MedPromptX: Grounded Multimodal Prompting for Chest X-ray Diagnosis

Chest X-ray images are commonly used for predicting acute and chronic cardiopulmonary conditions, but efforts to integrate them with structured clinical data face challenges due to incomplete electronic health records (EHR). This paper introduces MedPromptX, the first model to integrate multimodal large language models (MLLMs), few-shot prompting (FP) and visual grounding (VG) to combine imagery with EHR data for chest X-ray diagnosis. A pre-trained MLLM is utilized to complement the missing EHR information, providing a comprehensive understanding of patients' medical history. Additionally, FP reduces the necessity for extensive training of MLLMs while effectively tackling the issue of hallucination. Nevertheless, the process of determining the optimal number of few-shot examples and selecting high-quality candidates can be burdensome, yet it profoundly influences model performance. Hence, we propose a new technique that dynamically refines few-shot data for real-time adjustment to new patient scenarios. Moreover, VG aids in focusing the model's attention on relevant regions of interest in X-ray images, enhancing the identification of abnormalities. We release MedPromptX-VQA, a new in-context visual question answering dataset encompassing interleaved image and EHR data derived from MIMIC-IV and MIMIC-CXR databases. Results demonstrate the SOTA performance of MedPromptX, achieving an 11% improvement in F1-score compared to the baselines. Code and data are available at https://github.com/BioMedIA-MBZUAI/MedPrompt

Biodegradable elastic nanofibrous platforms with integrated flexible heaters for on-demand drug delivery

Delivery of drugs with controlled temporal profiles is essential for wound treatment and regenerative medicine applications. For example, bacterial infection is a key challenge in the treatment of chronic and deep wounds. Current treatment strategies are based on systemic administration of high doses of antibiotics, which result in side effects and drug resistance. On-demand delivery of drugs with controlled temporal profile is highly desirable. Here, we have developed thermally controllable, antibiotic-releasing nanofibrous sheets. Poly(glycerol sebacate)- poly(caprolactone) (PGS-PCL) blends were electrospun to form elastic polymeric sheets with fiber diameters ranging from 350 to 1100 nm and substrates with a tensile modulus of approximately 4-8 MPa. A bioresorbable metallic heater was patterned directly on the nanofibrous substrate for applying thermal stimulation to release antibiotics on-demand. In vitro studies confirmed the platform’s biocompatibility and biodegradability. The released antibiotics were potent against tested bacterial strains. These results may pave the path toward developing electronically controllable wound dressings that can deliver drugs with desired temporal patterns

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Fine-Tuned Large Language Models for Symptom Recognition from Spanish Clinical Text

<h3><strong>Abstract</strong></h3><p>The accurate recognition of symptoms in clinical reports is significantly important in the fields of healthcare and biomedical natural language processing. These entities serve as essential building blocks for clinical information extraction, enabling retrieval of critical medical insights from vast amounts of textual data. Furthermore, the ability to identify and categorize these entities is fundamental for developing advanced clinical decision support systems, aiding healthcare professionals in diagnosis and treatment planning. In this study, we participated in SympTEMIST – a shared task on detection of symptoms, signs and findings in Spanish medical documents. We combine a set of large language models finetuned with the data released by the task's organizers.</p><p> </p><p>This article is part of the <a href="https://zenodo.org/doi/10.5281/zenodo.10103190">Proceedings of the BioCreative VIII Challenge and Workshop: Curation and Evaluation in the era of Generative Models</a>.</p&gt

Simple function to find base pressure under triangular and trapezoidal footing with two eccentric loads

The purpose of this article is to create a simple general function to find the maximum base pressure of biaxial eccentric loads under a trapezoidal and triangular footing. Base pressure is the load per unit area below the foundation. The first step is to derive a function linking variables to the specific status by determining what variables can be observed in it and which variables are expected to be extracted from it. This research will focus on a specific status in foundation science and, thereafter, will produce a factor named k that is multiplied by the load divided by the area to find the maximum base pressure

Alcoholic Cardiomyopathy

Alcohol-induced toxicity leads to non-ischemic dilated cardiomyopathy characterized by loss of contractile function and dilatation of myocardial ventricles. These findings are coupled with a clinical history of heavy alcohol use in the absence of coronary artery disease as a supportive etiology. Alcohol use is an important cause for non-ischemic cardiomyopathy and accounts for 10% of all cases of dilated cardiomyopathies. The major risk factor for developing ACM is chronic alcohol abuse; however, there is no specific cutoff value for the amount of alcohol consumption that would lead to the development of ACM

Intestinal Parasites in Relation to Haemoglobin Level and Nutritional Status of School Children in Gaza, Journal of the Egyptian Society of parasitology

The prevalence of intestinal paresite and their relations to anemia and nutritional status among school children aged 6-11 years in Gaza was studied. The target area is overcrowded with improper sewage disposal system and low socioeconomic levels. Anaemia was assessed by haemoglobin level ( Hb and nutritional status by anthropometric measurements includind weight for age ( WA , weight for height ( WH and height for age ( HA . Intestinal parasites were found to be prevalent in Gaza. The overall prevalence was 24.5%. Giardia lamblia ( 62.2% was the most common parasite detected particularly in age group 6-7 years. followed by Ascaris lumbricoides ( 20.0% , then Entamoeba histolytica ( 18.0% . Parasitosis was generally declining with older age groups for both sexes. In general, the prevalence of anaemia was more common in the younger children. Malnutrition was found to be prevalent among children. Infected children of age group 8-9 years showed higher incidence of low WA than non infected ones. The prevalence of stunting and wasting among infected children of the youngest group was greater than that observed for controls. Regarding sex, no specific trend that relates the prevalence of anaemia with sex. Malnutrition was more prevalent among females than males

Sudden Onset Iron Overload Cardiomyopathy After Liver Transplantation

Iron overload cardiomyopathy has been described in patients who develop acute heart failure after liver transplantation but few reports of this are available. We present a case of a patient with end-stage liver disease who underwent a deceased donor liver transplantation and developed acute onset systolic heart failure with reduced left ventricular ejection fraction. A cardiac magnetic resonance image demonstrated late gadolinium enhancement with diffuse enhancement globally and T1 mapping with severely decreased pre-contrast T1 values suggesting iron overload cardiomyopathy. The patient was treated with iron chelating therapy as well as heart failure guideline-directed medical therapy with subsequent improvement in cardiac function on follow-up magnetic resonance images. Despite our patient’s diagnosis of iron overload cardiomyopathy, her iron studies showed normal serum iron and ferritin levels and no evidence of hepatic iron deposition in the transplanted liver