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Combined Lactate Glucose Ratio as a Novel Marker for Rapid Diagnosis of Cerebrospinal Fluid Bacterial Infection in Neurosurgical Patients: Diagnostic Accuracy Study and Benchtop Analyzer Correlation

Soon B, Jaafar AS, A Bakar A, Narayanan V

World Neurosurg, 2024 Nov;191:e607-e621.
PMID: 39265943 DOI: 10.1016/j.wneu.2024.09.012

OBJECTIVE: This study aimed to assess the diagnostic accuracy of a novel marker, the combined lactate glucose ratio (CLGR), in identifying cerebrospinal fluid (CSF) bacterial infection (CBI) in neurosurgical patients. Additionally, it seeks to establish cutoff values for CLGR and evaluate the reliability of measurement using blood gas analyzer (BGA).
METHODS: CSF samples were collected from 2 neurosurgical centers in Kuala Lumpur, Malaysia, between January 2022 and October 2023. Conventional markers and CLGR were quantified using standard laboratory methods, with BGA utilized for measurement when feasible. Samples were categorized into confirmed CBI-positive (CBI+) and CBI-negative (CBI-) groups. Marker performance was compared, and receiver operating characteristic analysis conducted. Pearson correlation assessed the agreement between BGA and laboratory measurements.
RESULTS: Among the 130 CSF samples, 11 were CBI+. Both cerebrospinal fluid lactate (cLac) and CLGR were significantly elevated in the CBI + group (P < 0.001). The area under the curve for cLac and CLGR was 0.990 and 0.994, respectively. Using a cutoff of 6.0 mmol/L, cLac demonstrated sensitivity of 100%, specificity of 93.3%, positive predictive value of 57.9%, negative predictive value of 100%, and diagnostic accuracy of 93.9%. CLGR ≥20.0 showed even higher accuracy: 100.0% sensitivity, 98.6% specificity, 84.6% positive predictive value, 100% negative predictive value, and overall accuracy of 98.5%. Both markers maintained excellent performance in blood-stained CSF. BGA measurements correlated well with laboratory results (r = 0.980 and 0.999, respectively, P < 0.001).
CONCLUSIONS: CLac levels ≥6.0 mmol/L and CLGR ≥20.0 accurately identified CBI in neurosurgical patients, with CLGR exhibiting superior efficacy. The potential for instant BGA measurement suggests promise for point-of-care testing.
Nitrate Classification Based on Optical Absorbance Data Using Machine Learning Algorithms for a Hydroponics System

Sulaiman R, Azeman NH, Abu Bakar MH, Ahmad Nazri NA, Masran AS, Ashrif A Bakar A

Appl Spectrosc, 2023 Feb;77(2):210-219.
PMID: 36348500 DOI: 10.1177/00037028221140924

Nutrient solution plays an essential role in providing macronutrients to hydroponic plants. Determining nitrogen in the form of nitrate is crucial, as either a deficient or excessive supply of nitrate ions may reduce the plant yield or lead to environmental pollution. This work aims to evaluate the performance of feature reduction techniques and conventional machine learning (ML) algorithms in determining nitrate concentration levels. Two features reduction techniques, linear discriminant analysis (LDA) and principal component analysis (PCA), and seven ML algorithms, for example, k-nearest neighbors (KNN), support vector machine, decision trees, naïve bayes, random forest (RF), gradient boosting, and extreme gradient boosting, were evaluated using a high-dimensional spectroscopic dataset containing measured nitrate-nitrite mixed solution absorbance data. Despite the limited and uneven number of samples per class, this study demonstrated that PCA outperformed LDA on the high-dimensional spectroscopic dataset. The classification accuracy of ML algorithms combined with PCA ranged from 92.7% to 99.8%, whereas the classification accuracy of ML algorithms combined with LDA ranged from 80.7% to 87.6%. The PCA with the RF algorithm exhibited the best performance with 99.8% accuracy.
Fulltext Detection of COVID-19 Virus on Surfaces Using Photonics: Challenges and Perspectives

Taha BA, Al Mashhadany Y, Bachok NN, Ashrif A Bakar A, Hafiz Mokhtar MH, Dzulkefly Bin Zan MS, et al.

Diagnostics (Basel), 2021 Jun 19;11(6).
PMID: 34205401 DOI: 10.3390/diagnostics11061119

The propagation of viruses has become a global threat as proven through the coronavirus disease (COVID-19) pandemic. Therefore, the quick detection of viral diseases and infections could be necessary. This study aims to develop a framework for virus diagnoses based on integrating photonics technology with artificial intelligence to enhance healthcare in public areas, marketplaces, hospitals, and airfields due to the distinct spectral signatures from lasers' effectiveness in the classification and monitoring of viruses. However, providing insights into the technical aspect also helps researchers identify the possibilities and difficulties in this field. The contents of this study were collected from six authoritative databases: Web of Science, IEEE Xplore, Science Direct, Scopus, PubMed Central, and Google Scholar. This review includes an analysis and summary of laser techniques to diagnose COVID-19 such as fluorescence methods, surface-enhanced Raman scattering, surface plasmon resonance, and integration of Raman scattering with SPR techniques. Finally, we select the best strategies that could potentially be the most effective methods of reducing epidemic spreading and improving healthcare in the environment.
MoS2-nanoflower enhanced programmable adsorption/desorption plasmonic detection for bipolar-molecules with high sensitivity

Chen Y, Chen Y, Shi W, Hu S, Huang Q, Liu GS, et al.

Biosens Bioelectron, 2022 Feb 15;198:113787.
PMID: 34864241 DOI: 10.1016/j.bios.2021.113787

High sensitivity and capturing ratio are strongly demanded for surface plasmon resonance (SPR) sensors when applied in detection of small molecules. Herein, an SPR sensor is combined with a novel smart material, namely, MoS2 nanoflowers (MNFs), to demonstrate programmable adsorption/desorption of small bipolar molecules, i.e., amino acids. The MNFs overcoated on the plasmonic gold layer increase the sensitivity by 25% compared to an unmodified SPR sensor, because of the electric field enhancement at the gold surface. Furthermore, as the MNFs have rich edge sites and negatively charged surfaces, the MNF-SPR sensors exhibit not only much higher bipolar-molecule adsorption capability, but also efficient desorption of these molecules. It is demonstrated that the MNF-SPR sensors enable controllable detection of amino acids by adjusting solution pH according to their isoelectric points. In addition, the MNFs decorated on the plasmonic interface can be as nanostructure frameworks and modified with antibody, which allows for specific detection of proteins. This novel SPR sensor provides a new simple strategy for pre-screening of amino acid disorders in blood plasma and a universal high-sensitive platform for immunoassay.
A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations

Haque F, Ibne Reaz MB, Chowdhury MEH, Md Ali SH, Ashrif A Bakar A, Rahman T, et al.

Comput Biol Med, 2021 12;139:104954.
PMID: 34715551 DOI: 10.1016/j.compbiomed.2021.104954

BACKGROUND: Diabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system.
METHOD: For designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features.
RESULTS: Top-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%-90%, and above 90%, respectively.
CONCLUSIONS: The findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients.
Fulltext Study protocol for a mixed methods approach to optimize colorectal cancer screening in Malaysia: Integrating stakeholders insights and knowledge-to-action framework

Chong DW, Jayaraj VJ, Ab Rahim FI, Syed Soffian SS, Azmi MF, Mohd Yusri MY, et al.

PLoS One, 2024;19(4):e0299659.
PMID: 38593177 DOI: 10.1371/journal.pone.0299659

INTRODUCTION: Colorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program.
METHODS: This study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program.
DISCUSSION: Through this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.