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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 6 | Issue 1
Page Nos. 1-52

Online since Wednesday, August 26, 2020

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COMMENTARY  

How to make medical information comparable and searchable p. 1
Wolfgang Orthuber
DOI:10.4103/digm.digm_4_20  
For accurate digital representation of original (e.g. medical) information we have to recall that any information is selection from a common set of possibilities. This one dimensional or multidimensional set is called “domain”. Letters and language vocabulary are only special examples of domains which lead to non-reproducible digital representation. Since introduction of the internet, however, it is technically feasible to define domains online. These “adapted domains” can be optimized in dependence of the application (e.g. medical diagnosis). Then all relevant features of the original information in this application can be represented and transported digitally by comparable and searchable “Domain Vectors” (DVs). This would be important e.g. for medical decision support, therefore the introduction of Domain Vectors is urgently recommended. The setup of a comfortable internet presence for definition of adapted domains (and Domain Vectors) would be a first step for this.
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REVIEW ARTICLES Top

Epidemic preparedness for COVID-19: A major challenge! p. 9
Priya Gogia, Veena Melwani, Satish Melwani, Rahul Gogia
DOI:10.4103/digm.digm_11_20  
Epidemic outbreaks and biological disasters pose serious challenges to the country due to enormous population and weak public health system; to combat the same, we need epidemic preparedness. The steps of epidemic preparedness embrace and incorporate to anticipate, prevent, prepare, detect, and respond. The four stages of the present epidemic COVID-19 have been described. The requirement of proper coordination among the epidemiologist, clinician, laboratory personnel, and health educator is sum and substance of it. Levels for epidemic preparedness inculcate preparation at four levels including central, state, local, and health facility. The impact of epidemic has adverse health, social, as well as economic implications.
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Rheumatoid pain models in rodents and the application of dynamic weight-bearing test Highly accessed article p. 13
Dawei Geng, Liming Wang, Nancy Q Liu, Jian Qin
DOI:10.4103/digm.digm_7_20  
Rheumatoid arthritis (RA) is an autoimmune systemic disease of unknown etiology, characterized by chronic inflammation and synovial infiltration of immune cells. Pain is one of the most dominant symptoms for patients with RA, which affects the health and quality of life. Animal models are helpful to study the pathogenesis of RA and related factors and mechanisms of RA-induced pain, which may aid in the development of new and better treatment strategies. Several animal models of RA have been validated to predict for efficacy in humans that include collagen type II-induced arthritis in rats and mice, adjuvant-induced arthritis in rats, and antigen induced arthritis in several species. However, the quantitative evaluation of pain in animal models is technically challenging. Until recent years, behavior methods are used to characterize acute and chronic pain stages by observing behavioral changes in preclinical arthritis models. Significant progress has been made in pain assessment with the development of nonreflexive tools, dynamic weight-bearing (DWB) apparatus was developed for the measurement of pain in rodents by capturing weight-bearing and surface distribution of the paws. In this article, we summarize several classical animal models of rheumatoid pain as well as discussion of the advantages and disadvantages of DWB test for spontaneous pain used in these models.
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SHORT COMMUNICATIONS Top

Maintaining oxygen supply in hospitals treating coronavirus disease 2019 cases p. 20
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/digm.digm_8_20  
The role of oxygen therapy in the management of coronavirus disease 2019 (COVID-19) cases is extremely crucial and all steps should be taken to ensure its availability in adequate amount in all the health care establishments treating the patients. The clinical data obtained from China revealed that out of the overall reported cases, 15% severe cases and 5% critically ill patients will require oxygen therapy. Moreover, it is essential to estimate the requirement of oxygen in the hospital and it can be done by using the essential supply forecast tool. In conclusion, in order to improve the treatment outcomes of COVID-19 patients, it is crucial to ensure the supply of high quality medical-grade oxygen to the severe and critically-ill group of patients. In addition, the hospitals should prepare for improving the oxygen surge capacity to meet the needs of sudden rise in the number of cases.
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An appeal for the business sector to join hands with public health authorities in the battle against coronavirus disease 2019 pandemic p. 22
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/digm.digm_5_20  
The coronavirus disease 2019 (COVID-19) outbreak has transformed into a global public health emergency and a pandemic, which has demonstrated very high risk of global transmission. The business and commerce sector have been advised to come forward by the government primarily because these businesses have a crucial role in interrupting the chain of transmission and thus reduce the likelihood of community transmission. Any interventions on their part will not only minimize the current risk of acquiring the infection by the employees, but will also play a significant part in reducing the impact on the business itself and the national economy as a whole. Simultaneously, the business sector should be totally dedicated towards the formulation of an emergency response plan in their workplace. In conclusion, the ongoing COVID-19 pandemic is a global health and community-level emergency and it cannot be effectively contained without the persistent support of all the stakeholders, including the business sector. The need of the hour is that the business sector should plan and implement aggressive and evidence-based actions to safeguard the lives of their employees, customers and the community at large.
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ORIGINAL ARTICLES Top

Magnetic resonance imaging-guided focused ultrasound robotic system with the subject placed in the prone position p. 24
Christakis Damianou, Marinos Giannakou, George Menikou, Leonidas Ioannou
DOI:10.4103/digm.digm_2_20  
Background: In this article, a medical robotic system that performs magnetic resonance imaging-guided focused ultrasound surgery ablation is presented. The main innovation of this robotic system is that all the actuators are placed outside the water container. The transducer is immersed in water through an arm which is attached to the angular stage. Materials and Methods: The system includes three linear and one angular stage. The device uses piezoelectric motors for each motion stage. The accuracy was achieved with optical encoders. A focused transducer operated at 1 MHz with a radius of curvature of 10 cm and a diameter of 4 cm was used. A polyacrylamide gel was used to assess the ultrasound protocol. Results: The system was tested in the magnetic resonance imaging (MRI) environment and was proved to be a magnetic resonance compatible. The accuracy of the system was tested, and it was found that spatial steps of 0.2 mm can be safely and reliably achieved. With this robotic system, it is possible to access many organs that ultrasound penetrates with the patient placed in a prone position. Conclusion: The proposed robotic system can be modified so that it can be used for other applications. One example of an alternative application is MRI-guided biopsy. Another application is to replace the transducer arm with a radio frequency (RF) device to perform MRI guided RF ablation. Finally, the maneuverability of the robotic system can be enhanced further by attaching another angular stage to the system.
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Magnetic resonance image-guided focused ultrasound robotic system with four computer-controlled axes with endorectal access designed for prostate cancer focal therapy p. 32
Marinos Giannakou, Georgios Menikou, Kleanthis Ioannides, Christakis Damianou
DOI:10.4103/digm.digm_1_20  
Background: A magnetic resonance image (MRI)-guided robotic system dedicated for prostate cancer (PC) was produced that carries a small spherically focused, single-element, ultrasonic transducer which can be potentially utilized endorectally. Materials and Methods: The developed robotic device utilizes four computer-controlled axes. An agar-based phantom was developed, which included a cavity that mimics the rectum geometry. Experiments with the system were performed in a 1.5T MRI system using the gel phantom. The transducer has a diameter of 18 mm, operates with 3 MHz, and focuses energy at 40 mm. Results: The functionality of the robot was assessed by means of magnetic resonance thermometry, demonstrating sufficient heating in both axes of operation (linear and angular). Conclusions: A functional MRI-guided robotic system was produced, which can create significant and controlled thermal exposures. The intention is to use the proposed device endorectally in the future for the focal treatment of PC.
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Simulating patient matching to clinical trials using a property rights blockchain p. 44
Jay Bergeron, Anh Nguyen, Casey Alt, Nicole Brewster, Le Quy Quoc Cuong, Thomas Krohn, Vien Luong, Michael Nguyen, Amalio Telenti, Jennifer Wulff, Sean Moss-Pultz
DOI:10.4103/digm.digm_30_19  
Objective: Biomedical data processing generally requires the secure stepwise transfer of sensitive personal information across multiple parties. Mediating such operations using distributed secure digital ledgers, i.e., blockchains, is investigated in this article. Materials and Methods: The bitmark property rights blockchain was used to simulate the process of assessing individuals for enrollment to specific clinical trials. In the scenario presented, a sponsor publishes a recruitment call for a clinical trial and patients signal their willingness to participate in the trial through blockchain transactions. The blockchain creates and maintains digital references of the medical data assets of prospective study participants as well as digital property certificates for assigning access rights to corresponding medical data assets. Trial matching services review the patient blockchain records and recommend study participants that are likely to meet the enrollment criteria of recruiting clinical trials. Digital certificates assign transient access rights to the data assets of the prospective study participants. These certificates are transferred to pertinent matching services and sponsors, allowing these organizations to examine the candidacy of each prospective study participant. Results: The trial matching simulation demonstrates that property rights blockchains can implement complicated multiparty interactions, such as those associated with medical data exchange, without supplemental peer-to-peer communications. Conclusions: Blockchain-based data marketplaces of the type described, when coupled with data-controlled virtual infrastructure environments (i.e., Medical Data Trusts), provide a viable model for managing the transfer, provenance, and processing of individual health information.
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