Automated detection of exudates and macula for grading of diabetic macular edema

Medical systems based on state of the art image processing and pattern recognition techniques are very common now a day. These systems are of prime interest to provide basic health care facilities to patients and support to doctors. Diabetic macular edema is one of the retinal abnormalities in which diabetic patient suffers from severe vision loss due to affected macula. It affects the central vision of the person and causes total blindness in severe cases. In this article, we propose an intelligent system for detection and grading of macular edema to assist the ophthalmologists in early and automated detection of the disease. The proposed system consists of a novel method for accurate detection of macula using a detailed feature set and Gaussian mixtures model based classifier. We also present a new hybrid classifier as an ensemble of Gaussian mixture model and support vector machine for improved exudate detection even in the presence of other bright lesions which eventually leads to reliable classification of input retinal image in different stages of macular edema. The statistical analysis and comparative evaluation of proposed system with existing methods are performed on publicly available standard retinal image databases. The proposed system has achieved average value of 97.3%, 95.9% and 96.8% for sensitivity, specificity and accuracy respectively on both databases.

Automated detection and grading of diabetic maculopathy in digital retinal images

Diabetic maculopathy is one of the retinal abnormalities in which a diabetic patient suffers from severe vision loss due to the affected macula. It affects the central vision of the person and causes blindness in severe cases. In this article, we propose an automated medical system for the grading of diabetic maculopathy that will assist the ophthalmologists in early detection of the disease. The proposed system extracts the macula from digital retinal image using the vascular structure and optic disc location. It creates a binary map for possible exudate regions using filter banks and formulates a detailed feature vector for all regions. The system uses a Gaussian Mixture Model-based classifier to the retinal image in different stages of maculopathy by using the macula coordinates and exudate feature set. The evaluation of proposed system is performed by using publicly available standard retinal image databases. The results of our system have been compared with other methods in the literature in terms of sensitivity, specificity, positive predictive value and accuracy. Our system gives higher values as compared to others on the same databases which makes it suitable for an automated medical system for grading of diabetic maculopathy.

Are soft tissue measurements on lateral cervical spine X-rays reliable in the assessment of traumatic injuries?

INTRODUCTION

Traumatic neck pain is a common presentation to the emergency department. Lateral plain radiographs remain the primary investigation in the assessment of these injuries. Soft tissue assessment forms an integral component of these radiographs. They can provide information on subtle injuries that may not be obvious. Many methods are used to assess the prevertebral soft tissue shadows. The two more commonly used techniques include the 'seven at two and two at seven' rule (method 1) and the ratio of the soft tissues with respect to the vertebral width (method 2).

AIM

To assess which of the above two methods in assessing cervical spine soft tissue shadows on lateral radiographs is more sensitive in the presence of cervical spine injuries.

METHODS

A retrospective analysis of consecutive traumatic cervical spine films performed within a busy trauma tertiary centre over a period of 7 months. Patients were divided into two groups: group 1-fractures; group 2-no fractures. The prevertebral soft tissue shadows were measured at referenced points on the lateral cervical spine films with respect to the above two methods and comparisons between the groups were made.

RESULTS

Thirty-nine patients in group 1 were compared to a control group of 60 patients in group 2. Both methods failed to identify any significant differences between the two groups. The sensitivity and specificity for method 1 was 7.6 and 93 %, and for method 2, they were 7.6 and 98 %, respectively.

CONCLUSION

There is no significant difference between the soft tissue shadows when comparing patients with and without cervical spine fractures on lateral radiographs. Both commonly used measures of soft tissue shadows in clinical practice are insensitive in identifying patients with significant osseous injuries. They, therefore, do not offer any further value in interpreting traumatic cervical spine radiographs. The management of patients with cervical spine trauma in the absence of obvious osseous injury on standard radiographs should warrant a computed tomography (CT) scan if clinically indicated.

Automated detection of exudates in colored retinal images for diagnosis of diabetic retinopathy

Medical image analysis is a very popular research area these days in which digital images are analyzed for the diagnosis and screening of different medical problems. Diabetic retinopathy (DR) is an eye disease caused by the increase of insulin in blood and may cause blindness. An automated system for early detection of DR can save a patient's vision and can also help the ophthalmologists in screening of DR. The background or nonproliferative DR contains four types of lesions, i.e., microaneurysms, hemorrhages, hard exudates, and soft exudates. This paper presents a method for detection and classification of exudates in colored retinal images. We present a novel technique that uses filter banks to extract the candidate regions for possible exudates. It eliminates the spurious exudate regions by removing the optic disc region. Then it applies a Bayesian classifier as a combination of Gaussian functions to detect exudate and nonexudate regions. The proposed system is evaluated and tested on publicly available retinal image databases using performance parameters such as sensitivity, specificity, and accuracy. We further compare our system with already proposed and published methods to show the validity of the proposed system.

Endoscopic dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is the treatment of distal nasolacrimal duct blockage. It has got many advantages of over external DCR with higher patient's acceptance. Twenty one consecutive cases of endoscopic DCR were studied during the period of two and a half years with a mean follow up period of 13.12 months (SD=7.05). The mean age of cases was 42.95 years (SD=14.49). In most of the cases the cause was either idiopathic (71.43%) or inflammatory (23.81%). The techniques used for making bony window were chisel-hammer (19.50%), powered drill (23.81%), Kerrison punch forceps (14.29%) or combination of powered drill and Kerrison punch forceps (42.86%). Silicon stent was used in 71.43% cases. There was no significant peroperative complication; premature extrusion of stent (4.76%), synaechia (9.52%), excessive granulation tissue formation (9.52%) and stomal stenosis with recurrence of symptoms (9.52%) were the complications noticed here. Anatomical success with patent stoma was observed in 90.48% cases but symptomatic improvement with dry comfortable eyes were seen in 86% cases. There was no statistically significant difference of outcome between this study and that of recently published studies (p>0.05). Some comparative studies showed both higher and lower success rates of endoscopic DCR than external procedure but there was no significant difference (p>0.05).

Audit on the success of partner notification for sexually transmitted infections in the West Midlands

The aim of this study is to investigate the success of partner notification (PN) among 13 genitourinary medicine centres in West Midlands. The West Midlands Audit Group conducted a regional audit between June and August 2007. Information on screening and management of patients with chlamydia, gonorrhoea, early syphilis and HIV were collected separately. Participating centres were asked to provide PN details for 10 index patients with each of chlamydia, gonorrhoea, early syphilis and HIV infections. For each index patient with chlamydia or gonorrhoea, 0.54 and 0.44 partners were screened, respectively. Among partners of patients with syphilis and HIV, 24% and 35% were screened, respectively. Only 9% of 311 screened partners were involved in casual partnerships with index patients. Acquisition of more robust targets for PN, better documentation, improved communication between genitourinary (GU) medicine centres, and provider referral may improve the performance of PN for Sexually transmitted infections.

An audit on the management of pelvic inflammatory disease in the West Midlands, UK

The potential complications of pelvic inflammatory disease (PID) make optimizing its management a high priority. A clinical audit of PID against current national management guidelines was conducted in 14 departments of genitourinary medicine in the West Midlands for women presenting with PID between January and December 2005. There were a total of 810 diagnoses of PID made from a total of 49,390 female attendees for that year, giving an incidence of 164 cases per 10,000 attendees. Of these 810 cases, data collection and analysis for this audit were performed on 139. An ofloxacin 400 mg twice daily (b.i.d.) based regimen was prescribed in 91 (65%, 95% confidence interval [CI] 57-73%) cases. Doxycycline 100 mg b. i. d. for 14 days plus metronidazole 400 mg b. i. d. for 5-14 days was prescribed in 44 (32%, 95% CI 25-40%) cases, but a third-generation cephalosporin was only given with this regimen in three cases. Partner notification was performed in 101 (73%, 95% CI 65-79%) cases. A total of 130 male contacts were recorded on the data collection forms, and of these 58 (45%) were traced and 51 (39%), treated. A follow-up appointment was given to 133 (96%, 95% CI 91-98%) women, although in most cases this was for seven days or more, and 104 (78%, 95% CI 67-81%) women attended for follow-up. Adherence to the national guidelines in this cohort of patients did not reach the national standard for choice of treatment regimen nor did it attain the target for proportion of male partners traced. Barriers preventing adherence to the national guidelines need to be explored and appropriate assistance given to physicians to help meet national standards of care.

Epilepsy: public knowledge and attitude in a slum area of Karachi, Pakistan

BACKGROUND

Epilepsy is a common but widely misunderstood illness. Consequently, epileptics suffer from considerable stigmatization in society. Since no studies have detailed the misperceptions about epilepsy in our community, it is not possible to provide focused intervention aimed at eliminating this prejudice.

PURPOSE

To assess the knowledge and attitude regarding epilepsy in an adult population of a Karachi slum area.

METHODS

A face-to-face interview was conducted on 487 consenting adult non-epileptics (305 males; 182 females) who were conveniently sampled. Chi-square test was employed to calculate the variability in knowledge and attitude with demographic and other variables.

RESULTS

In all, 12.5% had never heard about epilepsy. Among the rest, 66.7% identified epilepsy as being non-infectious, while 28.2% were unaware of any treatment available for it. Among the other 71.8%, 62.7% were aware of the existence of anti-epileptic drugs. Religious/spiritual treatment was chosen as the most effective treatment by 33.1%. Males were more likely to identify epilepsy as being non-infectious (p=0.02). Nearly 18% of the respondents would not object to their child marrying an epileptic, 69.5% did not want to socially isolate the epileptics, 83.1% said epileptics could receive academic education, 85.6% said they could perform activities of daily life and 62.4% said they could become useful members of the society. Those who considered epilepsy to be infectious were more likely to carry negative attitudes towards epilepsy (p<0.01 with four attitudes).

CONCLUSIONS

Considerable gaps exist in the community's knowledge about epilepsy. Some of these may explain the prevalence of negative attitudes towards this ailment.

Reducing the risk of gonorrhoea in black Caribbean men: can we identify risk factors?

OBJECTIVES

Grouping patients by self assigned ethnicity may hide intraethnic differences in disease associations and sexual behaviour patterns. The aim of the study was to detect associations between gonorrhoea with differences in ancestry, degree of acculturation, and religious belief in young black Caribbean men, which could subsequently be used to target health promotion interventions.

METHODS

A questionnaire based case-control study of black Caribbean men with gonorrhoea and a community control group without gonorrhoea.

RESULTS

A lesser degree of acculturation, attending a single sex school, increasing numbers of partners, lack of condom use, not being married, and a belief that sex before marriage was not wrong were associated with an increased risk of gonorrhoea. Country of birth and religious belief were not associated with gonorrhoea.

CONCLUSIONS

A number of factors were identified which may be useful in designing healthcare interventions in young black Caribbean men and these differed little from those in other ethnic groups. The healthcare intervention should include advice on reducing the number of partners and increasing the use of condoms.

Audit of official STD returns from genitourinary medicine

We audited the accuracy of KC 60 coding in our department over a two-week period in 1999. Case notes of 400 consecutive new and rebook patients who attended during each of the audit periods were reviewed, and their clinical diagnosis was compared with KC 60 returns entered into the computer and sent to the Department of Health. We concentrated on four KC 60 diagnoses of positive sexually transmitted infections: uncomplicated gonorrhoea (B1) and chlamydia (c4a), first episodes of anogenital warts (C 11 a) and herpes (C 10 a). At the end of the audit, specific recommendations were introduced, aiming at improving accuracy of KC 60 coding, and a re-audit was carried out in 2000, using identical methodology. In the first audit period there were 106 positive diagnoses, of which 41 (38.7%) were not recorded in the KC 60 returns. In the second audit period there were 149 positive diagnoses, of which 20 (13%) were not recorded, showing a significant improvement (Chi square P = 0.0005).

Seroprevalence of hepatitis A immunity in male genitourinary medicine clinic attenders: a case control study of heterosexual and homosexual men

OBJECTIVES

To compare the seroprevalence of hepatitis A in homosexual and heterosexual men to determine their susceptibility to infection and provide guidance for a policy on vaccination.

METHODS

A case-control study design was utilised to compare the risk factors associated with hepatitis A in homosexual and heterosexual men attending a city centre genitourinary medicine clinic. Demographic and sexual behavioural characteristics were included in univariate and multivariate models.

RESULTS

The overall seropositivity rate was 29% with no significant difference between homosexual and heterosexual men. Ethnicity and age were strongly associated with hepatitis A seropositivity in both homosexuals and heterosexuals. A history of sex in a sauna in homosexual men, and being born outside the United Kingdom for heterosexual men, was associated with hepatitis A seropositivity.

CONCLUSIONS

Targeted hepatitis A screening and vaccination of homosexual men attending UK genitourinary medicine clinics is not supported by the results of this study.

Viral sexually transmitted infections: current management strategies

Viral sexually transmitted infections are a major health problem associated with considerable morbidity. This article reviews the current strategies used in the management of infections such as genital warts, genital herpes and molluscum contagiosum. Pros and cons of different treatment regimens have been discussed with an emphasis on a selective approach to therapy. The importance of education, counselling and follow-up is highlighted and issues relating to the associated psychosexual morbidity have been addressed. Treatment of these infections in pregnancy and HIV has also been described.