Automated feature-based grading and progression analysis of diabetic retinopathy

BackgroundIn diabetic retinopathy (DR) screening programmes feature-based grading guidelines are used by human graders. However, recent deep learning approaches have focused on end to end learning, based on labelled data at the whole image level. Most predictions from such software offer a direct grading output without information about the retinal features responsible for the grade. In this work, we demonstrate a feature based retinal image analysis system, which aims to support flexible grading and monitor progression.MethodsThe system was evaluated against images that had been graded according to two different grading systems; The International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Severity Scale and the UK’s National Screening Committee guidelines.ResultsExternal evaluation on large datasets collected from three nations (Kenya, Saudi Arabia and China) was carried out. On a DR referable level, sensitivity did not vary significantly between different DR grading schemes (91.2–94.2.0%) and there were excellent specificity values above 93% in all image sets. More importantly, no cases of severe non-proliferative DR, proliferative DR or DMO were missed.ConclusionsWe demonstrate the potential of an AI feature-based DR grading system that is not constrained to any specific grading scheme.Subject terms: Diagnosis, Medical imaging     

Nutrition in Spondyloarthritis and Related Immune-Mediated Disorders

Recent research on the pathogenesis of spondyloarthritis and related immune-mediated diseases associated with human leukocyte antigen class I molecule B27 (HLA-B27) has led to significant progress in terms of management and prognosis, with multiple treatments being constantly evaluated and implemented. Correlations between the genetic background of spondyloarthritis and inflammatory bowel diseases and the inflammatory processes involving gut microbiota have been established. This knowledge has allowed progress in pharmacological therapy. The role of diet in the pathogenesis and treatment of diseases pertaining to the HLA-B27 spectrum is of great significance, considering possible future applications in individualized medicine. Diet impacts the composition of gut microbiota, representing a substrate for the synthesis of metabolites affecting the mucosal immune system. Certain pro-inflammatory mediators, such as emulsifiers and microparticles, induce a more profound cytokine response, promoting inflammation. Numerous diets, including the low-starch diet, the Mediterranean diet, diets with low contents of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP diets), gluten-free diets and fasting, have been analysed and correlated with patients’ symptomatology and dietary adherence. The aim of this review is to provide an extensive perspective on the diets available to patients with spondyloarthritis and related immune-mediated disorders.     

Development of Therapeutic and Prophylactic Zinc Compositions for Use against COVID-19: A Glimpse of the Trends,Inventions, and Patents

Zinc is an essential nutrient for human health; it is involved in the catalytic, structural, and regulatory functions of the human cellular system. Different compositions of zinc, as well as its pharmaceutically acceptable salts, are available on the market. Recent studies have demonstrated the role of zinc in combating COVID-19. It has been determined that zinc prevents the entry of SARS-CoV-2 into cells by lowering the expression of ACE-2 receptors and inhibiting the RNA-dependent RNA polymerase of SARS-CoV-2. Zinc also prevents the cytokine storm that takes place after the entry of SARS-CoV-2 into the cell, via its anti-inflammatory activity. The authors believe that no study has yet been published that has reviewed the trends, inventions, and patent literature of zinc compositions to treat/prevent COVID-19. Accordingly, this review has been written in order to fill this gap in the literature. The information about the clinical studies and the published patents/patent applications was retrieved from different databases. This review covers patent literature on zinc compositions up to 31 January 2022. Many important patents/patent applications for zinc-based compositions filed by innovative universities and industries were identified. The patent literature revealed zinc compositions in combination with zinc ionophores, antioxidants, antivirals, antibiotics, hydroxychloroquine, heparin, ivermectin, and copper. Most of these studies were supported by clinical trials. The patent literature supports the potential of zinc and its pharmaceutical compositions as possible treatments for COVID-19. The authors believe that countless zinc-based compositions are still unexplored, and there is an immense opportunity to evaluate a considerable number of the zinc-based compositions for use against COVID-19.     

The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada disease

Purpose: To study the effectiveness of mycophenolate mofetil (MMF) as first‐line therapy combined with systemic corticosteroids in acute uveitis associated with Vogt–Koyanagi–Harada (VKH) disease. The outcomes in this group were compared with those of another group of patients with VKH disease who were treated with corticosteroid monotherapy or with delayed addition of immunomodulatory therapy. Methods: This prospective study included 19 patients (38 eyes) diagnosed with acute uveitis associated with VKH disease. Results: The mean follow‐up period was 27.0 ± 11.1 months (range 16–54 months). Corticosteroid‐sparing effect was achieved in all patients. The mean interval between starting treatment and tapering prednisone to 10 mg or less daily was 5.1 ± 1.2 months (range 3–7 months). Ten (53%) patients discontinued treatment without relapse of inflammation. The mean time observed of treatment was 17.3 ± 11.9 months (range 3–41.5 months). Visual acuity of 20/20 was achieved by 38% of the eyes in the corticosteroid group and by 74% in the corticosteroid + MMF group (p < 0.001). Recurrent inflammation of ≥3 times was reduced significantly (p = 0.0383) in the corticosteroid + MMF group (3%) as compared to corticosteroid group (18%). Development of all complications was significantly higher in the corticosteroid group (43%) compared with the corticosteroid + MMF group (8%) (p < 0.001). None of the eyes in the corticosteroid + MMF group developed ‘sunset glow fundus’. Conclusions: Addition of MMF as first‐line therapy to corticosteroids in patients with acute uveitis associated with VKH disease leads to significant reduction in recurrences of uveitis and development of late complications and significantly improves visual outcome.     

Polyphenolic Fractions from Three Millet Types (Fonio,Finger millet,and Pearl millet): their Characterization and Biological Importance

BackgroundAs antioxidant-rich plant foods, cereals can impede lipid and starch breakdown in the human body, are germane to diabetes management.ObjectiveWe aim to identify newer sources of phytochemicals and health-promoting constituents desirable antidiabetic and antioxidant properties.MethodsThree millet types i.e. fonio (Digitaria exilis), finger millet (Eleusine coracana), and pearl millet (Pennisetum glaucum) available locally were investigated for antioxidant ability employing these assays i.e. DPPH, ABTS, H₂O₂, antidiabetic ability employing these assays i.e. α-amylase, α-glucosidase and inhibitory property on glycosylation formation. Preliminary characterization tools were employed i.e. UV-Visible spectroscopy (UV–visible) and Fourier-Transform Infrared Spectroscopy (FTIR) for the polyphenolic confirmation.ResultsThe absorbance intensity range 325–425 nm confirmed that polyphenolics are present in the three millet types; most of the biological results showed the activities are dose-dependent. Fonio millet extract revealed the highest activity against hemoglobin glycosylation (29.469 ± 0.399%) which compared favorably with the standard (acarbose) (29.354 ± 1.607%). Fonio millet extract also showed the best antioxidant activity (significantly higher% inhibition value = 47.909 ± 3.472) and the pearl millet revealed the least antioxidant activity (significantly lower% inhibition value = 44.910 ± 3.597) both at a concentration of 500 mg·ml^?1, though all the millet extracts showed activity towards this assay better than the standard (19.883 ± 2.485%). Fonio millet extract displayed a significantly higher percentage inhibition of α-amylase and glucosidase (43.729 ± 0.410% and 55.835 ± 2.198%) than finger millet (39.002 ± 1.604%; 43.971 ± 5.849%) and pearl millet (33.223 ± 2.708%; 30.845 ± 2.841%), respectively.ConclusionThe polyphenolic extracts from these millet types have therapeutic potentials, which may play significant roles in type 2 diabetes prevention and management, and hence these millets, especially fonio and finger millet, have the potential to be utilized as functional foods.     

Cyanobacteria and their toxins in treated-water storage reservoirs in Abha city, Saudi Arabia.

Occurrence of toxic cyanobacteria in drinking and recreational waters poses human health at risk as they can release potent toxins into the water. In the present study, open and covered treated-water storage reservoirs as well as their relevant tap waters in Abha city, Saudi Arabia, were surveyed for the presence of cyanobacteria and their toxins. The results revealed the contamination of most open reservoir and tap waters by algae and cyanobacteria, with an abundance of toxigenic species of cyanobacteria. Depending on the results of the Limulus amebocyte lysate (LAL) assay and enzyme linked immunosorbent assay (ELISA), endotoxins and microcystins (MCYSTs) were found in most open reservoir and tap waters at concentrations up to 32EUml(-1) and 0.3mugml(-1), respectively. The extracts of axenic cultures of most cyanobacterial species isolated from these reservoirs showed activity to LAL assay, with large endotoxin amounts obtained in Calothrix parietina (490EUg(-1)) and Phormidium tenue (210EUg(-1)). Based on ELISA and HPLC analysis for these extracts, only C. parietina can produce MCYSTs (202mugg(-1)) with a profile consisting of MCYST-RR and -LR. This study suggests that open treated-water storage reservoirs should be covered to prevent the presence of cyanobacteria and their toxins in such drinking and recreational waters.     

Technical skills for weight loss: preliminary data from a randomized trial

BACKGROUND: Optimal behavioral interventions for sustainable weight loss are uncertain. We therefore conducted a study among overweight/obese women comparing conventional dietary counseling of individuals (counseling-based intervention) to a novel, group-based skill-building intervention. METHODS: Eighty subjects were randomly assigned to either the counseling-based or to the skill-building intervention. Outcomes included weight loss, dietitian hours per group and per unit weight loss, and dollars spent per group and per unit weight lost. RESULTS: Weight loss at 6 months (follow-up rate 61.3%) in the counseling-based group was 8.8 lb (P = 0.0001), and in the skill-building group was 3.8 lb (P = 0.01). A total of 160 dietitian hours were required for the counseling-based group, and 131 for the skilled-building group. The counseling-based group cost an average of $21 per pound lost, while the skill-building cost an average of $48 per pound lost (P = 0.16). CONCLUSIONS: At 6 months, individualized office-based counseling produced more weight loss than a skill-building approach and cost less than half as much per pound of weight loss. Longer-term follow-up is required to determine if, as hypothesized, the skill-building intervention produces more sustainable weight loss.     

Prayer marks

BACKGROUND: Prayer marks (PMs) are asymptomatic, chronic skin changes that consist mainly of thickening, lichenification, and hyperpigmentation, and develop over a long period of time as a consequence of repeated, extended pressure on bony prominences during prayer. METHODS: Three hundred and forty-nine Muslims and 24 non-Muslims were examined for the appearance of PMs at different body sites. RESULTS: The prospective study of 349 Muslims (both males and females) with regular praying habits showed the occurrence of PMs on specific locations, such as the forehead, knees, ankles, and dorsa of the feet, leading to dermatologic changes consisting of lichenification and hyperpigmentation. The incidence of PMs was significantly higher in males than in females. Older subjects (over 50 years of age) demonstrated a significantly higher frequency of lichenification and hyperpigmentation, suggesting that repeated pressure and friction for prolonged periods are the causative factors for the development of PMs. Histologic examination of skin biopsies from the affected sites showed compact orthokeratosis, hypergranulosis, dermal papillary fibrosis, and dermal vascularization. PMs were not associated with any risk of secondary complications, such as erythema, bullous formation, and infections. CONCLUSIONS: PMs are commonly occurring dermatologic changes in Muslims who pray for prolonged periods.