Wireless COVID-19 Telehealth: Leukocytes Encryption Guided by Amino Acid Matrix.

In this era of wireless COVID-19 telehealth, visiting hospital for regular follow-ups could invite coronavirus in someone's body. Opting for proactive E-health services is the best thing. It helps the remote patients to share their confidential data through secured encryption. Telehealth services are emerging element in these proactive medical sciences. It helps the remote patients to share their confidential data through secured transmission. In this paper, amino acid guided matrix encoding scheme has been proposed. White blood cell count or Leukocute count is a dominant indicator of patients' health condition, even amid COVID-19. An abnormal growth in leukocyte count is mainly caused due to an infection, cancer, or any other severe symptoms. It initiates internal haematological inflammations, cardiovascular diseases, Type II diabetes, etc. Therefore, tracking leukocyte count may for disease diagnosis and further treatments. The leukocyte count is generally done in different pathologies, and the data evaluation needs the expertise of a pathologist. In this paper, a technique involving security measures to transmit the result of the histological test with the help of cryptography has been proposed. The data to be transferred to the concerned physician for further diagnosis with the help of proposed way of encryption using amino acids, which ensures no data loss, no data modification, no data theft in the middle of transmission. The proposed encryption method using the amino acid codes has produced results showing satisfactory performances such as p-values found to be 7.215544e-04 and 8.48904e-03 for the key stream and cipher key matrix monobit test respectively, and 8.10245e-04 and 8.10245e-04 for the key stream and cipher key matrix frequency test respectively. It may be used as a transmission module in any wireless COVID-19 Telehealth Systems.

Introduction

The novel corona virus disease termed as COVID-19 emerged from Wuhan, China in 2019 [1-3]. This is the time of the advent of the electronic based health system as the basic need for the emergent health services [4]. We don’t have any option except to maintain the social distancing, usage of masks and sanitization, for our basic works to be executed. The disease doesn’t wait for the pandemic to end and requires a rapid clinic visit which is at least not possible during this pandemic time interval. Patients are the mostly suffered under such critical conditions of threat. Intrusion of patients’ confidential data and medical reports is not at all desirable. This paper has been organized as: Introduction has been stated here itself in this section. Related works were cited in the Sect. 2. The problem domain and the solution domain were given under the Sects. 3 and 4 respectively. The proposed methodology has been explained in the Sect. 5 followed by its results at Sect. 6. The significance of our contribution with respect to earlier works has been mention under the Sect. 7. Section 8 has dealt with the comparison analysis. Conclusions were tagged in the Sect. 9. The limitations and future scope of improvements were briefed in the Sect. 9. Lastly, the following statements were incorporated such as Acknowledgement, Funding, Statements of Ethical Compliances, etc.

The advent of electronic based health system in the era of COVID-19 is likely to be one of the best emergent health services. Clinical diagnosis and treatments are possible globally using such E-Health systems. Coronavirus that affects the human immune system mostly in geriatric patients, co-morbid patients, pregnant women and children. Human immune system helps to fight against bacteria, viruses and other pathogenic organisms. An individual bearing low antibody (Ab) producing system gets affected easily by any invaders irrespective of its quality and quantity. That means their immunity has been compromised. Moreover, an individual with good antibody producing system i.e. having effective defence immune mechanism leads a healthy life. White Blood Corpuscles (WBC) or Leukocyte is said to be the chief army of the human immune system. The deviated magnitude of WBC count provides us the health conditions of a patient. Further, analysing the exact number of the different types of leukocyte provides us the idea of the individual might be affected by which type of disease in E-Health [5]. Evaluating the number of leukocyte in the blood smear was earlier done manually using Haemocytometer. It was a challenging task then. Now-a-days with the rapid development in the field of instrumentation, WBC counting for disease detection is done by different easy methods like Fourier Psychographic Microscopy (FPM). The leukocytes reports that are generated has to be transferred to the respective physicians/doctors for diagnosis and treatments. In electronic based health system, secured data communication through public channel is the biggest threat. Eavesdroppers are promptly active in nature to read the patient’s private data. So security has to be provided on medical data before transmission in E-Health [6, 7]. Cryptography is the technique of encrypting and decrypting the plain message into meaningless format for the intruders [8]. Symmetric key cryptography [9] involves the same key by the sender for encryption and by the recipient for decryption. If these two are processed with two unequal keys, then such is called asymmetric key cryptography. If a single character of the plain text is converted at a time with the key in case of symmetric key cryptography then it is called stream cipher. When a block of characters of the plain text are converted at a time with the key in case of symmetric key cryptography then it is called block cipher [10]. The effective method based on cryptographic is the physical characteristics of the data and public transmission channel are to be taken into consideration. RSA public key cryptography is the most frequently and inevitable algorithm for data transmission [11]. The security of RSA algorithm depends on the choice of prime numbers factoring [12]. In this proposed technique, haematological data are encoded through single letter codes of amino acids. The sequences of binary bits are derived through proposed method. Furthermore, that sequence has been equally partitioned into blocks. Each block will be put inside another frame of encryption technique. It could be done with an eye to combat the Man-In-The-Middle attacks. The differential leukocyte count could be done using standard digital mechanism, could be greatly used to detect and diagnose different diseases. From a genetic disorder to chromosomal disorders could be assessed by this method, i.e. from Cancer to Tuberculosis. Neutrophils responsible for the first line of defence occupying the highest percentage (60%) in the blood. Eosinophils has fight against infections caused by the parasites, generally gives allergic responses 0.1% of the white blood cells are Basophils, best role in asthma. Lymphocytes which either produce the antibodies against specific antigen or release cytokines like Interleukins (IL-1, 2, 3, 4), Tumour Necrosis Factor (TNF) and induce apoptosis of the infected host cell. The garbage trucks of the immune system, Monocytes and Macrophages (in tissues) are 5 to 12% of white blood cells in bloodstream and flushes pathogens by phagocytosis [13]. Following Table 1 represents the normal range of WBC. We have focused on WBC for proposed haematological encoded encryption scheme [14].

Table 1

Normal range of differential leukocyte count

Types of WBC	Percentage of WBC types (%)	Normal range in mm3
Neutrophils	40–60	2500–8000
Eosinophils	1–4	50–500
Basophils	0.5–1	25–100
Lymphocytes	20–40	1000–4000
Monocytes	2–8	100–700

According to the medical analysis [15], the normal Leukocyte Count for men is 5000–10,000/μL and that for women it is 4500–11,000/μL the varying count above or below this range is considered abnormal, showing the chances of disease. This aberrant Leukocyte count can face two scenarios i.e. either increased WBC count or decreased WBC count. The lower WBC count called “Leukopenia”—when the count is less than 5000 in men/μL and 4500/μL in women which might be because of diseases such as Sepsis, Aplastic anemia, Myelodysplastic syndrome, HIV etc., while when the WBC count is greater than 10,000/μL in men and 11,000/μL, this is said to be “Leukocytosis” which might be the indicator of diseases like Leukemia (CML, AML, ALL), Leukemoid reactions, and tissue damage. Similarly the varying number of varying WBC types indicates different types of disease in human body (Fig. 1).

Fig. 1

Differential leukocyte count [16]

Related Works on Biological Cryptography and Telecare Health

E-Health plays an emerging treatment procedure in the human community. Plenty of researches have been carried out at different global locations to provide more data security on the medical data. Extensive research works have been noted on DNA based cryptography [17]. Yamuna et al. [18] had developed an encryption technique based on amino acids. Authentication of the patients’ DNA sequences at the recipient’s end is an open challenge due several middle way attacks. Also the concept of key generation has been missing in their technique. Ahmed et al. [19] had proposed an amino acids and DNA based encryption method. Their technique had shown better performances than classical algorithm in terms of time complexity. Their technique has only six bits codon structures. Lower number of bits in the encryption key is proportional to higher chances of being compromised. Bazli et al. [20] had shown a technique on protein formation by using the molecular bio information. Standards graphical tests have not been tested in their proposed technique. Rathi et al. [21] had proposed a data security technique that involves amino acids and DNA with four square matrix decryption. But the security analysis likes of brute force attacks, middle man attacks, time stamp attacks, etc. were not included in their paper. Nirmala et al. [22] have proposed a scheme guided by amino acids protein sequencing. They have converted a plain data into amino acid protein sequences. The process of key generation is not robust in nature in terms of resistance against the intruders.

Sohal et al. [23] had proposed at DNA roused got symmetric key cryptography in the field of cloud computing. It is essential to strongly encrypt the message before transmitting to the clouds. Time complexity of their technique has not been illustrated there. Mulyad et al. [24] have proposed a strategy to improve the precision of ECG utilizing waveform division. The accuracy of this technique is itself a challenging constraint. Capua et al. [25] have proposed a technique to evaluate the patients' ECG signals in genuine casing. A sensor has been utilized to detect the ECG signs and it is handled utilizing an individual computerized colleague termed as Personal Digital Assistant (PDA). PDA can impart signs to the crisis/emergency unit when some strange readings are distinguished. The security mechanisms could have been enhanced during the mid way signal transmission over the network. Borghetti et al. [26] have built up a sensor based glove to gauge hand finger flexion for restoration. It comprises of a glove and a bunch of sensors set at the constant securing unit with proper setup, which thusly offers criticism to restoration unit utilizing patients' fingers positions. Patients may wrongly provide inputs (finger movements) to their proposed system. Thus, the system may not detect such exceptional cases. Sarkar et al. [27] had considered biometric encryption on fingerprints utilizing metaheuristic salp swarm algorithm. They have used the patients’ biometric traits to generate additional bio-key. Their performance comparison was missing their paper.

The possibility of WBC having inter-relationship with infection causing returned up late during 2001. Do Lee et al. [28] thought of a local area overview among African and Americans and tracked down that the WBC Count is more noteworthy than 7000 cells/mm3. It shows 1.9 times more occurrence of coronary diseases, 2.9 times more danger of episode ischemic stroke, and 2.3 times more odds of cardiovascular disease (CVD). The mortality for the least quartile of WBC check for example is less than 4800 cells/mm3 [29]. The inter-relationship between greater Leukocyte count and higher Systolic Blood Pressure (SBP) was observed to be uniformly linear,i.e. specifically high Leukocyte count is seen with SBP 130–139 mmHg whereas lower with those having SBP 120 mmHg [30]. The bacterial invasion during the septic infection results in change of leukocyte count in the body of a human being. The differential WBC count may be useful for determining the efficiency of bacterial infection, the arrival of the fever results in greater Leukocyte count which is more than 15,000/μL with the neutrophils count greater than 1500/μL. It happened because of the bacterial antigen activating the first and the second line of defence. The lymphocyte percentage showing a simultaneous decrease, causing lymphopenia and also the lowering of lymphocyte TCD4+, CD8+ and NK cells [31]. Moreover, Department of Hematology and Immunohaematology, the Hospital of Kenana, had visualized the fact that the Monocyte Count is said to have a higher percentage with the fall in the Leukocyte Count [32]. According to WHO, the hematological diagnosis during the illness of dengue fever it has been cited by Leucopenis i.e. Leucocyte < 5000 cells /mm3, thrombocytopenia < 150,000 cells/mm3, an increase of haematocrit (6–10%). Its symptoms includes such as arthralgia, headache, retro-orbital pain, myalgia, rash, hemorrhagic manifestations, leucopenia. Lately the DHF (fever having hemorrhagic tendency) proved it to be the dengue infection [33].

Further, Electronic Health Record (EHR) is the collection of data which is digitally formatted having patient’s electronically stored health record represented as graphs on paper chart. EHRs having patient diagnosis records which are shared across the specific segments of the health care which is highly secured for the authorized users as an EHR contains the medical statements and treatment histories of respective patients. A worthy level clinical data analysis system is produced by the EHR system which is gathered in a provider’s office which can be further diagnosis by high profile learned doctors for a broader recognition and cure of a patient’s suffering from any lethal disease.

Problem Domain

Because of the ongoing trend of data breaches and the increasing risk of data theft, this continues to be an open concern for not only business sector, academic research sector but also in the medical sector too. These issues have prompted us to explore new and stronger regulations to protect patients’ privacy, especially during the era of COVID-19. Following are the open challenges in such telemedicine sectors.

Existing wireless COVID-19 telehealth may divert the patients' data and reports (WBC, etc) by the undesired intervention of the intruders.

Negative impacts on patients’ treatments and recovery rates.

Maximum loads on the medical online transactions amid COVID-19. Most of the hospitals have set up their telehealth wings too. Data security is an open challenge here.

No papers were found on COVID-19 WBC secured encryption technique amid this global pandemic.

Solution Domain

This section has addressed the above challenges. For solving those concerned problem, we have used BLOSUM50 [34] which is a substitution matrix generally used for sequence alignment of proteins and generate specific scores against it. This method is used by us to generate the scores of specific amino acids against each other, the greatest score is taken as prior to generate the complimentary. The thing to be noted is the fact that 16 amino acids are taken into consideration among the 20 and each are assigned different WBC count level. So, the clinical physician instead of giving detailed information of the Blood Count need to only present the specific amino acid which is further converted into combinations of 30 bits of binary digits.

Proposed Methodology

BLOSUM50 [34] is used in this paper to generate the scores of the amino acids. There are generally twenty amino acids in total like E, P, A, C, G, Q, V, R, K, W, D, N, H, F, L, I, Y, S, T, and M. the last four amino acids were having minimum scores in BLOSUM50 when compared to other amino acids in the matrix [35]. These four are Y, S, T, and M, and are intentionally ignored in this proposed technique. The remaining amino acids were pooled into a matrix structure and corresponding proposed codes having four binary bits each. From the proposed code of WBC, a sequence of amino acids would be converted into complementary binary amino acids to generate the intermediate code. Lastly, the encrypted binary bits would be put into triangle encryption to have another round of encryption. This is done to protect the patient’s WBC from the external access in E-Health systems [36] especially in this COVID-19 period.

Now the transmittable sequence can be transported to the physician through asymmetric encryption in COVID-19 telehealth.

Asymmetric Encryption of Cipher Matrix

Predominantly, the last part has been the most important issue in electronic based health system is to encrypt the generated cipher matrix with the public key of doctor by RSA algorithm. In this proposed technique, asymmetric RSA encryption has been considered. The general algorithm may be written as below.

In the field of Telemedicine, online advices can be taken from remote places. The encrypted Leukocytes have to be transmitted to the doctor. The public key asymmetric RSA has been deployed in terms of a that has been defined as the RSA encryption [37].

Following Table 2 contains the amino acids assignment according to the varied ranges (in mm3) and corresponding diseases that may incur.

Table 2

Proposed amino acids assignment of different differential leukocyte counts

Amino acid	Range in mm3	Condition(s)	Common disease(s)
A	> 2400	Neutropenia	Ulcer, Abscesses, Rashes, Wounds taking higher healing time
R	2500–8000	Normal neutrophils	Not applicable
N	< 10,000	Neutrophilia	Herpes, Militarty TB, Hepatic Amoebiasis, Pneumocystis carinii
D	> 50	Eosinopenia	Thymoma, Hypogammaglobulinemia, Stress Reactions, Cushing’s syndrome
H	50–500	Normal Eosinophils	Not Applicable
I	< 500	Eosinophilia	Eosinophilia-myalgia-syndrome, Asthma, Eosinophilic Fasciitis
L	> 25	Basopenia	Urticaria, Hyperthyroidism, Increase of Glucocorticoids
K	25–100	Normal Basophiles	Not Applicable
C	< 100	Basophilia	CML, Ulcerative colitis, TB, Rheumatoid Arthritis, Inflammatory Bowel Disease (IBD)
Q	> 1000	Lymphopenia	HIV, Hypersplenism, Leukemia, Aplastic Lupus, Myelodysplatic syndrome
E	1000–4000	Normal Lymphocyte	Not Applicable
F	< 4000	Lymphophocytosis	Glandular fever, Chagas disease, Lymphoma, Toxoplasmosis, American-trypanosomiasis, TB
G	> 100	Monocytopenia	Acute Myeloid Leukemia, Hairy cell leukemia, Aplastic anemia, MonoMAC syndrome
P	100–700	Normal Monocyte	Not Applicable
W	< 700	Monocytosis	Sarcoidosis, Brucellosis, CMML

The cipher matrix can be formed using header row and corresponding key oriented rows generated through isosceles encryption triangle. Lastly, it can be encrypted through the public key of the physician though any of the asymmetric encryption.

Results Sections

This section deals with the results obtained on the proposed encryption system. Modern computer enabled with Intel processor, 4 GB primary memory, 1 TB secondary memory, and high level language are the basic configurations needed to have the outputs. The proposed technique of transmitting leukocytes count from one node to another using secured encryption has been illustrated. Amid this COVID-19, such wireless telehealth system is beneficial in the light of patients’ data security.

Three matrices were proposed for amino acids, encoded amino acids and complementary amino acids respectively. Following Matrix I contain the amino acids.

Following Matrix II contains the proposed encoded amino acids in binary bits.

The scores generated from BLOSUM 50 [34], has provided the baseline to create a complementary mechanism so that the specific amino acid can only interact with the respective other amino acids. More score indicated the more participation here. Amino acids with the bottom four lesser score has been ignore in this technique. The complementary principle is in accordance with the highest score between a specific amino acid and the rest, and then that amino acid as a complementary has been taken as it is shown in Table 3.

Table 3

Complementary method of amino acids in BLOSUM 50

Amino acids	Complementary amino acids	Amino acids	Complementary amino acids
K	P	W	D
H	V	I	Q
R	C	L	N
N	L	F	A
G	E	C	R
A	F	V	H
Q	I	P	K
D	W	E	G

The last round of encryption involves isosceles triangle encryption, where the entire binary leukocyte sequence will be blocked into equidistant blocks. Each block will be inserted into isosceles triangle encryption model. The key orientation on four ways has been depicted in Table 4.

Table 4

Key orientation of cipher matrix

Orientation	Key bits
Left top down	00010
Right top down	11101
Left down top	01011
Right down top	11000

The key bits are of five bits in length. These bits are inserted at the first row of the cipher matrix as header row. The physician performing the decryption operation at the opposite end of E-Health system would first extract the header row followed by the individual rows. The leukocyte conditions of the body are encoded with proposed amino acid, which is a pre-requisite condition as obtained from Table 3. The BLOSUM50 complementary rule as given in Table 3 has been obtained. The proposed binary sequence would be then passed to isosceles encryption technique [38]. The cipher matrix will be generated depending on the orientation of the key bits as given in Table 4. Thus, the encoded haematological data matrix can be transmitted through asymmetric encryption to the doctors using her/his private key. The inverse operation can be carried out to retrieve the actual leukocytes counts.

Let us assume a patient having higher Basophils and greater lymphocyte number in this COVID-19 situation and which is very much common circumstance. The amino acid sequence is C and F. The encrypted isosceles triangle may look like at the following Fig. 2.

Fig. 2

Encryption isosceles triangle

Statistical Key Analysis

In this following sub section, an exhausted analysis has been performed in the light of existing cryptographic methods on the proposed key stream and cipher key matrix. Comparative statements were drawn and tabulated below on the proposed key stream generation technique with existing classical algorithms like RSA, 3-DES, AES (192 bits). In the context of robustness, some of the statistical tests were carried out to evaluate the performances of the proposed technique. Specifically, to state that monobit and frequency tests were included in this section of study. The purpose of these statistical tests is to have the randomness in the key bits and cipher key matrix [39]. Following Tables 5, 6, 7 and 8 represent the monobit and frequency test for the proposed key stream and cipher key matrix. Satisfactory results were found to conclude the acceptance of the proposed technique.

Table 5

Monobit test for key stream

Sl. No	Encryption technique	Expected proportion value	Observed proportion value	p-value s	Status (proportion of passing)
1	RSA	0.942831	0.955011	7.778150e−02	Result is fine
2	AES(192bits)	0.942831	0.969801	7.580168e−03	Result is fine
3	3-DES	0.942831	0.978022	8.647011e−02	Result is fine
4	ProposedHere	0.942831	0.978843	7.215544e−04	Result is fine

Table 6

Monobit test for cipher key matrix

Sl. No	Encryption technique	Expected proportion value	Observed proportion value	p-value s	Status (proportion of passing)
1	RSA	0.920675	0.936572	7.547131e−03	Result is fine
2	AES(192bits)	0.920675	0.964780	7.583698e−02	Result is fine
3	3DES	0.920675	0.950017	7.587212e−02	Result is fine
4	ProposedHere	0.920675	0.941478	8.48904e−03	Result is fine

Table 7

Frequency test for key stream

Sl. No	Encryption technique	Expected proportion value	Observed proportion value	p-value s	Status (proportion of passing)
1	RSA	0.972104	0.996472	8.55897e−02	Result is fine
2	AES(192bits)	0.972104	0.987123	7.52369e−02	Result is fine
3	3-DES	0.972104	0.948717	7. 88746e−04	Result is fine
4	ProposedHere	0.972104	0.978960	8.10245e−04	Result is fine

Table 8

Frequency test for cipher key matrix

Sl. No	Encryption technique	Expected proportion value	Observed proportion value	p-value s	Status (proportion of passing)
1	RSA	0.95680	0.969875	8.589731e−03	Result is fine
2	AES 192bits	0.95680	0.923044	6.87845e−02	Result is fine
3	3DES	0.95680	0.901247	7.665871e−02	Result is fine
4	Proposed	0.95680	0.970125	8.879905e−03	Result is fine

From the above Table 5, the p-value observed for the proposed key stream is 7.215544e−04 in case of monobit test.

From the above mentioned Table 6 of monobit test, the p-value observed for the proposed cipher key matrix has been found to be 8.48904e−03.

According to the above stated Table 7 under the frequency test, the p-value for the proposed key stream is 8.10245e−04.

According to the above Table 8 of frequency test, the p-value for the proposed cipher key matrix to be found as 8.879905e−03. From the above noted Tables 5, 6, 7 and 8, it is clearer that the proposed technique has successfully passed the above stated statistical tests when compared with existing classical algorithms. This provides the robustness of the proposed technique.

Histogram Analysis

The identification of Leukocytes waveforms and their attributes is the target of determination of illnesses the Telecare E-Health frameworks [36]. Histogram is the graphical exhibition of numeric information of same size and it is utilized as an assessor of WBC parts. As a rule, it is created by estimating the varieties of the directions among the example esteems one or the other way in the accompanying Fig. 3, which contains the histogram of WBC check before encryption. It isn't uniformly dissipated graph.

Fig. 3

Histogram of plain WBC

The rewarding piece of the proposed strategy has been represented at Fig. 4 through histogram viewpoint. Utilizing the proposed encryption, a similar WBC has been utilized to produce the histogram. It is noted out that pinnacles are equitably ready. Consequently, the gatecrashers' errand has been sped up inside the Telecare transmission. Hence, they will not have the option to identify the session key.

Fig. 4

Histogram of WBC post proposed encryption

Security Analysis

In the Telecare E-Health system, patients’ medical data has to be kept secured [36, 38, 39]. This is the biggest challenge for the researchers. An enormous and constant progress is going at very speed pace on strengthening the encryption key. It protects each of medical data communication using public media. In this proposed technique, cryptography has been embedded on amino acids followed by another round of cipher key matrix has been done. Such are done only to confuse the intruders. Any proposed technique on the encryption algorithm is hypothetically supposed to be fragile in connection with brute-force attack by the intruders. To analyze the time needed to decipher the key by the intruder is another fruitful context. The fastest supercomputers have designed by the IBM, Oak Ridge National Laboratory in the year of 2018. That means 148 floating point operations per second can be performed by the said computers. To decode a single cipher text, the number of trials is on the WBC decrypted file of a patient. It can be said that an intruder may try 1000 operations per second to decode the cipher text. So, the number of trials accomplished per second may be . A year has number of seconds. Hence, the number of years expected to diffuse one cipher text is years. So it is more important to note that the time needed to decrypt a single key by the intruder in Telecare System, is almost impossible. The potency of the proposed technique rises exponentially with proposed crypto system. It may be considered as persistent enough in any kind of advanced Telecare E-Health Systems.

Medical Report Analysis: Tabular Analysis

The following Table 9 has been constructed after average data analysis [40] of a patient having higher basophile and lymphocyte count i.e. the normal basophile count of a healthy individual is in between 25 and 100 whereas the patient having basophile count of more than 200 i.e. 230, 210, 280 in the three mentioned consecutive days. The lymphocyte count that should be in between 1000 and 4000 i.e. more than 5000 (5500, 5200, 5850) in those analysed dates. This report helps the physician to put her/his concentration towards the diseases having such abnormal count of lymphocytes and basophiles.

Table 9

Differential WBC count report

Days	Neutrophiles in mm3	Eosinophils in mm3	Basophils in mm3	Lymphocytes in mm3	Monocytes in mm3
1	3000	250	230	5500	600
2	3200	200	210	5200	650
3	3250	225	280	5850	680

Further, this disease is said to be biphasic or even triphasic, and the analysis of such symptoms of each phase could help such reach to a strong conclusion of CML. After the diagnose, Jorge E. Cortes had realized that patients having common symptoms like fatigue, anorexia, upper left quadrant discomfort, and early satiety are seen at their early phase [40]. Moreover, in some cases retinal hemorrhages, tinnitus, priapism are also found. Further, at the later phases, the change in the peripheral blood and the bone marrow in the most concentration, having complications like anemia, infection related problems lymphadenopathy and bleeding disorders are too observed. The blastic phase comprises of tissue infiltration at lymph nodes, skin, bone etc. occurs. The platelet count is also 30–50% higher in such patients i.e. higher than 1,000,000/μL along with Thrombocytopenia [40]. This could help a physician to sum up with the disease known as Chronic Myelogenous Leukemia (CML).

Medical Report Analysis: Graphical Analysis

The diagram produced at Figs. 5 and 6 are the portrayal of information introduced at table of [40]. For example, the number of various leukocyte of typical sound individual and that of sick/ill individual experiences CML for the three successive days. The blood tally shows that the quantity of basophile and lymphocyte are expanded in number in CML than the typical person.

Fig. 5

WBC Count of a Healthy Individual

Fig. 6

WBC Count of Chronic Myelogenous Leukemia

This Chronic Myelogenous Leukemia (CML) is a genuine kind of Bone marrow disease for example surrenders in the light tissue inside the bones from where the leucocytes are produced. CML causes strange development of WBC inside the body. Here, the expression "Chronic" remains as the malignant growth advances gradually when contrasted with the intense subtype of leukemia and the expression "Myelogenous" signifies the sort of disease influenced cells in the body.Further to say, the later side effects of Chronic Myelogenous Leukemia which are by and large found in older grown-ups and is uncommon in kids, however the danger of its event is independent of all ages boundary. Subcutaneous knobs (hemorrhagic delicate skin injuries), lymphadenopathy, and side effects of leukemia at focal sensory system may make us limited to analysis which is explicit to a specific infection disregarding the else, making the method of conclusion of the sickness very easy.

Significant Contributions with Respect to Existing Works

Yamuna et al. [18] had proposed DNA encryption with the amino acids in a straight forward concatenation of binary bits. In our technique, we have used unit matrices of amino acids, encoded amino acids, and complementary amino acids to make the system more complex and unknown to the intruders during COVID-19 era. Their technique has used the number of carbons and sulphur in the amino acids to make the computational logic. But in this proposed technique unique randomized bits were assigned to the participating amino acids and kept secret to the external entities. We have used patients’ leukocytes count as the source of encryption. Additional round of encryption has been added in this proposed technique to resist against the malicious attackers in the middle. Such additional data security has not been observed in their paper [18]. Most importantly, they have stated to transfer the cipher text to the recipient without any security protocol. In this context, RSA has been used to transmit our cipher text to the physicians/doctors by their private key.

Abdo et al. [19] have also proposed a DNA encryption technique based on amino acids. Their technique has six bits codon structures. 4 * 4 unit matrices on several rounds were the base in this proposed technique. But in this proposed mechanism, twenty bits key stream has been proposed with low complexity. No randomness tests were carried out by their technique. On the contrary, statistical tests were conducted by the proposed technique on the key stream and cipher text matrix. The summarized observations were noted in the above stated Tables 5, 6, 7 and 8.

Comparison Analysis

In this section, we have presented two comparative statements. First one is to show our performances with respect to classical algorithms. Statistical tests were the key parameters involved mainly in this part. The amount of randomness can be observed by the obtained p-value (Table 10).

Table 10

Comparison table with classical algorithms

Comparison name/parameter	Selection Reason	Stream	RSA	AES(192 bits)	3-DES	Proposed here
Monobit Test/p-value	To determine the proportion of ones and zeros	Key Stream	7.778150e−02	7.580168e−03	8.647011e−2	7.215544e−04
Frequency Test/p-value	To determine the proportion of ones and zeros within different blocks	Key Stream	8.55897e−02	7.52369e−02	7. 88746e−04	8.10245e−04
Monobit Test/p-value	To determine the proportion of ones and zeros	Cipher Key Matrix	7.547131e−03	7.583698e−02	7.587212e−02	8.48904e−03
Frequency Test/p-value	To determine the proportion of ones and zeros within different blocks	Cipher Key Matrix	8.589731e−03	6.87845e−02	7.665871e−02	8.879905e−03

In the next table, we have put a comparison statement with respect to the papers that were presented in this literature survey Sect. 2. This will be good to have a summary of works at compact structure (Table 11).

Table 11

Comparison table with literature survey works

Comparison criteria	Reason behind criteria selection	Yamuna et al. [18]	Abdo et al. [19]	Bazli et al. [20]	Sohal et al. [23]	Proposed here
Matrix computing	The matrices are hard to detect by the Intruder rather than plain text	Absent	Absent	Absent	Absent	Present
Security at public channel	Cipher text are likely to be hacked during the public paths	Absent	Absent	Present	Present	Present
Key generation	Encryption key is the base of symmetric key cryptography	Weak	Weak	Strong	Strong	Strong
Time complexity evaluation	The time complexity is a crucial parameter for any cryptographic system	Absent	Present	Absent	Absent	Absent
Standard graphs	Efficacy of the proposed encryption can be better understood by graphical representations	Absent	Absent	Absent	Absent	Present

Conclusions

In this wireless COVID-19 telehealth, higher amount of accuracy and preciseness medical disease detection is the key parameter along with secured medical data transmission. Fetching the normal range of WBC Count to the computer and specifying the specific disease causing by the leukocyte level, the doctor could come up with the preciseness of disease detection and its concern diagnosis. A secured amino acid based encryption on leukocytes has been done with good statistics. This proposed encryption technique based on the amino acid codes has produced results showing satisfactory performances. It may be in terms of p-value s found to be 7.215544e−04 and 8.48904e−03 for the key stream and cipher key matrix monobit test respectively, and 8.10245e−04 and 8.10245e−04 for the key stream and cipher key matrix frequency test respectively. Additional round of encryption has been added here to resist against the unwanted malicious attackers. The medical data communication between the patients and the concerned doctors for the diagnosis is done with a new level of encryption mechanism guided through single letter amino acids. This can be used in this corona virus pandemic era as a tool of the digital health transformation.

Limitations and Future Scope of Improvement

Only sixteen amino acids with high scores were taken into consideration in this technique. It has been done create the unit matrices of order. The size of the matrices has been kept static here. Such involved matrices were amino acid matrix, encoded amino acid, and complementary acid. Moreover, the length of the key bits has been assigned as five binary bits long. Those can only be accomplished by four directions. But which way it has been encrypted at the patient’s ends the same direction to be followed by the doctor’s ends decryption during the final round. Monobit test and frequency test were carried out on the key stream and generated cipher text on the proposed technique.

In future, all the participating amino acids should be dwelled to make a larger unit amino acid matrices. Thus, all the amino acids can get equal participation in the proposed technique of encryption. Other mathematical tools can also be applied over the key bits and cipher key matrix. More to say that during this COVID-19 context, online medical transactions have rapidly spurred. To reduce certain number of transactions, artificial neural network synchronization may be applied to have the same orientation of key bits. Also the length of the key bits can be extended to manageable length. It may reduce the time complexity of such wireless COVID-19 telehealth system.

Mat I =	A	I	W	G
	P	R	C	Q
	L	K	E	D
	F	H	N	V

Mat II =	1101	0001	0010	1001
	0101	0011	1111	1011
	0100	0001	0110	1100
	0111	0000	1110	1010