The Challenges for Screening and Diagnosing Gestational Diabetes Mellitus in Brazil: a cross-sectional study in a low-risk obstetric hospital.

Background: Gestational Diabetes Mellitus (GDM) is a very prevalent disease and can cause several morbidities for women and their offspring. The literature demonstrates the necessity for a better approach during prenatal assistance to detect and treat the disease. We aimed to evaluate the model and efficacy of GDM screening and diagnosis in a referenced low-risk obstetrical center of the municipality of Assis, Sao Paulo state, Brazil. Moreover, the specific objective was to evaluate the prevalence of GDM. Methods: We conducted a retrospective cross-sectional study of pregnant women, in which 257 prenatal cards and the clinical approaches used for GDM diagnosis and their results. We observed the consecutive patients admitted to the low-risk referenced obstetrical service of the "Santa Casa de Assis-SP" for childbirth from January to August 2021. Results: There were 257 pregnant women, 227 prenatal cards obtained. Of these, 24.6% of the cards were considered incomplete, 25 (9.72%) did not contain the initial fasting plasma glucose information, and 93 (36.18%) did not describe this information in the second to the third trimester. The prevalence of GDM in the population was 14.78%. Conclusion: We observed many pregnant women not screened according to the recommended guidelines and many prenatal cards with incomplete information. According to the screening and diagnosis guidelines, GDM prevalence was underestimated. The lack of prenatal card information and inadequacy of screening and diagnoses were observed in this population.

Validation of a Saliva-Based Test for the Molecular Diagnosis of SARS-CoV-2 Infection

Background. Since the beginning of the pandemic, clinicians and researchers have been searching for alternative tests to improve the screening and diagnosis of the SARS-CoV-2 infection. Currently, the gold standard for virus identification is the nasopharyngeal (NP) swab. Saliva samples, however, offer clear, practical, and logistical advantages but due to a lack of collection, transport, and storage solutions, high-throughput saliva-based laboratory tests are difficult to scale up as a screening or diagnostic tool. With this study, we aimed to validate an intralaboratory molecular detection method for SARS-CoV-2 on saliva samples collected in a new storage saline solution, comparing the results to NP swabs to determine the difference in sensitivity between the two tests. Methods. In this study, 156 patients (cases) and 1005 asymptomatic subjects (controls) were enrolled and tested simultaneously for the detection of the SARS-CoV-2 viral genome by RT-PCR on both NP swab and saliva samples. Saliva samples were collected in a preservative and inhibiting saline solution (Biofarma Srl). Internal method validation was performed to standardize the entire workflow for saliva samples. Results. The identification of SARS-CoV-2 conducted on saliva samples showed a clinical sensitivity of 95.1% and specificity of 97.8% compared to NP swabs. The positive predictive value (PPV) was 81% while the negative predictive value (NPV) was 99.5%. Test concordance was 97.6% (Cohen’s Kappa = 0.86 ; 95% CI 0.81-0.91). The LoD of the test was 5 viral copies for both samples. Conclusions. RT-PCR assays conducted on a stored saliva sample achieved similar performance to those on NP swabs, and this may provide a very effective tool for population screening and diagnosis. Collection of saliva in a stabilizing solution makes the test more convenient and widely available; furthermore, the denaturing properties of the solution reduce the infective risks belonging to sample manipulation.

Review of Machine Learning Applications Using Retinal Fundus Images

Automating screening and diagnosis in the medical field saves time and reduces the chances of misdiagnosis while saving on labor and cost for physicians. With the feasibility and development of deep learning methods, machines are now able to interpret complex features in medical data, which leads to rapid advancements in automation. Such efforts have been made in ophthalmology to analyze retinal images and build frameworks based on analysis for the identification of retinopathy and the assessment of its severity. This paper reviews recent state-of-the-art works utilizing the color fundus image taken from one of the imaging modalities used in ophthalmology. Specifically, the deep learning methods of automated screening and diagnosis for diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma are investigated. In addition, the machine learning techniques applied to the retinal vasculature extraction from the fundus image are covered. The challenges in developing these systems are also discussed.

The Prevalence of Pulmonary Aspergillosis Among Clinically Suspected and Undertreated Tuberculosis Patients in Khartoum State, Sudan

Background Respiratory tract aspergillosis is a pulmonary disease cause by aspergillus species which are opportunistic fungi that mainly infect immuno-compromised patients . Objective(s) The present study aimed to detect the frequency of pulmonary aspergillosis among clinically suspected and under follow up tuberculosis patients conducted at Tropical Diseases Teaching Hospital, Omdurman, Khartoum State , Sudan during the period from December 2019 to November 2020. Materials and Methods One hundred and fifty sputum samples were collected from suspected cases of pulmonary tuberculosis and under follow up tuberculosis patients. All specimens were examined using 20% KOH and cultured on two sets of Sabouraudʹs Dextrose agar slope media with chloramphenicol. Results Asperigillus species were isolated from 9/150 (6%) patients. They represented 5(3.3%) A.fumigatus, 3 (2%) A. niger and 1 (0.6%) A. Flavus. It was found that all Aspergillus isolates were revealed from Non acid fast bacilli (Non AFB) patients 9/137(6.6%) with the most common frequency among asymptomatic patients 3/35(8.6%) , patients who were under tuberculosis treatment (8.5%), those who were under Rifampicin (RIF) and Isonizide (INH) treatment (10%) and with duration of less than three month. Also the higher percentage (13%) was represented among the age group range from 61-80 year and slightly among males 6/97 (6.2 %) than females 3/53 (5.7%). There was statistically non-significant association between the frequency of aspergillosis and the studied variables in this study. Conclusion The frequency of pulmonary aspergillosis among patients with anti-tuberculosis treatment reflects the need for routine screening and diagnosis of those patients since the use of anti- tuberculosis treatment can promote the growth and reproduction of fungi. Keywords Pulmonary aspergillosis, tuberculosis, follow up patients.

Extracellular Vesicles and Ovarian Cancer

Extracellular vesicles (EVs) are a varied group of cell-derived, microscopic, fluid-filled pouches released from cells into neighboring microenvironments that are quickly gaining recognition as a potentially powerful tool against epithelial ovarian cancer (EOC). Recent studies show that not only do EVs play an integral part in the development of cancer through intercellular communication, cell survival, and immune modulation but also may assist with early diagnosis and improved treatments. EOC currently has few effective screening options for early detection of this disease; and, therefore, it is detected at an advanced stage where it is more likely to recur, develop chemoresistance, and ultimately become fatal. Newer research has evaluated EVs as biomarkers for early screening and diagnosis and as novel targets for treatment of EOC. Moreover, EVs are possible targets for novel immunomodulatory therapies to directly target cancer cells or make cancer cells more susceptible to other treatment modalities. Therefore, EVs present an exciting, promising approach which may improve clinical outcome for EOC patients.

How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.