OCT-Angiography Findings in Patients with Amblyopia: Comparison between Healthy Controls, Treatment-Responsive, and Treatment-Unresponsive Amblyopic Patients

There is no consensus on whether amblyopia affects the retinal vascular plexus and morphology. Previous studies focused on the differences between amblyopic patients and normal controls without evaluating amblyopic eyes after patching. To evaluate differences in the superficial vascular density of amblyopic eyes, normal eyes, and amblyopic eyes reaching normal BCVA after patch therapy, OCTA was used. All patients underwent a comprehensive ophthalmological examination, including visual acuity, refraction, ocular motility tests, and anterior and posterior segment examination. OCTA was performed by an expert physician using the Zeiss Cirrus 5000-HD-OCT Angioplex (Carl Zeiss, Meditec, Inc., Dublin, OH, USA). OCTA scans were performed using a 3 × 3 mm2 and 6 × 6 mm2 fovea-centered image setting. The mean outer macular vessel density in the previously amblyopic group was 19.15 ± 0.51%. This was statistically significantly higher than in both the amblyopic group (18.70 ± 1.14%) and the normal controls (18.18 ± 1.40%) (p = 0.014). The previously amblyopic group also significantly differed from both normal controls and amblyopic eyes with regards to the inner (p = 0.011), outer (p = 0.006), and full (p = 0.003) macular perfusion. Finally, linear regression analysis revealed that BCVA was linearly correlated to outer perfusion in amblyopic (p = 0.003) and ex amblyopic eyes (p < 0.001). Considering the cross-sectional nature of our study, from our results, we can only hypothesize a possible correlation between light stimulation and retinal vasculature development. However, further longitudinal studies are needed to support this hypothesis.

Challenges Facing Emergency Medicine Residents in Saudi Arabia: A Cross-Sectional Study

ABSTRACT Background: Challenges related to the residency programme differ according to residents’ roles, interactions, culture, responsibilities and expectations. Aim: This study aims to explore the challenges faced by emergency medicine physicians during their residency programme. We also aim to investigate the influence of several demographic variables on their training experience. Method: This is a cross-sectional study, conducted in Saudi Arabia from June, 2021 to July 2021, using a survey designed by the author. Results: The total number of participants was 37. Of these, 24.3% (n=9) were R1 residents, 10.8% (n=4) were R2, 35.1% (n=13) were R3, and 29.7% (n=11) were R4. While most of the participants (89%) clearly understood which reference to use for studying, only 56.7% had a clear understanding of how to study for the exams. Reading club was advocated by 72% of participants, and only half the participants had a positive perception of leading, preparing, and discussing topics during academic activity. Of all the residency levels, R3 residents were the most supportive of having expert physician guidance during ED procedures, p=0.04. Other factors given more importance by R3 residents than by other levels were mentorship, p=0.051, and having a course review for the exam, p=0.001. Conclusion: This study uncovers several challenges reported by participants from different residency levels. We noted that the R3 training level, being a period of transition from junior to senior level, is a significant period requiring more attention; more emphasis on mentorship and reading club is advocated.

Validation of the Monitoring Efficacy of Neurogenic Bowel Treatment on Response (MENTOR) Tool in a Japanese Rehabilitation Setting

Study design: Prospective observational study. Objective: To validate the Monitoring Efficacy of NBD Treatment On Response (MENTOR) tool in individuals with a spinal cord injury (SCI) or spina bifida, suffering from neurogenic bowel dysfunction (NBD) in a rehabilitation center in Japan. Methods: First, the MENTOR tool was translated from English to Japanese using a validated translation process. Second, the MENTOR tool was validated in a rehabilitation clinic in Japan. Participants completed the MENTOR tool prior to a consultation with an expert physician. According to the results of the tool, each participant was allocated to one of three categories regarding change in treatment: “adequately treated,” “further discussion,” and “recommended change.” The results of the MENTOR tool were compared with the treatment decision made by an expert physician, who was blinded to the results of the MENTOR tool. Results: A total of 60 participants completed the MENTOR tool. There was an acceptable concordance between individuals allocated as respectively, being adequately treated (100%) and recommended change in treatment (61%) and the physicians’ decision on treatment. The concordance was lower for individuals allocated as requiring further discussion (48%). Conclusions: In this study the MENTOR tool was successfully validated in a Japanese rehab setting. The tool will help identify individuals with SCI that need further treatment of their NBD symptoms.

Detection and Classification of Gastrointestinal Diseases using Machine Learning

Background: Traditional endoscopy is an invasive and painful method of examining the gastrointestinal tract (GIT) not supported by the physicians and patients. To handle this issue, video endoscopy (VE) or wireless capsule endoscopy (WCE) is recommended and utilized for GIT examination. Furthermore, manual assessment of captured images is not possible for an expert physician because it’s a time taking task to analyze thousands of images thoroughly. Hence, there comes the need for a Computer-Aided-Diagnosis (CAD) method to help doctors in the analysis of images. Many researchers have proposed techniques for automated recognition and classification of abnormality in captured images. Introduction: In this article, existing methods for automated classification, segmentation and detection of several GI diseases are discussed. Paper gives a comprehensive detail about these state-of-the-art methods. Furthermore, literature is divided into several subsections based on preprocessing techniques, segmentation techniques, handcrafted features based techniques and deep learning based techniques. Finally, issues, challenges and limitations are also undertaken. Conclusion: This comprehensive review article combines information related to a number of GI diseases diagnosis methods at one place. Study of this article will facilitate the researchers to develop new algorithms and approaches for early detection of GI diseases detection with more promising results as compared to the existing ones of literature. Results: A comparative analysis of different approaches for the detection and classification of GI infections.

PSYCHOLOGICAL ASPECTS OF PROVIDING QUALITY MEDICO-SOCIAL EXPERT ASSISTANCE

The subject of deontology is the principles of not only in relation to the individual but also in relation to society. The object of Deontology in medical and social examination is first and foremost the personality of the expert physician, the peculiarities of his/her orientation, motivational spheres, his/her values, ideals, as well as the doctor's relationship with the patient. Keywords: deontology, medical and social expertise, ethics, disability.

Udział biegłego w przesłuchaniu świadka w postępowaniu cywilnym – wybrane problemy

In the light of the Act of 4 July 2019 about the amendment of the Act – Code of Civil Procedure and some other acts, many changes are introduced in the regulations on evidence in civil proceedings. The analysis focuses on presentation and assessment of the effects of changes contained in the Art. 272 1 of the Code of Civil Procedure. This provision provides for the introduction of participation of an expert in the hearing of a witness in civil proceedings. If there is doubt as to the ability to observe or recollect observations of a witness, the court may decide that the witness will testify with the attendance of an expert physician or psychologist, and the witness cannot oppose this. The provision is based on the current regulation of Art. 192 § 2 of the Code of Criminal Procedure. After the amendment enters into force, many problems arise regarding art. 272 1 of the Code of Civil Procedure and the other new procedural solutions, such as omission of evidence or repetition of evidence proceedings.

How not to waste: appropriateness in medicine

The idea that the author promotes is that the term waste amounts to inappropriateness whatever the economic environment referred to. The hope is that it can act as a prod for those people who wish to make more rational and economically more convenient work choices by reducing the opportunities for conflict, the loss of time, the legal disputes, the bottlenecks, the incompetence. Two possible approaches to waste are presented. The first represents the point of view of the industry, it is only apparently distant. Thought, the lean organization requires an effort of reading and perhaps greater analysis but, mutatis mutandis, the areas of waste, that is of inappropriateness, are perfectly adaptable to the health world. The second was born in the health world, originates from a work of an important author in the world of quality in medicine, identifies six categories of waste and was taken up in our country by the GIMBE Foundation, giving inspiration or a strong debate. Reflection on each category allows the expert physician to translate his content into his everyday life and draw hypotheses and stimuli for a possible change in clinical organizational practice, in a vision of contrasting inappropriateness. Homo medicus continually needs to be solicited and have elements of reflection to make choices that minimize, in this case, the behavior of inappropriateness (waste) prescriptive and organizational. KEY WORDS waste; appropriateness; lean production.

Recognition and Classification of Diabetic Retinopathy utilizing Digital Fundus Image with Hybrid Algorithms

Diabetic Retinopathy (Damage in Retina) is the most common threatening diabetic eye disease and cause leading vision loss and blindness. A patient with the diabetic disease needs to experience occasional screening of eye. To analysis, ophthalmologists may utilize fundus or retinal pictures of the patient gained from advanced fundus camera. However, if the symptoms are identified earlier and proper treatment is provided through regular screening and monitoring, the blindness or vision loss can be avoided. The present study is intended on developing an automatic system for the analysis of the retinal of fundus images by using image-processing techniques. So as to accelerate the procedure, the discovery of diabetic retinopathy image processing methods is utilized In this proposed study, the performance is evaluated using different segmentation algorithms and classifiers namely fuzzy c-means clustering, naïve Bayesian classifier, support vector machine to detect the diabetic retinopathy. The presentation of the strategy is assessed on the freely accessible retinal databases like DRIVE, STARE. The presentation of the retinal vessels on DRIVE database, sensitivity 100% and specificity 97.5% while for STARE database the sensitivity 99%, specificity 97%.The detection of accuracy can be defined with respect to expert physician hand-drawn and ground truths and the results are comparatively obtained and analyzed.

Performance of a 25% Inferior Vena Cava Collapsibility in Detecting Fluid Responsiveness When Assessed by Novice Versus Expert Physician Sonologists

Objectives: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. Methods: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a >10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. Results: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver–operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). Conclusions: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation.