Assistance from Automated ASPECTS Software Improves Reader Performance.

PURPOSE: To compare physicians' ability to read Alberta Stroke Program Early CT Score (ASPECTS) in patients with a large vessel occlusion within 6 hours of symptom onset when assisted by a machine learning-based automatic software tool, compared with their unassisted score. MATERIALS AND METHODS: 50 baseline CT scans selected from two prior studies (CRISP and GAMES-RP) were read by 3 experienced neuroradiologists who were provided access to a follow-up MRI. The average ASPECT score of these reads was used as the reference standard. Two additional neuroradiologists and 6 non-neuroradiologist readers then read the scans both with and without assistance from the software reader-augmentation program and reader improvement was determined. The primary hypothesis was that the agreement between typical readers and the consensus of 3 expert neuroradiologists would be improved with software augmented vs. unassisted reads. Agreement was based on the percentage of the individual ASPECT regions (50 cases, 10 regions each; N=500) where agreement was achieved. RESULTS: Typical non-neuroradiologist readers agreed with the expert consensus read in 72% of the 500 ASPECTS regions, evaluated without software assistance. The automated software alone agreed in 77%. When the typical readers read the scan in conjunction with the software, agreement improved to 78% (P<0.0001, test of proportions). The software program alone achieved correlations for total ASPECT scores that were similar to the expert readers who had access to the follow-up MRI scan to help enhance the quality of their reads. CONCLUSION: Typical readers had statistically significant improvement in their scoring of scans when the scan was read in conjunction with the automated software, achieving agreement rates that were comparable to neuroradiologists.

Urinary Albumin to Creatinine Ratio to Predict Diabetic Retinopathy: The Eyes Have It!

Introduction The Coronavirus disease 2019 (COVID-19) pandemic has provided a push in the search for alternative screening methods to replace annual fundoscopic examination of patients with type 2 diabetes mellitus (T2DM) to detect diabetic retinopathy (DR). Materials and methods This retrospective study was conducted using the data of T2DM patients from their routine follow-up hospital visits. The details from their history and physical examination were extracted. As part of their routine follow-up visit, they had undergone a panel of investigations that included blood glucose measurements and urinary albumin excretion measurements. Univariate and logistic multivariate regression analyses were applied to identify the potential clinical and laboratory parameters associated with the presence of DR in them. Results Analysis of the medical records of 272 T2DM patients revealed that 147 patients had DR while 125 did not. Furthermore, 135 had non-proliferative DR (64 mild, 53 moderate, and 18 severe grades), whereas the remaining 12 had proliferative DR. On sequential univariate and multiple regression analysis, urinary albumin creatinine ratio (UACR), known duration of T2DM, and history of ischemic heart disease were seen to be independently associated with the presence of DR. Median UACR for those without DR was 42.6 mg/g (range 18.21-183.3 mg/g) while for those with retinopathy it was 214 mg/g (range 45.4-1260 mg/g) (p<0.001). The receiver operating characteristics curve analysis provided an area under the curve of 70% for UACR. UACR value of 140 mg/g could predict the presence of DR with a sensitivity of 60.5% & specificity of 72%, as well as had positive and negative likelihood ratios of 2.16 and 0.54, respectively. Conclusion UACR has the potential to be used as a screening tool for DR until the easing of social restrictions due to the COVID-19 pandemic.

Study of Disease Severity and Outcomes in COVID-19 Patients With Chronic Kidney Disease at a Tertiary Care Hospital in South India.

BACKGROUND: Coronavirus disease 2019 (COVID-19) disproportionately affects individuals with various comorbidities. Among these, chronic kidney disease (CKD) has been shown to be strongly associated with the progression to severe disease. This study aimed to assess the severity and disease outcomes in patients with COVID-19 infection and CKD. METHODS: This is a retrospective study conducted at a tertiary care hospital from July 2021 to September 2021. The case records of patients with CKD and COVID-19 were studied. They were compared with age and gender-matched controls equally. The presenting symptoms, clinical course, severity of illness, laboratory markers, need for ventilator support, and mortality outcomes were studied. RESULTS: In total, 40 CKD and 40 non-CKD patients with COVID-19 were included in the study. It was also observed that among the patients with CKD, more patients had fever, breathlessness, and diarrhea. The requirement for noninvasive ventilation, ventilator, and inotropes was on the higher average for patients with CKD. Overall mortality was 27.5% in the CKD group and 2.5% in the non-CKD group, which was statistically significant (p = 0.002). CONCLUSIONS: COVID-19 patients with CKD had more severe illnesses with a requirement of ventilator support and had higher mortality than the patients without CKD. Patients with CKD are a key subset of patients with COVID-19 for whom more aggressive early treatment and stricter preventive measures may be beneficial.

A study to assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy: Medical records-based audit.

Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic agents have been tried. Remdesivir was found to be effective in few studies. Aims: To assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy. Methodology: This study was conducted in a tertiary hospital in South India after the approval of the Institutional ethical committee. It was a medical records-based retrospective, longitudinal study. Medical records of the inpatients with confirmed COVID-19 infection were reviewed from the period of June 15, 2020 to September 15, 2020. This study was conducted to assess the clinical and laboratory profile and outcome in the patients admitted with moderate and severe COVID-19 disease who received Remdesivir. Statistical Analysis: The analysis was done using SPSS Inc. released 2009, PASW statistics for Windows version 18.0, Chicago. Results: One hundred eleven (N = 111) patients were included in the study. 56 patients received the conventional treatment (Hydroxychloroquine HCQ) and 55 patients received Remdesivir. It was seen that among patients treated with HCQ, 24 (42.9%) required non-invasive ventilation and seven (12.7%) patients treated with Remdesivir required it (P = 0.001). It was noticed that the mean duration of hospitalization was 16.6 days in HCQ group and was 11.4 days in Remdesivir group (P = 0.021). Conclusion: The study demonstrates that Remdesivir does have benefit in reducing the mortality and duration of hospital stay. There was reduced requirement of non-invasive and invasive ventilation among patients treated with Remdesivir.