Cardiovascular risk prediction models incorporate myriad CVD risk factors. Current prediction models are developed from non-Asian populations, and their utility in other parts of the world is unknown. We validated and compared the performance of CVD risk prediction models in an Asian population. Four validation groups were extracted from a longitudinal community-based study dataset of 12,573 participants aged ≥18 years to validate the Framingham Risk Score (FRS), Systematic COronary Risk Evaluation 2 (SCORE2), Revised Pooled Cohort Equations (RPCE), and World Health Organization cardiovascular disease (WHO CVD) models. Two measures of validation are examined: discrimination and calibration. Outcome of interest was 10-year risk of CVD events (fatal and non-fatal). SCORE2 and RPCE performances were compared to SCORE and PCE, respectively. FRS (AUC = 0.750) and RPCE (AUC = 0.752) showed good discrimination in CVD risk prediction. Although FRS and RPCE have poor calibration, FRS demonstrates smaller discordance for FRS vs. RPCE (298% vs. 733% in men, 146% vs. 391% in women). Other models had reasonable discrimination (AUC = 0.706–0.732). Only SCORE2-Low, -Moderate and -High (aged <50) had good calibration (X² goodness-of-fit, P-value = 0.514, 0.189, 0.129, respectively). SCORE2 and RPCE showed improvements compared to SCORE (AUC = 0.755 vs. 0.747, P-value <0.001) and PCE (AUC = 0.752 vs. 0.546, P-value <0.001), respectively. Almost all risk models overestimated 10-year CVD risk by 3%–1430%. In Malaysians, RPCE are evaluated be the most clinically useful to predict CVD risk. Additionally, SCORE2 and RPCE outperformed SCORE and PCE, respectively. This work was supported by the Malaysian Ministry of Science, Technology, and Innovation (MOSTI) (Grant No: TDF03211036).

Background: Conventional risk score for predicting short and long-term mortality following an ST-segment elevation myocardial infarction (STEMI) is often not population specific. Objective: Apply machine learning for the prediction and identification of factors associated with short and long-term mortality in Asian STEMI patients and compare with a conventional risk score. Methods: The National Cardiovascular Disease Database for Malaysia registry, of a multi-ethnic, heterogeneous Asian population was used for in-hospital (6299 patients), 30-days (3130 patients), and 1-year (2939 patients) model development. 50 variables were considered. Mortality prediction was analysed using feature selection methods with machine learning algorithms and compared to Thrombolysis in Myocardial Infarction (TIMI) score. Invasive management of varying degrees was selected as important variables that improved mortality prediction. Results: Model performance using a complete and reduced variable produced an area under the receiver operating characteristic curve (AUC) from 0.73 to 0.90. The best machine learning model for in-hospital, 30 days, and 1-year outperformed TIMI risk score (AUC = 0.88, 95% CI: 0.846–0.910; vs AUC = 0.81, 95% CI:0.772–0.845, AUC = 0.90, 95% CI: 0.870–0.935; vs AUC = 0.80, 95% CI: 0.746–0.838, AUC = 0.84, 95% CI: 0.798–0.872; vs AUC = 0.76, 95% CI: 0.715–0.802, p < 0.0001 for all). TIMI score underestimates patients’ risk of mortality. 90% of non-survival patients are classified as high risk (>50%) by machine learning algorithm compared to 10–30% non-survival patients by TIMI. Common predictors identified for short- and long-term mortality were age, heart rate, Killip class, fasting blood glucose, prior primary PCI or pharmaco-invasive therapy and diuretics. The final algorithm was converted into an online tool with a database for continuous data archiving for algorithm validation. Conclusions: In a multi-ethnic population, patients with STEMI were better classified using the machine learning method compared to TIMI scoring. Machine learning allows for the identification of distinct factors in individual Asian populations for better mortality prediction. Ongoing continuous testing and validation will allow for better risk stratification and potentially alter management and outcomes in the future.

Freshwater algae can be used as indicators to monitor freshwater ecosystem condition. Algae react quickly and predictably to a broad range of pollutants. Thus they provide early signals of worsening environment. This study was carried out to develop a computer-based image processing technique to automatically detect, recognize, and identify algae genera from the divisions Bacillariophyta, Chlorophyta and Cyanobacteria in Putrajaya Lake. Literature shows that most automated analyses and identification of algae images were limited to only one type of algae. Automated identification system for tropical freshwater algae is even non-existent and this study is partly to fill this gap. The development of the automated freshwater algae detection system involved image preprocessing, segmentation, feature extraction and classification by using Artificial neural networks (ANN). Image preprocessing was used to improve contrast and remove noise. Image segmentation using canny edge detection algorithm was then carried out on binary image to detect the algae and its boundaries. Feature extraction process was applied to extract specific feature parameters from algae image to obtain some shape and texture features of selected algae such as shape, area, perimeter, minor and major axes, and finally Fourier spectrum with principal component analysis (PCA) was applied to extract some of algae feature texture. Artificial neural network (ANN) is used to classify algae images based on the extracted features. Feed-forward multilayer perceptron network was initialized with back propagation error algorithm, and trained with extracted database features of algae image samples. System's accuracy rate was obtained by comparing the results between the manual and automated classifying methods. The developed system was able to identify 93 images of selected freshwater algae genera from a total of 100 tested images which yielded accuracy rate of 93%. This study demonstrated application of automated algae recognition of five genera of freshwater algae. The result indicated that MLP is sufficient, and can be used for classification of freshwater algae. However for future studies, application of support vector machine (SVM) and radial basis function (RBF) should be considered for better classifying as the number of algae species studied increases.

Leukemia is the most prevalent form of blood cancer, affecting individuals across all age groups. Early and accurate diagnosis is crucial for effective treatment and improved clinical outcomes. Peripheral blood smear analysis, a key non-invasive diagnostic tool, often suffers from subjective interpretation, inter-observer variability, and a lack of readily available expertise. Although deep learning approaches, particularly Convolutional Neural Networks (CNNs), have demonstrated exceptional performance in binary classification tasks, multiclass classification of leukemia subtypes remains challenging due to limited data availability and morphological similarities between subtypes. This study presents a novel hybrid methodology that combines pre-trained CNN architectures, including VGG16, InceptionV3, and ResNet50, with advanced classification models such as Random Forest (RF), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and the deep learning-based Multi-Layer Perceptron (MLP). The method leverages publicly available datasets, the Acute Lymphoblastic Leukemia Image Database (ALL-IDB) and the Munich AML Morphology Dataset, to classify healthy cells, lymphoblasts, and myeloblasts. Pre-trained CNNs are employed for feature extraction, while the classifiers refine the predictions for improved accuracy. The proposed approach demonstrated exceptional performance, with the InceptionV3 + SVM combination achieving the highest accuracy of 88%, followed closely by VGG16 + XGBoost at 87%. MLP-based models also achieved strong results, effectively capturing non-linear patterns in the data. In contrast, ResNet50 exhibited limitations, likely due to overfitting caused by the small dataset. The novelty of this work lies in the integration of pre-trained deep learning architectures with hybrid classification techniques, enabling robust multiclass classification in data-constrained scenarios. This innovative approach offers a scalable and precise diagnostic tool, improving the speed and reliability of leukemia subtype identification and providing significant potential to enhance clinical decision-making and patient care.

Background: This study assesses the feasibility of using machine learning methods such as Random Forests (RF), Artificial Neural Networks (ANN), Support Vector Regression (SVR) and Self-Organizing Feature Maps (SOM) to identify and determine factors associated with hypertensive patients’ adherence levels. Hypertension is the medical term for systolic and diastolic blood pressure higher than 140/90 mmHg. A conventional medication adherence scale was used to identify patients’ adherence to their prescribed medication. Using machine learning applications to predict precise numeric adherence scores in hypertensive patients has not yet been reported in the literature. Methods: Data from 160 hypertensive patients from a tertiary hospital in Kuala Lumpur, Malaysia, were used in this study. Variables were ranked based on their significance to adherence levels using the RF variable importance method. The backward elimination method was then performed using RF to obtain the variables significantly associated with the patients’ adherence levels. RF, SVR and ANN models were developed to predict adherence using the identified significant variables. Visualizations of the relationships between hypertensive patients’ adherence levels and variables were generated using SOM. Result: Machine learning models constructed using the selected variables reported RMSE values of 1.42 for ANN, 1.53 for RF, and 1.55 for SVR. The accuracy of the dichotomised scores, calculated based on a percentage of correctly identified adherence values, was used as an additional model performance measure, resulting in accuracies of 65% (ANN), 78% (RF) and 79% (SVR), respectively. The Wilcoxon signed ranked test reported that there was no significant difference between the predictions of the machine learning models and the actual scores. The significant variables identified from the RF variable importance method were educational level, marital status, General Overuse, monthly income, and Specific Concern. Conclusion: This study suggests an effective alternative to conventional methods in identifying the key variables to understand hypertensive patients’ adherence levels. This can be used as a tool to educate patients on the importance of medication in managing hypertension.

Background: Conventional risk score for predicting in-hospital mortality following Acute Coronary Syndrome (ACS) is not catered for Asian patients and requires different types of scoring algorithms for STEMI and NSTEMI patients. Objective: To derive a single algorithm using deep learning and machine learning for the prediction and identification of factors associated with in-hospital mortality in Asian patients with ACS and to compare performance to a conventional risk score. Methods: The Malaysian National Cardiovascular Disease Database (NCVD) registry, is a multi-ethnic, heterogeneous database spanning from 2006–2017. It was used for in-hospital mortality model development with 54 variables considered for patients with STEMI and Non-STEMI (NSTEMI). Mortality prediction was analyzed using feature selection methods with machine learning algorithms. Deep learning algorithm using features selected from machine learning was compared to Thrombolysis in Myocardial Infarction (TIMI) score. Results: A total of 68528 patients were included in the analysis. Deep learning models constructed using all features and selected features from machine learning resulted in higher performance than machine learning and TIMI risk score (p < 0.0001 for all). The best model in this study is the combination of features selected from the SVM algorithm with a deep learning classifier. The DL (SVM selected var) algorithm demonstrated the highest predictive performance with the least number of predictors (14 predictors) for in-hospital prediction of STEMI patients (AUC = 0.96, 95% CI: 0.95–0.96). In NSTEMI in-hospital prediction, DL (RF selected var) (AUC = 0.96, 95% CI: 0.95–0.96, reported slightly higher AUC compared to DL (SVM selected var) (AUC = 0.95, 95% CI: 0.94–0.95). There was no significant difference between DL (SVM selected var) algorithm and DL (RF selected var) algorithm (p = 0.5). When compared to the DL (SVM selected var) model, the TIMI score underestimates patients’ risk of mortality. TIMI risk score correctly identified 13.08% of the high-risk patient’s non-survival vs 24.7% for the DL model and 4.65% vs 19.7% of the high-risk patient’s non-survival for NSTEMI. Age, heart rate, Killip class, cardiac catheterization, oral hypoglycemia use and antiarrhythmic agent were found to be common predictors of in-hospital mortality across all ML feature selection models in this study. The final algorithm was converted into an online tool with a database for continuous data archiving for prospective validation. Conclusions: ACS patients were better classified using a combination of machine learning and deep learning in a multi-ethnic Asian population when compared to TIMI scoring. Machine learning enables the identification of distinct factors in individual Asian populations to improve mortality prediction. Continuous testing and validation will allow for better risk stratification in the future, potentially altering management and outcomes.