PriMera Scientific Surgical Research and Practice (ISSN: 2836-0028) - Article In Press

Artificial Intelligence (AI) is a subfield of computer science concerned with developing systems and programs that have the ability to perceive information and convert this information into intelligent actions to achieve desired goals. They do this by receiving innumerable data and processing this data. Also they learn from their past to do task in well organized manner and to improve in future. Thus, AI describes computer models and programs which simulate human-level intelligence to perform cognitive functions, including solving complex problems and experience gathering.

Aims: The article describes the impact of various prognostic elements (CRP, age, duration of symptoms, operator skills, US examination) on the selection of operative method for patients with acute cholecystitis, and consequently displays the suggested preoperative scoring system.
Methods: The retrospective survey included patients operated for acute gallbladder inflammation during the period 2019-2023. Patients were divided into three groups: age (below 30, from 30-60, and above 60), CRP value (CRP<50mg/l, 50-100mg/l, CRP>100mg/l), duration of symptoms (below 3 days, 4-7 days, over 7 days), US examination (wall thickness 2mm, 4mm, more than 4mm), operator skill level (less than 50 operations a year, from 50-70 annually, over 70 annual operations). Each prognostic element was relevantly assessed, and resulted in the elaboration of preoperative scoring system for the laparoscopic cholecystectomy (LCH).
Results: During the indicated three years period 339 patients were operated; of those, 46.6% underwent the laparoscopic method, while 14.2 % needed conversion. Average CRP value in patients with LCH was 84.6mg/l, while the traditional open method indicated 125.5mg/l. Average duration of symptoms in LCH amounted to 2.7 days, and in traditional open method 4.1 days. Mean age of patients treated with laparoscopic method was younger (58.3 years), while the US examination both in LCH and the traditional open method indicated average wall thickness of 2-4 mm. Most LCH operations were performed by operators with over 70 performed annual operations. Screened patients over 60 years of age, CRP values exceeding 100mg/l, and duration of symptoms in excess of 7 days indicated significantly increased number of conversions, resulting in decisions for immediate open method cholecystectomy. Experience level of the operator significantly affected the percentage of conversions and consequent decisions for immediate open cholecystectomy (p<0.01). Each element was statistically evaluated and scored from 1-3, and the results were used in devising a scheme for preoperative classification of patients – preoperative scoring system (PSS).
Conclusion: Preoperative scoring system represents valuable reference for the operator in selecting the method of operation for patients with acute cholecystitis. Whilst any patient exceeding the PSS 11 is not suitable for LCH since there is almost 100% probability of conversion, the patients with PSS ranging from 5-9 are likely material for the LCH.

AI (ChatGPT 3.5) was programmed to simulate the mind of the cancer sufferer with regard to pain. Three simulations emerged from the Idea Coach feature of the Mind Genomics platform, BimiLeap.com. The first simulation allowed the user to overhear discussions among an oncologist, an analyst from an insurance company, an IT specialist in medical applications, the patient’s family, and the patient. The second simulation allowed the user to create three different mind-sets regarding post-procedure pain for the cancer sufferer: Survivor, Fighter, and Realist, respectively. The third simulation instructed the AI to create and answer questions about the mind-set, with comments from a doctor about each answer, and a prognosis over the next five years. The paper shows the ease with which AI can put a “human face” on the issue of cancer, and in turn become a tool for teaching medical students, as well as for working with cancer patients as it provides a better understanding of their condition.
Keywords: cancer patients; Mind Genomics; post-procedure pain; postoperative pain; synthesized patient mind-sets

Down-Klinefelter Syndrome is an exceptionally rare chromosomal disorder that arises from the coexistence of two distinct genetic anomalies: Down syndrome (trisomy 21) and Klinefelter syndrome (47, XXY). The patient is a 3-year-old male with a rare and complex chromosomal condition resulting from mosaic Down syndrome and Klinefelter syndrome (48, XXY+21). The child has a history of congenital heart disease (CHD), which necessitated surgical intervention. Post-surgical recovery has been complicated, including significant morbidity such as a left foot amputation caused by a crossed vasoconstriction reflex. The patient underwent several investigations to elucidate the extent of their complex medical issues. A Doppler ultrasound revealed limited arterial flow in the left lower limb post-ECMO, with only partial arterial signals detected. Down-Klinefelter syndrome is a rare chromosomal abnormality that combines features of Down syndrome and Klinefelter syndrome. Documented complications include hypothyroidism, infantile spasms, gastrointestinal dysfunction, and congenital heart disease. To date, more than 70 cases of double aneuploidy have been reported in the literature.
Keywords: Patients; Down sindrome; Chromosomal; Disorder; Genetic abnormality

“Sidekick,” an original short fiction work, explores the concept of belonging through its two main characters, Birch and Aggie, who struggle to find social acceptance. Birch’s struggle is with paranoid schizophrenia. While he exhibits symptoms of delusions and experiences auditory complex perceptions, as do many with paranoid schizophrenia, unlike most, he also sees visual hallucinations. The general population might confuse his disability with dissociative identity disorder, or existing in multiple personality states. Instead, Birch seems cut off from reality, and while highly intelligent and educated, has been unable, especially in recent years, to maintain a successful life. The narrator, Aggie, is a retiree whose career was spent as an expatriate working with farming communities for a non-governmental organization (NGO) in Cambodia. She has recently returned to her home in Virginia. Her perceptions and experience are partially based on research and my observations while visiting Cambodia and my conversations with NGO employees there. The greater portion, however, is informed by my observations and experiences over the last eighteen years as a member of the expatriate community in Doha, Qatar, one of the Gulf states. Usually, expatriates are motivated by imagining a better life abroad in status, salary, and/or in opportunities to make a meaningful contribution. Aggie’s desires fit within the latter category, and as is common with expat life, her dreams met with obstacles, which require adjustment if the expat is to remain abroad. Aggie was unable to find a way to adjust. However, upon her return, she has realized that her home is no longer familiar to her, and while she has never quite fit into the fashionable society of Richmond’s West End, her outsider status has become even more pronounced. Her first-person account relays her chance encounter at a café with the much younger Birch and the tentative attempts these two lonely people make in pursuing a possible platonic friendship.
Keywords: short fiction; humor; mystery; friendship; paranoid schizophrenia; expatriate; Virginia; Cambodia

Background
The main disadvantage of conventional Bassini hernioplasty is that it involves forceful approximation of the groin tissues associated with tension on the suture line, which leads to increased postoperative pain, longer hospital stay delay in resuming regular physical activity, and higher recurrence rate. New techniques of tension free repair have many advantages, including decreased tension, reduced postoperative pain, decreased analgesic consumption, faster return to normal physical activity and lower incidence of recurrence. Tension free techniques are divided into open (Trabucco) and endoscopic (laparoscopic TAPP and TEP). This study was undertaken to investigate the advantages and disadvantages of conventional and laparoscopic hernioplasty.

Patients and methods
During the period 2018-2019, 28 patients, 24 men (85,7 %) and 4 women (14,3 %), underwent endoscopic hernia repair at our department. During the same period, the open tension-free technique was used in 423 patients, 388 men (84,9 %) and 44 women (10,2 %). The mean age of laparoscopic and open tension group was 55 and 52 years, respectively. The techniques were compared in terms of operating time, hospital stay, postoperative pain, analgesic usage, recurrence rate, return to normal physical activity, and complications. Follow up examinations were scheduled at one month, six months, one year and five years after surgery.

Results
The operating time in laparoscopic hernioplasty is significantly longer than in tension-free hernia repair, yet there is no statistically difference between the two techniques as concerns the length of hospital stay. In patients undergoing laparoscopic hernia repair, return to normal physical activity was significantly less, analgesics during the first three postoperative days, and reported significantly lower level of pain assessed by the visual analogy scale. On follow-up examination at five years after surgery one recurrence (3,6 %) was found in both groups. There was no significant difference between the groups in terms of normal physical activity.

Conclusion
Tension-free hernioplasty is the method of choice in the treatment of adult patients with groin hernia. Laparoscopic hernia repair has its advantages and drawbacks. It is considerably more expansive than the tension-free approach, but its use is fully justified in adults with hernia recurrence.