Search results for: depression diagnosis

Authors: Farah Naja, Romy Abi Fadel, Yasmin Aridi, Aya Zarif, Dania Hariri, Mohammad Alameddine, Anas Mugharbel, Maya Khalil, Zeina Nahleh, Arafat Tfayli

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The objective of this study is to assess the prevalence and determinants of CAM use among breast cancer patients in Beirut, Lebanon. A secondary objective is to evaluate the association between CAM use and quality of life (QOL). A cross-sectional survey was conducted on 180 breast cancer patients recruited from two major referral centers in Beirut. In a face to face interview, participants completed a questionnaire comprised of three sections: socio-demographic and lifestyle characteristics, breast cancer condition, and CAM use. The assessment of QOL was carried using the FACT-B Arabic version. Prevalence of CAM use since diagnosis was 40%. CAM use was negatively associated with age, treatment at a philanthropic hospital and positively associated with having an advanced stage of disease. The most commonly used CAM was ‘Special food’ followed by ‘Herbal teas’. Only 4% of CAM users cited health care professionals as influencing their choice of CAM. One in four patients disclosed CAM use to their treating physician. There was no significant association between CAM use and QOL. The use of CAM therapies among breast cancer patients is prevalent in Lebanon. Efforts should be dedicated at educating physicians to discuss CAM use with their patients and advising patients to disclose of their use with their physicians.

Keywords: breast cancer, complementary and aLternative medicine, Lebanon, quality of life

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Authors: Muhammad Umar Hassan

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Renal cell carcinoma is a subset of kidney cancer that arises in the lining of DCT and is present in parenchymal tissue. Diagnosis is based on lab reports, including urinalysis, renal function tests (RFTs), and electrolyte balance, along with imaging techniques. Organ failure and other complications have been commonly observed in these cases. Over the years, the presentation of patients has varied, so carcinoma was classified on the basis of site, shape, and consistency for detailed analysis. Lifestyle patterns and occupational history were inquired about and recorded. Methods: Data from 100 patients presenting to the oncology and nephrology department of Mayo Hospital in the year 2015-2020 were included in this retrospective study on a random basis. The study was specifically focused on three risk factors. Smoking, occupational exposures, and Hakim medicine are taken by the patient for any cause. After procurement of data, follow-up contacts of these patients were established, resulting in a detailed analysis of lifestyle. Conclusion: The inference drawn is a direct causal link between smoking, industrial workplace exposure, and Hakim medicine with the development of Renal Cell Carcinoma. It was shown in the majority of the patients and hence confirmed our hypothesis.

Keywords: renal cell carcinoma, kidney cancer, clear cell carcinoma

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Authors: Asiri Wijesinghe, N. D. Kodikara, Damitha Sandaruwan

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The Diabetic Retinopathy (DR) is a rapidly growing interrogation around the world which can be annotated by abortive metabolism of glucose that causes long-term infection in human retina. This is one of the preliminary reason of visual impairment and blindness of adults. Information on retinal pathological mutation can be recognized using ocular fundus images. In this research, we are mainly focused on resurrecting an automated diagnosis system to detect DR anomalies such as severity level classification of DR patient (Non-proliferative Diabetic Retinopathy approach) and vessel tortuosity measurement of untwisted vessels to assessment of vessel anomalies (Proliferative Diabetic Retinopathy approach). Severity classification method is obtained better results according to the precision, recall, F-measure and accuracy (exceeds 94%) in all formats of cross validation. In ROC (Receiver Operating Characteristic) curves also visualized the higher AUC (Area Under Curve) percentage (exceeds 95%). User level evaluation of severity capturing is obtained higher accuracy (85%) result and fairly better values for each evaluation measurements. Untwisted vessel detection for tortuosity measurement also carried out the good results with respect to the sensitivity (85%), specificity (89%) and accuracy (87%).

Keywords: fundus image, exudates, microaneurisms, hemorrhages, tortuosity, diabetic retinopathy, optic disc, fovea

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Authors: Keshari Shrestha, Philip Vatterott

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal drug-related syndrome. DRESS classically presents with a diffuse maculopapular rash, fevers, and eosinophilia more than three weeks after drug exposure. DRESS can present with multi-organ involvement, with liver damage being the most common and severe. Pulmonary involvement is a less common manifestation and is associated with poor clinical outcomes. Chest imaging is often nonspecific, and symptoms can range from mild cough to acute respiratory distress syndrome (ARDS) . This is a case of a 49-year-old female with a history of recent clostridium difficile colitis status post treatment with oral vancomycin who presented with rash, acute liver and kidney failure, as well as diffuse nodular alveolar lung opacities concerning for DRESS syndrome with multi-organ involvement. Clinical Course: This patient initially presented to an outside hospital with clostridium difficile colitis, acute liver injury, and acute kidney injury. She developed a desquamating maculopapular rash in the setting of recent oral vancomycin, meloxicam, and furosemide initiation. She was hospitalized on two additional occasions with worsening altered mental status, liver injury, and acute kidney injury and was initiated on intermittent hemodialysis. Notably, she was found to have systemic eosinophilia (4100 cells/microliter) several weeks prior. She was transferred to this institution for further management where she was found to have encephalopathy, jaundice, lower extremity edema, and diffuse bilateral rhonchorous breath sounds on pulmonary examination. The patient was started on methylprednisolone for suspected DRESS syndrome. She underwent an evaluation for alternative causes of her organ failure. Her workup included a negative infectious, autoimmune, metabolic, toxic, and malignant work-up. Abdominal computed tomography (CT) and ultrasound were remarkable for evidence of hepatic steatosis and possible cirrhotic morphology. Additionally, a chest CT demonstrated diffuse and symmetric nodular alveolar lung opacities with peripheral sparing not consistent with acute respiratory distress syndrome or edema. Ultimately, her condition continued to decline, and she required intubation on several occasions. On hospital day 25 she succumbed to distributive shock in the setting of probable sepsis and multi-organ failure. Discussion: DRESS syndrome occurs in 1 in 1,000 to 10,000 patients with a mortality rate of around 10%. Anti-convulsant, anti-bacterial, anti-viral, and sulfonamide drugs are the most common drugs implicated in the development of DRESS syndrome; however, the list of offending agents is extensive . The diagnosis of DRESS syndrome is made after excluding other causes of disease such as infectious and autoimmune etiologies. The RegiSCAR scoring system is used to diagnose DRESS syndrome with 2-3 points indicating possible disease, 4-5 probable disease, and >5 definite disease. This patient scored a 7 on the RegiSCAR scale for eosinophilia, rash, organ involvement, and exclusion of other causes (infectious and autoimmune). While the pharmacologic trigger in this case is unknown, it is speculated to be caused by vancomycin, meloxicam, or furosemide due to the favorable timeline of initiation. Despite aggressive treatment, DRESS syndrome can often be fatal. Because of this, early diagnosis and treatment of patients with suspected DRESS syndrome is imperative.

Keywords: drug reaction with eosinophilia and systemic symptoms, multi-organ failure, pulmonary involvement, renal failure

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Authors: Luo Lan, Huang Jingjing, Li Huafang

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Hypoactive sexual desire disorder (HSDD) was common in China, and Chinese women's sexual health-seeking behaviors were found to be mainly impeded by their psychological barriers. However, underlying mechanisms for such unhealthy sexual health attitudes and symptoms of HSDD were unknown. Many studies suggested the correlation between women's psychological barriers, HSDD and attachment style but had limitations, so this study further explored their relationship. Chinese women of childbearing age were recruited from May 2020 to December 2022 in Shanghai, China. The Revised Adult Attachment Scale (RAAS), the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO), a sexual health attitude questionnaire, and a psychiatric interview were administered. The analytic sample contained 279 women, of which 107 women were HSDD patients. Women with a fearful attachment style were found to be more likely to be unwilling to communicate sexual health (aOR 2.55, 95%CI 1.05-6.28) and feel ashamed of sexual health-related disorders (aOR 2.66, 95%CI 1.14-6.13). They are also linked with a higher risk of HSDD (aOR 3.25, 95%CI 1.35-8.12). Therefore, fearful attachment style should be given enough attention in the whole process of the diagnosis and treatment of HSDD and should be one of the focuses that guide sexual education.

Keywords: attachment style, hypoactive sexual desire disorder, attitude to health, sexual desire, sexual distress

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Authors: Hassidou Saidou, Soulé Aminou

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As in many towns of African countries, the waste management, in particularly solid constitutes a major problem for the municipal authorities of Maradi. The aim of this study is to make a diagnosis of the present system of waste management in the town of Maradi. The approach was consisted to some interviews with the municipal authorities, cleaning up and health technicians and some housewives investigations. According to the health technicians of the town, the causes due to the problem of waste management in Maradi town are: collecting capacity insufficient, lack of effective sensitization of people, undeveloped and uncontrolled rubbish dumps, lack of gutter and its maintenance, and insufficient and unqualified human resources. As to the authorities, they denounce always the attitude and the behavior of citizens on the waste issue. The waste evacuation is doing by municipal collecting or by depositing in wild rubbish dump. Some people eliminate their waste by burning or duping in the streets or in their houses. According to our investigations, 52% of population evacuates their waste daily. The satisfaction rate of municipal collecting is for 32%. The analysis showed that the present system of waste management in Maradi town is failing. As solutions, we proposed to equip the technical offices with appropriated material and financial means, reinforce the involved actor’s capacities and making in application the operatives regulations for the waste management.

Keywords: maradi, municipal authorities, Niger Republic, solid waste management

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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Authors: Afolabi Comfort Yemisi

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Gender-based violence remains a serious threat to the growth, health, and safety of women and girls globally, including Nigeria. The rising violence of various shades of violence, especially against women and girls in the guise of cultural preservation, raised serious concerns. The challenge of this harmful gender narrative is more critical in attaining the Sustainable Development Goals and Goal 4 (Quality Education) in Nigeria. The study investigated the perception and effects of gender-based violence on sustainable development and education of the girl-child in Southwestern Nigeria. Primary and Secondary data were used for the study. Primary data were obtained using a structured questionnaire administered to young females in tertiary institutions, secondary schools, non-governmental organizations, and government institutions dealing with gender-based violence in the study area, while the secondary data were sourced from journals, books and dailies. A multistage random sampling technique was employed to select a sample of 360 respondents who completed the questionnaire for the study. Descriptive statistics and regression analysis were applied to the data collected. The result revealed a high prevalence of gender-based violence, and it was perceived to be culturally motivated. Sexual violence, sexual harassment and psychological violence were the significant forms of gender-based violence that adversely affected the Sustainable Development Goal 4. The result further revealed that loss of concentration, shame and depression, school drop-out, poor academic performance and inferiority complex were the major effects of gender-based violence on the education of girl-child in the study area. The study recommended that to avert catastrophic damages and adverse effects of gender-based violence on the girl-child, there is a need for thorough awareness and sensitization programmes to build their resilience. Also, enforcement of established laws against gender-based violence by both government and non-governmental institutions is sacrosanct.

Keywords: perception, effects, gender-based violence, sustainable development, education, girl-child, sensitisation

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Authors: Meriche Hacene

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Introduction: Allergy to animal hair is hypersensitivity to animal appendages to look for in front of any rhinoconjunctivitis or asthma. An anamnesis associated with the prick-tests makes it possible to guide the diagnosis, which will be supplemented in case of doubt by specific immunoglobulin E (IgE) assays. The objective of our study is to study the characteristics of patients sensitized to animal hair. Patients and methods: Retrospective study conducted on 105 adult patients and 69 children over a period of 3 years, including patients who received a specific IgE assay (respiratory panel and pediatric panel) by immunodot method. Result: 105 adult patients, including 74 women and 31 men, with an average age of 41 years, of which 8.5% had sensitization to animal hair (5 men and 4 women), namely: cat (5%), horse (4.7%) and dog (3.8%). For the 69 children, a slight female predominance was noted (56%), with an average age of 7.5 years, of which (13%) are sensitized to animal hair (5 girls and 4 boys): cat (10%), while awareness of dog and horse hair was less frequent with an identical prevalence of (4.34%). The dominant symptoms are rhinorrhea and sneezing for both categories, respectively (40% and 26.6% in adults and 23% for both symptoms in children). Cross-sensitization was observed in the 2 series: 1 single cat-dog and cat-horse case and 2 dog-horse cases in adults. In children, 100% of patients with sensitization to dog hair had cross-sensitization to cat hair, only 1 case was observed for cat-horse cross-reactivity. Conclusion This work shows that allergy to animal hair is common. Studies on more representative samples are recommended.

Keywords: specific IgE, allergy, cat, fed1

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Authors: Sabiha Sahin

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Background: Chest pain is a common complaint in children visiting the emergency department (ED). True organic problems like cardiac disease are rare. We assess the etiology of chest pain among children visiting a Pediatric ED in Eskisehir Osmangazi University. Method: We prospectively evaluated of children with chest pain who visited our Pediatric ED between 1 January 2013 and 31 December 2014. Any case of trauma-associated chest pain was excluded from this study. Results: A total of 100 patients (54 boys, 46 girls), mean age: 11,86±3,51 (age range, 6–17 years) were enrolled into this study; 100 patients had chest radiograms (100 %). Pneumonia was identified in 15 patients. All patients had electrocardiogram study (100 %) and 16 of them showed abnormalities. Additional diagnostic tests were performed on all patients including complete blood count analysis, cardiac markers (CK-MB, Troponin I) and lactate (blood gas analysis). Echocardiograms were performed on all patients and 16 of them showed abnormality (five of majör abnormality). Panendoscopy was done in 20 patients, and gastroesophageal reflux was found in 12 (%12). Overall, idiopathic chest pain and myalgia was the most common diagnosis (32 %). Other associated disorders were asthma (12 %), panic attack (13 %). Conclusion: The most common cause of chest pain prompting a child to visit the ED is idiopathic chest pain. Careful physical examination can reveal important clues and save many unnecessary examinations.

Keywords: child, chest pain, pediatric emergency department, evaluation

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Authors: Nicolas Koslover, Tamara Levene

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Aims: Tonsilitis is one of the most common presentations to the A+E department. We aimed to assess whether patients presenting with tonsilitis are being managed in-line with current guidance. We then set out to educate A+E staff about tonsilitis management and then assessed for improvement in management. Methods: All patients presenting to A+E in one fortnight with a documented diagnosis of tonsilitis were included. We reviewed the notes to assess the choice of treatment in each case and whether a clinical score (CENTOR or FEVERPain score) was used to guide choice of treatment (in accordance with NICE guideline [NG84]). We designed and delivered an educational intervention for A+E staff covering tonsilitis guidelines. The audit was repeated two weeks later. Results: Over the study period, 49 patients were included; only 35% (n=17) had either a clinical score documented or had all components of a score recorded. In total, 39% (n=19) were treated with antibiotics. Of these, 63% (n=12) should not have been prescribed an antibiotic and 37% (n=7) were prescribed an inappropriate antibiotic. At re-audit, (n=50 cases), 58% (n=29) had a clinical score documented and 28% (n=14) were treated with antibiotics. Of these, 29% (n=4) should not have been prescribed antibiotics and 21% (n=3) were prescribed an inappropriate antibiotic. Thus, after this teaching session, there was a significant improvement in antibiotic prescribing practices (63% vs. 29%, p=0.026). Conclusions: A+E assessment and management of tonsilitis frequently deviated from guidelines, but a single teaching session vastly improved clinical scoring and antibiotic prescribing practices.

Keywords: tonsilitis, education, emergency medicine, ENT

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Authors: H. D. Arora, Anjali Dhiman

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Uncertainty is found everywhere and its understanding is central to decision making. Uncertainty emerges as one has less information than the total information required describing a system and its environment. Uncertainty and information are so closely associated that the information provided by an experiment for example, is equal to the amount of uncertainty removed. It may be pertinent to point out that uncertainty manifests itself in several forms and various kinds of uncertainties may arise from random fluctuations, incomplete information, imprecise perception, vagueness etc. For instance, one encounters uncertainty due to vagueness in communication through natural language. Uncertainty in this sense is represented by fuzziness resulting from imprecision of meaning of a concept expressed by linguistic terms. Fuzzy set concept provides an appropriate mathematical framework for dealing with the vagueness. Both information theory, proposed by Shannon (1948) and fuzzy set theory given by Zadeh (1965) plays an important role in human intelligence and various practical problems such as image segmentation, medical diagnosis etc. Numerous approaches and theories dealing with inaccuracy and uncertainty have been proposed by different researcher. In the present communication, we generalize fuzzy entropy proposed by De Luca and Termini (1972) corresponding to Shannon entropy(1948). Further, some of the basic properties of the proposed measure were examined. We also applied the proposed measure to the real life decision making problem.

Keywords: entropy, fuzzy sets, fuzzy entropy, generalized fuzzy entropy, decision making

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Authors: Jyotismita Talukdar

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In this paper, a study has been made on the possibility and accuracy of early prediction of several Heart Disease using Artificial Neural Network. (ANN). The study has been made in both noise free environment and noisy environment. The data collected for this analysis are from five Hospitals. Around 1500 heart patient’s data has been collected and studied. The data is analysed and the results have been compared with the Doctor’s diagnosis. It is found that, in noise free environment, the accuracy varies from 74% to 92%and in noisy environment (2dB), the results of accuracy varies from 62% to 82%. In the present study, four basic attributes considered are Blood Pressure (BP), Fasting Blood Sugar (FBS), Thalach (THAL) and Cholesterol (CHOL.). It has been found that highest accuracy(93%), has been achieved in case of PPI( Post-Permanent-Pacemaker Implementation ), around 79% in case of CAD(Coronary Artery disease), 87% in DCM (Dilated Cardiomyopathy), 89% in case of RHD&MS(Rheumatic heart disease with Mitral Stenosis), 75 % in case of RBBB +LAFB (Right Bundle Branch Block + Left Anterior Fascicular Block), 72% for CHB(Complete Heart Block) etc. The lowest accuracy has been obtained in case of ICMP (Ischemic Cardiomyopathy), about 38% and AF( Atrial Fibrillation), about 60 to 62%.

Keywords: coronary heart disease, chronic stable angina, sick sinus syndrome, cardiovascular disease, cholesterol, Thalach

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Authors: Fatma Sümer

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Introduction: This case report aims to report myopic anisometropia with copy-image in monozygotic twins. Methods: In February 2021, a 6-year-old identical twin was seen, who was referred to us with the diagnosis of amblyopia in their left eye from an external center. Both twins had a full ophthalmic examination, which included visual acuity testing, ocular motility testing, cycloplegic refraction, and fundus examination. Results: On examination, “copy image” myopic anisometropia was discovered. Twin 1 had anisometropia with myopic astigmatism in the left eye. His cycloplegic refraction was +1.00 (-0.75x 75) in the right eye and -8.0 (-1.50x175) in the left eye. Similarly, twin 2 had anisometropia with myopic astigmatism in the left eye. His cycloplegic refraction was -7.75 (-1.50x180) in the left eye and +1.25 (-0.75x90 ) in the right eye. The best-corrected visual acuity was 20/60 in the amblyopic eyes and 20/20 in the unaffected eyes. There was no ocular deviation. In either patient, a slit-lamp microscopic examination revealed no abnormalities in the anterior parts of either eye. Fundoscopic examination revealed no abnormalities. No abnormal ocular movements were demonstrated. Conclusion: As far as we have reviewed in the literature, previous studies with twins were mostly concerned with mirror-effect myopic anisometropia and myopic anisometropia, whereas ipsilateral amblyopia and anisometropia were not reported in monozygotic twins. This case underscores the possible genetic basis of myopic anisometropia.

Keywords: amblyopia, anisometropia, myopia, twins

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Authors: Hatem A. El-Mezayen, Hossam Darwesh

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Background/Aim: Hepatocellular carcinoma (HCC) is often diagnosed at advanced stage where effective therapies are lacking. Identification of new scoring system is needed to discriminate HCC patients from those with chronic liver disease. Based on the link between vascular endothelial growth factor (VEGF) and HCC progression, we aimed to develop a novel score based on combination of VEGF and routine laboratory tests for early prediction of HCC. Methods: VEGF was assayed for HCC group (123), liver cirrhosis group (210) and control group (50) by Enzyme Linked Immunosorbent Assay (ELISA). Data from all groups were retrospectively analyzed including α feto protein (AFP), international normalized ratio (INR), albumin and platelet count, transaminases, and age. Areas under ROC curve were used to develop the score. Results: A novel index named hepatocellular carcinoma-vascular endothelial growth factor score (HCC-VEGF score)=1.26 (numerical constant) + 0.05 ×AFP (U L-1)+0.038 × VEGF(ng ml-1)+0.004× INR –1.02 × Albumin (g l-1)–0.002 × Platelet count × 109 l-1 was developed. HCC-VEGF score produce area under ROC curve of 0.98 for discriminating HCC patients from liver cirrhosis with sensitivity of 91% and specificity of 82% at cut-off 4.4 (ie less than 4.4 considered cirrhosis and greater than 4.4 considered HCC). Conclusion: Hepatocellular carcinoma-VEGF score could replace AFP in HCC screening and follow up of cirrhotic patients.

Keywords: Hepatocellular carcinoma, cirrhosis, HCV, diagnosis, tumor markers

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Authors: Nasib Zaman, Maneesha Kour, Muhammad Rizwan, Fazal Akbar

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Abstract: Chikungunya fever is a re-emerging rapidly spreading mosquito-borne disease cause by Aedes albopictus and Aedes aegypti mosquito vectors. Currently, it is affecting millions of people globally. Objective: This study's main objective was to find the incidence of chikungunya fever in the Swat region and the factors associated with the spread of this infection. Method: This study was carried out in different areas of Swat. Blood samples and data were collected from selected patients, and a questionnaire was filled for each patient. 3-5ml of the specimen was taken from the patient's vein and serum, or plasma was separated by centrifugation. Chikungunya tests were performed for IgG and IgM antibodies. The data was analyzed by SPSS and Graph Paid Prism 5. Results: A total of 169 patients were included in this study, out of which 103 (60.9%) having age less than 30 years were positive for chikungunya infection and 66 (39.1%) having more than 30 years were negative for this infection. Only 1 (0.6%) were positive for both IgG and IgM antibody. About 15 (8.9%) patients have diagnosed with positive IgG antibodies, and 25 (26.6%) patients were positive for IgM positive antibodies. The infection rate was significantly higher in males compared to females 71 (59.6%) vs. 14 (38%) P value=0.088, OR=1.7. Conclusion: This study concludes clinical knowledge and awareness that are necessary for a diagnosis of chikungunya infection properly. Therefore it is important to educate people for the eradication of this infection. Recommendation: This study also recommends investigating the other risk factors associated with this infection.

Keywords: Chikungunya, risk factor, Incidence, antibodies, mosquito

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Authors: Mian Huang, Chi Ma, Junyu Lin, William Lu

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Introduction: Bone health attracts more attention recently and an intelligent question and answer (QA) chatbot for osteoporosis is helpful for science popularization. With Generative Pretrained Transformer (GPT) technology developing, we build an osteoporosis corpus dataset and then fine-tune LLaMA, a famous open-source GPT foundation large language model(LLM), on our self-constructed osteoporosis corpus. Evaluated by clinical orthopedic experts, our fine-tuned model outperforms vanilla LLaMA on osteoporosis QA task in Chinese. Three-dimensional quantitative computed tomography (QCT) measured bone mineral density (BMD) is considered as more accurate than DXA for BMD measurement in recent years. We develop an automatic Phantom-less QCT(PL-QCT) that is more efficient for BMD measurement since no need of an external phantom for calibration. Combined with LLM on osteoporosis, our PL-QCT provides efficient and accurate BMD measurement for our chatbot users. Material and Methods: We build an osteoporosis corpus containing about 30,000 Chinese literatures whose titles are related to osteoporosis. The whole process is done automatically, including crawling literatures in .pdf format, localizing text/figure/table region by layout segmentation algorithm and recognizing text by OCR algorithm. We train our model by continuous pre-training with Low-rank Adaptation (LoRA, rank=10) technology to adapt LLaMA-7B model to osteoporosis domain, whose basic principle is to mask the next word in the text and make the model predict that word. The loss function is defined as cross-entropy between the predicted and ground-truth word. Experiment is implemented on single NVIDIA A800 GPU for 15 days. Our automatic PL-QCT BMD measurement adopt AI-associated region-of-interest (ROI) generation algorithm for localizing vertebrae-parallel cylinder in cancellous bone. Due to no phantom for BMD calibration, we calculate ROI BMD by CT-BMD of personal muscle and fat. Results & Discussion: Clinical orthopaedic experts are invited to design 5 osteoporosis questions in Chinese, evaluating performance of vanilla LLaMA and our fine-tuned model. Our model outperforms LLaMA on over 80% of these questions, understanding ‘Expert Consensus on Osteoporosis’, ‘QCT for osteoporosis diagnosis’ and ‘Effect of age on osteoporosis’. Detailed results are shown in appendix. Future work may be done by training a larger LLM on the whole orthopaedics with more high-quality domain data, or a multi-modal GPT combining and understanding X-ray and medical text for orthopaedic computer-aided-diagnosis. However, GPT model gives unexpected outputs sometimes, such as repetitive text or seemingly normal but wrong answer (called ‘hallucination’). Even though GPT give correct answers, it cannot be considered as valid clinical diagnoses instead of clinical doctors. The PL-QCT BMD system provided by Bone’s QCT(Bone’s Technology(Shenzhen) Limited) achieves 0.1448mg/cm2(spine) and 0.0002 mg/cm2(hip) mean absolute error(MAE) and linear correlation coefficient R2=0.9970(spine) and R2=0.9991(hip)(compared to QCT-Pro(Mindways)) on 155 patients in three-center clinical trial in Guangzhou, China. Conclusion: This study builds a Chinese osteoporosis corpus and develops a fine-tuned and domain-adapted LLM as well as a PL-QCT BMD measurement system. Our fine-tuned GPT model shows better capability than LLaMA model on most testing questions on osteoporosis. Combined with our PL-QCT BMD system, we are looking forward to providing science popularization and early morning screening for potential osteoporotic patients.

Keywords: GPT, phantom-less QCT, large language model, osteoporosis

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Authors: Krzysztof Malczewski

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PET is widely applied scanning procedure in medical imaging based research. It delivers measurements of functioning in distinct areas of the human brain while the patient is comfortable, conscious and alert. This article presents the new compression sensing based super-resolution algorithm for improving the image resolution in clinical Positron Emission Tomography (PET) scanners. The issue of motion artifacts is well known in Positron Emission Tomography (PET) studies as its side effect. The PET images are being acquired over a limited period of time. As the patients cannot hold breath during the PET data gathering, spatial blurring and motion artefacts are the usual result. These may lead to wrong diagnosis. It is shown that the presented approach improves PET spatial resolution in cases when Compressed Sensing (CS) sequences are used. Compressed Sensing (CS) aims at signal and images reconstructing from significantly fewer measurements than were traditionally thought necessary. The application of CS to PET has the potential for significant scan time reductions, with visible benefits for patients and health care economics. In this study the goal is to combine super-resolution image enhancement algorithm with CS framework to achieve high resolution PET output. Both methods emphasize on maximizing image sparsity on known sparse transform domain and minimizing fidelity.

Keywords: PET, super-resolution, image reconstruction, pattern recognition

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Authors: Jennifer Hunter, Francisco Ramirez, Neil A. Nedley, Thania Solorio, Christian Freed, Erica Kinjo

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People who have autoimmune disease are often at an increased risk for psychological disorders such as anxiety. Untreated psychological conditions can affect the development of disease and can affect one’s general quality of life. In this study, it was hypothesized that an educational community-based intervention would be useful in decreasing the anxiety levels of participants with autoimmune disease. Programs, 2-hours long each, were held weekly over a period of eight weeks. During every meeting, a 45-minute DVD presentation by a skilled physician was shown, a small group discussion was guided by trained facilitators, and weekly practical assignments were given to each participant. The focus of the program was to educate participants about healthy lifestyle behaviors such as exercise, nutrition, sleep hygiene, helpful thought patterns etc., and to provide a group environment in which each participant was supported. Participants were assessed pre-post program for anxiety using the Depression and Anxiety Assessment Test (registration TX 7-398-022), a validated mental health test based on DSM-5 criteria and demographics. Anxiety scores were classified according to the DSM-5 criteria into 4 categories: none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). Out of the participants who participated in programs conducted in the manner explained above (n=431), the average age was 54.9 (SD 16.6) and 81.9% were female. At baseline, the mean group anxiety level was 9.4 (SD 5.4). Within the baseline group, anxiety levels were as follows: none (21.1%), mild (22.0%), moderate (27.1%) and severe (29.7%). After the program, mean group anxiety decreased to 4.7 (SD 4.0). Post-program anxiety levels were as follows: none (54.8%), mild (27.1%), moderate (12.5%), severe (5.6%). The decrease in overall anxiety levels was significant t(431)=19.3 p<.001, 95% CI [0.815, 1.041]. It was concluded that the eight-week intensive was beneficial in decreasing the anxiety levels of participants. A long-term follow-up study would be beneficial in determining how lasting such improvements are especially since autoimmune diseases are often chronic. Additionally, future studies that utilize a control group would aid in establishing whether the improvements seen are due to the use of this specific lifestyle-educational program.

Keywords: anxiety, auto-immune disease, community-based educational program, lifestyle

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Authors: I. Iroka, L. Mgidlana, J. Willoughby, S. Dhlamini, P. Nxumalo, S. Sefadi, A. Mthembu, E. Gerber, E. Brits

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Introduction: Nephroblastoma is a common paediatric tumor with good survival rates when diagnosed and treated early. Method: This retrospective study aimed to describe the patients with nephroblastoma seen at Universitas Academic Hospital Complex between the years 2000 and 2020. Results: In the study period, there were 207 patients identified. The patient profile had slightly more male than female patients; the median age was under four years of age. The study found a median delay of one month between symptom onset and diagnosis; a common cause was a delay in seeking care. Patients diagnosed and treated more than a month after symptoms started had poorer survival rates. There was a higher rate of Stage IV disease compared to similar studies in South Africa. Good preoperative histology and no relapse had good survival rates.. Patients from Lesotho had longer delays and presented with more severe diseases than the South African cohort. Conclusion: Early identification and treatment lead to better outcomes. Health-seeking behaviour, misdiagnosis, and referral delays might contribute to the long delays. A targeted study for patients from Lesotho is recommended.

Keywords: nephroblastoma, South Africa, Lesotho, developing country

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Authors: Aml M. El-Sharkawy, Hossam M. Darwesh

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Abstract— Background/Aim: Hepatocellular carcinoma (HCC) is often diagnosed at advanced stage where effective therapies are lacking. Identification of new scoring system is needed to discriminate HCC patients from those with chronic liver disease. Based on the link between tumor associated trypsin inhibitor (TATI) and HCC progression, we aimed to develop a novel score based on combination of TATI and routine laboratory tests for early prediction of HCC. Methods: TATI was assayed for HCC group (123), liver cirrhosis group (210) and control group (50) by Enzyme Linked Immunosorbent Assay (ELISA). Data from all groups were retrospectively analyzed including α feto protein (AFP), international normalized ratio (INR), albumin and platelet count, transaminases, and age. Areas under ROC curve were used to develop the score. Results: A novel index named hepatocellular carcinoma-vascular endothelial growth factor score (HCC-TATI score) = 3.1 (numerical constant) + 0.09 ×AFP (U L-1) + 0.067 × TATI (ng ml-1) + 0.16 × INR – 1.17 × Albumin (g l-1) – 0.032 × Platelet count × 109 l-1 was developed. HCC-TATI score produce area under ROC curve of 0.98 for discriminating HCC patients from liver cirrhosis with sensitivity of 91% and specificity of 82% at cut-off 6.5 (ie less than 6.5 considered cirrhosis and greater than 4.4 considered HCC). Conclusion: Hepatocellular carcinoma-TATI score could replace AFP in HCC screening and follow up of cirrhotic patients.

Keywords: Hepatocellular carcinoma, cirrhosis, HCV, diagnosis, TATI

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Authors: Chia-Hui Chen, Chien-Kuo Wang

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Background: Full field digital mammography (FFDM) is widely used in diagnosis of breast cancer. Digital breast tomosynthesis (DBT) has recently been introduced into the clinic and is being used for screening for breast cancer in the general population. Hence, the radiation dose delivered to the patients involved in an imaging protocol is of utmost concern. Aim: To compare the surface radiation dose (ESD) of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) by using breast phantoms. Method: We analyzed the average entrance surface dose (ESD) of FFDM and DBT by using breast phantoms. Optically Stimulated luminescent Dosimeters (OSLD) were placed in a tissue-equivalent Breast phantom at difference sites of interest. Absorbed dose measurements were obtained after digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) exposures. Results: An automatic exposure control (AEC) is proposed for surface dose measurement during DBT and FFDM. The mean ESD values for DBT and FFDM were 6.37 mGy and 3.51mGy, respectively. Using of OSLD measured for surface dose during DBT and FFDM. There were 19.87 mGy and 11.36 mGy, respectively. The surface exposure dose of DBT could possibly be increased by two times with FFDM. Conclusion: The radiation dose from DBT was higher than that of FFDM and the difference in dose between AEC and OSLD measurements at phantom surface.

Keywords: full-field digital mammography, digital breast tomosynthesis, optically stimulated luminescent dosimeters, surface dose

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Authors: Xiao Yang, Ji Zhang, Yingli Song, Hui Huang, Jing Zhang, Yan Wang, Rongrong Han, Zhixuan Xiang, Lu Chen, Lingling Gao

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Aim and Objectives: To examine physical activity self-efficacy, identify its predictors, and further explore the mechanism of action among the predictors in mainland Chinese pregnant women with high risk for gestational diabetes mellitus (GDM). Background: Physical activity could protect pregnant women from developing GDM. Physical activity self-efficacy was the key predictor of physical activity. Design: A cross-sectional study was conducted from October 2021 to May 2022 in Zhengzhou, China. Methods: 252 eligible pregnant women completed the Pregnancy Physical Activity Self-efficacy Scale, the Social Support for Physical Activity Scale, the Knowledge on Physical Activity Questionnaire, the 7-item Generalized Anxiety Disorder scale, the Edinburgh Postnatal Depression Scale, and a socio-demographic data sheet. Multiple linear regression was applied to explore the predictors of physical activity self-efficacy. Structural equation modeling was used to explore the mechanism of action among the predictors. Results: Chinese pregnant women with a high risk for GDM reported a moderate level of physical activity self-efficacy. The best-fit regression analysis revealed four variables explained 17.5% of the variance in physical activity self-efficacy. Social support for physical activity was the strongest predictor, followed by knowledge of the physical activity, intention to do physical activity, and anxiety symptoms. The model analysis indicated that knowledge of physical activity could release anxiety and depressive symptoms and then increase physical activity self-efficacy. Conclusion: The present study revealed a moderate level of physical activity self-efficacy. Interventions targeting pregnant women with high risk for GDM need to include the predictors of physical activity self-efficacy. Relevance to clinical practice: To facilitate pregnant women with high risk for GDM to engage in physical activity, healthcare professionals may find assess physical activity self-efficacy and intervene as soon as possible on their first antenatal visit. Physical activity intervention programs focused on self-efficacy may be conducted in further research.

Keywords: physical activity, gestational diabetes, self-efficacy, predictors

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Authors: Dara Kutsyk, Olga Bondarenko, Mariya Sorochka

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In 21-century type 2 diabetes (T2D) has become a global health and social problem in the whole world. The goal of treatment for patients with T2D is to prevent complications of diabetes - macrovascular diseases (heart disease, stroke, and peripheral vascular disease) and microvascular diseases (retinopathy, neuropathy and nephropathy). Nitric oxide (NO) plays an important role in maintaining vascular homeostasis. Loss of NO function is one of the earliest indicators of disease and its progression especially in patients with T2D. Aim: To compare NO level between patients with well and bad controlled glycemia in T2D. Methods: The study included 32 patients with T2D. The diagnosis of T2D was confirmed due to International Diabetes Federation (IDF) criteria 2015. Patients were divided into two groups: with well controlled glycaemia (HbA1c < 7%) and bad controlled glycaemia (HbA1c > 7%). The control group consists of 15 healthy subjects. Results: NO level in patients with T2D is significantly higher (27,2 ±3,1 µmol), compared to controls (18,86±0,9 µmol; p < 0,001). A significant difference in NO level was found between patients with bad controlled glycaemia (25,9±2,2 µmol) and well controlled glycaemia (28,7 ± 3,0 µmol; p<0,01). The study showed a moderate negative correlation between NO level and HbA1c (-0,399; р< 0,05). Conclusions: Production of NO is impaired in patients with T2D, especially with badly controlled glycaemia. With the increase in HbAc serum NO decreases. This can be the main target for prevention vascular complication in T2D.

Keywords: type 2 diabetes, glycated hemoglobin, nitric oxide, Diabetes mellitus

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Authors: Andhiani Sharfina Arnellya, Mochammad Indra Permana, Dika Pramita Destiani, Ellin Febrina

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Health Research Data, Ministry of Health of Indonesia in 2007, showed coronary heart disease (CHD) or coronary artery disease (CAD) was the third leading cause of death in Indonesia after hypertension and stroke with 7.2% incidence rate. Antiplatelet is one of the important therapy in management of patients with CHD. In addition to therapeutic effect on patients, quality of life is one aspect of another assessment to see the success of antiplatelet therapy. The purpose of this study was to determine the quality of life of patients on oral antiplatelet therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This research is a cross sectional by collecting data through quality of life questionnaire of patients which performed prospectively as primary data and secondary data from medical record of patients. The results of this study showed that 54.3% of patients had a good quality of life, 45% had a moderate quality of life, and 0.7% had a poor quality of life. There are no significant differences in quality of life-based on age, gender, diagnosis, and duration of drug use.

Keywords: antiplatelet, quality of life, coronary artery disease, coronary heart disease

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Authors: Fae Princess Bermudez

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Background: One of the least significant leads on a 12-lead electrocardiogram is the augmented right lead (aVR), as it is not as specific compared to the other leads. In this case series, the value of lead aVR, which is more often than not ignored, is highlighted. Three cases of aVR ST segment elevation on 12-lead electrocardiogram are described, with the end outcome of demise of all three patients. The importance of immediate revascularization is described to improve prognosis in this group of patients. Objectives: This case series aims to primarily present under-reported cases of isolated aVR ST-segrment elevation myocardial infarction (STEMI), their course and outcome. More specific aims are to identify the criteria in determination of isolated aVR STEMI, know its clinical significance, and determine appropriate management for patients with this ECG finding. Method: A short review of previous studies, case reports, articles and guidelines from 2011-2016 was done. The author reviewed available literature, sorted out those that proved to be significant for the presented cases, and described them in conjunction with the aforementioned cases. Findings: Based on the limited information on these rare or under-reported cases, it was found that isolated aVR STEMI had a poorer prognosis that led to significant mortality and morbidity of patients. The significance of aVR ST-elevation was that of an occlusion of the left coronary artery or a severe three-vessel disease in the presence of an Acute Coronary Syndrome. Guidelines from American Heart Association/American College of Cardiology Foundation in 2013 already recognized ST-elevation of lead aVR in isolation as a STEMI; hence, recommended that patients with this particular ECG finding should undergo reperfusion strategies to improve prognosis. Conclusion: The indispensability of isolated aVR ST-segment elevation on ECG should alert physicians, especially Emergency physicians, to the high probability of Acute Coronary Syndrome with a very poor prognosis. If this group of patients is not promptly managed, demise may ensue, with cardiogenic shock as the most probable cause. With this electrocardiogram finding, physicians must be quick to make clinical decisions to increase chances of survival of this group of patients.

Keywords: AVR ST-elevation, diffuse ST-segment depression, left coronary artery infarction, myocardial infarction

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Authors: Omar M. Elmabrouk., Roaa Y. Taha., Najat M. Ebrahim, Sabbreen A. Mohammed

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Power transformers are the most crucial part of power electrical system, distribution and transmission grid. This part is maintained using predictive or condition-based maintenance approach. The diagnosis of power transformer condition is performed based on Dissolved Gas Analysis (DGA). There are five main methods utilized for analyzing these gases. These methods are International Electrotechnical Commission (IEC) gas ratio, Key Gas, Roger gas ratio, Doernenburg, and Duval Triangle. Moreover, due to the importance of the transformers, there is a need for an accurate technique to diagnose and hence predict the transformer condition. The main objective of this technique is to avoid the transformer faults and hence to maintain the power electrical system, distribution and transmission grid. In this paper, the DGA was utilized based on the data collected from the transformer records available in the General Electricity Company of Libya (GECOL) which is located in Benghazi-Libya. The Fuzzy Logic (FL) technique was implemented as a diagnostic approach based on IEC gas ratio method. The FL technique gave better results and approved to be used as an accurate prediction technique for power transformer faults. Also, this technique is approved to be a quite interesting for the readers and the concern researchers in the area of FL mathematics and power transformer.

Keywords: dissolved gas-in-oil analysis, fuzzy logic, power transformer, prediction

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Authors: Lorena GóMez Escorcia, Gustavo Aroca MartíNez, Jose Luiz Villarreal, Elkin Navarro Quiroz

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Lupus nephritis (LN) is a high-cost disease, occurring in about half of patients with Systemic Lupus Erythematosus (SLE). Renal biopsy constitutes the only protocol that, to date, allows a correct diagnosis of the level of renal involvement in these patients. However, this procedure can have various adverse effects such as kidney bleeding, muscle bleeding, infection, pain, among others. Therefore, the development of new diagnostic alternatives is required. The neutrophil gelatinase-associated lipocalin (NGAL) has been emerging as a novel biomarker of acute kidney injury. The aim of this study was to assess urinary NGAL levels as a marker for disease activity in patients with lupus nephritis. For this work included 50 systemic lupus erythematosus (SLE) patients, 50 with active lupus nephritis (LN), and 50 without autoimmune and renal disease as controls. TNGAL in urine samples was measured by enzyme-linked immunosorbent assay (ELISA). The results revealed that patients with kidney damage had an elevated urinary NGAL as compared to patients with lupus without kidney damage and controls (p <0.005), and the mean of uNGAL was (28.72 ± 4.53), (19.51 ± 4.72), (8.91 ± 3.37) respectively. Measurement of urinary NGAL levels showed a very good diagnostic performance for discriminating patients with Lupus nephritis from SLE without renal damage and of control individuals.

Keywords: lupus nephritis, biomarker, NGAL, urine samples

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Authors: Etienne Sugewe

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Purpose: The establishment of a positive HIV serologic status of an individual could have been an inhibitory factor to prevent risk behaviours in people living with HIV/AIDS. We conducted a cross-sectional study in order to assess the prevalence and predictors of risk behaviors among HIV-positive people in Douala-Cameroon. Methods: We used pre-checked questionnaires to systematically collect data from four HIV treatment centers in Douala. This was done to some of them during the distribution of drugs and to others during their classical rendezvous between the months of May and July 2012. The Chi-Square and Student t-test were used for cross tabulation of variables; multiple regression analysis was performed to identify predictors of risky sexual behaviours. Results: Of the 330 persons interviewed, sixty percent were reported to have had sexual intercourse after the diagnosis of HIV. We obtained 37% HIV-positive partners, and 63% had HIV- negative partners or partners with unknown status. Among our patients, 45% of the subjects with regular partners reported to have had anal or vaginal sex. Those whose score on the knowledge about HIV/AIDS was < 50% and where 90% of them were less susceptible to the condom during intercourse (p: 0.01). About 74% of patients on ARV were less susceptible to the use of condoms during sexual intercourse (p: 0.03). Conclusion: Risk sexual behaviours among people living with HIV/AIDS are common and potentially expose their partners. For HIV-positive partners, these habits pose a real risk of suprainfection by other strains of HIV. The need to increase awareness and education among people living with HIV is therefore highly recommended.

Keywords: HIV/AIDS, behaviours, HIV positive, Douala, 2012

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Authors: Maftunakhon Latipova, Feruza Khaydarova

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Obesity is considered a chronic metabolic disease that occurs at any age. Regulation of body weight in the body is carried out through complex interaction of a complex of interrelated systems that control the body's energy system. Energy imbalance is the cause of obesity and overweight, in which the supply of energy from food exceeds the energy needs of the body. Obesity is closely related to impaired appetite regulation, and a hypothalamus is a key place for neural regulation of food consumption. The nucleus of the hypothalamus is connected and interdependent on receiving, integrating and sending hunger signals to regulate appetite. Purpose of the study: to identify markers of food behavior. Materials and methods: The screening was carried out to identify eating disorders in 200 men and women aged 18 to 35 years with overweight and obesity and to check the effects of Orexin A and Neuropeptide Y markers. A questionnaire and questionnaires were conducted with over 200 people aged 18 to 35 years. Questionnaires were for eating disorders and hidden depression (on the Zang scale). Anthropometry is measured by OT, OB, BMI, Weight, and Height. Based on the results of the collected data, 3 groups were divided: People with obesity, People with overweight, Control Group of Healthy People. Results: Of the 200 analysed persons, 86% had eating disorders. Of these, 60% of eating disorders were associated with childhood. According to the Zang test result: Normal condition was about 37%, mild depressive disorder 20%, moderate depressive disorder 25% and 18% of people suffered from severe depressive disorder without knowing it. One group of people with obesity had eating disorders and moderate and severe depressive disorder, and group 2 was overweight with mild depressive disorder. According to laboratory data, the first group had the lowest concentration of Orexin A and Neuropeptide U in blood serum. Conclusions: Being overweight and obese are the first signal of many diseases, and prevention and detection of these disorders will prevent various diseases, including type 2 diabetes. Obesity etiology is associated with eating disorders and signal transmission of the orexinorghetic system of the hypothalamus.

Keywords: obesity, endocrinology, hypothalamus, overweight

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