Diagnostic Tool Research Articles

Automated Detection of Rheumatic Heart Disease via Unsegmented Heart Sound Analysis

Rheumatic Heart Disease (RHD) remains a significant cause of morbidity and mortality in many parts of the world, particularly in low-resource settings. Early detection and intervention are critical to mitigating its progression and reducing associated complications. This paper presents an automated approach for the detection of RHD utilizing unsegmented heart sound analysis through deep learning techniques. By leveraging Spectro-temporal representations of raw heart sound signals, our proposed method aims to capture subtle yet discriminative patterns indicative of RHD pathology. The deep learning model is trained on a dataset comprising a diverse range of heart sounds, including those from both RHD-positive and RHD-negative individuals. Through rigorous evaluation of unseen data, our approach demonstrates promising performance in accurately distinguishing between RHD and healthy heart sounds. Furthermore, the proposed methodology offers the potential for scalable and cost-effective screening in resource-limited settings, thereby facilitating early identification and management of RHD cases. This work contributes to the advancement of computer-aided diagnostic tools for cardiovascular diseases, with implications for improving healthcare outcomes and reducing the burden of RHD globally. Key Words: Rheumatic Heart Disease, Heart Sound Analysis, Deep Learning, Automated Detection, Unsegmented Signals, Spectro-Temporal Representation, Cardiovascular Disease.

COPD stage detection: leveraging the auto-metric graph neural network with inspiratory and expiratory chest CT images.

Chronic obstructive pulmonary disease (COPD) is a common lung disease that can lead to restricted airflow and respiratory problems, causing a significant health, economic, and social burden. Detecting the COPD stage can provide a timely warning for prompt intervention in COPD patients. However, existing methods based on inspiratory (IN) and expiratory (EX) chest CT images are not sufficiently accurate and efficient in COPD stage detection. The lung region images are autonomously segmented from IN and EX chest CT images to extract the lung radiomics and 3D CNN features. Furthermore, a strategy for concatenating and selecting features was employed in COPD stage detection based on radiomics and 3D CNN features. Finally, we combine all the radiomics, 3D CNN features, and factor risks (age, gender, and smoking history) to detect the COPD stage based on the Auto-Metric Graph Neural Network (AMGNN). The AMGNN with radiomics and 3D CNN features achieves the best performance at 89.7 of accuracy, 90.9 of precision, 89.5 of F1-score, and 95.8 of AUC compared to six classic machine learning (ML) classifiers. Our proposed approach demonstrates high accuracy in detecting the stage of COPD using both IN and EX chest CT images. This method can potentially establish an efficient diagnostic tool for patients with COPD. Additionally, we have identified radiomics and 3D CNN as more appropriate biomarkers than Parametric Response Mapping (PRM). Moreover, our findings indicate that expiration yields better results than inspiration in detecting the stage of COPD.

Cholangiocarcinoma: Recent Advances in Molecular Pathobiology and Therapeutic Approaches.

Cholangiocarcinomas (CCA) pose a complex challenge in oncology due to diverse etiologies, necessitating tailored therapeutic approaches. This review discusses the risk factors, molecular pathology, and current therapeutic options for CCA and explores the emerging strategies encompassing targeted therapies, immunotherapy, novel compounds from natural sources, and modulation of gut microbiota. CCA are driven by an intricate landscape of genetic mutations, epigenetic dysregulation, and post-transcriptional modification, which differs based on geography (e.g., for liver fluke versus non-liver fluke-driven CCA) and exposure to environmental carcinogens (e.g., exposure to aristolochic acid). Liquid biopsy, including circulating cell-free DNA, is a potential diagnostic tool for CCA, which warrants further investigations. Currently, surgical resection is the primary curative treatment for CCA despite the technical challenges. Adjuvant chemotherapy, including cisplatin and gemcitabine, is standard for advanced, unresectable, or recurrent CCA. Second-line therapy options, such as FOLFOX (oxaliplatin and 5-FU), and the significance of radiation therapy in adjuvant, neoadjuvant, and palliative settings are also discussed. This review underscores the need for personalized therapies and demonstrates the shift towards precision medicine in CCA treatment. The development of targeted therapies, including FDA-approved drugs inhibiting FGFR2 gene fusions and IDH1 mutations, is of major research focus. Investigations into immune checkpoint inhibitors have also revealed potential clinical benefits, although improvements in survival remain elusive, especially across patient demographics. Novel compounds from natural sources exhibit anti-CCA activity, while microbiota dysbiosis emerges as a potential contributor to CCA progression, necessitating further exploration of their direct impact and mechanisms through in-depth research and clinical studies. In the future, extensive translational research efforts are imperative to bridge existing gaps and optimize therapeutic strategies to improve therapeutic outcomes for this complex malignancy.

New Perspectives on the Role of Liquid Biopsy in Bladder Cancer: Applicability to Precision Medicine.

Bladder cancer (BC) is one of the most common tumors in the world. Cystoscopy and tissue biopsy are the standard methods in screening and early diagnosis of suspicious bladder lesions. However, they are invasive procedures that may cause pain and infectious complications. Considering the limitations of both procedures, and the recurrence and resistance to BC treatment, it is necessary to develop a new non-invasive methodology for early diagnosis and multiple evaluations in patients under follow-up for bladder cancer. In recent years, liquid biopsy has proven to be a very useful diagnostic tool for the detection of tumor biomarkers. This non-invasive technique makes it possible to analyze single tumor components released into the peripheral circulation and to monitor tumor progression. Numerous biomarkers are being studied and interesting clinical applications for these in BC are being presented, with promising results in early diagnosis, detection of microscopic disease, and prediction of recurrence and response to treatment.

Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review.

Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.

Étude CamiCon : évaluation d’un nouvel outil pour la réalisation d’un calendrier mictionnel automatisé et connecté

IntroductionA voiding diary (VD) is a key element in the evaluation of patients with overactive bladder (OAB) at initial presentation and during treatment to assess its effectiveness. In order to be clinically relevant, it must be performed over 3 days according to the International Continence Society (ICS). Unfortunately, some patients find it cumbersome. We aimed to evaluate the reliability and patient satisfaction when using a connected tank device. Material and methodWe conducted a single-center prospective study including 41 patients. Each patient completed a paper voiding diary and then a diary with Diary Pod® (DP) or inversely depending on the study arm. Data from 34 patients were collected. After completion of both diaries, patients completed a satisfaction questionnaire sent by email via GoogleForm. Study statistics were performed with Jamovi® and Excel® software. ResultData from 34 patients were analyzed. There was a statically significant difference (P=0.046) between the mean volume calculated from the paper VD and that calculated from the connected VD (DP). There was no statistically significant difference (P=0.112) between the mean number of daytime voids, mean number of nighttime voids (P=0.156), mean water intake (P=0.183) reported on the paper VD and the connected VD. Thirteen (42%) paper VD and 1 connected VD did not include documentation of the presence or absence of urine leakage or urgency. There was no statistically significant difference between the two calendars regarding the presence or absence of urine leakage (P=0.180) and urinary urgency (P=0.564). Eighty-four percent (26/31) preferred the connected tank to the usual method (paper/pen), while 55% (17/31) and 29% (9/31) of the participants respectively answered that the DP was “very definitely” or “definitely” an aid for performing VD. Nevertheless, 39% (12/31) and 55% (17/31) considered its price to be high or fair and only 22% (7/31) were inclined to buy it. ConclusionThis study showed that the Diary connected reservoir Pod® is a reliable and innovative tool for voiding schedules. It facilitates data collection for the majority of patients (83%) and could, through better patient compliance, provide better quality data and help their interpretation by the physician. These factors could encourage the implementation of the connected voiding diary as a diagnostic tool. It would also be used for the assessment of treatment effectiveness in daily clinical practice as well as in research. Its cost remains a major obstacle, judged by 39% of patients to be too high, and could therefore be proposed in specific situations requiring precise data.

An evaluation of common stock assessment diagnostic tools for choosing among state-space models with multiple random effects processes

State-space models have received increasing attention in fisheries stock assessments given their flexibility to incorporate multiple sources of process errors. Identifying which process errors to include is important because incorrectly including some process errors can induce bias in management quantities. Existing model selection tools commonly applied in traditional statistical catch-at-age models may not perform as well for state-space models. We evaluated the efficacy of common diagnostic tools for correctly identifying the presence, absence, and magnitude of three process errors (survival, selectivity, and natural mortality) in a simulation–estimation experiment. No model diagnostic tools could consistently identify the correct process error structure in all situations. Incorrectly attributing the process error from natural mortality to other processes, or vice versa, led to relatively large bias in management quantities. Furthermore, incorrectly including an additional source of process error in the assessment models exhibited similar performance to the correct model and generally showed unbiased estimates of management quantities; incorrectly excluding a source of process error, however, generated large biases. Thus, despite not having generally reliable model diagnostic tools for state-space assessments, practitioners should err on the side of using overly complex models, except for natural mortality unless there is external corroborating evidence of changing natural mortality.

Arboviruses and pregnancy: are the threats visible or hidden?

Mosquito-borne arboviral diseases are a global concern and can have severe consequences on maternal, neonatal, and child health. Their impact on pregnancy tends to be neglected in developing countries. Despite hundreds of millions of infections, 90% pregnancies being exposed, scientific data on pregnant women is poor and sometimes non-existent. Recently and since the 2016 Zika virus outbreak, there has been a newfound interest in these diseases. Through various neuropathogenic, visceral, placental, and teratogenic mechanisms, these arbovirus infections can lead to fetal losses, obstetrical complications, and a wide range of congenital abnormalities, resulting in long-term neurological and sensory impairments. Climate change, growing urbanization, worldwide interconnectivity, and ease of mobility allow arboviruses to spread to other territories and impact populations that had never been in contact with these emerging agents before. Pregnant travelers are also at risk of infection with potential subsequent complications. Beyond that, these pathologies show the inequalities of access to care on a global scale in a context of demographic growth and increasing urbanization. It is essential to promote research, diagnostic tools, treatments, and vaccine development to address this emerging threat.Background The vulnerability of pregnant women and fetuses to emergent and re-emergent pathogens has been notably illustrated by the outbreaks of Zika virus. Our comprehension of the complete scope and consequences of these infections during pregnancy remains limited, particularly among those involved in perinatal healthcare, such as obstetricians and midwives. This review aims to provide the latest information and recommendations regarding the various risks, management, and prevention for pregnant women exposed to arboviral infections.

Plasma tryptophan pathway metabolites quantified by liquid chromatography-tandem mass spectrometry as biomarkers in neuroendocrine tumor patients.

A good and accessible biomarker is of great clinical value in neuroendocrine tumor (NET) patients, especially considering its frequently indolent nature and long-term follow-up. Plasma chromogranin A (CgA) and 5-hydroxyindoleacetic acid (5-HIAA) are currently used as biomarkers in NET, but their sensitivity and specificity are restricted. 5-HIAA is the main metabolite of serotonin, an important neurotransmitter of the tryptophan pathway. The aim of this study is to estabish a sensitive and accurate method for the quantification of tryptophan pathway metabolites in plasma. We further aimed to evaluate its utility as a clinical tool in NET disease. We obtained plasma samples from NET patients and healthy controls recruited from the University Hospital of North Norway, Tromsø. Samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and eight metabolites of the tryptophan pathway were quantified. We included 130 NET patients (72/130 small intestinal [SI] NET, 35/130 pancreatic NET, 23/130 other origin) and 20 healthy controls. In the SI-NET group, 26/72 patients presented with symptoms of carcinoid syndrome (CS). We found that combining tryptophan metabolites into a serotonin/kynurenine pathway ratio improved diagnostic sensitivity (92.3%) and specificity (100%) in detecting CS patients from healthy controls compared with plasma 5-HIAA alone (sensitivity 84.6%/specificity 100%). Further, a clinical marker based on the combination of plasma serotonin, 5-HIAA, and 5OH-tryptophan, increased diagnostic capacity identifying NET patients with metastasized disease from healthy controls compared with singular plasma 5-HIAA, serotonin, or CgA. In addition, this marker was positive in 61% of curatively operated SI-NET patients compared with only 10% of healthy controls (p < .001). Our results indicate that simultaneous quantification of several tryptophan metabolites in plasma, using LC-MS/MS, may represent a clinically useful diagnostic tool in NET disease.

Unusual foreign bodies in upper aero digestive tract – Our experience at tertiary care centre

Foreign bodies ingestion is especially common in the pediatric age group, whereas in adults occur accidently or among those with psychiatric disorders, mental retardation, prisoners and alcoholics, Preexisting GI tract abnormalities, such as previous surgery, strictures, or functional abnormalities, increases the risk of a swallowed foreign body becoming lodged at the site of the abnormality.This retrospective study was conducted in 32 patients with upper aero digestive tract unusual foreign bodies presenting to our department on emergency basis in a duration of one year. This Study was conducted in ENT department tertiary care Centre in duration of 2021-2022, 32 patients presented with unusual FB in upper aero digestive tract were treated in our department on an emergency basis. There were 14 male (43.75%) and 18 female (56.25%) ranging in age from 2 to 62 years. The main symptoms patients complained were difficulty in swallowing and pain. Detailed history with examination of nasal cavity, oral cavity and pharynx by indirect laryngoscopy and finally X-ray or CT scan were the diagnostic tools as required. The location of the FB was in the esophagus, Pyriform sinus, hypopharynx in decreasing order.The treatment consisted of rigid endoscopy and foreign body removal under general anesthesia or sedation. No major complications occurred in procedure except one in with iatrogenic esophageal perforation that was managed conservatively. Endoscopy is a reliable method in the treatment of upper aero digestive tract foreign body (FB) impaction.

Differential responses of selectively bred mussels (Perna canaliculus) to heat stress-survival, immunology, gene expression and microbiome diversity.

New Zealand's green-lipped mussel (Perna canaliculus) is an ecologically and economically important species. Marine heatwaves are increasing in frequency around NZ's coastline, and these events are correlated with increased stress and mortality of some aquaculture species. This study aimed to identify general biomarkers of heat stress in P. canaliculus and to assess whether responses differed between genetically distinct selectively bred mussels. We exposed three families of selectively bred mussels (families A, B and C) to three seawater temperature regimes in the laboratory: 1) a "control" treatment (ambient 12°C), 2) a 26°C heat challenge with a subsequent recovery period, and 3) a sustained 26°C heat challenge with no recovery. We investigated whether the survival, immune response (hemocyte concentration and viability, oxidative stress and total antioxidant capacity), hemocyte gene expression and gill microbiome differed between the families during the temperature challenges. In the sustained heat-stress treatment, family A had the highest survival rate (42% compared with 25% and 5% for families C and B, respectively). Gene expression levels significantly shifted during thermal stress and differed between families, with family A more dissimilar than families B and C. Family C had substantially more genes impacted by temperature treatment and timepoint than the other families, while family B had very little genes/pathways that responded to thermal stress. Genes related to heat shock proteins and immune responses (e.g., AIF1, CTSC, TOLL8, CASP9, FNTA, AHCY, CRYAB, PPIF) were upregulated in all families during heat stress. Microbiome species-richness differed between families before and during heat-stress, with family A having a distinctly different microbiome flora than the other families. Microbial diversity changed similarly in all families exposed to prolonged heat-stress, with species of Vibrio and Campylobacter increasing in these mussels. Our study highlights the use of non-lethal sampling of hemocytes as a diagnostic tool to explore the immune response and gene expression of selectively bred mussels, to predict their response to ocean warming. This approach can identify potential thermotolerant candidates for further selective breeding, which may increase the resilience of the mussel aquaculture industry in a warming ocean.

Deep Ensemble Learning Model for Diagnosis of Lung Diseases from Chest X -Ray Images

Objectives: This study aims to develop a robust medical recognition system using deep learning for the identification of various lung diseases, including COVID-19, pneumonia, lung opacity, and normal states, from chest X-ray images. The focus is on implementing ensemble fixed features learning methods to enhance diagnostic capabilities, contributing to the development of a cost-effective and reliable diagnostic tool for combating the global epidemic of lung disorders. Methods: The study utilizes a Kaggle dataset containing COVID-19 chest radiography images. Raw X-ray images undergo preprocessing for contrast enhancement and noise removal while addressing dataset imbalance through near-miss resampling. Ensemble learning techniques, including two and three-level methods, are employed to harness the strengths of individual base learners—VGG16, InceptionV3, and MobileNetV2. The model's performance is evaluated using metrics such as accuracy, recall, precision, and F1-score. For remote access, a user interface and a shared web link are developed using Python Gradio. Findings: In two-level ensembles, features from base learners are concatenated and classified using a support vector machine. Three-level ensembles use concatenated features classified by three machine learning classifiers, employing a majority voting system for the final prediction. The two-level method achieved 93% accuracy, precision, recall, and F1 score. The three-level ensemble model demonstrates superior performance, achieving 94% accuracy in detecting four lung diseases, namely COVID-19, pneumonia, lung opacity, and normal states. Novelty: This research contributes to the field by showcasing the efficacy of deep learning technology, particularly ensemble learning, in enhancing the detection of lung diseases from raw chest X-ray images. The model employs three modified and efficient pretrained networks for automatic feature extraction, eliminating the need for manual feature engineering. The developed model stands as a promising decision-support tool for healthcare professionals, particularly in low-resource environments. Keywords: Convolutional Neural Network (CNN), Deep Learning (DL), Transfer Learning (TL), Ensemble learning (EL), Fixed feature extraction, Chest X­rays (CXR), Lung diseases

Ocular Ultrasonography and Effect of Topically Applied Rocuronium Bromide in Louisiana Pine Snakes (Pituophis ruthveni)

Abstract Louisiana pine snakes (Pituophis ruthveni) are a threatened species with a range limited to portions of Louisiana and Texas. There are captive reproduction programs that aim to assist in the recovery of this species. Therefore, obtaining information that can aid in maintaining their health, such as a complete ocular examination, is a critical component in conservation efforts. Examination of the snake ocular posterior segment is challenging due to the presence of striated uveal musculature which is unresponsive to anticholinergic agents, and the presence of the spectacle which may create a barrier to topical mydriatics. The objectives of this study were to document normal ocular biometric measurements (axial globe length (AP), lens thickness (LT) and vitreous chamber depth (VCD)) in this species using ultrasonography (US) and to assess the effects of topically applied rocuronium bromide (RB) solution (1- and 2-drop protocol, 20 μl and 40 μl, respectively) to facilitate non-invasive examination of the fundus. The ocular biometric measurements were then correlated to morphometric data including snout-vent length (SVL), tail length (TL), total body length (SVL + TL), sex and body condition score (BCS). We found that US, using an 8-18 MHz linear array probe, provided adequate image quality to measure the above parameters in all snakes (n = 8), and that there were no significant correlations between the morphometric data and ocular biometric US measurements (P &amp;gt; 0.05). RB solution applied topically to the healthy, intact spectacle did not induce mydriasis in a subset of this same population (n = 6) (P &amp;gt; 0.05) using either the 1- or 2-drop protocol. In conclusion, ocular US can be utilized as a non-invasive diagnostic tool in Louisiana pine snakes and further studies are needed to evaluate non-invasive methods of inducing mydriasis in this species.

Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study

Hepatitis B virus (HBV) elimination requires expanding and decentralising HBV care services. However, peripheral health facilities lack access to diagnostic tools to assess eligibility for antiviral therapy. Through the Hepatitis B in Africa Collaborative Network (HEPSANET), we aimed to develop and evaluate a score using tests generally available at lower-level facilities, to simplify the evaluation of antiviral therapy eligibility in people living with HBV. We surveyed the availability of clinical and laboratory parameters across different health-care levels in sub-Saharan Africa. We used data from the HEPSANET dataset, the largest cross-sectional dataset of treatment-naive people living with HBV in sub-Saharan Africa, to derive and validate the score. Participants from this dataset were included in the analysis if they were aged 18 years or older and had liver fibrosis stages determined by a liver stiffness measurement or liver histopathology. Participants with co-infections or metabolic disorders were excluded. We allocated participants to the derivation and validation sets by geographical site. In the derivation set, we used stepwise logistic regression to identify the best performing parameters for identifying participants that met the 2017 European Association for the Study of the Liver (EASL) criteria. Regression coefficients were converted into integer points to construct simplified algorithms for different health-care levels. In the validation set, we estimated the area under the receiver operating characteristic, sensitivity, and specificity of the simplified algorithm for identifying antiviral therapy eligibility defined by the 2017 EASL criteria. At 11 sites from eight countries that returned surveys, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count were generally available at district hospital levels, and hepatitis B e antigen and point-of-care HBV DNA tests were available only at regional and provincial hospital levels or above. Among 2895 participants included from the HEPSANET database (1740 [60·1%] male, 1155 [39·9%] female), 409 (14·1%) met EASL antiviral therapy eligibility criteria. In the derivation set, the optimal district-level hospital score was: ALT (IU/L), less than 40 (0 points), 40-79 (+1), 80 or greater (+2); AST (IU/L), less than 40 (0), 40-79 (+1), 80 or greater (+2); and platelet counts (109/L), less than 100 (+2), 100-149 (+1), 150 or greater (0). When combined with family history and clinical data for decompensated cirrhosis that do not require any biological tests, a cut-off of 2 points or more had a sensitivity and specificity of 82% (95% CI 76-86) and 95% (93-96) to identify treatment-eligible individuals in the derivation set, and 78% (71-85) and 87% (86-89) in the validation set, respectively. Using a score incorporating platelet counts, AST, and ALT, the majority of people living with HBV requiring antiviral therapy can be identified. Our findings suggest that clinical staging can be decentralised down to district hospital level in sub-Saharan Africa. European Association for the Study of the Liver Foundation, John C Martin Foundation. For the French translation of the abstract see Supplementary Materials section.

Loop‐mediated isothermal amplification assay: A novel disease diagnostics tool in sweetpotato seed quality assurance

AbstractSweetpotato is an important food crop in global production. However, sweetoptato viruses pose a threat to sustainable agriculture and cause significant economic loss. More than 30 viruses have been reported to date, with sweet potato feathery mottle virus (SPFMV) and sweet potato chlorotic stunt virus (SPCSV) occurring frequently and in combination, causing sweetpotato virus disease. The detection of viruses directly from sweetpotato is still a challenge, and efforts are being made toward this front. Therefore, rapid detection of viruses is critical for effective control. Current diagnostic tests are not sufficiently sensitive to reliably detect viruses directly from sweetpotato and require expensive laboratory equipment and a high level of skilled experience. Loop‐mediated isothermal amplification (LAMP) is sensitive and specific for both DNA/RNA amplification; it is affordable and its characteristics make it potentially suitable for on‐site testing. LAMP assays have been developed for several sweetpotato viruses: SPCSV, SPFMV, and sweet potato leaf curl virus (and related sweepoviruses). Laboratory validation showed a 100% diagnostic sensitivity for all three viruses. The LAMP on‐site testing results were comparable to those of polymerase chain reaction and reverse transcriptase polymerase chain reaction confirmatory laboratory tests. Interlab validation and packaging into affordable kits will ensure high adoption in sub‐Saharan Africa. The LAMP assay can be used for field surveys and monitoring the phytosanitary status of pre‐basic seed production in quarantine or certification program. This guarantees pathogen‐free planting material enters the seed system. We discuss opportunities for LAMP as a diagnostic assay for the rapid detection of sweetpotato viruses and its adoption as a quality control system for planting materials.

ADDUCTOR POLLICIS MUSCLE THICKNESS AS A DIAGNOSTIC TOOL FOR MALNUTRITION IN HOSPITALIZED PATIENTS

Malnutrition causes changes in body composition and compromises the physical and mental functions of individuals. One of its main characteristics is involuntary weight loss, associated with worse health outcomes. In hospital environments, the risk for the condition is high, especially among critical patients, the elderly or those undergoing surgery. This study explores the potential of adductor pollicis muscle thickness (EMAP) as an auxiliary diagnostic tool for detecting malnutrition in hospitalized patients, given its accessibility and low cost. The research involved 100 adult individuals and evaluated the correlations between EMAP, arm circumference (CB) and calf circumference (CP) with the participants body mass index (BMI). Furthermore, it suggested cut-off points for these anthropometric measurements for detecting malnutrition. The results indicated that CB and CP correlated more strongly with BMI compared to EMAP, being more effective choices for nutritional diagnosis. Regarding cutoff points, the values with the highest sensitivity and specificity for diagnosing malnutrition were 12.50 mm for EMAP, 26.00 cm for CB and 30.50 cm for CP, respectively.

New reference genomes to distinguish the sympatric malaria parasites, Plasmodium ovale curtisi and Plasmodium ovale wallikeri

Despite Plasmodium ovale curtisi (Poc) and wallikeri (Pow) being important human-infecting malaria parasites that are widespread across Africa and Asia, little is known about their genome diversity. Morphologically identical, Poc and Pow are indistinguishable and commonly misidentified. Recent rises in the incidence of Poc/Pow infections have renewed efforts to address fundamental knowledge gaps in their biology, and to develop diagnostic tools to understand their epidemiological dynamics and malaria burden. A major roadblock has been the incompleteness of available reference assemblies (PocGH01, PowCR01; ~ 33.5 Mbp). Here, we applied multiple sequencing platforms and advanced bioinformatics tools to generate new reference genomes, Poc221 (South Sudan; 36.0 Mbp) and Pow222 (Nigeria; 34.3 Mbp), with improved nuclear genome contiguity (> 4.2 Mbp), annotation and completeness (> 99% Plasmodium spp., single copy orthologs). Subsequent sequencing of 6 Poc and 15 Pow isolates from Africa revealed a total of 22,517 and 43,855 high-quality core genome SNPs, respectively. Genome-wide levels of nucleotide diversity were determined to be 2.98 × 10–4 (Poc) and 3.43 × 10–4 (Pow), comparable to estimates for other Plasmodium species. Overall, the new reference genomes provide a robust foundation for dissecting the biology of Poc/Pow, their population structure and evolution, and will contribute to uncovering the recombination barrier separating these species.

Detection of prions from spiked and free-ranging carnivore feces

Chronic wasting disease (CWD) is a highly contagious, fatal neurodegenerative disease caused by infectious prions (PrPCWD) affecting wild and captive cervids. Although experimental feeding studies have demonstrated prions in feces of crows (Corvus brachyrhynchos), coyotes (Canis latrans), and cougars (Puma concolor), the role of scavengers and predators in CWD epidemiology remains poorly understood. Here we applied the real-time quaking-induced conversion (RT-QuIC) assay to detect PrPCWD in feces from cervid consumers, to advance surveillance approaches, which could be used to improve disease research and adaptive management of CWD. We assessed recovery and detection of PrPCWD by experimental spiking of PrPCWD into carnivore feces from 9 species sourced from CWD-free populations or captive facilities. We then applied this technique to detect PrPCWD from feces of predators and scavengers in free-ranging populations. Our results demonstrate that spiked PrPCWD is detectable from feces of free-ranging mammalian and avian carnivores using RT-QuIC. Results show that PrPCWD acquired in natural settings is detectable in feces from free-ranging carnivores, and that PrPCWD rates of detection in carnivore feces reflect relative prevalence estimates observed in the corresponding cervid populations. This study adapts an important diagnostic tool for CWD, allowing investigation of the epidemiology of CWD at the community-level.

A novel triad for the diagnosis of endometriosis, the short anogenital distance combines with high endometrial BCL2 and low endometrial FASL.

To investigate the anogenital distance from the upper verge of the anus to the posterior fourchette (AGDAF ), FASL, and BCL2 combination as a reliable and non-invasive tool for the diagnosis of endometriosis. This study included 100 women with endometriosis and 50 women without endometriosis as the control group. All cases underwent history taking, body mass index (BMI) measurement, AGD measurement, and FASL and BCL2 immunohistochemical staining of the eutopic endometrial tissue. This study included 150 women divided into endometriosis and control groups. Endometriosis cases significantly had shorter AGDAF , 22.9 ± 2.6 mm, compared with the control group, 27.3 ± 3.5 mm (P < 0.001). Lower FASL and higher BCL2 expression were associated with endometriosis (P < 0.001). The combined measurement of AGDAF (cut-off point 24.55 mm) with FASL and BCL2 was associated with endometriosis (P < 0.001). The combined diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of AGDAF , FASL, and BCL2 were 83%, 78%, 87.3%, and 69.6%, respectively. The area under the curve was greater for AGDAF , FASL, and BCL2 in combination than for individual measurements. Combining short AGDAF with high BCL2 and low FASL is a highly sensitive, non-invasive diagnostic tool for endometriosis.

The significance of initial lactate levels in emergency department presentations of abdominal wall hernia.

Abdominal wall hernias are a frequent cause of abdominal pain-related emergency department visits. Our study aimed to establish the connection between lactate levels and patient outcomes in those with abdominal pain due to abdominal wall hernias. Our research followed a retrospective, observational, and descriptive approach and two center. We included patients who visited the emergency department for abdominal pain and were confirmed to have abdominal wall hernias through ultrasound. We enrolled 493 patients meeting the criteria. Median age was 65years, with 54% (n=266) being male. Regarding outcomes, 40.5% (n=200) were hospitalized, 27.7% (n=137) underwent surgery, and 7.9% (n=39) underwent bowel resection. Mortality rate during hernia-related hospital admission was 0.6% (n=3). For hospitalized patients, there were significant differences in white blood cell count, neutrophil count and percentage, platelet count, lymphocyte count, and percentage (p<0.05). Patients undergoing resection showed significant differences in neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage (p<0.05). Lactate levels were statistically significant in all patient groups requiring hospitalization, surgery, and resection (p<0.05). Sensitivity and specificity of lactate test results indicated in patients undergoing bowel resection, lactate values ≥1.96mmol/L had a specificity of 64%, sensitivity of 71%, and a negative predictive value of 96% (p<0.05). Low lactate levels in patients presenting to the emergency department with abdominal pain caused by abdominal wall hernias have a high negative predictive value for excluding strangulation and the need for bowel resection. Therefore, we recommend the use of lactate as an additional diagnostic tool in emergency department presentations related to abdominal wall hernias.