Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/non-COVID-19 Frameworks using Artificial Intelligence Paradigm: A Narrative Review

Enhancing sports image data classification in federated learning through genetic algorithm-based optimization of base architecture

Nowadays, federated learning is one of the most prominent choices for making decisions. A significant benefit of federated learning is that, unlike deep learning, it is not necessary to share data samples with the model owner. The weight of the global model in traditional federated learning is created by averaging the weights of all clients or sites. In the proposed work, a novel method has been discussed to generate an optimized base model without hampering its performance, which is based on a genetic algorithm. Chromosome representation, crossover, and mutation-all the intermediate operations of the genetic algorithm have been illustrated with useful examples. After applying the genetic algorithm, there is a significant improvement in inference time and a huge reduction in storage space. Therefore, the model can be easily deployed on resource-constrained devices. For the experimental work, sports data has been used in balanced and unbalanced scenarios with various numbers of clients in a federated learning environment. In addition, we have used four famous deep learning architectures, such as AlexNet, VGG19, ResNet50, and EfficientNetB3, as the base model. We have achieved 92.34% accuracy with 9 clients in the balanced data set by using EfficientNetB3 as the base model using a GA-based approach. Moreover, after applying the genetic algorithm to optimize EfficientNetB3, there is an improvement in inference time and storage space by 20% and 2.35%, respectively.

A Study of the Prevalence of Diabetic Retinopathy in Patients With Ischemic Heart Disease and Diabetes Mellitus

Background Diabetes mellitus is one of the most important and common chronic diseases worldwide and is expected to increase in prevalence. Diabetic retinopathy (DR) is one of the most prevalent microvascular sequelae of diabetes mellitus (DM), and ischemic heart disease is a macrovascular sequela. This study was conducted to find out the relation between the degree of DR and ischemic heart disease severity in Indian patients. Materials and methods This cross-sectional, descriptive, hospital-based study was conducted in the ophthalmology department at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from September 2022 to June 2024. A total of 200 eyes from 100 patients who were diagnosed with cases of ischemic heart disease and diabetes mellitus were included in the study. Patients with corneal pathology like endothelial dystrophies, corneal degenerations, corneal scars, or trauma preventing good visualization of the posterior segment were excluded from the study. Patients with active uveitis, patients with a history of undergoing any previous vitreoretinal surgery or laser procedures, non-compliant patients, patients not willing to undergo the procedure, or those not consenting to the study were also excluded. Written informed consent was obtained from each patient. Data was entered in Microsoft Excel and statistical analysis was done using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. As the continuous variables showed a skewed distribution, we used the Mann-Whitney test and the Kruskal-Wallis test to test the significance of the difference between continuous and categorical variables. A chi-square test was employed to check the association between categorical variables. Significance was assumed at an alpha error of 5%. Results The prevalence of diabetic retinopathy was found to be 95%. The mean age of patients with DR and patients with no diabetic retinopathy was 58.38 and 59.40 years, respectively, with the majority of the patients being in the age group of 60-69 years (46%). The majority of the patients were males (65%), while 35% were females. There was a significant association between the severity of diabetic retinopathy and the higher HbA1c levels, the use of insulin as a treatment modality, and the higher blood sugar levels in our study population. It was observed that the patients in our study with an ejection fraction of <40% had significantly higher severity of diabetic retinopathy in the form of PDR and high-risk PDR. The severity of the DR was directly correlated with the severity of IHD in our study, with most of the IHD patients with a 40-60% ejection fraction having moderate NPDR and patients with a >60% ejection fraction having mild or moderate NPDR. Conclusion The prevalence of diabetic retinopathy among the IHD patients with diabetes was 95% in our study, with moderate NPDR being the most common stage of DR seen among the patients. It was observed that more severe stages of diabetic retinopathy were seen in patients who were on treatment with insulin than in patients who were on treatment with OHA. Severe stages of diabetic retinopathy were associated with higher blood sugar levels (BSL) and higher glycated hemoglobin levels. In the present study, it was observed that a lower ejection fraction (<40%), which is a marker of reduced cardiac function, was associated with more severe stages of diabetic retinopathy.

Artificial intelligence for cardiovascular disease risk assessment in personalised framework: a scoping review

Background

The field of precision medicine endeavors to transform the healthcare industry by advancing individualised strategies for diagnosis, treatment modalities, and predictive assessments. This is achieved by utilizing extensive multidimensional biological datasets encompassing diverse components, such as an individual's genetic makeup, functional attributes, and environmental influences. Artificial intelligence (AI) systems, namely machine learning (ML) and deep learning (DL), have exhibited remarkable efficacy in predicting the potential occurrence of specific cancers and cardiovascular diseases (CVD).

Methods

We conducted a comprehensive scoping review guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Our search strategy involved combining key terms related to CVD and AI using the Boolean operator AND. In August 2023, we conducted an extensive search across reputable scholarly databases including Google Scholar, PubMed, IEEE Xplore, ScienceDirect, Web of Science, and arXiv to gather relevant academic literature on personalised medicine for CVD. Subsequently, in January 2024, we extended our search to include internet search engines such as Google and various CVD websites. These searches were further updated in March 2024. Additionally, we reviewed the reference lists of the final selected research articles to identify any additional relevant literature.

Findings

A total of 2307 records were identified during the process of conducting the study, consisting of 564 entries from external sites like arXiv and 1743 records found through database searching. After 430 duplicate articles were eliminated, 1877 items that remained were screened for relevancy. In this stage, 1241 articles remained for additional review after 158 irrelevant articles and 478 articles with insufficient data were removed. 355 articles were eliminated for being inaccessible, 726 for being written in a language other than English, and 281 for not having undergone peer review. Consequently, 121 studies were deemed suitable for inclusion in the qualitative synthesis. At the intersection of CVD, AI, and precision medicine, we found important scientific findings in our scoping review. Intricate pattern extraction from large, complicated genetic datasets is a skill that AI algorithms excel at, allowing for accurate disease diagnosis and CVD risk prediction. Furthermore, these investigations have uncovered unique genetic biomarkers linked to CVD, providing insight into the workings of the disease and possible treatment avenues. The construction of more precise predictive models and personalised treatment plans based on the genetic profiles of individual patients has been made possible by the revolutionary advancement of CVD risk assessment through the integration of AI and genomics.

Interpretation

The systematic methodology employed ensured the thorough examination of available literature and the inclusion of relevant studies, contributing to the robustness and reliability of the study's findings. Our analysis stresses a crucial point in terms of the adaptability and versatility of AI solutions. AI algorithms designed in non-CVD domains such as in oncology, often include ideas and tactics that might be modified to address cardiovascular problems.

Funding

No funding received.

UltraAIGenomics: Artificial Intelligence-Based Cardiovascular Disease Risk Assessment by Fusion of Ultrasound-Based Radiomics and Genomics Features for Preventive, Personalized and Precision Medicine: A Narrative Review

Cardiovascular disease (CVD) diagnosis and treatment are challenging since symptoms appear late in the disease's progression. Despite clinical risk scores, cardiac event prediction is inadequate, and many at-risk patients are not adequately categorised by conventional risk factors alone. Integrating genomic-based biomarkers (GBBM), specifically those found in plasma and/or serum samples, along with novel non-invasive radiomic-based biomarkers (RBBM) such as plaque area and plaque burden can improve the overall specificity of CVD risk. This review proposes two hypotheses: (i) RBBM and GBBM biomarkers have a strong correlation and can be used to detect the severity of CVD and stroke precisely, and (ii) introduces a proposed artificial intelligence (AI)-based preventive, precision, and personalized ( aiP 3 ) CVD/Stroke risk model. The PRISMA search selected 246 studies for the CVD/Stroke risk. It showed that using the RBBM and GBBM biomarkers, deep learning (DL) modelscould be used for CVD/Stroke risk stratification in the aiP 3 framework. Furthermore, we present a concise overview of platelet function, complete blood count (CBC), and diagnostic methods. As part of the AI paradigm, we discuss explainability, pruning, bias, and benchmarking against previous studies and their potential impacts. The review proposes the integration of RBBM and GBBM, an innovative solution streamlined in the DL paradigm for predicting CVD/Stroke risk in the aiP 3 framework. The combination of RBBM and GBBM introduces a powerful CVD/Stroke risk assessment paradigm. aiP 3 model signifies a promising advancement in CVD/Stroke risk assessment.

Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review

Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans.

Automatic Refractive Error Estimation Using Deep Learning-Based Analysis of Red Reflex Images

Purpose/Background: We evaluate how a deep learning model can be applied to extract refractive error metrics from pupillary red reflex images taken by a low-cost handheld fundus camera. This could potentially provide a rapid and economical vision-screening method, allowing for early intervention to prevent myopic progression and reduce the socioeconomic burden associated with vision impairment in the later stages of life. Methods: Infrared and color images of pupillary crescents were extracted from eccentric photorefraction images of participants from Choithram Hospital in India and Dargaville Medical Center in New Zealand. The pre-processed images were then used to train different convolutional neural networks to predict refractive error in terms of spherical power and cylindrical power metrics. Results: The best-performing trained model achieved an overall accuracy of 75% for predicting spherical power using infrared images and a multiclass classifier. Conclusions: Even though the model's performance is not superior, the proposed method showed good usability of using red reflex images in estimating refractive error. Such an approach has never been experimented with before and can help guide researchers, especially when the future of eye care is moving towards highly portable and smartphone-based devices.

Early Diagnosis of COVID-19 Images Using Optimal CNN Hyperparameters

Coronavirus disease (COVID-19) is a worldwide epidemic that poses substantial health hazards. However, COVID-19 diagnostic test sensitivity is still restricted due to abnormalities in specimen processing. Meanwhile, optimizing the highly defined number of convolutional neural network (CNN) hyperparameters (hundreds to thousands) is a useful direction to improve its overall performance and overcome its cons. Hence, this paper proposes an optimization strategy for obtaining the optimal learning rate and momentum of a CNN's hyperparameters using the grid search method to improve the network performance. Therefore, three alternative CNN architectures (GoogleNet, VGG16, and ResNet) were used to optimize hyperparameters utilizing two different COVID-19 radiography data sets (Kaggle (X-ray) and China national center for bio-information (CT)). These architectures were tested with/without optimizing the hyperparameters. The results confirm effective disease classification using the CNN structures with optimized hyperparameters. Experimental findings indicate that the new technique outperformed the previous in terms of accuracy, sensitivity, specificity, recall, F-score, false positive and negative rates, and error rate. At epoch 25, the optimized Resnet obtained high classification accuracy, reaching 98.98% for X-ray images and 98.78% for CT images.

Economics of Artificial Intelligence in Healthcare: Diagnosis vs. Treatment

Motivation: The price of medical treatment continues to rise due to (i) an increasing population; (ii) an aging human growth; (iii) disease prevalence; (iv) a rise in the frequency of patients that utilize health care services; and (v) increase in the price. Objective: Artificial Intelligence (AI) is already well-known for its superiority in various healthcare applications, including the segmentation of lesions in images, speech recognition, smartphone personal assistants, navigation, ride-sharing apps, and many more. Our study is based on two hypotheses: (i) AI offers more economic solutions compared to conventional methods; (ii) AI treatment offers stronger economics compared to AI diagnosis. This novel study aims to evaluate AI technology in the context of healthcare costs, namely in the areas of diagnosis and treatment, and then compare it to the traditional or non-AI-based approaches. Methodology: PRISMA was used to select the best 200 studies for AI in healthcare with a primary focus on cost reduction, especially towards diagnosis and treatment. We defined the diagnosis and treatment architectures, investigated their characteristics, and categorized the roles that AI plays in the diagnostic and therapeutic paradigms. We experimented with various combinations of different assumptions by integrating AI and then comparing it against conventional costs. Lastly, we dwell on three powerful future concepts of AI, namely, pruning, bias, explainability, and regulatory approvals of AI systems. Conclusions: The model shows tremendous cost savings using AI tools in diagnosis and treatment. The economics of AI can be improved by incorporating pruning, reduction in AI bias, explainability, and regulatory approvals.

Cardiovascular/Stroke Risk Stratification in Diabetic Foot Infection Patients Using Deep Learning-Based Artificial Intelligence: An Investigative Study

A diabetic foot infection (DFI) is among the most serious, incurable, and costly to treat conditions. The presence of a DFI renders machine learning (ML) systems extremely nonlinear, posing difficulties in CVD/stroke risk stratification. In addition, there is a limited number of well-explained ML paradigms due to comorbidity, sample size limits, and weak scientific and clinical validation methodologies. Deep neural networks (DNN) are potent machines for learning that generalize nonlinear situations. The objective of this article is to propose a novel investigation of deep learning (DL) solutions for predicting CVD/stroke risk in DFI patients. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) search strategy was used for the selection of 207 studies. We hypothesize that a DFI is responsible for increased morbidity and mortality due to the worsening of atherosclerotic disease and affecting coronary artery disease (CAD). Since surrogate biomarkers for CAD, such as carotid artery disease, can be used for monitoring CVD, we can thus use a DL-based model, namely, Long Short-Term Memory (LSTM) and Recurrent Neural Networks (RNN) for CVD/stroke risk prediction in DFI patients, which combines covariates such as office and laboratory-based biomarkers, carotid ultrasound image phenotype (CUSIP) lesions, along with the DFI severity. We confirmed the viability of CVD/stroke risk stratification in the DFI patients. Strong designs were found in the research of the DL architectures for CVD/stroke risk stratification. Finally, we analyzed the AI bias and proposed strategies for the early diagnosis of CVD/stroke in DFI patients. Since DFI patients have an aggressive atherosclerotic disease, leading to prominent CVD/stroke risk, we, therefore, conclude that the DL paradigm is very effective for predicting the risk of CVD/stroke in DFI patients.

Recommender System for the Efficient Treatment of COVID-19 Using a Convolutional Neural Network Model and Image Similarity

Background: Hospitals face a significant problem meeting patients' medical needs during epidemics, especially when the number of patients increases rapidly, as seen during the recent COVID-19 pandemic. This study designs a treatment recommender system (RS) for the efficient management of human capital and resources such as doctors, medicines, and resources in hospitals. We hypothesize that a deep learning framework, when combined with search paradigms in an image framework, can make the RS very efficient. Methodology: This study uses a Convolutional neural network (CNN) model for the feature extraction of the images and discovers the most similar patients. The input queries patients from the hospital database with similar chest X-ray images. It uses a similarity metric for the similarity computation of the images. Results: This methodology recommends the doctors, medicines, and resources associated with similar patients to a COVID-19 patients being admitted to the hospital. The performance of the proposed RS is verified with five different feature extraction CNN models and four similarity measures. The proposed RS with a ResNet-50 CNN feature extraction model and Maxwell-Boltzmann similarity is found to be a proper framework for treatment recommendation with a mean average precision of more than 0.90 for threshold similarities in the range of 0.7 to 0.9 and an average highest cosine similarity of more than 0.95. Conclusions: Overall, an RS with a CNN model and image similarity is proven as an efficient tool for the proper management of resources during the peak period of pandemics and can be adopted in clinical settings.

Diabetic Retinopathy May Covariate With Stroke in Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder with increasing prevalence per hour. Cataracts are one of the most common eye complications, and they affect all structures of the eye. The incidence of cataracts is increasing in patients with diabetes by several mechanisms. With the advancement of technology, cataract surgery is now a necessary procedure for diabetic patients. High-risk complications, like diabetic macular oedema, diabetic retinopathy (DR), phakic, postoperative cyst, and postoperative macular oedema, and macular oedema and endophthalmitis following surgery for a pseudocyst, could result in blindness. The importance of preoperative, intraoperative, and postoperative factors cannot be overestimated in managing complications and improving visual outcomes. DR can be a severe problem if it worsens and causes non-proliferative or proliferative DR or if fluid accumulation in the eye is diagnosed as macular oedema. A woman progressing to sight-threatening DR during childbearing age experiences distress and often requires ocular treatment. Diabetes that has been present for a more extended period, as well as more significant hyperglycaemia, hypertension, cardiovascular diseases, and elevated blood pressure, substantially predict the development of DR. Oxidative stress can be caused by hyperglycaemia, irregular metabolic processes, and people with DR developing neurodegeneration. Therefore, controlling postprandial hyperglycaemia is crucial for preventing DR. Femtosecond laser technology, multifocal intraocular lenses, and other surgical innovations are popularly referred to as surgical management; it will be engaged in the coming era to determine whether there will be a continued reduction in the complication of cataract surgery. This article aims to review the correlation of DR with stroke and its screening and to outline the critical management strategies. 

Deep Learning Paradigm for Cardiovascular Disease/Stroke Risk Stratification in Parkinson’s Disease Affected by COVID-19: A Narrative Review

Background and Motivation: Parkinson’s disease (PD) is one of the most serious, non-curable, and expensive to treat. Recently, machine learning (ML) has shown to be able to predict cardiovascular/stroke risk in PD patients. The presence of COVID-19 causes the ML systems to become severely non-linear and poses challenges in cardiovascular/stroke risk stratification. Further, due to comorbidity, sample size constraints, and poor scientific and clinical validation techniques, there have been no well-explained ML paradigms. Deep neural networks are powerful learning machines that generalize non-linear conditions. This study presents a novel investigation of deep learning (DL) solutions for CVD/stroke risk prediction in PD patients affected by the COVID-19 framework. Method: The PRISMA search strategy was used for the selection of 292 studies closely associated with the effect of PD on CVD risk in the COVID-19 framework. We study the hypothesis that PD in the presence of COVID-19 can cause more harm to the heart and brain than in non-COVID-19 conditions. COVID-19 lung damage severity can be used as a covariate during DL training model designs. We, therefore, propose a DL model for the estimation of, (i) COVID-19 lesions in computed tomography (CT) scans and (ii) combining the covariates of PD, COVID-19 lesions, office and laboratory arterial atherosclerotic image-based biomarkers, and medicine usage for the PD patients for the design of DL point-based models for CVD/stroke risk stratification. Results: We validated the feasibility of CVD/stroke risk stratification in PD patients in the presence of a COVID-19 environment and this was also verified. DL architectures like long short-term memory (LSTM), and recurrent neural network (RNN) were studied for CVD/stroke risk stratification showing powerful designs. Lastly, we examined the artificial intelligence bias and provided recommendations for early detection of CVD/stroke in PD patients in the presence of COVID-19. Conclusion: The DL is a very powerful tool for predicting CVD/stroke risk in PD patients affected by COVID-19.