Nevin Manimala

Comput Methods Biomech Biomed Engin. 2023 Dec 21:1-24. doi: 10.1080/10255842.2023.2294264. Online ahead of print.

ABSTRACT

Effective disease diagnosis is a critical unmet need on a global scale. The intricacies of the numerous disease mechanisms and underlying symptoms make developing a model for early diagnosis and effective treatment extremely difficult. Machine learning (ML) can help to solve some of these issues. Recently, various ensemble-based ML models have benefited clinicians in early diagnosis. However, one of the most difficult challenges in multi-level ensemble approaches is the classifier selection and their placement in the ensemble framework as it improves the overall performance. Let m classifiers have to select from n classifiers there are (nm) ways. Again, these (nm) possibilities can be arranged in m! ways. Finding the best m classifiers and their positions from total (nm)m! ways is a challenging and hard problem. To address this challenge, a dynamic three-level ensemble framework is proposed. A nested Genetic Algorithm (GA) and ensemble-based fitness function are employed to optimize the classifier selection and their placement in a three-level ensemble framework. Our approach used eleven classifiers and chose seven classifiers by maximizing the fitness function. The proposed model experiments on 12 disease datasets. The proposed model outperformed in terms of accuracy, F1, and G-measure on the Chronic Kidney Disease (CKD) dataset is 0.987, 0.988, and 0.989, respectively. In terms of AUC on the Heart disease dataset (HDD) is 0.998 and in terms of recall on the Hypothyroid disease dataset (HyDD) is 0.988. In addition, the proposed model superiority is statically evaluated by Wilcoxon-Signed-Rank (WSR) test compared with other ensemble models, such as random forest (RF), bagging classifier (BC), XGBoost (XGB), and gradient boost classifier (GBC) with probability value p < 0.05 results shows all the traditional ensemble model differs with proposed model and also effective size evaluated with using the matched-pairs rank biserial correlation coefficient w_c and statistical results shows effective size is large with RF and BC and effective size is medium with XGB and GBC. Proposed model has outperformed comparing with State-Of-The-Art (SOTA) ensemble and non-ensemble models. Further, the proposed model outperformed in terms of the ROC curve in the majority of the disease datasets. The results suggest the usage of the proposed model for disease diagnosis applications.

PMID:38126276 | DOI:10.1080/10255842.2023.2294264

JBI Evid Synth. 2023 Dec 21. doi: 10.11124/JBIES-23-00129. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this review is to examine and describe global pharmacy practice strategies and interventions designed to achieve health equity for First Peoples.

INTRODUCTION: Access to medicines and quality use of medicines is critical to achieving health equity for First Peoples. Pharmacists are uniquely placed to lead the charge in transforming current health systems, reducing health disparities, and bolstering the movement toward health equity.

INCLUSION CRITERIA: Global studies describing pharmacy practice strategies and interventions designed to achieve health equity for First Peoples will be considered for inclusion in the review. Studies relating to all areas of pharmacy practice, including community and clinical pharmacy, social, administrative, pharmaceutical sciences, practice, teaching, research, advocacy, or service relevant to the review’s objective will also be considered for inclusion. The types of studies to be included are qualitative, quantitative, and mixed methods, systematic reviews, scoping reviews, literature reviews, and gray literature.

METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, CINAHL, and gray literature sources will be searched from 1998 to present. Titles, abstracts, and full texts will be screened against the inclusion criteria. Strategies and interventions identified in the included reviews will be mapped to a published framework, outlining actionable strategies for pharmacy practice inclusion in sustainable efforts to achieve health equity. Qualitative content analysis and descriptive statistics will be utilized with data presented in tables, accompanied by a narrative.

REVIEW REGISTRATION: Open Science Framework osf.io/qa64b.

PMID:38126268 | DOI:10.11124/JBIES-23-00129

Histol Histopathol. 2023 Dec 14:18690. doi: 10.14670/HH-18-690. Online ahead of print.

ABSTRACT

We aimed to study the effects of different extensive confluent necrosis on complete biochemical remission, side effects of immunosuppressants, and outcomes in patients with autoimmune hepatitis (AIH). Patients with liver biopsy, receiving standard immunosuppressive therapy (IST), and regular follow-up were retrospectively recruited. Demographic and clinicopathological characteristics between Ishak confluent necrosis scores ≤4 (the non-severe AIH group) and ≥5 (the severe AIH group) were compared. The Kaplan-Meier Survival analysis, Cox regression analysis, and log-rank test were performed. Bilateral p<0.05 was considered statistical significance. One hundred and forty-two patients were enrolled, the median age was 56.0, and 83.8% were female. There were no significant differences in aminotransferases and immunological markers between the two groups. Patients in the severe AIH group had significantly worse liver synthetic function, a higher proportion of cirrhosis, and histologically a higher degree of portal inflammation, interface hepatitis, fibrosis stage, and a higher histological activity index score (all p<0.05). Patients in the severe AIH group had a lower response than the other group after four weeks (57.1% vs. 86.3%, p=0.002). However, differences in complete biochemical remission (CBR) were insignificant. Eight patients experienced end-point events. Kaplan-Meier survival analysis showed no significant difference between the two groups (p=0.343). For adverse effects of IST, patients in the severe group tended toward a higher incidence of corticosteroid adverse effects without statistical significance. Our study indicated that patients with histologically severe confluent necrosis (Ishak score≥5) had significantly worse liver synthetic function and a higher degree of liver fibrosis before IST. Compared with their counterparts, this subgroup of patients showed delayed biochemical response but eventually comparable CBRs, side effects, and long-term outcomes.

PMID:38126225 | DOI:10.14670/HH-18-690

Pharmacoepidemiol Drug Saf. 2023 Dec 21. doi: 10.1002/pds.5747. Online ahead of print.

ABSTRACT

PURPOSE: Antipsychotic agents, which may increase the risk of infection through dopaminergic dysregulation, are prescribed to a fraction of patients following critical illness. We compared the rate of recurrent sepsis among patients who filled a prescription for antipsychotics with high- or low-D₂ affinity.

METHODS: Population-based cohort with active comparator design. We included sepsis survivors older than 65 years with intensive care unit admission and new prescription of antipsychotics in Ontario 2008-2019. The primary outcome were recurrent sepsis episodes within 1 year of follow-up. Patients who filled a prescription within 30 days of hospital discharge for high-D₂ affinity antipsychotics (e.g., haloperidol) were compared with patients who filled a prescription within 30 days of hospital discharge for low-D₂ affinity antipsychotics (e.g., quetiapine). Multivariable zero-inflated Poisson regression models with robust standard errors adjusting for confounding at baseline were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).

RESULTS: Overall, 1879 patients filled a prescription for a high-D_2, and 1446 patients filled a prescription for a low-D₂ affinity antipsychotic. Patients who filled a prescription for a high-D₂ affinity antipsychotic did not present a higher rate of recurrent sepsis during 1 year of follow-up, compared with patients who filled a prescription for a low-D₂ affinity antipsychotic (IRR: 1.12; 95% CI: 0.94, 1.35).

CONCLUSIONS: We did not find conclusive evidence of a higher rate of recurrent sepsis associated with the prescription of high-D₂ affinity antipsychotics (compared with low-D₂ affinity antipsychotics) by 1 year of follow-up in adult sepsis survivors with intensive care unit admission.

PMID:38126218 | DOI:10.1002/pds.5747

J Periodontal Res. 2023 Dec 21. doi: 10.1111/jre.13223. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the present research is to evaluate the salivary levels of leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in periodontal health and disease (gingivitis and stage III periodontitis) and also to compare the discriminative efficiencies of both biomarkers in periodontal disease.

BACKGROUND: LRG is a new acute-phase protein whose functions are still being investigated. LRG and CRP are both biomarkers that are increased by inflammation. No clinical study has yet investigated the comparison of the level of LRG and CRP in periodontal health, gingivitis and periodontitis in saliva samples.

METHODS: A total of 60 individuals, including 20 periodontally healthy (control group/group C), 20 with gingivitis (group G), and 20 with Stage III periodontitis (group P), who were systemically healthy and non-smokers, participated in this study. Periodontal charts were used for recording clinical periodontal parameters and saliva LRG and CRP levels were measured by ELISA. Analyzing the area under the curve (AUC) was performed by the receiver-operating characteristics curve.

RESULTS: Salivary levels of LRG and CRP were significantly higher in disease groups than in group C (p < .05). Positive statistically significant correlations were observed between both biomarkers and clinical parameters (p < .05). There was also a strong positive correlation between two biomarkers (p < .05). In distinguishing periodontal disease from periodontal health, LRG (AUC = 0.833) and CRP (AUC = 0.826) were found to have similar accuracy (p = .923).

CONCLUSION: LRG and CRP may be useful and similarly effective biomarkers in the diagnosis of periodontal diseases based on the findings of this study.

PMID:38126217 | DOI:10.1111/jre.13223

Clin Nephrol. 2023 Dec 21. doi: 10.5414/CN110970. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic inflammatory indicators are important in the prognoses of various diseases. Such indicators, including the neutrophil-to-lymphocyte ratio (NLR), can be meaningful in predicting the clinical outcome in patients diagnosed with idiopathic membranous nephropathy (IMN).

MATERIALS AND METHODS: 112 IMN patients diagnosed by renal biopsy were recruited retrospectively. The endpoint was defined as a combination of partial and complete remission. Statistical analysis determined the independent factors associated with clinical remission and the predictive utility of NLR.

RESULTS: Within the 12-month follow-up period, 72 patients achieved clinical remission after treatment. Univariate analysis identified significant differences in serum albumin, estimated glomerular filtration rate (eGFR), proteinuria, neutrophil count, and NLR between the remission group and the non-remission group (all p < 0.05). Cox proportional hazards indicated that elevated eGFR (HR 1.022, 95% CI (1.009 – 1.035), p = 0.001), lower NLR (HR 0.345, 95% CI (0.237 – 0.501), p = 0.0001), and decreased proteinuria (HR 0.826, 95% CI (0.693 – 0.984), p = 0.032) were protective elements for remission. With an optimal cut-off value of 2.61, the pre-treatment NLR had an excellent ability to identify the remission (area under the curve (AUC), 0.785). Participants were separated into low- and high-NLR groups by using 2.61. Kaplan-Meier survival curves revealed significantly higher remission rates in the lower group (p < 0.0001).

CONCLUSION: The NLR is an effective indicator for predicting clinical remission in patients with IMN.

PMID:38126194 | DOI:10.5414/CN110970

Harefuah. 2023 Dec;162(10):656-659.

ABSTRACT

INTRODUCTION: Obstructed Defecation Syndrome (ODS) is a complex surgical condition which involves structural and functional problems which significantly affects quality of life. There is limited information about the Da-Vinci Robotic System use in the treatment of this condition. This study examines the outcomes of robotic-assisted rectopexy. The primary outcome is recovery from surgery, with secondary outcomes including post-surgical complications, length of hospital stay, rehospitalization rate and recurrence after surgery.

METHODS: A retrospective analysis was conducted of prospectively collected data for patients who underwent robotic assisted surgery for ODS between 2011-2022. A colorectal surgeon performed all surgeries at the Sheba Medical Center using the Da Vinci™ robotic system. This analysis uses descriptive statistics and presents the results as medians and ranges.

RESULTS: Out of 33 patients included, 26 (84.9%) were female. Median age was 67 years (Range:19-85 years). Median American Society of Anesthesiology (ASA) score was 2 (1-3). Median Charlson’s comorbidity score was 3 (0-4). Median patients’ Body Mass Index (BMI) was 23.2 (15.6-33.4) kg/m2. Eight patients (24.4%) underwent previous procedure for ODS. Most (23) patients included (69.7%) underwent robotic assisted ventral rectopexy. Other interventions included combined anterior and posterior rectopexy (9.1%), combined ventral rectopexy and sacrocolpopexy (12.1%) and posterior rectopexy (9.1%). No cases of conversion to laparoscopic /open techniques were recorded. Median operation time was 135 minutes (70-270). One intra-operative complication recorded was an injury to the rectum during anterior dissection (3%). No significant blood loss was recorded. A total of 27 patients (81.8%) were operated using the Da Vinci Si system, and the rest (6) using the 6 Da Vinci Xi system. Two patients had post-operative complications. Median length of stay (LOS) was 4 days (2-6 days). Readmission rate within 30 days was 9.1%. Two patients (6.1%) had recurrence of rectal prolapse. Median follow-up was 60 (4-116) months.

CONCLUSIONS: Robotic-assisted surgery for obstructed defecation syndrome is safe, with fast recovery of the patient and it is efficient during long-term follow-up.

PMID:38126149

Harefuah. 2023 Dec;162(10):644-649.

ABSTRACT

INTRODUCTION: The subarachnoid space (SAS) is a potential space surrounding the brain where the cerebrospinal fluid (CSF) flows. Previous work demonstrated how the SAS width changes during pregnancy and measured the normal values per gestational week.

OBJECTIVES: Studying the ratio between the fetal brain volume (STV) and the SAS width (SS ratio), as measured via fetal magnetic resonance imaging (MRI) in different fetal pathologies – macrocephaly and microcephaly, and studying the correlation between this ratio and the gestational week.

METHODS: A retrospective study was conducted on 77 fetuses that underwent fetal MRI scans during gestational weeks 29-37, in three groups: 23 normocephaly, 27 macrocephaly, and 27 microcephaly. SAS width was measured in 10 points via fetal MRI scans, and a ratio was calculated between the width and STV.

RESULTS: The SS ratio is largest in microcephaly group and smallest in normocephaly group, with the macrocephaly group between them. All comparisons were statistically significant except between the macrocephaly and normocephaly groups. There was a strong positive correlation between SS ratio and week of gestation.

CONCLUSIONS: The SS ratio is statistically different between normocephalic fetuses and fetuses with macrocephaly or microcephaly. From week 29 this ratio enlarges with gestational age.

DISCUSSION: The SAS affects the fetal head circumference, an important parameter of fetal growth, thus we decided to study the SS ratio in pathologies of the head circumference. Previous work demonstrated how the STV and the SAS width expand starting at a specific gestational age, thus the gestational week also affects the SS ratio. Summary: The SS ratio is affected by pathologies of the fetal head circumference and by gestational age.

PMID:38126147

Acta Ophthalmol. 2023 Dec 21. doi: 10.1111/aos.16619. Online ahead of print.

ABSTRACT

PURPOSE: To compare detection rates of microaneurysms (MAs) on high-speed megahertz optical coherence tomography angiography (MHz-OCTA), fluorescein angiography (FA) and colour fundus photography (CF) in patients with diabetic retinopathy (DR).

METHODS: For this exploratory cross-sectional study, MHz-OCTA data were acquired with a swept-source OCT prototype (A-scan rate: 1.7 MHz), and FA and CF imaging was performed using Optos® California. MA count was manually evaluated on en face MHz-OCTA/FA/CF images within an extended ETDRS grid. Detectability of MAs visible on FA images was evaluated on corresponding MHz-OCTA and CF images. MA distribution and leakage were correlated with detectability on OCTA and CF imaging.

RESULTS: 47 eyes with severe DR (n = 12) and proliferative DR (n = 35) were included. MHz-OCTA and CF imaging detected on average 56% and 36% of MAs, respectively. MHz-OCTA detection rate was significantly higher than CF (p < 0.01). The combination of MHz-OCTA and CF leads to an increased detection rate of 70%. There was no statistically significant association between leakage and MA detectability on OCTA (p = 0.13). For CF, the odds of detecting leaking MAs were significantly lower than non-leaking MAs (p = 0.012). Using MHz-OCTA, detection of MAs outside the ETDRS grid was less likely than MAs located within the ETDRS grid (outer ring, p < 0.01; inner ring, p = 0.028). No statistically significant difference between rings was observed for CF measurements.

CONCLUSIONS: More MAs were detected on MHz-OCTA than on CF imaging. Detection rate was lower for MAs located outside the macular region with MHz-OCTA and for leaking MAs with CF imaging. Combining both non-invasive modalities can improve MA detection.

PMID:38126128 | DOI:10.1111/aos.16619

J Appl Physiol (1985). 2023 Dec 21. doi: 10.1152/japplphysiol.00622.2023. Online ahead of print.

ABSTRACT

Potential health benefits of an acute fast include reductions in blood pressure and increases in vagal cardiac control. These purported health benefits could put fasted humans at risk for cardiovascular collapse when exposed to central hypovolemia. The purpose of this study was to test the hypothesis that an acute 24-hour fast (vs 3-hours postprandial) would reduce tolerance to central hypovolemia induced via lower body negative pressure (LBNP). We measured blood ketones (β-OHB) to confirm a successful fast (N=18). We recorded the ECG, beat-to-beat arterial pressure, muscle sympathetic nerve activity (MSNA; N=7), middle cerebral artery blood velocity (MCAv), and forearm blood flow. Following a 5-min baseline, LBNP was increased by 15 mmHg until -60 mmHg and then increased by 10 mmHg every 5-min in a stepwise manner until onset of presyncope. Data are expressed as means ± SE. P-values ≤ 0.05 were considered statistically significant. β-OHB increased (β-OHB; 0.12±.04 fed vs. 0.47±.11, p<0.01 mmol/L fast). Tolerance to central hypovolemia was decreased by ~10% in the fasted condition measured via total duration of negative pressure (1370 89 fed vs. 1229±94 s fast, p=0.04), and was negatively associated with fasting blood ketones (R =-0.542, P = 0.02). During LBNP, heart rate and MSNA increased similarly, but in the fasted condition forearm vascular resistance was significantly reduced. Our results suggest that acute fasting reduces tolerance to central hypovolemia by blunting increases in peripheral resistance, indicating that prolonged fasting may hinder an individual’s ability to compensate to a loss of blood volume.

PMID:38126086 | DOI:10.1152/japplphysiol.00622.2023