scholarly journals Artificial intelligence assisted electrocardiography for early diagnosis of thyrotoxic periodic paralysis

2021 ◽  
Author(s):  
Chin Lin ◽  
Chin-Sheng Lin ◽  
Ding-Jie Lee ◽  
Chia-Cheng Lee ◽  
Sy-Jou Chen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Early Diagnosis ◽  
Validation Cohort ◽  
Laboratory Data ◽  
Diagnostic System ◽  
Periodic Paralysis ◽  
Medical Emergency ◽  
Diagnostic Process ◽  
Routine Laboratory ◽  
Thyrotoxic Periodic Paralysis

Abstract CONTEXT Thyrotoxic periodic paralysis (TPP) characterized by acute weakness, hypokalemia and hyperthyroidism is a medical emergency with a great challenge in early diagnosis since most TPP patients do not have overt symptoms. OBJECTIVE To assess artificial intelligence (AI)-assisted electrocardiography (ECG) combined with routine laboratory data in the early diagnosis of TPP. METHODS A deep learning model (DLM) based on ECG12Net, an 82-layer convolutional neural network, was constructed to detect hypokalemia and hyperthyroidism. The development cohort consisted of 39 ECGs from patients with TPP and 502 ECGs of hypokalemic control; the validation cohort consisted of 11 ECGs of TPP and 36 ECGs of non-TPP with weakness. The AI-ECG based TPP diagnostic process was then consecutively evaluated in 22 male patients with TTP-like features. RESULTS In the validation cohort, the DLM-based ECG system detected all cases of hypokalemia in TPP patients with a mean absolute error of 0.26 mEq/L and diagnosed TPP with an area under curve (AUC) of ~80%, surpassing the best standard ECG parameter (AUC=0.7285 for the QR interval). Combining the AI predictions with the estimated glomerular filtration rate (eGFR) and serum chloride (Cl -) boosted the diagnostic accuracy of the algorithm to AUC 0.986. In the prospective study, the integrated AI and routine laboratory diagnostic system had a PPV of 100% and F-measure 87.5%. CONCLUSIONS An AI-ECG system reliably identifies hypokalemia in patients with paralysis and integration with routine blood chemistries provides valuable decision support for the early diagnosis of TPP.

scholarly journals Employment of Artificial Intelligence Based on Routine Laboratory Results for the Early Diagnosis of Multiple Myeloma

2021 ◽  
Vol 11 ◽  
Author(s):  
Wei Yan ◽  
Hua Shi ◽  
Tao He ◽  
Jian Chen ◽  
Chen Wang ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Multiple Myeloma ◽  
Early Diagnosis ◽  
Machine Learning Algorithms ◽  
Support Vector ◽  
Diagnostic Model ◽  
Routine Laboratory ◽  
Data Set ◽  
Hepatic Diseases ◽  
Laboratory Results

ObjectiveIn order to enhance the detection rate of multiple myeloma and execute an early and more precise disease management, an artificial intelligence assistant diagnosis system is developed.Methods4,187 routine blood and biochemical examination records were collected from Shengjing Hospital affiliated to China Medical University from January 2010 to January 2020, which include 1,741 records of multiple myeloma (MM) and 2,446 records of non-myeloma (infectious diseases, rheumatic immune system diseases, hepatic diseases and renal diseases). The data set was split into training and test subsets with the ratio of 4:1 while connecting hemoglobin, serum creatinine, serum calcium, immunoglobulin (A, G and M), albumin, total protein, and the ratio of albumin to globulin data. An early assistant diagnostic model of MM was established by Gradient Boosting Decision Tree (GBDT), Support Vector Machine (SVM), Deep Neural Networks (DNN), and Random Forest (RF). Out team calculated the precision and recall of the system. The performance of the diagnostic model was evaluated by using the receiver operating characteristic (ROC) curve.ResultsBy designing the features properly, the typical machine learning algorithms SVM, DNN, RF and GBDT all performed well. GBDT had the highest precision (92.9%), recall (90.0%) and F1 score (0.915) for the myeloma group. The maximized area under the ROC (AUROC) was calculated, and the results of GBDT (AUC: 0.975; 95% confidence interval (CI): 0.963–0.986) outperformed that of SVM, DNN and RF.ConclusionThe model established by artificial intelligence derived from routine laboratory results can accurately diagnose MM, which can boost the rate of early diagnosis.

scholarly journals Thyrotoxic Periodic Paralysis in Young Caucasian Male

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A966-A966
Author(s):  
Sujata Panthi ◽  
Rajib Kumar Bhattacharya
Keyword(s):  
Muscle Weakness ◽  
Past History ◽  
Lower Extremities ◽  
Asian Population ◽  
Periodic Paralysis ◽  
Medical Emergency ◽  
Graves Disease ◽  
Free T4 ◽  
Thyrotoxic Periodic Paralysis ◽  
Caucasian Male

Abstract Background: Thyrotoxic periodic paralysis (TPP) can be a medical emergency as delay in diagnosis can lead to life-threatening arrhythmia. Periodic paralysis is more prevalent in the Asian population. We report a case of thyrotoxic periodic paralysis in a young Caucasian male. Case: A 24-year-old male with a past history of Graves’ disease, hypertension, and asthma was brought to the hospital due to leg weakness and fall. He was initially diagnosed with Graves’ disease 2 years ago. The patient could not take methimazole or metoprolol due to the affordability issue for the last 18 months. On presentation, he fell on the floor while attempting to stand up from the couch. He could not stand up or pick his cell phone. He remained on the floor for 2-3 hrs. A review of the system was positive for palpitation and fatigue and negative for diarrhea, weight loss, anxiety, sleep problem, and dry eyes. On arrival, he had a pulse of 100/min, BP of 157/85 mmHg with rest of vitals signs normal. Motor strength on bilateral lower extremities were 2/5. Upper extremity strength was normal. No thyromegaly or thyroid bruit was noted in the exam. The rest of the physical exam was normal. Labs showed Potassium 1.9 with a normal reference range (RR) of 3.5 - 5.1 mmol/l. His TSH was < 0.01 (RR 0.35 - 5.00 MCU/ML), Free T4 was 5.0 (RR 0.6- 1.6 NG/DL), Total T3 was 425 (RR 87 - 180 NG/DL) and CK was 70 (RR 35- 232 U/L). EKG showed sinus rhythm at 90 bpm with no PR, T/ST, or QT abnormalities. He was given IV potassium and was also started on methimazole 10mg TID and metoprolol. His weakness and tachycardia were improved the next day. We discussed with him the options of medical management vs. surgery. He underwent a total thyroidectomy. Biopsy showed nodular hyperplasia consistent with graves’ disease. Discussion: Thyrotoxic periodic paralysis (TPP) is characterized by hypokalemia and episode of acute muscle weakness in lower extremities in the setting of hyperthyroidism. The pathophysiology of TPP remains uncertain. Hyperthyroidism is a hyperadrenergic state in which beta-2-adrenergic stimulation in muscle cells directly induces cellular K+ uptake by increasing cAMP, leading to activation of Na/K ATPase. The increase in the influx of intracellular K+ leads to hypokalemia and skeletal muscle weakness. Some studies show pathophysiology can be different in Caucasians compared to the Asian population that there could be abnormalities in Na and K channels other than Na/K ATPase. Potassium replacement should be done with caution as hypokalemia is due to intracellular shift and rebound hyperkalemia is common during the management. Beta-blocker may reverse adrenergic overstimulation of Na/K ATPase. It can help rapidly improve paralytic symptoms.

Early diagnosis of thyrotoxic periodic paralysis: Spot urine calcium to phosphate ratio*

2006 ◽  
Vol 34 (12) ◽  
pp. 2984-2989 ◽  
Author(s):  
Shih-Hua Lin ◽  
Pauling Chu ◽  
Chih-Jen Cheng ◽  
Shi-Jye Chu ◽  
Yi-Jen Hung ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Periodic Paralysis ◽  
Urine Calcium ◽  
Thyrotoxic Periodic Paralysis ◽  
Spot Urine

scholarly journals Role of Artificial Intelligence in the Early Diagnosis of Oral Cancer. A Scoping Review

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4600
Author(s):  
María García-Pola ◽  
Eduardo Pons-Fuster ◽  
Carlota Suárez-Fernández ◽  
Juan Seoane-Romero ◽  
Amparo Romero-Méndez ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Oral Cancer ◽  
Early Diagnosis ◽  
Scoping Review ◽  
Large Scale ◽  
Population Based ◽  
Training Data ◽  
Diagnostic Process ◽  
Clinical Patient ◽  
Early Diagnosis Of Cancer

The early diagnosis of cancer can facilitate subsequent clinical patient management. Artificial intelligence (AI) has been found to be promising for improving the diagnostic process. The aim of the present study is to increase the evidence on the application of AI to the early diagnosis of oral cancer through a scoping review. A search was performed in the PubMed, Web of Science, Embase and Google Scholar databases during the period from January 2000 to December 2020, referring to the early non-invasive diagnosis of oral cancer based on AI applied to screening. Only accessible full-text articles were considered. Thirty-six studies were included on the early detection of oral cancer based on images (photographs (optical imaging and enhancement technology) and cytology) with the application of AI models. These studies were characterized by their heterogeneous nature. Each publication involved a different algorithm with potential training data bias and few comparative data for AI interpretation. Artificial intelligence may play an important role in precisely predicting the development of oral cancer, though several methodological issues need to be addressed in parallel to the advances in AI techniques, in order to allow large-scale transfer of the latter to population-based detection protocols.

scholarly journals SUN-LB88 Thyrotoxic Periodic Paralysis in Hispanic Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tahira Sarwar ◽  
Jose Martinez ◽  
Johnathan Kirupakaran ◽  
Giovanna Rodriguez ◽  
Gül Bahtiyar
Keyword(s):  
Early Recognition ◽  
Case Reports ◽  
Laboratory Data ◽  
Periodic Paralysis ◽  
Graves Disease ◽  
Free T4 ◽  
Rare Presentation ◽  
Thyrotoxic Periodic Paralysis ◽  
Lower Extremity Weakness ◽  
Abnormal Gait

Abstract BACKGROUND: Thyrotoxic periodic paralysis (TPP) presents as acute intermittent attacks of weakness related to hypokalemia, commonly reported in Asians and rare in Hispanics(1). Patients with TPP will have triiodothyronine (T3) triggered increased Na+/K+ ATPase pump activity and transcription of the KCNJ18 gene that encodes for the Kir2.6 channel(2). This permits insulin, catecholamines, stress and alcohol(3) to increase cellular intake of potassium, which causes depolarization and leads to weakness and paralysis. We report a case of TPP in a young Hispanic man who presented with lower extremity weakness and falls. CASE PRESENTATION: A 34-year-old Hispanic man with Graves’ disease, non-adherent to medications presented with generalized weakness, more pronounced in legs, and recurrent falls. Physical examination was unremarkable except for mild enlargement of thyroid gland and abnormal gait due to weakness. Laboratory data showed hypokalemia of 1.8 mmol/L (3.7-5.1 mmol/L) and a TSH level of <0.004 mIU/L (0.34-5.6 mIU/L). Free T4 3.74 ng/dL (0.6-1.6 ng/dL), free T3 597 pg/dL (230-420 Pg/dL), thyroid stimulating Ig 148 (<130). Electrocardiogram did not show U waves. Radio iodine 123 scan of thyroid revealed diffusely increased 24-hour radioactive uptake of 66.5% (10-30%). The patient was diagnosed with TPP and supplemented with three doses of potassium 40 mEq IV infusion. Methimazole and metoprolol were started. He made a good clinical recovery within days. After discharge, he was treated with I-131 (13 mci) and developed postablative hypothyroidism on long term. He was euthyroid on levothyroxine. He did not have any recurrence of weakness at 7-year follow-up. CONCLUSION: TPP is uncommonly seen in Hispanics patients as opposed to Asians(3). Physicians should consider TPP as part of the differential diagnosis in young hyperthyroid Hispanic men presenting with weakness or paralysis, as early recognition and treatment can reduce recovery time and potentially prevent tachyarrhythmia or death. REFERENCES: 1. Matta A, Koppala J, Gossman W. Thyrotoxic hypokalaemic periodic paralysis: a rare presentation of Graves’ disease in a Hispanic patient. BMJ Case Rep. 2014;2014. 2. Ryan DP, Ptacek LJ. Mutations in Potassium Channel Kir2.6 Cause Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis. Cell, 140(1), pp.88-98. 3. Amblee, A. and Gulati, S. (2016). Thyrotoxic Periodic Paralysis: Eight Cases in Males of Hispanic Origin from a Single Hospital. AACE Clinical Case Reports, 2(1), pp.e58-e64.

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