Heart Alert: A heart disease prediction system using machine learning approach and optimization techniques

Background@#Cardiovascular diseases belong to the top three leading causes of mortality in the Philippines with 17.8 % of the total deaths. Lifestyle-related habits such as alcohol consumption, smoking, poor diet and nutrition, high sedentary behavior, overweight, and obesity have been increasingly implicated in the high rates of heart disease among Filipinos leading to a significant burden to the country's healthcare system. The objective of this study was to predict the presence of heart disease using various machine learning algorithms (support vector machine, naïve Bayes, random forest, logistic regression, decision tree, and adaptive boosting) evaluated on an anonymized publicly available cardiovascular disease dataset. @*Methodology@#Various machine learning algorithms were applied on an anonymized publicly available cardiovascular dataset from a machine learning data repository (IEEE Dataport). A web-based application system named Heart Alert was developed based on the best machine learning model that would predict the risk of developing heart disease. An assessment of the effects of different optimization techniques as to the imputation methods (mean, median, mode, and multiple imputation by chained equations) and as to the feature selection method (recursive feature elimination) on the classification performance of the machine learning algorithms was made. All simulation experiments were implemented via Python 3.8 and its machine learning libraries (Scikit-learn, Keras, Tensorflow, Pandas, Matplotlib, Seaborn, NumPy). @*Results@#The support vector machine without imputation and feature selection obtained the highest performance metrics (90.2% accuracy, 87.7% sensitivity, 93.6% specificity, 94.9% precision, 91.2% F1-score and an area under the receiver operating characteristic curve of 0.902 ) and was used to implement the heart disease prediction system (Heart Alert). Following very closely were random forest with mean or median imputation and logistic regression with mode imputation, all having no feature selection which also performed well. @*Conclusion@#The performance of the best four machine learning models suggests that for this dataset, imputation technique for missing values may or may not be done. Likewise, recursive feature elimination for feature selection may not apply as all variables seem to be important in heart disease prediction. An early accurate diagnosis leading to prompt intervention efforts is very crucial as it improves the patient's quality of life and diminishes the risk of developing cardiac events.

Reliability and validity of a Kannada rate of reading test

Purpose: Kannada, one of the Dravidian languages, is the official language of Karnataka state of India. There is a need for a test using Kannada words that can assess visual aspects of reading independently of syntactic and semantic knowledge. Methods: A test of reading rate in Kannada was developed following the design principles of the Wilkins Rate of Reading Test (RRT). Fifteen high-frequency bisyllabic Kannada words were selected. Children were recruited from state and private schools that used Kannada or English as the medium of instruction. A total of 799 children from Grade 2 to 9 participated in the study. Reading rate was measured using the English RRT and the Kannada version twice in immediate succession during the first session. In 85 children, measurements using the Kannada RRT were repeated after an interval of 15 days. Results: Pearson product moment correlation between the two immediately successive tests was 0.95 for the Kannada RRT and 0.91 for the English RRT. The correlation for the tests separated by an interval of 15 days was 0.83. When Kannada was the medium of instruction, there was little difference between test scores for Kannada and English. When English was the medium of instruction, test scores were greater in English. Scores increased as expected with age (P < 0.0001), similarly for Kannada and English tests. Conclusion: The newly developed Kannada RRT is both reliable and valid and can be used as a tool for measuring the visual aspects of reading.

Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations

The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H1-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%–70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3–10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.

Treatment of Chronic Spontaneous Urticaria

Chronic spontaneous urticaria is defined as persistent symptoms of urticaria for 6 weeks or more. It is associated with autoimmunity in approximately 45 percent of patients. Therapy is often difficult however the initial approach should employ high-dose non-sedating antihistamines; 4-6 tablets/day may be necessary. It has been shown that the response to 4 tablets/day exceeds 3, and exceeds 2, which exceeds 1. However the dose that corresponds to the maximal dose of first generation antihistamines (hydroxyzine, diphenhydramine) used previously, is 6/day. Yet over half the patients are refractory to antihistamines and other agents should be tried next. Whereas current guidelines (published) often add leukotriene antagonists and/or H2 receptor antogonists next, these are of little utility. Likewise drugs effective for urticarial vasculitis (colchicine, dapsone, sulfasalazine, hydroxychloroquine) are effective in a small percentage of patients and no study suggests that the response rate of any of them exceeds the 30% placebo responses seen in most double-blind, placebo controlled studies. The drugs that are effective for antihistamine-resistant chronic spontaneous urticaria are corticosteroids, cyclosporine, and Omalizumab. Use of steroids is limited by toxicity. If used at all, a dose of no more than 10 mg/day should be employed with a weekly reduction of 1 mg. The response rates to cyclosporine and Omalizumab are each close to 75%. Cyclosporine can be used effectively if care is taken to monitor blood pressure, urine protein, blood urea nitrogen, and creatinine, every 6 weeks. Omalizumab has the best profile in terms of efficacy/toxicity and, once approved by federal agencies for use in chronic spontaneous urticaria, a dramatic change in the treatment paradigm, whether associated with autoimmunity or not, is predicted. A phase 3 trial is currently in place. Refractoriness to both Omalizumab and cyclosporine is expected to be less than 5 percent of patients. Other agents, can then be tried.

Aneurismas múltiplos de pontes aorto-coronárias de veia safena com ruptura fatal / Multiple aneurysms of aortocoronary saphenous vein grafts with fatal rupture

Aneurismas de pontes aorto-coronárias de veia safena são eventos raros, usualmente assintomáticos e detectados de forma incidental. Rupturas espontâneas de pontes de safena são raras, havendo poucos dados radiológicos disponíveis na literatura. Relatamos o caso de um senhor de 39 anos internado com hematêmese dez anos depois de ter sido submetido a cirurgia de revascularização miocárdica. Imagens tomográficas mostraram três aneurismas nas pontes de safena, mas o exame não detectou ruptura. O paciente veio a falecer e a necropsia revelou que a causa do óbito havia sido ruptura de aneurisma de pontes de safena. Esse caso ilustra a necessidade de tratamento agressivo de aneurismas sintomáticos de pontes coronarianas.

Aortocoronary saphenous vein graft (SVG) aneurysms are rare, and are usually asymptomatic and detected incidentally. Spontaneous rupture of SVG is rare and imaging data are few. We report on a 39-year old man who was admitted to the hospital with hematemesis 10 years after aortocoronary bypass surgery. CT images revealed 3 aortocoronary SVG aneurysms, but failed to detect any rupture. His subsequent death due to rupture of SVG aneurysm was documented at autopsy, illustrating the need for aggressive treatment of symptomatic coronary graft aneurysms.

Quantitative characterization of reversible macromolecular associations via sedimentation equilibrium: an introduction

The measurement and analysis of sedimentation equilibrium provides one of the most powerful and widely applicable methods for the characterization of reversible associations of macromolecules in solution. Recent developments in instrumentation, experimental design, and data analysis have substantially broadened the range of systems to which this technique may be applied, simplified its application, and reduced the cost of acquiring analytical capability.

Efecto del Inositol 1, 4, 5 Trifosfato sobre [Ca2+] en músculos esqueléticos de sujectos susceptibles al síndrome de hipertemia maligna / Effects of Inositol 1, 4, 5 Triphosphate on free myoplasmic calcium concentration in malignante hyperthemia suceptible patients

Se estudió el efecto del inositol 1, 4, 5 trifosfato (InsP3) sobre la concentración de Ca++ libre de mioplásmico ([Ca++]) en biopsias musculares de sujetos sanos y susceptibles a hipertermia maligna (HM) con o sin encubación previa en dantrolene. El material utilizado incluyó microeléctrodos específicos para Ca++, y la microinyección de InsP3 por separado. En fibras musculares no susceptibles a HM, la inyección de 0,5 µM de InsP3 indujo un aumento de la [Ca++], de 0,12 ñ 0.01 µM a 0,37 ñ 0,03 µM que lle gó a 0,81 ñ 0,04 µM al doblar la dosis, con oscilación sarcométrica en casi la mitad de las preparaciones con esta dossis. El mismo procedimiento en miofibrillas susceptibles a HM produjo efectos mayores y más sostenidos; con 0,5 µM de InsP3 [Ca++], basal de 0,32 ñ 0,02 µM se elevó a 1,22 ñ 0,08 µM, y duplicando las dosis sólo se pudo medir algunas células que no sufrieron contracción local, que de 0,36 ñ 0,02 µM incrementaron la [Ca++], a 1,48 ñ 0,1 µM. La incubación previa con dantralone bloqueó el efecto del InsP3 sobre [Ca++], en ambos tipos de miofibrillas

Efecto del dantroleno sódico sobre la concentración de Ca2+ mioplásmico en porcinos susceptibles a hipertermia maligna / Effect of sodium dantrolene on myoplasmic Ca2+ concentration in malign hypertermia in susceptible pigs

Se estudió la [Ca2+]i en reposo, y sus modificaciones por acción del dantroleno sódico en cerdos susceptibles a HM, bajo anestesia con N2O-halotano-pancurinio. A un Vm en reposo de -85 ñ 1 mV la [Ca2+]i fue de 0.41 (ñ 0.01) micronM. Dosis de dantroleno de 0,5 mg/Kg redujeron la [Ca2+]i pero no impidieron la ocurrencia del síndrome de HM. Este fue prevenido por dosis de 1 mg/Kg parcialmente y 2,5 mg/øg totalmente; en ambos casos sin afectar el potencial de membrana (Vm) en reposo, de la fibra musuclar. Se sugiere que el nivel crítico de [Ca2]i en este animal; sobre el cual se desencadena el episodio es de 0,19-0,2 micronM. y el mal funcionamiento de la homeostasis del Ca2+ está relacionado al síndrome

La crisis de hipertermia maligna en porcinos susceptibles está asociada a un inchemento en la [Ca2+]i / Crisis of malignant hyperthermia in susceptible swines is associated with an increase in [Ca2+]i

La Hipertermia Maligna (HM) es un síndrome farmacogenético iniciado generalmente por la exposición del individuo susceptible a agentes anestésicos volátiles y/o relajantes musculares despolarizantes. Nosotros hemos usado los microelectrodos selectivos a calcio preparados y calibrados como ha sido previamente descrito para medir in vivo la concentración de calcio libre intracelular en fibras musculares de porcinos susceptibles a la HM (Poland China) y en porcinos control (Yorkshire). Los animales fueron anestesiados con tiopental y fentanil y ésta se mantuvo con 66% NO2 y 34% O2; como relajante muscular no despolarizante se utilizó pancuronium. El potencial de membrana y la concentración de calcio obtenidos sobre las fibras superficiales del músculo peroneus longus en los animales susceptibles fue de -82 + ou - 1,76 mV y 0,47 + ou - 0,06 micronM (Media + ou - EEM, n = 27), mientras que en los controles fue de -83,3 + ou - 1,06 mV y 0,12 + ou - 0,01 micronM. La exposición de los animales susceptibles a halothane o succinilcolina disparó la crisis hipertérmica la cual se acompañó de un incremento en la [Ca2+]i libre alcanzando un valor de 10,62 + ou - 3,16 micronM (Media + ou - EEM, n=8) y 8 + ou - 1,07 micronM (Media + ou - EEM n=6). La administración del relajante muscular dantrolene disminuyó sustancialmente la concentración de calcio libre a 0,35 + ou - 0,01 micronM (n=6). Estos resultados muestran que la crisis de Hipertermia Maligna está acompañada de un incremento en los niveles de concentración de calcio libre intracelular y también se muestra que el efecto del dantrolene en el tratamiento de este mal está asociado con una disminución en la concentración de este catión