A rapid triage test for active pulmonary tuberculosis in adult patients with persistent cough

2019 ◽  
Vol 11 (515) ◽  
pp. eaaw8287 ◽  
Author(s):  
Rushdy Ahmad ◽  
Liangxia Xie ◽  
Margaret Pyle ◽  
Marta F. Suarez ◽  
Tobias Broger ◽  
...  
Keyword(s):  
Single Molecule ◽  
Host Response ◽  
Machine Learning Algorithms ◽  
Adult Patients ◽  
World Health ◽  
Blood Protein ◽  
Blood Proteins ◽  
Active Pulmonary Tuberculosis ◽  
Persistent Cough ◽  
Triage Test

Improved tuberculosis (TB) prevention and control depend critically on the development of a simple, readily accessible rapid triage test to stratify TB risk. We hypothesized that a blood protein-based host response signature for active TB (ATB) could distinguish it from other TB-like disease (OTD) in adult patients with persistent cough, thereby providing a foundation for a point-of-care (POC) triage test for ATB. Three adult cohorts consisting of ATB suspects were recruited. A bead-based immunoassay and machine learning algorithms identified a panel of four host blood proteins, interleukin-6 (IL-6), IL-8, IL-18, and vascular endothelial growth factor (VEGF), that distinguished ATB from OTD. An ultrasensitive POC-amenable single-molecule array (Simoa) panel was configured, and the ATB diagnostic algorithm underwent blind validation in an independent, multinational cohort in which ATB was distinguished from OTD with receiver operator characteristic–area under the curve (ROC-AUC) of 0.80 [95% confidence interval (CI), 0.75 to 0.85], 80% sensitivity (95% CI, 73 to 85%), and 65% specificity (95% CI, 57 to 71%). When host antibodies against TB antigen Ag85B were added to the panel, performance improved to 86% sensitivity and 69% specificity. A blood-based host response panel consisting of four proteins and antibodies to one TB antigen can help to differentiate ATB from other causes of persistent cough in patients with and without HIV infection from Africa, Asia, and South America. Performance characteristics approach World Health Organization (WHO) target product profile accuracy requirements and may provide the foundation for an urgently needed blood-based POC TB triage test.

Risk Factor Identification, Classification and Prediction Summary of Chronic Kidney Disease

2020 ◽  
Vol 13 ◽  
Author(s):  
Pramila Arulanthu ◽  
Eswaran Perumal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Diagnosis ◽  
Medical Data ◽  
Machine Learning Algorithms ◽  
World Health ◽  
Medical Field ◽  
Data Set ◽  
Medical Issues ◽  
Health Organization

: The medical data has an enormous quantity of information. This data set requires effective classification for accurate prediction. Predicting medical issues is an extremely difficult task in which Chronic Kidney Disease (CKD) is one of the major unpredictable diseases in medical field. Perhaps certain medical experts do not have identical awareness and skill to solve the issues of their patients. Most of the medical experts may have underprivileged results on disease diagnosis of their patients. Sometimes patients may lose their life in nature. As per the Global Burden of Disease (GBD-2015) study, death by CKD was ranked 17th place and GBD-2010 report 27th among the causes of death globally. Death by CKD is constituted 2·9% of all death between the year 2010 and 2013 among people from 15 to 69 age. As per World Health Organization (WHO-2005) report, 58 million people expired by CKD. Hence, this article presents the state of art review on Chronic Kidney Disease (CKD) classification and prediction. Normally, advanced data mining techniques, fuzzy and machine learning algorithms are used to classify medical data and disease diagnosis. This study reviews and summarizes many classification techniques and disease diagnosis methods presented earlier. The main intention of this review is to point out and address some of the issues and complications of the existing methods. It is also attempts to discuss the limitations and accuracy level of the existing CKD classification and disease diagnosis methods.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

scholarly journals 51 Small cell/lymphohistiocytic morphology is associated with CD8 positivity, retained T cell markers, a trend of decreased PD-L1 expression, but not outcome in adults with ALK+ ALCL

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A54-A54
Author(s):  
Mahsa Khanlari ◽  
Shaoying Li ◽  
Roberto N Miranda ◽  
Swaminathan Iyer ◽  
Cameron Yin ◽  
...  
Keyword(s):  
T Cell ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Small Cell ◽  
Adult Patients ◽  
World Health ◽  
Proliferation Index ◽  
Cell Markers ◽  
Large Cell Lymphoma

BackgroundSeveral morphologic patterns of ALK+ anaplastic large cell lymphoma (ALCL) are recognized: common, small cell, lymphohistiocytic, Hodgkin-like, and composite patterns.1 Small cell (SC) and lymphohistiocytic (LH) patterns are thought to be closely associated with poorer outcome in children with ALK+ ALCL.2 However, the clinicopathologic and prognostic features of SC/LH patterns of ALK+ ALCL are not yet reported in adults. Recently, we found PD-L1 expression in a large subset of ALK+ ALCL cases, however, PD-L1 expression in SC/LH versus non-SC/LH ALCL has not been reported.MethodsAmong 102 adult patients with ALK+ ALCL seen at our institution from January 1, 2007 through August 30, 2018, 18 (18%) cases had a SC and/or LH pattern. The clinical, pathologic, and outcome data were compared between SC/LH and non-SC/LH ALK+ ALCL cases using Fisher’s exact test. Overall survival (OS) was analyzed using the Kaplan-Meier method and compared using the log-rank test.ResultsThere were no significant differences in clinical features including age, gender, nodal versus extranodal involvement, B symptoms, stage, leukocytosis/lymphocytosis, and serum LDH levels between patients with SC/LH versus non-SC/LH ALK+ ALCL. Compared to non-SC/LH cases, SC/LH ALCL was more often positive for CD2 (92% vs. 36%, p = 0.0007), CD3 (81% vs. 15%, p = 0.0001), CD7 (80% vs. 37%, p = 0.03), and CD8 (54% vs. 7%, p = 0.0006). SC/LH ALCL showed a trend of decreased PD-L1 expression than non-SC/LH cases (24% vs. 46%, p = 0.11). There were no significant differences in the expression of CD4, CD5, CD25, CD43, CD45, CD56, TCR A/B, TCR G/D, cytotoxic markers, EMA, Ki-67 proliferation index. The induction chemotherapy and response rate in patients with SC/LH ALK+ ALCL were similar to patients with non-SC/LH ALK+ ALCL. After a median follow-up of 30.5 months (range, 0.3–224 months), there was no significant difference in OS between patients with SC/LH versus non-SC/LH ALK+ ALCL (p = 0.88).ConclusionsIn adults with ALK+ALCL, the SC/LH morphologic pattern is associated with a CD8+ T cell immunophenotype and retention of expression of T cell markers (CD2, CD3, and CD7). The trend of decreased PD-L1 expression in SC/LH ALCL suggests that these patients may not be ideal candidates for PD-L1 immunotherapy. The SC/LH patterns of ALK+ ALCL have no impact on the prognosis of adult patients which is in contrast to the reported association of the SC/LH patterns with poorer outcome in children with ALK+ ALCL.Ethics ApprovalThe study was approved by the Institutional Review Board at MD Anderson Cancer Center, Approval number: PA16-0897ReferencesSwerdlow SH, Campo E, The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016;127:2375–2390.Brugières L, Deley MC, CD30 (+) anaplastic large-cell lymphoma in children: Analysis of 82 patients enrolled in two consecutive studies of the French Society of Pediatric Oncology. Blood 1998;92:3591–3598.

Developmental venous anomaly in adult patients with diffuse glioma

Neurology ◽  
2018 ◽  
Vol 92 (1) ◽  
pp. e55-e62 ◽  
Author(s):  
Alexandre Roux ◽  
Myriam Edjlali ◽  
Sayuri Porelli ◽  
Arnault Tauziede-Espariat ◽  
Marc Zanello ◽  
...  
Keyword(s):  
External Validation ◽  
Adult Patients ◽  
World Health ◽  
Diffuse Glioma ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Control Sets ◽  
Control Set ◽  
Validation Set ◽  
Health Organization

ObjectiveTo determine the prevalence of developmental venous anomaly in adult patients with diffuse glioma.MethodsWe performed a retrospective cohort study (2010–2016) of consecutive adult patients harboring a supratentorial diffuse glioma in 2 centers: Sainte-Anne Hospital (experimental and control sets) and Pitié-Salpêtrière Hospital (external validation set). We included 219 patients with diffuse glioma (experimental set), 252 patients with brain metastasis (control set), and 200 patients with diffuse glioma (validation set). The inclusion criteria were age ≥18 years at diagnosis, histopathologic diagnosis of diffuse glioma according to the 2016 World Health Organization classification of tumors of the CNS, surgery as first-line treatment without previous oncologic treatment, available presurgical MRI performed with similar acquisition protocol, and absence of a nodular-like or a ring-like pattern of contrast enhancement on MRI that may preclude the identification of a possible developmental venous anomaly within the glioma.ResultsWe found more developmental venous anomaly in the experimental set (21.5%) than in the control set (5.2%, p < 0.001). Similarly, we found more developmental venous anomaly in the validation set (23.5%) than in the control set (5.2%, p < 0.001). There was no difference in the developmental venous anomaly prevalence between the experimental and validation sets. The developmental venous anomaly distribution was not significantly associated with histopathologic, molecular, or imaging findings of the diffuse gliomas.ConclusionsWe report and replicate in an external cohort a high prevalence of developmental venous anomaly in adult patients with diffuse glioma, which suggests a potential underlying common predisposition or a causal relationship that requires deeper investigations.

scholarly journals Risk factors and health related quality of life among adult patients of depression presenting at psychiatric OPD clinic of Aziz Fatima Medical College and Hospital Faisalabad.

2020 ◽  
Vol 27 (09) ◽  
pp. 1976-1982
Author(s):  
Subhan Ullah ◽  
Zubash Aslam ◽  
Ghulam Abbas Shiekh
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Depressive Disorder ◽  
Adult Patients ◽  
World Health ◽  
Health Related Quality ◽  
World Health Organization Quality ◽  
Related Quality ◽  
Health Related

Objectives: To determine the risk factors of depressive disorders and health related quality of life among adult patients of depression presenting at psychiatric OPD clinic of Aziz Fatima Hospital Faisalabad. Study Design: Cross-sectional study. Setting: Psychiatric OPD clinic of Aziz Fatima Hospital Faisalabad Pakistan. Period: 1st August 2019 to 31st December 2019. Material & Method: 150 patients for the screening of depression Patient Health Questionnaire (PHQ) was used. For measuring health related quality of life World Health Organization Quality of Life (WHOQOL-Brief) was used. Results: It was found that out of 150 patients with depressive disorder 104(69.3%) were female and 46(30.7%) were male patients. Findings of the study assessed that depressive disorder not only impacts on the patients' mood but it also impairs the individuals overall perception of their general health, physical health, psychological wellbeing, social relationship and also distorted perception of their surrounding psychosocial environment. Conclusion: Depressive disorder is common in patients visiting psychiatric OPD clinic and findings of study suggested that age, education level, socio-economic status, death of parent at early age, unemployment, workplace issues, parental separation, loss of partner and family history of depression are important demographic variables which plays the role of significant risk factor for depression and impairs the quality of life among depressive patients.

scholarly journals Detection of Diabetic Patterns using Supervised Learning

2019 ◽  
Vol 9 (2) ◽  
pp. 1169-1173
Keyword(s):  
Machine Learning ◽  
Predictive Models ◽  
Learning Algorithms ◽  
Machine Learning Algorithms ◽  
Supervised Machine Learning ◽  
World Health ◽  
Performance Parameters ◽  
Major Health ◽  
Major Increase ◽  
Boosted Tree

World Health Organization’s (WHO) report 2018, on diabetes has reported that the number of diabetic cases has increased from one hundred eight million to four hundred twenty-two million from the year 1980. The fact sheet shows that there is a major increase in diabetic cases from 4.7% to 8.5% among adults (18 years of age). Major health hazards caused due to diabetes include kidney function failure, heart disease, blindness, stroke, and lower limb dismembering. This article applies supervised machine learning algorithms on the Pima Indian Diabetic dataset to explore various patterns of risks involved using predictive models. Predictive model construction is based upon supervised machine learning algorithms: Naïve Bayes, Decision Tree, Random Forest, Gradient Boosted Tree, and Tree Ensemble. Further, the analytical patterns about these predictive models have been presented based on various performance parameters which include accuracy, precision, recall, and F-measure.

scholarly journals A Comparison on Supervised and Semi-Supervised Machine Learning Classifiers for Gestational Diabetes Prediction

2021 ◽  
Vol 9 (12) ◽  
pp. 1001-1005
Author(s):  
Lokesh Kola
Keyword(s):  
Machine Learning ◽  
Gestational Diabetes ◽  
Supervised Learning ◽  
Machine Learning Algorithms ◽  
Supervised Machine Learning ◽  
World Health ◽  
Middle Income ◽  
Diabetes Prediction ◽  
Supervised Machine Learning Classifiers ◽  
Health Organization

Abstract: Diabetes is the deadliest chronic diseases in the world. According to World Health Organization (WHO) around 422 million people are currently suffering from diabetes, particularly in low and middle-income countries. Also, the number of deaths due to diabetes is close to 1.6 million. Recent research has proven that the occurrence of diabetes is likely to be seen in people aged between 18 and this has risen from 4.7 to 8.5% from 1980 to 2014. Early diagnosis is necessary so that the disease does not go into advanced stages which is quite difficult to cure. Significant research has been performed in diabetes predictions. As time passes, challenges keep increasing to build a system to detect diabetes systematically. The hype for Machine Learning is increasing day to day to analyse medical data to diagnose a disease. Previous research has focused on just identifying the diabetes without specifying its type. In this paper, we have we have predicted gestational diabetes (Type-3) by comparing various supervised and semi-supervised machine learning algorithms on two datasets i.e., binned and non-binned datasets and compared the performance based on evaluation metrics. Keywords: Gestational diabetes, Machine Learning, Supervised Learning, Semi-Supervised Learning, Diabetes Prediction

scholarly journals Huge heterogeneity in survival in a subset of adult patients with resected, wild-type isocitrate dehydrogenase status, WHO grade II astrocytomas

2019 ◽  
Vol 130 (4) ◽  
pp. 1289-1298 ◽  
Author(s):  
Gaëtan Poulen ◽  
Catherine Gozé ◽  
Valérie Rigau ◽  
Hugues Duffau
Keyword(s):  
Radiation Therapy ◽  
Malignant Transformation ◽  
Isocitrate Dehydrogenase ◽  
Adult Patients ◽  
World Health ◽  
Wild Type ◽  
Who Grade ◽  
Grade Ii ◽  
The Individual

OBJECTIVEWorld Health Organization grade II gliomas are infiltrating tumors that inexorably progress to a higher grade of malignancy. However, the time to malignant transformation is quite unpredictable at the individual patient level. A wild-type isocitrate dehydrogenase (IDH-wt) molecular profile has been reported as a poor prognostic factor, with more rapid progression and a shorter survival compared with IDH-mutant tumors. Here, the oncological outcomes of a series of adult patients with IDH-wt, diffuse, WHO grade II astrocytomas (AII) who underwent resection without early adjuvant therapy were investigated.METHODSA retrospective review of patients extracted from a prospective database who underwent resection between 2007 and 2013 for histopathologically confirmed, IDH-wt, non–1p19q codeleted AII was performed. All patients had a minimum follow-up period of 2 years. Information regarding clinical, radiographic, and surgical results and survival were collected and analyzed.RESULTSThirty-one consecutive patients (18 men and 13 women, median age 39.6 years) were included in this study. The preoperative median tumor volume was 54 cm3 (range 3.5–180 cm3). The median growth rate, measured as the velocity of diametric expansion, was 2.45 mm/year. The median residual volume after surgery was 4.2 cm3 (range 0–30 cm3) with a median volumetric extent of resection of 93.97% (8 patients had a total or supratotal resection). No patient experienced permanent neurological deficits after surgery, and all patients resumed a normal life. No immediate postoperative chemotherapy or radiation therapy was given. The median clinical follow-up duration from diagnosis was 74 months (range 27–157 months). In this follow-up period, 18 patients received delayed chemotherapy and/or radiotherapy for tumor progression. Five patients (16%) died at a median time from radiological diagnosis of 3.5 years (range 2.6–4.5 years). Survival from diagnosis was 77.27% at 5 years. None of the 21 patients with a long-term follow-up greater than 5 years have died. There were no significant differences between the clinical, radiological, or molecular characteristics of the survivors relative to the patients who died.CONCLUSIONSHuge heterogeneity in the survival data for a subset of 31 patients with resected IDH-wt AII tumors was observed. These findings suggest that IDH mutation status alone is not sufficient to predict risk of malignant transformation and survival at the individual level. Therefore, the therapeutic management of AII tumors, in particular the decision to administer early adjuvant chemotherapy and/or radiation therapy following surgery, should not solely rely on routine molecular markers.

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