Classification of Stages Diabetic Retinopathy Using MobileNetV2 Model

Diabetic retinopathy (DR) is a complication of diabetes mellitus that causes retinal damage that can lead to vision loss if not detected and treated promptly. The common diagnosis stages of the disease take time, effort, and cost and can be misdiagnosed. In the recent period with the explosion of artificial intelligence, deep learning has become the most popular tool with high performance in many fields, especially in the analysis and classification of medical images. The Convolutional Neural Network (CNN) is more widely used as a deep learning method in medical imaging analysis with highly effective. In this paper, the five-stage image of modern DR (healthy, mild, moderate, severe, and proliferative) can be detected and classified using the deep learning technique. After cross-validation training and testing on the corresponding 5,590-image dataset, a pre-MobileNetV2 training model is proposed in classifying stages of diabetic retinopathy. The average accuracy of the model achieved was 93.89% with the precision of 94.00%, recall 92.00% and f1-score 90.00%. The corresponding thermal image is also given to help experts for evaluating the influence of the retina in each different stage.

Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not Have worse Radiological and Functional Outcomes than Accidental Fallers

Individuals who fall from heights of ≥6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. Therefore, we aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed 49 fallers who fell from heights of ≥6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatment between 2014 and 2017. Fallers were divided into intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients were accidental fallers. Psychiatric counseling was provided to each of the intentional fallers during follow-up. All intentional fallers had preexisting mental disorders, and the most common diagnosis was adjustment disorder. The group of intentional fallers predominantly comprised females that had a higher injury and new injury severity scores and longer hospital stays. However, early loss of fixation (<3 months) and functional outcomes (Merle d’Aubigné and Majeed hip scores at 6- and 12-month follow-ups) did not significantly differ between intentional and accidental fallers. We found that intentional fallers with pelvic and acetabular fractures may have more severe combined injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers with the implementation of well-designed surgical protocols and individualized physical and mental rehabilitation programs.

Frequency and burden of neurological manifestations in hospitalized patients with COVID-19: findings from a large Brazilian cohort

Background Scientific data regarding the prevalence of COVID-19 neurological manifestations and prognosis in Latin America countries is still lacking. Therefore, the study aims to understand neurological manifestations of SARS-CoV 2 infection in the Brazilian population and its association with patient outcomes, such as in-hospital mortality. Methods This study is part of the Brazilian COVID-19 Registry, a multicentric COVID-19 cohort, including data from 37 Brazilian hospitals. For the analysis, patients were grouped according to the presence of self-reported vs. clinically-diagnosed neurological manifestations and matched with patients without neurological manifestations by age, sex, number of comorbidities, hospital, and whether or not patients ha neurological underlying disease. Results From 7,232 hospitalized patients with COVID-19, 27.8% presented self-reported neurological manifestations, 9.9% were diagnosed with a clinically-defined neurological syndrome and 1.2% did not show any neurological symptoms. In patients with self-reported symptoms, the most common ones were headache (19.3%), ageusia (10.4%) and anosmia (7.4%). Meanwhile, in the group with clinically-defined neurological syndromes, acute encephalopathy was the most common diagnosis (10.5%), followed by coma (0.6%1) and seizures (0.4%). Men and younger patients were more likely to self-report neurological symptoms, while women and older patients were more likely to develop a neurological syndrome. Patients with clinically-defined neurological syndromes presented a higher prevalence of comorbidities, as well as lower oxygen saturation and blood pressure at hospital admission. In the paired analysis, it was observed that patients with clinically-defined neurological syndromes were more likely to require ICU admission (46.9 vs. 37.9%), mechanical ventilation (33.4 vs. 28.2%), to develop acute heart failure (5.1 vs. 3.0%, p=0.037) and to die (40.7 vs. 32.3%, p<0.001) when compared to controls. Conclusion Neurological manifestations are an important cause of morbidity in COVID-19 patients. More specifically, patients with clinically defined neurological syndromes presented a poorer prognosis for the disease when compared to matched controls.

Psychiatric Morbidity in Elderly Patients attending OPD of Lumbini Medical College and Teaching Hospital

INTRODUCTION: Geriatric psychiatry patients are increasing but enough work has not been done in this area of Nepal. We conducted this study to find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. MATERIAL AND METHODS: Medical records of psychiatric patients above 65 years of age visiting outpatient department of Lumbini Medical College and Teaching Hospitalfrom April 1, 2018 to March 31, 2019 were reviewed. Risks of having different psychiatric disorders was estimated using odds ratio. RESULTS: A total of 300 cases were enrolled in the study. Mean age of the study group was 71.49(SD=6.99). There were more females. Depressive disorderwas the most common diagnosis followed by somatoform disorder, anxiety disorder, dementia and others. Depressive disorder was higher in females and in younger subgroup of the elderly patient.The risk of having dementia was higher in older group. CONCLUSION: Depressive disorder was the most common psychiatric disorderfollowed by somatoform disorder in elderly patients above 65 years of age. Male patients were more likely to suffer psychiatric disorder as compared to females in this age.

Pediatric Dental Emergency Pattern and Dental Care Provided during COVID-19 Pandemic Lockdown at a Tertiary Care Center in Kathmandu, Nepal

Introduction: Pediatric dental management is difficult in its own way which was even more challenging during COVID-19 outbreak and lockdown period. Constrained dental providing clinics and hospitals severely compromised the pediatric dental needs and services. Objective: The aim of this study was to describe pattern of dental emergencies encountered and services provided to the pediatric patients visiting a dental hospital during the first lockdown period in Kathmandu, Nepal. Methods: A cross sectional study was done from 24 March 2020 to 21 July 2020 among the pediatric patients who visited dental hospital during lockdown. Data was collected from questionnaire and dental case history sheet, and statistically analyzed in Statistical Package of Social Sciences (SPSS) version 20. Results: Of the total 172 pediatric patients of mean age 8.3± 2.60 years, majority were males (59.3%) and of 6-12 age group (76.2%). Major complain was mobile/retained teeth (38.4%) and most common diagnosis was exfoliating mobility (23.3%). According to American Dental Association (ADA, 2020) guidelines, urgent dental care (46.5%) followed by non-emergency dental care (43.6%) were mostly found. The predominant procedures were emergency (68.6%) and least was elective (9.3%) and treatment given to majority was extraction (51.8%).There was a statistically significant association between age group and pediatric dental care (ADA). Conclusions: The findings of this study regarding dental emergency encountered and definitive treatment received even during pandemic lockdown can be helpful in finding out how dental care was provided and can be applicable in similar future pandemics.

Clinical Profile of Migrant Workers Admitted in Medical Ward at Tertiary Care Hospital

Background: One of the defining elements of Nepal's socioeconomic environment is labor migration. Migrant workers are more likely to develop occupational diseases because they do dangerous tasks and have limited access to occupational health care. The purpose of this paper is to produce clinical profile of migrant workers admitted in medical ward at tertiary care hospital. Materials and Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital on migrant workers patients admitted in medical ward from October 2018 to September 2019. The sample enrollment process was consecutively who were admitted under medical ward. Pre-designed questionnaire was used to collect data for clinical profile of the patients. Data were entered in Microsoft Excel and analyzed. Results: The migrant workers in this study mainly came from Malaysia, United Arab Emirates, Saudi Arabia, Qatar and Kuwait. They are almost male (97.1%) in this study with mean age of 30.3±7 years in age. The commonest age group of migration was 20-29 year. The highest number of workers 22 (31.1%) had visited to Malaysia in the seek of work. The most common symptoms among them were weakness 15 (21.7%) and headache 13 (18.8%). The highest diagnosis among them was diabetes mellitus 13 (18.8%) and hypertension 11(15.9%). The highest number of workers was involved in their job at different foreign countries as a labor at factories or at construction site 32 (46.4%). Conclusion: Male from younger age group were mainly observed as migrant worker with their proclivity to work in Malaysia. The most common diagnosis among them was diabetes mellitus and hypertension. Most migrant workers worked as workers in factories and construction sites

Pseudoretinoblastoma: Distribution Based on Gender, Age, and Laterality

Purpose: To investigate the distribution of pseudoretinoblastoma (PSRB) cases based on gender, age, and lateralityMethods: The clinical records of 607 patients (851 eyes) who were referred for suspicion of retinoblastoma between October 1998 and May 2021 were retrospectively evaluated. Patients were stratified by age as follows: ≤1 year, >1-3 years, >3-5 years, and >5 years.Results: PSRB conditions were detected in 190/607 (31.3%) patients. Of 190 patients, 129 (67.9%) were males and 61 (32.1%) were females (p=0.001). The 3 most common diagnoses were persistent fetal vasculature (PFV; 16.3%), Coats disease (15.3%), and optic nerve head drusen (ONHD; 5.3%). In males, the 3 most common diagnoses were Coats disease (20.2%), PFV (14.0%), and chorioretinal coloboma (6.2%). The 3 most common diagnoses in females included PFV (21.3%), retinal dysplasia, congenital glaucoma, and combined hamartoma (each accounting for 6.6%). PFV was the most common diagnosis in ≤1 year old patient group (26.6%). Coats disease and PFV were the most common diagnoses in >1-3 years old patient group (16.7%, for each diagnosis). Coats disease was the most common diagnosis in >3-5 years old (30.8%) and >5 years old patient groups (13.1%). PSRBs were unilateral in 121/190 (63.7%) patients and bilateral in 69/190 (36.3%). The most common unilateral and bilateral diagnoses were Coats disease (24.0%) and PFV (24.6%) respectively.Conclusion: In our study, 31.3% of patients referred for suspicion of retinoblastoma received the diagnosis of PSRB. PSRB spectrum encompasses different diseases, the distribution of which differ depending on gender, age, and laterality.

Addressing Dual Disorders in a Medium-Term Admission Unit

Due to the significant functional repercussions suffered by patients with dual disorder, we must evaluate which ones can benefit from intensive rehabilitative therapies in medium-stay psychiatric units. This was a retrospective study of patient medical records which intended to analyze sociodemographic and clinical variables and parameters related to the hospitalization and discharge of patients admitted to the Medium-Stay Unit (MSU) at the Castellón Provincial Hospital Consortium over 2 years (2017 and 2018), according to the presence or absence of dual disorders in these patients. Patients with a dual disorder represented 55.2% of the hospitalized patients. A higher proportion of them were male, were relatively younger, and had an earlier onset of mental illness, fewer associated medical pathologies, and shorter hospital admission times to the Short-Term Hospitalization Unit than those who did not present a dual disorder. A diagnosis on the schizophrenia spectrum with cannabis use or polyconsumption was the most common diagnosis; 98.2% of all the patients responded adequately to admission to the MSU. This work highlighted the need for higher doses of depot paliperidone in patients with dual disorders.

Comparative Evaluation of the Efficacy of Hydrocortisone Suppository and Durvadi gudavarti in Raktarsha: A Management Protocol

The most common diagnosis for any anorectal complaint particularly of rectal bleeding in adults is haemorrhoidal disease. Regardless of grading conservative treatment is used primarily in symptomatic haemorrhoids. In Ayurveda, Sthanik Chikitsa (Local application) in the management of Arsha (Hemorrhoids) includes pralepa/pratisaran (Paste application). Instead of applying the lepa in the clinics by the clinician/proctologist, those formulations could be developed into Gudavarti (traditional suppository) & used in the management of Raktarsha (bleeding piles) for better compliance. Hence, development of ‘Durvadi Gudavarti’ using the indigenous medicinal herbs mentioned in Charaka Sanhita (Classical Ayurveda text) for pratisaran/pralepa in Raktarsha & its efficacy will be evaluated. Objectives: To study & compare the efficacy in patient treated with standard- Hydrocortisone suppository group & interventional- Durvadi Gudavarti group in the management of Raktarsha (Bleeding piles). Methodology: 130 patients of 2nd grade hemorrhoids will be selected and will be allocated into two equal groups by computer randomization. Experimental group will be treated with Durvadi Gudavarti & control group with Hydrocortisone based suppository for 2 weeks. Following Symptoms- PR Bleeding, Anal Pain, Prolapse of Pile mass/Lump, Anal pruritus, Mucous discharge & Constipation will be assessed subjectively and Size/ (Volume in cubic millimeter) of pile mass will be the objective parameter for study. Clinical evaluation will be done at Baseline and 3rd, 5th, 10th, 15th day after treatment onset. Proportion of patients that would respond clinically on 10th day will be the main end point, determined via disappearance of the clinical symptoms & more than or equal to 50 % reduction in the initial size of pile mass/lump. Time to response & need for any oral/ parenteral medication for pain, bleeding and constipation would be the secondary variables. Side effects (type, duration & severity) will be registered carefully. Expected Results: Durvadi Gudavarti contains indigenous herbs having anti-inflammatory, analgesic, haemostatic, wound healing, astringent, & laxative properties. Hence, it is expected to be as efficacious as Hydrocortisone suppository with lesser side effect in the management of Raktarsha. Results will be assessed on the basis of clinical assessment criteria using proper statistical values and tools. Changes will be observed in objective outcomes. Conclusion: Durvadi Gudavarti will be efficacious in the management of Raktarsha.

Characterizing telemedicine use in clinical immunology and allergy in Canada before the COVID-19 pandemic

Rationale There exists a geographic barrier to access CIA care for patients who live in rural communities; telemedicine may bridge this gap in care. Herein we characterized the use of telemedicine in CIA at a population-based level and single centre. Methods Before the COVID-19 pandemic, telemedicine care was provided via the Ontario Telemedicine Network (OTN) in Ontario, Canada. Descriptive data were collected from the OTN administrative database and from electronic medical records at a single academic centre during 2014 to 2019. The potential distance travelled and time saved by telemedicine visits were calculated using postal codes. Results A total of 1298 telemedicine visits was conducted over OTN, with an average of 216 visits per year. Only 11% of the allergists/immunologists used telemedicine to provide care before the COVID-19 pandemic. In the single centre that provided the majority of the telemedicine care, 66% patients were female and the overall mean age was 46. The most common diagnosis was immunodeficiency (40%), followed by asthma (13%) and urticaria (11%). Most patients required at least one follow-up via telemedicine. The average potential two-way distance travelled per visit was 718 km and the average potential time travelled in total was 6.6 h. Conclusion Telemedicine was not widely used by allergists/immunologists in Ontario, Canada before the COVID-19 pandemic. It could offer a unique opportunity to connect patients who live in remote communities and allergists/immunologists who practice in urban centres in Canada. Independent of the current pandemic, our study further highlights the need for more physicians to adopt and continue telemedicine use as well as for healthcare agencies to support its use as a strategic priority once the pandemic is over.