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Rezaei S, Sakadi F, Hiew FL, Rodriguez-Leyva I, Kruja J, Wasay M, Seidi OA, Abdel-Aziz S, Nafissi S, Mateen F. Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach. Gates Open Res 2022; 5:178. [PMID: 35299829 PMCID: PMC8901583 DOI: 10.12688/gatesopenres.13447.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.
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Affiliation(s)
- Shawheen Rezaei
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA
| | | | - Fu-Liong Hiew
- Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ildefonso Rodriguez-Leyva
- Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico.,Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
| | - Jera Kruja
- Neurology, University of Medicine, Tirana, Tirana, Albania.,Neurology, University Hospital Center Mother Teresa, Tirana, Albania
| | - Mohammad Wasay
- Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Osheik AbuAsha Seidi
- University of Khartoum, Khartoum, Sudan.,Neurology, Soba University Hospital, Khartoum, Sudan
| | | | - Shahriar Nafissi
- Neurology, Tehran University of Medical Sciences, Tehran, Iran.,Neurology, Shariati Hospital, Tehran, Iran
| | - Farrah Mateen
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA.,Harvard Medical School, Boston, Massachusetts, 02115, USA
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Rezaei S, Sakadi F, Hiew FL, Rodriguez-Leyva I, Kruja J, Wasay M, Seidi OA, Abdel-Aziz S, Nafissi S, Mateen F. Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach. Gates Open Res 2021; 5:178. [DOI: 10.12688/gatesopenres.13447.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person’s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people.
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Image Quality Assessment to Emulate Experts’ Perception in Lumbar MRI Using Machine Learning. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11146616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Medical image quality is crucial to obtaining reliable diagnostics. Most quality controls rely on routine tests using phantoms, which do not reflect closely the reality of images obtained on patients and do not reflect directly the quality perceived by radiologists. The purpose of this work is to develop a method that classifies the image quality perceived by radiologists in MR images. The focus was set on lumbar images as they are widely used with different challenges. Three neuroradiologists evaluated the image quality of a dataset that included T1-weighting images in axial and sagittal orientation, and sagittal T2-weighting. In parallel, we introduced the computational assessment using a wide range of features extracted from the images, then fed them into a classifier system. A total of 95 exams were used, from our local hospital and a public database, and part of the images was manipulated to broaden the distribution quality of the dataset. Good recall of 82% and an area under curve (AUC) of 77% were obtained on average in testing condition, using a Support Vector Machine. Even though the actual implementation still relies on user interaction to extract features, the results are promising with respect to a potential implementation for monitoring image quality online with the acquisition process.
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Pluta P, Giza A, Kolenda M, Fendler W, Braun M, Chudobiński C, Chałubińska-Fendler J, Araszkiewicz M, Loga K, Lembas L, Witkowska M, Pluta A, Kolasiński J, Basta P, Kołacińska-Voytkuv A, Cieśla S, Jesionek-Kupnicka D, Jankau J, Kuczyński M, Kalinka E, Zadrożny M, Murawa D. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in Poland: analysis of patient series and practical guidelines for breast surgeons. Arch Med Sci 2020; 19:1243-1251. [PMID: 37732037 PMCID: PMC10507758 DOI: 10.5114/aoms.2020.100637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/07/2020] [Indexed: 09/22/2023] Open
Abstract
Introduction Although breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is infrequent, with less than 1000 noted cases worldwide, patients consenting for breast implant surgery should be aware of its risk. We describe the first Polish multicenter case-series data on BIA-ALCL patients and present diagnostic and treatment recommendation for breast surgeons. Material and methods In cooperation with the Polish Society of Surgical Oncology and Polish Lymphoma Research Group, we collected BIA-ALCL cases in Poland. Results We retrospectively reviewed clinical data of seven BIA-ALCL patients, diagnosed between July 2013 and November 2019. The median time from implant placement to the first BIA-ALCL symptoms was 65 months (range: 33-96 months). All the patients were exposed to textured implants at presentation. Capsulectomy with implant removal was performed in all the patients with immediate reimplantation in 2 cases. In a median follow-up of 19 months (range 5-81 months), there was no recurrence and all the patients stayed alive. Between 2013 and 2019, the incidence of BIA-ALCL in Polish female population age 30 and above ranged from 0 to 0.021/100 000/year. Conclusions BIA-ALCL is scarce in the Polish population. In a short-term follow-up, patients' prognosis remains excellent. Due to the withdrawal of roughly textured implants from the market and the exclusion of likely the most potent etiologic factor, it might be expected that the incidence of BIA-ALCL will become even rarer.
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Affiliation(s)
- Piotr Pluta
- Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Agnieszka Giza
- Department of Hematology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wojciech Fendler
- Department of Radiation Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Marcin Braun
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Cezary Chudobiński
- Department of Radiology, Regional Oncology Centre, Copernicus Memorial Hospital, Lodz, Poland
| | | | - Michał Araszkiewicz
- Legal Advisor’s Office, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Karolina Loga
- Department of Radiotherapy and General Oncology, Regional Oncology Centre, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | | | - Magdalena Witkowska
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Pluta
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Paweł Basta
- Departament of Gynecology and Oncology, Jagiellonian University, Medical College Breast Unit of University Hospital, Krakow, Poland
| | | | - Sławomir Cieśla
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences University, Zielona Gora, Poland
| | | | - Jerzy Jankau
- Department of Plastic Surgery, Gdansk Medical University, Gansk, Poland
| | | | - Ewa Kalinka
- Department of Oncology, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Marek Zadrożny
- Department of Surgical Oncology and Breast Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland
| | - Dawid Murawa
- Clinic of General Surgery and Surgical Oncology, Faculty of Medicine and Health Sciences University, Zielona Gora, Poland
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