M3BUNet: Mobile Mean Max UNet for Pancreas Segmentation on CT-Scans

Segmenting organs in CT scan images is a necessary process for multiple downstream medical image analysis tasks. Currently, manual CT scan segmentation by radiologists is prevalent, especially for organs like the pancreas, which requires a high level of domain expertise for reliable segmentation due to factors like small organ size, occlusion, and varying shapes. When resorting to automated pancreas segmentation, these factors translate to limited reliable labeled data to train effective segmentation models. Consequently, the performance of contemporary pancreas segmentation models is still not within acceptable ranges. To improve that, we propose M3BUNet, a fusion of MobileNet and U-Net neural networks, equipped with a novel Mean-Max (MM) attention that operates in two stages to gradually segment pancreas CT images from coarse to fine with mask guidance for object detection. This approach empowers the network to surpass segmentation performance achieved by similar network architectures and achieve results that are on par with complex state-of-the-art methods, all while maintaining a low parameter count. Additionally, we introduce external contour segmentation as a preprocessing step for the coarse stage to assist in the segmentation process through image standardization. For the fine segmentation stage, we found that applying a wavelet decomposition filter to create multi-input images enhances pancreas segmentation performance. We extensively evaluate our approach on the widely known NIH pancreas dataset and MSD pancreas dataset. Our approach demonstrates a considerable performance improvement, achieving an average Dice Similarity Coefficient (DSC) value of up to 89.53% and an Intersection Over Union (IOU) score of up to 81.16 for the NIH pancreas dataset, and 88.60% DSC and 79.90% IOU for the MSD Pancreas dataset

Examining the contribution of fiscal policy on economic growth: Analytical insights from Pakistan

To better understand the influence of fiscal policy (FP) on economic growth (EG) in Pakistan, this study investigates the importance of the amount of output produced by different factors of production in Pakistan's economy. The annual time series data has been collected from the State Bank of Pakistan and World Bank Data-Base from the years (2001-2020). The Autoregressive Distributed Lag (ARDL) model is used for empirical research to assess the significant factors of EG, and the Augmented Dickey-Fuller (ADF) unit root test is used to ensure that all of the variables are stationary. Using annual time series data from 2001 to 2020. Based on these findings, this study recommends adopting a proactive fiscal policy framework that incorporates expansionary measures. We argue that this strategy has the capacity to stimulate and maintain Pakistan's economic growth path, thereby fostering a more promising and prosperous future. Moreover, the study found the impact of government expenditures (GE), gross fixed capital creation (GFCC), and direct and indirect taxes on Gross domestic Product (GDP). Additionally, findings showed that government expenditures, gross fixed capital creation, indirect, and direct taxes have a strong effect on economic growth. It is argued that an expansionary fiscal policy in the future could greatly benefit Pakistan's economic growth

Diagnostic Measures in Childhood Tuberculosis: A Short Review

The trends of incidence, morbidity and mortality of tuberculosis in children have always remained unclear because of lack of a definitive diagnostic tool in mostly cases. The diagnosis of tuberculosis in children remains a major challenge as it is seldom confirmed and is mostly based on clinical signs, symptoms and special investigations e. g. TST, chest X-ray and sputum smear microscopy. Sputum smear microscopy is positive in less than 10-15% of children with TB and culture yields are nearly about 30-40%. In low burden countries, the triad of (a) known contact with an infectious source case, (b) a positive tuberculin skin test and (c) a suggestive CXR is usually used to establish a diagnosis of childhood TB. The research on childhood tuberculosis is often neglected due to technical difficulties like slow growth in culture, the difficulty of obtaining specimens and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. The complexity in making an exact diagnosis of tuberculosis in children have led to the development of several diagnostic approaches like point scoring systems, diagnostic classifications and diagnostic algorithms. The aim of this study was to review and analyse the different diagnostic approaches to childhood tuberculosis. In this paper, the mostly used techniques like culture methods as well as the non-culture methods including serology, biochemistry and polymerase chain reaction and DNA fingerprinting for the diagnosis of tuberculosis will be discussed. Keywords: Diagnostic measures, Childhood, Tuberculosi

Recurrent takotsubo cardiomyopathy in the setting of transient neurological symptoms: a case report

<p>Abstract</p> <p>Introduction</p> <p>First described in Japan, takotsubo cardiomyopathy is increasingly becoming recognized worldwide as a cause of sudden and reversible diminished left ventricular function characterized by left apical ballooning and hyperkinesis of the basal segments, often with symptoms mimicking a myocardial infarction. Associated with physical or emotional stress, its exact pathogenesis has not been established, though evidence supports a neurohumoral etiology. Additionally, recurrence of this condition is rare. In this report, we present a rare case of recurrent takotsubo cardiomyopathy in a post-menopausal woman who presented with transient neurological complaints on both occasions.</p> <p>Case presentation</p> <p>We present a rare case of a 76-year-old Caucasian woman with no history of congestive heart failure who presented to our emergency department twice with transient neurological complaints. On the first occasion, she was found to have transient aphasia which resolved within 24 hours, yet during that period she also developed symptoms of congestive heart failure and was noted to have a new, significantly depressed ejection fraction with apical akinesis and possible apical thrombus. One month after her presentation a repeat echocardiogram revealed complete resolution of all wall motion abnormalities and a return to baseline status. Seven months later she presented with ataxia, was diagnosed with vertebrobasilar insufficiency, and again developed symptoms and echocardiography findings similar to those of her first presentation. Once again, at her one-month follow-up examination, all wall motion abnormalities had completely resolved and her ejection fraction had returned to normal.</p> <p>Conclusion</p> <p>Though the exact etiology of takotsubo cardiomyopathy is unclear, a neurohumoral mechanism has been proposed. Recurrence of this disorder is rare, though it has been reported in patients with structural brain abnormalities. This report is the first to describe recurrent takotsubo cardiomyopathy in a patient with transient neurological symptoms. In our patient, as expected in patients with this condition, complete resolution of all left ventricular abnormalities occurred within a short period of time. It is important for clinicians to be aware of this increasingly recognized syndrome, including its association with recurrence, especially in the clinical setting of neurologic dysfunction.</p

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Effectiveness of Roflumilast in Treating Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

From PubMed via Jisc Publications RouterHistory: accepted 2022-03-03Publication status: epublishBackground Chronic obstructive pulmonary disease (COPD) is a chronic airflow obstructive condition. The mainstay of treatment is to avoid exacerbation and manage the symptoms. Roflumilast is being used as a part of treatment to reduce the inflammatory process in this disease. Method This systematic review and meta-analysis were conducted following the provided guidelines. PubMed, Cochrane Library, and Cinahl were considered for searching the desired studies selected until 19 June 2021. The eligibility criteria for inclusion and exclusion were set before selecting studies. Result Five hundred eighty (580) studies were identified at the beginning. Removal of duplicates was done using Endnote software. The eligibility criteria, including the randomized controlled trial study design and others, were applied for screening the title and abstracts. Six studies were selected for the qualitative analysis. After assessing the data from these studies, it was found that roflumilast is an effective drug to treat COPD. Roflumilast plays an essential role in improving quality of life, inflammatory process, and clinical improvement. The drug's mild to moderate adverse effects were observed, but no significant severe adverse events were reported, and the drug was well tolerated. Conclusion Roflumilast is a valuable drug that can be used for its beneficial effects on COPD exacerbation. The benefits of the drug outweigh its adverse effects. [Abstract copyright: Copyright © 2022, Naseem et al.