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Haque AU, Ghani S, Saeed M, Schloer H. Pneumonia classification: A limited data approach for global understanding. Heliyon 2024; 10:e26177. [PMID: 38390159 PMCID: PMC10881372 DOI: 10.1016/j.heliyon.2024.e26177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
As the human race has advanced, so too have the ailments that afflict it. Diseases such as pneumonia, once considered to be basic flu or allergies, have evolved into more severe forms, including SARs and COVID-19, presenting significant risks to people worldwide. In our study, we focused on categorizing pneumonia-related inflammation in chest X-rays (CXR) using a relatively small dataset. Our approach was to encompass a comprehensive view, addressing every potential area of inflammation in the CXR. We employed enhanced class activation maps (mCAM) to meet the clinical criteria for classification rationale. Our model incorporates capsule network clusters (CNsC), which aids in learning different aspects such as geometry, orientation, and position of the inflammation seen in the CXR. Our Capsule Network Clusters (CNsC) rapidly interpret various perspectives in a single CXR without needing image augmentation, a common necessity in existing detection models. This approach significantly cuts down on training and evaluation durations. We conducted thorough testing using the RSNA pneumonia dataset of CXR images, achieving accuracy and recall rates as high as 98.3% and 99.5% in our conclusive tests. Additionally, we observed encouraging outcomes when applying our trained model to standard X-ray images obtained from medical clinics.
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Affiliation(s)
- Anwar Ul Haque
- SMCS, Institute of Business Administration Karachi, Pakistan
| | - Sayeed Ghani
- SMCS, Institute of Business Administration Karachi, Pakistan
| | - Muhammad Saeed
- Department of Computer Science, University of Karachi, Pakistan
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2
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Kumar R, Haresh KP, Sharma DN, Gupta A, Gupta S, Vellaiyan S, Rath GK. Low-dose radiotherapy for COVID 19: A radioimmunological perspective. J Cancer Res Ther 2021; 17:295-302. [PMID: 34121671 DOI: 10.4103/jcrt.jcrt_1045_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The world is fighting the onslaught of COVID 19 for the last 10 months, ever since the first case was reported in December 2019 in Wuhan, China. Now, it has spread to over 200 countries. COVID 19-associated respiratory syndrome is causing a lot of mortality and morbidity. There are reports suggesting that the complications and ARDS associated with COVID 19 is an immune response reaction. The cytokine storm associated with severe cases of COVID 19 acts as a cause of death in many sick patients. It has been shown that COVID 19 is associated with a peculiar immune profile: Decrease in CD3, CD4, CD8, natural killer cell and B-cells; Rise in interleukin (IL)-4, IL-6 and tumor necrosis factor (TNF) alpha; Decrease in IL-10; Decrease in interferon-gamma. Low-dose radiotherapy (LDRT) immunosuppressive features resulting from M2 macrophage phenotype activation, increase in IL-10, transforming growth factor beta, a decrease in IL-6, TNF alpha and an increase in CD3, CD4, and CD8 T cell counts may negate the harmful effects of cytokine release syndrome. Literature review shows that radiation was previously used to treat viral pneumonia with a good success rate. This practice was discontinued in view of the availability of effective antibiotics and antivirals. As there are no scientifically proven treatment for severe COVID 19-associated respiratory distress today, it is prudent that we understand the benefits of LDRT at this critical juncture and take rational decisions to treat the same. This article provides an radioimmunological rationale for the treatment of immune crisis mediated complications in severe cases of COVID 19.
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Affiliation(s)
- Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kunhi Parambath Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi; Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Anil Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subramani Vellaiyan
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi; Department of Radiation Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
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Lonsdale DO, Lipman J. Global personalization of antibiotic therapy in critically ill patients. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1874823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Dagan O Lonsdale
- Department of Clinical Pharmacology, St George’s, University of London, London, UK
- Department of Critical Care, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jeffrey Lipman
- Department of Intensive Care, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Pappas TN. President Warren G. Harding and the 5 Doctors Who Managed His Final Illness. ANNALS OF SURGERY OPEN 2020; 1:e006. [PMID: 37637452 PMCID: PMC10455054 DOI: 10.1097/as9.0000000000000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022] Open
Abstract
Warren G. Harding was elected president of the United States in 1920 and died before he finished his third year in office. Early in 1923, he had progressive weakness, shortness of breath, and chest pain. In July of 1923, while on a western trip, he developed an episode of abdominal pain and fever. His trip was truncated and he was taken to the Palace Hotel in San Francisco, where 5 physicians attempted to treat his worsening symptoms. He died on August 2 of what was presumed to be a stroke. Historians have disagreed over the President's cause of death. This article reviews the medical evidence available from the doctors who cared for the President in an effort to define Harding's terminal illness.
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Affiliation(s)
- Theodore N. Pappas
- From the Department of Surgery, Duke University School of Medicine, Duke University Medical Center, Durham, NC
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Abstract
Increasing hospital admissions for pneumonia have been reported recently but it is not known whether pneumonia incidence rates have increased in the community. To determine whether incidence rates of pneumonia increased in primary care in the United Kingdom from 2002 to 2017, an open cohort study was conducted using electronic health records from the UK Clinical Practice Research Datalink. Clinically diagnosed pneumonia, influenza pneumonia, pleural infection and clinically suspected pneumonia, defined as chest infection treated with antibiotics, were evaluated. Age-standardised and age-specific rates were estimated. Joinpoint regression models were fitted and annual percentage changes (APC) were estimated. There were 70.7 million person-years of follow-up with 120 662 episodes of clinically diagnosed pneumonia, 1 831 005 of clinically suspected pneumonia, 23 814 episodes of influenza pneumonia and 2644 pleural infections over 16 years. The incidence of clinically diagnosed pneumonia increased from 1.50 per 1000 person-years in 2002 to 2.22 per 1000 in 2017. From 2010 to 2017, the APC in age-standardised incidence was 5.1% (95% confidence interval 3.4-6.9) compared with 0.3% (-0.6 to 1.2%) before 2010. Clinically suspected pneumonia incidence rates increased from 2002 to 2008 with an APC 3.8% (0.8-6.9) but decreased with an APC -4.9% (-6.7 to -3.1) from 2009 to 2017. Influenza pneumonia increased in the epidemic year of 2009. There was no overall trend in pleural infection. The results show that clinically diagnosed pneumonia has increased in primary care but there was a contemporaneous decline in recording of clinically suspected pneumonia or 'chest infection'. Changes in disease labelling practice might partly account for these trends.
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Ercibengoa M, Alonso M, Vicente D, Morales M, Garcia E, Marimón JM. Utility of MALDI-TOF MS as a new tool for Streptococcus pneumoniae serotyping. PLoS One 2019; 14:e0212022. [PMID: 30753210 PMCID: PMC6372175 DOI: 10.1371/journal.pone.0212022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
Nowadays, more than 95 different Streptococcus pneumoniae serotypes are known, being less than one third responsible for the majority of severe pneumococcal infections. After the introduction of conjugate vaccines, a change in the epidemiology of the serotypes causing invasive pneumococcal disease has been observed making the surveillance of circulating serotypes especially relevant. Some recent studies have used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) technology to identify the most frequent pneumococcal serotypes that cause invasive disease. The objectives of this study were to evaluate the efficacy of previously described discriminatory peaks determined by MALDI-TOF MS for the identification of serotypes 6B, 19F, 19A and 35B using reference and clinical isolates and to try to identify other discriminatory peaks for serotypes 11A, 19F and 19A using transformed pneumococcal strains. Most of the proposed peaks defined in the literature for the identification of serotypes 6B, 19F, 19A, 35B were not found in the spectra of the 10 reference isolates nor in those of the 60 clinical isolates tested corresponding to these four serotypes. The analysis and comparison of the mass spectra of genetically modified pneumococci (transformed strains) did not allow the establishment of new discriminatory peaks for serotypes 11A, 19F, and 19A. MALDI-TOF MS in the usual range of 2,000 to 20,000 m/z did not prove to be a valid technique for direct S. pneumoniae serotyping.
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Affiliation(s)
- María Ercibengoa
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Preventive Medicine and Health Public Department, University of Basque Country UPV/EHU, San Sebastián, Spain
- * E-mail:
| | - Marta Alonso
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
| | - Diego Vicente
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Preventive Medicine and Health Public Department, University of Basque Country UPV/EHU, San Sebastián, Spain
| | - Maria Morales
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Departamento de Biotecnología Microbiana y de Plantas, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Ernesto Garcia
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
- Departamento de Biotecnología Microbiana y de Plantas, Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Jose María Marimón
- Hospital Universitario Donostia–Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
- CIBER de Enfermedades Respiratorias–CIBERES, Madrid, Spain
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Rijkers GT, Yousif LI, Spoorenberg SM, van Overveld FJ. Triptych of the Hermit Saints: pneumococcal polysaccharide vaccines for the elderly. Risk Manag Healthc Policy 2018; 11:55-65. [PMID: 29636634 PMCID: PMC5881283 DOI: 10.2147/rmhp.s130405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pneumococcal pneumonia is a serious disease with considerable morbidity and mortality in the elderly. Despite adequate antibiotic treatment, the long-term mortality of pneumococcal pneumonia remains high. Preventive measures in the form of vaccination, therefore, are warranted. Twenty-three-valent polysaccharide vaccines have a broad coverage but limited efficacy. Pneumococcal conjugate vaccines have been shown in children to be able to prevent invasive and mucosal pneumococcal diseases. It should be realized that the serotype composition of current pneumococcal conjugate vaccines is not tailored for the elderly, and that replacement disease can occur. Yet, the current 13-valent conjugate vaccine has been shown to protect against infections with vaccine serotypes. Long-term mortality of pneumococcal pneumonia should be included in policy making about the introduction of these vaccines for the elderly.
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Affiliation(s)
- Ger T Rijkers
- Department of Science, University College Roosevelt, Middelburg, the Netherlands.,Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Laura Ie Yousif
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
| | | | - Frans J van Overveld
- Department of Science, University College Roosevelt, Middelburg, the Netherlands
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Dickson RP, Erb-Downward JR, Huffnagle GB. Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis. THE LANCET RESPIRATORY MEDICINE 2014; 2:238-46. [PMID: 24621685 DOI: 10.1016/s2213-2600(14)70028-1] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pneumonia is a major cause of morbidity and mortality for which no new methods of treatment have entered clinical practice since the discovery of antibiotics. Innovations in the techniques of culture-independent microbial identification have shown that the lungs, previously deemed sterile in the absence of infection, contain diverse and dynamic communities of microbes. In this Personal View, we argue that these observations have shown the inadequacy of traditional conceptual models of lung microbiology and the pathogenesis of pneumonia, hampering progress in research and practice. We propose three new conceptual models to replace the traditional models of lung microbiology: an adapted island model of lung biogeography, the effect of environmental gradients on lung microbiota, and pneumonia as an emergent phenomenon propelled by unexplored positive feedback loops. We argue that the ecosystem of lung microbiota has all of the features of a complex adaptive system: diverse entities interacting with each other within a common space, showing interdependent actions and possessing the capacity to adapt to changes in conditions. Complex adaptive systems are fundamentally different in behaviour from the simple, linear systems typified by the traditional model of pneumonia pathogenesis, and need distinct analytical approaches.
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Affiliation(s)
- Robert P Dickson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - John R Erb-Downward
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gary B Huffnagle
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan MI, USA
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Calabrese EJ, Dhawan G. How radiotherapy was historically used to treat pneumonia: could it be useful today? THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2013; 86:555-70. [PMID: 24348219 PMCID: PMC3848110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
X-ray therapy was used to treat pneumonia during the first half of the 20th century. Fifteen studies report that approximately 700 cases of bacterial (lobar and bronchopneumonia), sulfanilamide non-responsive, interstitial, and atypical pneumonia were effectively treated by low doses of X-rays, leading to disease resolution, based on clinical symptoms, objective disease biomarkers, and mortality incidence. The capacity of the X-ray treatment to reduce mortality was similar to serum therapy and sulfonamide treatment during the same time period. Studies with four experimental animal models (i.e., mice, guinea pig, cat, and dog) with bacterial and viral pneumonia supported the clinical findings. The mechanism by which the X-ray treatment acts upon pneumonia involves the induction of an anti-inflammatory phenotype that leads to a rapid reversal of clinical symptoms, facilitating disease resolution. The capacity of low doses of X-rays to suppress inflammatory responses is a significant new concept with widespread biomedical and therapeutic applications.
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Affiliation(s)
- Edward J. Calabrese
- To whom all correspondence should be
addressed: Edward J. Calabrese, PhD, Professor of Toxicology, Department of
Public Health, Environmental Health Sciences, Morrill I, N344, University of
Massachusetts, Amherst, MA 01003; Tele: 413-545-3164; Fax: 413-545-4692;
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Singer M, Nambiar S, Valappil T, Higgins K, Gitterman S. Historical and regulatory perspectives on the treatment effect of antibacterial drugs for community-acquired pneumonia. Clin Infect Dis 2008; 47 Suppl 3:S216-24. [PMID: 18986293 DOI: 10.1086/591407] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A noninferiority margin based on the treatment effect of antibacterial drugs is required for noninferiority studies of community-acquired pneumonia. A quantitative estimate of treatment effect is generally determined from placebo-controlled trials, but, since the mid-to-late 1930s, no studies have compared outcomes for patients who received placebo (or no specific therapy) with those for patients who received an antibacterial drug for treatment of community-acquired pneumonia. In this article, early controlled studies, as well as observational data, are reviewed, and the beneficial effect of antibacterial drugs on mortality rates among patients with pneumococcal pneumonia is demonstrated. However, because these data were obtained in the early 20th century, several important factors have changed, including patient populations, the etiological agents of pneumonia, and medical standards of care. Thus, the applicability of these studies to the determination of a noninferiority margin for contemporary trials for community-acquired pneumonia remains in question.
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Affiliation(s)
- M Singer
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Antimicrobial Products, Silver Spring, Maryland 20993, USA.
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