Clinical validation and assessment of a modular fluorescent imaging system and algorithm for rapid detection and quantification of dental plaque

Background

Significant numbers of adults and children have untreated plaque due to poor oral hygiene and consequently suffer from associate dental and systemic diseases.

Methods

A handheld device equipped with 405 nm light-emitting diodes was constructed to examine the prevalence of red fluorescence signatures associated with dental plaque. This device was used for in vivo imaging of all four incisors and all four canines of twenty-eight consenting human subjects. The same areas were further imaged under white light illumination with a commercial image-processing based plaque-imaging device, and evaluated by a hygienist and dentist. A custom computer vision algorithm using pixel information was developed to calculate plaque coverage ratios ranging from 0 (no plaque) to 1 (complete plaque coverage) for images captured by both devices.

Results

The algorithm calculated red fluorescence-based plaque coverage ratios ranging from 0.011 to 0.211 for the subjects imaged. Clinical assessment and statistical analyses of associated plaque ratios of the 405 nm device images indicated high sensitivity and specificity in detecting dental plaque by the experimental device compared to the commercial reference device.

Conclusions

The low-cost and open source 405 nm device and the associated computer vision algorithm successfully captured red fluorescence signatures associated with dental plaque and demonstrated comparable performance to a commercially available device. Therefore, a proof of concept validation was provided for the construction and application of a sensitive cost-effective plaque-detecting device. A miniaturized mobile adaptable version of the device was also provided, together with and a step-by-step guide for device assembly and webhost the associated software, to facilitate open-source access to a cost-effective at-home, in-clinic oral care technology.

Trial registration

ClinicalTrials.gov NCT03379337, December 19 2017. Retrospectively registered.

     

Development of an Anthropomorphic Shoulder Phantom Model That Simulates Bony Anatomy for Sonographic Measurement of the Acromiohumeral Distance

The purpose of this project was to create a sonographic phantom model of the shoulder that was accurate in bone configuration. Its main purpose was for operator training to measure the acromiohumeral distance. A computerized 3‐dimensional model of the superior half of the humerus and scapula was rendered and 3‐dimensionally printed. The bone model was embedded in a gelatin compound and set in a shoulder‐shaped mold. The materials used had speeds of sound that were well matched to soft tissue and epiphyseal bone. The model was specifically effective in simulating the acromiohumeral distance because of its accurate bone geometry.     

Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19

Purpose:To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction.Methods:The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2).Results:A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication.Conclusion:Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.     

Convalescent plasma associates with reduced mortality and improved clinical trajectory in patients hospitalized with COVID-19

BACKGROUNDEvidence supporting convalescent plasma (CP), one of the first investigational treatments for coronavirus disease 2019 (COVID-19), has been inconclusive, leading to conflicting recommendations. The primary objective was to perform a comparative effectiveness study of CP for all-cause, in-hospital mortality in patients with COVID-19.METHODSThe multicenter, electronic health records–based, retrospective study included 44,770 patients hospitalized with COVID-19 in one of 176 HCA Healthcare–affiliated community hospitals. Coarsened exact matching (1:k) was employed, resulting in a sample of 3774 CP and 10,687 comparison patients.RESULTSExamination of mortality using a shared frailty model, controlling for concomitant medications, date of admission, and days from admission to transfusion, demonstrated a significant association of CP with lower mortality risk relative to the comparison group (adjusted hazard ratio [aHR] = 0.71; 95% CI, 0.59–0.86; P < 0.001). Examination of patient risk trajectories, represented by 400 clinico-demographic features from our real-time risk model (RTRM), indicated that patients who received CP recovered more quickly. The stratification of days to transfusion revealed that CP within 3 days after admission, but not within 4 to 7 days, was associated with a significantly lower mortality risk (aHR = 0.53; 95% CI, 0.47–0.60; P < 0.001). CP serology level was inversely associated with mortality when controlling for its interaction with days to transfusion (HR = 0.998; 95% CI, 0.997–0.999; P = 0.013), yet it did not reach univariable significance.CONCLUSIONSThis large, diverse, multicenter cohort study demonstrated that CP, compared with matched controls, is significantly associated with reduced risk of in-hospital mortality. These observations highlight the utility of real-world evidence and suggest the need for further evaluation prior to abandoning CP as a viable therapy for COVID-19.FUNDINGThis research was supported in whole by HCA Healthcare and/or an HCA Healthcare–affiliated entity, including Sarah Cannon and Genospace.     

Continuous glucose monitoring in patients with insulinoma

Background Insulinomas are rare neuroendocrine tumours that are usually small and may take time to localize. They cause recurrent life‐threatening spontaneous hypoglycaemia. Recurrent hypoglycaemia causes loss of hypoglycaemia awareness, putting the patient at further risk, but this has rarely been described in insulinoma. We describe the utility of continuous glucose monitoring (CGM) in patients with insulinoma. Patients and methods Three patients, aged 72 years (patient 1), 37 years (patient 2) and 24 years (patient 3), with suspected insulinoma attended our investigation unit, in a university teaching hospital. Biochemical diagnosis was confirmed by elevated plasma insulin and C‐peptide during biochemical hypoglycaemia [plasma glucose < 2·2 mM (40 mg/dl)]. Surgery confirmed histology in all. CGM was used to monitor frequency and time of hypoglycaemia during diagnosis and medical treatment, and after definitive surgical treatment. Results All patients had evidence of hypoglycaemia unawareness. At diagnosis in patients 1–3, CGM revealed 6·1%, 21·9% and 71·0% of time spent in moderate hypoglycaemia (plasma glucose 2·2–3·0 mM), and 1·4%, 11·4% and 48·1% of time in severe hypoglycaemia (plasma glucose < 2·2 mM), respectively. On diazoxide this reduced to 0·6%, 5·4% and 5·7% time in moderate hypoglycaemia, and no severe hypoglycaemia in patients 1 and 3, and 0·5% in patient 2. Octreotide therapy in patients 2 and 3 resulted in 5·8% and 0% of time in moderate hypoglycaemia, respectively, and no severe hypoglycaemia. After surgical excision CGM confirmed cure in all. Conclusions CGM in insulinoma is useful in detecting hypoglycaemia, and hypoglycaemia unawareness, monitoring response to medical therapy and for confirming cure postoperatively, and is useful in the management of this uncommon but dangerous condition.