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1.
Urologiia ; (4): 158-163, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34486290

RESUMO

Modern methods for the early diagnosis of acute kidney injury using high-precision biomarkers in various pathological conditions, including patients with combined trauma, is reviewed in the article. The pathological processes of cell damage underlying the etiology and pathogenesis of acute kidney injury require a quick and early start of preventive measures. As a consequence, the problem of early diagnosis of acute kidney damage and search of ways to optimize it are still relevant. In case of a possible acute kidney injury, in addition to situations when the renal tissue is already damaged, it is very important to determine level of acute kidney injury biomarkers in biological fluids. The results of our clinical study carried out in the clinic of the Department of Faculty and Endoscopic surgery of the KBSU named after H.M. Berbekov, dedicated to the early diagnosis of acute kidney injury in patients with combined trauma using the serum biomarker cystatin , are also presented.


Assuntos
Injúria Renal Aguda , Cistatina C , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Biomarcadores , Creatinina , Diagnóstico Precoce , Humanos
2.
Acta Biomed ; 92(4): e2021224, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34487088

RESUMO

Background and aim - Evidence on discrete dimensions underlining negative symptoms in First Episode Affective Psychosis (FEAP) may be useful for their treatment strategy, but is still relatively scarce. Aim of this study was to examine the negative symptom configuration in patients with FEAP using both exploratory and confirmatory factor analysis methods on the Positive And Negative Syndrome Scale (PANSS). Methods - Seventy-eight participants, aged 13-35 years, completed the PANSS within the "Parma Early Psychosis" (Pr-EP) program, a specialized protocol of early detection and intervention in psychosis implemented since January 2013 in all public adolescent and adult mental health services of the Parma Department of Mental Health (Northern Italy). Results - A 3-factor model (i.e. "Alogia", "Social Withdrawal" and "Motor/Affective Expression Poverty" domains) was identified. As an alternative, a 2-factor solution previously proposed in patients with first episode schizophrenia (always within the Pr-EP program) also showed good fit indices in our FEAP sample. Conclusions - Our results suggest the crucial importance of identifying discrete negative symptom domains already at the onset of affective psychosis in order to implement specific early intervention strategies aiming to improve prognosis and long-term outcomes also in this young FEAP help-seeking population.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Adolescente , Diagnóstico Precoce , Seguimentos , Humanos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Esquizofrenia/diagnóstico , Esquizofrenia/terapia
3.
Rev Med Liege ; 76(9): 672-676, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34477338

RESUMO

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that manifests in altered or reduced social behaviours, social communication disorders, and repetitive behaviours and/or restricted interests. The etiology of ASD is complex and multifactorial. The etiopathogenesis of the disorder is multiple, including brain abnormalities, visual contact and early interaction disorders. These signs are often the focus of parental concerns. In addition, since ASD is neurodevelopmental, all signs are not always present simultaneously. Indeed, they appear progressively, until the age of 3 years, at which the diagnosis can usually be made. Nevertheless, in more complex cases, this diagnosis may be considered later. The first signs of ASD (before 24 months) will be addressed because they are crucial for an early diagnosis. Their knowledge allows the establishment of a follow-up as well as its quick specific care. Indeed, by acting during a developmental period when brain plasticity is high, early intervention allows to modify the evolution of symptoms, and later on to limit secondary handicaps.


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/diagnóstico , Pré-Escolar , Diagnóstico Precoce , Humanos
4.
Croat Med J ; 62(4): 387-398, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34472742

RESUMO

Idiopathic normal pressure hydrocephalus (iNPH) is a condition resulting from impaired cerebrospinal fluid (CSF) absorption and excretion characterized by a triad of symptoms comprising dementia, gait disturbance (impaired trunk balance), and urinary incontinence. CSF biomarkers not only assist in diagnosis but are also important for analyzing the pathology and understanding appropriate treatment indications. As the neuropathological findings characteristic of iNPH have yet to be defined, there remains no method to diagnose iNPH with 100% sensitivity and specificity. Neurotoxic proteins are assumed to be involved in the neurological symptoms of iNPH, particularly the appearance of cognitive impairment. The symptoms of iNPH can be reversed by improving CSF turnover through shunting. However, early diagnosis is essential as once neurodegeneration has progressed, pathological changes become irreversible and symptom improvement is minimal, even after shunting. Combining a variety of diagnostic methods may lead to a more definitive diagnosis and accurate prediction of the prognosis following shunt treatment. Identifying comorbidities in iNPH using CSF biomarkers does not contraindicate shunting-based intervention, but does limit the improvement in symptoms it yields, and provides vital information for predicting post-treatment prognosis.


Assuntos
Hidrocefalia de Pressão Normal , Biomarcadores , Derivações do Líquido Cefalorraquidiano , Diagnóstico Precoce , Humanos , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/epidemiologia , Hidrocefalia de Pressão Normal/cirurgia , Prognóstico
5.
Analyst ; 146(18): 5474-5495, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34515706

RESUMO

Acute myocardial infarction (AMI) is the main cause of death from cardiovascular diseases. Thus, early diagnosis of AMI is essential for the treatment of irreversible damage from myocardial infarction. Traditional electrocardiograms (ECG) cannot meet the specific detection of AMI. Cardiac troponin I (cTnI) is the main biomarker for the diagnosis of myocardial infarction, and the detection of cTnI content has become particularly important. In this review, we introduced and compared the advantages and disadvantages of various cTnI detection methods. We focused on the analysis and comparison of the main indicators and limitations of various cTnI biosensors, including the detection range, detection limit, specificity, repeatability, and stability. In particular, we pay more attention to the application and development of electrochemical biosensors in the diagnosis of cardiovascular diseases based on different biological components. The application of electrochemical microfluidic chips for cTnI was also briefly introduced in this review. Finally, this review also briefly discusses the unresolved challenges of electrochemical detection and the expectations for improvement in the detection of cTnI biosensing in the future.


Assuntos
Técnicas Biossensoriais , Infarto do Miocárdio , Biomarcadores , Diagnóstico Precoce , Humanos , Infarto do Miocárdio/diagnóstico , Troponina I
6.
Curr Opin Cardiol ; 36(5): 623-629, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397468

RESUMO

PURPOSE OF REVIEW: Mechanical complications of myocardial infarction are a group of postischemic events and include papillary muscle rupture resulting in ischemic mitral regurgitation, ventricular septal defect, left ventricle free wall rupture, pseudoaneurysm, and true aneurysm. Advances made in management strategies, such as the institution of 'Code STEMI' and percutaneous interventions, have lowered the incidence of these complications. However, their presentation is still associated with increased morbidity and mortality. Early diagnosis and appropriate management is crucial for facilitating better clinical outcomes. RECENT FINDINGS: Although the exact timing of a curative intervention is not known, emerging percutaneous and transcatheter approaches and improving mechanical circulatory support (MCS) devices have greatly enhanced our ability to manage and treat some of the complications postinfarct. SUMMARY: Although the incidence of mechanical complications of myocardial infarction has decreased over the past few decades, these complications are still associated with high rates of morbidity and mortality. The combination of early and accurate diagnosis and subsequent appropriate management are imperative for optimizing clinical outcomes. Although more randomized clinical trials are needed, mechanical circulatory support devices and emerging therapeutic strategies can be offered to carefully selected patients.


Assuntos
Ruptura Cardíaca Pós-Infarto , Insuficiência da Valva Mitral , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Diagnóstico Precoce , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/terapia , Humanos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
7.
Dtsch Med Wochenschr ; 146(15): 950-954, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34344028

RESUMO

Acromegaly is a rare but severe disorder which is usually due to an excessive secretion of growth hormone (GH) by a pituitary adenoma. Screening mainly relies on the measurement of insulin-like growth factor 1, and confirmatory diagnostics includes a GH suppression test. As delayed diagnosis results in increased morbidity and mortality, we here discuss recently published suggestions regarding the biochemical work-up of suspected cases and the follow-up of co-morbidities. Moreover, new analytical tools (such as automatic identification of typical facial changes using artificial intelligence) are presented, hopefully allowing for an earlier diagnosis in the future. So far, surgery is still regarded as therapy of first choice. In cases without postoperative remission, a new imaging approach (combining sellar magnetic resonance imaging and position emission tomography) may improve the results of repeated surgery. The pharmaceutical arsenal now includes the first orally available somatostatin analogue, and recent data on possible drug combinations and the outcome of radiotherapy are presented. Finally, special attention is paid to older and pregnant patients, as well as certain considerations during the COVID-19 pandemic (where appropriate diagnosis and management of acromegaly is particularly challenging).


Assuntos
Acromegalia/diagnóstico , Acromegalia/cirurgia , Acromegalia/diagnóstico por imagem , Acromegalia/terapia , Adenoma/cirurgia , Comorbidade , Diagnóstico Precoce , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Prognóstico
8.
Anal Chem ; 93(33): 11461-11469, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34369744

RESUMO

Diabetes is a metabolic disease caused by high blood sugar. Patients are often suffering from high blood pressure and arteriosclerosis, which may even evolve into liver disease, kidney disease, and other diabetic complications. Dipeptide peptidase IV (DPP-IV) plays an important role in regulating blood sugar levels and is one of the targets for the diagnosis and treatment of diabetes. Here, a long-wavelength ratiometric fluorescent probe DCDHFNH2-dpp4 for detecting DPP-IV was designed and synthesized. DCDHFNH2-dpp4 was used to detect DPP-IV in healthy, tumor-bearing, and diabetic mice, and only diabetic mice showed strong fluorescence signals. In organ imaging, it is found that DPP-IV is relatively enriched in the liver of diabetic mice. In addition, probe DCDHFNH2-dpp4 also exhibited a significant ratiometric fluorescence signal in the serum of diabetic mice. Therefore, the fluorescent probe DCDHFNH2-dpp4 has shown outstanding potential in the early diagnosis of diabetes, and DCDHFNH2-dpp4 is hopeful to be applied to actual clinical medicine.


Assuntos
Diabetes Mellitus Experimental , Corantes Fluorescentes , Animais , Diagnóstico Precoce , Humanos , Fígado , Camundongos
9.
AMIA Annu Symp Proc ; 2021: 152-160, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34457129

RESUMO

Models predicting health complications are increasingly attempting to reflect the temporally changing nature of patient status. However, both the practice of medicine and electronic health records (EHR) have yet to provide a true longitudinal representation of a patient's medical history as relevant data is often asynchronous and highly missing. To match the stringent requirements of many static time models, time-series data has to be truncated, and missing values in samples have to be filled heuristically. However, these data preprocessing procedures may unconsciously misinterpret real-world data, and eventually lead into failure in practice. In this work, we proposed an augmented gated recurrent unit (GRU), which formulate both missingness and timeline signals into GRU cells. Real patient data of post-operative bleeding (POB) after Colon and Rectal Surgery (CRS) was collected from Mayo Clinic EHR system to evaluate the effectiveness of proposed model. Conventional models were also trained with imputed dataset, in which event missingness or asynchronicity were approximated. The performance of proposed model surpassed current state-of-the-art methods in this POB detection task, indicating our model could be more eligible to handle EHR datasets.


Assuntos
Registros Eletrônicos de Saúde , Diagnóstico Precoce , Humanos
10.
Isr Med Assoc J ; 23(8): 516-520, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392630

RESUMO

BACKGROUND: Acute extremity compartment syndrome is a surgical emergency for which timely diagnosis is essential. OBJECTIVES: To assess whether the time from the initial insult to the fasciotomy of compartment syndrome of the upper extremity affects outcomes and to examine the differences between compartment syndrome secondary to fractures and that resulting from a non-fracture etiology with regard to the time from insult to fasciotomy and the long-term patient outcomes. METHODS: Patients presented with documented fasciotomy treatment following acute upper extremity compartment syndrome and a minimum of 6 months follow-up. Patient information included demographics, cause of compartment syndrome, method of diagnosis, and outcome on follow-up. RESULTS: Our study was comprised of 25 patients. Fasciotomies were performed for compartment syndrome caused by fracture in 11 patients (44%), and due to insults other than fractures in 14 patients (56%). The average time to fasciotomy in patients without a fracture was 10.21 hours and 16.55 hours with a fracture. Fasciotomy performed more than 24 hours from the initial insult was not found to significantly affect long-term sequelae compared to fasciotomy performed earlier than 24 hours from the initial insult. The non-fracture group had more long-term sequelae than the fracture group (13/15 patients and 5/11 patients, respectively). CONCLUSIONS: Most injuries treated for fasciotomy of compartment syndrome were non-fracture related, with more complications found in patients with non-fracture related injuries. Time interval from insult to fasciotomy did not affect outcome and was longer in the fracture group, suggesting longer monitoring in this group and supporting fasciotomy even with late presentation.


Assuntos
Síndromes Compartimentais , Fasciotomia/métodos , Fraturas Ósseas/complicações , Efeitos Adversos de Longa Duração , Extremidade Superior , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Diagnóstico Precoce , Traumatismos por Eletricidade/complicações , Feminino , Fraturas Ósseas/diagnóstico , Hematoma/complicações , Humanos , Israel/epidemiologia , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/etiologia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Mordeduras de Serpentes/complicações , Tempo para o Tratamento/estatística & dados numéricos , Extremidade Superior/lesões , Extremidade Superior/cirurgia
11.
J Int Med Res ; 49(8): 3000605211035895, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34433328

RESUMO

OBJECTIVE: Tuberous sclerosis (TSC) is an autosomal dominant disorder, often detected during childhood. We present the results of genetic testing in a newborn with suspected TSC. METHODS: A newborn with no specific clinical manifestations of TSC showed evidence of TSC on magnetic resonance imaging and echocardiography. Next-generation sequencing (NGS) and multiple ligation-dependent probe amplification (MLPA) of the TSC1 and TSC2 gene exons were carried out to confirm the diagnosis. RESULTS: The results of MLPA were negative, but NGS showed a heterozygous mutation in the TSC1 gene comprising insertion of a T residue at c.2165 (exon 17) to c.2166 (exon 17), indicating a loss of function mutation. These results were verified by Sanger sequencing. This genetic change was present in the newborn but the parental genotypes were wild-type, indicating a de novo mutation. CONCLUSIONS: In this case, a case of TSC caused by a heterozygous mutation in the TSC1 gene was confirmed by NGS sequencing. This indicates the suitability of genetic testing for the early diagnosis of clinically rare and difficult-to-diagnose diseases, to guide clinical treatment.


Assuntos
Proteína 1 do Complexo Esclerose Tuberosa , Esclerose Tuberosa , Análise Mutacional de DNA , Diagnóstico Precoce , Humanos , Recém-Nascido , Mutação , Esclerose Tuberosa/diagnóstico por imagem , Esclerose Tuberosa/genética , Proteína 1 do Complexo Esclerose Tuberosa/genética , Proteína 2 do Complexo Esclerose Tuberosa/genética , Proteínas Supressoras de Tumor/genética
12.
Sensors (Basel) ; 21(16)2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34450770

RESUMO

Smuggling of drugs and cigarettes in small inflatable boats across border rivers is a serious threat to the EU's financial interests. Early detection of such threats is challenging due to difficult and changing environmental conditions. This study reports on the automatic detection of small inflatable boats and people in a rough wild terrain in the infrared thermal domain. Three acquisition campaigns were carried out during spring, summer, and fall under various weather conditions. Three deep learning algorithms, namely, YOLOv2, YOLOv3, and Faster R-CNN working with six different feature extraction neural networks were trained and evaluated in terms of performance and processing time. The best performance was achieved with Faster R-CNN with ResNet101, however, processing requires a long time and a powerful graphics processing unit.


Assuntos
Aprendizado Profundo , Algoritmos , Diagnóstico Precoce , Humanos , Redes Neurais de Computação , Navios
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 779-785, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412744

RESUMO

OBJECTIVE: To verify the specific differentiated subsets of monocytes in sepsis, and to screen and construct the differential gene set of monocytes used for early diagnosis of sepsis. METHODS: Patients with sepsis admitted to Guangdong Provincial People's Hospital from June 2020 to March 2021 were enrolled, and peripheral blood mononuclear cells (PBMC) were extracted. Single-cell sequencing technology and pseudo-time analysis were used to verify the differential subsets of monocytes. Bioinformatics methods were used to analyze the expression of genes in differential subsets of monocytes and screen out differential genes for the preliminary construction of a candidate differential gene set. The digital polymerase chain reaction (PCR) technology was used to verify the candidate differential genes in PBMC of sepsis patients and sepsis human myeloid leukemia mononuclear cells (THP-1) models, and the Venn diagram was used to construct the final differential gene set of monocytes. Gene Expression Omnibus (GEO) database was used to validate the differential gene set of monocytes. RESULTS: (1) The results of cell annotation and pseudo-time analysis showed that the differentiation of NEAT1+CD163+ monocyte occurred in the early stage of sepsis was significantly different from other subsets, which validated that NEAT1+CD163+ monocyte was the characteristic subset in the pathological process of sepsis. (2) Twenty-two differential genes related to sepsis were screened out from the gene expression of NEAT1+CD163+ monocyte. After further verification by digital PCR, basic leucine zipper ATF-like transcription factor (BATF), JUNB proto-oncogene, carcinoembryonic antigen-related cell adhesion molecule 4 (CEACAM4), chromosome 9 open reading frame 95 (C9orf95), G protein subunit alpha 15 (GNA15), complement C3a receptor 1 (C3AR1), transforming growth factor beta 1 (TGFB1) and mitochondrial carrier homolog 1 (MTCH1) were screened out to construct the final differential gene set of monocytes. (3) The external validation results showed that C9orf95 gene had no data in GSE154918 and GSE133822 from GEO, it was excluded during validation. In GSE154918, the expressions of BATF, JUNB, CEACAM4, GNA15, C3AR1, TGFB1, and MTCH1 in the sepsis group were significantly higher than those in the healthy control group (log2expression level: BATF was 12.78±0.08 vs. 11.39±0.35, JUNB was 16.88±0.07 vs. 16.04±0.03, CEACAM4 was 14.73±0.08 vs. 13.77±0.05, GNA15 was 13.16±0.06 vs. 12.30±0.04, C3AR1 was 14.62±0.13 vs. 12.87±0.05, TGFB1 was 16.95±0.05 vs. 16.57±0.36, MTCH1 was 14.80±0.02 vs. 14.61±0.15, all P < 0.05). In GSE133822, the expressions of BATF, CEACAM4, GNA15, and C3AR1 in the sepsis group were significantly higher than those in the health control group (log2expression level: BATF was 8.66±0.16 vs. 7.92±0.14, CEACAM4 was 9.20±0.16 vs. 8.36±0.20, GNA15 was 10.66±0.18 vs. 10.13±0.16, C3AR1 was 11.49±0.27 vs. 10.48±0.16, all P < 0.05), while the expressions of JUNB, TGFB1, and MTCH1 were not statistically different between two groups. The results of gene set variation analysis (GSVA) showed that the enrichment scores of monocytes differential gene set of sepsis group were significantly higher than those of the healthy control group in both GSE154918 (0.38±0.04 vs. -0.44±0.02) and GSE133822 (0.56±0.02 vs. 0.20±0.05, both P < 0.01). Receiver operator characteristic curve (ROC curve) analysis showed that the differential gene set of monocytes had a reliable diagnostic value for early sepsis with the area under ROC curve (AUC) of 0.993 [95% confidence interval (95%CI) was 0.980-1.000] in GSE154918 and 0.944 (95%CI was 0.873-1.000) in GSE133822. CONCLUSIONS: A differential gene set of monocytes (BATF, JUNB, CEACAM4, GNA15, C3AR1, TGFB1, and MTCH1) screened out by single-cell sequencing and digital PCR technology has a reliable diagnostic value for the early sepsis, and may provide a new idea for the early diagnosis of sepsis.


Assuntos
Monócitos , Sepse , Diagnóstico Precoce , Humanos , Leucócitos Mononucleares , Reação em Cadeia da Polimerase , Sepse/diagnóstico , Sepse/genética , Tecnologia
14.
Curr Cardiol Rep ; 23(10): 134, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34410523

RESUMO

PURPOSE OF REVIEW: Cardiac amyloidosis is an increasingly recognized condition with a growing range of targeted therapies, but diagnosis requires a high index of suspicion and multimodality imaging expertise. Early diagnosis remains key to improving quality of life and survival. This article reviews the multimodality imaging approach to the diagnosis, differentiation, and prognosis of cardiac amyloidosis. RECENT FINDINGS: Recent advances in multimodality cardiac imaging have allowed for earlier diagnosis of cardiac amyloidosis resulting in earlier initiation of life-saving therapy in cases of light chain amyloidosis and life-prolonging therapy in transthyretin amyloidosis. With these advances in multimodality imaging, it is important for cardiologists and cardiac imagers to be aware of the subtleties of early disease, the appropriate diagnostic approach as well as understanding the practicalities and pitfalls that are encountered with each modality.


Assuntos
Neuropatias Amiloides Familiares , Cardiomiopatias , Cardiomiopatias/diagnóstico por imagem , Diagnóstico Precoce , Coração , Humanos , Imagem Multimodal , Qualidade de Vida
15.
Arthritis Res Ther ; 23(1): 217, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412670

RESUMO

BACKGROUND: Early diagnosis of knee osteoarthritis (OA) is important in managing this disease, but such an early diagnostic tool is still lacking in clinical practice. The purpose of this study was to develop diagnostic models for early stage knee OA based on the first 2-year clinical course after the patient's initial presentation in primary care and to identify whether these course factors had additive discriminative value over baseline factors. METHODS: We extracted eligible patients' clinical and radiographic data from the CHECK cohort and formed the first 2-year course factors according to the factors' changes over the 2 years. Clinical expert consensus-based diagnosis, which was made via evaluating patients' 5- to 10-year follow-up data, was used as the outcome factor. Four models were developed: model 1, included clinical course factors only; model 2, included clinical and radiographic course factors; model 3, clinical baseline factors + clinical course factors; and model 4, clinical and radiographic baseline factors + clinical and radiographic course factors. All the models were built by a generalized estimating equation with a backward selection method. Area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI) were calculated for assessing model discrimination. Delong's method compared AUCs. RESULTS: Seven hundred sixty-one patients with 1185 symptomatic knees were included in this study. Thirty-seven percent knees were diagnosed as OA at follow-up. Model 1 contained 6 clinical course factors; model 2: 6 clinical and 3 radiographic course factors; model 3: 6 baseline clinical factors combined with 5 clinical course factors; and model 4: 4 clinical and 1 radiographic baseline factors combined with 5 clinical and 3 radiographic course factors. Model discriminations are as follows: model 1, AUC 0.70 (95% CI 0.67-0.74); model 2, 0.74 (95% CI 0.71-0.77); model 3, 0.77 (95% CI 0.74-0.80); and model 4, 0.80 (95% CI 0.77-0.82). AUCs of model 3 and model 4 were slightly but significantly higher than corresponding baseline-factor models (model 3 0.77 vs 0.75, p = 0.031; model 4 0.80 vs 0.76, p = 0.003). CONCLUSIONS: Four diagnostic models were developed with "fair" to "good" discriminations. First 2-year course factors had additive discriminative value over baseline factors.


Assuntos
Osteoartrite do Joelho , Estudos de Coortes , Progressão da Doença , Diagnóstico Precoce , Humanos , Osteoartrite do Joelho/diagnóstico por imagem , Curva ROC
16.
BMJ Open ; 11(8): e045978, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408030

RESUMO

INTRODUCTION: The gradual changes over the decades in the longevity and ageing of European society as a whole can be directly related to the prolonged decline in the birth rate and increase in the life expectancy. According to the WHO, there is an increased risk of dementia or other cognitive disorders as the population ages, which have a major impact on public health. Mild cognitive impairment (MCI) is described as a greater than expected cognitive decline for an individual's age and level of education, but that does not significantly interfere with activities of daily living. Patients with MCI exhibit a higher risk of dementia compared with others in the same age group, but without a cognitive decline, have impaired walking and a 50% greater risk of falling.The urban lifestyle and advent of smartphones, mobility and immediate access to all information via the internet, including health information, has led to a totally disruptive change in most general aspects.This systematic review protocol is aimed at evaluating the effectiveness of technology-based interventions in the detection, prevention, monitoring and treatment of patients at risk or diagnosed with MCI. METHODS AND ANALYSIS: This review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. The search will be performed on MEDLINE (PubMed), CENTRAL, CINAHL Plus, ISI Web of Science and Scopus databases from 2010 to 2020. Studies of interventions either randomised clinical trials or pre-post non-randomised quasi-experimental designs, published in English and Spanish will be included. Articles that provide relevant information on the use of technology and its effectiveness in interventions that assess improvements in early detection, prevention, follow-up and treatment of the patients at risk or diagnosed with MCI will be included. ETHICS AND DISSEMINATION: Ethics committee approval not required. The results will be disseminated in publications and congresses.


Assuntos
Atividades Cotidianas , Disfunção Cognitiva , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/prevenção & controle , Diagnóstico Precoce , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Tecnologia
17.
Lancet Digit Health ; 3(9): e587-e598, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34334333

RESUMO

BACKGROUND: Self-reported symptoms during the COVID-19 pandemic have been used to train artificial intelligence models to identify possible infection foci. To date, these models have only considered the culmination or peak of symptoms, which is not suitable for the early detection of infection. We aimed to estimate the probability of an individual being infected with SARS-CoV-2 on the basis of early self-reported symptoms to enable timely self-isolation and urgent testing. METHODS: In this large-scale, prospective, epidemiological surveillance study, we used prospective, observational, longitudinal, self-reported data from participants in the UK on 19 symptoms over 3 days after symptoms onset and COVID-19 PCR test results extracted from the COVID-19 Symptom Study mobile phone app. We divided the study population into a training set (those who reported symptoms between April 29, 2020, and Oct 15, 2020) and a test set (those who reported symptoms between Oct 16, 2020, and Nov 30, 2020), and used three models to analyse the self-reported symptoms: the UK's National Health Service (NHS) algorithm, logistic regression, and the hierarchical Gaussian process model we designed to account for several important variables (eg, specific COVID-19 symptoms, comorbidities, and clinical information). Model performance to predict COVID-19 positivity was compared in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) in the test set. For the hierarchical Gaussian process model, we also evaluated the relevance of symptoms in the early detection of COVID-19 in population subgroups stratified according to occupation, sex, age, and body-mass index. FINDINGS: The training set comprised 182 991 participants and the test set comprised 15 049 participants. When trained on 3 days of self-reported symptoms, the hierarchical Gaussian process model had a higher prediction AUC (0·80 [95% CI 0·80-0·81]) than did the logistic regression model (0·74 [0·74-0·75]) and the NHS algorithm (0·67 [0·67-0·67]). AUCs for all models increased with the number of days of self-reported symptoms, but were still high for the hierarchical Gaussian process model at day 1 (0·73 [95% CI 0·73-0·74]) and day 2 (0·79 [0·78-0·79]). At day 3, the hierarchical Gaussian process model also had a significantly higher sensitivity, but a non-statistically lower specificity, than did the two other models. The hierarchical Gaussian process model also identified different sets of relevant features to detect COVID-19 between younger and older subgroups, and between health-care workers and non-health-care workers. When used during different pandemic periods, the model was robust to changes in populations. INTERPRETATION: Early detection of SARS-CoV-2 infection is feasible with our model. Such early detection is crucial to contain the spread of COVID-19 and efficiently allocate medical resources. FUNDING: ZOE, the UK Government Department of Health and Social Care, the Wellcome Trust, the UK Engineering and Physical Sciences Research Council, the UK National Institute for Health Research, the UK Medical Research Council, the British Heart Foundation, the Alzheimer's Society, the Chronic Disease Research Foundation, and the Massachusetts Consortium on Pathogen Readiness.


Assuntos
Inteligência Artificial , COVID-19/diagnóstico , Modelos Biológicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anosmia , COVID-19/complicações , Dor no Peito , Dispneia , Diagnóstico Precoce , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Pandemias , Estudos Prospectivos , SARS-CoV-2 , Autorrelato , Sensibilidade e Especificidade , Reino Unido , Adulto Jovem
19.
BMC Health Serv Res ; 21(1): 863, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425814

RESUMO

BACKGROUND: Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIV-exposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation. We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 Qual test (Cepheid, Sunnyvale, CA, USA) for early infant diagnosis (EID) as part of routine services in four public hospitals in Myanmar. METHODS: This sub-study was part of a randomised controlled stepped-wedge trial (Australian and New Zealand Clinical Trials Registry, number 12616000734460) designed to investigate the impact of POC testing for EID in Myanmar and Papua New Guinea. Infants recruited during the intervention phase underwent POC testing at the participating hospitals as part of routine care. Semi-structured interviews with 23 caregivers, 12 healthcare providers and 10 key informants were used to explore experiences of POC-EID testing. The research team and hospital staff documented and discussed implementation challenges throughout the study. RESULTS: Overall, caregivers and healthcare workers were satisfied with the short turnaround time of the POC test. Occasional delays in POC testing were mostly attributable to late receipt of samples by laboratory technicians and communication constraints among healthcare staff. Hospital staff valued technical assistance from the research group and the National Health Laboratory. Despite staff shortages and infrastructure challenges such as unreliable electricity supply and cramped space, healthcare workers and caregivers found the implementation of the POC test to be feasible at pilot sites. CONCLUSIONS: As plans for national scale-up evolve, there needs to be a continual focus on staff training, communication pathways and infrastructure. Other models of care, such as allowing non-laboratory-trained personnel to perform POC testing, and cost effectiveness should also be evaluated.


Assuntos
Infecções por HIV , Sistemas Automatizados de Assistência Junto ao Leito , Austrália , Diagnóstico Precoce , Infecções por HIV/diagnóstico , Humanos , Lactente , Mianmar
20.
Am J Nurs ; 121(9): 66-69, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34438436

RESUMO

ABSTRACT: It's important to be aware of the signs and symptoms of mental illness and to take action to ensure people experiencing mental health problems receive the assistance and treatment they need. For nurses, this is as true at home as it is at work, particularly so when a person is exhibiting aggressive tendencies or other behaviors that could potentially lead to harm. With the COVID-19 crisis leading many family members to live more closely together for extended periods, nurses should be able to identify concerning behaviors and know what to do if they observe these in their loved ones.


Assuntos
Transtornos Mentais/prevenção & controle , Saúde Mental , Diagnóstico Precoce , Família , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Humanos
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