157 research outputs found
Psychiatric Case Record
Bipolar Disorder-Mania:
Patient was apparently normal one-month back, Then all of a sudden he developed sleep disturbances –mainly difficult in initiation of sleep. He also started abusing his family members for unwanted things. Subsequently, he started talking excessively and irritable. Sometimes he sings film songs and dances.
He used to say that God Supreme exists in himself and so he has all the powers of Almighty. With that superior power he says that he can solve all the problems in this world. He also says that he has invented herbs to keep people young.
For the past one week, he talks excessively without having an hour of sleep & wanders here and there & found excessively smoking. He becomes excessively spiritual and goes to near by villages for offering prayers to God. He takes only a little food everyday and he is very much keen in personal cleanliness.
Paranoid Schizophrenia:
She was apparently normal 8 months back, then she developed sleep disturbances in the form of difficult in falling asleep. She was found talking & smiling to herself at night & day with mirror gazing. She started saying that her neighbour & relatives are planning to kill herself by poisoning.
In this context she had frequent quarrels with them and she refused to take food prepared by her mother in law.
She left the home at night without informing any one and started wandering in the road side near her home. She was complaining that she hears voices as if her neighbour & relatives were talking about her among themselves
She was not doing house hold activities for past 6 months and she was not taking care of her child. Her personal hygiene was very much deteriorated slowly as she used to take bath & brush, only if she was asked to do so. She started abusing & assaulting the strangers and family members.
Generalised Anxiety Disorder:
Six months back he was apparently normal. He is working as a system analyst in a private bank . He had once, made a mistake in his bank work for which he was given charges by his employer, followed this event he becomes very tense and afraid whenever his boss called him. He is very cautious that he should not commit any mistakes. Even though he is not doing so, he fears that he may commit some mistake in his work. At that moment he develops palpitation, giddiness, breathlessness, excessive sweating over palms and soles. Slowly these symptoms present through out the day even when he was not in his office, and he could not control his
fearfulness. For the past 6 months he didn’t sleep well. His sleep is disturbed by bad dreams.
Recurrent Depressive Disorder:
Patient was apparently alright 2 months back. Then she developed sleep disturbances particularly early morning awakening, she use to wake up by 3.00 am and use to brood about herself and started crying. She was not doing her domestic work as before, as she felt excess tiredness and use to take frequent rests. She developed poor communication. She had lost her interest in pleasurable activities and was not interested in watching TV, and
attending family gatherings. She stayed aloof most of the time & calm, quiet and withdrawn. She was expressing her helplessness and hopelessness about the future.
She started to have decline in maintaining self care. 15 days back, she frequently expressed suicidal ideas and she had attempted suicide by hanging herself and was rescued by neighbours.
5 days back, she started talking in an irrelevant manner. She was smiling to self. She was assaulting her family members. She was suspicious that her neighbour had done black magic on her and also saying that people are talking about her. She reported hearing the voice of her neighbour
scolding and threatening her.
Organic Brain Syndrome – Dementia:
Ten months back he was apparently alright. Then his relatives noticed himself frequently misplaces things inside his home. Then he started behaving aggressively. He was beating his wife without reason. He was roaming here and there, running out of home and wandering aimlessly.
He was not able to come back home when he goes out. He was brought back to home by his relatives.
Slowly he developed fearfulness and tremulousness while he was staying alone.
He also started saying that his family members & neighbours were talking about himself, in this context he would make frequent quarrels with them. He also started hearing voices of known male voices abusing himself in third person.
He sleeps for few hour only. He is passing urine and motion inside the house. He is asking about his brother and mother-in-law who were expired long back. He behaves abnormally such as pouring water in the plate while eating. And his relatives found the symptoms were worsened by evening.
All these symptoms started insidiously, increased in severity through time and attained the present state.
No history of loss of appetite / crying spells / suicidal tendencies / convulsions / fever / head injury
The Effect of Optic Disc Center Displacement on Retinal Nerve Fiber Layer Measurement Determined by Spectral Domain Optical Coherence Tomography
Purpose: To investigate the effect of optic disc center displacement on retinal nerve fiber layer (RNFL) measurement determined by spectral domain optical coherence tomography (SD-OCT). Methods: The optic disc center was manipulated at 1-pixel intervals in horizontal, vertical, and diagonal directions. According to the manipulated optic disc center location, the RNFL thickness data were resampled: (1) at a 3.46-mm diameter circle; and (2) between a 2.5-mm diameter circle and 5.4-mm square. Error was calculated between the original and resampled RNFL measurements. The tolerable error threshold of the optic disc center displacement was determined by considering test-retest variability of SD-OCT. The unreliable zone was defined as an area with 10% or more variability. Results: The maximum tolerable error thresholds of optic disc center displacement on the RNFL thickness map were distributed from 0.042 to 0.09 mm in 8 directions. The threshold shape was vertically elongated. Clinically important unreliable zones were located: (1) at superior and inferior region in the vertical displacement; (2) at inferotemporal region in the horizontal displacement, and (3) at superotemporal or inferotemporal region in the diagonal displacement. The unreliable zone pattern and threshold limit varied according to the direction of optic disc displacement. Conclusions: Optic disc center displacement had a considerable impact on whole RNFL thickness measurements. Understanding the effect of optic disc center displacement could contribute to reliable RNFL measurements.This study was supported by the National Research Foundation of Korea (NRF), which is funded by the Ministry of Education, Science, and Technology (no. NRF-2015R1C1A2A01053008). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Visual field and structural alterations in age-related macular degeneration
The thesis investigated progression of the central 10° visual field with structural changes at the macula in a cross-section of patients with varying degrees of agerelated macular degeneration (AMD). The relationships between structure and function were investigated for both standard and short-wavelength automated perimetry (SWAP). Factors known to influence the measure of visual field progression were considered, including the accuracy of the refractive correction on SWAP thresholds and the learning effect. Techniques of assessing the structure to function relationships between fundus images and the visual field were developed with computer programming and evaluated for repeatability. Drusen quantification of fundus photographs and retro-mode scanning laser ophthalmoscopic images was performed. Visual field progression was related to structural changes derived from both manual and automated methods. Principal Findings: • Visual field sensitivity declined with advancing stage of AMD. SWAP showed greater sensitivity to progressive changes than standard perimetry. • Defects were confined to the central 5°. SWAP defects occurred at similar locations but were deeper and wider than corresponding standard perimetry defects. • The central field became less uniform as severity of AMD increased. SWAP visual field indices of focal loss were of more importance when detecting early change in AMD, than indices of diffuse loss. • The decline in visual field sensitivity over stage of severity of AMD was not uniform, whereas a linear relationship was found between the automated measure of drusen area and visual field parameters. • Perimetry exhibited a stronger relationship with drusen area than other measures of visual function. • Overcorrection of the refraction for the working distance in SWAP should be avoided in subjects with insufficient accommodative facility. • The perimetric learning effect in the 10° field did not differ significantly between normal subjects and AMD patients. • Subretinal deposits appeared more numerous in retro-mode imaging than in fundus photography
A review of feature-based retinal image analysis
Retinal imaging is a fundamental tool in ophthalmic diagnostics. The potential use of retinal imaging within screening programs, with consequent need to analyze large numbers of images with high throughput, is pushing the digital image analysis field to find new solutions for the extraction of specific information from the retinal image. The aim of this review is to explore the latest progress in image processing techniques able to recognize specific retinal image features. and potential features of disease. In particular, this review aims to describe publically available retinal image databases, highlight different performance evaluators commonly used within the field, outline current approaches in feature-based retinal image analysis, and to map related trends. This review found two key areas to be addressed for the future development of automatic retinal image analysis: fundus image quality and the affect image processing may impose on relevant clinical information within the images. Performance evaluators of the algorithms reviewed are very promising, however absolute values are difficult to interpret when validating system suitability for use within clinical practice
Clinical Applications of Artificial Intelligence in Glaucoma
Ophthalmology is one of the major imaging-intensive fields of medicine and thus has potential for extensive applications of artificial intelligence (AI) to advance diagnosis, drug efficacy, and other treatment-related aspects of ocular disease. AI has made impressive progress in ophthalmology within the past few years and two autonomous AIenabled systems have received US regulatory approvals for autonomously screening for mid-level or advanced diabetic retinopathy and macular edema. While no autonomous AI-enabled system for glaucoma screening has yet received US regulatory approval, numerous assistive AI-enabled software tools are already employed in commercialized instruments for quantifying retinal images and visual fields to augment glaucoma research and clinical practice. In this literature review (non-systematic), we provide an overview of AI applications in glaucoma, and highlight some limitations and considerations for AI integration and adoption into clinical practice
Automated retinal analysis
Diabetes is a chronic disease affecting over 2% of the population in the UK [1]. Long-term complications of diabetes can affect many different systems of the body including the retina of the eye. In the retina, diabetes can lead to a disease called diabetic retinopathy, one of the leading causes of blindness in the working population of industrialised countries. The risk of visual loss from diabetic retinopathy can be reduced if treatment is given at the onset of sight-threatening retinopathy. To detect early indicators of the disease, the UK National Screening Committee have recommended that diabetic patients should receive annual screening by digital colour fundal photography [2]. Manually grading retinal images is a subjective and costly process requiring highly skilled staff. This thesis describes an automated diagnostic system based oil image processing and neural network techniques, which analyses digital fundus images so that early signs of sight threatening retinopathy can be identified. Within retinal analysis this research has concentrated on the development of four algorithms: optic nerve head segmentation, lesion segmentation, image quality assessment and vessel width measurements. This research amalgamated these four algorithms with two existing techniques to form an integrated diagnostic system. The diagnostic system when used as a 'pre-filtering' tool successfully reduced the number of images requiring human grading by 74.3%: this was achieved by identifying and excluding images without sight threatening maculopathy from manual screening
Computational Analysis of Fundus Images: Rule-Based and Scale-Space Models
Fundus images are one of the most important imaging examinations in modern ophthalmology
because they are simple, inexpensive and, above all, noninvasive.
Nowadays, the acquisition and
storage of highresolution
fundus images is relatively easy and fast. Therefore, fundus imaging
has become a fundamental investigation in retinal lesion detection, ocular health monitoring and
screening programmes. Given the large volume and clinical complexity associated with these images,
their analysis and interpretation by trained clinicians becomes a timeconsuming
task and is
prone to human error. Therefore, there is a growing interest in developing automated approaches
that are affordable and have high sensitivity and specificity. These automated approaches need to
be robust if they are to be used in the general population to diagnose and track retinal diseases. To
be effective, the automated systems must be able to recognize normal structures and distinguish
them from pathological clinical manifestations.
The main objective of the research leading to this thesis was to develop automated systems capable
of recognizing and segmenting retinal anatomical structures and retinal pathological clinical
manifestations associated with the most common retinal diseases. In particular, these automated
algorithms were developed on the premise of robustness and efficiency to deal with the difficulties
and complexity inherent in these images. Four objectives were considered in the analysis of
fundus images. Segmentation of exudates, localization of the optic disc, detection of the midline
of blood vessels, segmentation of the vascular network and detection of microaneurysms.
In addition, we also evaluated the detection of diabetic retinopathy on fundus images using the
microaneurysm detection method. An overview of the state of the art is presented to compare the
performance of the developed approaches with the main methods described in the literature for
each of the previously described objectives. To facilitate the comparison of methods, the state of
the art has been divided into rulebased
methods and machine learningbased
methods.
In the research reported in this paper, rulebased
methods based on image processing methods
were preferred over machine learningbased
methods. In particular, scalespace
methods proved
to be effective in achieving the set goals.
Two different approaches to exudate segmentation were developed. The first approach is based on
scalespace
curvature in combination with the local maximum of a scalespace
blob detector and
dynamic thresholds. The second approach is based on the analysis of the distribution function of
the maximum values of the noise map in combination with morphological operators and adaptive
thresholds. Both approaches perform a correct segmentation of the exudates and cope well with
the uneven illumination and contrast variations in the fundus images.
Optic disc localization was achieved using a new technique called cumulative sum fields, which was
combined with a vascular enhancement method. The algorithm proved to be reliable and efficient,
especially for pathological images. The robustness of the method was tested on 8 datasets.
The detection of the midline of the blood vessels was achieved using a modified corner detector
in combination with binary philtres and dynamic thresholding. Segmentation of the vascular network
was achieved using a new scalespace
blood vessels enhancement method. The developed
methods have proven effective in detecting the midline of blood vessels and segmenting vascular
networks.
The microaneurysm detection method relies on a scalespace
microaneurysm detection and labelling
system. A new approach based on the neighbourhood of the microaneurysms was used
for labelling. Microaneurysm detection enabled the assessment of diabetic retinopathy detection.
The microaneurysm detection method proved to be competitive with other methods, especially with highresolution
images. Diabetic retinopathy detection with the developed microaneurysm
detection method showed similar performance to other methods and human experts.
The results of this work show that it is possible to develop reliable and robust scalespace
methods
that can detect various anatomical structures and pathological features of the retina. Furthermore,
the results obtained in this work show that although recent research has focused on machine learning
methods, scalespace
methods can achieve very competitive results and typically have greater
independence from image acquisition. The methods developed in this work may also be relevant
for the future definition of new descriptors and features that can significantly improve the results
of automated methods.As imagens do fundo do olho são hoje um dos principais exames imagiológicos da oftalmologia
moderna, pela sua simplicidade, baixo custo e acima de tudo pelo seu carácter nãoinvasivo.
A
aquisição e armazenamento de imagens do fundo do olho com alta resolução é também relativamente
simples e rápida. Desta forma, as imagens do fundo do olho são um exame fundamental
na identificação de alterações retinianas, monitorização da saúde ocular, e em programas de rastreio.
Considerando o elevado volume e complexidade clínica associada a estas imagens, a análise
e interpretação das mesmas por clínicos treinados tornase
uma tarefa morosa e propensa a erros
humanos. Assim, há um interesse crescente no desenvolvimento de abordagens automatizadas,
acessíveis em custo, e com uma alta sensibilidade e especificidade. Estas devem ser robustas para
serem aplicadas à população em geral no diagnóstico e seguimento de doenças retinianas. Para
serem eficazes, os sistemas de análise têm que conseguir detetar e distinguir estruturas normais
de sinais patológicos.
O objetivo principal da investigação que levou a esta tese de doutoramento é o desenvolvimento
de sistemas automáticos capazes de detetar e segmentar as estruturas anatómicas da retina, e os
sinais patológicos retinianos associados às doenças retinianas mais comuns. Em particular, estes
algoritmos automatizados foram desenvolvidos segundo as premissas de robustez e eficácia para
lidar com as dificuldades e complexidades inerentes a estas imagens.
Foram considerados quatro objetivos de análise de imagens do fundo do olho. São estes, a segmentação
de exsudados, a localização do disco ótico, a deteção da linha central venosa dos vasos
sanguíneos e segmentação da rede vascular, e a deteção de microaneurismas. De acrescentar que
usando o método de deteção de microaneurismas, avaliouse
também a capacidade de deteção da
retinopatia diabética em imagens do fundo do olho.
Para comparar o desempenho das metodologias desenvolvidas neste trabalho, foi realizado um
levantamento do estado da arte, onde foram considerados os métodos mais relevantes descritos na
literatura para cada um dos objetivos descritos anteriormente. Para facilitar a comparação entre
métodos, o estado da arte foi dividido em metodologias de processamento de imagem e baseadas
em aprendizagem máquina.
Optouse
no trabalho de investigação desenvolvido pela utilização de metodologias de análise espacial
de imagem em detrimento de metodologias baseadas em aprendizagem máquina. Em particular,
as metodologias baseadas no espaço de escalas mostraram ser efetivas na obtenção dos
objetivos estabelecidos.
Para a segmentação de exsudados foram usadas duas abordagens distintas. A primeira abordagem
baseiase
na curvatura em espaço de escalas em conjunto com a resposta máxima local de um detetor
de manchas em espaço de escalas e limiares dinâmicos. A segunda abordagem baseiase
na
análise do mapa de distribuição de ruído em conjunto com operadores morfológicos e limiares
adaptativos. Ambas as abordagens fazem uma segmentação dos exsudados de elevada precisão,
além de lidarem eficazmente com a iluminação nãouniforme
e a variação de contraste presente
nas imagens do fundo do olho. A localização do disco ótico foi conseguida com uma nova técnica
designada por campos de soma acumulativos, combinada com métodos de melhoramento da rede
vascular. O algoritmo revela ser fiável e eficiente, particularmente em imagens patológicas. A robustez
do método foi verificada pela sua avaliação em oito bases de dados. A deteção da linha central
dos vasos sanguíneos foi obtida através de um detetor de cantos modificado em conjunto com
filtros binários e limiares dinâmicos. A segmentação da rede vascular foi conseguida com um novo
método de melhoramento de vasos sanguíneos em espaço de escalas. Os métodos desenvolvidos mostraram ser eficazes na deteção da linha central dos vasos sanguíneos e na segmentação da rede
vascular. Finalmente, o método para a deteção de microaneurismas assenta num formalismo de
espaço de escalas na deteção e na rotulagem dos microaneurismas. Para a rotulagem foi utilizada
uma nova abordagem da vizinhança dos candidatos a microaneurismas. A deteção de microaneurismas
permitiu avaliar também a deteção da retinopatia diabética. O método para a deteção
de microaneurismas mostrou ser competitivo quando comparado com outros métodos, em particular
em imagens de alta resolução. A deteção da retinopatia diabética exibiu um desempenho
semelhante a outros métodos e a especialistas humanos.
Os trabalhos descritos nesta tese mostram ser possível desenvolver uma abordagem fiável e robusta
em espaço de escalas capaz de detetar diferentes estruturas anatómicas e sinais patológicos
da retina.
Além disso, os resultados obtidos mostram que apesar de a pesquisa mais recente concentrarse
em metodologias de aprendizagem máquina, as metodologias de análise espacial apresentam
resultados muito competitivos e tipicamente independentes do equipamento de aquisição das imagens.
As metodologias desenvolvidas nesta tese podem ser importantes na definição de novos
descritores e características, que podem melhorar significativamente o resultado de métodos automatizados
A Health Insurance Portability and Accountability Act–Compliant Ocular Telehealth Network for the Remote Diagnosis and Management of Diabetic Retinopathy
In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States
- …