Role of artificial intelligence in risk prediction, prognostication, and therapy response assessment in colorectal cancer: current state and future directions

Artificial Intelligence (AI) is a branch of computer science that utilizes optimization, probabilistic and statistical approaches to analyze and make predictions based on a vast amount of data. In recent years, AI has revolutionized the field of oncology and spearheaded novel approaches in the management of various cancers, including colorectal cancer (CRC). Notably, the applications of AI to diagnose, prognosticate, and predict response to therapy in CRC, is gaining traction and proving to be promising. There have also been several advancements in AI technologies to help predict metastases in CRC and in Computer-Aided Detection (CAD) Systems to improve miss rates for colorectal neoplasia. This article provides a comprehensive review of the role of AI in predicting risk, prognosis, and response to therapies among patients with CRC

Role of Machine Learning-Based CT Body Composition in Risk Prediction and Prognostication: Current State and Future Directions

CT body composition analysis has been shown to play an important role in predicting health and has the potential to improve patient outcomes if implemented clinically. Recent advances in artificial intelligence and machine learning have led to high speed and accuracy for extracting body composition metrics from CT scans. These may inform preoperative interventions and guide treatment planning. This review aims to discuss the clinical applications of CT body composition in clinical practice, as it moves towards widespread clinical implementation

Aspirin and Statin in COVID19; A Case Series

Objective To present an informal case series of patients that received low-dose Aspirin (ASA) and a Statin as adjuvant therapy for COVID19. Background COVID19 is characterized by a significant inflammatory reaction contributing to multiorgan failure and death. The cytokine storm observed in COVID19 is comparable to influenza. Statins, extensively used and known to be safe, have been reported to reduce influenza pneumonia-related mortality. Furthermore, they improve endothelial function and reduce thrombosis. ASA prevents platelet aggregation and leads to clot lysis, and in combination with Statins is known to significantly decrease IL-6 levels. Methods Four consecutive patients admitted to our service in late April, received ASA and Atorvastatin. Only one case received Dexamethasone. Three patients started therapy within three days of hospitalization and one on day eight. We followed patients’ status, inflammatory markers, transaminases, LDH and radiographic findings. Results Hospital stay ranged from 10 to 21 days. The patient with the longest stay developed pulmonary emboli(PE) requiring mechanical ventilation before the introduction of ASA and Statin. Inflammatory markers decreased in all patients after therapy introduction. Three patients had a downward trending D-dimer and did not develop venous thromboembolism. D-dimer and LDH remained elevated in the patient with PE. Another patient had upward trend of LDH. Transaminases were within normal limits, and pulmonary infiltrates resolved or improved in all patients who were discharged in stable condition. Conclusion The combination of low-dose ASA and a Statin as adjuvant therapy for COVID19 may be safe and effective. This hypothesis warrants further investigation in clinical trials

Mycoplasma Associated Minimal Change Disease in a Young Adult; A Case Report

introduction: Mycoplasma pneumoniae is a leading cause of pneumonia in young adults. Extrapulmonary manifestations include neurologic, hematologic, cardiologic, musculoskeletal, and mucocutaneous, but renal involvement is rare. Minimal change disease is a rare disorder in adults and is usually idiopathic. Additionally, mycoplasma is a rare cause of secondary minimal change disease. Case Description: 28-year-old male presented with lower extremity swelling and progressive exertional SOB for 1 week. He denies fever but reports sore throat and cough four weeks prior. On presentation, vital signs were stable. Exam showed decreased breath sounds and anasarca. Pertinent labs showed AKI and marked hypoalbuminemia. CT scan showed extensive anasarca. A 24hour urinary protein was positive for 6gm/dl of proteinuria. His anasarca and kidney function continued to worsen, therefore a renal biopsy was performed and pulse steroids was started. Biopsy showed podocyte foot process effacement and C3 deposits on immunofluorescence suggesting a diagnosis of minimal change disease and immune-mediated glomerulonephritis. IgM for mycoplasma pneumoniae was positive. In addition to steroids, he received doxycycline, atorvastatin and albumin. His clinical status and kidney function improved and was discharged home in stable condition. Discussion: The association between mycoplasma pneumoniae and renal failure was first reported by Duman in 1976. The antibody and immune complex mediated mechanisms are likely the cause of frank nephrotic syndrome in these patients. Without appropriate intervention there is a high risk of worsening outcomes. Early glucocorticoids remain an appropriate therapy and the dose intensity depends on the clinical and/or histopathological findings. Early treatment of mycoplasma can prevent progression

COVID-19 the Lung Popper!

Introduction COVID-19 can result in multiple complications including thrombo-embolism, ARDS and septic shock. A rare complication is Spontaneous pneumomediastinum(SPM), pneumothorax(PNX) and subcutaneous emphysema(SCE) unrelated to positive-pressure ventilators. Such patients have a potential for a worse outcome. Case Description A 63-year-old male, non-smoker, with PMH of hypertension and diabetes-mellitus presented with worsening SOB and fever after testing positive for COVID-19. He denied cough, chest pain or vomiting. On exam he was calm with oxygen-saturation of 96% on non-rebreather, and had bilateral pulmonary rhonchi. Labs showed elevated inflammatory markers with significant LDH of 804units/L. Initial CT-chest showed extensive bilateral infiltrates. He completed antibiotics, antiviral and continued on steroids. He remained on supplemental oxygen and never required a positive-pressure oxygen device. On day-13, he decompensated. Repeat CT-chest showed extensive SCE and SPM compressing the anterior heart with biapical PNX. He responded well to conservative management and his oxygen requirements decreased. Follow up CT-chest in a month showed significant improvement of the SPM and resolution of the PNX and SCE. Discussion Macklin describes the pathophysiology behind SPM, which involves alveolar rupture leading to air leak through the broncho-vascular sheath to the mediastinum. Studies suggest that the cytokine storm in COVID-19 can result in diffuse alveolar injury. This will prone the alveolar wall to rupture. High LDH, which signifies cellular damage, was associated with SPM in SARS-CoV. Most cases in the literature show spontaneous resolution with conservative management including mitigation of reasons that increase alveolar pressure. A sudden worsening outcome should prompt an early CT-chest

MSSA Bacteremia; But Where Does it Originate?

Introduction MSSA bacteremia can result from multiple etiologies and searching for a source is important to avoid potential complications. A rare etiology is pyomyositis; a purulent skeletal muscle infection with localized abscess formation. It classically occurs in tropical countries. Case Description A 23-year-old athletic female presented with lower back pain radiating to the right leg. The pain is throbbing and aggravated by movement. She denied fever or weakness. On exam she was stable and had a positive straight-leg-test. Labs showed a leukocytosis of 15. A spinal-CT demonstrated L4-L5 disc bulge. She was sent home on NSAIDs. However, she returned with spiking fever. Her leukocytosis jumped to 26. Blood cultures grew MSSA within 24hours and continued to grow on 3 separate occasions despite vancomycin use. A TEE ruled-out infective endocarditis. A history review was only positive for mild back pain. Therefore lumbar-MRI with contrast was performed, revealing myositis of the right iliopsoas, gluteus-medius and paraspinal muscles with anterior muscle abscess. She underwent percutaneous abscess drainage and finished 4 weeks of oxacillin. She had a favorable outcome. Discussion Pyomyositis has 3 clinical stages and \u3e90% presents on stage 2. Progression to stage 3 can cause osteomyelitis, endocarditis, rhabdomyolysis, septic emboli and/or shock. Mortality is high as 10%. Predisposing factors such as HIV, malignancy and injection-drug-use should be mitigated. Athletes are predisposed to minor muscle injury that increases muscle perfusion and iron favoring bacterial growth. Delay in diagnosis is attributed to the deeply situated muscle but careful history, exam and appropriate imaging is the key