveness of AI with EUS in the diagnosis of PC. Methods: Studies from MEDLINE and EMBASE databases reporting the AI performance applied to EUS imaging for recognizing PC. Data were analyzed using descriptive statistics. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the included studies. Results: A total of 11 articles reported the role of EUS in the diagnosis of PC. The overall accuracy, sensitivity, and specificity of AI in recognizing PC were 80-97.5%, 83-100%, and 50-99%, respectively, with corresponding positive predictive value (PPV) and negative predictive value (NPV) of 75-99% and 57-100%, respectively. Types of AI studied were artificial neural networks (ANNs), convolutional neural networks (CNN), and support vector machine (SVM). Seven studies using other than basic ANN reported a sensitivity and specificity of 88-96% and 83-94% to differentiate PC from CP. Two studies using SVM reported a 94-96% sensitivity, 93%-99% specificity, and 94-98% accuracy to diagnose PC from CP. The reported sensitivity and specificity of detection of malignant from benign Intraductal Papillary Mucinous Neoplasms (IPMNs) was 96% and 92%, respectively. Conclusion: AI reported a high sensitivity with high specificity and accuracy to diagnose PC, differentiate PC from CP, and differentiate benign from malignant IPMN when used with EUS.