989 research outputs found
Numerical Simulation and Design of COVID-19 Disease Detection System Based on Improved Computing Techniques
The high demand for testing the sickness has led to a lack of resources at emergency clinics as the coronavirus epidemic continues. PC vision-based frameworks can be used to increase the productivity of Coronavirus localization. However, a significant amount of information preparation is needed to create an accurate and reliable model, which is currently impractical given the peculiar nature of the illness. One such model is for differentiating pneumonia cases by using radiographs, and it has achieved sufficiently high exactness to be used on patients. Various models are currently being used inside the medical services sector to order different illnesses. This proposal evaluates the benefit of using motion learning to broaden the presentation of the Coronavirus location model, starting from the premise that there is limited information available for Coronavirus ID. Infections that affect the human lungs include viral pneumonia caused by the coronavirus and other viruses. The World Health Organization (W.H.O.) proclaimed Covid a pandemic in 2020; the sickness originated in China and quickly spread to other countries. Early diagnosis of infected patients aids in saving the patient's life and prevents the infection's further spread. As one of the quickest and least expensive methods for diagnosing the condition, the convolutional neural organization (CNN) model is suggested in this research study to assist in the early detection of the infection using chest X-Beam images. Two convolutional brain organizations (CNN) models were created using two different datasets. The primary model was created for double characterization using one of the datasets that only included pneumonia cases and common chest X-Beam images. The second model made use of the information advanced by the primary model using move learning and was created for three class divisions on chest X-Beam images of cases with the coronavirus, pneumonia, and regular cases
Seeking diagnostic and prognostic biomarkers for childhood bacterial pneumonia in sub-Saharan Africa: study protocol for an observational study
INTRODUCTION: Clinically diagnosed pneumonia in children is a leading cause of paediatric hospitalisation and mortality. The aetiology is usually bacterial or viral, but malaria can cause a syndrome indistinguishable from clinical pneumonia. There is no method with high sensitivity to detect a bacterial infection in these patients and, as result, antibiotics are frequently overprescribed. Conversely, unrecognised concomitant bacterial infection in patients with malarial infections occur with omission of antibiotic therapy from patients with bacterial infections. Previously, we identified two combinations of blood proteins with 96% sensitivity and 86% specificity for detecting bacterial disease. The current project aimed to validate and improve these combinations by evaluating additional biomarkers in paediatric patients with clinical pneumonia. Our goal was to describe combinations of a limited number of proteins with high sensitivity and specificity for bacterial infection to be incorporated in future point-of-care tests. Furthermore, we seek to explore signatures to prognosticate clinical pneumonia. METHODS AND ANALYSIS: Patients (n=900) aged 2-59 months presenting with clinical pneumonia at two Gambian hospitals will be enrolled and classified according to criteria for definitive bacterial aetiology (based on microbiological tests and chest radiographs). We will measure proteins at admission using Luminex-based immunoassays in 90 children with definitive and 160 with probable bacterial aetiology, and 160 children classified according to the prognosis of their disease. Previously identified diagnostic signatures will be assessed through accuracy measures. Moreover, we will seek new diagnostic and prognostic signatures through machine learning methods, including support vector machine, penalised regression and classification trees. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Gambia Government/Medical Research Council Unit The Gambia Joint Ethics Committee (protocol 1616) and the institutional review board of Boston University Medical Centre (STUDY00000958). Study results will be disseminated to the staff of the study hospitals, in scientific seminars and meetings, and in publications. TRIAL REGISTRATION NUMBER: H-38462
Human Immunodeficiency Virus-Associated Chronic Lung Disease in Children and Adolescents in Zimbabwe: Chest Radiographic and High-Resolution Computed Tomographic Findings.
Background: Chronic respiratory symptoms are common among children living with human immunodeficiency virus (HIV). We investigated the radiological features of chronic lung disease in children aged 6-16 years receiving antiretroviral therapy for ≥6 months in Harare, Zimbabwe. Methods: Consecutive participants from a HIV clinic underwent clinical assessment and chest radiography. Participants with an abnormal chest radiograph (assessed by a clinician) and/or those meeting a clinical case definition for chronic lung disease underwent high-resolution computed tomography (HRCT). Radiological studies were scored independently and blindly by 2 thoracic radiologists. Relationships between radiological abnormalities and lung function were examined. Results: Among 193 participants (46% female; median age, 11.2 years; interquartile range, 9.0-12.8 years), the median CD4 cell count was 720/µL (473-947/µL), and 79% had a human immunodeficiency virus (HIV) load of <400 copies/mL. The most common chest radiographic finding was ring/tramline opacities (55 of 193 participants; 29%). HRCT scans were evaluated in 84 participants (69%); decreased attenuation (present in 43%) was the dominant abnormality seen. The extent of decreased attenuation was strongly correlated with both the severity and extent of bronchiectasis (rs = 0.68 and P < .001 for both). The extent of decreased attenuation was also negatively correlated with forced expiratory volume in first second of expiration (rs = -0.52), forced vital capacity (rs = -0.42), and forced expiratory flow, midexpiratory phase (rs = -0.42) (P < .001 for all). Conclusions: The HRCT findings strongly suggest that obliterative bronchiolitis may be the major cause of chronic lung disease in our cohort. Further studies to understand the pathogenesis and natural history are urgently needed
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Current diagnostic techniques for pneumonia: a scoping review
Community-acquired pneumonia is one of the most lethal infectious diseases, especially for infants and the elderly. Given the variety of causative agents, the accurate early detection of pneumonia is an active research area. To the best of our knowledge, scoping reviews on diagnostic techniques for pneumonia are lacking. In this scoping review, three major electronic databases were searched and the resulting research was screened. We categorized these diagnostic techniques into four classes (i.e., lab-based methods, imaging-based techniques, acoustic-based techniques, and physiological-measurement-based techniques) and summarized their recent applications. Major research has been skewed towards imaging-based techniques, especially after COVID-19. Currently, chest X-rays and blood tests are the most common tools in the clinical setting to establish a diagnosis; however, there is a need to look for safe, non-invasive, and more rapid techniques for diagnosis. Recently, some non-invasive techniques based on wearable sensors achieved reasonable diagnostic accuracy that could open a new chapter for future applications. Consequently, further research and technology development are still needed for pneumonia diagnosis using non-invasive physiological parameters to attain a better point of care for pneumonia patients
Characterization of pneumonia among children under five years of age hospitalized in Thimphu, Bhutan
Programa de Doctorat en Medicina i Recerca Translacional / Tesi realitzada a l'Institut de Salut Global de Barcelona - Hospital ClĂnic[eng] The general objective of this thesis was to describe the epidemiology, aetiology, clinical presentation, and radiological findings of pneumonia among Bhutanese children to better characterize childhood pneumonia in Bhutan and to contribute to the understanding of this disease in the local context. This thesis also aimed to assess the diagnostic and prognostic performance of host-response biomarkers alone, combined, or in addition to clinical scoring scales to risk-stratify children hospitalized with pneumonia and predict their outcome.
The first article acknowledges the need for local research in Bhutan and comments on
the specific challenges experienced when trying to conduct it.
The second article is a systematic review that summarizes current knowledge around
childhood pneumonia in Bhutan and identifies knowledge gaps in this area. The findings
of this review were used as the starting point to guide further research and to establish
the objectives of the Respiratory Infections in Bhutanese Children (RIBhuC) study.
We reported the findings of the RIBhuC study in articles 3 to 6 of this thesis. In brief, the
RIBhuC study took place between 1 July 2017 and 30 June 2018. We prospectively
enrolled all children between 2 and 59 months admitted to the Jigme Dorji Wangchuck
National Referral Hospital (JDWNRH) in Thimphu with WHO-defined clinical pneumonia,
provided parents or caregivers consented to study participation. On admission, we
performed a comprehensive physical examination, including anthropometric and vital
signs measurements. We recorded demographic and clinical data from medical files and
through family interviews. We performed an antero-posterior chest radiograph within 24
hours of admission and classified children according to radiological findings following
WHO radiological criteria. We collected blood samples upon enrolment or as soon as
possible after enrolment for haematology, biochemistry, and bacterial culture, and two
drops of blood on filter paper for the identification of Streptococcus pneumoniae by realtime
polymerase chain reaction (RT-PCR). In addition, we measured plasma levels of
eleven host-response biomarkers, including six markers of immune and endothelial
activation: interleukin-6 (IL-6), interleukin-8 (IL-8), soluble triggering receptor expressed
on myeloid cells-1 (sTREM-1), soluble tumour necrosis factor receptor 1 (sTNFR1),
angiopoietin-2 (Angpt-2), and soluble fms-like tyrosine kinase 1 (sFlt1). Finally, we
collected respiratory samples through nasopharyngeal washing for the molecular
identification of seventeen respiratory viruses and four atypical bacteria and the
detection and capsular typing of Streptococcus pneumoniae.
The third article describes the aetiological profile and the demographic and clinical
characteristics of this cohort of children admitted with WHO-defined clinical pneumonia.
The fourth article reports data on the prevalence of pneumococcal nasopharyngeal
carriers and on the pneumococcal serotypes circulating among Bhutanese children with
clinical pneumonia before the introduction of the pneumococcal conjugate vaccine in the
country. We identified and compared respiratory viruses among children with and
without pneumococcal nasopharyngeal colonization to contribute to the understanding
of the interplay between pneumococcal nasopharyngeal colonization and viral coinfections.
The fifth article describes the radiological findings of the RIBhuC cohort and the
differences in radiological outcomes by demographic characteristics, aetiology, clinical
features, and host-response biomarker levels. We also evaluated the utility of hostresponse
biomarkers in discerning between bacterial and viral pneumonia, taking
radiological endpoint pneumonia as a proxy for bacterial aetiology.
The sixth and last article of this thesis assessed the performance of a wide range of
clinical characteristics, laboratory testing, clinical scoring scales, and host-response
biomarkers to risk-stratify children with clinical pneumonia in Bhutan and predict their
outcome.[spa] El objetivo principal de esta tesis fue identificar y reducir las lagunas de conocimiento
sobre la epidemiologia, la etiologia, la presentacion clinica y los hallazgos radiologicos de
la neumonia infantil en Butan para caracterizar esta enfermedad y contribuir a su
comprension en el contexto local. Esta tesis tambien tuvo como objetivo evaluar el rol
diagnostico y pronostico de ciertos biomarcadores por si solos, combinados o en adicion
a escalas de puntuacion clinica para estratificar el riesgo de los ninos hospitalizados con
neumonia y predecir su resultado clinico.
El primer artĂculo senala la necesidad de realizar investigacion a nivel local y comenta los
desafios especificos encontrados en un pais como Butan para llevarla a cabo.
El segundo artĂculo es una revision sistematica que resume el conocimiento actual sobre
la neumonia infantil en Butan y que identifica las lagunas de conocimiento en este
campo. Se utilizaron los resultados de esta revision y las carencias de conocimiento para
enfocar los objetivos del estudio RIBhuC (del ingles Respiratory Infections in Bhutanese
Children).
Se detallan los principales hallazgos del estudio RIBhuC en los artĂculos 3 a 6 de esta
tesis. El estudio RIBhuC se llevo a cabo entre el 1 de julio del 2017 y el 30 de junio del
2018 en el Hospital Nacional de Referencia Jigme Dorji Wangchuck, en Thimphu. Se
recluto prospectivamente a todos los ninos entre 2 y 59 meses ingresados por neumonia
clinica segun los criterios de la OMS, siempre que los padres o cuidadores aceptaran
participar en el estudio. Al ingreso, se realizo un examen fisico completo incluyendo
mediciones antropometricas y toma de signos vitales. Se recogieron datos demograficos
y clinicos mediante entrevistas con los familiares y a partir del expediente medico. Se
realizo una radiografia de torax anteroposterior en las primeras 24 horas del ingreso y se
20
clasificaron los ninos segun los criterios radiologicos de la OMS. Se recogieron muestras
de sangre en el momento del reclutamiento, o lo antes posible despues del
reclutamiento, para analisis de hematologia y bioquimica, cultivo bacteriano, e
identificacion de Streptococcus pneumoniae mediante la reaccion en cadena de la
polimerasa en tiempo real a partir de dos gotas de sangre recogidas en papel de filtro.
Tambien se midieron los niveles plasmaticos de once biomarcadores de respuesta del
huesped, incluyendo seis marcadores de activacion endotelial e inmune: la interleucina-6
(IL-6), la interleucina-8 (IL-8), el receptor de activacion soluble expresado en celulas
mieloides-1 (sTREM-1), el receptor soluble del factor de necrosis tumoral 1 (sTNFR1), la
angiopoyetina-2 (Angpt-2), y la tirosina quinasa-1 soluble similar a fms (sFlt1).
Finalmente, se recogieron muestras respiratorias mediante lavado nasofaringeo para la
identificacion molecular de 17 virus respiratorios y 4 bacterias atipicas, asi como para la
deteccion y tipificacion capsular neumococica.
El tercer artĂculo describe el perfil etiologico y las caracteristicas demograficas y clinicas
de esta cohorte de ninos butaneses ingresados con neumonia clinica.
El cuarto artĂculo presenta la prevalencia de portadores nasofaringeos neumococicos y
los serotipos neumococicos circulantes entre los ninos butaneses ingresados con
neumonia clinica antes de la introduccion de la vacuna antineumococica conjugada en el
pais. Comparamos la prevalencia y tipos de virus respiratorios entre ninos con y sin
colonizacion nasofaringea neumococica para contribuir a la comprension de la
interaccion entre la colonizacion nasofaringea neumococica y las coinfecciones virales.
El quinto artĂculo describe los hallazgos radiologicos y evalua las diferencias en cuanto a
caracteristicas demograficas, etiologicas, clinicas y niveles de biomarcadores segun las
caracteristicas radiologicas. En este articulo, tambien se evalua la utilidad de
biomarcadores para diferenciar entre neumonia bacteriana y viral, considerando el
hallazgo de neumonia radiologica (condensacion, derrame pleural o ambos) como
indicador de neumonia bacteriana.
El sexto y Ăşltimo artĂculo de esta tesis evalua el rendimiento de caracteristicas clinicas,
pruebas de laboratorio, escalas de puntuacion clinica y biomarcadores para estratificar el
riesgo pronostico de los ninos con neumonia clinica en el momento del ingreso y predecir
su resultado clinico
Characterization of pneumonia among children under five years of age hospitalized in Thimphu, Bhutan
[eng] The general objective of this thesis was to describe the epidemiology, aetiology, clinical presentation, and radiological findings of pneumonia among Bhutanese children to better characterize childhood pneumonia in Bhutan and to contribute to the understanding of this disease in the local context. This thesis also aimed to assess the diagnostic and prognostic performance of host-response biomarkers alone, combined, or in addition to clinical scoring scales to risk-stratify children hospitalized with pneumonia and predict their outcome.
The first article acknowledges the need for local research in Bhutan and comments on
the specific challenges experienced when trying to conduct it.
The second article is a systematic review that summarizes current knowledge around
childhood pneumonia in Bhutan and identifies knowledge gaps in this area. The findings
of this review were used as the starting point to guide further research and to establish
the objectives of the Respiratory Infections in Bhutanese Children (RIBhuC) study.
We reported the findings of the RIBhuC study in articles 3 to 6 of this thesis. In brief, the
RIBhuC study took place between 1 July 2017 and 30 June 2018. We prospectively
enrolled all children between 2 and 59 months admitted to the Jigme Dorji Wangchuck
National Referral Hospital (JDWNRH) in Thimphu with WHO-defined clinical pneumonia,
provided parents or caregivers consented to study participation. On admission, we
performed a comprehensive physical examination, including anthropometric and vital
signs measurements. We recorded demographic and clinical data from medical files and
through family interviews. We performed an antero-posterior chest radiograph within 24
hours of admission and classified children according to radiological findings following
WHO radiological criteria. We collected blood samples upon enrolment or as soon as
possible after enrolment for haematology, biochemistry, and bacterial culture, and two
drops of blood on filter paper for the identification of Streptococcus pneumoniae by realtime
polymerase chain reaction (RT-PCR). In addition, we measured plasma levels of
eleven host-response biomarkers, including six markers of immune and endothelial
activation: interleukin-6 (IL-6), interleukin-8 (IL-8), soluble triggering receptor expressed
on myeloid cells-1 (sTREM-1), soluble tumour necrosis factor receptor 1 (sTNFR1),
angiopoietin-2 (Angpt-2), and soluble fms-like tyrosine kinase 1 (sFlt1). Finally, we
collected respiratory samples through nasopharyngeal washing for the molecular
identification of seventeen respiratory viruses and four atypical bacteria and the
detection and capsular typing of Streptococcus pneumoniae.
The third article describes the aetiological profile and the demographic and clinical
characteristics of this cohort of children admitted with WHO-defined clinical pneumonia.
The fourth article reports data on the prevalence of pneumococcal nasopharyngeal
carriers and on the pneumococcal serotypes circulating among Bhutanese children with
clinical pneumonia before the introduction of the pneumococcal conjugate vaccine in the
country. We identified and compared respiratory viruses among children with and
without pneumococcal nasopharyngeal colonization to contribute to the understanding
of the interplay between pneumococcal nasopharyngeal colonization and viral coinfections.
The fifth article describes the radiological findings of the RIBhuC cohort and the
differences in radiological outcomes by demographic characteristics, aetiology, clinical
features, and host-response biomarker levels. We also evaluated the utility of hostresponse
biomarkers in discerning between bacterial and viral pneumonia, taking
radiological endpoint pneumonia as a proxy for bacterial aetiology.
The sixth and last article of this thesis assessed the performance of a wide range of
clinical characteristics, laboratory testing, clinical scoring scales, and host-response
biomarkers to risk-stratify children with clinical pneumonia in Bhutan and predict their
outcome.[spa] El objetivo principal de esta tesis fue identificar y reducir las lagunas de conocimiento
sobre la epidemiologia, la etiologia, la presentacion clinica y los hallazgos radiologicos de
la neumonia infantil en Butan para caracterizar esta enfermedad y contribuir a su
comprension en el contexto local. Esta tesis tambien tuvo como objetivo evaluar el rol
diagnostico y pronostico de ciertos biomarcadores por si solos, combinados o en adicion
a escalas de puntuacion clinica para estratificar el riesgo de los ninos hospitalizados con
neumonia y predecir su resultado clinico.
El primer artĂculo senala la necesidad de realizar investigacion a nivel local y comenta los
desafios especificos encontrados en un pais como Butan para llevarla a cabo.
El segundo artĂculo es una revision sistematica que resume el conocimiento actual sobre
la neumonia infantil en Butan y que identifica las lagunas de conocimiento en este
campo. Se utilizaron los resultados de esta revision y las carencias de conocimiento para
enfocar los objetivos del estudio RIBhuC (del ingles Respiratory Infections in Bhutanese
Children).
Se detallan los principales hallazgos del estudio RIBhuC en los artĂculos 3 a 6 de esta
tesis. El estudio RIBhuC se llevo a cabo entre el 1 de julio del 2017 y el 30 de junio del
2018 en el Hospital Nacional de Referencia Jigme Dorji Wangchuck, en Thimphu. Se
recluto prospectivamente a todos los ninos entre 2 y 59 meses ingresados por neumonia
clinica segun los criterios de la OMS, siempre que los padres o cuidadores aceptaran
participar en el estudio. Al ingreso, se realizo un examen fisico completo incluyendo
mediciones antropometricas y toma de signos vitales. Se recogieron datos demograficos
y clinicos mediante entrevistas con los familiares y a partir del expediente medico. Se
realizo una radiografia de torax anteroposterior en las primeras 24 horas del ingreso y se
20
clasificaron los ninos segun los criterios radiologicos de la OMS. Se recogieron muestras
de sangre en el momento del reclutamiento, o lo antes posible despues del
reclutamiento, para analisis de hematologia y bioquimica, cultivo bacteriano, e
identificacion de Streptococcus pneumoniae mediante la reaccion en cadena de la
polimerasa en tiempo real a partir de dos gotas de sangre recogidas en papel de filtro.
Tambien se midieron los niveles plasmaticos de once biomarcadores de respuesta del
huesped, incluyendo seis marcadores de activacion endotelial e inmune: la interleucina-6
(IL-6), la interleucina-8 (IL-8), el receptor de activacion soluble expresado en celulas
mieloides-1 (sTREM-1), el receptor soluble del factor de necrosis tumoral 1 (sTNFR1), la
angiopoyetina-2 (Angpt-2), y la tirosina quinasa-1 soluble similar a fms (sFlt1).
Finalmente, se recogieron muestras respiratorias mediante lavado nasofaringeo para la
identificacion molecular de 17 virus respiratorios y 4 bacterias atipicas, asi como para la
deteccion y tipificacion capsular neumococica.
El tercer artĂculo describe el perfil etiologico y las caracteristicas demograficas y clinicas
de esta cohorte de ninos butaneses ingresados con neumonia clinica.
El cuarto artĂculo presenta la prevalencia de portadores nasofaringeos neumococicos y
los serotipos neumococicos circulantes entre los ninos butaneses ingresados con
neumonia clinica antes de la introduccion de la vacuna antineumococica conjugada en el
pais. Comparamos la prevalencia y tipos de virus respiratorios entre ninos con y sin
colonizacion nasofaringea neumococica para contribuir a la comprension de la
interaccion entre la colonizacion nasofaringea neumococica y las coinfecciones virales.
El quinto artĂculo describe los hallazgos radiologicos y evalua las diferencias en cuanto a
caracteristicas demograficas, etiologicas, clinicas y niveles de biomarcadores segun las
caracteristicas radiologicas. En este articulo, tambien se evalua la utilidad de
biomarcadores para diferenciar entre neumonia bacteriana y viral, considerando el
hallazgo de neumonia radiologica (condensacion, derrame pleural o ambos) como
indicador de neumonia bacteriana.
El sexto y Ăşltimo artĂculo de esta tesis evalua el rendimiento de caracteristicas clinicas,
pruebas de laboratorio, escalas de puntuacion clinica y biomarcadores para estratificar el
riesgo pronostico de los ninos con neumonia clinica en el momento del ingreso y predecir
su resultado clinico
Updates in Management of SARS-CoV-2 Infection
Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has spread worldwide from the beginning of 2020. The infection is mostly asymptomatic but some patients may develop COVID‑19 (coronavirus disease 2019) with a severe or critical course leading to pneumonia, acute respiratory distress syndrome, and multiorgan failure. Apart from the virus‑related damage of the lungs, pathomechanism of the disease seems to be linked to thromboembolism and inflammation accompanied by overproduction of proinflammatory cytokines, termed a cytokine storm, responsible for multiorgan damage and death. Since the development of a new therapeutic molecule, dedicated strictly to a particular virus is time‑consuming, physicians and scientists have started to test and repurpose old medications. Unfortunately, after one year of pandemics, there is still a lack of optimal therapy and no clear indicators of recovery. A major issue is also insufficient knowledge on predictors of the severe or deadly course of the disease, which could also help to switch from one therapeutic option to another. Due to many gaps still existing in the management of COVID-19, there is a need for the accumulation of new data particularly from real-world experience, which could be applicable to practice guidelines. The objective of this special issue of the Journal of Clinical Medicine is to provide an update on the mangement for the diagnostic workup and pharmacotherapy of SARS‑CoV‑2 infection
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