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The method for intelligent diagnosis of COVID-19 based on the LeNet-ViT deep neural network was proposed. The LeNet-ViT model was created, it has the following advantages: the input image is not square, which expands the scope;the input image is pre-compressed and the new size depends on the original image size, and it is empirically determined, which increases the model training speed and the model identification accuracy;the number of pairs "convolutional layer - downsampling layer” depends on the image's size, and it is automatically determined, which increases the model classification accuracy;the number of layer planes is automatically determined, which speeds up the definition of the model structure;the patch size depends on the image size, and it is empirically determined, which increases the model identification accuracy;the number of encoder blocks is empirically determined, which increases the model learning speed;the use of a convolutional neural network allows to efficiently extract features, and the use of a visual transformer allows to effectively analyze these features. The proposed method for intelligent diagnosis of COVID-19 can be used in various intelligent computer systems for medical diagnostics. © 2022 Copyright for this paper by its authors.
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Background: The study of the features of the course and mutual influence of the new coronavirus disease COVID-19 and various rheumatic diseases (RD) in children can still give us new lessons, warnings and fears. Objectives: To update the analysis in a retrospective study the course of covid-19 in children with RD based on the results of two years of the pandemic. To analyze the impact of COVID-19 on the course of RD in children. Methods: Retrospective analysis based on data from single center. The study included patients with RD and confirmed COVID-19 for 2 years (2020-2021). Results: Were registered 320 cases of COVID-19 in children with RD. 158 (49%) patients were asymptomatically infected, 162 (51%) had clinical symptoms. A detailed description of the groups is presented in Table 1. Clinical symptoms were fever (67%), anosmia (47%), rhinitis (34%), cough (19%), arthralgia/myalgia (16%), dyspepsia (5%), rash (2.5%), pneumonia (3%). In the majority of cases (98%), COVID-19 proceeded in mild to moderate severity. Hospitalization due to COVID-19 was required just in 5 cases. 2 children were admitted to the intensive care unit. First, an 11-year-old girl with sJIA with the history of recurrent episodes of MAS resolved by regular administration of canakinumab. 2nd, a 12-year-old girl with Sjogren's syndrome, who received Rituximab and 1 month later she developed the COVID-19 with MIS-like clinical picture, pneumonia with 25%CT lessions. Both cases have a favorable outcome. The clinical characteristics of the patients are presented in Table 1. COVID-19 didǹt affect the course of RD in the 86% of pts. However, 15% developed a fare of the RD with average of 3 months after COVID-19. In this group for 13 pts (girls mostly F/M-9/4, mean age 15 years [9;16]), COVID-19 triggered the new onset of RD (non-systemic JIA-4, Uveitis-1, non-bacterial osteomyelitis-3, systemic JIA-2, Scleroderma-2, Sjögren's syndrome-1. 12 from 13 these children had clinical symptoms on COVID-19. Whether this is Long-COVID syndrome or an independent RD is not known. Conclusion: Our study suggests that the new coronavirus infection in most cases in children with RD, had mild or asymptomatic course, regardless of therapy with immunosuppressive drugs and bDMARD, except of 1 observation with the previous therapy of Rituximab. Worsening of RD after coronavirus infection developed in 15% of cases, regardless of its clinical manifestations. In 13 patients, the RD were started just after COVID-19. The explosive increasing of the incidence of a new strain of COVID-19 for a past month may change the current results and conclusions.
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Background: Primary Sjögren's syndrome (pSS) is a chronic and progressive multisystem autoimmune disease which rarely onset in children and adolescents. Diagnostic delay in large part of patients are common due to the non-specifc and variable symptoms and the slow progression of disease. Objectives: To analyse demographic data, specifc extraglandular, salivary and ocular manifestations, laboratory parameters and therapy of pSS with juvenile onset. Methods: Retrospective study of all patients (pts) with pSS in single center. Results: pSS was verifed in 15 pts (6.7% were boys), which amounted to 23.8% of all pts with SS in our pediatric rheumatologic department. The median age of pSS onset was 8.0 y.o. [IQR 7.0;10.2]. The median of disease duration at the time of pSS verifcation was 2.75 years [2.2;5.6]. All patients had systemic manifestations at onset: constitutional abnormalities-33.3%, nonerosive polyarthritis-64.3%, polyarthralgias-26.7%, lymphadenopathy-73.3%, cutaneous involvement-53.3% (2-xerosis, 2-annular erythema, 1-erythema nodo-sum, 2-Raynaud phenomenon, 2-nonspecifc spotty rashes, 1-hemorrhagic rash). At the time of diagnosis 7 pts (46.7%) had isolated involvement of salivary glands, 8 pts (53.3%)-combined with involvement of lacrimal glands. The decrease in salivary gland function was recorded in 80% of cases, hypolacrimia-in 46.7%, 1 patient had isolated hypolacrimia. Recurrent parotitis was present in 6 pts (40.0%). At time of diagnosis pulmonary involvement had 20.0% of pts, 1 patient had renal tubular acidosis. 8 pts (53.3%) had various hematological disorders: anemia-in 3 pts (20.0%), leukopenia-in 6 (40.0%). ANA Hep-2 were detected in 100% pts (in titer 1/640-4, 1/1280-7, 1/2560-3, 1/20480-1, with mixed patterns in all pts: speckled + homogeneous-9 pts, speckled + homogeneous+cytoplasmic-6 pts), anti-Ro-in 12 pts (80.0%), anti-La-in 8 pts (53.3%), RF+-in 9 pts (60.0%). 6 pts (40.0%) had polyclonal hypergammaglob-ulinemia, max 42%. 2 pts (13.3%) had concomitant autoimmune non-rheumatic disease;1-cutaneous psoriasis, 1-autoimmune thyroiditis. The treatment of each patient was justifed by the main individual manifestations: 93.3% received glucocorticoids, 26.7%-methotrexate, 33.3%-hydroxychloroquine, 6.7%-mycophenolate mofetil. Treatment with biologics (B) was received by 13 (93.3%) pts (7-rituximab (RTM), 6-abatacept (ABA)) with a good response in 10 pts, including improvement in the function of the salivary and lacrimal glands in 7 pts. 1 patient received 2B-RTM and ABA sequentially due to the development of MAS 7 days after 1st RTM infusion. B was discontinued in 3 pts: 1 due to development of hemorrhagic vasculitis 2 days after the 1st RTM infusion, 1-COVID-19 with lung involvement (CT 3-4) 2 weeks after the 1st RTM infusion, 1-inefficiency of ABA during 15 months. Conclusion: In our pediatric rheumatologic department pts with pSS made up less than a quarter of all pts with SS. The diagnosis was verifed delayed in all pts, which can be explained by a wide range of nonspecifc manifestations at the onset. However, the manifestations of SS that were present at the time of diagnosis were brought under control on the background of complex therapy, including the prescription of B, with a good efficacy and safety profile of therapy.
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Ferritin is a complex protein composite (iron protein) that plays the role of the main intracellular iron depot in humans and animals, consisting of the protein apoferritin and the ferric atom in the composition of phosphate hydroxide. The reference value of ferritin in women is 200 fig/l, in men — 300fig/l. Ferritin is a marker of total body iron stores, and low levels are specific for iron deficiency. Ferritin is also involved in immune processes and has both pro-inflammatory and immunosuppressive activity. Hyperferritinemia is a nonspecific symptom that occurs in a number of immunoinflammatory, infectious diseases, as well as during body iron stores overload. Hyperferritinemia is a criterion sign of macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis, systemic lupus erythematosus and Kawasaki disease, as well as a predictive biomarker of adult-onset Still's disease. High ferritin levels occur in catastrophic antiphospholipid syndrome, as well as in infectious pathologies such as septic shock and COVID-19, including multisystem inflammatory syndrome associated with COVID-19. Ferritin concentration is an important parameter for assessing the activity and prognosis of the disease, which allows a rational approach to the choice of therapy in these patients. © 2022, Ima-Press Publishing House. All rights reserved.
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The paper proposes a method for intelligent diagnosis of COVID-19 based on a neural network of generalized bell-shaped functions and fuzzy logic. The study modern lies in the fact that for intelligent diagnosis COVID-19 was well established as a model of an artificial neural network, selected the three evaluation criteria effectiveness of the proposed models and identified the structure and parameters of the proposed second model based on the method of back propagation in batch mode that is focused on the technology of parallel information processing, and fuzzy diagnostic rules that are formed based on the identified model. The author's models and functions for their structural and parametric adaptation make it possible to increase the reliability, accuracy, speed of decision making. The author's method of intelligent diagnostics can be used in COVID-19 in various intelligent systems of medical diagnostics.
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Background: About one year ago at the beginning of the new SARS-CoV-2 infection pandemic, it was expected, that rheumatic disease (RD) and immunosuppressive therapy could predispose to a more severe course of the COVID-19 infection. At that time, it was unspeakable how this infection would occur in children with RB in compare to adults. Now it's time to draw preliminary conclusions. Objectives: to analyze all features of COVID19 infection in children with RD Methods: The retrospective single center study of all patients with pediatric RD who had the COVID19 infection up to the end of January 2021. It was analyzed all variety of clinical manifestations, changing in therapy at the time of COVID-19 and after it, the dynamics of the RD and consequences of the new viral disease. Results: The study included 66 patients under the age of 18 with various RS, including autoinflammatory disease (AIDs). The diagnostic distribution, sex ratio, age and previous therapy present in the Table 1. There were patients treated with DMARDS (methotrexate -47, hydroxychloroquine -3, mycophenolate mofetil -2, colchicine -1), NSAID monotherapy -6, systemic steroids -10;29 patients recived Biologics, including combination with methotrexate. None of our patients had a severe course of the COVID-19, none of 66 patients was hospitalized for emergency indications in the intensive care unit or in other specialized departments. The diagnosis of COVID-19 infection was based on different evidences: positive PCR in 15 (23%) cases, high levels of immunoglobulins G and M -in 64 (97%) and 7 (11%) respectively, viral pneumonia was confirmed by CT in 2 (10%) cases. A manifest clinical picture presented just in 21 (32 %) of patients, the others were carried the disease asymptomatically. Among the clinical manifestations of SARS-CoV-2 that were observed in our patients were the following: fever, as the most frequent symptom -19 (90%), rhinitis -12 (57%), anosmia -10 (48%), sore throat -3 (14%), arthralgia/myalgia in 4 (19%), rash -1 (5%) case, cough -4 (19%) cases. it is important to note that until July 2020, only 4 patients were registered, and in the next 6 months -62. The treatment against COVID-19 in our patients with clinical symptoms included: NSAID monotherapy -4 (19%), Systemic steroids -2 (10%), Hydroxychloroquine -2(10%), Antibiotics-5 (24%).Conclusion: Our study suggests that the presence of RD and immunosuppression therapy does not lead to an increased frequency or severe course of COVID-19 infection in children. The final conclusion will be drawn as the data accumulates.
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Aims Assessment of the capabilities of the SpyGlass system in the diagnosis and treatment of diseases of the pancreato-biliary zone. Methods From 12.2017 to 12.2020 we performed 191 single operator cholangiopancreatoscopies (SOC) in 188 patients(m-83, f-108;ranged 25-89 years;average age 57.2±32 years) using SpyGlass (Boston Scientific) in 4 leading Russianhospitals. All patient and cholangiopancreatoscopy data were recorded in the national registry. There were 164cholangioscopies and 27 pancreatoscopies. The indications for cholangioscopy were: undifferentiated strictures (97/188-51.6 %), large stones (42/188-22.3 %), “difficult strictures”, when it was impossible guidewire installation with traditionalway (15/188-8 %), postoperative benign strictures with ligatures and clips (11/188-5.8 %);for pancreaticoscopy-undifferentiated pancreatic strictures (13/188-6.9 %), morphologic verification of IPMN (3/188-1.6 %), large virsungolites(8/188-4.2 %) and assessment of the spread of major papilla adenoma on pancreatic duct (2/188-1.1 %). Results The overall technical success of SOCs was 96.3 % (184/191). Intraductal biopsy was successful in 85/87-97.7 %cases. Cholangiocarcinoma was obtained in 52(61.2 %) cases, benign strictures-in others. Therapeutic interventions weresuccessful in 64/70-91.4 % cases (laser lithotripsy of bile duct stones-14/15, electrohydraulic lithotripsy of bile ductstones-14/15 and of pancreatic duct stones-4/7, guidewire placement under visual control and further stenting-22/22,removal of ligatures(7) and clips(4) of bile duct-11/11). We had 7(3.8 %) complications-acute pancreatitis(3),bleeding(1) and cholangitis(3). Lethal outcomes after retrograde interventions not directly related to the SOC itself occurredin 2(1.1 %) patients at 5(ongoing pancreatic necrosis) and 3 day(multiple organ failure associated with COVID-19) afterERCP. Conclusions The opportunity of widespread use of SOC system in daily work for direct endoscopic examination of ductalsystems and performing invasive interventions under direct visual control provides new opportunities for increasing thelevel of diagnosis and the effectiveness of therapeutic interventions up to 96.3 %, without increasing the number of side effects during retrograde interventions.
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The clinical presentation and outcomes of infection with the novel coronavirus (COVID-19) are characterized by exceptional variability in manifestations, which depend on many factors, one of which is the patient’s age. One of the severe life-threatening manifestations in adults is severe acute respiratory syndrome (SARS-CoV-2), in some cases accompanied by the development of multiple organ failure. During the first two to three months of the COVID-19 pandemic, the global medical community was of the opinion that this disease in children is usually mild and not fatal. However, with the accumulation of new information, it became clear that there is a growing recognition of the existence of multisystem inflammatory syndrome in children, chronologically associated with SARS-CoV-2, which can lead to serious consequences. The article presents the main epidemiological, clinical and laboratory characteristics of the syndrome, as well as discusses the issues of its pathogenesis, differential diagnosis with a number of other acute conditions associated with an dysbalance of cytokines. Клиническая картина и исходы коронавирусной болезни 2019 (coronavirus disease - COVID-19) зависят от многих факторов, одним из которых является возраст пациента. Одним из тяжелых жизнеугрожающих проявлений у взрослых является острый респираторный дистресс-синдром (ОРДС), в ряде случаев сопровождающийся развитием полиорганной недостаточности. В течение первых месяцев пандемии COVID-19 сложилось мнение, что у детей это заболевание, как правило, протекает в легкой форме и не приводит к летальному исходу. Однако по мере накопления новых сведений стала очевидной возможность тяжелого течения COVID-19 у детей, приводящего к развитию патологии, получившей название «мультисистемный воспалительный синдром» (Multisystem inflammatory syndrome in children - MIS-C). В статье обсуждаются эпидемиологические, клинические и лабораторные характеристики MIS-C, подходы к дифференциальной диагностике с другими воспалительными заболеваниями у детей, предполагаемые механизмы иммунопатогенеза и перспективы фармакотерапии.