Artificial Intelligence: A Next-Level Approach in Confronting the COVID-19 Pandemic.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which caused coronavirus diseases (COVID-19) in late 2019 in China created a devastating economical loss and loss of human lives. To date, 11 variants have been identified with minimum to maximum severity of infection and surges in cases. Bacterial co-infection/secondary infection is identified during viral respiratory infection, which is a vital reason for morbidity and mortality. The occurrence of secondary infections is an additional burden to the healthcare system; therefore, the quick diagnosis of both COVID-19 and secondary infections will reduce work pressure on healthcare workers. Therefore, well-established support from Artificial Intelligence (AI) could reduce the stress in healthcare and even help in creating novel products to defend against the coronavirus. AI is one of the rapidly growing fields with numerous applications for the healthcare sector. The present review aims to access the recent literature on the role of AI and how its subfamily machine learning (ML) and deep learning (DL) are used to curb the pandemic's effects. We discuss the role of AI in COVID-19 infections, the detection of secondary infections, technology-assisted protection from COVID-19, global laws and regulations on AI, and the impact of the pandemic on public life.

Diagnostic Accuracy of Frequency-Doubling Technology and the Moorfields Motion Displacement Test for Glaucoma.

PURPOSE: Portable perimetric testing could be useful for community-based glaucoma screening programs. Frequency-doubling technology (FDT) and the Moorfields motion displacement test (MDT) are portable perimeters that have shown promise as potential screening tools for glaucoma. This study's goal was to determine the diagnostic accuracy of FDT and MDT for visual field defects and glaucoma. DESIGN: Prospective, cross-sectional, diagnostic accuracy study. PARTICIPANTS: A consecutive series of patients aged ≥ 50 years who presented to a glaucoma clinic in South India and had never undergone Humphrey field analyzer (HFA) visual field testing in the past. METHODS: Participants underwent 24-2 Swedish Interactive Thresholding Algorithm (SITA) Standard HFA perimetry, FDT perimetry, MDT perimetry, and iPad perimetry using visualFields Easy in random order. Ophthalmologist grades of HFA and optic nerve head photographs were used as reference standards for glaucoma and field defect presence. Receiver operating characteristic curves were constructed to assess the diagnostic accuracy of various parameters for each test. MAIN OUTCOME MEASURES: Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). RESULTS: Overall, 292 eyes from 173 participants were included, with 112 eyes classified as moderate or worse glaucoma. For moderate or worse glaucoma detection, the best parameter on FDT was mean deviation (MD) (AUROC, 0.84; 95% confidence interval [CI], 0.79-0.89) and the best parameter on MDT was global probability of true damage (GPTD) (AUROC, 0.87; 95% CI, 0.82-0.91). When specificity was set to 90%, the sensitivity for detection of moderate or worse glaucoma was 55% (95% CI, 39%-68%) for FDT MD and 62% (95% CI 52%-71%) for MDT GPTD. CONCLUSIONS: Frequency-doubling technology and MDT perimetry had fair diagnostic accuracy for glaucoma detection when administered to naïve test takers in this South Indian population. Although not appropriate for use as a sole glaucoma screening test, these perimetric tests may be useful as ancillary tests. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Diagnostic accuracy of an iPad application for detection of visual field defects.

BACKGROUND/OBJECTIVES: Tablet-based perimetry could be used to test for glaucomatous visual field defects in settings without easy access to perimeters, although few studies have assessed diagnostic accuracy of tablet-based tests. The goal of this study was to determine the diagnostic accuracy of iPad perimetry using the visualFields Easy application. SUBJECTS/METHODS: This was a prospective, cross-sectional study of patients undergoing their first Humphrey Field Analyser (HFA) visual field test at a glaucoma clinic in India. Participants underwent 24-2 SITA Standard HFA testing and iPad-based perimetry with the visualFields Easy application. Reference standards for both visual field loss and suspected glaucoma were determined by ophthalmologist review of HFA results and optic disc photographs. Receiver operating characteristic curves were constructed to assess diagnostic accuracy at various test thresholds. RESULTS: 203 eyes from 115 participants were included, with 82 eyes classified as moderate or worse glaucoma. iPad perimetry had an area under the receiver operating characteristic (AUROC) curve of 0.64 (95% CI 0.57 to 0.71) for detection of any visual field defect relative to HFA and an AUROC of 0.68 (0.59 to 0.76) for detection of moderate or worse glaucoma relative to ophthalmologist examination. At a set specificity of 90%, the sensitivity of iPad perimetry for detection of moderate or worse glaucoma was 35% (22-48%). CONCLUSIONS: iPad perimetry using the visualFields Easy application had inadequate diagnostic accuracy to be used as a screening tool for glaucoma in this South Indian population.

Application of Internet of Things on the Healthcare Field Using Convolutional Neural Network Processing.

Population at risk can benefit greatly from remote health monitoring because it allows for early detection and treatment. Because of recent advances in Internet-of-Things (IoT) paradigms, such monitoring systems are now available everywhere. Due to the essential nature of the patients being monitored, these systems demand a high level of quality in aspects such as availability and accuracy. In health applications, where a lot of data are accessible, deep learning algorithms have the potential to perform well. In this paper, we develop a deep learning architecture called the convolutional neural network (CNN), which we examine in this study to see if it can be implemented. The study uses the IoT system with a centralised cloud server, where it is considered as an ideal input data acquisition module. The study uses cloud computing resources by distributing CNN operations to the servers with outsourced fitness functions to be performed at the edge. The results of the simulation show that the proposed method achieves a higher rate of classifying the input instances from the data acquisition tools than other methods. From the results, it is seen that the proposed CNN achieves an average accurate rate of 99.6% on training datasets and 86.3% on testing datasets.

Weighted butterfly optimization algorithm with intuitionistic fuzzy Gaussian function based adaptive-neuro fuzzy inference system for covid-19 prediction.

Covid-19 cases are increasing each day, however none of the countries successfully came up with a proper approved vaccine. Studies suggest that the virus enters the body causing a respiratory infection post contact with a disease. Measures like screening and early diagnosis contribute towards the management of COVID- 19 thereby reducing the load of health care systems. Recent studies have provided promising methods that will be applicable for the current pandemic situation. The previous system designed a various Machine Learning (ML) algorithms such as Decision Tree (DT), Random Forest (RF), XGBoost, Gradient Boosting Machine (GBM) and Support Vector Machine (SVM) for predicting COVID-19 disease with symptoms. However, it does not produce satisfactory results in terms of true positive rate. And also, better optimization methods are required to enhance the precision rate with minimum execution time. To solve this problem the proposed system designed a Weighted Butterfly Optimization Algorithm (WBOA) with Intuitionistic fuzzy Gaussian function based Adaptive-Neuro Fuzzy Inference System (IFGF-ANFIS) classifier for predicting the magnitude of COVID- 19 disease. The principle aim of this method is to design an algorithm that could predict and assess the COVID-19 parameters. Initially, the dataset regarding COVID-19 is taken as an input and preprocessed. The parameters included are age, sex, history of fever, travel history, presence of cough and lung infection. Then the optimal features are selected by using Weighted Butterfly Optimization Algorithm (WBOA) to improve the classification accuracy. Based on the selected features, an Intuitionistic fuzzy Gaussian function based Adaptive-Neuro Fuzzy Inference System (IFGF-ANFIS) classifier is utilized for classifying the people having infection possibility. The studies conducted on this proposed system indicates that it is capable of producing better results than the other systems especially in terms of accuracy, precision, recall and f-measure.

Comparison of Structural, Functional, Tonometric, and Visual Acuity Testing for Glaucoma: A Prospective Diagnostic Accuracy Study.

PURPOSE: To determine the diagnostic accuracy of potential screening tests for moderate to advanced glaucoma. DESIGN: Prospective diagnostic test accuracy study. PARTICIPANTS: The study enrolled a consecutive series of patients aged ≥50 years who presented to a glaucoma clinic in South India without ever having received automated visual field testing. METHODS: All participants underwent 8 index tests: OCT of the peripapillary retinal nerve fiber layer, optic disc photography, Moorfield's Motion Displacement Test (MDT), frequency doubling technique perimetry, noncontact tonometry, pneumatonometry, presenting visual acuity, and best-corrected visual acuity. Participants also underwent stereoscopic photographs and Humphrey visual fields, which were used by 2 ophthalmologists to arrive at the reference standard diagnosis of moderate to advanced glaucoma. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. RESULTS: A total of 217 people were enrolled; 321 eyes from 180 participants had all tests performed. Of these, 127 eyes (40%) were classified as having moderate to advanced glaucoma. Among the 8 tests, OCT best optimized sensitivity (84%, 95% confidence interval [CI], 76-90) and specificity (75%, 95% CI, 68-81). Moorfield's Motion Displacement Test was the best perimetric test, with a sensitivity of 91% (95% CI, 85-96) and specificity of 53% (95% CI, 44-61). Pressure and vision tests were not sensitive (e.g., sensitivity of 16%, 95% CI, 9-23 for noncontact tonometry and 23%, 95% CI, 15-31 for best-corrected visual acuity). Moorfield's Motion Displacement Test identified 16 of 127 eyes (13%) with glaucoma that were not captured by OCT, but also had false-positive results in 65 of 194 eyes (34%) without glaucoma that OCT correctly classified as negative. CONCLUSIONS: OCT had moderate sensitivity and fair specificity for diagnosing moderate to advanced glaucoma and should be prioritized during an initial assessment for glaucoma.

Accuracy of autorefraction in an adult Indian population.

PURPOSE: Autorefractors allow non-specialists to quickly assess refractive error, and thus could be a useful component of large-scale vision screening programs. In order to better characterize the role of autorefraction for public health outreach programs in resource-limited settings, the diagnostic accuracy of two autorefractors was assessed relative to subjective refraction in an adult Indian population. METHODS: An optometrist refracted a series of patients aged ≥50 years at an eye clinic in Bangalore, India using the Nidek ARK-900 autorefractor first, followed by the 3nethra Royal autorefractor, and then subjective refraction. The diagnostic accuracy of each autorefractor for myopia, hyperopia, and astigmatism was assessed using subjective refraction as the reference standard, and measures of agreement between refractions were calculated. RESULTS: A total of 197 eyes in 104 individuals (mean age 63 ± 8 years, 52% female) were evaluated. Both autorefractors produced spherical equivalent estimates that were on average more hyperopic than subjective refraction, with a measurement bias of +0.16 D (95%CI +0.09 to +0.23D) for Nidek and +0.42 D (95%CI +0.28 to +0.54D) for 3nethra. When comparing pairs of measurements from autorefraction and subjective refraction, the limits of agreement were approximately ±1D for the Nidek autorefractor and ±1.75D for the 3Nethra autorefractor. The sensitivity and specificity of detecting ≥1 diopter of myopia were 94.6% (95%CI 86.8-100%) and 92.5% (95%CI 88.9-97.5%) for the Nidek, and 89.2% (95%CI 66.7-97.4) and 77.5% (95%CI 71.2-99.4%) for the 3Nethra. The accuracy of each autorefractor increased at greater levels of refractive error. CONCLUSIONS: The sensitivity and specificity of the Nidek autorefractor for diagnosing refractive error among adults ≥50 years in an urban Indian clinic was sufficient for screening for visually significant refractive errors, although the relatively wide limits of agreement suggest that subjective refinement of the eyeglasses prescription would still be necessary.

Zosteriform Cutaneous Metastases with Primary Endometrial Carcinoma.

Cutaneous metastases from endometrial adenocarcinoma are ominous and are seldom seen, though metastases occurring at the local sites, such as pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs are well recognized. The zosteriform pattern of lesions is even more rare. Here, we describe an interesting case of a 60-year-old female with carcinoma endometrium, presenting with zosteriform cutaneous metastasis.

Epidemiological pattern of Malassezia, its phenotypic identification and antifungal susceptibility profile to azoles by broth microdilution method.

Background: Malassezia though known for its cutaneous infections can potentially cause invasion. The skin infections caused by Malassezia have poor patient compliance due to its chronicity and recurrent nature of the disease. There is also a lack of standardised antifungal susceptibility profile for Malassezia due to its complex growth requirement. Objective: This study was performed to understand the epidemiological pattern of disease and to study the antifungal susceptibility testing (AFST) profile so as to choose the appropriate drug/drugs to treat the infections caused by Malassezia. Materials and Methods: Samples were collected and processed, species were identified by conventional method and AFST was done by broth microdilution method. Results: The epidemiological pattern showed adolescent females commonly affected in torso. The most common lesion was pityriasis versicolor. The systemic antifungal of choice was itraconazole with the lowest minimum inhibitory concentration (MIC) of 0.125-1 µg/ml. The best topical drug with the lowest MIC value was clotrimazole 0.03-0.5 µg/ml. Conclusion: AFST is important as it will help the dermatologist to choose the appropriate antifungal agents for the patient and thereby reduce the chronicity of the disease with good patient compliance.

Nitric oxide donors offer protection to RBC from storage lesion.

BACKGROUND: Red blood cell (RBC), which is the most commonly transfused blood component, due to its ability to save a life in absence of any other blood components, can be stored up to maximum 6 weeks by following standard preservation procedure. During storage, RBC undergoes various biophysical and biochemical changes (commonly known as storage lesion) for which blood transfusion with "old RBC" shows a lot of clinical problems especially relevant to critically ill patients. Recent research on S-nitrosylation of haemoglobin to improve oxygen delivery of banked blood revealed the important role of nitric oxide (NO) in protecting storage lesion. MATERIALS AND METHODS: In the present study, we used various "NO donating" chemicals with different NO release dynamics and chemistries in RBC storage cocktails to test the effects of NO on storage lesion. Changes in different storage markers were evaluated after 7 days storage of pre-treated RBC. RESULTS: All the NO donors have shown protection against hemolysis. However, S-nitroso glutathione (GSNO) ranks first in shielding RBCs from storage lesion and additionally, it helps in elevating the value of 2, 3-di phosphoglycerate (2, 3-DPG), improving the RBC membrane fluidity and decreasing the adhesion towards endothelial monolayer. DISCUSSION: Present study reveals that NO released from NO donors confers protection against storage lesions of the RBC. Further, the study confirms that pre-treatment with GSNO, a NO donor and a nitrosylating agent, ensures the best protection to RBC during low temperature storage, when compared to other NO donor treatments.

Genetic predisposition and prediction protocol for epithelial neoplasms in disease-free individuals: A systematic review.

BACKGROUND: Epithelial neoplasm is an important global health-care problem, with high morbidity and mortality rates. Early diagnosis and appropriate treatment are essential for increased life survival. Prediction of occurrence of malignancy in a disease-free individual by any means will be a great breakthrough for healthy living. AIMS AND OBJECTIVES: The aims and objectives were to predict the genetic predisposition and propose a prediction protocol for epithelial malignancy of various systems in our body, in a disease-free individual. METHODS: We have searched databases both manually and electronically, published in English language in Cochrane group, Google search, MEDLINE and PubMed from 2000 to 2019. We have included all the published, peer-reviewed, narrative reviews; randomized controlled trials; case-control studies; and cohort studies and excluded the abstract-only articles and duplicates. Specific words such as "etiological factors," "pathology and mutations," "signs and symptoms," "genetics and IHC marker," and "treatment outcome" were used for the search. A total of 1032 citations were taken, and only 141 citations met the inclusion criteria and were analyzed. RESULTS: After analyzing various articles, the etiological factors, clinical signs and symptoms, genes and the pathology involved and the commonly used blood and tissue markers were analyzed. A basic investigation strategy using immunohistochemistry markers was established. CONCLUSION: The set of proposed biomarkers should be studied in future to predict genetic predisposition in disease-free individuals.

Spindle cell rhabdomyosarcoma of the anterior mandible manifesting as a periapical lesion of pulpal origin: Case report.

A 25-year-old male patient presented with swelling and pain in the mandibular anterior region for the previous 6 months. He had a history of repeated traumatic episodes associated with his lower incisors. A periapical radiograph revealed a radiolucent lesion involving the apices of the lower incisors, whereas cone beam computed tomography revealed a large osteolytic lesion involving all mandibular incisors and loss of labial and lingual cortical plates. Histological, immunohistochemical and bone scan examination of the curetted tissue established a differential diagnosis of spindle cell rhabdomyosarcoma of the anterior mandible. Such rare but life-threatening oral cancers can be correctly diagnosed and treated only through systematic analysis of clinical findings and examining the diseased tissue with histological and other diagnostic procedures.

Reproducibility of 5 Methods of Ocular Tonometry.

PURPOSE: To evaluate the agreement between Goldmann applanation tonometry (GAT; Haag-Streit, Bern, Switzerland) and several portable tonometers that could be used for glaucoma screening programs. DESIGN: Evaluation of a diagnostic test. PARTICIPANTS: Three hundred twenty-one eyes of 168 participants seeking treatment at the glaucoma clinic of a tertiary eye hospital in India. METHODS: Participants underwent intraocular pressure (IOP) measurement with GAT and 4 index tests: the Icare TA01i rebound tonometer (Icare USA, Raleigh, NC), a noncontact tonometer (NCT; Topcon CT-80; Topcon; Tokyo, Japan), a pneumatonometer (Model 30; Reichert Technologies; Depew, NY), and the Tono-Pen AVIA (Reichert Technologies). MAIN OUTCOME MEASURES: Estimates of reproducibility of IOP measurements between each index test and GAT, including the intraclass correlation coefficient (ICC) and the Bland-Altman 95% limits of agreement. RESULTS: The Icare showed the greatest agreement with GAT (ICC, 0.69; 95% confidence interval, 0.61-0.74), followed by the NCT (ICC, 0.65; 95% confidence interval, 0.58-0.71), the Tono-Pen (ICC, 0.51; 95% confidence interval, 0.43-0.59), and the pneumatonometer (ICC, 0.36; 95% confidence interval, 0.27-0.44). The pneumatonometer and Tono-Pen tended to overestimate IOP relative to GAT, with a mean difference of 3.4 mmHg (95% limits of agreement [LOA], -7.3 to 14.1 mmHg) for the pneumatonometer and 3.2 mmHg (95% LOA, -6.1 to 12.6 mmHg) for the Tono-Pen. In contrast, measurements from the Icare and NCT were on average within 1 point of those for GAT (mean difference, -0.4 mmHg [95% LOA, -8.4 to 7.6 mmHg] and -0.5 mmHg [95% LOA, -8.7 to 7.6 mmHg], respectively). CONCLUSIONS: The Icare and NCT both demonstrated good agreement with GAT across a wide range of IOPs and could be considered for glaucoma screening programs.

Multistation exercises: a combination of problem-based learning and team-based learning instructional design for large-enrollment classes.

To introduce active learning session for a large group of 250 students, we combined the strengths of problem-based learning and team-based learning to promote a structured active learning strategy with less faculty involvement. For the implementation of this strategy, a case on anemia was selected based on the module already covered in classes. Structured exercises were preplanned on six different concepts that a student should possess for solving the problem. The large group of 250 students was divided into groups of 41 or 42 each. The groups were facilitated by one faculty member for one structured exercise. At the station, the group of 41 or 42 was further broken down into 6 smaller groups comprising 7 students each. After completion of the exercise, students cycled to the next exercise station facilitated by another faculty member. The case was solved in a plenary session. The effectiveness of the method was assessed by comparing the academic performance of the group with other similar groups from the previous year. The intervention group performed significantly better than the nonintervention group on the related item. Quartile subanalysis found that the effect was present in the performance of average and higher quartile groups, but not in the lower quartile group.

Assessment of histological changes in antemortem gingival tissues fixed at various time intervals: A method of estimation of postmortem interval.

INTRODUCTION: Conventional methods to estimate the time of death are adequate, but a histological method is yet unavailable to assess postmortem interval (PMI). The autolytic changes that occur in an unfixed antemortem gingival tissue which reflects histologically at an early stage are similar to changes that occur in postmortem tissue. These histological changes can be used and applied in a postmortem tissue as a method to assess PMI. AIMS: The aim of the study is to assess the histological changes in a gingival tissue left unfixed for various time intervals and to correlate the findings with duration. MATERIALS AND METHODS: Sixty gingival tissues obtained from patients following therapeutic extractions, impactions, gingivectomy and crown lengthening procedures were used. Each tissue obtained was divided into two pieces and labeled as "A", the control group and " B" the study group. Tissues labeled "A" were fixed in 10% formalin immediately and tissues labeled"B" were placed in closed containers and fixed after 15, 30, 45 min, 1, 2, and 4 h time interval. Of the sixty tissues in the study group " B", ten tissues were used for each time interval under investigation. All the fixed tissues were processed, stained, assessed, and analyzed statistically using Pearson correlation and regression analysis. RESULTS: Histological changes appear at 15 min in an unfixed antemortem tissue. At 2 h interval, all layers with few cells in basal cell layer are involved. At 4 h interval, loss of stratification and complete homogenization of cells in the superficial layers with prominent changes in basal layer is evident. There was a positive correlation (<1.0) between the time interval and the appearance of the histological changes. CONCLUSION: Histological changes such as complete homogenization of cells in superficial layers and loss of epithelial architecture at 4 h in unfixed antemortem tissue may be used as a criterion to estimate PMI, after further studies on postmortem tissues.

Stevens-Johnson syndrome induced by a combination of lamotrigine and valproic acid.

Lamotrigine and valproic acid are well-tolerated anticonvulsants, but frequently associated with severe cutaneous reactions, such as the Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis, when used in combination. We report a case of SJS likely induced by the use of a lamotrigine and valproic acid regimen and as a dental surgeon it is important to identify such lesion and report to pharmacovigilance.

An Unusual Content in a Congenital Hernia - Complete Spleno -gonadal Fusion Band.

Six years old boy underwent elective inguinal exploration for left congenital hernia. Per- operatively, an elongated, purplish-red, fleshy band of tissue was found inside the sac, adherent to the upper pole of testis. Biopsy was taken and the wound closed. An MRI done after 4 weeks proved the origin of the band from spleen. Laparotomy and excision of the band was done. The histo-pathology of the specimen was reported as normal splenic tissue. The above features are consistent with a diagnosis of spleno - gonadal fusion (SGF).