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Neves LM, Pinto M, Zin OA, Cunha DP, Agonigi BNS, Motta FL, Gomes LHF, Horovitz DDG, Almeida DC, Malacarne J, Guida L, Braga A, Carvalho AB, Pereira E, Rodrigues APS, Sallum JMF, Zin AA, Vasconcelos ZFM. The cost of genetic diagnosis of suspected hereditary pediatric cataracts with whole-exome sequencing from a middle-income country perspective: a mixed costing analysis. J Community Genet 2024; 15:235-247. [PMID: 38730191 PMCID: PMC11217199 DOI: 10.1007/s12687-024-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Up to 25% of pediatric cataract cases are inherited. There is sparse information in the literature regarding the cost of whole-exome sequencing (WES) for suspected hereditary pediatric cataracts. Molecular diagnosis of suspected hereditary pediatric cataracts is important for comprehensive genetic counseling. We performed a partial economic evaluation with a mixed costing analysis, using reimbursement data and microcosting approach with a bottom-up technique to estimate the cost of using WES for genetic diagnosis of suspected hereditary pediatric cataracts from the perspective of the Brazilian governmental health care system. One hundred and ten participants from twenty-nine families in Rio de Janeiro (RJ) were included. Costs of consumables, staff and equipment were calculated. Two scenarios were created: (1) The reference scenario included patients from RJ with suspected hereditary pediatric cataracts plus two family members. (2) The alternative scenario considered other genetic diseases, resulting in 5,280 exams per month. Sensitivity analysis was also performed. In the reference scenario, the total cost per exam was 700.09 United States dollars (USD), and in the alternative scenario, the total cost was 559.23 USD. The cost of WES alone was 527.85 USD in the reference scenario and 386.98 USD in the alternative scenario. Sensitivity analysis revealed that the largest costs were associated with consumables in both scenarios. Economic evaluations can help inform policy decisions, especially in middle-income countries such as Brazil.
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Affiliation(s)
- Luiza M Neves
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
- Department of Ophthalmology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Márcia Pinto
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil.
| | - Olivia A Zin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
- Instituto Brasileiro de Oftalmologia, Rio de Janeiro, 22250-040, Brazil
| | - Daniela P Cunha
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Bruna N S Agonigi
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | | | - Leonardo H F Gomes
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Dafne D G Horovitz
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Daltro C Almeida
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Jocieli Malacarne
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Leticia Guida
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Andressa Braga
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
| | - Adriana Bastos Carvalho
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-971, Brazil
| | | | - Ana Paula S Rodrigues
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
| | - Juliana M F Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
| | - Andrea A Zin
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
- Instituto Brasileiro de Oftalmologia, Rio de Janeiro, 22250-040, Brazil
- Instituto Catarata Infantil, Rio de Janeiro, 22250-040, Brazil
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Bilal A, Liu X, Shafiq M, Ahmed Z, Long H. NIMEQ-SACNet: A novel self-attention precision medicine model for vision-threatening diabetic retinopathy using image data. Comput Biol Med 2024; 171:108099. [PMID: 38364659 DOI: 10.1016/j.compbiomed.2024.108099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Abstract
In the realm of precision medicine, the potential of deep learning is progressively harnessed to facilitate intricate clinical decision-making, especially when navigating multifaceted datasets encompassing Omics, Clinical, image, device, social, and environmental dimensions. This study accentuates the criticality of image data, given its instrumental role in detecting and classifying vision-threatening diabetic retinopathy (VTDR) - a predominant global contributor to vision impairment. The timely identification of VTDR is a linchpin for efficacious interventions and the mitigation of vision loss. Addressing this, This study introduces "NIMEQ-SACNet," a novel hybrid model by the prowess of the Enhanced Quantum-Inspired Binary Grey Wolf Optimizer (EQI-BGWO) with a self-attention capsule network. The proposed approach is characterized by two pivotal advancements: firstly, the augmentation of the Binary Grey Wolf Optimization through Quantum Computing methodologies, and secondly, the deployment of the enhanced EQI-BGWO to adeptly calibrate the SACNet's parameters, culminating in a notable uplift in VTDR classification accuracy. The proposed model's ability to handle binary, 5-stage, and 7-stage VTDR classifications adroitly is noteworthy. Rigorous assessments on the fundus image dataset, underscored by metrics such as Accuracy, Sensitivity, Specificity, Precision, F1-Score, and MCC, bear testament to NIMEQ-SACNet's pre-eminence over prevailing algorithms and classification frameworks.
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Affiliation(s)
- Anas Bilal
- College of Information Science and Technology, Hainan Normal University, Haikou, 571158, China
| | - Xiaowen Liu
- College of Information Science and Technology, Hainan Normal University, Haikou, 571158, China
| | - Muhammad Shafiq
- School of Information Engineering, Qujing Normal University, Sichuan, China
| | - Zohaib Ahmed
- Department of Criminology and Forensic Sciences, Lahore Garrison University, Lahore, Pakistan
| | - Haixia Long
- College of Information Science and Technology, Hainan Normal University, Haikou, 571158, China.
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Kuang G, Halimitabrizi M, Edziah AA, Salowe R, O’Brien JM. The potential for mitochondrial therapeutics in the treatment of primary open-angle glaucoma: a review. Front Physiol 2023; 14:1184060. [PMID: 37601627 PMCID: PMC10433652 DOI: 10.3389/fphys.2023.1184060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Glaucoma, an age-related neurodegenerative disease, is characterized by the death of retinal ganglion cells (RGCs) and the corresponding loss of visual fields. This disease is the leading cause of irreversible blindness worldwide, making early diagnosis and effective treatment paramount. The pathophysiology of primary open-angle glaucoma (POAG), the most common form of the disease, remains poorly understood. Current available treatments, which target elevated intraocular pressure (IOP), are not effective at slowing disease progression in approximately 30% of patients. There is a great need to identify and study treatment options that target other disease mechanisms and aid in neuroprotection for POAG. Increasingly, the role of mitochondrial injury in the development of POAG has become an emphasized area of research interest. Disruption in the function of mitochondria has been linked to problems with neurodevelopment and systemic diseases. Recent studies have shown an association between RGC death and damage to the cells' mitochondria. In particular, oxidative stress and disrupted oxidative phosphorylation dynamics have been linked to increased susceptibility of RGC mitochondria to secondary mechanical injury. Several mitochondria-targeted treatments for POAG have been suggested, including physical exercise, diet and nutrition, antioxidant supplementation, stem cell therapy, hypoxia exposure, gene therapy, mitochondrial transplantation, and light therapy. Studies have shown that mitochondrial therapeutics may have the potential to slow the progression of POAG by protecting against mitochondrial decline associated with age, genetic susceptibility, and other pathology. Further, these therapeutics may potentially target already present neuronal damage and symptom manifestations. In this review, the authors outline potential mitochondria-targeted treatment strategies and discuss their utility for use in POAG.
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Affiliation(s)
- Grace Kuang
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Mina Halimitabrizi
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy-Ann Edziah
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Salowe
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Joan M. O’Brien
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
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Short-Term In Vitro ROS Detection and Oxidative Stress Regulators in Epiretinal Membranes and Vitreous from Idiopathic Vitreoretinal Diseases. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7497816. [PMID: 36567907 PMCID: PMC9788888 DOI: 10.1155/2022/7497816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Abstract
Background A plethora of inflammatory, angiogenic, and tissue remodeling factors has been reported in idiopathic epiretinal membranes (ERMs). Herein we focused on the expression of a few mediators (oxidative, inflammatory, and angiogenic/vascular factors) by means of short-term vitreal cell cultures and biomolecular analysis. Methods Thirty-nine (39) ERMs and vitreal samples were collected at the time of vitreoretinal surgery and biomolecular analyses were performed in clear vitreous, vitreal cell pellets, and ERMs. ROS products and iNOS were investigated in adherent vitreal cells and/or ERMs, and iNOS, VEGF, Ang-2, IFNγ, IL18, and IL22 were quantified in vitreous (ELISA/Ella, IF/WB); transcripts specific for iNOS, p65NFkB, KEAP1, NRF2, and NOX1/NOX4 were detected in ERMs (PCR). Biomolecular changes were analyzed and correlated with disease severity. Results The higher ROS production was observed in vitreal cells at stage 4, and iNOS was found in ERMs and increased in the vitreous as early as at stage 3. Both iNOS and NOX4 were upregulated at all stages, while p65NFkB was increased at stage 3. iNOS and NOX1 were positively and inversely related with p65NFkB. While NOX4 transcripts were always upregulated, NRF2 was upregulated at stage 3 and inverted at stage 4. No significant changes occurred in the release of angiogenic (VEGF, Ang-2) and proinflammatory (IL18, IL22 and IFNγ) mediators between all stages investigated. Conclusions ROS production was strictly associated with iNOS and NOX4 overexpression and increased depending on ERM stadiation. The higher iNOS expression occurred as early as stage 3, with respect to p65NFkB and NRF2. These last mediators might have potential prognostic values in ERMs as representative of an underneath retinal damage.
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Grani F, Soto-Sánchez C, Fimia A, Fernández E. Toward a personalized closed-loop stimulation of the visual cortex: Advances and challenges. Front Cell Neurosci 2022; 16:1034270. [PMID: 36582211 PMCID: PMC9792612 DOI: 10.3389/fncel.2022.1034270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
Current cortical visual prosthesis approaches are primarily unidirectional and do not consider the feed-back circuits that exist in just about every part of the nervous system. Herein, we provide a brief overview of some recent developments for better controlling brain stimulation and present preliminary human data indicating that closed-loop strategies could considerably enhance the effectiveness, safety, and long-term stability of visual cortex stimulation. We propose that the development of improved closed-loop strategies may help to enhance our capacity to communicate with the brain.
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Affiliation(s)
- Fabrizio Grani
- Institute of Bioengineering, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Cristina Soto-Sánchez
- Institute of Bioengineering, Universidad Miguel Hernández de Elche, Elche, Spain,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Antonio Fimia
- Departamento de Ciencia de Materiales, Óptica y Tecnología Electrónica, Universidad Miguel Hernández de Elche, Elche, Spain
| | - Eduardo Fernández
- Institute of Bioengineering, Universidad Miguel Hernández de Elche, Elche, Spain,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain,*Correspondence: Eduardo Fernández,
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