Medios– An offline, smartphone-based artificial intelligence algorithm for the diagnosis of diabetic retinopathy

Purpose: An observational study to assess the sensitivity and specificity of the Medios smartphone-based offline deep learning artificial intelligence (AI) software to detect diabetic retinopathy (DR) compared with the image diagnosis of ophthalmologists. Methods: Patients attending the outpatient services of a tertiary center for diabetes care underwent 3-field dilated retinal imaging using the Remidio NM FOP 10. Two fellowship-trained vitreoretinal specialists separately graded anonymized images and a patient-level diagnosis was reached based on grading of the worse eye. The images were subjected to offline grading using the Medios integrated AI-based software on the same smartphone used to acquire images. The sensitivity and specificity of the AI in detecting referable DR (moderate non-proliferative DR (NPDR) or worse disease) was compared to the gold standard diagnosis of the retina specialists. Results: Results include analysis of images from 297 patients of which 176 (59.2%) had no DR, 35 (11.7%) had mild NPDR, 41 (13.8%) had moderate NPDR, and 33 (11.1%) had severe NPDR. In addition, 12 (4%) patients had PDR and 36 (20.4%) had macular edema. Sensitivity and specificity of the AI in detecting referable DR was 98.84% (95% confidence interval [CI], 97.62–100%) and 86.73% (95% CI, 82.87–90.59%), respectively. The area under the curve was 0.92. The sensitivity for vision-threatening DR (VTDR) was 100%. Conclusion: The AI-based software had high sensitivity and specificity in detecting referable DR. Integration with the smartphone-based fundus camera with offline image grading has the potential for widespread applications in resource-poor settings.

Knowledge, attitude and practice among private medical professionals enrolled in public private partnership program for prevention of mother to child transmission of human immunodeficiency virus in three districts of Karnataka

Background: Human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), is one of the world’s most serious public health challenges. Nearly all young children newly infected with HIV are infected through mother-to-child transmission. Only about half of the HIV infected mothers received ART and quarter of the babies born through HIV infected mothers receive ARV prophylaxis. This low coverage due to a high proportion of women delivering in private health facilities. Lack of policy for the private sector, inadequate knowledge and fear of occupational exposure are some barriers.Methods: A cross sectional study conducted among private practitioners enrolled in parent to child transmission (PPTCT) program in three districts of Karnataka. 175 obstetricians and pediatricians engaged in giving care to HIV infected mother and children were selected randomly and were interviewed using a pre tested semi structured questionnaire and the scores were graded.Results: Mean age of the participants was 38.95 years with SD of 9.12 years. The mean years of experience was found to be 14.36 years with SD of 6.45 years. The knowledge was average scoring 66.56%. The attitude and practice were 69.21% and 64.21% respectively. The mean score for KAP was 28.89 (9.56) out of 43 questions. There was significant association between age of the participants, specialization and years of experience with scoring.Conclusions: The knowledge, attitude and practice among private practitioners were average. To enhance the coverage of PMTCT, there is a need for strengthening private sector with strong political will thus reducing morbidity and mortality of the disease.

Evaluation Of Pulmonary Hypertension In Chronic Obstructive Pulmonary Disease

Introduction: The early detection and treatment of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) becomes important to prevent right heart failure. We aimed to pulmonary hypertension in COPD patients by non-invasive methods.Materials and Methods: After Ethical committee clearance, the purpose of the study was explained to the patient and obtained informed consent from 105 Clinically diagnosed as COPD were included and ECG, Chest X-Ray, 2-D Echocardiography pulmonary hypertension is evaluated.Results: Of 105 COPD patients, 96 had PH. Prevalence of pulmonary hypertension in COPD patients were 54 (51.43%): 9 (25.71%) of mild COPD patients, 16 (45.71%) of moderate COPD and 29 (82.85%) of severe COPD.Conclusion: the chest radiography electrocardiography and 2 D-Echocardiography are the best clinical assessment and non-invasive investigations for the screening for pulmonary hypertension and subsequent development of cor pulmonale.

In vitro propagation of Dendrobium macrostachyum Lindl.--a threatened orchid.

In vitro propagation of Dendrobium macrostachyum, a threatened and endemic species was achieved through nodal explants. The nodal explants were cultured on Murashige and Skoog (MS) basal medium and MS medium supplemented with N6-benzyladenine (BA-2.22, 4.44 and 8.88 microM), Kinetin (KN-2.32, 4.65, and 9.29 microM) and Coconut water (CW, 5, 10 and 15%) individually or in combination with 2.69 microM alpha-naphthalene acetic acid (NAA). Axillary shoots were induced directly from nodal explants in medium containing BA, KN or CW. Optimal shoot induction (6 shoots/explant) was attained from nodal explants cultured on medium supplemented with 15% CW. Well developed shoots rooted at an average 5 roots per shoot in half strength MS medium devoid of any growth regulators.

Intraoperative blood glucose levels in neurosurgical patients : an evaluation of two fluid regimens.

Based on the evidence that hyperglycaemia aggravates ischaemic cerebral injury, it has been suggested that blood glucose levels be kept within 200 mg/dL during intracranial neurosurgery. Hypoglycaemia, however, can be a serious problem if glucose-containing solutions are avoided during the first four hours, as suggested in some studies. In order to explore the possibility of administering glucose in moderation so that the blood glucose levels are within acceptable limits, but at the same time the risk of hyoglycaemia is eliminated, we compared two intraoperative fluid regimens. Of the 52 neurosurgical patients studied, 32 patients received alternately 500 ml of 5% dextrose in normal saline and Ringer's lactate (DNS/RL Group) and 18 patients received alternately 500 ml of Ringer's lactate and normal saline (RL/NS Group). Blood glucose concentrations were determined at the end of each unit of fluid, until the patient received 4 units of fluid. In the DNS/RL group, blood glucose values peaked with the administration of each unit of DNS and tended to return towards the baseline with the subsequent RL, but remained higher than the previous control value. In the RL/NS group, there was a progressive increase in blood glucose values throughout the study period, but the increase was not statistically significant. The blood glucose levels were significantly different between the two groups after each unit of fluid except at the end of the fourth unit. Two patients in the RL/NS group had hypoglycaemia. In conclusion, the DNS/RL regimen maintains blood glucose levels within acceptable limits while avoiding the risk of hyperglycaemia. Withholding glucose completely, lowers blood glucose levels, but carries a risk of hypoglycaemia in some patients.

Efficacy of naturopathy and yoga in bronchial asthma--a self controlled matched scientific study.

Asthma is one of the common psychosomatic illness influenced by many factors. Bronchodilators give temporary relief and have side effects. The present study is aimed at finding the efficacy of a non-pharmacological approach of naturopathy and Yoga in bronchial asthma. A total no of 37 patients (19 men, 18 women) with mean age 35.06 yrs (men), 40.74 yrs (women) admitted to INYS, Bangalore, for the period of 21 days. The treatment included 1. Diet therapy 2. Nature cure treatment and 3. Yoga therapy. The various parameters including lung function test were measured on admission and once a week. Results showed the significant improvement in PEFR, VC, FVC, FEV1, FEV/FEC %, MVV, ESR and absolute eosinophil count. The patients reported a feeling of well being, freshness and comfortable breathing. Naturopathy and yoga helps in inducing positive health, alleviating the symptoms of disease by acting at physical and mental levels.

Direct somatic embryogenesis and plantlet regeneration from leaf explants of niger, Guizotia abyssinica (L.f.) Cass.

Somatic embryogenesis was induced in niger (Guizotia abyssinica (L.f.) Cass.) using a simple one step method. Leaf explants were cultured on MS medium with 2,4-D and BAP/Kn individually and in combination. Somatic embryogenesis occurred directly without an intervening callus proliferation phase from subepidermal regions of leaf explants on MS medium supplemented with 2,4-D (2.0 and 5.0 microM) plus Kn/BAP (1.0 and 2.0 microM). Regenerated somatic embryos were successfully grown into whole plants.

Growth response of African catfish, Clarias gariepinus (Burchell) to varied protein and lipid levels.

To study the growth response of African catfish (Clarias gariepinus) to the diets containing two protein (30 and 35%) and two lipid levels (12 and 18%) in a closed recirculatory system for 60 days, fish were fed to satiation twice daily. The experiment was carried out in triplicate groups. Fortnightly sampling of fish and water samples was carried out. The best result in terms of growth was obtained with the diet containing 34.62% protein and 12.12% lipid. The protein to lipid ratio was 18.57 in the diet that gave best percentage weight gain. However best survival, food conversion ratio and protein efficiency ratio were recorded in the diet containing 29.86% protein and 18.08% lipid.

Spinal tuberculosis with neurological deficits.

Two hundred patients suffering from tuberculosis (TB) of the spine with neurological complications were the subjects of this review. They were graded according to the Frankel system into--A: complete neurological deficit; B: sparing of some sensation; C: sparing of sensation but no useful motor function; D: sparing of sensation and useful motor function; and E: no deficits. Investigations carried out included detailed neurological assessment, radiography, contrast myelography and, in the later stages of the study, spinal computerized tomography (CT) scan. The authors believe that contrast myelography provides the best indication of spinal compression in TB spine. Treatment was by surgical decompression followed by chemotherapy. The surgical approach for thoracic spine disease was by the anterior transthoracic route. Cervical lesions were also approached by the anterior route, lateral to the carotid vessels. Unexpected findings during operation included lymphoma, plasmacytoma, non-tuberculous granulation tissue, salmonella osteomyelitis and tumour metastasis. Ten patients died during the postoperative period, all of whom had extensive systemic TB. When indicated, antituberculous drugs were administered postoperatively for two years and immobilization was done in a plaster cast for 3 months. Only 30 patients showed partial recovery. Improvement was found to be related to the grade of deficit; thoracic lesions with severe neurological deficits showed the least improvement while lumbar disease had the best outcome. The study recommended a combination of surgery and chemotherapy for all cases of TB spine with neurological deficits after a short delay during which respiratory function should be improved. The surgery should aim at decompression of the cord by removal of pus, granulation tissue and sequestra, with internal splintage with bone grafts to reduce the hospital stay. Conservative treatment is unwise because it is not always possible to distinguish between TB and neoplastic lesions.

Gyrate atrophy of the choroid and retina.

A rare case of gyrate atrophy of the choroid and retina is reported in two female siblings. The diagnosis was made on clinical, electrophysiological, angiographic and biochemical features. This possibly is the first documentation of hyperornithemic gyrate atrophy (HOGA) from the Indian subcontinent.

Biological characteristics of a factor suppressing Biological characteristics of a factor suppressing follicle stimulating hormone (inhibin) from ovine testes.

Inhibin (follicle stimulating hormone suppressing factor) isolated from ovine testes has been characterized for its biological activity using a variety of tests. The bioassay used – inhibition of the human chorionic gonadotropin induced increment in the mouse uterine weight– demonstrates that there is a significant increment in specific activity (approx. 300-fold) with the progress of purification. Eventhough the final product has not been obtained in a homogenous state it has been possible to show that (a) [125I]-labelled inhibin is preferentially taken up and retained by the pituitary, pretreatment of rats with testosterone facilitating this uptake; (b) it is able to suppress specifically the levels of follicle stimulating hormone in castrated as well as immature intact rats and (c) treatment of immature male rats with inhibin preparation for ten days results in impairment of testicular function as judged by 3H-thymidine incorporation into testicular DNA and testicular hyaluronidase activity.