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Diabetic retinopathy is a pathological change of the retina that occurs for long-term diabetes. The patients become symptomatic in advanced stages of diabetic retinopathy resulting in severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy stages. There is a need of an automated screening tool for the early detection and treatment of patients with diabetic retinopathy. This paper focuses on the segmentation of red lesions using nested U-Net Zhou et al. (Deep Learning in Medical Image Analysis and Multimodal Learning for Clinical Decision Support, Springer, 2018) followed by removal of false positives based on the sub-image classification method. Different sizes of sub-images were studied for the reduction in false positives in the sub-image classification method. The network could capture semantic features and fine details due to dense convolutional blocks connected via skip connections in between down sampling and up sampling paths. False-negative candidates were very few and the sub-image classification network effectively reduced the falsely detected candidates. The proposed framework achieves a sensitivity of [Formula: see text], precision of [Formula: see text], and F1-Score of [Formula: see text] for the DIARETDB1 data set Kalviainen and Uusutalo (Medical Image Understanding and Analysis, Citeseer, 2007). It outperforms the state-of-the-art networks such as U-Net Ronneberger et al. (International Conference on Medical Image Computing and Computer-Assisted Intervention, Springer, 2015) and attention U-Net Oktay et al. (Attention u-net: Learning where to look for the pancreas, 2018).
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Retinopatia Diabética , Humanos , Retinopatia Diabética/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Fundo de Olho , Retina , Processamento de Imagem Assistida por Computador , AlgoritmosRESUMO
BACKGROUND: Although delamanid has been approved for the treatment of multidrug-resistant TB (MDR-TB) in numerous regions, in areas where it is not yet registered it can be accessed as part of salvage therapy (in particular for those patients with limited treatment options) via the Otsuka compassionate use programme. Here we present the analysis of interim treatment outcomes by 24â weeks of more than 200 MDR-TB patients globally who received delamanid under this programme. METHODS: We evaluated treatment efficacy with respect to culture negativity at 24â weeks, as well as the safety profile of delamanid, in an MDR-TB patient cohort treated under compassionate use between 2014 and 2019. RESULTS: Among patients who received delamanid as part of a multidrug regimen, 123 (61%) out of 202 had extensively drug-resistant TB (XDR-TB), 66 (33%) out of 202 had HIV co-infection and 34 (17%) out of 202 were children aged between 6 and 17â years. Of those patients who were culture positive at delamanid treatment initiation and who completed 24â weeks of delamanid treatment in combination with other anti-tuberculosis (TB) drugs, culture negativity was achieved in 116 (79%) out of 147 cases. The corresponding rates of culture negativity for patients with XDR-TB and HIV co-infection, as well as the paediatric subgroup were 69 (77%) out of 90, 44 (92%) out of 48 and 20 (80%) out of 25, respectively. QT interval prolongation was the most frequently observed serious adverse event and was reported in 8% of patients receiving delamanid. Overall, treatment safety outcomes did not reveal any new or unidentified risks. CONCLUSIONS: The use of delamanid combined with other active drugs has the potential to achieve high rates of culture negativity in difficult-to-treat drug-resistant TB cases, with a favourable safety profile.
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Nitroimidazóis , Tuberculose Resistente a Múltiplos Medicamentos , Adolescente , Adulto , Antituberculosos/uso terapêutico , Criança , Ensaios de Uso Compassivo , Humanos , Oxazóis , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológicoRESUMO
PURPOSE: To report characteristic optical coherence tomography (OCT) patterns as a guide in diagnosis of Waldenstrom macroglobulinemia in a patient presenting with bilateral vision loss. CASE REPORT: A 60-year-old male patient presented with bilateral sudden-onset vision loss and low-grade fever. The patient had bilateral exudative retinal detachment involving the macula. Spectral domain OCT revealed neurosensory detachment along with a very regular and harmonious cystoid change in the outer retina as well as deposits around photoreceptors. The patient had lymphadenopathy and hepatosplenomegaly. Serum protein electrophoresis showed the presence of M band in the gamma globulin region, which, on immune fixation, showed a monoclonal band at the "IgM and K" region. Infiltration by lymphoplasmacytic proliferative cells with secondary myelofibrosis was seen in the bone marrow biopsy specimen. The immunophenotype scattergram of lymphoplasmacytic proliferative cells of bone marrow showed no light-chain expression, and the cells were brightly positive for CD19, CD5, and CD20. Quantitative assay of immunoglobulin M was 10,057 mg/dL. CONCLUSIONS: Spectral domain OCT showing a harmonious and regular cystoid pattern and deposits around photoreceptors was a guide in our diagnosis of this case of Waldenstrom macroglobulinemia presenting with retinal detachment and retinal deposits.
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Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Macroglobulinemia de Waldenstrom/diagnóstico , Humanos , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Células Fotorreceptoras de Vertebrados/patologia , Plasmaferese , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/terapia , Transtornos da Visão/terapia , Macroglobulinemia de Waldenstrom/terapiaRESUMO
To study correlation of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) with systemic risk factors. Institutional cross-sectional double-masked non-interventional study with 330 eyes of middle-aged male type 2 diabetes patients with DME. Various systemic parameters were measured. Diffuse retinal thickening (DRT), cystoid and serous patterns of DME were identified on OCT. Comparison between DRT versus non-DRT and serous versus non-serous eyes was done in respect to systemic parameters. Correlation of serous and DRT pattern was tested with systemic parameters above and below specified values. Mean age was 54.4 ± 7.1 years. Mean duration of diabetes was 8.7 ± 4.2 years. Mean serum globulin level was significantly higher (p = 0.018) in serous compared to non-serous group. Prevalence of serous DME was significantly high in those with serum globulin level >3.5 gm/dl (prevalence ratio = 3.01, p = 0.040). Significant correlation of central macular thickness was observed with duration of diabetes (p = 0.002, r = 0.440).Visual acuity (logMAR) was correlated significantly with HbA1C (p = 0.031, r = 0.305). Increased serum globulin, a positive phase reactant of inflammation, was found significant independent risk factor for development of serous DME. This study did not identify any modifiable systemic factor for any of the OCT patterns in DME.
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Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/complicações , Edema Macular/diagnóstico , Disco Óptico/patologia , Tomografia de Coerência Óptica/métodos , Fatores Etários , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Humanos , Índia/epidemiologia , Edema Macular/epidemiologia , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acuidade VisualRESUMO
OBJECTIVES: There are conflicting reports regarding the association of angiotensin 1 converting enzyme (ACE) gene polymorphism with diabetic retinopathy (DR). We compared ACE gene insertion/deletion (I/D) polymorphism between patients with and without DR in a middle-aged Indian population. The secondary outcome measure was the comparison of ACE gene I/D polymorphism in different grades of DR severity. METHODS: Institutional cross-sectional case-control study with middle-aged (45-64 years) type 2 diabetes patients from Eastern India with DR (DR group) and without DR (NODR group). Polymerase chain reaction (PCR) was used to determine the ACE gene I/D polymorphism through primers flanking the polymorphic region of 287â¯bp Alu repeat sequence in intron 16. RESULTS: Genotyping for the ACE gene I/D polymorphisms were done for 107 patients in each group. The presence of DR had no significant association with the prevalence of ACE I/D genotype compared to those without DR either in the recessive model (p=0.588) or in the dominant model (p=0.891). The allele contrast was also similar between DR and NODR (p=0.837) groups. The severity of retinopathy was associated with the ACE I/D genotype in the recessive model (p=0.043) but not in the dominant model (p=0.136). However, the severity of retinopathy was associated with allele contrast (p=0.016). CONCLUSIONS: The ACE gene polymorphism was not associated with diabetic retinopathy in middle-aged Indian patients with type 2 diabetes in our study. However, the severity of DR was associated with the ACE gene polymorphism in these patients.
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Aims: People with type 2 diabetes mellitus are at increased risk of developing hepatic steatosis. We determined the prevalence of hepatic steatosis in middle-aged patients with and without diabetic retinopathy (DR) in an Indian population. We feel this information is critical, with trends of increasing chronic liver disease-related mortality at younger ages. Method: Institution-based analytical cross-sectional study with 114 middle-aged type 2 diabetes patients; 57 in each group with <15 years of duration of DM and without excessive drinking. Hepatic steatosis was determined by the hepatic steatosis index (HSI), hepatic ultrasonography (USG), and elastography. Result: The HSI in DR (37.9 ± 3.9) was more (P = 0.012) than in without diabetic retinopathy (NODR) (36.3 ± 3.3). There was no difference between two groups in liver span (P = 0.829) or in the prevalence of fatty liver (P = 0.562) as determined by conventional USG. Elastography value (kPa) was more (P = 0.001) in DR (6.51 ± 1.85) than in NODR (5.14 ± 1.60). On elastography, 50.9% in DR had a likelihood ratio (Metavir score for a stiffness value) for stage 2 Metavir score. In DR, 11.8% of those missed by USG had a likelihood ratio for ≥ stage 2 Metavir score on elastography. The presence of DR was independently correlated with kPa value (P < 0.001). Conclusion: A significantly higher prevalence of hepatic steatosis was observed in DR in this population. DR can be a useful biomarker for early hepatic screening in midlife, particularly with hepatic elastography, so that timely diagnosis of hepatic steatosis can be made.
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Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Técnicas de Imagem por Elasticidade , Fígado Gorduroso , Hepatopatia Gordurosa não Alcoólica , Pessoa de Meia-Idade , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Técnicas de Imagem por Elasticidade/efeitos adversos , Cirrose Hepática/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Estudos Transversais , Fígado Gorduroso/complicações , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/epidemiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagemRESUMO
To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.
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Transtornos da Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Distribuição de Qui-Quadrado , Criança , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Prevalência , População Urbana , Acuidade VisualRESUMO
PURPOSE: Prevalence of cerebral small vessel disease (SVD) in elderly patients with diabetic retinopathy (DR) is higher than in those without DR. We determined the prevalence and severity of SVD in middle-aged patients with DR and compared it with those without DR (NODR) in a subset of the Indian population. We feel this information is critical with evolving trends of an increasing incidence of stroke at younger ages. METHOD: Institution-based analytical cross-sectional study with 88 middle-aged type 2 diabetes patients; 44 in each group with <10 years diabetes duration, <8% HbA1C value, and with no history of cardiovascular disease. The presence and severity of SVD were determined by magnetic resonance imaging (MRI). RESULT: Prevalence of SVD was 59.1% among study participants; 70.5% in DR and 47.7% in NODR (p = .03). Significantly increased SVD score (p = .008), high SVD score (p = .030), and white matter hyperintensity (WMH) load (p = .017) were observed in DR compared to NODR. There was no difference in the load of lacune and microbleed. SVD score did not differ according to the severity of DR (p = .395). The location-wise study of MRI revealed a significantly higher SVD load at the centrum semiovale in DR than in NODR (p = .014). We observed a 2.6 times greater chance of SVD (Odds ratio: 2.6, 95% CI 1.1-6.3) and a 9.6 times greater chance of high SVD score (Odds ratio: 9.6, 95% CI 1.1-80.0) in DR compared to NODR. CONCLUSION: Significantly higher burden of SVD in DR was observed, particularly affecting the centrum semiovale suggesting an association of mid-life SVD with DR in this population.
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Doenças de Pequenos Vasos Cerebrais , Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Acidente Vascular Cerebral , Idoso , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
PURPOSE: Diabetes mellitus (DM) patients are more likely to experience sleep disturbances than normal. Sleep disturbances may contribute to the development of diabetic retinopathy (DR) by higher inflammatory markers in circulation. We investigated the association between sleep quality and DR. METHODS: Institutional case control study with type 2 DM patients of <10 years duration and HbA1c ⩽8%; 70 cases with DR and 70 controls without DR (NODR) (power 0.8). Sleep quality was assessed by Pittsburg sleep quality index (PSQI) questionnaire and compared. RESULTS: Cronbach's alpha was 0.777 with high internal homogeneity. Global PSQI score in DR (7.44 ± 3.99; 95%CI 6.88, 9.42) was more than in NODR (4.30 ± 3.26; 95%CI 3.87, 6.45) (p < 0.001). All sleep disturbance scores were more in DR except sleep duration. Poor sleep (PSQI score>5) was more prevalent in DR (p = 0.000) and associated with increasing DR severity (p = 0.026). Normal sleep latency was recorded in 78.57% and 42.85% patients in NODR and DR respectively (p < 0.001). Severe difficulty in subjective sleep quality (p = 0.024), sleep latency (p = 0.002) and daytime dysfunction (p < 0.001) was seen more in DR. Elevated daytime dysfunction was observed with increasing DR severity (p = 0.008). The optimal cut-off for global PSQI score and sleep latency for DR was 5.5 (OR: 5.97; 95%CI 2.86, 12.47) and 25 min(OR: 4.89; 95%CI 2.32, 10.26) respectively. CONCLUSION: Sleep disturbance is positively associated with DR. Our study identifies cut off value for DR of a modifiable parameter like sleep latency. It emphasizes the need of sleep quality assessment for risk assessment of DR.
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Diabetes Mellitus , Retinopatia Diabética , Transtornos do Sono-Vigília , Estudos de Casos e Controles , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Humanos , Sono , Qualidade do SonoRESUMO
Diabetic retinopathy (DR) is a common health concern. Unfortunately, the metabolic pathway causing DR is yet to be understood. The carotenoid level in the human body is known to protect the health of the eyes. In this work, resonance Raman spectroscopy and multivariate analysis of the spectral data of human serum are reported as next-generation spectropathologic tools to detect retinal degeneration efficiently. The proposed technique shows promise by endorsing ocular carotenoids as a critical biomarker for such pathosis. Furthermore, the multivariate analysis of the spectral data distinguishes between two different stages of the disease. The machine learning algorithm is used to estimate a significant accuracy of 94% of the proposed model for the classification. As the carotenoid level can be controlled by dietary intake, we believe that the reported results also indicate a therapeutic role of the same in DR.
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Diabetes Mellitus , Retinopatia Diabética , Algoritmos , Antioxidantes , Carotenoides , Retinopatia Diabética/diagnóstico , Humanos , Aprendizado de MáquinaRESUMO
UNLABELLED: To compare changes in posterior vitreous detachment (PVD) following intravitreal injection of bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged type 2 diabetes patients and to correlate this change with change in central macular thickness (CMT). DESIGN: cross sectional study. Fifteen consecutive patients treated by intravitreal bevacizumab (group A) and ten patients treated by intravitreal triamcinolone (group B). Institutional study carried out by retrospective analysis of patient registers including serial optical coherence tomography (OCT) images at baseline, and after 1 and 4 months. A central macular thickness (CMT) and vitreomacular relationship was noted on OCT. PVD was graded on a linear scale (0-4). Change in grade of PVD was correlated with change in CMT at each follow-up. At month 4, the decrease in mean CMT from baseline was 51.2 µ (P = 0.000) and 45 µ (P = 0.022) in group A and group B, respectively, with no significant difference between the two groups (P = 0.874). A change in grades of PVD from baseline to month 4 was significant in both group A (P = 0.001) and group B (P = 0.004) with no significant difference between the two groups (P = 0.906). A significant correlation between change in PVD and reduction of CMT was observed in group A (P = 0.011) but not in group B (P = 0.315). Both bevacizumab and triamcinolone caused a significant reduction in macular thickness and a significant change in grade of PVD. Change in PVD played an influential role in the reduction of macular thickness following bevacizumab.
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Anticorpos Monoclonais Humanizados/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Descolamento do Vítreo/fisiopatologia , Inibidores da Angiogênese/administração & dosagem , Bevacizumab , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência ÓpticaRESUMO
OBJECTIVE: Determination of the pattern of HIV/AIDS in patients attending voluntary confidential counseling and testing center (VCCTC) and prevention of parent-to-child transmission (PPTCT) center of a low-prevalence district of Eastern India. To find out high-risk group and interventional strategy for prevention. METHOD: Cross-sectional exploratory secondary data analysis from the VCCTC and PPTCT register. RESULT: Of the 1348 participants, 160 (11.86%) adults were HIV seropositive. Prevalence in males and females was 9.8% and 20.7%, respectively. Among 22 (1.63%) seropositive children, transmission was vertical in 18 (81.8%). Seventy-one (88.75%) positive adult males were migratory goldsmiths working in Mumbai and other big cities. They were clustered in a particular locality (Daspur). CONCLUSION: Goldsmiths migrated from Daspur to big cities are the bridge populations who are responsible for higher prevalence of HIV in their families and locality. Interventional strategies targeted at this high-risk group are suggested.
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Infecções por HIV/epidemiologia , População Rural/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Fármacos Anti-HIV/administração & dosagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soropositividade para HIV/transmissão , HIV-1 , Humanos , Índia/epidemiologia , Lactente , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Nevirapina/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Inibidores da Transcriptase Reversa/administração & dosagem , Fatores de Risco , Adulto JovemRESUMO
Idiopathic intracranial hypertension remains a disease of unknown etiology. Epidemiology, associations, features, and prognosis in children have changed over the years. The main clinical complaint of pediatric idiopathic intracranial hypertension is headache with visual disturbance. We report on a patient with childhood idiopathic intracranial hypertension, who presented without headache after hemodialysis for acute renal failure. Idiopathic intracranial hypertension without headache is believed to have a poor prognosis. However, this child demonstrated a favorable outcome with medical therapy. The child was followed with serial optical coherence tomography of retinal nerve fiber layer thickness around the optic nerve head. In the absence of a reliable procedure to evaluate the therapeutic efficacy in the follow-up of patients with idiopathic intracranial hypertension, the importance of optical coherence tomography, a noninvasive, objective, and reproducible procedure, is highlighted as a useful adjunct in the management of idiopathic intracranial hypertension.
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Pseudotumor Cerebral/terapia , Diálise Renal/métodos , Injúria Renal Aguda/terapia , Adolescente , Feminino , Humanos , Pseudotumor Cerebral/etiologia , Pseudotumor Cerebral/fisiopatologia , Diálise Renal/efeitos adversos , Tomografia de Coerência Óptica , Transtornos da Visão/etiologiaRESUMO
Malignant melanoma is a tumor of melanocytic origin. Lymphatic and hematogenous metastases are common in this condition. Retrospective analysis was performed in 16 consecutive cases diagnosed histopathologically as malignant melanoma at the pathology department of a medial college in eastern India. 75% of the patients were male; majority of them was in their sixth decade. All (100%) the lesions were pigmented. The primary site was known in all cases, except two (12.5%). Out of the 14 cases with known primary site 11 (78.57%) were cutaneous melanomas, including one arising in labia minora, two (14.29%) were ocular and one (7.14%) was vaginal in origin. Among cutaneous melanomas, superficial spreading type was the commonest variety and mixed population of epithelioid and spindle cell was the commonest histopathological pattern. The commonest grade of invasion was grade III (Clark's). The clinical presentation of the case of vaginal melanoma and the two cases of secondary melanomas, including the one with obscure primary tumor, were bewildering and hence are discussed separately.
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Melanoma/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Oculares/patologia , Feminino , Humanos , Neoplasias Hepáticas/secundário , Linfonodos/patologia , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Vagina/patologia , Neoplasias Vaginais/patologiaRESUMO
BACKGROUND: Parkinson's disease (PD) is one of the most common neurodegenerative movement disorders and its incidence is increasing worldwide along with population aging. Previous clinical and histologic studies suggest that the neurodegenerative process, which affects the brain, may also affect the retina of PD patients. OBJECTIVE: The objective of this study was to determine the thickness changes of retina nerve fibers and macular volume with optical coherence tomography (OCT) in PD patients. MATERIALS AND METHODS: The spectral domain OCT was used to assess the thickness of retinal nerve fiber layer (RNFL) and macular volume from 34 PD patients and 50 healthy age-matched controls. RESULTS: Compared with healthy age-matched controls, the RNFL thickness of PD patients was much thinner (P < 0.05) in all retinal quadrants, with temporal thinning being more than nasal thinning. Macular volumes were diminished in both perifoveal and outer macular regions in all sectors (P < 0.05) with preserved foveal volume. The degree of tissue loss corroborated with the severity of disease as objectively assessed by standardized rating scales (UPDRS). CONCLUSION: There is generalized retinal nerve degeneration in patients of PD and the degree of loss correlated with the severity and duration of disease.
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INTRODUCTION: Image-based early detection for diabetic retinopathy (DR) needs value addition due to lack of well-defined disease-specific quantitative imaging biomarkers (QIBs) for neuroretinal degeneration and spectropathological information at the systemic level. Retinal neurodegeneration is an early event in the pathogenesis of DR. Therefore, development of an integrated assessment method for detecting neuroretinal degeneration using spectropathology and QIBs is necessary for the early diagnosis of DR. METHODS: The present work explored the efficacy of intensity and textural features extracted from optical coherence tomography (OCT) images after selecting a specific subset of features for the precise classification of retinal layers using variants of support vector machine (SVM). Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR) spectroscopy were also performed to confirm the spectropathological attributes of serum for further value addition to the OCT, fundoscopy, and fluorescein angiography (FA) findings. The serum metabolomic findings were also incorporated for characterizing retinal layer thickness alterations and vascular asymmetries. RESULTS: Results suggested that OCT features could differentiate the retinal lesions indicating retinal neurodegeneration with high sensitivity and specificity. OCT, fundoscopy, and FA provided geometrical as well as optical features. NMR revealed elevated levels of ribitol, glycerophosphocholine, and uridine diphosphate N-acetyl glucosamine, while the FTIR of serum samples confirmed the higher expressions of lipids and ß-sheet-containing proteins responsible for neoangiogenesis, vascular fragility, vascular asymmetry, and subsequent neuroretinal degeneration in DR. CONCLUSION: Our data indicated that disease-specific spectropathological alterations could be the major phenomena behind the vascular attenuations observed through fundoscopy and FA, as well as the variations in the intensity and textural features observed in OCT images. Finally, we propose a model that uses spectropathology corroborated with specific QIBs for detecting neuroretinal degeneration in early diagnosis of DR.
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BACKGROUND: Association of C-reactive protein (CRP) and body mass index (BMI) with diabetic retinopathy (DR) has conflicting reports. METHOD: Sixty diabetes patients each with DR (Group A), no DR (Group B) and 60 healthy volunteers (control, group C) were studied. CRP was measured. BMI was calculated. RESULT: Significant difference in CRP was observed between groups A & B (p=0.000) and A & C (p=0.007). No significant difference in BMI was observed. Central macular thickness correlated positively with CRP and negatively with BMI. CONCLUSION: We observed strong association of CRP with DR and no significant relationship between DR and BMI.
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Proteína C-Reativa/metabolismo , Retinopatia Diabética/sangue , Retinopatia Diabética/epidemiologia , População Branca , Índice de Massa Corporal , Retinopatia Diabética/etnologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de RiscoRESUMO
Vision impairment due to pathological damage of the retina can largely be prevented through periodic screening using fundus color imaging. However the challenge with large-scale screening is the inability to exhaustively detect fine blood vessels crucial to disease diagnosis. In this work we present a computational imaging framework using deep and ensemble learning based hybrid architecture for reliable detection of blood vessels in fundus color images. A deep neural network (DNN) is used for unsupervised learning of vesselness dictionaries using sparse trained denoising auto-encoders (DAE), followed by supervised learning of the DNN response using a random forest for detecting vessels in color fundus images. In experimental evaluation with the DRIVE database, we achieve the objective of vessel detection with max. avg. accuracy of 0.9327 and area under ROC curve of 0.9195.
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Vasos Retinianos , Fundo de Olho , Humanos , Redes Neurais de Computação , RetinaRESUMO
PURPOSE: The purpose of the study was to differentiate ischemic central retinal vein occlusion (CRVO) from nonischemic CRVO during the early acute phase using plasma homocysteine as a biochemical marker. METHODS: Fasting plasma homocysteine, serum vitamin B12, and folate levels were measured in 108 consecutive unilateral elderly adult (age >50 years) ischemic CRVO patients in the absence of local and systemic disease and compared with a total of 144 age and sex matched nonischemic CRVO patients and 120 age and sex matched healthy control subjects. RESULTS: Homocysteine level was significantly increased in the patients with ischemic CRVO in comparison with nonischemic CRVO patients (p = 0.009) and also in comparison with control subjects (p < 0.001). Analysis also showed that hyperhomocysteinemia was associated with increased incidence of ischemic CRVO (odds ratio, 18) than that for nonischemic CRVO (odds ratio, 4.5). Serum vitamin B12 and folate levels were significantly lower (p < 0.001) in CRVO patients compared to the control but were not significantly different between nonischemic and ischemic CRVO patients (p > 0.1). CONCLUSIONS: Hyperhomocysteinemia can be regarded as useful in differentiating nonischemic and ischemic CRVO during the early acute phase in absence of local and systemic disease in the elderly adult (age >50 years) population.
Assuntos
Biomarcadores/sangue , Hiper-Homocisteinemia/complicações , Oclusão da Veia Retiniana/diagnóstico , Doença Aguda , Idoso , Estudos de Casos e Controles , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Oclusão da Veia Retiniana/complicações , Fatores de TempoRESUMO
PURPOSE: The aim of this study was to evaluate choroidal neovascular (CNV) lesions with fluorescein angiography (FA) and to identify quantitative parameters and correlate these parameters to treatment outcomes. SUBJECTS AND METHODS: This institution based cross-sectional study evaluated 30 eyes with active sub-foveal predominantly classic CNV treated with bevacizumab. Pre- and post-injection segmented FA images were analyzed. Lesion area and CNV lesion were manually delineated. Outcome measure was the change 1-month after each injection in different intensity values (0-255 divided in eight regions A [lowest intensity] to H [highest intensity] on a linear scale) in lesion area, perimeter, greatest linear dimension (GLD), area, visual acuity (VA) and central macular thickness (CMT). RESULTS: At month 3, statistically significant changes from baseline occurred in VA, CMT, lesion area, GLD and perimeter (P < 0.05 all comparisons). Change in CMT from baseline to 3 months postinjection was correlated with change in VA (P = 0.009, r = 0.469) and intensity regions B (P = 0.001, r = -0.565), D (P = 0.001, r = 0.560), E (P = 0.035, r = 0.386). At month 3, change in intensity values 0-63 (A + B) was negatively correlated with CMT (P = 0.001, r = -0.575) and lesion area (P = 0.019, r = -0.427); change in intensity values 64-223 (C-G) was positively correlated with CMT (P = 0.000, r = 0.636) and lesion area (P = 0.002, r = 0.551). CONCLUSIONS: Decrease in area, GLD, perimeter and area with intensity ≥ 64 on segmented FA were associated with a favorable outcome of treatment. These parameters may be useful adjuncts to existing evaluation techniques during follow-up of CNV.