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Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

World Journal of Gastrointestinal Surgery 2024年第4期16卷 1097-1108页

作者： Hassam Ali Faisal Inayat vishali moond Ahtshamullah Chaudhry Arslan Afzal Zauraiz Anjum Hamza Tahir Muhammad Sajeel Anwar Dushyant Singh Dahiya Muhammad Sohaib Afzal Gul Nawaz Amir H Sohail Muhammad Aziz Department of Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Allama Iqbal Medical CollegeLahorePunjab 54550Pakistan Department of Internal Medicine Saint Peter's University Hospital and Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine St.Dominic's HospitalJacksonMS 39216United States Department of Internal Medicine Rochester General HospitalRochesterNY 14621United States Department of Internal Medicine Jefferson Einstein HospitalPhiladelphiaPA 19141United States Department of Internal Medicine UHS Wilson Medical CenterJohnsonNY 13790United States Division of Gastroenterology Hepatology and MotilityThe University of Kansas School of MedicineKansasKS 66160United States Department of Internal Medicine Louisiana State University HealthShreveportLA 71103United States Department of Surgery University of New Mexico School of MedicineAlbuquerqueNM 87106United States Department of Gastroenterology and Hepatology The University of ToledoToledoOH 43606United States

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy

关键词： Roux-en-Y gastric bypass Venous thromboembolism Machine learning Bariatric surgery Predictive modeling

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Global trends in hepatitis C-related hepatocellular carcinoma mortality:A public database analysis(1999-2019)

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World Journal of Virology 2024年第1期13卷 69-83页

作者： Hassam Ali Fnu Vikash vishali moond Fatima Khalid Abdur Rehman Jamil Dushyant Singh Dahiya Amir Humza Sohail Manesh Kumar Gangwani Pratik Patel Sanjaya K Satapathy Department of Internal Medicine/Gastroenterology East Carolina University Brody School of MedicineGreenvilleNC 27834United States Department of Internal Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 10461United States Department of Internal Medicine Saint Peter's University Hospital/Robert Wood Johnson Medical SchoolNew BrunswickNJ 08901United States Department of Internal Medicine Quaid-e-Azam Medical CollegeBahawalpur 63100PunjabPakistan Department of Internal Medicine Samaritan Medical CentreWatertownMA 13601United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Department of Surgery New York University Winthrop HospitalNew YorkMineloaNY 11501United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Gastroenterology Mather Hospital/Hofstra University Zucker School of MedicineNY 11777United States Division of Hepatology Department of MedicineNorth Shore University HospitalManhassetNY 11030United States

BACKGROUND Hepatitis C is the leading cause of chronic liver disease worldwide and it significantly contributes to the burden of hepatocellular carcinoma(HCC).However,there are marked variations in the incidence and mortality rates of HCC across different geographical regions.With the advent of new widely available treatment modalities,such as direct-acting antivirals,it is becoming increasingly imperative to understand the temporal and geographical trends in HCC mortality associated with Hepatitis C.Furthermore,gender disparities in HCC mortality related to Hepatitis C are a crucial,yet underexplored aspect that adds to the disease's global impact.While some studies shed light on gender-specific trends,there is a lack of comprehensive data on global and regional mortality rates,particularly those highlighting gender disparities.This gap in knowledge hinders the development of targeted interventions and resource allocation strategies.DISCUSSION The results of our study show an overall decline in the mortality rates of patients with hepatitis C-related HCC over the last two decades.Notably,females exhibited a remarkable decrease in mortality compared to males.Regionally,East Asia and the Pacific displayed a significant decline in mortality,while Europe and Central Asia witnessed an upward trend.Latin America and the Caribbean also experienced an increase in mortality rates.However,no significant difference was observed in the Middle East and North Africa.North America exhibited a notable upward trend.South Asia and Sub-Saharan Africa significantly declined throughout the study period.This raises the hope of identifying areas for implementing more targeted resources.Despite some progress,multiple challenges remain in meeting the WHO 2030 goal of eliminating viral hepatitis[24].

关键词： Carcinoma Hepatocellular Antiviral agents Global Burden of Disease Quality indicators Health care Liver neoplasms Hepatitis C Chronic hepatitis C

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Prevalence of cognitive dysfunction,psychological morbidity and abuse in the community-based elderly population in India

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上海精神医学 2020年第5期33卷 345-351页

作者： Manjeet Singh Bhatia Shruti Srivastava vishali moond Psychiatry University College of Medical Sciences and Guru Tegh Bahadur Hospital

Background The elderly population in India is expected to grow enormously by 2050 owing to an increase in life expectancy.Community-based data on the prevalence of psychological morbidity,abuse and cognitive dysfunction are scarce.Aims To determine the prevalence of cognitive dysfunction,psychological morbidity and abuse in the elderly population in a resettlement colony from East Delhi,India.Methods A cross-sectional study was conducted on the elderly population of a resettlement colony,in East Delhi,comprising 5 blocks and 12 subblocks with a total population of 65 000.The study was carried out within2 months from April to August 2017.The self-reported questionnaires were administered to detect cognitive dysfunction,psychological morbidity,social support and pattern of abuse.Results The mean age of the study subjects was70.29 years(53.8% were males,78.8% were married,86.9% were Hindus and 75% were living with children).A total of 106 subjects(66.6%) belonged to the lower socioeconomic strata with 120(75%) living with children.Most of the subjects(70.6%) studied below the primary level of education.As detected on Goldberg General Health Questionnaire-12,56.9% of the subjects had psychological morbidity.On Dementia Assessment by Rapid Test,33.1%of subjects were screened positive.The pattern of abuse reported was as follows:emotional abuse(16.9%),physical abuse(7.5%),sexual abuse(1.9%) and social neglect(1 8.1%).The social support score was found to be46.22(12.22).Conclusion The results of this community-based study signify that appropriate steps at the policy level need to be undertaken so that abuse as well as neglect can be prevented.In addition,screening the elderly population helps to detect early cognitive dysfunction,psychological morbidity,abuse victims and individuals with poor support.

关键词： cognition disorders geriatric psychiatry mental health morbidity psychological trauma

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