Prediction of unplanned 30-day readmission for ICU patients with heart failure.

BACKGROUND: Intensive Care Unit (ICU) readmissions in patients with heart failure (HF) result in a significant risk of death and financial burden for patients and healthcare systems. Prediction of at-risk patients for readmission allows for targeted interventions that reduce morbidity and mortality. METHODS AND RESULTS: We presented a process mining/deep learning approach for the prediction of unplanned 30-day readmission of ICU patients with HF. A patient's health records can be understood as a sequence of observations called event logs; used to discover a process model. Time information was extracted using the DREAM (Decay Replay Mining) algorithm. Demographic information and severity scores upon admission were then combined with the time information and fed to a neural network (NN) model to further enhance the prediction efficiency. Additionally, several machine learning (ML) algorithms were developed to be used as the baseline models for the comparison of the results. RESULTS: By using the Medical Information Mart for Intensive Care III (MIMIC-III) dataset of 3411 ICU patients with HF, our proposed model yielded an area under the receiver operating characteristics (AUROC) of 0.930, 95% confidence interval of [0.898-0.960], the precision of 0.886, sensitivity of 0.805, accuracy of 0.841, and F-score of 0.800 which were far better than the results of the best baseline model and the existing literature. CONCLUSIONS: The proposed approach was capable of modeling the time-related variables and incorporating the medical history of patients from prior hospital visits for prediction. Thus, our approach significantly improved the outcome prediction compared to that of other ML-based models and health calculators.

A process mining- deep learning approach to predict survival in a cohort of hospitalized COVID-19 patients.

BACKGROUND: Various machine learning and artificial intelligence methods have been used to predict outcomes of hospitalized COVID-19 patients. However, process mining has not yet been used for COVID-19 prediction. We developed a process mining/deep learning approach to predict mortality among COVID-19 patients and updated the prediction in 6-h intervals during the first 72 h after hospital admission. METHODS: The process mining/deep learning model produced temporal information related to the variables and incorporated demographic and clinical data to predict mortality. The mortality prediction was updated in 6-h intervals during the first 72 h after hospital admission. Moreover, the performance of the model was compared with published and self-developed traditional machine learning models that did not use time as a variable. The performance was compared using the Area Under the Receiver Operator Curve (AUROC), accuracy, sensitivity, and specificity. RESULTS: The proposed process mining/deep learning model outperformed the comparison models in almost all time intervals with a robust AUROC above 80% on a dataset that was imbalanced. CONCLUSIONS: Our proposed process mining/deep learning model performed significantly better than commonly used machine learning approaches that ignore time information. Thus, time information should be incorporated in models to predict outcomes more accurately.

Association of serum uric acid with high-sensitivity C-reactive protein in postmenopausal women.

OBJECTIVES: To explore the independent correlation between serum uric acid and low-grade inflammation (measured by high-sensitivity C-reactive protein, hs-CRP) in postmenopausal women. METHODS: A total of 378 healthy Iranian postmenopausal women were randomly selected in a population-based study. Circulating hs-CRP levels were measured by highly specific enzyme-linked immunosorbent assay method and an enzymatic calorimetric method was used to measure serum levels of uric acid. Pearson correlation coefficient, multiple linear regression and logistic regression models were used to analyze the association between uric acid and hs-CRP levels. RESULTS: A statistically significant correlation was seen between serum levels of uric acid and log-transformed circulating hs-CRP (r = 0.25, p < 0.001). After adjustment for age and cardiovascular risk factors (according to NCEP ATP III criteria), circulating hs-CRP levels were significantly associated with serum uric acid levels (ß = 0.20, p < 0.001). After adjustment for age and cardiovascular risk factors, hs-CRP levels ≥3 mg/l were significantly associated with higher uric acid levels (odds ratio =1.52, 95% confidence interval 1.18-1.96). CONCLUSION: Higher serum uric acid levels were positively and independently associated with circulating hs-CRP in healthy postmenopausal women.

Breast cancer genetic risk profile is differentially associated with interval and screen-detected breast cancers.

BACKGROUND: Polygenic risk profiles computed from multiple common susceptibility alleles for breast cancer have been shown to identify women at different levels of breast cancer risk. We evaluated whether this genetic risk stratification can also be applied to discriminate between screen-detected and interval cancers, which are usually associated with clinicopathological and survival differences. PATIENTS AND METHODS: A 77 single-nucleotide polymorphism polygenic risk score (PRS) was constructed for breast cancer overall and by estrogen receptor (ER) status. PRS was inspected as a continuous (per standard deviation increment) variable in a case-only design. Modification of the PRS by mammographic density was evaluated by fitting an additional interaction term. RESULTS: PRS weighted by breast cancer overall estimates was found to be differentially associated with 1865 screen-detected and 782 interval cancers in the LIBRO-1 study {age-adjusted odds ratio (OR)perSD [95% confidence interval (CI)] 0.91 [0.83-0.99], P = 0.023}. The association was found to be more significant for PRS weighted by ER-positive breast cancer estimates [ORperSD = 0.90 (0.82-0.98), P = 0.011]. This result was corroborated by two independent studies [combined ORperSD = 0.87 (0.76-1.00), P = 0.058] with no evidence of heterogeneity. When enriched for 'true' interval cancers among nondense breasts, the difference in the association with PRS in screen-detected and interval cancers became more pronounced [ORperSD = 0.74 (0.62-0.89), P = 0.001], with a significant interaction effect between PRS and mammographic density (Pinteraction = 0.017). CONCLUSION: To our knowledge, this is the first report looking into the genetic differences between screen-detected and interval cancers. It is an affirmation that the two types of breast cancer may have unique underlying biology.

Common genetic variability in ESR1 and EGF in relation to endometrial cancer risk and survival.

We investigated common genetic variation in the entire ESR1 and EGF genes in relation to endometrial cancer risk, myometrial invasion and endometrial cancer survival. We genotyped a dense set of single-nucleotide polymorphisms (SNPs) in both genes and selected haplotype tagging SNPs (tagSNPs). The tagSNPs were genotyped in 713 Swedish endometrial cancer cases and 1567 population controls and the results incorporated into logistic regression and Cox proportional hazards models. We found five adjacent tagSNPs covering a region of 15 kb at the 5' end of ESR1 that decreased the endometrial cancer risk. The ESR1 variants did not, however, seem to affect myometrial invasion or endometrial cancer survival. For the EGF gene, no association emerged between common genetic variants and endometrial cancer risk or myometrial invasion, but we found a five-tagSNP region that covered 51 kb at the 5' end of the gene where all five tagSNPs seemed to decrease the risk of dying from endometrial cancer. One of the five tagSNPs in this region was in strong linkage disequilibrium (LD) with the untranslated A61G (rs4444903) EGF variant, earlier shown to be associated with risk for other forms of cancer.

Inverse association between cigarette and water pipe smoking and hypertension in an elderly population in Iran: Bushehr elderly health programme.

The collected data in Bushehr Elderly Health (BEH) Program which had detailed the data on participants' smoking status and habits, was analysed to investigate the association between smoking of both water pipes and cigarettes and hypertension in an elderly population. Three thousand elderly men and women who participated in the baseline assessment of the BEH Program-a prospective population-based study being conducted in Bushehr, Iran-were selected randomly through a multistage, stratified cluster sampling method. Systolic and diastolic blood pressures were measured twice using a mercury sphygmomanometer, and researchers asked participants about medical history of hypertension as well as history of cigarette and water pipe smoking. Researchers used binary logistic regression models to assess the association of hypertension and smoking, and found an inverse, statistically significant association between current smoking and hypertension (odds ratio (OR)=0.50 (95% confidence interval (CI)=0.41, 0.60)). The association remained statistically significant after controlling for age, education and body mass index (OR=0.54 (95% CI=0.45, 0.66)). Findings were consistent for cigarette and water pipe smoking by sex (all ORs were inverse and statistically significant). Both cigarette and water pipe smoking were associated with reduced hypertension among older people, but the strength of association was different between men and women and also between cigarette and water pipe smoking. The reasons behind the association as well as the differences observed need to be investigated through more comprehensive, longitudinal studies.

Compositional changes of PBL population in patients with chronic hepatitis B virus infection.

In this report we have analysed the peripheral blood lymphocyte of several patients with chronic hepatitis B virus infection with flow cytometry. Based on the presence and absence of the HBeAb, patients were divided into two groups. In both, all the patients were HBsAg positive with normal range of serum alanine aminotranferase (23.9 +/- 17.8). We have found that the immunophenotypic profiles of patients were different from healthy donors with significant decrease in CD(3)(+) T cells, specially CD(8)(+) T cells and a significant increase in the CD(19)(+) B cells. The differences were seen in other subset of T cells (CD(4)(+)) or NK cells (CD(56)(+)/CD(16)(+)) and HLA-DR markers were not significant. When the phenotypic profiles of both groups were compared with each other, such changes were more dominant in group II, with HBeAb positive than in group I, with HBeAb negative. Also, we have seen a correlation between the increase of CD(19)(+) B cells and the decrease of CD CD(3)(+) T cells. No such correlation was observed with other cells.

Effectiveness of methoprene, an insect growth regulator, against malaria vectors in Fars, Iran: a field study.

Methoprene, an insect growth regulator, was evaluated under field conditions against the main malaria vectors in the Islamic Republic of Iran. The effect of 5, 10 and 20 kg ha(-1) concentration ofmethoprene granule formulation and 100 and 200 mL ha(-1) concentration of EC formulation was measured to determine any changes in Anophelini larval abundance and IE ratio in both rice fields and artificial ponds. In artificial ponds, granular methoprene at a dose of 20 kg ha(-1) inhibited adult emergence by 77.1% after 1 day and 65.9% after 3 days. The emulsifiable concentrate formulation of methoprene at 200 mL ha(-1) inhibited adult emergence by 83.7% after 1 day and 32.2% after 3 days. In rice fields, inhibition of emergence was 44.3% at 20 kg ha(-1) granule and 35.8% for emulsifiable concentrate at 200 mL ha(-1) after 3 days. The results vary depending on the mosquito species, treatment methods, breeding places and type of formulation.

Mixed infections of Vibrio cholerae O1 Ogawa EL Tor with Shigella dysenteriae.

Mixed infections caused by enteric pathogens such as bacteria, virus, protozoa and helminthes were reported in different literatures. This report also describes the co-infections caused by Vibrio cholerae O1 Ogawa EL Tor with Shigella dysenteriae in a patient. A 36-year-old man was admitted in Fatemeh Zahra Hospital of Bushehr Iran with fever, vomiting and dysentery. His stool sample was cultured, for identification purposes TCBS, XLD and other media were used. V. cholerae and S. dysenteriae were identified. Both species were resistant to ampicillin and sensitive to nalidixic acid and trimethoprim-sulfamethoxazol. Shigella was resistant to tetracycline. The results of the study showed that places where diarrheal diseases especially cholera are endemic, it is better to examine for those patients with dysentery for the presence of the V. cholerae O1. That will prevent the spread of pathogenic organism in the community.