An Efficient Deep Learning Approach to Automatic Glaucoma Detection Using Optic Disc and Optic Cup Localization

Glaucoma is an eye disease initiated due to excessive intraocular pressure inside it and caused complete sightlessness at its progressed stage. Whereas timely glaucoma screening-based treatment can save the patient from complete vision loss. Accurate screening procedures are dependent on the availability of human experts who performs the manual analysis of retinal samples to identify the glaucomatous-affected regions. However, due to complex glaucoma screening procedures and shortage of human resources, we often face delays which can increase the vision loss ratio around the globe. To cope with the challenges of manual systems, there is an urgent demand for designing an effective automated framework that can accurately identify the Optic Disc (OD) and Optic Cup (OC) lesions at the earliest stage. Efficient and effective identification and classification of glaucomatous regions is a complicated job due to the wide variations in the mass, shade, orientation, and shapes of lesions. Furthermore, the extensive similarity between the lesion and eye color further complicates the classification process. To overcome the aforementioned challenges, we have presented a Deep Learning (DL)-based approach namely EfficientDet-D0 with EfficientNet-B0 as the backbone. The presented framework comprises three steps for glaucoma localization and classification. Initially, the deep features from the suspected samples are computed with the EfficientNet-B0 feature extractor. Then, the Bi-directional Feature Pyramid Network (BiFPN) module of EfficientDet-D0 takes the computed features from the EfficientNet-B0 and performs the top-down and bottom-up keypoints fusion several times. In the last step, the resultant localized area containing glaucoma lesion with associated class is predicted. We have confirmed the robustness of our work by evaluating it on a challenging dataset namely an online retinal fundus image database for glaucoma analysis (ORIGA). Furthermore, we have performed cross-dataset validation on the High-Resolution Fundus (HRF), and Retinal Image database for Optic Nerve Evaluation (RIM ONE DL) datasets to show the generalization ability of our work. Both the numeric and visual evaluations confirm that EfficientDet-D0 outperforms the newest frameworks and is more proficient in glaucoma classification.

Telemedicine and Teleconsulting in the Era of COVID-19 Pandemic: A Useful Tool from Screening to Intensive Care Monitoring

The COVID-19 global pandemic has had striking effects on clinical practice and medical assistance and the progressive evolution of telemedicine and telehealth systems has allowed healthcare professionals to connect with patients yet respecting the striking need for social distancing. This article aims to review the possible ways to use telehealth and teleconsulting systems to guarantee an adequate level of clinical assistance starting from screening procedures up to support the management of patients admitted to intensive care units area, thus balancing the need to ensure continuity of care and at the same time limiting the possible sources of contagion expansion. Telemedicine may be a useful tool to improve clinical assistance and reduce the financial burden on the health system in a long-term view. Although it cannot completely replace patient-physician interactions, it would be desirable to implement this field and made it accessible to the largest part of the population.

Prevalence of Patients Affected by Fibromyalgia in a Cohort of Women Underwent Mammography Screening

Fibromyalgia is a widespread condition which is currently underdiagnosed; therefore we conceived this study in order to assess whether a diagnostic suspicion may be assumed during widespread screening procedures, so that patients for which a reasonable diagnostic suspicion exist may be redirected towards rheumatologic evaluation. We analyzed a sample of 1060 patients, all of whom were female and undergoing standard breast cancer screening procedures, and proceeded to evaluate the level of pain they endured during mammographic exam. We also acquired a range of other information which we related to the level of pain endured; we suggested a rheumatologic examination for those patients who endured the highest level of pain and then we evaluated how many patients in this subgroup were actually diagnosed with fibromyalgia. Out of the 1060 patients who participated to our study, 139 presented level 4 pain intensity; One patient did not go for rheumatologic examination; the remaining 138 underwent rheumatologic evaluation, and 50 (36%, 28–44, 95% CI) were diagnosed with fibromyalgia. Our study shows that assessing the level of pain endured by patients during standard widespread screening procedures may be an effective asset in deciding whether or not to suggest specialist rheumatologic evaluation for fibromyalgia.

How and why do we screen for colorectal cancer?

After almost 50 years of data analysis, screening for colorectal cancer has proven to be an effective tool in reducing colorectal cancer mortality. However, implementing the optimal strategy represents a challenge for many healthcare facilities around the world. There is much discussion regarding how screening should be done, the optimal tools that should be used, and the proper timing for screening procedures. Another essential step is to maintain the adherence of patients to screening programs. Also, the recommendation for lowering the age to initiate screening is in progress, as there is an increase in colorectal incidence in people born after 1970.

Juvenile Idiopathic Arthritis Associated Uveitis

Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. The development of associated uveitis represents a significant risk for serious complications, including permanent loss of vision. Initiation of early treatment is important for controlling JIA-uveitis, but the disease can appear asymptomatically, making frequent screening procedures necessary for patients at risk. As our understanding of pathogenic drivers is currently incomplete, it is difficult to assess which JIA patients are at risk of developing uveitis. Identification of specific risk factors for JIA-associated uveitis is an important field of research, and in this review, we highlight the genomic, transcriptomic, and proteomic factors identified as potential uveitis risk factors in JIA, and discuss therapeutic strategies.

Endoscopy to Diagnose and Prevent Digestive Cancers in Lynch Syndrome

Lynch syndrome patients could benefit from various recommendations to prevent digestive cancers. In this review, we summarize the criteria to identify Lynch syndrome in patients with digestive cancers. We detail endoscopic screening procedures in patients with Lynch syndrome for gastric, small bowel, pancreatic, and colorectal cancers. We review the precise modalities of endoscopic follow-up, particularly the discrepancies that exist between the guidelines of the various scientific societies. We discuss the treatment of colorectal cancers in Lynch syndrome cases and patient adherence to endoscopic follow-up programs.

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

The main focus of Coronavirus disease 2019 (COVID-19) infection is pulmonary complications through virus-related neurological manifestations, ranging from mild to severe, such as encephalitis, cerebral thrombosis, neurocognitive (dementia-like) syndrome, and delirium. The hospital screening procedures for quickly recognizing neurological manifestations of COVID-19 are often complicated by other coexisting symptoms and can be obscured by the deep sedation procedures required for critically ill patients. Here, we present two different case-reports of COVID-19 patients, describing neurological complications, diagnostic imaging such as olfactory bulb damage (a mild and unclear underestimated complication) and a severe and sudden thrombotic stroke complicated with hemorrhage with a low-level cytokine storm and respiratory symptom resolution. We discuss the possible mechanisms of virus entrance, together with the causes of COVID-19-related encephalitis, olfactory bulb damage, ischemic stroke, and intracranial hemorrhage.