Efficacy of an Artificial Intelligence App (Aysa) in Dermatological Diagnosis: Cross-Sectional Analysis.

BACKGROUND: Dermatology is an ideal specialty for artificial intelligence (AI)-driven image recognition to improve diagnostic accuracy and patient care. Lack of dermatologists in many parts of the world and the high frequency of cutaneous disorders and malignancies highlight the increasing need for AI-aided diagnosis. Although AI-based applications for the identification of dermatological conditions are widely available, research assessing their reliability and accuracy is lacking. OBJECTIVE: The aim of this study was to analyze the efficacy of the Aysa AI app as a preliminary diagnostic tool for various dermatological conditions in a semiurban town in India. METHODS: This observational cross-sectional study included patients over the age of 2 years who visited the dermatology clinic. Images of lesions from individuals with various skin disorders were uploaded to the app after obtaining informed consent. The app was used to make a patient profile, identify lesion morphology, plot the location on a human model, and answer questions regarding duration and symptoms. The app presented eight differential diagnoses, which were compared with the clinical diagnosis. The model's performance was evaluated using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and F1-score. Comparison of categorical variables was performed with the χ2 test and statistical significance was considered at P<.05. RESULTS: A total of 700 patients were part of the study. A wide variety of skin conditions were grouped into 12 categories. The AI model had a mean top-1 sensitivity of 71% (95% CI 61.5%-74.3%), top-3 sensitivity of 86.1% (95% CI 83.4%-88.6%), and all-8 sensitivity of 95.1% (95% CI 93.3%-96.6%). The top-1 sensitivities for diagnosis of skin infestations, disorders of keratinization, other inflammatory conditions, and bacterial infections were 85.7%, 85.7%, 82.7%, and 81.8%, respectively. In the case of photodermatoses and malignant tumors, the top-1 sensitivities were 33.3% and 10%, respectively. Each category had a strong correlation between the clinical diagnosis and the probable diagnoses (P<.001). CONCLUSIONS: The Aysa app showed promising results in identifying most dermatoses.

The Short and Long of COVID-19: A Review of Acute and Chronic Radiologic Pulmonary Manifestations of SARS-2-CoV and Their Clinical Significance.

Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature.

Midfacial Toddler Excoriation syndrome (MiTES): case series, diagnostic criteria and evidence for a pathogenic mechanism.

BACKGROUND: PRDM12 polyalanine tract expansions cause two different disorders; Midfacial Toddler Excoriation Syndrome (MiTES) - itch with normal pain sensation associated with homozygous 18 alanines (18A), and congenital insensitivity to pain (CIP) with normal itch with homozygous 19A. Knowledge of the phenotype, genotype, and disease mechanism of MiTES is incomplete. Why PRDM12 18A versus 19A can cause almost opposite phenotypes is unknown; no other poly-alanine or poly-glutamine tract expansion disease causes two such disparate phenotypes. METHODS: We assessed the genotype and phenotype of 9 new, 9 atypical, and 6 previously reported patients diagnosed with MiTES. Using cell lines with homozygous PRDM12 of 12A (normal), 18A (MiTES) and 19A (CIP) we examined PRDM12 aggregation and subcellular localisation by image separation confocal microscopy and sub-cellular fractionation western blotting. RESULTS: MiTES presents in the first year of life, and in all cases the condition regresses over the first decade leaving scarring. The MiTES phenotype is highly distinctive. Features overlapping with PRDM12-CIP are rarely found. The genotype-phenotype study of PRDM12 polyalanine tract shows that 7A -15A are normal; 16A -18A are associated with MiTES; 19A leads to CIP; and no clinically atypical MiTES cases had an expansion. PRDM12 aggregation and sub-cellular localisation differ significantly between 18A and normal 12A cell lines and between 18A and 19A cell lines. MiTES is a new protein aggregation disease. CONCLUSION: We provide diagnostic criteria for MiTES, and improved longitudinal data. MiTES and CIP are distinct phenotypes despite their genotypes varying by a single alanine in the PRDM12 polyalanine tract. We found clear distinctions between the cellular phenotypes of normal, MiTES and CIP cells.. We hypothesise that the developmental environment of the trigeminal ganglion is unique and critically sensitive to prenatal and postnatal levels of PRDM12.

Role of Hematological Indices as Predictors of Systemic Inflammation in Dermatology.

Hematological indices have long been used in a variety of conditions as indicators of systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inexpensive tools in predicting severity and disease activity in acute coronary syndrome, malignancy, coronavirus disease 2019 (COVID-19) illness, and other autoimmune conditions. Evidence suggests that such hematological indices can be used in various dermatoses as predictors of systemic inflammation, to assess the severity of the disease, prognosis, and treatment response.

Cementless versus Cemented Total Knee Arthroplasty Using the Same Implant Design: A Mean 5-Year Follow-up Study.

Cementless implant use continues to increase primarily due to increased numbers of younger and obese patients opting for primary total knee arthroplasty (TKA). Given the increased use of cementless implants, the purpose of this study was to evaluate the midterm clinical performance of cementless TKA using a highly porous tibial baseplate compared with its cemented counterpart of the same system. We conducted a retrospective case-control study of 400 patients undergoing primary TKA that included 200 patients with cementless components matched for age and body mass index (BMI) to 200 patients with cemented implants of the same implant design with a 5-year follow-up. We evaluated clinical results, complications, revisions, and overall survivorship between the cohorts. Statistical analysis was performed using student t-test and chi-square analysis. There was no statistical difference in age (64.3 vs. 64.3 p = 0.81), BMI (34 vs. 33.1 p = 0.19), preoperative Knee Society Score (KSS) function (41 vs. 32.3 p = 0.22), and preoperative KSS knee score (39.2 vs. 38.3 p = 0.54) between the cementless and cemented cohorts, respectively. The cementless group had seven revisions, while the cemented group had nine revisions (p = 0.609). The cementless group had one revision due to aseptic loosening versus five in the cemented group (p = 0.09). Postoperative 5-year KSS knee scores were 92.84 versus 91.75 (p = 0.386) and function scores were 81.81 versus 69.65 (p = 0.00004) in the cementless and cemented groups, respectively. The cementless group had survivorship of 96.5% for all-cause revision compared with 95.5% in the cemented group at 5-year follow-up (p = 0.60). Cementless TKA using a highly porous tibial baseplate showed excellent midterm results with one case of aseptic loosening at 5-year follow-up and with similar Knee Society outcome scores and survivorship compared with the cemented group. Cementless TKA demonstrated noninferiority to cemented TKA and could be used as an alternative mode of fixation in patients opting for primary TKA. Additional long-term follow-up is needed to determine if cementless TKA can demonstrate improved survivorship over cemented TKA.

Cementless metal-backed patellar components in primary total knee arthroplasty using an implant of modern design.

Aims: The use of cementless total knee arthroplasty (TKA) components has increased during the past decade. The initial design of cementless metal-backed patellar components had shown high failure rates due to many factors. The aim of this study was to evaluate the clinical results of a second-generation cementless, metal-backed patellar component of a modern design. Methods: This was a retrospective review of 707 primary TKAs in 590 patients from a single institution, using a cementless, metal-backed patellar component with a mean follow-up of 6.9 years (2 to 12). A total of 409 TKAs were performed in 338 females and 298 TKAs in 252 males. The mean age of the patients was 63 years (34 to 87) and their mean BMI was 34.3 kg/m2 (18.8 to 64.5). The patients were chosen to undergo a cementless procedure based on age and preoperative radiological and intraoperative bone quality. Outcome was assessed using the Knee Society knee and function scores and range of motion (ROM), complications, and revisions. Results: A total of 24 TKAs (3.4%) in 24 patients failed and required revision surgery, of which five were due to patellar complications (0.71%): one for aseptic patellar loosening (0.14%) and four for polyethylene dissociation (0.57%). A total of 19 revisions (2.7%) were undertaken in 19 patients for indications which did not relate to the patella: four for aseptic tibial loosening (0.57%), one for aseptic femoral loosening (0.14%), nine for periprosthetic infection (1.3%), one for popliteus impingement (0.14%), and four for instability (0.57%). Knee Society knee and function scores, and ROM, improved significantly when comparing pre- and postoperative values. Survival of the metal-backed patellar component for all-cause failure was 97.5% (95% confidence interval 94.9% to 100%) at 12 years. Conclusion: The second-generation cementless TKA design of metal-backed patellar components showed a 97.5% survival at 12 years, with polyethylene dissociation from the metal-backing being the most common cause of patellar failure. In view of the increased use of TKA, especially in younger, more active, or obese patients, these findings are encouraging at mean follow-up of seven years.

Ante-mortem and Post-mortem Diagnosis Modalities and Phylogenetic Analysis of Rabies Virus in Domestic and Wild Animals of Gujarat, India.

In the present study, total of 32 ante-mortem (AM) samples (saliva = 18 and corneal smears = 14) from six animal species (cattle = 5; camel = 1; goat = 1; horse = 1; buffalo = 4; dog = 6) and 28 post-mortem (PM) samples of domestic (cattle = 6; camel = 1; goat = 1; buffalo = 5; dog = 7) and wild animals (lion = 4, mongoose = 2; bear = 1; leopard = 1) were examined for rabies diagnosis in Gujarat, India. Direct fluorescent antibody test (dFAT) and reverse transcriptase polymerase chain reaction (RT-PCR) were applied on AM samples, whereas along with dFAT and RT-PCR, histopathological examination, immunohistochemistry (IHC) and real time PCR (qPCR) were used for PM diagnosis. Nucleotide sequencing of full nucleoprotein (N) and glycoprotein (G) genes were carried out upon representative amplicons. In AM examination, 7/18 saliva and 5/14 corneal impressions samples were found positive in dFAT and 8/18 saliva samples were found positive in RT-PCR. In PM examination, 14/28 samples showed positive results in dFAT and IHC with unusual large fluorescent foci in two samples. In histopathology, 11/28 samples showed appreciable lesion and Negri bodies were visible in 6 samples, only. Out of 23 brain samples examined. 12 samples were found positive in N gene RT-PCR and qPCR, and 10 samples in G gene RT-PCR. Phylogenetic analysis of N gene revealed that test isolates (except sample ID: lion-1; lion, Gir) form a close group with sequence ID, KM099393.1 (Mongoose, Hyderabad) and KF660246.1 (Water Buffalo, Hyderabad) which was far from some south Indian and Sri Lankan isolates but similar to Indian isolates from rest of India and neighboring countries. In G gene analysis, the test isolates form a close group with sequence ID, KP019943.1. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01126-0.

Wheat leaf diseases classification and severity analysis using HT-CNN and Hex-D-VCC-based boundary tracing mechanism.

Wheat is one among the significant crops for humans. Significant fungal illnesses of wheat are brought on by multiple pathogens. Wheat output could be enhanced by the early identification of wheat leaf disease. Thus, a novel hyperparameter tanh-based convolutional neural network (HT-CNN)-based wheat leaf disease prediction is proposed with its severity level. Here, initially, the red, green, and blue (RGB) images are converted into a hue saturation value (HSV) image. Next, the small probability space filtering is applied to the V component. Afterward, the contrast of the V component has been enhanced. The obtained HSV image is converted into the RGB image. Then, by employing weighted Canberra distance-based K-means (WCD-K means), the affected and normal regions are segmented. Next, the image is binarized. Afterward, for tracing a boundary around disease-affected region, the hex directional vertex chain code (Hex-D-VCC) is applied over the binarized image, and then the features are extracted. By employing baker's map-based Harris hawks optimization (BM-HHO), the optimal features are selected. For classifying disease, the selected features are further given into the HT-CNN, and the severity level is calculated to minimize the yield loss. As per the experimental result, the proposed model shows higher accuracy and efficacy when analogized to the other methods.

Free Hip Arthroplasty Templating Software - Does it Work?

Background: Preoperative planning is important for successful total hip arthroplasty (THA) and has been historically performed using acetate templates. Digital software templating has been adopted for evaluating implant size, position, and alignment. Commercial software can be expensive, but free programs exist. Detroit Bone Setter (detroitbonesetter.com, Detroit, MI) is a freely available templating program, but hasn't been validated. Our study reports this program's accuracy for templating THA. Methods: Sixty-five patients undergoing THA between 2017 and 2022 at 2 hospitals were included. All cases were templated by the senior author or orthopaedic trauma fellow prospectively or retrospectively in a blinded fashion. Direct anterior or posterior approaches were used based on attending surgeon's preference. A student's t-test was used to compare means of templated vs actual implant sizes of femoral and acetabular components. Results: There was no significant difference between implanted (mean [M] = 6.4, standard deviation [SD] = 2.0) and templated femoral component sizes (M = 5.7, SD = 2.1). There was a significant difference between implanted (M = 57.0, SD = 3.9) and templated acetabular component sizes (M = 53.4, SD = 3.0). Bland-Altman testing demonstrated femoral components with positive measurement bias of 0.62, indicating slight overestimation of implant size. Acetabular component size was overestimated with positive measurement bias of 3.6 mm. Conclusions: Detroit Bone Setter is advantageous as it is freely available and supports most major company implants. It accurately templated femoral component size but consistently overestimated acetabular component size by 3.6 mm. Further studies are needed prior to recommending its routine use for templating THA when other validated methods exist. It could be used with caution when no other methods are available.

Analyzing the Predictability of an Artificial Intelligence App (Tibot) in the Diagnosis of Dermatological Conditions: A Cross-sectional Study.

BACKGROUND: Artificial intelligence (AI) aims to create programs that reproduce human cognition and processes involved in interpreting complex data. Dermatology relies on morphological features and is ideal for applying AI image recognition for assisted diagnosis. Tibot is an AI app that analyzes skin conditions and works on the principle of a convolutional neural network. Appropriate research analyzing the accuracy of such apps is necessary. OBJECTIVE: This study aims to analyze the predictability of the Tibot AI app in the identification of dermatological diseases as compared to a dermatologist. METHODS: This is a cross-sectional study. After taking informed consent, photographs of lesions of patients with different skin conditions were uploaded to the app. In every condition, the AI predicted three diagnoses based on probability, and these were compared with that by a dermatologist. The ability of the AI app to predict the actual diagnosis in the top one and top three anticipated diagnoses (prediction accuracy) was used to evaluate the app's effectiveness. Sensitivity, specificity, and positive predictive value were also used to assess the app's performance. Chi-square test was used to contrast categorical variables. P<.05 was considered statistically significant. RESULTS: A total of 600 patients were included. Clinical conditions included alopecia, acne, eczema, immunological disorders, pigmentary disorders, psoriasis, infestation, tumors, and infections. In the anticipated top three diagnoses, the app's mean prediction accuracy was 96.1% (95% CI 94.3%-97.5%), while for the exact diagnosis, it was 80.6% (95% CI 77.2%-83.7%). The prediction accuracy (top one) for alopecia, acne, pigmentary disorders, and fungal infections was 97.7%, 91.7%, 88.5%, and 82.9%, respectively. Prediction accuracy (top three) for alopecia, eczema, and tumors was 100%. The sensitivity and specificity of the app were 97% (95% CI 95%-98%) and 98% (95% CI 98%-99%), respectively. There is a statistically significant association between clinical and AI-predicted diagnoses in all conditions (P<.001). CONCLUSIONS: The AI app has shown promising results in diagnosing various dermatological conditions, and there is great potential for practical applicability.

Utility of Dermoscopy in Cutaneous Small Vessel Vasculitis: Preliminary Observations from a Study of 30 Cases.

Background: Dermoscopy is a non-invasive diagnostic technique that provides an added advantage to the routine clinical diagnostic exercise. Role of dermoscopy in cutaneous small vessel vasculitis has not been explored well. Objective: This study was intended to delineate the dermoscopic features of cutaneous small vessel vasculitis and to correlate them with histopathological findings of the disease. Materials and Methods: This was a cross-sectional study involving 30 patients with cutaneous small vessel vasculitis confirmed by histopathology and direct immunofluorescence. In each patient, dermoscopic features of early/evolving and established lesions were recorded. Dermoscopic-histopathological correlation was assessed for established lesions. Results: On dermoscopy, the early/evolving lesions showed a dull red background in all the 30 (100%) patients, red globules in 8 (26.7%), and red dots in 4 (13.30%) patients. The established lesions showed red background in 28 (93.3%) patients, white and yellow structureless areas in 19 (63.33%) patients each, red globules in 18 (60%), and red dots in 16 (53.3%) patients. A statistically significant association between red globules and red blood cell extravasation was noted (P-0.01). White and yellow structureless areas also showed a statistically significant association between sparse (P-0.023) and dense (P-0.007) perivascular infiltrates, respectively. Conclusion: Dermoscopy of cutaneous small vessel vasculitis exhibits fairly reliable and reproducible features correlating well with histopathological aspects of the disease. Hence, inclusion of dermoscopy in the clinical diagnostic protocol for cutaneous small vessel vasculitis is beneficial in complementing the clinical diagnosis and in differentiating from other inflammatory purpuras.

Platelet-rich Fibrin versus Platelet-rich Plasma: A Study to Assess Efficacy as a Regenerative Medicine Strategy for Chronic Cutaneous Ulcers.

Background: The management of nonhealing ulcers has been a major challenge clinically. Current therapies include debridement, offloading, etc., which show a poor response. Newer modalities include stem cells, platelet-derived growth factors, and fibrin glues, which reduce healing time. Platelets play a major role in wound healing through the secretion of growth factors, chemokines, etc. and have been an area of interest as a modality in regenerative medicine. Aims and Objective: The aim was to study the comparative efficacy of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) as a regenerative medicine strategy for chronic cutaneous ulcers. Materials and Methods: Forty-four ulcers of duration greater than six weeks were enrolled for a comparative study comprising two groups, each divided either into group A receiving PRF dressings or group B receiving PRP dressing for six weeks. The ulcer evaluation was performed at baseline, each weekly dressing, and a two-week follow-up. Results: Primary efficacy was assessed by the percentage reduction in the volume of ulcers and re-epithelization at eight weeks. In total, 95.2% of ulcers in group A and 90.4% of ulcers in group B showed complete re-epithelization. One ulcer in group A and two ulcers in group B developed an infection. The recurrence of the ulcer was seen in four ulcers in the PRF group and three ulcers in the PRP group. Conclusion: Dressings done with PRF and PRP showed similar efficacy in the percentage reduction in the volume and re-epithelization of chronic cutaneous ulcers. Both dressings were associated with similar complications. PRF and PRP dressings provide a safe, efficacious, and inexpensive regenerative medicine strategy in the healing of chronic cutaneous ulcers.

Heterotopic ossification in the knee following retrograde nailing of a femur fracture.

BACKGROUND: Heterotopic ossification (HO) is a pathologic bone formation in extra skeletal tissue and articular space. This was an objection to nailing of femur fractures across the knee; however, this has not been the case in many thousands of cases. Nonetheless, we present a patient in who placement of a retrograde nail resulted in calcification in the knee requiring excision. CASE PRESENTATION: A 42-year-old male presented to the clinic complaining of pain, popping, clicking, and mocking in the right knee, especially in the patellar region. Nine months prior he suffered an ipsilateral femur fracture that was treated with a retrograde intramedullary nail. X-ray and CT scan were used to confirm the presentation of a heterotopic bone mass in the Hoffa area of the right knee. The patient underwent an arthrotomy for excision of the bone mass. The bone mass was excised, but bone in the ACL was not removed. The patient experienced pain relief and improved range of motion following excision. CONCLUSION: Intraarticular heterotopic ossification is an infrequent event. We present a case of heterotopic ossification in the knee following retrograde nailing. The patient experienced improved symptoms and range of motion after excision of the intraarticular heterotopic bone mass.

Cementless Metal-Backed Patellar Components in Primary Total Knee Arthroplasty: An Average 10-Year Follow-Up.

BACKGROUND: Historically, 1st generation metal-backed cementless patellar implants demonstrated high failure rates due to multiple factors. The 2nd generation cementless implants were developed with purported improvements in component design and polyethylene wear characteristics. This study evaluated clinical results of a current generation cementless metal-backed patellar implant with a minimum 5-year follow-up. METHODS: One hundred and thirty-six primary total knee arthroplasties (TKAs) with metal-backed cementless patellae were compared to 183 cemented patellae with the same implant design. The cementless group mean age was 61 years (range, 40 to 81), mean body mass index (BMI) of 34.9 (range, 22.6 to 64.5), and mean follow-up of 10 years (range, 5 to 13). The cemented group mean age was 65 years (range, 32 to 89), mean BMI of 32.5 (range, 18.2 to 56.6), and mean follow-up of 10 years (range, 5 to 12). Significant demographic differences of age (P < .001), BMI (P < .01), and sex (P < .001) were found, with cementless patients being younger, heavier, and with more men. RESULTS: There were no statistical differences in non-revision procedures (P = .214), TKA revisions (P = .639), patellar revisions (P = .151), and patellar aseptic loosening (P = .737). The 10-year survivorship of the cementless metal-backed patella was 95.9% with all-cause failure as the endpoint. The 10-year survivorship of the cemented patellar component was 98.9%. CONCLUSION: This study demonstrated noninferiority of a 2nd generation HA-coated cementless metal-backed patellar implant in primary TKA compared to cemented patellae with 10-year survivorship of 95.9%. Advances in implant design and polyethylene wear properties have led to improved clinical results with metal-backed patellar components in primary TKA.

Cementless Total Knee Arthroplasty Using a Highly Porous Tibial Baseplate in Morbidly Obese Patients: Minimum 5-Year Follow-Up.

Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) can pose a challenging problem with implant survivorship due to greater stress at the cement-bone interface. With the advent of additive manufacturing (three-dimensional printing), highly porous implants are now readily available. The purpose of this study was to review the results of primary TKA in the morbidly obese (body mass index [BMI] ≥ 40) patient using a highly porous cementless tibial baseplate. This is a retrospective study of 167 TKAs in patients with morbid obesity undergoing primary cementless TKA with a minimum 5-year follow-up. A total of 6 patients died and 14 were lost to follow-up, leaving 147 TKAs in 136 patients with a mean follow-up of 66 months (range 60-79 months). The average age was 59 years (range 36-84 years) and average BMI was 45 kg/m2 (range 39.5-63.9). Clinical results, patient-reported outcome measures, radiographs, and complications were reviewed. There were 9 failures requiring revision, including 3 for aseptic tibial loosening (2.0%), 2 for deep infection (1.4%), 2 for patellar resurfacing (1.4%), 1 for patella instability (0.7%), and 1 for extensor mechanism rupture (0.7%). Knee Society Score (KSS) improved from 48 to 90 at 2- and 5-year follow-up. KSS function score improved from 49 to 68 and 79 at 2- and 5-year follow-up, respectively. Survivorship with aseptic loosening as the endpoint was 98.0% at 5 years. Cementless TKA using a highly porous tibial baseplate in morbidly obese patients demonstrated excellent clinical results with 98% survivorship at 5 years and appears to offer durable long-term biologic fixation as an alternative to mechanical cement fixation in this challenging group of patients.