Artificial intelligence and visual inspection in cervical cancer screening

INTRODUCTION: Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm.METHODS: A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values.RESULTS: Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively.CONCLUSION: This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.</p

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations:PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

Abstract Background High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence. Methods PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy. Discussion PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid. Trial registration ClinicalTrials.gov, NCT05234112 . Registered 10 February 202

Sirtuin 6 inhibition protects against glucocorticoid-induced skeletal muscle atrophy by regulating IGF/PI3K/AKT signaling

Chronic activation of stress hormones such as glucocorticoids leads to skeletal muscle wasting in mammals. However, the molecular events that mediate glucocorticoid-induced muscle wasting are not well understood. Here, we show that SIRT6, a chromatin-associated deacetylase indirectly regulates glucocorticoid-induced muscle wasting by modulating IGF/PI3K/AKT signaling. Our results show that SIRT6 levels are increased during glucocorticoid-induced reduction of myotube size and during skeletal muscle atrophy in mice. Notably, overexpression of SIRT6 spontaneously decreases the size of primary myotubes in a cell-autonomous manner. On the other hand, SIRT6 depletion increases the diameter of myotubes and protects them against glucocorticoid-induced reduction in myotube size, which is associated with enhanced protein synthesis and repression of atrogenes. In line with this, we find that muscle-specific SIRT6 deficient mice are resistant to glucocorticoid-induced muscle wasting. Mechanistically, we find that SIRT6 deficiency hyperactivates IGF/PI3K/AKT signaling through c-Jun transcription factor-mediated increase in IGF2 expression. The increased activation, in turn, leads to nuclear exclusion and transcriptional repression of the FoxO transcription factor, a key activator of muscle atrophy. Further, we find that pharmacological inhibition of SIRT6 protects against glucocorticoid-induced muscle wasting in mice by regulating IGF/PI3K/AKT signaling implicating the role of SIRT6 in glucocorticoid-induced muscle atrophy.Fil: Mishra, Sneha. No especifíca;Fil: Cosentino, Claudia. Harvard Medical School; Estados UnidosFil: Tamta, Ankit Kumar. No especifíca;Fil: Khan, Danish. No especifíca;Fil: Srinivasan, Shalini. No especifíca;Fil: Ravi, Venkatraman. No especifíca;Fil: Abbotto, Elena. Università degli Studi di Genova; ItaliaFil: Arathi, Bangalore Prabhashankar. No especifíca;Fil: Kumar, Shweta. No especifíca;Fil: Jain, Aditi. No especifíca;Fil: Ramaian, Anand S.. No especifíca;Fil: Kizkekra, Shruti M.. No especifíca;Fil: Rajagopal, Raksha. No especifíca;Fil: Rao, Swathi. No especifíca;Fil: Krishna, Swati. No especifíca;Fil: Asirvatham Jeyaraj, Ninitha. Indian Institute of Technology; IndiaFil: Haggerty, Elizabeth R.. Harvard Medical School; Estados UnidosFil: Silberman, Dafne Magalí. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Kurland, Irwin J.. No especifíca;Fil: Veeranna, Ravindra P.. No especifíca;Fil: Jayavelu, Tamilselvan. No especifíca;Fil: Bruzzone, Santina. Università degli Studi di Genova; ItaliaFil: Mostoslavsky, Raul. Harvard Medical School; Estados UnidosFil: Sundaresan, Nagalingam R.. No especifíca

Efficacy of lesion sterilization and tissue repair in primary tooth with internal resorption: A case series

Lesion sterilization and tissue repair (LSTR) treatment involves the use of a triple antibiotic mixture in a suitable vehicle, which is used to disinfect root canal systems. This report highlights three cases where LSTR therapy using triple antibiotic paste was attempted in primary molars exhibiting gross periradicular pathosis and internal resorption. Follow-up examinations revealed reduction of periradicular pathosis and reversal of internal resorption in all the three cases. This case series opens a perspective on the use of LSTR therapy as an alternative option to extraction in treating primary teeth with gross periradicular pathosis and internal resorption

Social support influencing diabetes self-management behaviors: A cross-sectional study in Udupi Taluk

Background: India is witnessing an increase in diabetic cases as peoples′ lifestyle change. This rapid increase of cases has led to an increase in the healthcare burden of the country with a considerable financial strain occurring due to the cost spent on diabetes treatment annually. Proper management of diabetes is based on good self-management behaviors (diet control, physical activity, glucose monitoring, and adherence to medication). Globally, studies have indicated the link between self-management behaviors and social support. Proper self-management behaviors could be the key to reducing the healthcare burden arising due to diabetes. Objective: The objective of this study was to estimate the prevalence of compliance to treatment among diabetes patients and to assess the influence of social support on the self-management behaviors of diabetes patients. Materials and Methods: A two-stage cluster sampling technique was employed to recruit 330 patients with Type 2 diabetes. A validated questionnaire was used to collect data on social support and self-management behaviors. Results: Prevalence of compliance to treatment among diabetic patients was found to be 82.1%. This study showed that diabetes patients received highest social support for glucose monitoring (69.4%) followed by diet control (46.7%) and physical activity (31.2%). Chi-square test showed a statistical association between social support and diet control (P < 0.001), social support and physical activity (P < 0.001), and social support and glucose monitoring (P = 0.001). Conclusion: Presence of good social support was found to positively influence the self-management behavior of diabetes patients. Higher level of evidence can be generated to place interventions in this regard

Factors influencing the reproductive health of women in rural areas of Ujjain, Madhya Pradesh

Background: A woman’s health is an integral part of any country. There are numerous factors that influence a woman’s decision of her reproductive health. A better understanding of these factors could help address gaps and barriers influencing the reproductive health choices of women in rural areas.Methods: A community based cross-sectional study was carried out among women of ages 18-45 years in rural areas of Ujjain, Madhya Pradesh to study factors influencing the reproductive health choices of women in rural areas of Ujjain. 300 women were asked comprehensively about their reproductive health via a semi structured questionnaire which comprised of domains from their menarche history to their menopausal history. Data was analyzed and chi square test was used to find factors influencing the reproductive health choices of women.Results: The median age of the participants was 30.8 years (IQR: 25, 36). Around 61% of the participants were aware of the family planning methods but only 29% of the participants used modern contraceptive methods. Age, educational background of participants, employment, partner education were all factors significantly (p&lt;0.05) associated with the reproductive health choices of women.Conclusions: The reproductive health of   women was shown to be significantly associated with her education, her employment status, her age, and her partner’s education. Therefore, it is important to raise awareness among women, their partners and, the family members about importance of the reproductive health of a woman