Seasonal malaria chemoprevention in Africa and China's upgraded role as a contributor: a scoping review.

BACKGROUND: Children under five are the vulnerable population most at risk of being infected with Plasmodium parasites, especially in the Sahel region. Seasonal malaria chemoprevention (SMC) recommended by World Health Organization (WHO), has proven to be a highly effective intervention to prevent malaria. Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services, it is, therefore, necessary to seek a more coordinated and integrated approach to increasing the pace, coverage and resilience of SMC. Towards this end, fully leverage the resources of major players in the global fight against malaria, such as China could accelerate the SMC process in Africa. METHODS: We searched PubMed, MEDLINE, Web of Science, and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC. We used gap analysis to investigate the challenges and gaps of SMC since COVID-19. Through the above methods to explore China's prospective contribution to SMC. RESULTS: A total of 68 research articles and reports were found. Through gap analysis, we found that despite the delays in the SMC campaign, 11.8 million children received SMC in 2020. However, there remained some challenges: (1) a shortage of fully covered monthly courses; (2) lack of adherence to the second and third doses of amodiaquine; (3) four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer; (4) additional interventions are needed to consolidate SMC efforts. China was certified malaria-free by WHO in 2021, and its experience and expertise in malaria elimination can be shared with high-burden countries. With the potential to join the multilateral cooperation in SMC, including the supply of quality-assured health commodities, know-how transfer and experience sharing, China is expected to contribute to the ongoing scale-up of SMC. CONCLUSIONS: A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run. More actions are entailed to promote the partnership and China can be one of the main contributors with various roles.

FAIR Health Informatics: A Health Informatics Framework for Verifiable and Explainable Data Analysis.

The recent COVID-19 pandemic has hit humanity very hard in ways rarely observed before. In this digitally connected world, the health informatics and investigation domains (both public and private) lack a robust framework to enable rapid investigation and cures. Since the data in the healthcare domain are highly confidential, any framework in the healthcare domain must work on real data, be verifiable, and support reproducibility for evidence purposes. In this paper, we propose a health informatics framework that supports data acquisition from various sources in real-time, correlates these data from various sources among each other and to the domain-specific terminologies, and supports querying and analyses. Various sources include sensory data from wearable sensors, clinical investigation (for trials and devices) data from private/public agencies, personnel health records, academic publications in the healthcare domain, and semantic information such as clinical ontologies and the Medical Subject Heading ontology. The linking and correlation of various sources include mapping personnel wearable data to health records, clinical oncology terms to clinical trials, and so on. The framework is designed such that the data are Findable, Accessible, Interoperable, and Reusable with proper Identity and Access Mechanisms. This practically means to tracing and linking each step in the data management lifecycle through discovery, ease of access and exchange, and data reuse. We present a practical use case to correlate a variety of aspects of data relating to a certain medical subject heading from the Medical Subject Headings ontology and academic publications with clinical investigation data. The proposed architecture supports streaming data acquisition and servicing and processing changes throughout the lifecycle of the data management. This is necessary in certain events, such as when the status of a certain clinical or other health-related investigation needs to be updated. In such cases, it is required to track and view the outline of those events for the analysis and traceability of the clinical investigation and to define interventions if necessary.

Integrating palm oil biomass waste utilization in coal-fired power plants for meeting near-term emission targets.

Biomass co-firing with coal can be adopted in the electricity sector to promote greenhouse gas reduction, renewable energy production, and resource efficiency improvement toward environmental sustainability. This realization, however, requires effective management of supply chain issues, such as the collection of biomass feedstock, the transportation of biomass, and the localization of biomass processing plants to deliver the co-firing scales needed. This work addresses these issues by providing a techno-economic assessment conducted in a spatially-explicit manner to investigate the opportunity for scaling up the co-firing deployment at the national scale. The modeling approach is applied to the case of Malaysia's coal and palm oil biomass industries. The number of cases involving the impact of energy decarbonization targets, economic policy instrument, and supply chain cost parameter variations on the co-firing scales deployed are assessed. The findings show that densified biomass feedstock can substitute significant shares of coal capacities to deliver up to 29 MtCO2/year of carbon dioxide reduction. Nevertheless, this would cause a surge in the electricity system cost by up to 2 billion USD/year due to the substitution of up to 40% of the coal plant capacities. In facilitating the maximal deployment of co-firing at the national scale, more than 100 solid biofuel production plants would need to be built to support a maximum of 41 TWh/year of co-firing capacity. Actions to minimize the specific cost elements of the biomass co-firing supply chain are thus needed in the near term to increase the effectiveness of economic policy instrument to promote co-firing and reduce environmental emissions.

Sonodynamic antimicrobial chemotherapy: An emerging alternative strategy for microbial inactivation.

Sonodynamic antimicrobial chemotherapy (SACT), which relies on a combination of low-intensity ultrasound and chemotherapeutic agents termed sonosensitizers, has been explored as a promising alternative for microbial inactivation. Such treatment has superior penetration ability, high target specificity, and can overcome resistance conferred by the local microenvironment. Taken of these advantages, SACT has been endowed with an extensive application prospect in the past decade and attracted more and more attention. This review focusses on the current understanding of the mechanism of SACT, the interaction of sonodynamic action on different microbes, the factors affecting the efficacy of SACT, discusses the findings of recent works on SACT, and explores further prospects for SACT. Thus, a better understanding of sonodynamic killing facilitates the scientific community and industry personnel to establish a novel strategy to combat microbial burden.

GASC1 promotes hepatocellular carcinoma progression by inhibiting the degradation of ROCK2.

Hepatocellular carcinoma (HCC) is a devastating malignancy without targeted therapeutic options. Our results indicated that the histone demethylase GASC1 signature is associated with later tumor stage and poorer survival in HCC patients. GASC1 depletion led to diminished HCC proliferation and tumor growth. A distinct heterogeneity in GASC1 levels was observed among HCC cell populations, predicting their inherent high or low tumor-initiating capacity. Mechanistically, GASC1 is involved in the regulation of several components of the Rho-GTPase signaling pathway including its downstream target ROCK2. GASC1 demethylase activity ensured the transcriptional repression of FBXO42, a ROCK2 protein-ubiquitin ligase, thereby inhibiting ROCK2 degradation via K63-linked poly-ubiquitination. Treatment with the GASC1 inhibitor SD70 impaired the growth of both HCC cell lines and xenografts in mice, sensitizing them to standard-of-care chemotherapy. This work identifies GASC1 as a malignant-cell-selective target in HCC, and GASC1-specific therapeutics represent promising candidates for new treatment options to control this malignancy.

KEAP1 Mutations Drive Tumorigenesis by Suppressing SOX9 Ubiquitination and Degradation.

The transcription factor SOX9 is frequently amplified in diverse advanced-stage human tumors. Its stability has been shown to be tightly controlled by ubiquitination-dependent proteasome degradation. However, the exact underlying molecular mechanisms remain unclear. This work reports that SOX9 protein abundance is regulated by the Cullin 3-based ubiquitin ligase KEAP1 via proteasome-mediated degradation. Loss-of-function mutations in KEAP1 compromise polyubiquitination-mediated SOX9 degradation, leading to increased protein levels, which facilitate tumorigenesis. Moreover, the loss of critical ubiquitination residues in SOX9, by either a SOX9 (ΔK2) truncation or K249R mutation, leads to elevated protein stability. Furthermore, it is shown that the KEAP1/SOX9 interaction is modulated by CKIγ-mediated phosphorylation. Importantly, it is demonstrated that DNA damage drugs, topoisomerase inhibitors, can trigger CKI activation to restore the KEAP1/SOX9 interaction and its consequent degradation. Collectively, herein the findings uncover a novel molecular mechanism through which SOX9 protein stability is negatively regulated by KEAP1 to control tumorigenesis. Thus, these results suggest that mitigating SOX9 resistance to KEAP1-mediated degradation can represent a novel therapeutic strategy for cancers with KEAP1 mutations.

A tumor-associated splice-isoform of MAP2K7 drives dedifferentiation in MBNL1-low cancers via JNK activation.

Master splicing regulator MBNL1 shapes large transcriptomic changes that drive cellular differentiation during development. Here we demonstrate that MBNL1 is a suppressor of tumor dedifferentiation. We surveyed MBNL1 expression in matched tumor/normal pairs across The Cancer Genome Atlas and found that MBNL1 was down-regulated in several common cancers. Down-regulation of MBNL1 predicted poor overall survival in breast, lung, and stomach adenocarcinomas and increased relapse and distant metastasis in triple-negative breast cancer. Down-regulation of MBNL1 led to increased tumorigenic and stem/progenitor-like properties in vitro and in vivo. A discrete set of alternative splicing events (ASEs) are shared between MBNL1-low cancers and embryonic stem cells including a MAP2K7∆exon2 splice variant that leads to increased stem/progenitor-like properties via JNK activation. Accordingly, JNK inhibition is capable of reversing MAP2K7∆exon2-driven tumor dedifferentiation in MBNL1-low cancer cells. Our work elucidates an alternative-splicing mechanism that drives tumor dedifferentiation and identifies biomarkers that predict enhanced susceptibility to JNK inhibition.

Secondary Plasma Cell Leukaemia.

Plasma cell leukaemia is a clinical condition in which plasma cells circulating in the peripheral blood constitute >20% of white blood cells (WBC) and there is evidence of plasma cell monoclonality. It is important to be diagnosed early for better treatment outcome. Although it is a rare disease, cases have been reported from Pakistan and other countries (including our neighbouring countries), hence making this case report. After taking history of present and past ailments, physical examination was carried out. Blood and bone marrow sampling were done after taking informed written consent from the patient. Blood samples were obtained in plain bottle, anticoagulated bottle and bone marrow was obtained from posterior iliac spine under 2% lignocaine. Plasma cell leukaemia is a rare and aggressive disease, difficult to diagnose and treat, requires early recognition and therapeutic intervention.

Gastrointestinal tract metastasis presenting as intussusception in invasive lobular carcinoma of the breast: A case report.

INTRODUCTION: Breast cancer metastasis to the gastrointestinal (GI) tract is rare and occurs more frequently in invasive lobular carcinoma. Patients may be asymptomatic or present with variable vague symptoms that may be mistakenly attributed to side effects of chemotherapy or other benign GI diseases. Treatment follows the principles of systemic disease and includes hormonal therapy, chemotherapy and signal transduction inhibitors, with surgical intervention indicated for complications such as obstruction, perforation and hemorrhage. PRESENTATION OF CASE: We present the case of a female patient with a history of invasive lobular breast carcinoma who had undergone mastectomy and axillary dissection, followed by chemoradiotherapy. Over the next nine years, she developed ovarian and bone metastases for which appropriate treatment was provided. A right iliac fossa mass was discovered during routine clinic review, though she remained asymptomatic. Computed tomography scan showed ileocecal intussusception. Histopathological examination of the right hemicolectomy specimen following emergency surgery confirmed metastatic invasive lobular carcinoma to the GI tract. DISCUSSION: GI tract metastasis may present 30 years after the primary breast cancer. Up to 20% of patients may be asymptomatic as shown by Montagna et al. When present, symptoms are commonly non-specific and vague. Histological diagnosis is challenging. GI metastasis typically appears as intramural infiltration of the bowel wall by small cells arranged in cords. CONCLUSION: It is important to maintain a suspicion for GI tract metastasis in breast cancer patients who present with abdominal mass or GI symptoms, as this aids in prompt institution of accurate and appropriate management.

Broad regulation of gene isoform expression by Wnt signaling in cancer.

Differential gene isoform expression is a ubiquitous mechanism to enhance proteome diversity and maintain cell homeostasis. Mechanisms such as splicing that drive gene isoform variability are highly dynamic and responsive to changes in cell signaling pathways. Wnt/ß-catenin signaling has profound effects on cell activity and cell fate and is known to modify several splicing events by altering the expression of individual splicing factors. However, a global assessment of how extensively Wnt signaling regulates splicing and other mechanisms that determine mRNA isoform composition in cancer is lacking. We used deep time-resolved RNA-seq in two independent in vivo Wnt-addicted tumor models during treatment with the potent Wnt inhibitor ETC-159 and examined Wnt regulated splicing events and splicing regulators. We found 1025 genes that underwent Wnt regulated variable exon usage leading to isoform expression changes. This was accompanied by extensive Wnt regulated changes in the expression of splicing regulators. Many of these Wnt regulated events were conserved in multiple human cancers, and many were linked to previously defined cancer-associated splicing quantitative trait loci. This suggests that the Wnt regulated splicing events are components of fundamental oncogenic processes. These findings demonstrate the wide-ranging effects of Wnt signaling on the isoform composition of the cell and provides an extensive resource of expression changes of splicing regulators and gene isoforms regulated by Wnt signaling.

Vitamin D Profile Of Outdoor Patients Presenting With Aches And Pains.

BACKGROUND: Vitamin D, a fat-soluble vitamin, plays regulatory role in more than 300-800 genes. Daily requirement of vitamin D depends upon the age and exposure to sun. Approximately one billion people in different parts of the world including Pakistan are either Vitamin D deficient or have insufficient levels of vitamin D. The present study, a descriptive cross-sectional study, aimed at knowing the status of vitamin D3 in outdoor patients from Hazara division, having aches and pains. It was conducted over a period of four years on 453 outdoor patients of either sex and all the age groups presenting to Ayub Teaching Hospital. Sample was selected by non-random convenience sampling technique. METHODS: Common causes of aches and pains other than Vitamin D deficiency were excluded by history, examination and basic laboratory tests. Vitamin D3 estimation was done by immunoassay. RESULTS: Mean age of the participants was 40±19.62 years; the mean level of vitamin D was 21.88±14.12 ng/ml. As much as 398 (87%) participants aged 20-60 years were either vitamin D3 deficient 330 (69.9%), or had vitamin D insufficiency 68 (17.7%). Gender wise, 295 (65%) were females and 158 (35%) males, with female to male ratio of 1.29:1. Normal vitamin D3 level was detected in 55 (12.5%) participants with male predominance. CONCLUSIONS: Vitamin D deficiency is alarmingly high in patients presenting with aches and pains, in all age groups, effecting females more than males.

Morphology Of Bone Marrow In Visceral Leishmaniasis.

BACKGROUND: Visceral Leishmaniasis (Kala Azar), a vector borne parasitic disease is endemic in many parts of the world including South East Asia. It is a chronic febrile ailment caused by Leishmania Donovani (LD). More than three hundred million people living in the endemic areas are at high risk and fourteen million are living with the disease. METHODS: This prospective study was conducted on seventy-five patients over a period of twelve years at the department of Pathology Ayub Medical College Abbottabad, focusing on the morphology of bone marrow aspirate obtained from patients. The aspirate was smeared on glass slides, fixed with alcohol and stained with Giemsa stain. The microscopic examination of stained slides was carried out by the single microscopist to avoid the difference of opinion. The initial diagnosis was further confirmed by tow experienced microscopists. RESULTS: A minor difference was observed in the number of male and female participants, 38 versus 37, with male to female ratio of 1.02:1. The majority of the patients were 1- 15 years old. As much as 45.2% patients were 1-5 years old. In this age group, males were affected more than the females with male to female ratio of 1.4:1. Most of the patients belonged to district Battagram and Tor Ghar. Bone marrow aspiration was easy and the marrow aspirate was found having marrow fragments on naked eye examination in majority of the patients. Extrahistiocytic LD bodies alone were seen in 100%, extra and intrahistiocytic in 80% and intrahistiocytic alone in 33.3% patients. The parasite index was 1-5 to 1-10 in 53.4% and 26.6% patients respectively. CONCLUSIONS: Visceral Leishmaniasis is endemic in the study area. Bone marrow examination, although an invasive procedure, gives direct microscopic diagnosis of visceral Leishmaniasis and may be considered where indicated.

Visceral Leishmaniasis In Adults.

Visceral Leishmaniasis (also known as Kala Azar) is a parasitic infection caused by Leishmania Donovani in the East and Leishmania Infantum in the west. It is prevalent in many countries including India, Bangladesh, Nepal, Africa and part of America. The disease follows chronic course and is usually lethal if left untreated. It has also been reported from different parts of Pakistan, including Northern areas, Districts Mansehra & Abbottabad and Hilly areas of Khyber Pukhtoonkhawah. Most the cases have been reported in paediatric population. Except one case, reported previously from Abbottabad. The present two cases were also seen in adults.

MRI assessment of pathological stage and surgical margins in anterior prostate cancer (APC) using subjective and quantitative analysis.

PURPOSE: To evaluate magnetic resonance imaging (MRI) for assessment of extraprostatic extension (EPE) and positive surgical margins (PSM) in anterior prostate cancer (APC). MATERIALS AND METHODS: With Institutional Review Board approval, 25 APC (>2/3 of tumor anterior to urethra) were assessed using 3T MRI by two blinded radiologists for: size and maximal leading edge of tumor (relative to anterior fibromuscular stroma [AFMS]) on b ≥1000 sec/mm2 echo-planar-MRI fused onto T2 -weighted-MRI, invasion of AFMS and EPE. Comparisons were performed between APCs by EPE/PSM using chi-square, multivariable analysis, and receiver operator characteristic (ROC) analysis. RESULTS: The prevalence of EPE and PSM were 52% (13/25) and 36% (9/25). Tumor sizes were larger with EPE (22.5 ± 8.4 vs. 14.7 ± 6.3, P = 0.02) and PSM (23.0 ± 9.3 vs. 16.4 ± 7.0, P = 0.06). Area under ROC curve (AUC-ROC) for the diagnosis of EPE by tumor size was 0.77 (95% confidence interval [CI] 0.58-0.95); ≥16 mm size = sensitivity/specificity 69.2/66.7%. Maximal leading edge of tumor was greater with EPE (2.4 ± 2.2 vs. -0.2 ± 3.0) and PSM (2.8 ± 2.3 vs. -0.3 ± 2.5), (P = 0.023, 0.031). AUC-ROC for diagnosis of EPE/PSM by leading edge was 0.78 (CI 0.57-0.97) and 0.75 (CI 0.56-0.94). A ≥1 mm leading edge yielded sensitivity/specificity of 76.9/75.0% and 77.8/62.5% for diagnosis of EPE/PSM. 60-72% (15-18/25) tumors invaded AFMS (k = 0.74), which was not associated with EPE/PSM (P = 0.12-0.14). Radiologists' assessment of EPE had sensitivity/specificity of 61.5-69.2/50.0-75.0% (k = 0.53). CONCLUSION: Tumor size and leading edge of tumor relative to AFMS may enable diagnosis of EPE and positive surgical margins in APC. LEVEL OF EVIDENCE: 2 J. MAGN. RESON. IMAGING 2017;45:1296-1303.

Acute toxicity of herbicide (glyphosate) in Clarias gariepinus juveniles.

The constant discharge of agricultural waste into aquatic environment has led to accumulation of heavy chemicals and other variety of pollutants. Herbicides present in these wastes are washed down, carried by rains and flood to nearby aquatic environment. Glyphosate is one of the most popular herbicides used by farmers in Kano because of its active reaction on killing weeds without affecting the crops. A toxicity test of glyphosate was conducted using concentrations of 0, 0.004, 0.005, 0.006, 0.007 ml/l. The mortality rate of each concentration was determined and the physicochemical parameters (Dissolved oxygen and pH) were also determined. The result showed that high mortality occurs at 0.007 ml/l and less mortality was found at 0.004 ml/l. Hence, mortality is dose dependent. DO and pH decreases with increase in glyphosate concentration. Furthermore, the juveniles showed abnormal behaviour. The LC50 value at 96 h was 0.0072 ml/l. There was significant difference between the initial and final pH value (p < 0.05). On the other hand, the initial and final DO values showed no significant difference (p > 0.05). However, correlation between DO and pH showed no significant difference (p > 0.05). The findings of this study established that glyphosate has some level of toxicity on Clarias gariepinus juveniles. In addition, it was found that mortality, changes in behaviour, DO and pH are dose dependent. Therefore, it was suggested that an appropriate concentration that will not be detrimental to non-target organisms should be used by farmers. Alternatively, Biological method should be used as a substitute for chemical method of controlling weeds.

Intratumoral pseudoaneurysms in hepatocellular carcinoma: do they occur de novo without any prior intervention? A tertiary care center experience of 6 years.

BACKGROUND: Intratumoural pseudoaneurysms (ITPA) within hepatocellular carcinomas (HCC) usually arise as postprocedural complications of endovascular therapies or surgical procedures. Their de novo presence in HCC without any prior interventions has not been adequately described in medical literature. PURPOSE: To evaluate and quantify the presence of intratumoural pseudoaneurysms (ITPA) within hepatocellular carcinomas (HCC) prior to any intervention. MATERIAL AND METHODS: Retrospective cross-sectional review of 519 patients with HCC at a tertiary care university hospital with the purpose to evaluate and quantify the presence of ITPA present prior to any therapy. Patients' baseline data along with viral marker status, alpha fetoprotein (AFP) levels, imaging findings, and any prior treatment provided were recorded. Multi-detector computed tomography (MDCT) scans of selected patients were reviewed for presence of any ITPA and their incidence was calculated. RESULTS: ITPAs without any prior therapy were found in 5% (25/519) of patients with HCC. Seventeen of 25 (68%) patients had liver cirrhosis while eight of 25 (32%) patients were non-cirrhotic on imaging. Multiple ITPAs were seen in 44% (11/25) of patients. Eight percent (2/25) of patients had pseudoaneurysm-associated hemorrhage, 20% (5/25) had lung metastasis, 12% (3/25) had portal vein thrombosis, 8% (2/25) had hepatic vein thrombosis, and 16% (4/25) had peritumoral hematoma. The incidence of de novo ITPAs occurring in patients with HCC without any prior therapy or intervention was 0.24%. CONCLUSION: These cases provide a unique insight into an additional feature of HCC and usefulness of recognizing the ITPAs on imaging studies. Although de novo ITPAs in HCC are uncommon, occurring with an incidence rate of 0.24%, their presence in hypervascular hepatic lesion may point towards the diagnosis of HCC. Additionally, they should be accounted for in management planning as they can lead to complications of rupture and hemorrhage.

Accuracy of 64-slice multidetector computed tomography scan in detection of the point of transition of small bowel obstruction.

PURPOSE: To determine the accuracy of 64-slice multidetector computed tomography scans in detecting the point of transition of small bowel obstruction by using surgical findings as the gold standard. MATERIALS AND METHODS: Cross-sectional study of 59 patients with SBO who underwent 64-slice MDCT scans of the abdomen followed by surgery from 1 June 2008 to 31 January 2010 at a tertiary care center. Point of transition between distended and collapsed small bowel loops were precisely determined on 64-slice MDCT and subsequently correlated with surgical findings. Data analysis was done on SPSS version 16. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of MDCT in detection of the point of transition were calculated. RESULTS: Out of 59 patients, 64-slice MDCT was able to detect the point of transition of SBO in 90% (53/59) of patients, while in 10% (6/59) of these patients the point of transition was not found on MDCT. Overall for detection of the point of transition of small bowel obstruction 64-slice MDCT has 93% sensitivity, 67% specificity, 98% positive predictive value, 33% negative predictive value and 92% accuracy, respectively. CONCLUSION: Sixty-four-slice MDCT is highly accurate in diagnosing the point of transition of small bowel obstruction with an accuracy of 92%. It can be used as a localizing tool before surgery for small bowel obstruction.

Diagnosis of hepatoma using grayscale and Doppler ultrasound in patients with chronic liver disease.

OBJECTIVE: To determine the diagnostic accuracy of liver ultrasound for the detection of hepatoma in chronic liver disease (CLD) patients by either taking histopathology or serum α-fetoprotein levels or a biphasic computed tomography (CT) scan (whichever is available) as the gold standard. STUDY DESIGN: Cross-sectional. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to January 2010. METHODS: A total of 239 patients (156 males and 83 females) with clinical suspicion or surveillance of hepatoma in CLD referred to the radiology department for ultrasound evaluation followed by either liver biopsy and histopathology or serum α-fetoprotein level or biphasic CT scan. RESULTS: The sensitivity of ultrasound for hepatoma detection in CLD was 65%, specificity was 85%, and accuracy was 70%, and positive predictive value and negative predictive value were 92% and 45%, respectively. CONCLUSION: Ultrasound is a relatively quick, safe, reasonably accurate, and noninvasive imaging modality for the detection of hepatoma in CLD and can be complemented with clinical assessment of screening high-risk patients.

Can computer assisted diagnosis (CAD) be used as a screening tool in the detection of pulmonary nodules when using 64-slice multidetector computed tomography?

OBJECTIVES: To evaluate (1) whether or not the addition of computer-assisted diagnosis (CAD) to 64-slice multidetector computed tomography (CT) can be used as a screening tool for detection of pulmonary nodules in routine CT chest examinations and (2) whether or not to advocate the incorporation of CAD as a screening tool into our daily practice. MATERIALS AND METHODS: A retrospective cross-sectional analysis of 109 consecutive patients who had all undergone routine contrast-enhanced CT chest examinations for indications other than lung cancer at the Radiology Department of Aga Khan University Hospital, Karachi, between November 2010 and January 2011. All examinations were evaluated in terms of the detection of pulmonary nodules by a consultant radiologist and CAD (ImageChecker CT Algorithm R2 Technology) software. The ability of CAD software to detect pulmonary nodules was evaluated against the reference standard. In addition, a chest radiologist also calculated the number of pulmonary nodules. The sensitivity and specificity of the CAD software were calculated against the reference standard by using a 2 × 2 table. The Mann-Whitney U test was applied to compare the performances of CAD and the radiologist. RESULTS: CAD detected 610 pulmonary nodules while the radiologist detected only 113. The reference standard declared 198 pulmonary nodules to be true nodules. CAD detected 95% of all true nodules (189/198), whereas the radiologist detected only 57% (113/198). In the detection of true pulmonary nodules, CAD had 98% sensitivity compared with the radiologist who had 57% sensitivity; the statistical difference between their performances had a P value <0.001. CONCLUSION: Considering the high sensitivity of CAD to detect nearly all true pulmonary nodules, we advocate its application as a screening tool in all CT chest examinations for the early detection of pulmonary nodules and lung carcinoma.