Colombia Medica

Morphometric analysis and tortuosity typing of the large intestine segments on computed tomography colonography with artificial intelligence

2024-11-13T11:51:16-05:00

Background:
Morphological properties such as length and tortuosity of the large intestine segments play important roles, especially in interventional procedures like colonoscopy.

Objective:
Using computed tomography (CT) colonoscopy images, this study aimed to examine the morphological features of the colon's anatomical sections and investigate the relationship of these sections with each other or with age groups. The shapes of the transverse colon were analyzed using artificial intelligence.

Materials and Methods:
The study was conducted as a two- and three-dimensional examination of CT colonography images of people between 40 and 80 years old, which were obtained retrospectively. An artificial intelligence algorithm (YOLOv8) was used for shape detection on 3D colon images.

Results:
160 people with a mean age of 89 men and 71 women included in the study was 57.79±8.55 and 56.55±6.60, respectively, and there was no statistically significant difference (p=0.24). The total colon length was 166.11±25.07 cm for men and 158.73±21.92 cm for women, with no significant difference between groups (p=0.12). As a result of the training of the model Precision, Recall, and mAP were found to be 0.8578, 0.7940, and 0.9142, respectively.

Conclusion:
The study highlights the importance of understanding the type and morphology of the large intestine for accurate interpretation of CT colonography results and effective clinical management of patients with suspected large intestine abnormalities. Furthermore, this study showed that 88.57% of the images in the test data set were detected correctly and that AI can play an important role in colon typing.

Increased para-aortic adipose tissue on echocardiography may closely be related with fragmented QRS

2024-02-25T13:54:09-05:00

Background:
The association of fragmented QRS (fQRS) with many cardiac pathologies such as cardiac fibrosis has been described previously. Paraaortic adipose tissue (PAT) is thought to be associated with many cardiac diseases and there is only one publication on its echocardiographic evaluation. This study aims to describe the possible relationship between fQRS and PAT.

Methods:
Patients presenting to the cardiology outpatient clinic were evaluated for inclusion in the study. Presence of additional R' wave or notching/splitting of S wave in two contiguous ECG leads was defined as fragmented QRS (fQRS) and patients were divided into two groups according to fQRS status on ECG. The hypoechoic space in front of the ascending aorta was considered as PAT in the parasternal long-axis view. The medical history and routine laboratory parameters of the participants were recorded. Univariate and multivariate binary regression analysis was used to determine the relationship between PAT and fQRS.

Results:
A total of 221 patients were enrolled and divided into two groups according to fQRS status. PAT was significantly higher in the fQRS group [9.2mm (7.1/12.3) vs 6.8mm (1.2/10.9), p=0.001]. Univariate analysis showed significant association between fragmented QRS and PAT size (OR 1.122, p= 0.001). Binary regression analysis revealed an independent and strong association between aortic size (OR 1.4, CI 1.012-1.938, p=0.042), paraaortic adipose tissue (OR 1.483, CI 1.084-2.029, p=0.014) and fragmented QRS.

Conclusions:
The presence of fQRS is associated with PAT, a newly defined parameter in echocardiography.

Quality in aesthetic medicine and surgery. a systematic review of clinical practice guidelines

2024-11-13T11:51:12-05:00

Background:
Guidelines in medicine are essential tools to provide quality and standardised medical care. We analysed the quality of aesthetic medicine guidelines.

Methods:
A systematic review with a prospective registration protocol (https://osf.io/8pdyv) of databases (MEDLINE, EMBASE, Web of Science, Scopus, CDSR), web pages of scientific societies and grey literature was done from inception to February 2023 and without language restrictions. Quality was evaluated using AGREE II (% of the maximum score), RIGHT (% of the total 35 items) and a shared decision making (SDM) quality assessment tool (31 items score) individually and in duplicate, respectively.

Results:
Six (86%) guidelines were classified as not recommended; one (14%) was recommended with modifications, and all were classified as poorly reported (7/7; 100%). The median overall quality was 27% (IQR: 26-43) and 26% (IQR 1536) for AGREE II and RIGHT, respectively. No document used these tools for its development. SDM appeared superfluity in almost all of the guidelines explored.

Conclusions:
Aesthetic medicine and surgical guidelines had low quality and must be improved. There is a wide range of improvement, especially in applicability, reporting of evidence, recommendations, conflict of interest, quality control and SDM. These guidelines require a rigorous methodology based on systematic reviews to ensure quality evidence-based recommendations.

Simultaneous periodontal and endodontic surgery: report of four clinical cases

2024-11-13T11:51:19-05:00

Case Description:
Four cases of patients aged 41, 33, 43 and 68 years who presented periapical lesions and needed periodontal surgery for pre-prosthetic purposes.

Clinical Findings:
The first case presented an intra-radicular retainer that was difficult to remove and likely to generate a root fracture. In addition, asymmetry of the gingival zenith was observed. The second case presented a complete crown at 16 with mesial marginal mismatch and subgingival margins distally. The third case presented a vestibular fistula with inflammation at the cervical level. The fourth case presented a vestibular fistula in the upper right lateral incisor. All patients showed apical lesions.

Treatment and Outcome:
The first three cases received coronal lengthening and apical surgery in the same surgical procedure. In the fourth case, apical surgery was performed, and placement of implants 13 and 15 with a pontic of 14. During the clinical control and radiographs performed after the surgical procedures, bone filling of the lesion was found.

Clinical Relevance:
Considering the results obtained, performing the periodontal and endodontic surgery procedures in a single surgical act is suggested. This reduces costs, travel, number of appointments, medication intake and post-surgical complications.