Experimental AI Tool Predicts Which Patients with Pandemic Virus Will Develop Serious Respiratory Disease

An artificial intelligence tool accurately predicted which patients newly infected with the COVID-19 virus would go on to develop severe respiratory disease, a new study found.

The work was led by NYU Grossman School of Medicine and the Courant Institute of Mathematical Sciences at New York University, in partnership with Wenzhou Central Hospital and Cangnan People's Hospital, both in Wenzhou, China.

Named "SARS-CoV-2," the new virus causes the disease called "coronavirus disease 2019" or "COVID-19." As of March 30, the virus had infected 735,560 patients worldwide. According to the World Health Organization, the illness has caused more than 34,830 deaths to date, more often among older patients with underlying health conditions. The New York State Department of Health has reported more than 33,700 cases to date in New York City.

Published online March 30 in the journal Computers, Materials & Continua, the study also revealed the best indicators of future severity, and found that they were not as expected.

"While work remains to further validate our model, it holds promise as another tool to predict the patients most vulnerable to the virus, but only in support of physicians' hard-won clinical experience in treating viral infections," says corresponding study author Megan Coffee, MD, PhD, clinical assistant professor in the Division of Infectious Disease & Immunology within the Department of Medicine at NYU Grossman School of Medicine.

"Our goal was to design and deploy a decision-support tool using AI capabilities – mostly predictive analytics – to flag future clinical coronavirus severity," says co-author Anasse Bari, PhD, a clinical assistant professor in Computer Science at the Courant institute. "We hope that the tool, when fully developed, will be useful to physicians as they assess which moderately ill patients really need beds, and who can safely go home, with hospital resources stretched thin."

Surprise Predictors

For the study, demographic, laboratory, and radiological findings were collected from 53 patients as each tested positive in January 2020 for the SARS-CoV2 virus at the two Chinese hospitals. Symptoms were typically mild to begin with, including cough, fever, and stomach upset. In a minority of patients, however, severe symptoms developed with a week, including pneumonia.

The goal of the new study was to determine whether AI techniques could help to accurately predict which patients with the virus would go on to develop Acute Respiratory Distress Syndrome or ARDS, the fluid build-up in the lungs that can be fatal in the elderly.

For the new study, the researchers designed computer models that make decisions based on the data fed into them, with programs getting "smarter" the more data they consider. Specifically, the current study used decision trees that track series of decisions between options, and that model the potential consequences of choices at each step in a pathway.

The researchers were surprised to find that characteristics considered to be hallmarks of COVID-19, like certain patterns seen in lung images (e.g. ground glass opacities), fever, and strong immune responses, were not useful in predicting which of the many patients with initial, mild symptoms would go to develop severe lung disease. Neither were age and gender helpful in predicting serious disease, although past studies had found men over 60 to be at higher risk.

Instead, the new AI tool found that changes in three features – levels of the liver enzyme alanine aminotransferase (ALT), reported myalgia, and hemoglobin levels – were most accurately predictive of subsequent, severe disease. Together with other factors, the team reported being able to predict risk of ARDS with up to 80 percent accuracy.

ALT levels – which rise dramatically as diseases like hepatitis damage the liver – were only a bit higher in patients with COVID-19, researchers say, but still featured prominently in prediction of severity. In addition, deep muscle aches (myalgia) were also more commonplace, and have been linked by past research to higher general inflammation in the body.

Lastly, higher levels of hemoglobin, the iron-containing protein that enables blood cells to carry oxygen to bodily tissues, were also linked to later respiratory distress. Could this explained by other factors, like unreported smoking of tobacco, which has long been linked to increased hemoglobin levels? Of the 33 patients at Wenzhou Central Hospital interviewed on smoking status, the two who reported having smoked, also reported that they had quit.

Limitations of the study, say the authors, included the relatively small data set and the limited clinical severity of disease in the population studied. The latter may be due in part to an as yet unexplained dearth of elderly patients admitted into the hospitals during the study period. The average patient age was 43.  

"I will be paying more attention in my clinical practice to our data points, watching patients closer if they for instance complain of severe myalgia," adds Coffee. "It's exciting to be able to share data with the field in real time when it can be useful. In all past epidemics, journal papers only published well after the infections had waned."

Along with Coffee and Bari, authors of the study included first author Xiangao Jiang, along with Jianping Huang, Jichan Shi, Jianyi Dai, Jing Cai, Zhengxing Wu, and Guiqing He, in the Department of Infectious Diseases at Wenzhou Central Hospital. Also from Wenzhou Central Hospital was author Yitong Huang of Department of Gynaecology.

Also study authors were Junzhang Wang of the Courant Institute of Mathematical Sciences at New York University, Xinyue Jiang of Columbia University, and Tianxiao Zhang in Department of Infectious Diseases at Cangnan People's Hospital. Coffee is also adjunct faculty in the Department of Population and Family Health at the Mailman School of Public Health at Columbia.

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6 things that can happen if you rub your eyes too much

Rubbing your eyes after spending long hours ogling at the screen can give you temporary relief. But when done often or too much, it can lead to eye diseases, worsening the existing condition and even increase the risk of eye infection.
​The dangers of rubbing your eyes

If you stare at the computer all day long or have eye allergy, nothing feels more satisfying than giving your eyes a good rub. Rubbing the eyes feels therapeutic because it stimulates the vagus nerve, which can slow down your heartbeat and relieve stress.

Having said that, rubbing eyes too vigorously and too often can result in eye damage and exacerbate existing conditions, increasing your risk of infections. Here are seven things that can happen when you keep rubbing your eyes:

​It can increase the risk of serious eye disease
Chronic eye rubbing can weaken the cornea and lead to its distortion called keratoconus. Continuous rubbing of the corneal tissue can cause it to thin and become more cone-shaped. Severe damage can require a corneal transplant.

​You can scratch your cornea

That eyelash or piece of dust in your eyes can cause immense irritation and temptation to rub the eyes. But this can make the situation worse. This puts you at risk of scratching your cornea, which typically heals in a day or two. But if not treated properly, it can result in an ulcer. If something like this happens, use water or saline to rinse your eye instead.

​It can make your glaucoma worse
If you have any existing eye condition, rubbing the eyes can make it even worse. Glaucoma is often caused by an increase in the pressure inside the eye, known as intraocular pressure (IOP). This pressure can lead to several problems including damage of the optic nerve, which can eventually cause vision loss.

Patients taking glaucoma medicine are suggested not to rub their eyes, even if the medication makes them feel itchy and blurry.

​It can make your nearsightedness worse

People with nearsightedness, also called myopia, can make their condition worse by rubbing their eyes. The condition has become common among people in the past few decades. According to a 2016 study published in the Opthalmology, nearly 9.6 million people are highly myopic and their vision tends to worsen over time.

​It can increase your risk of infection

Even if you wash or sanitize your hands often, they can still pick up thousands of germs. Touching your eyes with dirty hands can transfer the bacteria to the eyes that can cause conjunctivitis or redness in the eyes. If you get an infection in your eyes, a warm compress may help soothe it.

​You can get dark circles and bloodshot eyes
If you rub your eye hard enough, you can break the tiny blood vessels in your eyes, which can result in bloodshot eyes. Dark circles can appear due to the inflammation caused by continuously rubbing the eyelid. The appearance of dark circles post eye rubbing is called post-inflammatory pigmentary alteration. 

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Air pollution's tiny particles may trigger heart attacks

Researchers have found that even a few hours' exposure to ambient ultrafine particles common in air pollution may potentially trigger a non-fatal heart attack.

Myocardial infarction is a major form of cardiovascular disease worldwide. Ultrafine particles (UFP) are 100 nanometres or smaller in size. In urban areas, automobile emissions are the primary source of UFP.

For the study, published in the journal Environmental Health Perspectives, researchers investigated the effects of UFP exposure and heart attacks using the number of particles and the particle length and surface area concentrations at hourly intervals of exposure.

"This study confirms something that has long been suspected--air pollution's tiny particles can play a role in serious heart disease. This is particularly true within the first few hours of exposure," said the study's first author Kai Chen, Assistant Professor at Yale University in the US.

UFP constitute a health risk due to their small size, large surface areas per unit of mass, and their ability to penetrate the cells and get into the blood system, the study said.

The researchers were interested in whether transient UFP exposure could trigger heart attacks and whether alternative metrics such as particle length and surface area concentrations could improve the investigation of UFP-related health effects.

The research team examined data from a registry of all non-fatal MI cases in Augsburg, Germany.

The study looked at more than 5,898 non-fatal heart attack patients between 2005 and 2015.

The individual heart attacks were compared against air pollution UFP data on the hour of the heart attack and adjusted for a range of additional factors, such as the day of the week, long-term time trend and socio-economic status.

"This represents an important step toward understanding the appropriate indicator of ultrafine particles exposure in determining the short-term health effects, as the effects of particle length and surface concentrations were stronger than the ones of particle number concentration and remained similar after adjustment for other air pollutants," said Chen.

"Our future analyses will examine the combined hourly exposures to both air pollution and extreme temperature. We will also identify vulnerable subpopulations regarding pre-existing diseases and medication intake," Chen added.

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Researchers identify new prevention strategy for type 1 diabetes

A protein newly identified as important in type 1 diabetes can delay onset of the disease in diabetic mice, providing a new target for prevention and treatment in people, according to research led by scientists at the U.S. Department of Energy's Pacific Northwest National Laboratory and Indiana University School of Medicine. Because type 1 diabetes is incurable and has serious lifelong health consequences, prevention is a major research goal.

The key to the new study, published online January 9, 2020, in the journal Cell Metabolism, is a technique called mass spectrometry, which can comprehensively detect proteins that are found at extremely low levels in the body, but can have large effects on health.

The multidisciplinary research team of physicians and biochemists used a new strategy to pinpoint proteins in beta cells, a subset of pancreatic islets that increase or decrease in response to immune system attack. Beta cells normally regulate blood sugar levels in the pancreas. In people susceptible to type 1 diabetes (previously called insulin-dependent or juvenile diabetes) these cells are slowly destroyed by the body's own immune system. Here, the researchers focused on how islets respond to inflammation.

The researchers treated human pancreatic islets with substances produced by the body and thought to be involved in the diabetes disease process. They identified a total of 11,324 proteins, with 387 affected by the treatment. Of these 387, they narrowed their focus to one: growth differentiation factor 15 (GDF15).

We wanted to identify proteins that can intervene in the diabetes disease process. We became interested in GDF15 because the protein level was suppressed by 70 percent after treatment. Ernesto Nakayasu, a biomedical scientist at PNNL and co-lead author of the study      

              GDF15 is known for its protective effects in different types of cells in the human body but it had never been studied in islets. When the researchers measured levels of GDF15 in pancreas tissue from people with diabetes, they found the protein was depleted in their malfunctioning islet cells.

But the key piece of evidence emerged when the scientists treated non-obese diabetic mice withGDF15, and it reduced development of diabetes by 53%. Non-obese diabetic mice are a common model for testing type 1 diabetes treatments because they spontaneously develop autoimmune diabetes with many similarities to the human disease. 

"We hypothesized that reduced GDF15 was not a good thing for islet survival, and indeed that was the case," said Raghu Mirmira, a study principal investigator. "This work opens the way for us to consider these sorts of 'islet protective factors' as therapies to prevent or reverse type 1 diabetes." 

Mirmira until recently served as professor of pediatric diabetes and director of the Center for Diabetes and Metabolic Diseases at Indiana University School of Medicine. He is now a professor of medicine in the Section of Endocrinology, Diabetes & Metabolism at the University of Chicago

"This approach differs substantially from current thinking that targets the immune system. While GDF15 may be one new therapy, we identified other proteins that may work in conjunction with GDF15, so this work really represents a treasure-trove of information that can be mined for new therapies," said Mirmira.PNNL's Tom Metz, the co-principal investigator and an expert in mass spectrometry-based proteomics of islets, agreed, adding:

This study illustrates the power of non-reductionist, comprehensive approaches, such as proteomics, for discovering new information in complex systems. The protective role of GDF15 against islet destruction and its ability to delay onset of type 1 diabetes in the mouse model would have been very difficult to discover without performing the initial comprehensive proteomics analysis of stressed human islets.

The researchers are now working on the idea that low levels of GDF15 in islets may somehow be playing a proactive role in instigating the autoimmune attack that ultimately kills them.This thinking is somewhat counterintuitive in the type 1 diabetes field, but it is this kind of out-of-the-box thinking that may lead to therapies we never thought of previously.Raghu Mirmira, a study principal investigator.

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12 Common Diabetes Myths Debunked

There are many misleading myths surrounding diabetes. Unfortunately for me, I took some of these myths at face value and believed them to be true. Coming across this article really helped me to separate fact from fiction about the disease which affects millions around the world. Here are 12 diabetes-related myths debunked: 

Myth 1: Diabetes Isn't a Serious Disease Fact: Diabetes IS a serious, chronic disease. However, its effects can be controlled if managed properly. Nevertheless, it still kills more people annually than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

Myth 2: Diabetes Is a Death Sentence Fact: This isn't true. The better diabetics take care of themselves, the longer they will live. Doctor’s recommendations with regard to diet and exercise should be followed closely, ensuring that medication is taken correctly.

Myth 3: You Can't Do Too Much Exercise if You Have Diabetes Fact: While it’s true that diabetics who take insulin or other medications that increase insulin production in the body have to balance exercise, insulin levels, and diet, those who are taking oral medications such as metformin and sitagliptin can exercise as much as they like.

Myth 4: You'll Get Diabetes if You're Overweight or Obese

Fact: While weight is a risk factor for diabetes, there are other factors at play too, such as family history. Many overweight people never develop Type 2 diabetes. There are also many Type 2 diabetics with a normal weight.

Myth 5: Insulin Will Do You Harm Fact: Insulin is actually a lifesaver, but what makes it challenging is that many people find it difficult to manage. Taking insulin safely requires testing blood sugar levels many times a day to avoid harmful low blood sugar reactions.

Myth 6: Diabetes Means You Don't Produce Enough Insulin Fact: This is true for people with type 1 diabetes – their pancreas stops producing insulin completely. Those who have the more common type of diabetes, type 2, tend to have sufficient insulin when they’re first diagnosed. The main problem type 2 diabetics have is that their insulin doesn’t cause the cells in their bodies to absorb glucose from the food they eat. Their pancreases may also stop producing enough insulin with the passage of time, which means they’ll need injections.

Myth 7: Diabetes Means You Have to Inject Yourself Fact: Injections are only applicable to diabetics who inject their medications. These days, insulin pens that don’t require injections are available. Furthermore, drawing blood to measure blood sugar is painless thanks to the latest blood sugar meters. Many new diabetes medications can also be taken orally.

Myth 8. Eating Too Much Sugar Causes Diabetes

Fact: The only shred of truth in this myth is that recent research has indicated those who were already at risk of developing diabetes increased their risk of developing it further by drinking lots of sugared drinks. Sugar in itself, doesn’t cause diabetes, however it does contribute to obesity, which is a major cause of the disease.

Myth 9: "I Know Exactly When My Blood Sugar Level Is High or Low" Fact: This one is particularly dangerous, because some diabetics tend to rely on how they’re feeling as a gauge for whether their blood sugar levels are low. While certain symptoms are indicative of low blood sugar levels, they tend to become less accurate over time. The only sure-fire way of knowing whether they’re low or not is to actually check.

Myth 10: Diabetics Can't Eat Sweets Fact: Diabetics can eat whatever they want, as long as they pay attention to portion sizes and how often they’re eating their favorite treat. What they cannot do is eat too much of what they like. An example of this is having a smaller piece of cake than usual for dessert, and not having dessert as often.

Myth 11: Diabetes Makes You More prone to Colds or Flu Fact: While diabetics are no more vulnerable to contagious illnesses than anyone else, getting flu shots is important, because diabetics are a lot more likely to suffer serious complications from the flu than those who do not have the disease.

Myth 12: Diabetics on Insulin Haven't Taken Care of Themselves Fact: During the early stages of the disease, or just after diagnosis, insulin levels can be controlled adequately through eating a healthy diet, exercising and oral medications. As the disease progresses, your pancreas may begin to produce less insulin or stop producing insulin completely, which means that you’ll require insulin injections.

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