Advances in the diagnosis of herpes simplex stromal necrotising keratitis: A feasibility study on deep learning approach

Purpose: Infectious keratitis, especially viral keratitis (VK), in resource?limited settings, can be a challenge to diagnose and carries a high risk of misdiagnosis contributing to significant ocular morbidity. We aimed to employ and study the application of artificial intelligence?based deep learning (DL) algorithms to diagnose VK. Methods: A single?center retrospective study was conducted in a tertiary care center from January 2017 to December 2019 employing DL algorithm to diagnose VK from slit?lamp (SL) photographs. Three hundred and seven diffusely illuminated SL photographs from 285 eyes with polymerase chain reaction–proven herpes simplex viral stromal necrotizing keratitis (HSVNK) and culture?proven nonviral keratitis (NVK) were included. Patients having only HSV epithelial dendrites, endothelitis, mixed infection, and those with no SL photographs were excluded. DenseNet is a convolutional neural network, and the two main image datasets were divided into two subsets, one for training and the other for testing the algorithm. The performance of DenseNet was also compared with ResNet and Inception. Sensitivity, specificity, receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were calculated. Results: The accuracy of DenseNet on the test dataset was 72%, and it performed better than ResNet and Inception in the given task. The AUC for HSVNK was 0.73 with a sensitivity of 69.6% and specificity of 76.5%. The results were also validated using gradient?weighted class activation mapping (Grad?CAM), which successfully visualized the regions of input, which are significant for accurate predictions from these DL?based models. Conclusion: DL algorithm can be a positive aid to diagnose VK, especially in primary care centers where appropriate laboratory facilities or expert manpower are not available

Anterior staphyloma repair following trauma and surgery – A retrospective review of techniques and outcomes over 25 years

Purpose: To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. Methods: This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Results: Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3–159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Conclusion: Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

The prevalence of anti-hepatitis C antibody among acute febrile illness cases in Idar Taluk, Gujarat, West India

Purpose: The major cause of chronic hepatitis is infections with hepatitis B virus and hepatitis C virus (HCV) globally. However, there exists sparse epidemiological data regarding the prevalence of HCV infection from India. Methodology: We carried out a cross-sectional study to estimate the prevalence of anti-HCV antibody among acute febrile illness cases aged between 1 and 65 years in Idar Taluk, Sabarkantha district, Gujarat state located in West India. A total of 702 serum samples collected from the study area during the year 2017, were screened for anti-hepatitis C IgG by enzyme-linked immunosorbent assay. The serum samples screened positive were then subjected to molecular testing for confirmation. Results: Among the 702 study participants screened, 16 cases were reported to be anti-HCV IgG positive with an estimated seroprevalence rate of 2.3% (95% confidence interval: 1.4%–3.7%). Out of the 16 cases, two samples were confirmed positive by molecular testing indicating active infection. When analysed phylogenetically, one strain was genotyped as HCV1b genotype, and the other one was clustered along with HCV3a genotype. Both the patients with hepatitis C infection were observed to be having a probable 1-year survival rate of 100% and a 2-year survival rate of 85% when the Child-Turcotte-Pugh classification was applied. Conclusion: The estimated seroprevalence of hepatitis C in Idar Taluk, Sabarkantha district, west India was 2.3%. HCV genotypes 1b and 3a were observed to be circulating in the study area.

Effects of blood transfusion on gastrointestinal anastomosis – Our experience in 52 patients.

Background: Patients, operative technique and instrumental factors, all affect the intestinal anastomosis outcome. Preoperative, intraoperative and postoperative blood transfusion influences the very common surgical procedure. Blood transfusion is discriminated from other risk factors in that; its intentionally added risk factor. Aims & Objective: The effect of intra-operative and post-operative blood transfusion on elective gastrointestinal anastomosis mainly evaluated by following factors; (1) surgical site complications (2) anastomosis leak (3) faecal fistula and (4) death. Material and Methods: To evaluate the effect of blood transfusion (Intraoperative and Postoperative) in outcome of Gastrointestinal anastomosis at Government General Hospital. Data collected from fifty two patients who underwent elective gastro intestinal anastomosis at our hospital. Results: The total number of patients was 52, 28male and 24 female. Mean age was 43 years, 17.3% were underwent small bowel anastomosis, 83.7% were underwent large bowel anastomosis, and 15.38% were transfused intraoperative and 26.92% were transfused postoperatively. Regardless other risk factors the incidence of surgical site infection was significantly high in transfused patients (25%), also there was a high rate of other complications in transfused patients. Conclusion: Intraoperative and post-operative blood transfusion is a good predictor for development of complications in elective intestinal anastomosis. There were some limitations in this study, as other risk factors might change the outcome and the effect of blood amount wasn’t considered, so more precise studies have to be done to give more support to our results.

The surgical approach in huge scrotal lymphedema.

Giant Scrotal Lymphoedema is a rare disease. Such Scrotal elephantiasis presents multiple problems both to the patient as well as the treating clinician obstruction, aplasia, or hypoplasia of the lymphatic vessels. The most common cause worldwide is lymphatic Filariasis. A case where the resected scrotal tissue weighed 30kg which is one of the largest so far mentioned in literatures. The lymphedema was progressive over 15 year’s duration and the testes were not palpable with the penis deeply buried. There is no effective medical treatment for filariasis. There are different surgical methods for scrotal filariasis in the literature. In this case, the patient was treated by Modified Charles procedure. Once fibrosis sets in resectional therapy will be needed in most cases. Successful reduction scrotoplasty with acceptable cosmetic results can be obtained in giant scrotal lymphedemas weighing as large as 30kg as in this case.

Recent trends in interstitial lung disease: Study of 25 cases .

Background: Interstitial lung disease accounts for more than 200 etiology. There has been worldwide increase in diagnosis of interstitial lung disease because of the help of recent advance diagnostic tools. Aims & Objective: to study age & sex distribution, to correlate symptoms & pulmonary function, role of HRCT as etiology diagnosis particular in interstitial pulmonary fibrosis, to study ECG & 2D ECHO changes and to study pulmonary function test pattern. Material and Methods: This was the study of 25 cases of interstitial lung disease in which various parameters like DLCO, PFT, 2D ECHO, ECG, identification of etiology, assessment of prognosis & role of immunosuppressant, steroids were studied. The exclusion criteria was age < 12 years. Results: The age distribution was highest in age group of 50-70 years. Occupational interstitial lung disease was more common in male while the connective tissue disorders are common in female which lead to more incidence of interstitial lung disease. Pulmonary function test is very helpful for prognosis. The patient with high pulmonary artery pressure had worst prognosis. HRCT is a useful tool for diagnosis of IPF without biopsy. Conclusion: Interstitial lung disease with moderate to severe pulmonary artery hypertension leads to poor prognosis. HRCT is very useful non-invasive diagnostic tool for interstitial lung disease.