Early Diagnosis Program Research Articles

Cancer Data, Case Increase Rates and Future Prospects in the Northeastern Anatolia Region of Türkiye, a Special Region for Gastric and Esophageal Cancers in 2018-2023

Aim: Cancer is a major cause of death. Globocan data shows 20 million new cancer cases and 9.7 million cancer deaths a year. Lung cancer is the most common cancer globally, followed by breast, colorectal, prostate and stomach cancers. Cancer types vary by age, gender, race, and region. Documenting regional cancer data is crucial for screening, early diagnosis, and treatment of common cancers, as well as understanding the underlying causes. Despite the high incidence of upper gastrointestinal (GI) cancers in eastern Türkiye, there is little documented evidence on specific cancer types in these regions. Material and Method: In order to investigate the incidence of cancer in our region, the medical records of 6,603 patients diagnosed with cancer and subsequently treated in our clinic between 2018 and 2023 were analysed and specific cancer sites were recorded. Results: It has been demonstrated that cancers of the upper GI tract, represent the most prevalent cancer site, accounting for 21.2% (n=1403) of all cases. This equates to one in every five patients diagnosed with cancer. Additionally, significant findings were yielded with respect to other forms of cancer. Conclusion: It is imperative to document these data to highlight the necessity for investigating and preventing the underlying causes of upper GI cancer in our region. Furthermore, the establishment of screening programs for early diagnosis and intensified research on treatment modalities are crucial steps in combating this disease.

Newborn screening and rapid genomic diagnosis of neuromuscular diseases

Background In recent years, treatments have been approved for certain neuromuscular diseases. In some cases, early pre-symptomatic treatment is necessary for optimal response, and thus newborn screening is critical. Objective To review the current status of newborn screening programs for neuromuscular diseases and early diagnosis through genetic testing. Methods Following the PRISMA guidelines, a literature search was performed on PubMed for screening of neuromuscular diseases; the search was conducted on literature available as of 1 May 2024. Results Included were 77 articles on newborn screening for seven diseases: spinal muscular atrophy (19 studies), Duchenne muscular dystrophy (15), Pompe disease (20), X-linked adrenoleukodystrophy (14), Krabbe disease (6), metachromatic leukodystrophy (2), and myotonic dystrophy 1 (1). Ten articles on rapid genomic diagnosis were identified. Conclusion Since 2021, newborn screening programs for neuromuscular diseases have been established, notably in X-linked adrenoleukodystrophy, spinal muscular atrophy, Pompe disease, and Duchenne Muscular Dystrophy. Even in diseases where treatment is currently not life-changing, such as Krabbe disease, new newborn screening programs continue to be implemented, especially in the USA. The use of genetic diagnostic tests does not yet appear to be widespread or at least not widely reported. As new treatments become available, genomic newborn screening programs will need to be rapidly and broadly implemented.

Transfusions, disease-modifying treatments, and curative therapies for sickle cell anemia in Africa: where are we now?

The mortality burden of sickle cell anemia (SCA) is centered in sub-Saharan Africa. In addition to a lack of systematic programs for early diagnosis, access to disease-modifying treatments is limited to only a few urban centers. Providing a safe and adequate blood supply is a major challenge, heightening mortality from SCA-associated complications that require urgent blood transfusion and making the delivery of regular transfusion therapy for stroke prevention nonfeasible. Hydroxyurea therapy with proven clinical benefits for pain episodes, acute chest syndrome, malaria, transfusions, hospitalizations, and stroke prevention is the most feasible treatment for SCA in Africa. Access barriers to hydroxyurea treatment include poor availability, unaffordable costs, health professionals' reluctance to prescribe, a lack of national guidelines, and exaggerated fears about drug toxicities. Strategies for the local manufacture of hydroxyurea combined with the systematic education and training of health professionals using guidelines supported by the World Health Organization can help surmount the access barriers. Hematopoietic stem cell transplantation as a curative therapy is available in only 7 countries in Africa. The few patients who have suitable sibling donors and can afford a transplant must usually travel out of the country for treatment, returning to their home countries where expertise and resources for posttransplant follow-up are lacking. The recently developed ex-vivo gene therapies are heavily dependent on technical infrastructure to deliver, a daunting challenge for Africa. Future in-vivo gene therapies that bypass myeloablation and ex-vivo processing would be more suitable. However, enthusiasm for pursuing these gene therapies should not overlook strategies to make hydroxyurea universally accessible in Africa.

Most Prevalent Cancer Subtypes in Saudi Arabia

The most prevalent cancers are those in Saudi Arabia (oral, thyroid, lung, breast, liver, and colorectal). Males have a greater chance than females to develop prostate, lung, liver, colorectal, and stomach cancers, whereas females are more likely to advance breast, lung, colorectal, cervical, as well as thyroid cancers. A few cancer cases in Saudi Arabia have doubled in frequency over the past few years. The most prevalent cancers being liver, lungs, colorectal, stomach, and the prostate. The Saudi population's changing way of life, early diagnosis program, screening campaign, a lack of preventing cancer, as well as social pressures to cancer research are all to blame for this. Obesity, genetics, living a bad diet, smoking, exposure to infectious diseases, as well as a deficiency in iodine as well as vitamin D all appear to raise the risk of getting cancer in Saudi Arabia.

Current situation and capacity of cancer diagnosis and treatment in county hospitals in China: a multicenter cross-sectional survey

PurposeCounty-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity.MethodsA nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis.ResultsThe study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored.ConclusionWhile county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas.

An economic evaluation of breast cancer interventions in Kenya

Cancer is the third leading cause of death in Kenya. Breast cancer is responsible for 3100 deaths annually. Quantifying the economic and social impacts of breast cancer supports inclusion of cancer care within Kenya's universal healthcare plan. Kenya's Ministry of Health led an economic cost-benefit analysis of expanding breast cancer prevention and treatment services. Three scenarios (early diagnosis only, screening with clinical breast exam (CBE-led), and screening with mammography (MG-led)) were modelled using an adapted version of a deterministic state-transition cohort simulation model jointly developed by the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) and maintained by Forecast Health. Real world evidence on the favorable stage-shift induced by each early detection scenario was used as model inputs. The model estimated the mortality benefits of favorable stage-shifting, and net financial costs and health and economic benefits in 2020 USD. Respectively, over 40 years, the cost to sustain early diagnosis programs only, CBE-led screening, or mammogram-led screening would require 1.4, 2.8, or 5.2 percent increases above current government health spending. All three strategies are economically efficient in the long run. Net economic benefits of expanded breast cancer care using clinical breast exam screening are $2.3 billion dollars (USD) over the next 40 years with 236,000 women's lives saved in Kenya. Mammographic screening provides net benefits of $1.9 billion (USD) with an additional 34,000 lives saved over 40 years compared to the CBE-led screening approach. Over 40 years, an early diagnosis-only strategy saves the fewest lives and has the lowest net benefit among the three strategies. We offer a novel economic evaluation for breast cancer prevention and care expansion within Universal Health Coverage in Kenya. It demonstrates the economic viability of providing those services in a low-middle income (LMI) context. The work was funded by the World Bank Group's Tackling Non-Communicable Diseases Challenges in Low- and Middle-Income Countries Trust Fund, supported by the Access Accelerated Partnership. This report was also partially financed by the Global Financing Facility for Women, Children and Adolescents (GFF). The GFF is a global multi-stakeholder partnership hosted at the World Bank that provides catalytic financing and technical support for safe and equitable delivery of essential health and nutrition services for women, children and adolescents, while helping countries to build more resilient health systems.

Prevalence of Radiolucent and Radiopaque Jawbone Lesions Using Panoramic Radiographic Analysis in Hail, Saudi Arabia: A Retrospective, Cross-Sectional, Observational Study.

Background Oral diseases are among the most prevalent public health issues worldwide, underscoring the importance of early diagnosis and effective prevention programs. Determining the prevalence of jawbone lesions is crucial for developing targeted interventions and ensuring timely treatment. Panoramic radiography, also known as orthopantomogram, has become a cornerstone in radiographic examinations, offering a comprehensive view of the dental and maxillofacial regions. Its accessibility and ability to detect a wide range of pathologies make it an invaluable diagnostic tool. This study aimed to assess the prevalence and distribution of radiolucent and radiopaque jawbone lesions in the population of Hail, Saudi Arabia, using panoramic radiographic analysis. Methodology A retrospective, cross-sectional study was conducted using pre-existing panoramic radiographs of individuals aged 18 years and older in Hail, Saudi Arabia. The radiographs were analyzed for the presence of jawbone lesions, classified as radiolucent, radiopaque, or mixed, and their anatomical distribution was recorded. Statistical analysis was performed using the chi-square test, with a significance level set at p-values <0.05. Results A total of 389 jawbone lesions were identified in 177 subjects, representing a prevalence of 45.5%. Radiolucent lesions were the most common, observed in 153 (39.3%) subjects, while radiopaque lesions were found in 18 (4.6%) subjects, and mixed lesions in six (1.5%) subjects. The mandible was more frequently affected than the maxilla, with 104 (59%) lesions occurring in the mandible and 52 (29%) lesions in the maxilla. The posterior region of the jaw was the most commonly involved site, accounting for 124 (31.9%) cases. Gender and age did not significantly influence the prevalence or type of lesions, although a higher incidence was noted in the 31-45-year age group. Conclusions This study revealed a significant prevalence of jawbone lesions in the Hail population, with radiolucent lesions being the most common type, predominantly affecting theposterior region of the mandible. The findings highlight the importance of early detection and targeted dental health initiatives in this region. Further research, particularly longitudinal studies, is recommended to explore the natural history of these lesions and their impact on oral health over time.

Biallelic loss-of-function variations in BTD cause profound biotinidase deficiency in an Indian patient.

Biotinidase deficiency (BD) is a rare, autosomal recessive metabolic disorder characterized by neurocutaneous symptoms. This study investigates a case of profound BD in an Indian infant and the underlying genetic basis. A 10-month-old male presenting with seizures, hypotonia, ataxia, visual impairments, and developmental delay underwent biochemical and genetic analysis. Biotinidase activity was measured using an ELISA kit. Sanger sequencing of the biotinidase (BTD) gene was performed to identify genetic variations. In silico analysis was employed to assess the potential impact of the identified variants. The infant biotinidase activity was undetectable and its suggest profound biotinidase deficiency. Novel biallelic loss-of-function variations (c.903G > A and c.946C > T) in the BTD gene were identified, leading to premature stop codons and truncated, non-functional protein fragments. This case expands our knowledge of BD genetic diversity and underscores the critical role of early diagnosis and newborn screening programs in managing this treatable condition.

Justification for the creation of intelligent programs for early diagnosis, lung cancer phenotyping and treatment effectiveness assessment

BACKGROUND. Ordinary DICOM viewers used in practical medicine (Vitrea, EFilm, K-Pacs, etc.) allow only densitometric researches, which does not give a complete picture of the histological structure of the investigated tissues. Digital software processing of computed tomography (CT) data helps to investigate in detail the morphofunctional state of tissues and formations. OBJECTIVE. In view of the digital software processing of CT data, to justify the possibility of creating intelligent programs based on convolutional neural networks for early diagnostics, phenotyping and control of efficiency of lung cancer treatment. MATERIALS AND METHODS. The retrospective analysis of the data of 23 patients who were on treatment at the SI “National scientific center of phthisiology, pulmonology and allergology named after F.G. Yanovsky of the NAMS of Ukraine”. On the eve of operative treatment the patients underwent a full complex of inspections, including a CT scan. Digital software processing of CT data was conducted taking into account the results of immunohistochemical and pathistological inspections of removed tumours using the Dragonfly program. RESULTS. Differences in the histograms of various immunohistochemical forms of lung cancer have been revealed, that allows to create intelligent systems based on convolutional neural networks. It will help to conduct early diagnostics, phenotyping and control of efficiency of the personalized treatment of patients with lung cancer.

The TEOGIC study project: a comprehensive characterization of early onset gastrointestinal cancer in the Northern area of Spain

BackgroundGastrointestinal cancers represent one of the most prevalent diseases worldwide. Strikingly, the incidence of Early Onset Gastrointestinal Cancer (EOGIC) has been rising during the last decades and changes in lifestyle and environmental exposure seem to play a role. EOGIC has been defined as a different entity compared to on-average gastrointestinal cancer, with distinct clinical and molecular characteristics. Inherent to the particularities of younger age, there is an unmet need for a tailored approach for the management of these patients. The TEOGIC proposes a comprehensive study to characterize EOGIC patients in the northern of Spain.MethodsPatients with histologically confirmed new diagnosis of colorectal, gastroesophageal and pancreatic adenocarcinoma will be considered for two cohorts: EOGIC (≤ 50 years old) and non-EOGIC (60–75 years old), with a ratio of 1:2. Two hundred and forty patients will be recruited in 4 Public Hospitals from northern Spain. After receiving unified informed consent, demographic and clinical data of the patients will be collected in a REDCap database. Lifestyle related data will be obtained in questionnaires assessing diet, physical activity and the general quality of life of the patients before diagnosis. Biological samples prior to any onco-specific treatment will be obtained for the analyses of circulating inflammatory proteins, gut microbiota, and the proteome of the tumor microenvironment. Histologic characteristics and routine biomarkers will be also collected. Thereafter, data will be integrated and analyzed to assess tumor specific, pan-tumor and sex-associated differential characteristics of EOGIC.DiscussionThe underlying risk factors and differential characteristics of EOGIC remain poorly studied, particularly in our geographical area. Although limited by the exploratory nature and the small sample size estimated to be recruited, TEOGIC represents the first attempt to comprehensively characterize these young patients, and thus attend to their special needs. Findings derived from this study could contribute to raise awareness and preventive behaviors in the population. In parallel, molecular studies could lead to the identification of potential novel non-invasive biomarkers and therapeutic targets that would help in the development of the tailored clinical management of these patients, focusing on screening programs for early diagnosis and precision medicine.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care.

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services. Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021). The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health. The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care. Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality. The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Vulvar Carcinoma: Standard of Care and Perspectives.

Treatment of vulvar carcinoma (VC) is challenging. The objectives of this review were to describe for clinicians the epidemiologic and clinical aspects of VC, the standard of care in terms of primary local treatment and systemic therapies, and the recent innovations and perspectives emerging from translational research in immuno-oncology. We conducted a comprehensive review outlying the clinical aspects and biologic background of vulvar cancer, highlighting modern treatment strategies on the basis of a personalized approach. Epidemiologic data showed a recent rise in incidence of VC, attributed to human papillomavirus. Surgery is the mainstay of primary treatment, but multimodal approaches are frequently required in the presence of adverse prognosis histopathologic factors. Chemoradiation is indicated when organ-sparing surgery is not feasible. However, inability to achieve high locoregional control rates in advanced cases and the morbidity associated with local treatments are still key issues. Recent clinical data showed the benefit of individualized strategies combining organ-sparing surgical strategies, less invasive lymph node staging procedures, and refinement in radiotherapy modalities. Among the most important research area, there is a sound rationale for testing modern systemic approaches such as immune checkpoint inhibitors in selected patients with recurrent and/or metastatic tumors. Although no specific data exist for VC, the role of supportive care and post-treatment rehabilitation strategies is also crucial. There are still insufficient studies dedicated to patients with VC. Public health programs for prevention, screening, and early diagnosis are required, and clinical research should be strengthened to provide high-quality clinical evidence and improve patients' oncologic and functional outcomes.

Application of two-dimensional polymerase chain reaction to detect four types of microorganisms in feces for assisted diagnosis of IBD

BackgroundThe incidence of inflammatory bowel disease (IBD) continues to increase annually, accounting for about 6.8 million cases in 2017 worldwide. However, there is currently no gold standard for the diagnosis of IBD. MethodsA method for the detection of four microorganisms in feces by two-dimensional polymerase chain reaction (2D-PCR) has been developed. Plasmids were used to validate the sensitivity and specificity of the method. Clinical samples were tested using a 2D-PCR method. Optimal diagnostic thresholds for IBD were determined based on ROC results. ResultsOf the 112 samples, 78 were from IBD patients and 34 from patients with other gastrointestinal (GI) diseases. Thomasclavelia ramosum and univ907-1062 positivity are necessary, and two or more positives of the three bacteria (Thomasclavelia spiroforme, Thomasclavelia saccharogumia or Clostridium cluster XVIII) are the optimal diagnostic thresholds for IBD. The area under the curve was 0.826 with a 95% confidence interval of 0.735–0.981 and a p-value of 0.000, corresponding to a sensitivity of 0.769 and a specificity of 0.853. ConclusionsBased on the detection results of microorganisms, IBD and GI can be effectively distinguished. The detection of four microorganisms in feces can assist clinicians in the differential diagnosis of IBD. Our experiment aims to provide a better program for early clinical diagnosis and regular dynamic monitoring of IBD.

Basic new born and antenatal screening for aspirational districts: unique methods of management and treatment of inherited disorders

Background: Early screening, diagnosis and management program can contribute in reducing the burden of genetic disorders which can lead to early neonatal death or long-term disability in the vulnerable areas. UMMID (Unique Methods of Management and treatment of Inherited Disorders) and NIDAN (National Inherited Diseases Administration), aimed at developing a community level program for need assessment and to evaluate the feasibility of basic screening for some genetic/endocrine disorders in high-risk population. Methods: UMMID was carried out at the aspirational district Ranchi, Jharkhand for 3 years (2019-2022) to perform newborn screening (NBS) in &lt;7 days old newborn babies for 5 metabolic disorders and to screen antenatal mothers for prevention of thalassemia and other hemoglobinopathies. Results: G6PD deficiency being more prevalent in Ranchi district out of five metabolic disorders screened. 13.6% of screen positive cases were confirmed positive for hemoglobinopathies. c.20 A&gt;T is the most common mutation found among carriers. Conclusions: This initiative underscores the need of such screening programs in aspirational districts to manage and prevent these disorders effectively.

Evaluation of the Tuberculosis Surveillance System in the Southern Region of Iran

Aim The aim of this study was the evaluation of Tuberculosis (TB) surveillance system in Southern Iran. Background TB is one of the most important infectious diseases that has been common since ancient times. Methods This is a cross-sectional descriptive-analytical study that was conducted by the census method using the TB Surveillance System on 77 patients with tuberculosis in the southern region of Kerman province in Iran. The study was conducted over one year, from April 2020 to March 2021. Statistical tests were used by SPSS version 20 to analyze the data. Results 90.62% of the patients were cured and the rest experienced treatment failure and absenteeism. The average and standard deviation of the interval between the onset of the first symptom and the diagnosis and discovery of the disease were 88 and 93 days, respectively. Regarding the treatment duration, 95.5% of the cases followed the prescribed duration while the remaining cases did not. Among the affected patients, 34.8% had a history of hospitalization, while the rest had no such history. The average hospitalization duration was 12.92 days, with a standard deviation of 9.94 days. The longest hospital stay was 60 days, while the shortest was 2 days. Conclusion We need to have a suitable program for early diagnosis of TB, compliance with the length of treatment, and training of private and public centers to strengthen the care system. Additionally, we should strengthen the process of the directly observed treatment, short-course (DOTS) program to control TB.

Targeted diagnostics of breast cancer based on a comprehensive analysis of risk factors

BACKGROUND: To date, there are no effective methods for early diagnosis and screening of breast cancer. High-tech methods, such as magnetic resonance imaging and contrasted computed tomography, as well as positron emission computed tomography have high resolution, but their high cost does not allow the use of these techniques for screening and primary diagnosis.&#x0D; AIM: To improve the quality and efficiency of diagnostic measures for breast cancer through a personalized approach based on an analysis of a set of risk factors.&#x0D; MATERIALS AND METHODS: Data from the population cancer registry of the Altai Territory, created at the Altai Regional Oncology Center (Barnaul, Russia), were used. To date, the register includes information on 308 550 patients with malignant neoplasms, including 31 783 women with breast cancer.&#x0D; Based on the method of targeted prevention by A.F. Lazarev “Method for determining the risk of breast cancer according to Lazarev A.F.” (Patent No. 2651131) an “Automated program for early diagnosis of breast cancer” was developed. The program significantly reduces the time for the formation of groups of high cancer risk precancers and increases the efficiency of breast cancer detection, and also makes it possible to develop a set of targeted preventive measures personally for each patient. Testing of this algorithm included testing of 512 patients, as a result of which a high-risk precancer group was formed. In the established register, patients underwent a complex of in-depth examinations (ultrasound examination, mammography, magnetic resonance imaging with dynamic contrast, and puncture of tumors if indicated).&#x0D; RESULTS: The precancer group at high risk of developing breast cancer consisted of 92 patients, in-depth examination revealed 7 patients with established breast cancer, which amounted to 7.6%. All cases of breast cancer were detected in stages I and II.&#x0D; CONCLUSION: Targeted diagnostics using the “Automated program for early diagnosis of breast cancer” allows to improve the quality and efficiency of diagnostic measures for breast cancer identification through personalized approach, using multiple risk factors.

Caregivers’ experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India

BackgroundIndia has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers’ perspectives on barriers and facilitators to access and utilize EID services.MethodsThe study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers’ of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers’ perspectives.ResultsThe stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.DiscussionThe study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers’ perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.ConclusionThe study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Laboratory practice is central to earlier myeloma diagnosis: Utilizing a primary care diagnostic tool and laboratory guidelines integrated into haematology services.

Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis? The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme's working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a 'GP Myeloma diagnostic tool' and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.

Swin-GA-RF: genetic algorithm-based Swin Transformer and random forest for enhancing cervical cancer classification.

Cervical cancer is a prevalent and concerning disease affecting women, with increasing incidence and mortality rates. Early detection plays a crucial role in improving outcomes. Recent advancements in computer vision, particularly the Swin transformer, have shown promising performance in image classification tasks, rivaling or surpassing traditional convolutional neural networks (CNNs). The Swin transformer adopts a hierarchical and efficient approach using shifted windows, enabling the capture of both local and global contextual information in images. In this paper, we propose a novel approach called Swin-GA-RF to enhance the classification performance of cervical cells in Pap smear images. Swin-GA-RF combines the strengths of the Swin transformer, genetic algorithm (GA) feature selection, and the replacement of the softmax layer with a random forest classifier. Our methodology involves extracting feature representations from the Swin transformer, utilizing GA to identify the optimal feature set, and employing random forest as the classification model. Additionally, data augmentation techniques are applied to augment the diversity and quantity of the SIPaKMeD1 cervical cancer image dataset. We compare the performance of the Swin-GA-RF Transformer with pre-trained CNN models using two classes and five classes of cervical cancer classification, employing both Adam and SGD optimizers. The experimental results demonstrate that Swin-GA-RF outperforms other Swin transformers and pre-trained CNN models. When utilizing the Adam optimizer, Swin-GA-RF achieves the highest performance in both binary and five-class classification tasks. Specifically, for binary classification, it achieves an accuracy, precision, recall, and F1-score of 99.012, 99.015, 99.012, and 99.011, respectively. In the five-class classification, it achieves an accuracy, precision, recall, and F1-score of 98.808, 98.812, 98.808, and 98.808, respectively. These results underscore the effectiveness of the Swin-GA-RF approach in cervical cancer classification, demonstrating its potential as a valuable tool for early diagnosis and screening programs.

Early diagnostics of prostate cancer based on a comprehensive analysis of risk factors

BACKGROUND: There is a trend of increasing incidence and mortality from prostate cancer. Existing methods for early diagnosis and screening of prostate cancer did not demonstrate enough efficiency.&#x0D; AIM: To improve the quality and efficiency of diagnostic measures for prostate cancer through a personalized approach to patients based on an analysis of a set of risk factors.&#x0D; MATERIALS AND METHODS: The methodology was developed using the data from the population-based Cancer Registry of the Altai Territory, created at the Altai Regional Oncology Center in Barnaul, Russia. At the moment the Cancer Registry included information on 308 550 patients with malignant neoplasms, including 15 167 males with prostate cancer. On the basis of the method of prostate cancer risk assessment proposed by Lazarev AF an automated program for early diagnosis of prostate cancer has been developed. Testing of this technique included assessment of 532 patients (aged between 23 and 82).&#x0D; RESULTS: 128 patients were determined to belong to the high risk pre-cancer group. A high-risk precancer registry was created, which included the patients having individual risk of developing prostate cancer either increased or high or absolute. Upon a set of in-depth examinations, 7 of 128 patients (9.3%) were diagnosed with prostate cancer, all at early stages (I or II). Thus, the incidence of prostate cancer among the patients from the high risk pre-cancer registry was significantly higher than the average observed during prophylactic examinations (0.01%).&#x0D; CONCLUSION: The automated program for early diagnosis of prostate cancer could be implemented with the aim to assign in-depth examination in more targeted manner to patients at high risk of prostate cancer and to contribute to detection the cancer in the early stages.