ABSTRACT
Purpose: To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT?A) using proprietary software (automated) and image processing software (manual) in diabetic patients. Methods: In a retrospective study, OCT?A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP?VD, automated and manual), deep capillary plexus VD (DCP?VD, manual), and correlation between automated and manual SCP?VD. Results: OCT?A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP?VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP?VD (Huang and Otsu methods) did not differ between the groups. Manual DCP?VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP?VD correlated moderately with manual SCP?VD using Huang method (r = 0.51, P < 0.001) with a mean difference of ?0.01% (agreement limits from ?6.60% to +6.57%). Conclusion: DCP?VD differs consistently between NoDR and NPDR with image processing, while SCP?VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm
ABSTRACT
Giant cell tumour is a benign tumour of the bone. It is aggressive locally and has low metastatic potential.(1) Following lower end of femur and upper tibia, distal end of radius is the third most evident location for giant cell tumour (GCT) and about 10 percent of GCT involves distal radius.(2) GCT have often been identified as difficult to manage, mainly due to their close proximity to multiple tendons, median nerves, radial arteries and carpals.(3) Surgical treatment includes extended curettage of bone and replacing the cavity with bone graft, or excision of the tumour followed by reconstruction of bone with autograft or allograft.(1) Wrist fusion after ulnar translocation results in reduced range of pronation and supination movements in the forearm initially and mainly flexion and extension of the wrist joint, lag of the extensor pollicis brevis and longus tendons, abductor pollicis longus, stiffness and the risk of infections at the site.(6) Physiotherapy has been shown to be effective in the post-surgery treatment of patients. Nonetheless, the therapeutic program involves passive movement to active movements, manual joint mobilization, progressive resisted exercises, muscle energy technique and electrotherapy with adequate patient education. This has been shown to help improve patient outcomes and alleviate pain and recover full range of motion.(7)The distal end of the radius is the third most apparent site for giant cell tumour (GCT) after the lower end of the femur and upper tibia and about 10 per cent of GCT includes distal radius. After ulnar translocation and wrist arthrodesis the full range of motion cannot be regained at the wrist joint and which makes the case unique, physical therapy has been shown to be helpful for improving patient performance and quality of life in post-surgical situations. Patient main concerns were pain and oedema around wrist with loss of strength, power and range of motion. Main clinical findings found in this case were severe reduction in of range of motion at CMC, MCP and IP joints. Reduced strength in hand muscles. Loss of superficial sensation over C6, C7 in affected extremity (right). Giant Cell Tumour that was confirmed by X-Ray and histopathology as well as MRI. Nerve injury confirmed by Nerve Conduction Velocity. Therapeutic interventions are found to be beneficial in these type cases. The patient was able to achieve 4/6 activities of daily living and gain functional range of motion after continuous 10 weeks of intensive systematic physiotherapy treatment program.
ABSTRACT
Objective To obtain an estimate of the size of, and human immunodeficiency (HIV) prevalence among, young people and children living on the streets of Eldoret, Kenya. Methods We counted young people and children using a point-in-time approach, ensuring we reached our target population by engaging relevant community leaders during the planning of the study. We acquired point-in-time count data over a period of 1 week betweethe hours of 08:00 and 23:00, from both a stationary site and by mobile teams. Participants provided demographic data and a finger print(to avoid double-counting) and were encouraged to speak with an HIV counsellor and undergo HIV testing. We used a logistic regression (model to test for an association between age or sex and uptake of HIV testing and seropositivity. Findings Of the 1419 eligible participants counted, 1049 (73.9%) were male with a median age of 18 years. Of the 1029 who spoke with a counsellor, 1004 individuals accepted HIV counselling and 947 agreed to undergo an HIV test. Combining those who were already aware of their HIV-positive status with those who were tested during our study resulted in an overall HIV seroprevalence of 4.1%. The seroprevalence was 2.7% (19/698) for males and 8.9% (23/259) for females. We observed an increase in seroprevalence with increasing age for both sexes, but of much greater magnitude for females. Conclusion By counting young people and children living on the streets and offering them HIV counselling and testing, we could obtain population-based estimates of HIV prevalence