Lung Diseases Diagnosis-Based Deep Learning Methods: A Review

This review paper examines the current state of lung disease diagnosis based on deep learning (DL) methods. Lung diseases, such as Pneumonia, TB, Covid-19, and lung cancer, are significant causes of morbidity and mortality worldwide. Accurate and timely diagnosis of these diseases is essential for effective treatment and improved patient outcomes. DL methods, which utilize artificial neural networks to extract features from medical images automatically, have shown great promise in improving the accuracy and efficiency of lung disease diagnosis. This review discusses the various DL methods that have been developed for lung disease diagnosis, including convolutional neural networks (CNNs), deep neural networks (DNNs), and generative adversarial networks (GANs). The advantages and limitations of each method are discussed, along with the types of medical imaging techniques used, such as X-ray and computed tomography (CT). In addition, the review discusses the most commonly used performance metrics for evaluating the performance of DL for lung disease diagnosis: the area under the curve (AUC), sensitivity, specificity, F1-score, accuracy, precision, and the receiver operator characteristic curve (ROC). Moreover, the challenges and limitations of using DL for lung disease diagnosis, including the limited availability of annotated data, the variability in imaging techniques and disease presentation, and the interpretability and generalizability of DL models, are highlighted in this paper. Furthermore, strategies to overcome these challenges, such as transfer learning, data augmentation, and explainable AI, are also discussed. The review concludes with a call for further research to address the remaining challenges and realize DL's full potential for improving lung disease diagnosis and treatment

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluation of the efficiency of laser acupuncture in management of chronic lateral epicondylitis in adolescents

Background/aim Lateral epicondylitis known frequently as tennis elbow, is a common disease affecting the elbow joint. It affects 1 to 3% of the population yearly especially individuals in their forties, although the pain has usually a gradual onset, it may occur abruptly. Laser acupuncture is a complementary modality that is used to stimulate the acupoints by low-power laser beam instead of the traditional needles. The present study aims to evaluate the efficiency of laser acupuncture in the management of chronic lateral epicondylitis in adolescents. Patient and methods This study is a randomized controlled trial study on sixty adolescent patients with lateral epicondylitis visiting the acupuncture and laser clinic in excellence Medical Centre, National Research Centre, Cairo, Egypt, during the first of November 2023 till the end of January 2024. The patients were divided into two groups (30 each). The first group was subjected to low-power laser and brufen 400 mg twice daily for 4 weeks, while the patients in the second group were given just the same dose of brufen and used as a control. Pain score, patient rated elbow score, and interleukin-6 (IL-6) were measured before and after the end of treatment. IL-6 was measured by Elisa techniques. Results The present study exhibited insignificant differences (P>0.05) between the studied groups of adolescents with chronic lateral epicondylitis regarding pain score and Patient elbow score before intervention and then it became significantly lower (P<0.05) in both groups group at the end of treatment with Laser and brufen or without Laser. However, adolescent patients subjected to laser and brufen exhibited more reduction (P<0.01) than in the control group treated with brufen only. In addition, the levels of IL-6 exhibited more reduction in the Laser group (P<0.01) than in the control group. Conclusion Low-power laser is efficient in pain reduction and improvement of elbow joint function when 200 mw power, continuous wave, and 12 Joules energy is applied on each acupoint in chronic lateral epicondylitis adolescent patients

Aromatase Deficiency due to a Homozygous <b><i>CYP19A1</i></b> Mutation in a 46,XX Egyptian Patient with Ambiguous Genitalia

International audienceAromatase deficiency (AD) is a very rare disorder resulting from mutations in the CYP19A1 gene encoding aromatase, a cytochrome P450 enzyme that plays a pivotal role in androgen conversion to estrogens. AD is inherited in an autosomal recessive trait, and to date only 35 cases have been described in the literature. Herein, we depict a new patient reared as a male, who presented at the age of 21 years with no palpable testis, hypoplastic scrotum, penis-like phallus (3 cm), and penoscrotal hypospadias. The patient was born to consanguineous parents, his karyotype was 46,XX, and SRY was negative. Pelvic sonar showed a small hypoplastic uterus, and no testis could be identified. Serum testosterone was within the reference range of females along with high gonadotropins. Pathology of gonadal biopsy showed ovarian stroma negative for oocytic follicle consistent with streak gonads. All these data were suggestive of AD, which was subsequently confirmed by molecular investigation of the CYP19A1 gene. A homozygous splice site mutation in the donor splice site of exon 9 was identified, c.1263 + 1G>T. This is the first report of such a rare disorder in an Egyptian patient. Our results reinforce the importance of considering AD in patients with 46,XX disorders of sex development after ruling out congenital adrenal hyperplasia

Evaluation of eosinophil, immune-globulin E and Interleukin 6 levels in bronchial asthmatic children after management with needle and laser acupuncture

Background/aim Bronchial asthma is a disabling disease causing interruption with the daily activities of children. Acupuncture proved to be beneficial in improving the symptoms of the disease and decreasing the dose of conventional medications that must be taken and may have serious side effects. This study aims to evaluate the variations of some inflammatory and immunity markers such as Eosinophil, immune-globulin E (IgE), and Interleukin 6 (IL6) in bronchial asthmatic children after treatment with needle and laser acupuncture. Patients and methods In this randomized controlled clinical trial, we included 75 patients divided into three groups. Each group has 25 children. The patients in the first group received laser sessions three times a week for 4 weeks. Those in the second group were treated by needle acupuncture during the same period of time, while the children in third group received only conventional medications and were used as control. Complete blood cell count, which reveals eosinophilic count, was determined, as well as serum IgE and IL6 were measured using Elisa techniques at baseline and after one month of treatment. Results All the patients in the three groups showed significant improvement concerning their symptoms and laboratory parameters number of attacks/week and night awakens/month all decrease significantly (P<0.001) also IgE (P<0.001) after 1 month of treatment with needle or laser. However, children receiving needle and laser sessions showed more significant improvement (P<0.05) than the control group, with no differences between the two groups. White blood cells, eosinophils, IgE, IL 6 were statistically decreased (P<0.05) after the end of the sessions. Conclusion Needle and laser acupuncture proved efficient in relieving the symptoms of the bronchial asthma in children more than conventional medications alone, as well as Eosinophil, IgE, and IL6 levels were significantly decreased after the treatment

Comparing different fentanyl concentrations added to local anesthetic mixture in peribulbar block for cataract surgery

AbstractObjectiveEvaluation of the effect of different concentrations of fentanyl added to the local anesthetic mixture on the onset and duration of globe anesthesia, after peribulbar block, with the least side effects.DesignDouble blinded randomized controlled clinical trial.SettingKasr Al Aini hospital, Cairo University.Methods60 patients with cataract grade 1–3 in the age group 40–70years, with American Society of Anesthesiologists (ASA) grade I, II and III, scheduled for elective cataract surgery under regional anesthesia. They were randomly divided into four groups: in Group 1 (Control Group), patients received Lidocaine 2% and Hyaluronidase 15IU/ml; in Groups 2, 3 and 4 (Fentanyl Groups), the patients received Lidocaine 2% and Hyaluronidase 15IU/ml in addition to Fentanyl 1μg/ml, 2μg/ml and 3μg/ml respectively. The onset and duration of lid and globe akinesia were assessed. Postoperative Visual Analogue Score was recorded each hour up to 6h.ResultsNo statistical significant difference was observed between the four groups in the onset and duration of lid and globe akinesia. There was a significant difference between the control group and the fentanyl groups as regards the duration of analgesia that was significantly prolonged in the groups that received fentanyl at concentrations of 2μg/ml and 3μg/ml in these group patients required analgesia after 116±19min and 144±11min respectively compared to the control group and the group that received fentanyl at a concentration of 1μg/ml group who required analgesia after 100–103min.ConclusionAdding Fentanyl at concentrations⩾2–3μg/ml to the local anesthetic mixture (Lidocaine and Hyaluronidase) for regional peribulbar block provides safe and effective method in improving postoperative analgesia in patients undergoing cataract surgery

&lt;b&gt;&lt;i&gt;WT1&lt;/i&gt;&lt;/b&gt; Gene Mutation, p.R462W, in a 46,XY DSD Patient from Egypt with Gonadoblastoma and Review of the Literature

&lt;i&gt;WT1&lt;/i&gt; gene mutations have been described in 46,XY patients with ambiguous genitalia or complete gonadal dysgenesis with or without Wilms' tumor, nephropathy, gonadoblastoma, and other defects, e.g., cryptorchidism or hypospadias. p.R462W is a hot spot mutation in exon 9 and is the most common mutation in patients with Denys-Drash syndrome. However, in this study we report an Egyptian patient with a novel phenotype carrying the p.R462W mutation. We also review the heterogeneity of phenotypes of previously reported patients with the p.R462W (previously referred to as Arg394Trp) mutation.</jats:p

Cytogenetic Spectrum of Ovotesticular Difference of Sex Development (OT DSD) among a Large Cohort of DSD Patients and Literature Review

Ovotesticular difference of sex development (OT DSD) is a rare genetic disorder with an incidence of about 1/100,000 live births. The majority of OT DSD patients show a 46,XX karyotype, others may have 46,XX/46,XY chimerism or exhibit various mosaic sex chromosome combinations, and less commonly they may have a 46,XY karyotype. The aim of this work is to report the clinical, pathological, and karyotypic variations in OT DSD patients diagnosed among a large cohort of DSD patients. The study included 10 patients thoroughly evaluated for clinical, genital, and hormonal abnormalities and subjected to imaging studies, laparoscopy with gonadal biopsy, karyotype, and FISH analysis. The current study revealed a greater percentage of mosaic cell line combinations than previously reported and showed variable cytogenetic abnormalities, including the rare isodicentric (Y)(p11.32) abnormality and X;Y translocation. The study also revealed a unique pattern of gonadal type and combination frequencies. To our knowledge, this is the first study on OT DSD patients among a large cohort of DSD patients in Egypt and the Middle East.</jats:p