Head and Neck Surgery: A Differential Diagnosis in Otolaryngology

Introduction: In otolaryngology of the head and neck surgery; differential diagnosis is a practical and comprehensive guide that is organized uniquely by signs and symptoms instead of by diseases. Aim: This study will describe the keys to diagnostic evaluation and differential diagnosis of presenting symptoms for problems affecting each otolaryngology organ system.Methods: Each symptom opens with the patient’s presentation followed by an easily accessible list of potential diagnoses and supplementary data on the features of the different diseases to help correctly identify the problem. And identify features labeled by signs and symptoms, not by disease, and then enable quick clinical reference In-depth coverage of the diagnostic and treatment evaluation of all ENT disorders.

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Multi-Label Active Learning-Based Machine Learning Model for Heart Disease Prediction

The rapid growth and adaptation of medical information to identify significant health trends and help with timely preventive care have been recent hallmarks of the modern healthcare data system. Heart disease is the deadliest condition in the developed world. Cardiovascular disease and its complications, including dementia, can be averted with early detection. Further research in this area is needed to prevent strokes and heart attacks. An optimal machine learning model can help achieve this goal with a wealth of healthcare data on heart disease. Heart disease can be predicted and diagnosed using machine-learning-based systems. Active learning (AL) methods improve classification quality by incorporating user–expert feedback with sparsely labelled data. In this paper, five (MMC, Random, Adaptive, QUIRE, and AUDI) selection strategies for multi-label active learning were applied and used for reducing labelling costs by iteratively selecting the most relevant data to query their labels. The selection methods with a label ranking classifier have hyperparameters optimized by a grid search to implement predictive modelling in each scenario for the heart disease dataset. Experimental evaluation includes accuracy and F-score with/without hyperparameter optimization. Results show that the generalization of the learning model beyond the existing data for the optimized label ranking model uses the selection method versus others due to accuracy. However, the selection method was highlighted in regards to the F-score using optimized settings

Nanoemulsification Improves the Pharmaceutical Properties and Bioactivities of Niaouli Essential Oil (Melaleuca quinquenervia L.)

We develop a suitable delivery system for niaouli essential oil (NEO) using a nanoemulsification method for acne vulgaris. Prepared nanoemulsions (NEs) were characterized for droplet dimension, rheology, surface charge, and stability. The ability of NEO formulations against Propionibacterium acnes and Staphylococcus epidermidis was investigated and all formulations showed antiacne potential in vitro. Ex vivo permeation studies indicated significant improvement in drug permeations and steady state flux of all NEO-NEs compared to the neat NEO (p &lt; 0.05). On the basis of the studied pharmaceutical parameters, enhanced ex vivo skin permeation, and marked effect on acne pathogens, formulation NEO-NE4 was found to be the best (oil (NEO; 10% v/v); Kolliphor EL (9.25% v/v), Carbitol (27.75% v/v), and water (53% v/v)). Concisely, the in vitro and ex vivo results revealed that nanoemulsification improved the delivery as well as bioactivities of NEO significantly

A Simulation Study for Trimetallic Nanosized Alloy (Ni, Cu, and Ag) in Hydrogenation of Organic Compounds: A Case Study of “Nitrophenols”

Trimetallic system (Ni, Cu, and Ag) supported on alumina was utilized for hydrogenation of nitrophenols. The catalytic active centers for hydrogenation were attributed only to the presence of Ni. However, the presence of bi- or trimetallic systems improves the catalytic activity via extra synergism. The catalytic activity was measured as the time for reaching 100% conversion. The function of synergism was fitted for both bimetallic systems (Ni:Ag; Ni:Cu) individually. Subsequently, three-dimensional function was fitted for trimetallic system (Ni:Cu:Ag) based on the linear combination of data for individual bimetallic system. After a complex calculation areal function was evaluated. An Excel program was written to simply evaluate the catalytic activity of trimetallic system with high accuracy. Characterization of catalysts was performed using EPR and pulsed chemisorption by hydrogen. These characterizations of samples enable us to evaluate particle size, metallic surface area, and degree of dispersion. These values were successfully correlated with the synergism function. The program written then could be capable of predicting these values for any trimetallic system

Energy Efficiency through the Implementation of an AI Model to Predict Room Occupancy Based on Thermal Comfort Parameters

Room occupancy prediction based on indoor environmental quality may be the breakthrough to ensure energy efficiency and establish an interior ambience tailored to each user. Identifying whether temperature, humidity, lighting, and CO2 levels may be used as efficient predictors of room occupancy accuracy is needed to help designers better utilize the readings and data collected in order to improve interior design, in an effort to better suit users. It also aims to help in energy efficiency and saving in an ever-increasing energy crisis and dangerous levels of climate change. This paper evaluated the accuracy of room occupancy recognition using a dataset with diverse amounts of light, CO2, and humidity. As classification algorithms, K-nearest neighbors (KNN), hybrid Adam optimizer&ndash;artificial neural network&ndash;back-propagation network (AO&ndash;ANN (BP)), and decision trees (DT) were used. Furthermore, this research is based on machine learning interpretability methodologies. Shapley additive explanations (SHAP) improve interpretability by estimating the significance values for each feature for classifiers applied. The results indicate that the KNN performs better than the DT and AO-ANN (BP) classification models have 99.5%. Though the two classifiers are designed to evaluate variations in interpretations, we must ensure that they have accurate detection. The results show that SHAP provides successful implementation following these metrics, with differences detected amongst classifier models that support the assumption that model complexity plays a significant role when predictability is taken into account

Energy Efficiency through the Implementation of an AI Model to Predict Room Occupancy Based on Thermal Comfort Parameters

Room occupancy prediction based on indoor environmental quality may be the breakthrough to ensure energy efficiency and establish an interior ambience tailored to each user. Identifying whether temperature, humidity, lighting, and CO2 levels may be used as efficient predictors of room occupancy accuracy is needed to help designers better utilize the readings and data collected in order to improve interior design, in an effort to better suit users. It also aims to help in energy efficiency and saving in an ever-increasing energy crisis and dangerous levels of climate change. This paper evaluated the accuracy of room occupancy recognition using a dataset with diverse amounts of light, CO2, and humidity. As classification algorithms, K-nearest neighbors (KNN), hybrid Adam optimizer–artificial neural network–back-propagation network (AO–ANN (BP)), and decision trees (DT) were used. Furthermore, this research is based on machine learning interpretability methodologies. Shapley additive explanations (SHAP) improve interpretability by estimating the significance values for each feature for classifiers applied. The results indicate that the KNN performs better than the DT and AO-ANN (BP) classification models have 99.5%. Though the two classifiers are designed to evaluate variations in interpretations, we must ensure that they have accurate detection. The results show that SHAP provides successful implementation following these metrics, with differences detected amongst classifier models that support the assumption that model complexity plays a significant role when predictability is taken into account