OBJECTIVE:This study aims at develop and evaluate an artificial intelligence programming software, an integrated system that automatically detects and classifies cells from microscopic Pap smear slide images taken on Android phones or tabs to diagnose the cervical cell morphology in a time-efficient and cost-effective manner. METHODS:This study presents an integrated system designed to automatically detect and classify cells in Pap smear slide images, differentiating cellular morphologies. The system leverages three deep learning (DL) and one machine learning (ML) models, each tailored to specific tasks in the image analysis pipeline. The analysis of 292 hospital in-house microscopic Pap smear images was conducted from July 2023 to December 2024 at CliniMed LifeSciences, Kolkata, India. The following article describes the datasets used, the training procedures and the performance metrics for each model. Results: Pap smear images have been validated and standardized by using SipakMed, Herlev (public datasets) and hospital in-house data. A total of 292 in-house Pap smear images have been analysed through the newly developed AI software. Standardization and validation include an Intersection-over-Union score of cell-nuclei boundary extraction model of 71.14%, the accuracy of cell classification model and morphological feature based ML model are 99.213% and 91.23% respectively. The custom AI model could successfully classify 98.09% and 80.49% of normal and abnormal cells in hospital in-house samples respectively. Also a significant meaningful correlation is observed between biopsy (gold standard) and AI reports. CONCLUSION:AI offers a lot of promise for diagnosing cervical cancer, and its uses in cervical cytology screening are particularly well-established. Manual screening of cervical cytology smears is a time-tested method, but AI is set to revolutionize the process by improving outreach, availability, accuracy and economy. A total of 292 hospital in-house Pap smear images have been validated and examined in this study with significant accuracy percentages between AI and expert eyes.
Chronic otitis media (COM) is often considered a unilateral disease based on presenting symptoms; however, the contralateral asymptomatic ear may harbour subclinical pathology. Evaluating the contralateral ear is important for early detection and prevention of bilateral disease. To assess the anatomical, functional, and radiological status of the asymptomatic contralateral ear in patients with unilateral chronic otitis media. This hospital-based cross-sectional study was conducted in the Department of Otorhinolaryngology of a tertiary care centre. Patients aged 12–50 years with unilateral symptomatic chronic otitis media were included. Both ears were evaluated using otoscopy/oto-endoscopy for tympanic membrane changes, pure tone audiometry for hearing assessment, impedance audiometry for middle ear function, and radiological imaging for mastoid air cell status. Findings in the asymptomatic contralateral ear were analysed and compared with the affected ear. A considerable proportion of asymptomatic contralateral ears showed abnormalities, including tympanic membrane retraction, tympanosclerosis, otitis media with effusion, and reduced mastoid pneumatization. Audiological assessment revealed mild hearing loss and altered middle ear compliance in several contralateral ears, despite absence of clinical symptoms. The asymptomatic contralateral ear in unilateral chronic otitis media frequently demonstrates anatomical, functional, and radiological changes. Routine bilateral ear evaluation is essential in all patients with unilateral COM to facilitate early diagnosis and prevent future disease progression.
Atopic dermatitis (AD) is a chronic inflammatory skin disease with significant morbidity. Recognising the need for region-specific guidance, the Skin Allergy Research Society and Society for Eczema Studies have collaborated to develop updated, evidence-based guidelines tailored to the Indian context. These guidelines address AD management across all age groups, special populations while considering local epidemiology, healthcare infrastructure, and treatment accessibility. A structured Delphi consensus process was conducted among 23 dermatology experts over 3 months through virtual and in-person meetings. Literature from MEDLINE, Cochrane, and Google Scholar was systematically reviewed, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach was used to assess evidence quality. Clinical recommendations were refined through multiple voting rounds, leading to consensus statements. Recommendations are based on an extensive literature review up to December 2024. This document updates the 2019 Skin Allergy Society guidelines, reinforcing global recommendations while allowing local adaptability. These guidelines provide updated recommendations for topical, systemic, phototherapy, and biologic therapies in AD. Key advancements include the introduction of topical crisaborole and JAK inhibitors for mild to moderate AD, along with a focus on emerging systemic therapies, such as biologics and systemic JAK inhibitors. In the Indian context, the guidelines define the roles of dupilumab and abrocitinib while also addressing the off-label use of tofacitinib and baricitinib in resource-limited settings. Specific recommendations are provided for children, elderly patients, and pregnant women, emphasising safety considerations for systemic and biologic therapies. These guidelines align with global AD management while incorporating India-specific adaptations based on epidemiology, accessibility, and affordability. They serve as a key reference for dermatologists, pediatricians, and general practitioners in India and other resource-limited settings. Though tailored for India, they are also relevant to dermatologists in developing countries, guiding treatment selection based on disease patterns, environmental factors, and medication availability.
Introduction Critical thinking and clinical reasoning are two core competencies essential for medical students in their evolution from passive learners to proficient future clinicians. These competencies require higher-order cognitive skills which cannot be accomplished through conventional lectures. In contemporary medical education, team-based learning (TBL) has emerged as an active innovative instructional strategy which promotes active participation, accountability, problem-solving, and higher-order thinking. The California Critical Thinking Skills Test (CCTST) assesses critical thinking, while the Script Concordance Test (SCT) measures clinical reasoning under uncertainty. The study aimed to evaluate the effectiveness of TBL in improving critical thinking and clinical reasoning among first-year MBBS students. Method An educational interventional study was conducted among 152 first-year MBBS students during a TBL session which included their pre-class preparation, Individual Readiness Assurance Test (IRAT), Team Readiness Assurance Test (TRAT), and application exercises with immediate facilitator feedback. To assess critical thinking, a 20-item questionnaire called the Critical Thinking Assessment Test (CTAT) on adrenal cortex disorders was constructed based on the domains described in the CCTST. To measure clinical reasoning, a 30-item questionnaire was developed on the same topic based on SCT. The two questionnaires which were developed by the investigator and validated by an expert panel were used before and after the TBL session. Result A substantial improvement was observed in SCT (Cohen's d=0.89) in comparison to CTAT scores (Cohen's d=0.73) after the TBL session. The TBL intervention strengthened the relationship between clinical reasoning (SCT) and critical thinking (CTAT) transforming a weak correlation (r=0.163; p=0.045) into a moderate, statistically significant correlation (r=0.369; p<0.0001). Student performance increased progressively from IRAT (3.27±1.68) to TRAT (8.97±0.87) to application exercises (11.36±1.35) (p<0.0001). Conclusion The study indicates that the implementation of TBL sessions in the early stage of medical training of students can bridge the gap between basic science concepts and clinical applications enhancing both critical thinking and clinical reasoning.
