Knowledge and Practice of Breast Self-Examination among Women in Seberang Perai Utara District, Penang: AMDI Medical Coach Experience

Breast cancer is the leading cause of cancer mortality in women and is a major health concern in both developing and developed countries 1. Regular breast cancer screening is the single most important public health strategy to reduce breast cancer mortality 2. Breast self-examination (BSE) is one of the screening modality available and regular BSE is the best way to notice breast changes. Women should be encouraged to know what is normal for them, be informed of early symptoms of breast cancer, and promptly report any changes or concerns 3. Advanced Medical and Dental Institute (AMDI) Medical Coach begins its operation in 2013 with the aim to create awareness among the public about the importance of health screening which include BSE and mobile mammograph

Local Descriptor for Retinal Fundus Image Registration

A feature-based retinal image registration (RIR) technique aligns multiple fundus images and composed of pre-processing, feature point extraction, feature descriptor, matching and geometrical transformation. Challenges in RIR include difference in scaling, intensity and rotation between images. The scale and intensity differences can be minimised with consistent imaging setup and image enhancement during the pre-processing, respectively. The rotation can be addressed with feature descriptor method that robust to varying rotation. Therefore, a feature descriptor method is proposed based on statistical properties (FiSP) to describe the circular region surrounding the feature point. From the experiments on public Fundus Image Registration dataset, FiSP established 99.227% average correct matches for rotations between 0° and 180°. Then, FiSP is paired with Harris corner, scale-invariant feature transform (SIFT), speeded-up robust feature (SURF), Ghassabi's and D-Saddle feature point extraction methods to assess its registration performance and compare with the existing feature-based RIR techniques, namely generalised dual-bootstrap iterative closet point (GDB-ICP), Harris-partial intensity invariant feature descriptor (PIIFD), Ghassabi's-SIFT, H-M 16, H-M 17 and D-Saddle-histogram of oriented gradients (HOG). The combination of SIFT-FiSP registered 64.179% of the image pairs and significantly outperformed other techniques with mean difference between 25.373 and 60.448% (p = <;0.001*)

Palliative brachytherapy to axilla and hypopharynx in elderly patient with hypopharyngeal squamous cell carcinoma — case report

Brachytherapy (BT) is an important local treatment of tumor and it can be applied to different anatomical sites either in a curative or palliative setting. BT can deliver large dose of radiation to the tumor while sparing the surrounding normal tissue which translates into a better therapeutic ratio compared to external beam radiotherapy. However, the evidence for the use of brachytherapy in the palliative setting is lacking in the literature. In this case report, we describe the brachytherapy technique and outcome of a patient with squamous cell carcinoma of the hypopharynx who underwent palliative brachytherapy to the hypopharynx and metastatic tumor at the right axilla.

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Lumbosacral osteosarcoma with dural spread, skip lesions and intravascular extension: A case report

Primary osteosarcoma of the spine is indeed rare and only several sporadic cases have been reported. It tends to occur in a slightly older age group than those with appendicular skeleton tumours. We present here an unusual case of aggressive lumbosacral osteosarcoma in a young teenager complicated by extensive dural spread, skip lesions and intravascular extension. Although a histopathological examination is mandatory to establish the diagnosis, this case emphasises the need of imaging to ascertain the full extent of disease spread especially in deciding the type of treatment to be instituted and to evaluate the response to the treatment

Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication

Macroprolactinoma has the potential to cause base of skull erosion and often extends into the sphenoid sinus. Rapid shrinkage of this invasive tumor following dopamine agonist therapy has been postulated to cause unplugging of the eroded area, leading to cerebrospinal fluid leakage. To the best of our knowledge, the occurrence of spontaneous cerebrospinal fluid leak in treatment-naive prolactinomas is very rare, the majority of which involve undiagnosed macroprolactinomas. We describe here a lady presented late with giant macroprolactinoma, complicated by cerebrospinal fluid leakage. This case raised the dilemma in the management pertaining to the role of either pharmacotherapy or surgical intervention, or combination of both. As she strictly refused surgery, she was treated with bromocriptine which was later changed to cabergoline. On follow-up, there was cessation of cerebrospinal fluid leak, marked reduction of serum prolactin level, and imaging evidence of tumor shrinkage. The majority of patients with medically induced cerebrospinal fluid leakage will require surgical procedures to overcome this complication; however, there are isolated cases of leakage resolution on continuing dopamine agonist therapy while awaiting surgery. The use of dopamine agonist does not necessarily cause worsening of cerebrospinal fluid leakage and instead may produce spontaneous resolution as in this case

Malignant obstruction of superior vena cava: Endovascular stenting using Y-configuration stent in stent technique

Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Y-configuration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique

Automated DeepLabV3+ based model for left ventricle segmentation on short-axis late gadolinium enhancement-magnetic cardiac resonance imaging images

Accurate segmentation of myocardial scar tissue on late gadolinium enhancement-magnetic cardiac resonance imaging (LGE-CMR) is exceptionally vital for clinical applications, enabling precise diagnosis and effective treatment of various cardiac diseases, such as myocardial infarction and cardiomyopathies. However, the ventricle (LV) variations in the size and shape, artifacts, and image resolution of LGE-CMR has made automatic segmentation of myocardial scar tissue more challenging. While many existing approaches delineate the LV myocardium region using multi-modal segmentation, these models may be computationally complex and suffer from misalignment. Therefore, this study proposed an automatic dual-stage DeepLabV3+ based approach tailored for myocardial scar segmentation on short-axis LGE-MRI exclusively. To segment myocardial scar tissue, the second stage employs the segmented LV chamber from the previous stage. The encoder part of the framework utilizes a MobileNetV2 and ResNet50 backbone for the first and second segmentation, respectively, aiming for optimal resolution of feature maps. Both stages tailor an improved Atrous Spatial Pyramid Pooling module in the DeepLabV3+ model with fine-tuned dilated atrous rates to effectively extract the LV chamber and myocardial scar from the complex LGE-MRI background. Based on the results, the proposed dual-stage network recorded an outstanding segmentation performance, with mean Dice score of 96.02% for LV chamber segmentation and 68.01% for scar tissue extraction

Fundus Image Registration Technique Based on Local Feature of Retinal Vessels

Feature-based retinal fundus image registration (RIR) technique aligns fundus images according to geometrical transformations estimated between feature point correspondences. To ensure accurate registration, the feature points extracted must be from the retinal vessels and throughout the image. However, noises in the fundus image may resemble retinal vessels in local patches. Therefore, this paper introduces a feature extraction method based on a local feature of retinal vessels (CURVE) that incorporates retinal vessels and noises characteristics to accurately extract feature points on retinal vessels and throughout the fundus image. The CURVE performance is tested on CHASE, DRIVE, HRF and STARE datasets and compared with six feature extraction methods used in the existing feature-based RIR techniques. From the experiment, the feature extraction accuracy of CURVE (86.021%) significantly outperformed the existing feature extraction methods (p &le; 0.001*). Then, CURVE is paired with a scale-invariant feature transform (SIFT) descriptor to test its registration capability on the fundus image registration (FIRE) dataset. Overall, CURVE-SIFT successfully registered 44.030% of the image pairs while the existing feature-based RIR techniques (GDB-ICP, Harris-PIIFD, Ghassabi&rsquo;s-SIFT, H-M 16, H-M 17 and D-Saddle-HOG) only registered less than 27.612% of the image pairs. The one-way ANOVA analysis showed that CURVE-SIFT significantly outperformed GDB-ICP (p = 0.007*), Harris-PIIFD, Ghassabi&rsquo;s-SIFT, H-M 16, H-M 17 and D-Saddle-HOG (p &le; 0.001*)