Evaluation of an offline, artificial intelligence system for referable glaucoma screening using a smartphone-based fundus camera: a prospective study.

BACKGROUND/OBJECTIVES: An affordable and scalable screening model is critical for undetected glaucoma. The study evaluated the performance of an offline, smartphone-based AI system for the detection of referable glaucoma against two benchmarks: specialist diagnosis following full glaucoma workup and consensus image grading. SUBJECTS/METHODS: This prospective study (tertiary glaucoma centre, India) included 243 subjects with varying severity of glaucoma and control group without glaucoma. Disc-centred images were captured using a validated smartphone-based fundus camera analysed by the AI system and graded by specialists. Diagnostic ability of the AI in detecting referable Glaucoma (Confirmed glaucoma) and no referable Glaucoma (Suspects and No glaucoma) when compared to a final diagnosis (comprehensive glaucoma workup) and majority grading (image grading) by Glaucoma specialists (pre-defined criteria) were evaluated. RESULTS: The AI system demonstrated a sensitivity and specificity of 93.7% (95% CI: 87.6-96.9%) and 85.6% (95% CI:78.6-90.6%), respectively, in the detection of referable glaucoma when compared against final diagnosis following full glaucoma workup. True negative rate in definite non-glaucoma cases was 94.7% (95% CI: 87.2-97.9%). Amongst the false negatives were 4 early and 3 moderate glaucoma. When the same set of images provided to the AI was also provided to the specialists for image grading, specialists detected 60% (67/111) of true glaucoma cases versus a detection rate of 94% (104/111) by the AI. CONCLUSION: The AI tool showed robust performance when compared against a stringent benchmark. It had modest over-referral of normal subjects despite being challenged with fundus images alone. The next step involves a population-level assessment.

Microplastics in oral healthcare products (OHPs) and their environmental health risks and mitigation measures.

The environmental input of microplastics from personal care products has received significant attention; however, less focus has been paid to oral healthcare products. The present study assessed the occurrence of microplastics in commercially available oral healthcare products such as toothbrushes, toothpastes, toothpowder, mouthwash, dental floss, and mouth freshener spray that have a pan-India distribution. The extracted microplastics were quantified and characterised using a microscope and ATR-FTIR. All products showed microplastic contamination, where toothbrushes showed the maximum particles (30-120 particles/brush) and mouth freshener sprays (0.2-3.5 particles/ml) had the least abundance. Fragments, fibres, beads, and films were the various shapes of microplastics observed, where fragments (60%) were dominant. Various colours such as pink, green, blue, yellow, black, and colourless were observed, where colourless (40%) particles were dominant. Microplastics were categorized into three sizes: <0.1 mm (63%), 0.1-0.3 mm (35%), and >0.3 mm (2%). Four major types of polymers, such as polyethylene (52%), polyamide (30%), polyethylene terephthalate (15%), and polybutylene terephthalate (3%), were identified. Risk assessment studies such as Daily Microplastics Emission (DME), Annual Microplastics Exposure (AME), and Polymer Hazard Index (PHI) were carried out. The DME projection for India was the highest for mouthwash (74 billion particles/day) and the least for mouth freshener sprays (0.36 billion particles/day). The AME projection for an individual was the highest in toothbrushes (48,910 particles ind.-1 yr.-1) and the least in mouth freshener sprays (111 particles ind.-1 yr.-1). PHI shows that the identified polymers fall under the low-to high-risk categories. This study forecasts the community health risks linked to microplastics in oral healthcare products and suggests mitigation strategies. It has the potential to shape environmental policy development in response.

Septilin: A versatile anticlastogenic, antigenotoxic, antioxidant and histoprotective herbo-mineral formulation on cisplatin-induced toxicity in mice.

Septilin (Spt), a herbo-mineral formulation contains the extracts of Maharasanadi qoath, Tinospora cordifolia, Rubia cordifolia, Emblica officinalis, Moringa pterigosperma, Glycyrrhiza glabra and powders of Balsamodendron mukul and Shankha bhasma. In the present study, the anticlastogenic, antigenotoxic, antioxidant and histoprotective effects of Spt against cisplatin (Csp) induced toxicity in Swiss albino mice were investigated. The micronucleus (MN) test was used to assess the anticlastogenic potential of Spt (125, 250 and 500 mg/kg bw; p.o., 5 days) on somatic cells of mice. The sperm shape abnormality assay detects germinal nuclear damage, which induces spermatogenic dysfunction. Comet assay was employed to study the antigenotoxic potential of Spt on Csp (10 mg/kg bw; i.p.) induced DNA strand breaks in bone marrow cells of mice. The antioxidant enzyme activity of liver superoxide dismutase (SOD) and a biological antioxidant, reduced glutathione (GSH) were measured to determine its hepatoprotective property. The ability of Spt to protect against the histopathologic alterations accompanying Csp-induced liver and testicular injury was studied. The frequencies of MN induced by Csp in bone marrow and peripheral blood cells of mice were significantly decreased by the pre-treatment of Spt. Csp treatment increased the percentage of DNA strand breaks and depleted levels of SOD and GSH content along with histopathological changes. Supplementation of Spt attenuated the toxicity of Csp in liver and testes tissues possible viaimprovement of enzymatic and histological parameters toward normal. This study suggests that the protection offered by Spt against Csp-induced toxicity is partly related to the maintenance of the antioxidant system. Overall, this study shows the protective role of Spt against Csp-induced toxicity in somatic and male germinal cells of mice.

The management of a persistent periapical lesion caused by an apicomarginal defect, associated with a root end fracture in an endodontically treated tooth: a clinical report.

This is a case report of the presentation and the management of an apicomarginal defect which was associated with a root end fracture in an endodontically treated tooth. In spite of a successful Root Canal Treatment (RCT), if the fractured root end is left intact, considering inadverdent ankylosis or resorption, it may progress to the development of a bony dehiscence.