Efficacy of deep learning-based artificial intelligence models in screening and referring patients with diabetic retinopathy and glaucoma.

Purpose: To analyze the efficacy of a deep learning (DL)-based artificial intelligence (AI)-based algorithm in detecting the presence of diabetic retinopathy (DR) and glaucoma suspect as compared to the diagnosis by specialists secondarily to explore whether the use of this algorithm can reduce the cross-referral in three clinical settings: a diabetologist clinic, retina clinic, and glaucoma clinic. Methods: This is a prospective observational study. Patients between 35 and 65 years of age were recruited from glaucoma and retina clinics at a tertiary eye care hospital and a physician's clinic. Non-mydriatic fundus photography was performed according to the disease-specific protocols. These images were graded by the AI system and specialist graders and comparatively analyzed. Results: Out of 1085 patients, 362 were seen at glaucoma clinics, 341 were seen at retina clinics, and 382 were seen at physician clinics. The kappa agreement between AI and the glaucoma grader was 85% [95% confidence interval (CI): 77.55-92.45%], and retina grading had 91.90% (95% CI: 87.78-96.02%). The retina grader from the glaucoma clinic had 85% agreement, and the glaucoma grader from the retina clinic had 73% agreement. The sensitivity and specificity of AI glaucoma grading were 79.37% (95% CI: 67.30-88.53%) and 99.45 (95% CI: 98.03-99.93), respectively; DR grading had 83.33% (95 CI: 51.59-97.91) and 98.86 (95% CI: 97.35-99.63). The cross-referral accuracy of DR and glaucoma was 89.57% and 95.43%, respectively. Conclusion: DL-based AI systems showed high sensitivity and specificity in both patients with DR and glaucoma; also, there was a good agreement between the specialist graders and the AI system.

A Novel PCR-RFLP to Detect and Differentiate Schistosoma spindale and S. indicum, the Pathogenic Schistosomes in Indian Cattle.

PURPOSE: Visceral schistosomosis is an economically important trematode infection caused by Schistosoma spindale and S. indicum in among ruminants. The lack of sensitive diagnostic tools has often led to underestimation of the prevalence in live animals. A sensitive copro-PCR targeting partial mitochondrial gene was developed to detect Schistosoma spp. However, this protocol could not differentiate between the two species. This study was conducted to explore the possibility of species differentiation using restriction fragment length polymorphism of PCR products (PCR- RFLP). METHODS: Polymerase chain reaction was carried out to amplify mitochondrial gene of adult S. spindale and S. indicum. Copro PCR was done with schistosome-positive faecal samples. A novel PCR-RFLP was designed targeting the Hpy166II recognition sequence in the mitochondrial gene sequence of S. indicum. RESULT: The PCR using primers targeting the mitochondrial gene of S. spindale and S. indicum amplified a distinct product of approximately 454 bp with adult fluke as well as faecal DNA, which upon RFLP with Hpy166II yielded 330 bp and 124 bp products with S. indicum amplicons alone. CONCLUSION: The novel PCR-RFLP possesses the potential to be used in epidemiological surveys among bovines and in snail intermediate hosts to screen for S. spindale and S. indicum infection.

Optical Coherence Tomography-Based Prevalence of Diabetic Macular Edema and its Associated Risk Factors in Urban South India: A Population-Based Study.

BACKGROUND: To estimate the prevalence of optical coherence tomography (OCT)-defined diabetic macular oedema (DME) in urban South Indian population and to elucidate their associated risk factors. METHODS: Of 911 participants from the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study-II (SN-DREAMS-), 759 who underwent OCT were analysed. The participants underwent a comprehensive examination and retinal photography following a standard protocol for diabetic retinopathy (DR) grading. The subjects were categorized into centre-involving DME (CI-DME), non-centre involving DME (NCI-DME), and No-DME based on the mean retinal thickness at the central 1 mm, inner and outer ETDRS subfields. RESULTS: The prevalence of CI-DME and NCI-DME in the Chennai population was 3.03% (95% CI: 3.01-3.05) and 10.80% (95% CI: 10.7-11.02). NCI-DME was found to be higher by 9.5% (95% CI: 0.07-0.11) in the early stages of DR. A greater number of subjects with CI DME were aged >60 years and had diabetes mellitus (DM) for >10 years. The significant risk factors for NCI-DME are diastolic blood pressure, serum total cholesterol, serum triglyceride, insulin use and neuropathy (OR (95% CI): 0.97 (0.94-100), 1.00 (1.00-1.01), 0.99 (0.98-0.99), 2.32 (1.15-4.68) and 4.24 (1.22-14.69), respectively) and for CI DME are duration of diabetes, anaemia, neuropathy and insulin use (OR (95% CI): 2.49 (0.96-6.40), 3.41 (1.34-8.65), 10.58 (1.68-66.56) and 3.51 (1.12-10.95), respectively). CONCLUSIONS: The prevalence of NCI-DME was found to be higher than that of CI-DME in patients with DR.

Deltamethrin resistance in south Indian isolates of Rhipicephalus (Boophilus) microplus.

The present communication deals with the detection and characterization of deltamethrin resistance in tick populations using biological (larval packet test), biochemical (esterase enzyme assay) and molecular assays. Ticks were collected from cattle farms of Korutla, Telangana (KOR), Mehboob Nagar, Telangana (MBN), Nagpur, Maharashtra (NAG), Parbani, Maharashtra (PBN), Madhavaram, Tamil Nadu (MAD), Cuddalore, Tamil Nadu (CUD), Sakhleshpur, Karnataka (SAK) and Buvenduvella, Karnataka (BUV). Out of eight field isolates, seven were identified as Rhipicephalus (Boophilus) microplus while one isolate (CUD) was identified as R. (B.) annulatus. The LC50 values and resistance factors (RF) of field isolates were assessed by larval packet test (LPT). RF values of two isolates viz., Korutla and Parbhani (KOR, PAR) were close to that of reference susceptible isolate. R. (B.) microplus isolate from Nagpur (NAG) and Sakleshpur (SAK) revealed slightly higher RF values (6.42 and 4.51). They revealed slightly elevated esterase enzyme activity too. Other isolates did not reveal higher values for RF or esterase activity. Previously identified mutations conferring synthetic pyrethroid resistance in R. (B.) microplus populations were analysed by sequencing the mutation flanking regions of the carboxyl esterase and the sodium channel genes (domain III S6 and domain II S4-5 linker region). However, these point mutations were not detected in the field isolates. The results of the present study revealed that low levels of synthetic pyrethroid resistance had developed in field populations of ticks of southern India.

Phylogenetic analysis of bovine Theileria spp. isolated in south India.

The objective of the present study is to determine the phylogenetic position of the Theileria organisms in blood of cattle of southern India using molecular tools. Theileria annulata (Namakkal isolate, Tamil Nadu) and three Theileria field isolates (free of T. annulata) from Wayanad, Kerala (Wayanad 1, 2, 3) were used. The small subunit ribosomal RNA (SSU rRNA) and major piroplasm surface protein (MPSP) gene products were cloned, sequenced and the phylogenetic tree constructed. SSU rRNA gene of Wayanad 1 isolate (JQ706077) revealed maximum identity with Theileria velifera or Theileria cervi. The phylogenetic tree constructed based on SSU rRNA genes revealed that Wayanad 1 isolate belonged to a new type which share common ancestor with all the other theilerial species while Wayanad 2 and 3 isolates (JX294459, JX294460) were close to types A and C respectively. Based on MPSP gene sequences, Wayanad 2 and 3 (JQ706078, JX648208) isolates belonged to Type 1 and 3 (Chitose) respectively. When, the previously reported MPSP type 7 is also considered from the same study area, Theileria orientalis types 1, 3 and 7 are observed in south India. SSU rRNA sequence of South Indian T. annulata (JX294461) showed a maximum identity with Asian isolates while the Tams1 merozoite surface antigen (MSA) gene (JX648210) showed maximum identity with north Indian isolate.