Tag: pubmed

Comput Med Imaging Graph. 2021 Oct 23;94:102008. doi: 10.1016/j.compmedimag.2021.102008. Online ahead of print.

ABSTRACT

The global pandemic of coronavirus disease 2019 (COVID-19) is continuing to have a significant effect on the well-being of the global population, thus increasing the demand for rapid testing, diagnosis, and treatment. As COVID-19 can cause severe pneumonia, early diagnosis is essential for correct treatment, as well as to reduce the stress on the healthcare system. Along with COVID-19, other etiologies of pneumonia and Tuberculosis (TB) constitute additional challenges to the medical system. Pneumonia (viral as well as bacterial) kills about 2 million infants every year and is consistently estimated as one of the most important factor of childhood mortality (according to the World Health Organization). Chest X-ray (CXR) and computed tomography (CT) scans are the primary imaging modalities for diagnosing respiratory diseases. Although CT scans are the gold standard, they are more expensive, time consuming, and are associated with a small but significant dose of radiation. Hence, CXR have become more widespread as a first line investigation. In this regard, the objective of this work is to develop a new deep transfer learning pipeline, named DenResCov-19, to diagnose patients with COVID-19, pneumonia, TB or healthy based on CXR images. The pipeline consists of the existing DenseNet-121 and the ResNet-50 networks. Since the DenseNet and ResNet have orthogonal performances in some instances, in the proposed model we have created an extra layer with convolutional neural network (CNN) blocks to join these two models together to establish superior performance as compared to the two individual networks. This strategy can be applied universally in cases where two competing networks are observed. We have tested the performance of our proposed network on two-class (pneumonia and healthy), three-class (COVID-19 positive, healthy, and pneumonia), as well as four-class (COVID-19 positive, healthy, TB, and pneumonia) classification problems. We have validated that our proposed network has been able to successfully classify these lung-diseases on our four datasets and this is one of our novel findings. In particular, the AUC-ROC are 99.60, 96.51, 93.70, 96.40% and the F1 values are 98.21, 87.29, 76.09, 83.17% on our Dataset X-Ray 1, 2, 3, and 4 (DXR1, DXR2, DXR3, DXR4), respectively.

PMID:34763146 | DOI:10.1016/j.compmedimag.2021.102008

J Int AIDS Soc. 2021 Nov;24(11):e25833. doi: 10.1002/jia2.25833.

ABSTRACT

INTRODUCTION: A potential concern with the use of dapivirine (DPV) for HIV prevention is the selection of a drug-resistant virus that could spread and reduce the effectiveness of non-nucleoside reverse transcriptase (NNRTI)-based first-line antiretroviral therapy. We evaluated HIV-1 seroconversions in MTN-020/ASPIRE for selection of drug resistance and evaluated the genetic basis for observed reductions in susceptibility to DPV.

METHODS: MTN-020/ASPIRE was a placebo-controlled, Phase III safety and effectiveness study of DPV ring for HIV-1 prevention conducted at 15 sites in South Africa, Zimbabwe, Malawi and Uganda between 2012 and 2015. Plasma from individuals who seroconverted in ASPIRE was analysed for HIV-1 drug resistance using both population Sanger sequencing and next-generation sequencing (NGS) with unique molecular identifiers to report mutations at ≥1% frequency. DPV susceptibility of plasma-derived recombinant HIV-1 containing bulk-cloned full-length reverse transcriptase sequences from MTN-020/ASPIRE seroconversions was determined in TZM-bl cells. Statistical significance was calculated using the Fisher’s exact test.

RESULTS: Plasma from all 168 HIV seroconversions were successfully tested by Sanger sequencing; 57 of 71 DPV arm and 82 of 97 placebo (PLB) arm participants had NGS results at 1% sensitivity. Overall, 18/168 (11%) had NNRTI mutations including K101E, K103N/S, V106M, V108I, E138A/G, V179D/I/T and H221Y. Five samples from both arms had low-frequency NNRTI mutations that were not detected by Sanger sequencing. The frequency of NNRTI mutations from the DPV arm (11%) was not different from the PLB arm (10%; p = 0.80). The E138A mutation was detected in both the DPV (3 of 71 [4.2%]) and PLB arm (5 of 97 [5.2%]) and conferred modest reductions in DPV susceptibility in some reverse transcriptase backgrounds but not others.

CONCLUSIONS: HIV-1 drug resistance including NNRTI resistance did not differ between the DPV and placebo arms of the MTN-020/ASPIRE study, indicating that drug resistance was not preferentially acquired or selected by the DPV ring and that the preventive benefit of DPV ring outweighs resistance risk.

PMID:34762770 | DOI:10.1002/jia2.25833

Int J Health Plann Manage. 2021 Nov 11. doi: 10.1002/hpm.3373. Online ahead of print.

ABSTRACT

This study aims to investigate the determinants of the quality MRI in the Turkish healthcare system. The analysis is done by analysing the referred cases to a major university radiology department in Turkey, and matching the hospital and MRI use characteristics of the source institutions, where the original MRI was taken. Quality of MRI was measured by specialist radiologists. The resulting quality was analysed by gender and imaging area characteristics, source institutional quality, MRI use statistics in source institution and MRI machine use inclination of the source institution. Chi-square and logistic regression were conducted, with regional fixed effects. In the largest dataset, the highest quality institutions have significantly higher average expected MRI quality compared to one level beneath them (0.74 vs. 0.63) (P = 0.02), there is also a significant MRI quality difference between the second highest level of institution, and the third and the fourth (0.63-0.54). Smaller (<0.1) but significant quality difference (P = 0.05) exists for institutions with the lowest two quality levels. In the smaller dataset, with data only from the lowest two institutional quality groups, with a finer institutional quality grading, differences in institutional quality is again found to be a significant driver of MRI quality (P = 0.035).

PMID:34762751 | DOI:10.1002/hpm.3373

J Viral Hepat. 2021 Nov 11. doi: 10.1111/jvh.13631. Online ahead of print.

ABSTRACT

Many patients with chronic hepatitis B do not receive adequate follow-up. This study aimed to develop a risk score to predict clinical events in patients with chronic hepatitis B virus (HBV) infection at the population level for identifying patients at high-risk to warrant regular follow-up. This study analyzed population-based data from the nationwide claims database of South Korea obtained between 2005 and 2015. We identified 507,239 non-cirrhotic patients with chronic HBV infection who are not under antiviral treatment. A risk score for predicting clinical events (hepatocellular carcinoma, death, or liver transplantation) was developed based on multivariable Cox proportional hazard model in a development cohort (n = 401,745) and validated in a validation cohort (n = 105,494). The cumulative incidence rates of clinical events at 5 years were 2.56% and 2.44% in the development and validation cohorts, respectively. Clinical events in Asymptomatic Patients with chronic HBV infection (CAP-B) score ranging from 0 to 7.5 points based on age, sex, socioeconomic status, chronic hepatitis C co-infection, diabetes mellitus, statin or antiplatelet exposure, smoking, alcohol consumption, alanine aminotransferase, and gamma-glutamyltransferase had good discriminatory accuracy in both the development and validation cohorts (c-indices for 3-, 5-, 10-year risk prediction: all 0.786). The predicted and observed probabilities of clinical events were calibrated in both cohorts. A score of >3.5 points identified subjects at distinctly high risk. The CAP-B score using easily accessible variables can predict clinical events and may allow selection of patients with chronic HBV infection for priority of regular follow-up.

PMID:34762757 | DOI:10.1111/jvh.13631

Int J Health Plann Manage. 2021 Nov 11. doi: 10.1002/hpm.3383. Online ahead of print.

ABSTRACT

BACKGROUND: At the biological level, ageing results from a plodding decline in physical and mental capability, an emergent menace of malady, and eventually, fatality. Even though a few of the geriatric’s health changes are hereditary, to a great extent is due to individual’s physical and societal surroundings and their residence, locality, societies, gender, ethnicity or socio-economic status. The current debate is well popular by the relationship between increasing diversity and the ageing population with healthcare expenditure in the United States. Higher diversity in society and increasing ageing population have various socio-economic consequences. A good policy in this regard helpful to managed and get fruitful outcomes.

OBJECTIVE: This study aims to examine the direct effects of diversity and ageing population on healthcare spending. The assortment observed in geriatrics is not arbitrary. A huge portion emerges from individual’s physical and social settings and the influence of these environs on their prospect and well-being demeanour.

METHOD: This study used the Bayesian-vector autoregressive model, impulse response analysis, and variance decomposition and data over the period 1990-2018 for empirical analysis of the United States.

RESULTS: The empirical findings indicate that diversity and ageing population are more persistent with health expenditure in the United States. This study concludes that an increase in diversity and ageing population will rely on the long-term healthcare facility.

CONCLUSION: The study suggests that cohesive society and effective health intervention might aid in curtailing expenditure pressure linked with elderly population. Furthermore, a recommendation of this study is a good opportunity for healthcare policymakers and further researches.

PMID:34762749 | DOI:10.1002/hpm.3383

Med Anthropol Q. 2021 Nov 11. doi: 10.1111/maq.12675. Online ahead of print.

ABSTRACT

Since the early 2000s, Turkey has been going through a dynamic period of health reforms where the global push toward health statistics has converged with the state’s pronatalist concerns over declining birth rates. Reproductive behaviors are now monitored via health information technologies such as centralized databases. The World Health Organization and the Turkish Ministry of Health celebrate these technologies as essential steps toward evidence-based health care delivery. The everyday realities of these technologies, however, are more complicated, especially for nurses and their patients. Drawing on ethnographic fieldwork in state-run health clinics in Istanbul, this article demonstrates how these data-driven health technologies build on nurses’ gendered care labor and increase surveillance on urban poor and/or ethnoracially minoritized communities. In doing so, I argue that the datafication of reproduction operates as a particular mode of “reproductive governance” (Morgan and Roberts 2012) that reflects and reproduces existing social hierarchies and inequalities.

PMID:34762750 | DOI:10.1111/maq.12675

Int J Gynaecol Obstet. 2021 Nov 11. doi: 10.1002/ijgo.14015. Online ahead of print.

ABSTRACT

BACKGROUND: Pregnant patients are potentially vulnerable to COVID-19.

OBJECTIVES: To clarify the clinical features of COVID-19 and analyze maternal/fetal morbidity and mortality and the obstetric and neonatal outcomes of pregnant patients.

SEARCH STRATEGY: Embase, PubMed, Web of Science, CINAHAL, LILACS, Google Scholar, and Scopus.

SELECTION CRITERIA: Articles published from December 2019 to February 2021.

DATA COLLECTION AND ANALYSIS: The reviewers extracted relevant data from the full-text. Data synthesis was performed using the R-4.1.0 Project for Statistical Computing for Windows. The meta-analysis of the included studies was carried out using the random-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis.

RESULTS: A total of 70 studies included 10 047 pregnant women with COVID-19, of whom 71.6% were in their third trimester. The most common symptoms were fever, cough, chest pain, dyspnea, and fatigue. Most newborns were delivered preterm (24%, 95% confidence interval [CI] 0.17-0.34, I² =93%) and via cesarean delivery (42%, 95% CI 0.38-0.47, I² =92%). There were 108 maternal mortalities (2%, 95% CI 0.01-0.03, I² =54%) and 50 abortions (5%, 95% CI 0.03-0.09, I² =73%). The neonatal outcomes included fetal distress (11%, 95% CI 0.06-0.19, I² =91%), birth weight (15%, 95% CI 0.10-0.21, I² =76%), APGAR <7 (19%, 95% CI 0.12-0.28, I² =43%), admission to the neonatal intensive care unit (28%, 95% CI 0.17-0.43, I² =90%), and fetal mortality (2%, 95% CI 0.01-0.03, I² =46%).

CONCLUSION: There was no evidence of severe acute respiratory syndrome coronavirus-2 in the placenta, breast milk, umbilical cord, and amniotic fluid.

PMID:34762735 | DOI:10.1002/ijgo.14015

Int J Health Plann Manage. 2021 Nov 11. doi: 10.1002/hpm.3384. Online ahead of print.

ABSTRACT

BACKGROUND: During a pandemic, the occurrence of infections and case fatality rates are expected to vary from one country to another due to several variables such as poverty, existing comorbidities, population density, access to health care, availability and quality of health system resources, and environmental factors.

OBJECTIVES: Our aim is to investigate the relationship between various demographic and socioeconomic factors and reported COVID-19 morbidity and mortality indicators in different countries. Also, to determine the position of the countries relative to each other in terms of three indicators including COVID-19 cases, deaths and tests.

METHODS: Canonical correlation analysis is used to investigate the intercorrelations between independent variables and the COVID-19 cases and deaths for 92 countries. Countries’ performances are measured by MULTIMOORA.

RESULTS: Human Development Index, smoking habits, percentage of elderly population and test frequency are the most significant variables associated with COVID-19 morbidity and mortality according to our study findings. Singapore, New Zealand and Australia are the best performed countries.

CONCLUSIONS: Several significant and unexpected associations exist between socioeconomic factors and the COVID-19 cases and deaths. Singapore, New Zealand and Australia are surrounded by water, have been more successful in the pandemic process compared to other countries.

PMID:34762746 | DOI:10.1002/hpm.3384

Med Ultrason. 2021 Nov 3. doi: 10.11152/mu-3246. Online ahead of print.

ABSTRACT

AIM: Transvaginal ultrasonography (TVUS) has shown varying results in the staging of cervical cancer patients around the world. Hence, the current review was done to assess the diagnostic accuracy of TVUS for identifying parametrial, stromal invasion and lymph node metastasis among cervical cancer patients.

MATERIAL AND METHODS: We conducted a systematic search for all studies reporting the diagnostic accuracy of TVUS for staging of cervical cancer in the databases of PubMed Central, MEDLINE, EMBASE, MEDLINE, SCOPUS and Cochrane library from inception till March 2021. Meta-analysis was performed using STATA software “midas” package.

RESULTS: Eleven studies with 760 patients were included. The pooled sensitivity and specificity of TVUS for diagnosing parametrial invasion were 62% (95% CI, 40-80) and 91% (95% CI, 79-97), for stromal invasion were 84% (95% CI, 77-90) and 80% (95% CI, 61-91), for lymph node metastasis were 52% (95% CI, 8-93) and 95% (95% CI, 68-99). There was significant heterogeneity found with all the outcomes with significant chi-square test and I2 statistic >75%.

CONCLUSION: TVUS has limited applicability and use as a screening or diagnostic tool for local staging of cervical cancer patients. Further reviews comparing multiple non-invasive imaging modalities are required to pick the best tool for local staging of cervical cancer.

PMID:34762728 | DOI:10.11152/mu-3246

PLoS One. 2021 Nov 11;16(11):e0259631. doi: 10.1371/journal.pone.0259631. eCollection 2021.

ABSTRACT

The COVID-19 pandemic has affected all dimensions of lives and has become a social problem as it continues to spread widely through the continuous interactions of people in public spaces where they earn a living. Curbing the spread of COVID-19 requires restrictions in these public spaces, however, the compliance to these measures depends largely on the understanding and interpretations of COVID 19 by users of these public spaces. This study examined the contextual interpretations of public space users about COVID-19 prevention in Ibadan Metropolis, Oyo State. The study was a rapid ethnographic survey in selected public spaces (markets and commercial motor parks) in Ibadan metropolis. Data were collected through participant observation, key informant interviews (3 females; 3 males) and in-depth interviews (30) with, traders, head porters, clients/buyers and commercial vehicle drivers in these public spaces. Interviews conducted were transcribed, sorted into themes using Atlas-ti 7.5.7 and subjected to interpretive-content analysis. Findings revealed that some respondents felt COVID-19 was brought into Nigeria by rich frequent global voyagers, others felt it was through “uncultured” sexual life or wrath of God. Some also doubted the existence of the disease and many of the respondents perceived COVID-19 as a disease reported by the government or a political propaganda to siphon funds. The users of the public spaces in Ibadan Metropolis have variegated perception about the existence and severity of this rapidly spreading virus and this has grave implications for COVID-19 control in the State. Thus, regular interaction with public space users are essential for control efforts.

PMID:34762710 | DOI:10.1371/journal.pone.0259631