Using SMOTE to counter data imbalances triggered a tradeoff between the model's sensitivity and specificity, which can be masked under a similar area under the curve The proposed aggregate rank selection approach resulted in a balanced performing model compared to other criteria Finally, factors such as comorbidity conditions, source of admission, and payer types were associated with the increased risk of a prolonged LOS Conclusions Prolonged LOS is mostly associated with pre-intraoperative clinical and patient socioeconomic factors Accurate patient identification with the risk of prolonged LOS using the selected model can provide hospitals a better tool for planning early discharge and resource allocation, thus reducing avoidable hospitalization costs © 2020 The Korean Society of Medical InformaticsObjectives The aim of this study was to develop machine learning ML and initial nursing assessment INA-based emergency department ED triage to predict adverse clinical outcome Methods The retrospective study included ED visits between January 2016 and December 2017 that resulted in either intensive care unit admission or emergency room death We trained four classifiers using logistic regression and a deep learning model on INA and low dimensional LD INA, logistic regression on the Korea Triage and acuity scale KTAS and Sequential Related Organ Failure Assessment SOFA We varied the outcome ratio for external validation Finally, variables of importance were identified using the random forest model's information gain The four most influential variables were used for LD modeling for efficiency Results A total of 86,304 patient visits were included, with an overall outcome rate of 35 The area under the curve AUC values for the KTAS model were 768 749-786 with logistic regression and 740 721-759 for the SOFA model, while the AUC values of the INA model were 872 859-886 and 876 863-889 with logistic regression and deep learning, suggesting that the ML and INA-based triage system result more accurately predicted the outcomes The AUC values for the LD model were 812 794-829 and 807 789-825 for logistic regression and deep learning, respectively Conclusions We developed an ML and INA-based triage system for EDs The novel system was able to predict clinical outcomes more accurately than existing triage systems, KTAS and SOFA © 2020 The Korean Society of Medical InformaticsObjectives Electronic Health Record EHR systems are increasingly used as an effective method to share patients' records among different hospitals However, it is still a challenge to access scattered patient data through multiple EHRs  https//wwwselleckchemcom/products/anisomycinhtml  Our goal is to build a system to access patient records easily among EHRs without relying on a centralized supervisory system Methods We apply consortium blockchain to compose a distributed system using Hyperledger Fabric incorporating existent EHRs Peer nodes hold the same ledger on which the address of a patient record in an EHR is written Individual patients are identified by unique certificates issued by a local certificate authorities that collaborate with each other in a channel of the network To protect a patient's privacy, we use a proxy re-encryption scheme when the data are transferred We designed and implemented various chaincodes to handle business logic agreed by member organizations of the network Results We developed a prototype system to implement our concept and tested its performance including chaincode logic The results demonstrated that our system can be used by doctors to find patient's records and verify patient's consent on access to the data Patients also can seamlessly receive their past records from other hospitals The access log is stored transparently and immutably in the ledger that is used for auditing purpose Conclusions Our system is feasible and flexible with scalability and availability in adapting to existing EHRs for strengthening security and privacy in managing patient records link2 Our research is expected to provide an effective method to integrate dispersed patient records among medical institutions © 2020 The Korean Society of Medical InformaticsCostus afer C afer is a plant commonly known as ginger lily, spiral ginger, or bush cane It is reportedly used in traditional medicine practice TMP to treat and manage many ailments including diabetes mellitus, stomach ache, arthritis, inflammation, and gout These purported ethnomedicinal uses have triggered many research studies on the plant to amass scientific evidence However, these research reports are scattered, and thus, this systematic review seeks to provide a comprehensive update on it covering its traditional uses, phytochemical and nutritional constituents, pharmacological activities, and toxicological effects An online search was done using search engines such as Google Scholar, PubMed, and ScienceDirect from the period 1970 to 2019 The online search included the use of keywords, "Costus afer Ker-Gawl" or "Costus afer" The search revealed that the stem and leaves of the plant contain substantial amounts of micronutrients and macronutrients The leaves, stem, rhizomes, and roots of C afer contain several steroidal sapogenins, aferosides, dioscin, and paryphyllin C and flavonoid glycoside kaempferol-3-O-α-L-rhamnopyranoside Experimental studies on various parts of the plant showed bioactivities such as antihyperglycemic, hepatocellular protection, cardioprotection, nephroprotection, testicular protection, CNS depressant, analgesic, antiarthritis, antibacterial, and antioxidant Based on these evident data, it is concluded that the plant could be used as an alternative and complementary therapy for many oxidative stress-related diseases, provided further scientific studies on the toxicological and pharmacological aspects are carried out Copyright © 2019 Daniel Boison et alA 3-year-old female spayed rat terrier presented for hyperactivity and repetitive circling to the right of less than one-hour duration On examination, the patient was dehydrated, hyperactive, and dysphoric Laboratory tests initially revealed elevations in creatine kinase CK and aspartate aminotransferase AST Serial chemistries indicated significant progression of CK elevation to a maximum of 181,900 U/L on day 3 along with the development of profuse myoglobinuria A urine drug screening test was positive for amphetamine metabolites This patient was treated with sedatives, aggressive fluid diuresis, and antioxidants The dog recovered uneventfully with no indicators of renal dysfunction based on serial blood chemistries and was discharged five days after presentation Follow-up blood chemistries taken four days after discharge revealed near normalization of CK and resolution of myoglobinuria This case report describes a particularly severe case of rhabdomyolysis associated with amphetamine toxicity and its successful treatment Copyright © 2020 M Ryan Smith and Virginie A WurlodAnemia postkidney transplantation is an important issue which has been correlated with increased hospitalizations and higher mortality Infections, including those due to parvovirus B19, CMV, and BK virus polyomavirus, have also been associated with an increased risk of anemia Here, we present a case of new-onset anemia in a kidney transplant recipient within 3 months of transplant The patient was found to have multiple viral infections from parvo B19, BK virus, and rhinovirus The anemia resolved completely after successful reduction in the parvo B19 and BK viral load Workup for viral infections must be considered in the differential diagnosis of postkidney transplant anemia Copyright © 2020 Neeraj Sharma and Ranvir BajwaIntroduction Omental cysts are a part of cystic lymphangiomas and are benign proliferations of ectopic lymphatics without a communication with the normal lymphatic system They commonly involve the neck in the pediatric population and are uncommon at other sites and occur rarely in adults Case Presentation link3 A 42-year-old female with complaints of vague lower abdominal pain for 8 months presented with a soft, nontender swelling of size 22 × 18 cm in the hypogastrium and umbilical region Computerized tomography CT of the abdomen showed a peripherally enhancing hypodense cystic lesion of size 19 × 14 × 12 cm perhaps arising from the mesentery The cyst had spontaneously reduced in size by about 70 over the next 4 months During surgery, the cyst of size 10 × 9 × 8 cm was present in the greater omentum Excision was done, and histopathology was suggestive of cystic lymphangioma Discussion Cystic lymphangiomas have an incidence of 1/20000 at infancy and 1/100000 to 1/250000 of hospital admissions in adults, and the female-to-male ratio is 2  1 In adults, they are found in the age group between 40 and 70 years Spontaneous regression of omental cysts is very rare and presumably from increased pressure in cysts overcoming incomplete obstructions or by establishment of alternative routes of drainage Conclusion As the disease is essentially benign and if there are no significant pressure symptoms, the cysts of short duration can be watched further for regression Long-standing, symptomatic cysts, nonregression, and diagnostic uncertainty will warrant surgery to confirm the diagnosis and relieve the symptoms Copyright © 2020 Haraesh Maranna et alPulmonary tuberculosis TB and lung cancer are becoming increasingly prevalent especially in developing countries The occurrence of lung cancer after 30 years of completed pulmonary TB treatment is rare We report a rare occurrence of a squamous cell carcinoma SCC in the post TB lung after 30 years of completed pulmonary tuberculosis treatment A 60-year-old male, an apparently healthy nonsmoker, presented with a community-acquired Klebsiella pneumonia Imaging revealed a destroyed left lung with cavities with air-fluid levels An enhancing lesion was noted at the left upper lobe, and a guided biopsy revealed a SCC He was fit for surgery and underwent an open left pneumonectomy The left lung was destroyed and cavitatory due to the previous tuberculosis A peripherally located tumor was noted in the left upper lobe Histology revealed a moderately differentiated keratinizing type SCC pT4N0Mx The negative cultures and histology excluded an active pulmonary tuberculosis The postsurgical lung function at 1 month showed satisfactory improvement with good functional capacity He was then referred to the oncologist for adjuvant therapy The occurrence of post-TB lung cancer after 30 years in an otherwise healthy male without active TB suggests an increased long-term risk of cancer even in the absence of other robust risk factors Therefore, the chronic inflammatory process in the diseased lung is probably the cause for lung cancer in the absence of active TB Thus, we suggest long-term surveillance after completed pulmonary TB treatment even in otherwise healthy asymptomatic individuals Copyright © 2020 Arulprashanth Arulanantham et alHydatid disease HD is caused by Echinococcus granulosus and is endemic in many parts of the world This parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most frequently targeted organs The spleen and mesentery are unusual locations We report a case of simultaneous huge splenic and mesenteric hydatid cyst in a 91-year-old male patient The patient was presented with chronic abdominal pain, increased frequency of defecation, and typical history of animal contact cattle, sheep, and dogs After performing imaging studies, he was diagnosed with a simultaneous huge spleen and pelvic mesentery hydatid cyst that was managed surgically by splenectomy, pelvic mesenteric cyst deroofing, and partial cystectomy Copyright © 2020 Mostafa M Abdelmaksoud et al