ABSTRACT
With the advancement of digital technology, a large number of medical images are created in the field of digital medicine. Object detection is a critical field of study in medical image analysis, detection and processing. Object detection is the categorization of the pixels in an image that determines where the objects in the image are located. Image classification is the global classification of an image's pixels. The objects are identified but not located from all of the pixels in the image. The intelligent identification process for the adjuvant diagnosis to assist medical doctors of various disciplines is in high demand. The need for the high accurate object detection method for the medical images remains a major challenge toward disease detection in the health care. With this summary overview, a novel model is proposed for lung CT scan image detection as 18-Convolutional Layered Deep U-Net architecture for diagnosis of COVID-19 detection through object detection. Model fitting is done with 18-Convolutional Layered Deep U-Net architecture, and the model design is formed with four contraction path and four expansive path layers. The customized model design is fine-tuned with the parameter optimization. The object detection is done, and the performance is analyzed. The dataset is also fitted with existing deep convolution neural network models like region-based, threshold, edge-based and clustering-based method, and the performance is analyzed and compared with proposed model with metrics like pixel accuracy, intersection over union and dice coefficient. Implementation results show that the proposed models have pixel accuracy of 98.32%, intersection over union of 48.7% and dice coefficient of 97.56% compared to existing object detection models. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
Background and Aims: The case fatality rate of acute spontaneous intracerebral hemorrhage (ICH) is high 54% at 1 year, and only 12% to 39% of survivors achieve long term functional independence. The INTEnsive care bundle with blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT3) was an international, multicentre, cluster-randomized clinical trial to assess a multifaceted goal-directed care bundle of physiological management in patients with acute ICH. We aimed to study the challenges encountered in recruitment during the pandemics in India. Method(s): Between August 2020 and October 2022, all adult patients presenting with spontaneous ICH within 6 hours from symptom onset were enrolled under the standard of usual care management until they are informed of crossing over to intervention and to be contacted at 6 months follow-up. Result(s): Six out of ten screened centres participated. The pandemic posed many challenges to the recruitment of patients in the trial: The ethics committee meetings were interrupted, preventing us enrolling more sites. Fewer patients presented to hospital due to fear of covid, economic crisis, transportation barriers, delayed presentation beyond 6 hours due to poor triaging, delay in RTPCR testing, slow referrals, unwillingness to followup in outpatient clinic. Solutions: frequent virtual meetings with ethics committees were held by site PIs, RTPCR switched to rapid testing, ER physicians trained to rapidly identify ICH cases and trial strategy was modified at each centre to boost recruitment. Conclusion(s): Alternative approaches for rapid triaging and modified strategies to recruitment are needed to overcome challenges of implementing a stroke trial during a pandemic.
ABSTRACT
The COVID19 pandemic posed unprecedented challenges towards the delivery of neuro-rehabilitation services across the globe. A nation-wide lockdown made the accessibility to neuro-rehab facilities especially difficult for people with disabilities. Since there was not much data available on practices of neuro rehab during the COVID-19 pandemic, a cross sectional observational study was conducted to evaluate the changes in neuro rehabilitation practices in India during this pandemic using an online survey. The pandemic affected the people with disabilities in not merely the physical domains but also social effects, participation restriction and psychological effects and yet majority of both hospital and home-based physiotherapists reported a decrease in referrals and number of therapy sessions provided to the patients. Tele-rehabilitation has emerged as a new model of rehabilitation for delivery of neuro rehabilitation. It offers an alternate way of facilitating communication between the rehab professional and the patient. This includes strategies like low cost virtual reality gaming for rehab in children, mobile based rehab, etc. However, the shift to telerehab provides a tremendous learning opportunity and a huge scope for innovation in improving its accessibility to the community, especially in LMICs. Majority of both Hospital and Home-based Physiotherapists reported a decrease in referrals and number of therapy sessions provided to the patients. Despite evidence on the need for physiotherapy for respiratory care, most respondents did not implement the same. No protocols/guidelines for therapy delivery were implemented or used by our sample of respondents. This paper highlights the needs under three main categories, (1) Development and implementation of suitable clinical-practice-guidelines, clinical-monitoring systems for Neurological Physiotherapy, (2) incorporation of evidence-based respiratory care as part of neurological physiotherapy especially during such pandemics, (3) changes in policies at government and private sectors for inclusion and appropriate implementation of neurophysiotherapy along with public awareness programmes on the need for continued physiotherapy.
ABSTRACT
Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.