Retinal Blood Vessel Tracking and Diameter Estimation via Gaussian Process With Rider Optimization Algorithm.

Retinal blood vessels structure analysis is an important step in the detection of ocular diseases such as diabetic retinopathy and retinopathy of prematurity. Accurate tracking and estimation of retinal blood vessels in terms of their diameter remains a major challenge in retinal structure analysis. In this research, we develop a rider-based Gaussian approach for accurate tracking and diameter estimation of retinal blood vessels. The diameter and curvature of the blood vessel are assumed as the Gaussian processes. The features are determined for training the Gaussian process using Radon transform. The kernel hyperparameter of Gaussian processes is optimized using Rider Optimization Algorithm for evaluating the direction of the vessel. Multiple Gaussian processes are used for detecting the bifurcations and the difference in the prediction direction is quantified. The performance of the proposed Rider-based Gaussian process is evaluated with mean and standard deviation. Our method achieved high performance with the standard deviation of 0.2499 and mean average of 0.0147, which outperformed the state-of-the-art method by 6.32%. Although the proposed model outperformed the state-of-the-art method in normal blood vessels, in future research, one can include tortuous blood vessels of different retinopathy patients, which would be more challenging due to large angle variations. We used Rider-based Gaussian process for tracking blood vessels to obtain the diameter of retinal blood vessels, and the method performed well on the "STrutred Analysis of the REtina (STARE) Database" accessed on Oct. 2020 (https://cecas.clemson.edu/~ahoover/stare/). To the best of our knowledge, this experiment is one of the most recent analysis using this type of algorithm.

Spectrum of Inherited Bleeding Disorder with Special Reference to von Willebrand Disease in Eastern India.

Background The objective of this study is to study the prevalence, clinical spectrum, and hematological profile of inherited bleeding disorder with special reference to von Willebrand disease in eastern India. Materials and Methods This prospective study was done in a tertiary care center in the eastern part of India over 2 years. Detailed history and clinical findings were noted in a proforma. Laboratory analysis included prothrombin time, activated partial thromboplastin time, bleeding time, and fibrinogen assay along with tests related to specific factor assay. Results One hundred and five patients were diagnosed as suffering with the inherited bleeding disorder out of a total of 1,204 patients. The age of patients ranged from 13 days to 35 years. The most common presenting clinical feature was prolonged bleeding after cut (76.19%). Out of 105 patients, 97 patients (92.38%) had coagulation defect, 5 patients (4.76%) had von Willebrand disease (vWD), and 3 patients (2.85%) had platelet defect. Most common coagulation defect was hemophilia A (84 cases), followed by hemophilia B (8 cases). Other rare congenital factor deficiencies were seen in five cases (5.15%). Only platelet defect was Glanzmann's thrombasthenia (GT). The age of vWD patients ranged from 4.5 years to 24 years. Forty percent patients with vWD disease were type 1 followed by 40% of type 2N and 20% of type 3 vWD. Conclusion vWD was not so common in eastern India. vWD was present only in 4.76% cases in this study. The most common coagulation defect was hemophilia A (86.59%) in our study. GT was present in only 2.85% cases.

Neutrophil-to-Lymphocyte Ratio and Ferritin as Measurable Tools for Disease Burden and B Symptoms in Pediatric Patients With Hodgkin Lymphoma.

BACKGROUND: Pediatric Hodgkin lymphoma (HL) has been treated successfully with risk-adapted and response-adapted therapy. While risk factors like Ann Arbor staging system, B symptoms, bulky disease, and erythrocyte sedimentation rate were measured objectively, B symptoms are subjective tools. We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) and inflammatory marker levels correlated with B symptoms and disease burden. MATERIALS AND METHODS: We conducted a retrospective chart review of all children ≤14 years old with pathology-confirmed HL treated at our institution. Data included clinical and pathologic features, pretreatment erythrocyte sedimentation rate, ferritin levels; monocyte, neutrophil, and lymphocyte counts; and NLR. Optimum cutoffs of variables significantly associated with B symptoms were determined based on receiver operating characteristic curves. RESULTS: Sixty-four patients were included in the analysis. Sixteen patients (25%) had B symptoms. Patients with B symptoms had higher ferritin levels (P<0.0001), monocyte counts (P=0.0060), neutrophil counts (P=0.0003) and NLR (P<0.0001), and lower lymphocyte counts (P=0.0017). Multiple receiver operating characteristic curves were generated to identify the optimum cutoff. Sensitivities and specificities of NLR (cutoff, 3.5) and ferritin (cutoff, 173 ng/mL) were the highest (81.25% and 81.25% [P<0.0001] and 89.36% and 75% [P<0.0001], respectively). Patients with NLR >3.5 and ferritin >173 (ng/mL) had significantly higher stage, bulky disease, and B symptoms. NLR and ferritin are not predictive of worst outcome in the cohort analyzed. CONCLUSIONS: NLR and ferritin levels were associated with high disease burden and B symptoms. Therefore, these variables can be used as measurable tools for B symptoms that can help stratify patients with HL. Larger and prospective studies are needed to validate these findings.

Recently Described Entity of Intracholecystic Papillary Neoplasm of Gallbladder with Coexisting Xanthogranulomatous Cholecystitis: an Unusual Association.

Intracholecystic papillary neoplasm (ICPN) of the gallbladder is a relatively new concept and is suspected to share clinicopathologic features with intraductal papillary mucinous neoplasm (IPMN) of the pancreas and intraductal papillary neoplasm of the bile duct (IPNB). The literature on the clinicopathologic characteristics of preinvasive intraepithelial neoplasms of the gall bladder is fairly limited, partly owing to variability in its definition and terminology. We report an extremely rare case of coexistent xanthogranulomatous inflammation and intracholecystic tubulo-papillary neoplasm with low-grade dysplasia in a 48-year-old male patient. Although there are many case reports of simultaneous carcinoma gallbladder with xanthogranulomatous cholecystitis (XGC), however, the association of ICPN with XGC has not been previously described. To the best of our knowledge, this is the first case report of ICPN of gallbladder coexisting with xanthogranulomatous cholecystitis.

Mean Tip-Apex Distance In Lag Screw Cut-Out After Dynamic Hip Screw Fixation Of Hip Fracture.

BACKGROUND: To determine mean tip-apex distance after Dynamic Hip Screw fixation of intertrochanteric fracture. METHODS: This descriptive cross-sectional study was conducted in the Department of Orthopaedics, Hayatabad Medical Complex, Peshawar from October 2015 to September 2016 on a total 285 patients. RESULTS: A total of 285 patients were observed. Status of TAD among 285 patients was analysed as 171 (60%) patients had TAD ranged 15 mm to 20 mm, 91(32%) patients had TAD ranged 21 mm to 25 mm, 23 (8%) patients had TAD ranged >25mm. Mean TAD was 18 mm with SD±7.45. Eight percent patients had screw cut out while 92% patients didn't had screw cut out. CONCLUSIONS: To avoid lag screw cut out in dynamic hip screw for intertrochanteric fracture of hip the Tip apex distance must be accurate otherwise there will be cut out of lag screw.

Splenectomy in Patients with Sickle Cell Disease in Tabuk.

BACKGROUND: Sickle cell disease is a common genetic disease in Saudi Arabia; it is an autosomal recessive disorder characterized by production of abnormal hemoglobin S and is associated with high morbidity and mortality. Acute splenic sequestration is a life-threatening complication for this disease. Prophylactic splenectomy is the only effective strategy for preventing future life-threatening episodes. AIM: The aim of this study was to study hospital records for all children aged 2 to 12 year old with Sickle cell disease who underwent splenectomy in Tabuk in Saudi Arabia. METHODS: Records of 24 children (13 males, 11 females) who underwent splenectomy in surgery department of King Salman North West Armed Hospital, Tabuk, Saudi Arabia between 2008 and 2015 were reviewed retrospectively and analyzed for age, sex, indications for splenectomy, surgical technique, preoperative and postoperative length of stay, operative and postoperative complications, acute chest syndrome, painful crises, blood transfusion and fever (preoperative and postoperative). RESULTS: We stressed on the information about the details of operation, the frequency of blood transfusion, fever, acute chest syndrome and painful crisis before and after operation. CONCLUSION: Here we found that blood transfusion frequency decreased after splenectomy.