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Javaid U, Mahmud TH, Rasheed A, Javaid AUR, Riaz S, Zohaib A. Factors Leading to Diagnostic and Therapeutic Delay of Rheumatoid Arthritis and Their Impact on Disease Outcome. Cureus 2023; 15:e34481. [PMID: 36874695 PMCID: PMC9982193 DOI: 10.7759/cureus.34481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Objective To identify the factors which lead to delay in diagnosis and initiation of disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients and their impact on disease outcome and functional ability. Methodology This cross-sectional study was conducted from June 2021 to May 2022 at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore. Inclusion criteria were patients aged >18 years who were diagnosed with RA, based on American College of Rheumatology (ACR) criteria 2010. Delay was defined as any sort of delay which leads to delay in diagnosis or initiation of treatment of more than three months. The factors and impact on disease outcome were measured by using Disease Activity Score-28 (DAS-28) for disease activity and Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional disability. The collected data were analyzed with Statistical Package for Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY, USA). Results One hundred and twenty patients were included in the study. Mean delay in referral to a rheumatologist was 36.75±61.07 weeks. Fifty-eight (48.3%) patients with RA were misdiagnosed before presentation to a rheumatologist. Sixty-six (55%) patients had the perception that RA is a non-treatable disease. Delay in diagnosis of RA from onset of symptoms (lag 3) and delay in start of DMARDs from onset of symptoms (lag 4) were significantly associated with increased DAS-28 and HAQ-DI scores (p-value 0.001). Conclusion The factors which led to diagnostic and therapeutic delay were delayed consultation with a rheumatologist, old age, low education status and low socioeconomic status. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies had no role in diagnostic and therapeutic delay. Many RA patients were misdiagnosed with gouty arthritis and undifferentiated arthritis before consulting a rheumatologist. This diagnostic and therapeutic delay compromises RA management leading to high DAS-28 and HAQ-DI in RA patients.
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Affiliation(s)
- Umair Javaid
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Tafazzul H Mahmud
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Aflak Rasheed
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | | | - Saima Riaz
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Amer Zohaib
- Rheumatology, Sheikh Zayed Postgraduate Medical Institute, Lahore, PAK
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Zohaib A, Rasheed A, Mahmud TEH, Hayat U, Shabbir S, Riaz S, Jamil MZZ, Javaid U. Correlation of Hypothyroidism With Disease Activity Score-28 in Patients of Rheumatoid Arthritis. Cureus 2022; 14:e26382. [PMID: 35911270 PMCID: PMC9329509 DOI: 10.7759/cureus.26382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic autoimmune disorder with variable disease course including periods of flares and remissions. High disease activity in terms of disease activity score-28 (DAS-28) results in significant morbidity. Hypothyroidism is found to be associated with higher DAS-28 scores in RA. This study is planned to determine overt and subclinical hypothyroidism and its correlation with the DAS-28 score in patients with RA. Methodology This study was conducted from June 2021 to March 2022 at the department of rheumatology and immunology at Shaikh Zayed Hospital, Lahore, Pakistan. Inclusion criteria were any male and female patients aged between 18 and 70 years. The blood samples of diagnosed patients with RA were sent for thyroid function tests (thyroxine [FT4], thyroid-stimulating hormone [TSH]), and erythrocyte sedimentation rate (ESR), and the patients were categorized as overt hypothyroidism, subclinical hypothyroidism, and non-hypothyroid. The collected data were analyzed on Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). Results The mean age of patients was 38.18 ± 9.78 years. The mean duration of symptoms was 14.65 ± 1.04 months. There were 182 (91%) females and 18 (9%) males. The mean number of swollen joints was 2.26 ± 2.8, and the mean number of tender joints was 4.16 ± 5.11. Sixty patients (30%) had high disease activity, i.e., DAS-28 score > 5.1. Fifty-seven patients (28.5%) with RA had subclinical hypothyroidism, and 19 patients (9.5%) had overt hypothyroidism. Pain visual analog scale (VAS) and DAS-28 were significantly higher in hypothyroid patients. Conclusion It was concluded that patients of RA with concomitant hypothyroidism had increased disease activity with increased tender joints. Thyroid function tests should be included in the clinical evaluation of RA patients. The evaluation of thyroid functional status must be done during screening in RA patients. This will detect thyroid disorders earlier, with early treatment initiation and possibly a better prognosis.
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Hazafa A, Iqbal MO, Javaid U, Tareen MBK, Amna D, Ramzan A, Piracha S, Naeem M. Inhibitory effect of polyphenols (phenolic acids, lignans, and stilbenes) on cancer by regulating signal transduction pathways: a review. Clin Transl Oncol 2022; 24:432-445. [PMID: 34609675 DOI: 10.1007/s12094-021-02709-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023]
Abstract
Natural products, especially polyphenols (phenolic acids, lignans, and stilbenes) are suggested to be more potent anticancer drugs because of their no or less adverse effects, excess availability, high accuracy, and secure mode of action. In the present review, potential anticancer mechanisms of action of some polyphenols including phenolic acids, lignans, and stilbenes are discussed based on clinical, epidemiological, in vivo, and in vitro studies. The emerging evidence revealed that phenolic acids, lignans, and stilbenes induced apoptosis in the treatment of breast (MCF-7), colon (Caco-2), lung (SKLU-1), prostate (DU-145 and LNCaP), hepatocellular (hepG-2), and cervical (A-431) cancer cells, cell cycle arrest (S/G2/M/G1-phases) in gastric (MKN-45 and MKN-74), colorectal (HCT-116), bladder (T-24 and 5637), oral (H-400), leukemic (HL-60 and MOLT-4) and colon (Caco-2) cancer cells, and inhibit cell proliferation against the prostate (PC-3), liver (LI-90), breast (T47D and MDA-MB-231), colon (HT-29 and Caco-2), cervical (HTB-35), and MIC-1 cancer cells through caspase-3, MAPK, AMPK, Akt, NF-κB, Wnt, CD95, and SIRT1 pathways. Based on accumulated data, we suggested that polyphenols could be considered as a viable therapeutic option in the treatment of cancer cells in the near future.
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Affiliation(s)
- A Hazafa
- Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisalabad, 38040, Pakistan.
| | - M O Iqbal
- Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao, 266003, China
| | - U Javaid
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - M B K Tareen
- College of Food Science & Technology, Huazhong Agricultural University, Huazhong, China
| | - D Amna
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - A Ramzan
- Department of Botany, University of Agriculture Faisalabad, Faisalabad, 38040, Pakistan
| | - S Piracha
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad, 38040, Pakistan
| | - M Naeem
- College of Life Science, Hebei Normal University, Shijiazhuang, China
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Javaid U, Souris K, Huang S, Lee JA. Denoising proton therapy Monte Carlo dose distributions in multiple tumor sites: A comparative neural networks architecture study. Phys Med 2021; 89:93-103. [PMID: 34358755 DOI: 10.1016/j.ejmp.2021.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/04/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Monte Carlo (MC) algorithms provide accurate modeling of dose calculation by simulating the delivery and interaction of many particles through patient geometry. Fast MC simulations using large number of particles are desirable as they can lead to reliable clinical decisions. In this work, we assume that faster simulations with fewer particles can approximate slower ones by denoising them with deep learning. MATERIALS AND METHODS We use mean squared error (MSE) as loss function to train networks (sNet and dUNet), with 2.5D and 3D setups considering volumes of 7 and 24 slices. Our models are trained on proton therapy MC dose distributions of six different tumor sites acquired from 50 patients. We provide networks with input MC dose distributions simulated using 1 × 106 particles while keeping 1 × 109 particles as reference. RESULTS On average over 10 new patients with different tumor sites, in 2.5D and 3D, our models recover relative residual error on target volume, ΔD95TV of 0.67 ± 0.43% and 1.32 ± 0.87% for sNet vs. 0.83 ± 0.53% and 1.66 ± 0.98% for dUNet, compared to the noisy input at 12.40 ± 4.06%. Moreover, the denoising time for a dose distribution is: < 9s and < 1s for sNet vs. < 16s and < 1.5s for dUNet in 2.5D and 3D, in comparison to about 100 min (MC simulation using 1 × 109 particles). CONCLUSION We propose a fast framework that can successfully denoise MC dose distributions. Starting from MC doses with 1 × 106 particles only, the networks provide comparable results as MC doses with1 × 109 particles, reducing simulation time significantly.
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Affiliation(s)
- Umair Javaid
- Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), UCLouvain, Belgium; Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium.
| | - Kevin Souris
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
| | - Sheng Huang
- Department of Med. Phys., Memorial Sloan Kettering Cancer Center, New York, United States
| | - John A Lee
- Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), UCLouvain, Belgium; Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
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Barragán-Montero A, Javaid U, Valdés G, Nguyen D, Desbordes P, Macq B, Willems S, Vandewinckele L, Holmström M, Löfman F, Michiels S, Souris K, Sterpin E, Lee JA. Artificial intelligence and machine learning for medical imaging: A technology review. Phys Med 2021; 83:242-256. [PMID: 33979715 PMCID: PMC8184621 DOI: 10.1016/j.ejmp.2021.04.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 02/08/2023] Open
Abstract
Artificial intelligence (AI) has recently become a very popular buzzword, as a consequence of disruptive technical advances and impressive experimental results, notably in the field of image analysis and processing. In medicine, specialties where images are central, like radiology, pathology or oncology, have seized the opportunity and considerable efforts in research and development have been deployed to transfer the potential of AI to clinical applications. With AI becoming a more mainstream tool for typical medical imaging analysis tasks, such as diagnosis, segmentation, or classification, the key for a safe and efficient use of clinical AI applications relies, in part, on informed practitioners. The aim of this review is to present the basic technological pillars of AI, together with the state-of-the-art machine learning methods and their application to medical imaging. In addition, we discuss the new trends and future research directions. This will help the reader to understand how AI methods are now becoming an ubiquitous tool in any medical image analysis workflow and pave the way for the clinical implementation of AI-based solutions.
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Affiliation(s)
- Ana Barragán-Montero
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium.
| | - Umair Javaid
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
| | - Gilmer Valdés
- Department of Radiation Oncology, Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Dan Nguyen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, UT Southwestern Medical Center, USA
| | - Paul Desbordes
- Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), UCLouvain, Belgium
| | - Benoit Macq
- Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM), UCLouvain, Belgium
| | - Siri Willems
- ESAT/PSI, KU Leuven Belgium & MIRC, UZ Leuven, Belgium
| | | | | | | | - Steven Michiels
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
| | - Kevin Souris
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
| | - Edmond Sterpin
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium; KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Belgium
| | - John A Lee
- Molecular Imaging, Radiation and Oncology (MIRO) Laboratory, UCLouvain, Belgium
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Javaid U, Souris K, Huang S, Lee J. OC-0214: Comparison of deep convolutional neural networks to denoise Monte Carlo proton dose distributions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Javaid U, Souris K, Dasnoy D, Huang S, Lee JA. Mitigating inherent noise in Monte Carlo dose distributions using dilated U-Net. Med Phys 2019; 46:5790-5798. [PMID: 31600829 DOI: 10.1002/mp.13856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/17/2019] [Accepted: 09/29/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Monte Carlo (MC) algorithms offer accurate modeling of dose calculation by simulating the transport and interactions of many particles through the patient geometry. However, given their random nature, the resulting dose distributions have statistical uncertainty (noise), which prevents making reliable clinical decisions. This issue is partly addressable using a huge number of simulated particles but is computationally expensive as it results in significantly greater computation times. Therefore, there is a trade-off between the computation time and the noise level in MC dose maps. In this work, we address the mitigation of noise inherent to MC dose distributions using dilated U-Net - an encoder-decoder-styled fully convolutional neural network, which allows fast and fully automated denoising of whole-volume dose maps. METHODS We use mean squared error (MSE) as loss function to train the model, where training is done in 2D and 2.5D settings by considering a number of adjacent slices. Our model is trained on proton therapy MC dose distributions of different tumor sites (brain, head and neck, liver, lungs, and prostate) acquired from 35 patients. We provide the network with input MC dose distributions simulated using 1 × 10 6 particles while keeping 1 × 10 9 particles as reference. RESULTS After training, our model successfully denoises new MC dose maps. On average (averaged over five patients with different tumor sites), our model recovers D 95 of 55.99 Gy from the noisy MC input of 49.51 Gy, whereas the low noise MC (reference) offers 56.03 Gy. We observed a significant reduction in average RMSE (thresholded >10% max ref) for reference vs denoised (1.25 Gy) than reference vs input (16.96 Gy) leading to an improvement in signal-to-noise ratio (ISNR) by 18.06 dB. Moreover, the inference time of our model for a dose distribution is less than 10 s vs 100 min (MC simulation using 1 × 10 9 particles). CONCLUSIONS We propose an end-to-end fully convolutional network that can denoise Monte Carlo dose distributions. The networks provide comparable qualitative and quantitative results as the MC dose distribution simulated with 1 × 10 9 particles, offering a significant reduction in computation time.
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Affiliation(s)
- Umair Javaid
- ICTEAM, UCLouvain, Louvain-la-Neuve, 1348, Belgium
- IREC/MIRO, UCLouvain, Brussels, 1200, Belgium
| | | | | | - Sheng Huang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - John A Lee
- ICTEAM, UCLouvain, Louvain-la-Neuve, 1348, Belgium
- IREC/MIRO, UCLouvain, Brussels, 1200, Belgium
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Javaid U, Dasnoy D, Lee J. PO-1016 Segmentation of CT images with AI: compensating annotation uncertainties using contour augmentation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bassyouni M, Iqbal N, Iqbal SS, Abdel-hamid SS, Abdel-Aziz M, Javaid U, Khan MB. Ablation and thermo-mechanical investigation of short carbon fiber impregnated elastomeric ablatives for ultrahigh temperature applications. Polym Degrad Stab 2014. [DOI: 10.1016/j.polymdegradstab.2014.08.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Thomas DR, Kamel H, Azharrudin M, Ali AS, Khan A, Javaid U, Morley JE. The relationship of functional status, nutritional assessment, and severity of illness to in-hospital mortality. J Nutr Health Aging 2005; 9:169-75. [PMID: 15864397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Prediction of in-hospital mortality may direct hospital resources towards those patients most at risk. A number of single domain risk instruments have been developed, indicating that functional status, nutritional assessment, and severity of illness individually predict in-hospital mortality. The interaction among these predictors is less well described. OBJECTIVE To determine the relationship of functional status, nutritional assessment, and severity of illness to in-hospital mortality. DESIGN, SETTING, SUBJECTS Cohort study of 1712 consecutive admissions over a one year period to an Internal Medical Service at a tertiary university teaching hospital. MAIN OUTCOME MEASURES Death during hospital admission. RESULTS Dependency in activities of daily living (OR = 3.37, 95% CI 1.78 to 6.37, p = 0.0002) and body mass index less than 20 (OR = 2.38, 95% CI 1.20 to 4.74, p = 0.01) predicted in-hospital mortality after adjusting for nutritional risk assessment, and severity of illness score. CONCLUSIONS Impairment in functional status and low body mass index produce the best predictors of inhospital mortality, after adjusting for nutritional risk and severity of illness score. Among these factors, functional impairment may be amenable to correction.
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Affiliation(s)
- D R Thomas
- Division of Geriatric Medicine, Saint Louis Health Sciences Center and, GRECC, Veterans Administration Center, MO 63104, USA.
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