Background and aim: Optical diagnosis (OD) of colonic polyps is poorly reproducible outside high-volume referral centres. Present study aimed to assess whether real-time AI-assisted OD is accurate enough to implement the leave-in-situ strategy for diminutive (5mm) rectosigmoid (DRSPs) polyps. Methods: Consecutive colonoscopy outpatients with 5mm) rectosigmoid (DRSPs) polyps. Methods: Consecutive colonoscopy outpatients with >1 DRSP were included. DRSPs were categorized as adenomas or non-adenomas by the endoscopist, with different expertise in OD, with the assistance of real-time AI system (CADEYE, Fujifilm Co., Tokyo-Japan). Primary study endpoint was >90% negative predictive value (NPV) for adenomatous histology in high-confidence AI-assisted OD of DRSPs (Preservation and Incorporation of Valuable endoscopic Innovations (PIVI-1) threshold), with histopathology as reference standard. The agreement between optical- and histology-based post-polypectomy surveillance intervals (>90%, PIVI-2 threshold) was also calculated according to European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force (USMSTF) guidelines. Results: Overall 596 DRSPs were retrieved for histology in 389 patients; AI-assisted high-confidence OD was made in 92.3%. The NPV of AI-assisted OD for DRSPs (PIVI-1) was 91.0% (95%CI [87.1-93.9]%). PIVI-2 threshold was met in 97.4% (95%CI [95.7-98.9]%) and 92.6% (95%CI [90.0-95.2]%) of patients according to ESGE and USMSTF, respectively. The AI-assisted OD accuracy was significantly lower for non-experts (82.3%; 95% CI [76.4-87.3]%) than for experts (91.9%; 95%CI [88.5-94.5]%), however non-experts in OD quickly approached experts’ performances over time. Conclusion: AI-assisted OD matches the required PIVI thresholds. However, this does not offset the need for a high-level confidence and expertise by the endoscopist. The AI system seems to be useful especially for non-experts.
Background
Acetaminophen inhibits cell-free hemoglobin-induced lipid peroxidation and improves renal function in severe falciparum malaria, but has not been evaluated in other infections with prominent hemolysis including Plasmodium knowlesi malaria.
Methods
PACKNOW was an open-label randomised controlled trial of acetaminophen (500mg or 1000mg 6-hourly for 72 hours) versus no acetaminophen in Malaysian patients aged ≥5 years with knowlesi malaria of any severity. The primary endpoint was change in creatinine at 72 hours. Secondary endpoints included longitudinal changes in creatinine in patients with severe malaria or AKI (acute kidney injury), stratified by hemolysis.
Results
During 2016-2018, 396 patients (age 12-96 years) were randomised to acetaminophen (n=199) or no acetaminophen (n=197). Overall, creatinine fell by a mean (SD) 14.9% (18.1) in the acetaminophen arm versus 14.6% (16.0) in the control arm (p=0.81). In severe disease, creatinine fell by 31.0% (26.5) in the acetaminophen arm versus 20.4% (21.5) in the control arm (p=0.12), and in those with hemolysis by 35.8% (26.7) and 19% (16.6) respectively (p=0.07). No difference was seen overall in patients with AKI; however, in those with AKI and hemolysis, creatinine fell by 34.5% (20.7) in the acetaminophen arm versus 25.9% (15.8) in the control arm (p=0.041). Mixed-effects modelling demonstrated a benefit of acetaminophen at 72 hours (p=0.041) and 1 week (p=0.002) in patients with severe malaria and with AKI and hemolysis (p=0.027 and p=0.002 respectively).
Conclusions
Acetaminophen did not improve creatinine among the entire cohort, but may improve renal function in patients with severe knowlesi malaria, and in those with AKI and hemolysis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.