Fuzzy spectral clustering for automated delineation of chronic wound region using digital images.

Chronic wound is an abnormal disease condition of localized injury to the skin and its underlying tissues having physiological impaired healing response. Assessment and management of such wound is a significant burden on the healthcare system. Currently, precise wound bed estimation depends on the clinical judgment and remains a difficult task. The paper introduces a novel method for ulcer boundary demarcation and estimation, using optical images captured by a hand-held digital camera. The proposed approach involves gray based fuzzy similarity measure using spatial knowledge of an image. The fuzzy measure is used to construct similarity matrix. The best color channel was chosen by calculating the mean contrast for 26 different color channels of 14 color spaces. It was found that Db color channel has highest mean contrast which provide best segmentation result in comparison with other color channels. The fuzzy spectral clustering (FSC) method was applied on Db color channel for effective delineation of wound region. The segmented wound regions were effectively post-processed using various morphological operations. The performance of proposed segmentation technique was validated by ground-truth images labeled by two experienced dermatologists and a surgeon. The FSC approach was tested on 70 images. FSC effectively segmented targeted ulcer boundary yielding 91.5% segmentation accuracy, 86.7%, Dice index and 79.0%. Jaccard score. The sensitivity and specificity was found to be 87.3% and 95.7% respectively. The performance evaluation shows the robustness of the proposed method of wound area segmentation and its potential to be used for designing patient comfort centric wound care system.

Carbon nanodot impregnated fluorescent nanofibers for in vivo monitoring and accelerating full-thickness wound healing.

Semiconductor quantum dots are overwhelmingly used for in situ monitoring and imaging of cell-scaffold interactions. However, quantum dots suffer from oxidative biodegradation in biological systems, besides being toxic due to the presence of heavy metals. In this study, we report the development of an intrinsically fluorescent nanofibrous scaffold of polycaprolactone-gelatin for skin tissue regeneration and noninvasive monitoring of scaffold activity in vivo. The presence of the incorporated carbon nanodots played a critical role in imparting the scaffold with these novel characteristics. The developed scaffold was uniform and bead free with fiber diameter of 698 ± 420 nm and pore diameter of 2.93 ± 1.13 µm. Inclusion of carbon nanodots not only bestowed uniform fluorescence of the scaffold but also promoted fibroblast cell adhesion, migration and proliferation. Co-culture of fibroblast and keratinocyte cells on the scaffold surface also enabled the development of a stratified epithelial layer. The scaffold exhibited antioxidant properties by scavenging free radicals and reducing the expression of antioxidative enzymes. Upon implantation in a full-thickness excision wound, the scaffold accelerated the progression of healing and the regenerated skin exhibited a stratified epithelial layer with mature dermal tissue. The scaffold enabled noninvasive monitoring of the wound healing kinetics in vivo through two-photon microscopy. With excellent photoluminescence, biocompatibility, and photo stability, the scaffold can suitably be used for prolonged monitoring of cell-scaffold interactions and further efficiently reduce the oxidative stress during continuous imaging. Additionally, being synthesized from inexpensive precursors employing a simple procedure, carbon nanodot production is cost-effective and the developed scaffold would be an off-the-shelf, readily available economical product.

Spectral Clustering for Unsupervised Segmentation of Lower Extremity Wound Beds Using Optical Images.

Chronic lower extremity wound is a complicated disease condition of localized injury to skin and its tissues which have plagued many elders worldwide. The ulcer assessment and management is expensive and is burden on health establishment. Currently accurate wound evaluation remains a tedious task as it rely on visual inspection. This paper propose a new method for wound-area detection, using images digitally captured by a hand-held, optical camera. The strategy proposed involves spectral approach for clustering, based on the affinity matrix. The spectral clustering (SC) involves construction of similarity matrix of Laplacian based on Ng-Jorden-Weiss algorithm. Starting with a quadratic method, wound photographs were pre-processed for color homogenization. The first-order statistics filter was then applied to extract spurious regions. The filter was selected based on the performance, evaluated on four quality metrics. Then, the spectral method was used on the filtered images for effective segmentation. The segmented regions were post-processed using morphological operators. The performance of spectral segmentation was confirmed by ground-truth pictures labeled by dermatologists. The SC results were additionally compared with the results of k-means and Fuzzy C-Means (FCM) clustering algorithms. The SC approach on a set of 105 images, effectively delineated targeted wound beds yielding a segmentation accuracy of 86.73 %, positive predictive values of 91.80 %, and a sensitivity of 89.54 %. This approach shows the robustness of tool for ulcer perimeter measurement and healing progression. The article elucidates its potential to be incorporated in patient facing medical systems targeting a rapid clinical assistance.

Automated tissue classification framework for reproducible chronic wound assessment.

The aim of this paper was to develop a computer assisted tissue classification (granulation, necrotic, and slough) scheme for chronic wound (CW) evaluation using medical image processing and statistical machine learning techniques. The red-green-blue (RGB) wound images grabbed by normal digital camera were first transformed into HSI (hue, saturation, and intensity) color space and subsequently the "S" component of HSI color channels was selected as it provided higher contrast. Wound areas from 6 different types of CW were segmented from whole images using fuzzy divergence based thresholding by minimizing edge ambiguity. A set of color and textural features describing granulation, necrotic, and slough tissues in the segmented wound area were extracted using various mathematical techniques. Finally, statistical learning algorithms, namely, Bayesian classification and support vector machine (SVM), were trained and tested for wound tissue classification in different CW images. The performance of the wound area segmentation protocol was further validated by ground truth images labeled by clinical experts. It was observed that SVM with 3rd order polynomial kernel provided the highest accuracies, that is, 86.94%, 90.47%, and 75.53%, for classifying granulation, slough, and necrotic tissues, respectively. The proposed automated tissue classification technique achieved the highest overall accuracy, that is, 87.61%, with highest kappa statistic value (0.793).

Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association.

An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies.

Comparative study of clinical efficacy of amitriptyline and pregabalin in postherpetic neuralgia.

The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia, which is very difficult to treat. Significant beneficial effects have been found for amitriptyline, gabapentin, pregabalin, carbamazepine, sodium valproate, oxycodone, corticosteroid, topical capsaicin, tramadol, etc. The aim of this open randomized comparative study was to demonstrate clinical efficacy of amitriptyline and pregabalin. The study included 50 patients, 32 (64%) male and 18 (36%) female, randomized to receive either amitriptyline or pregabalin (n=25 each). Amitriptyline was administered in a dose of 25 mg once daily and pregabalin in a dose of 75 mg twice daily. Inclusion criteria were as follows: postherpetic neuralgia of more than 1 month duration; pain of at least moderate severity; and patient age 40 years or older and no pregnancy. Patients with a history of any serious diseases (renal, cardiac, hepatic or seizure) were excluded. Total treatment period spanned 8 weeks, with patient follow up visits at 2, 4 and 8 weeks to assess the degree of improvement in pain perception and any adverse reaction. Patients with four herpes zoster types were included in this study, of which thoracic type predominated (54%). Other types were cervical in 12 (24%), trigeminal in 8 (16%) and lumbosacral in 3 (6%) patients. Prodromal symptoms before herpes zoster were reported by 66% of study patients. Satisfactory improvements of pain perception at the end of 8 weeks (>75%) were noticed in pregabalin group, which was statistically significant (χ(2)2=10.08; P<0.05). Dry mouth was the commonest complication in amitriptyline group and dizziness in pregabalin group. More importantly, none of the patients stopped treatment due to adverse reaction. In conclusion, therapy with pregabalin is better compared to amitriptyline in postherpetic neuralgia patients. However, a similar study in a larger sample is required to validate the present findings.

Outbreak of cutaneous anthrax in a tribal village: a clinico-epidemiological study.

BACKGROUND: Anthrax is a life-threatening infectious disease that normally affects animals, especially ruminants. It is caused by the bacteria Bacillus anthracis. The most common mode of infection is through the skin, which causes a painless sore that usually heals without treatment. If left untreated, cutaneous anthrax may progress in up to 20% of cases to septicaemia with potentially lethal outcome. METHODOLOGY: We visited a small tribal village of the state of West Bengal, where an outbreak of cutaneous anthrax was suspected following slaughtering a dead bullock. The population at risk were subjected to detailed interrogation, thorough clinical examination and relevant investigations. RESULTS: The mean age of our study population was 32.1 years, and 100% were male. The mean incubation period was three days. Most cases (81.8%) were exposed to the bacteria during butchering. The predominantly affected sites were fingers (54.5%), followed by forearms (18.2%), around elbows (18.2%) and arm (9.1%). All cases initially had painless papules, ulcers with vesicles; dissemination of the lesion was seen in 27.3% of patients. 9 patients (who were alive) underwent complete blood count, baseline biochemistry and chest X-ray. Smears were made from the cutaneous lesions for gram's stain in 5 patients. Wound swabs were also inoculated in nutrient broth and subcultured in blood agar media. FNAC from the enlarged axillary lymph node was done in 1 patient and blood was sent for aerobic culture in 2 individuals. Both the blood cultures were sterile. Smears made from the culture obtained from cutaneous lesion of one of the affected person revealed gram positive aerobic spore bearing non-motile bacilli in long chain with capsular halo suggesting Bacillus anthracis. In this outbreak, the attack rate was 7% and case fatality rate was 18%. CONCLUSION: Cutaneous anthrax should be considered as a differential diagnosis in cases presenting with painless ulcers, vesicles or eschars with a recent history of exposure to animals or animal products. It is important to recognise the clinical aspects of this disease in routine practice since any delay in treatment may have fatal consequences, as observed in this study.

Melasma: a clinico-epidemiological study of 312 cases.

BACKGROUND: Melasma is an acquired increased pigmentation of the skin, characterized by gray-brown symmetrical patches, mostly in the sun-exposed areas of the skin. The pathogenesis is unknown, but genetic or hormonal influences with UV radiation are important. AIMS: Our present research aims to study the clinico-epidemiological pattern and the precipitating or provocation factors in melasma. MATERIALS AND METHODS: A total of 312 patients were enrolled for the study over a period of one year. RESULTS: The mean age of patients with melasma was 33.45 years, ranging from 14 to 54 years. There was female preponderance with a female to male ratio of approximately 4 : 1. The mean age of onset was 29.99 years, with the youngest and oldest being 11 and 49 years, respectively. The patients sought medical treatment on an average of 3.59 years after appearance of melasma. About 55.12% of our patients reported that their disease exacerbated during sun exposure. Among 250 female patients, 56 reported pregnancy and 46 reported oral contraceptive as the precipitating factors. Only 34 patients had given history of exacerbation of melasma during pregnancy. A positive family history of melasma was observed in 104 (33.33%) patients. Centrofacial was the most common pattern (55.44%) observed in the present study. Wood light examination showed the dermal type being the most common in 54.48% and epidermal and mixed were seen in 21.47% and 24.03% of the cases, respectively. We tried to find an association with endocrinal diseases and observed that 20 of them had hypothyroidism. CONCLUSION: The exact cause of melasma is unknown. However, many factors have been implicated in the etiopathogenesis of this disorder. Here we try to identify the causative factors and provocation to develop melasma.

Multiple generalized xanthogranuloma in adult: case report and treatment.

Xanthogranuloma is a benign, asymptomatic, and self-healing disorder of non-Langerhans cell histiocytosis, affecting mostly infants, children, and rarely adults. Diagnosis is easy in typical cases but become more complex in unusual forms. We report a case of a 28-year-old male patient who presented with multiple diffuse brown-to-yellowish papulonodular eruptions over extremities, ears, face, trunk, and extensors of joints with almost bilaterally symmetrical distribution for a period of one month. Histopathological examination of the skin biopsy specimen revealed features of xanthogranuloma. The patient was put on isotretinoin 20 mg once daily. Most of the lesions subsided or flattened within two months of isotretinoin therapy. This case is interesting because of the severity and atypical nature of the disease and also, the patient responded with isotretinoin therapy. But further study is required to observe the effectiveness of isotretinoin in xanthogranuloma.

Solitary hydatid cyst in thigh without any detectable primary site.

Echinococcus granulosus causes a zoonotic infection called Cystic Echinococcosis (CE). Surgeons meet with hydatid cysts of the liver and lungs with reasonable frequency. However hydatid cyst may also appear in other parts of the body. A 30 years old lady presented with a smooth slow-growing subcutaneous nodule on the anteromedial side of the right thigh with no detectable primary site in the liver or lung. The case was subsequently diagnosed as hydatid cyst of muscle and radical surgery was done under coverage of anihelminthic drug. The common practice in this type of case is to do fine needle aspiration cytology (FNAC) taking the lesion to be a soft tissue neoplasm. The aim of this case presentation is to be aware of that in case of a diffuse non-tender swelling with history of gradual increase in size, hydatid cyst should be considered in the differential diagnosis.

Migratory polyarthritis in familial hypercholesterolemia (type IIa hyperlipoproteinemia).

Metabolic disorders are often encountered in clinical practice. Some of these diseases are associated with dermatological and musculoskeletal manifestations. Familial hypercholesterolemia is a disorder of lipoprotein metabolism characterized by elevated cholesterol, low-density lipoprotein cholesterol, xanthomas and early onset atherosclerosis. Tendinitis and arthritis have been rarely reported in patients with familial hypercholesterolemia. Here is presented a case of a young girl with migratory polyarthritis, who was diagnosed as probable homozygote familial hypercholesterolemia with hypercholesterolemic arthritis. A proper knowledge of cutaneous manifestations helps to identify patients at risk, establish the underlying diagnosis, and start early and effective therapy.

Epidcermolytic hyperkeratosis: a case report.

Epidermolytic hyperkeratosis is a rare autosomal dominant genodermatosis that presents at birth as generalised erythema, blisters and erosions. In subsequent periods, erythema and blistering improves but patients go on to develop hyperkeratosis scalingthat is especially prominent along joint flexures, neck, hands and feet. The disease is caused by mutations in either keratin 1 or 10. Treatment options include topical emollients containing glycerin, lactic acid, urea and alpha-hydroxy acid and topical and systemic retinoids. Here a rare case in a 23 years old male is reported with epidermolytic hyperkeratosis and treated successfully with mixture of topical emollients with retinoid and systemic isotretinoin.

Tri-filial presentation of familial tuberous sclerosis with renal tumors.

Tuberous sclerosis is a rare neuro-cutaneous syndrome with autosomal dominant penetrance. Only some organs are involved, e.g., skin (earthy skin thickenings, ash leaf patches), cerebral cortex (hamartomatous nodules) and kidneys, (angiolipoma, adenocarcinoma). These hamar-tomatous swellings resemble potatoes and hence, referred to as tubers. We herein report on three patients (all familial), father, son and granddaughter, with this rare involvement, from the eastern part of India. The father and son had involvement of only the skin (i.e. nose) and kidneys while the disease penetrated further in the subsequent filial generations with son and granddaughter having skin, brain and bilateral kidney involvement. This kind of tri-filial progression has not till date, been reported from this region, making it an interesting case presentation.