The chest X-ray is considered a significant clinical utility for basic examination and diagnosis. The human lung area can be affected by various infections, such as bacteria and viruses, leading to pneumonia. Efficient and reliable classification method facilities the diagnosis of such infections. Deep transfer learning has been introduced for pneumonia detection from chest X-rays in different models. However, there is still a need for further improvements in the feature extraction and advanced classification stages. This paper proposes a classification method with two stages to classify different cases from the chest X-ray images based on a proposed Advanced Squirrel Search Optimization Algorithm (ASSOA). The first stage is the feature learning and extraction processes based on a Convolutional Neural Network (CNN) model named ResNet-50 with image augmentation and dropout processes. The ASSOA algorithm is then applied to the extracted features for the feature selection process. Finally, the Multi-layer Perceptron (MLP) Neural Network’s connection weights are optimized by the proposed ASSOA algorithm (using the selected features) to classify input cases. A Kaggle chest X-ray images (Pneumonia) dataset consists of 5,863 X-rays is employed in the experiments. The proposed ASSOA algorithm is compared with the basic Squirrel Search (SS) optimization algorithm, Grey Wolf Optimizer (GWO), and Genetic Algorithm (GA) for feature selection to validate its efficiency. The proposed (ASSOA + MLP) is also compared with other classifiers, based on (SS + MLP), (GWO + MLP), and (GA + MLP), in performance metrics. The proposed (ASSOA + MLP) algorithm achieved a classification mean accuracy of (99.26%). The ASSOA + MLP algorithm also achieved a classification mean accuracy of (99.7%) for a chest X-ray COVID-19 dataset tested from GitHub. The results and statistical tests demonstrate the high effectiveness of the proposed method in determining the infected cases.

Advanced Meta-Heuristics, Convolutional Neural Networks, and Feature Selectors for Efficient COVID-19 X-Ray Chest Image Classification

Although the widespread use of mold-active agents (especially the new generation of triazoles) has resulted in reductions of documented invasive mold infections (IMIs) in patients with hematological malignancies and allogeneic hematopoietic stem cell transplantation (HSCT), a subset of such patients still develop breakthrough IMIs (bIMIs). There are no data from prospective randomized clinical trials to guide therapeutic decisions in the different scenarios of bIMIs. In this viewpoint, we present the current status of our understanding of the clinical, diagnostic, and treatment challenges of bIMIs in high-risk adult patients with hematological cancer and/or HSCT receiving mold-active antifungals and outline common clinical scenarios. As a rule, managing bIMIs demands an individualized treatment plan that takes into account the host, including comorbidities, certainty of diagnosis and site of bIMIs, local epidemiology, considerations for fungal resistance, and antifungal pharmacological properties. Finally, we highlight areas that require future investigation in this complex area of clinical mycology.

/pdf/breakthrough-invasive-mold-infections-in-the-hematology-3w22mpc49r.pdf

Breakthrough invasive mold infections in the hematology patient: Current concepts and future directions

How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach

The burden of Invasive Aspergillosis in patients with haematological malignancy: A meta-analysis and systematic review.

Background
Myelodysplastic syndromes (MDS) are characterized by ineffective erythropoiesis with dysplastic bone marrow leading to peripheral cytopenia, risk of infection, and progression to acute myelogenous leukemia. Maitake mushroom beta-glucan, a dietary supplement, stimulates hematopoietic progenitor cell differentiation, granulocyte colony-stimulating factor production, and recovery of peripheral blood leukocytes after bone marrow injury. This phase II trial examined the effects of Maitake on innate immune function in MDS.

/pdf/maitake-mushroom-extract-in-myelodysplastic-syndromes-mds-a-1z23ys3iqf.pdf

Maitake mushroom extract in myelodysplastic syndromes (MDS): a phase II study

Patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) are at risk for invasive aspergillosis (IA) even prior to the introduction of stem cell transplantation (SCT). In times of increasing triazole resistance and changing use of antifungal prophylaxis, insight into the risk factors for IA is needed to improve strategies for preventing IA in this population. Consecutive patients who received remission-induction therapy for AML or MDS at the Leiden Academic Medical Centre were included. Instead of standard antifungal prophylaxis, an assertive protocol for diagnosis of suspected fungal infection was in place. IA was classified according to the revised European Organization for Research and Treatment of Cancer criteria. Potential predisposing characteristics for IA were compared by uni- and multivariate analyses. In 45 (25%) of 184 included episodes (167 patients), IA was diagnosed prior to SCT. A multivariate Cox regression model demonstrated that relapsed AML (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.1-5.1; P = 0.02), secondary AML (HR, 5.2; 95% CI, 2.3-11.8; P < 0.001), and prolonged duration of neutropenia (HR, 2.2; 95% CI, 1.2-4.0; P = 0.01) were independently associated with IA. Use of granulocyte-colony-stimulating factor showed a trend toward a protective effect (HR, 0.37; 95% CI, 0.1-31.0; P = 0.06). Relapsed AML, secondary AML, and duration of neutropenia were independent factors for determining the risk for development of IA prior to SCT. The results provide further guidance for antifungal stewardship programs when integrating individual patient tailored decision making in antifungal prophylaxis strategies.

/pdf/relapsed-and-secondary-disease-drive-the-risk-profile-for-3k8flknall.pdf

Relapsed and secondary disease drive the risk profile for invasive aspergillosis prior to stem cell transplantation in patients with acute myeloid leukemia or myelodysplastic syndrome

Background: In patients with an acute lower respiratory tract infection (LRTI), general practitioners (GPs) often find it challenging to decide to prescribe antibiotics or not. C-reactive protein (...

Clinical factors, C-reactive protein point of care test and chest X-ray in patients with pneumonia : A survey in primary care

/pdf/the-complex-case-of-aspergillus-and-mortality-4dqx1lmubu.pdf

The Complex Case of Aspergillus and Mortality.

Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.

https://biblio.ugent.be/publication/8693636/file/8693637.pdf

Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B

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Papers

Relapsed and secondary disease drive the risk profile for invasive aspergillosis prior to stem cell transplantation in patients with acute myeloid leukemia or myelodysplastic syndrome

Clinical factors, C-reactive protein point of care test and chest X-ray in patients with pneumonia : A survey in primary care

The Complex Case of Aspergillus and Mortality.

Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B