ABSTRACT
Gender-affirming hormone therapy (GAHT) is the most frequent treatment offered to gender-incongruent individuals, which reduces dysphoria. The goal of therapy among gender-incongruent individuals seeking gender affirmation as male is to change their secondary sex characteristics to affect masculine physical appearances. GAHT greatly improves mental health and quality of life among gender incongruent individuals. India-specific guideline for appropriate care for gender-incongruent individuals is almost absent. This document is intended to assist endocrinologists and other healthcare professionals interested in gender incongruity for individuals seeking gender affirmation as male. A safe and effective GAHT regimen aims to effect masculinising physical features without adverse effects. In this document, we offer suggestions based on an in-depth review of national and international guidelines, recently available evidence and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement provides protocols for the hormone prescribing physicians relating to diagnosis, baseline evaluation and counselling, prescription planning for masculinising hormone therapy, choice of therapy, targets for monitoring masculinising hormone therapy, clinical and biochemical monitoring, recommending sex affirmation surgery and peri-operative hormone therapy. The recommendations made in this document are not rigid guidelines, and the hormone-prescribing physicians are encouraged to modify the suggested protocol to address emerging issues.
ABSTRACT
Automatic grading of retinal blood vessels from fundus image can be a useful tool for diagnosis, planning and treatment of eye. Automatic diagnosis of retinal images for early detection of glaucoma, stroke, and blindness is emerging in intelligent health care system. The method primarily depends on various abnormal signs, such as area of hard exudates, area of blood vessels, bifurcation points, texture, and entropies. The development of an automated screening system based on vessel width, tortuosity, and vessel branching are also used for grading. However, the automated method that directly can come to a decision by taking the fundus images got less attention. Detecting eye problems based on the tortuosity of the vessel from fundus images is a complicated task for opthalmologists. So automated grading algorithm using deep learning can be most valuable for grading retinal health. The aim of this work is to develop an automatic computer aided diagnosis system to solve the problem. This work approaches to achieve an automatic grading method that is opted using Convolutional Neural Network (CNN) model. In this work we have studied the state-of-the-art machine learning algorithms and proposed an attention network which can grade retinal images. The proposed method is validated on a public dataset EIARG1, which is only publicly available dataset for such task as per our knowledge.
Subject(s)
Diabetic Retinopathy , Retinal Vessels , Algorithms , Diabetic Retinopathy/diagnostic imaging , Diagnosis, Computer-Assisted , Fundus Oculi , Humans , Neural Networks, Computer , Retinal Vessels/diagnostic imagingABSTRACT
Cross sex hormone therapy (CSHT) is a strongly desired medical intervention for gender incongruent individuals. The goal is to change secondary sex characteristics to facilitate gender presentation that is consistent with the desired sex. When appropriately prescribed CSHT can greatly improve mental health and quality of life for gender incongruent individuals. Appropriate care for gender incongruent individuals in India is almost absent due to lack of country specific guideline and lack of training amongst the medical professionals. This document is intended to assist endocrinologists and physicians whose adult gender incongruent client is seeking gender reaffirmation as female (transfeminine). These individuals require a safe and effective CSHT regimen that will suppress endogenous male hormone secretion and maintain physiologic levels of female sex hormone. In this document, we offer suggestions based on an in-depth review of Guidelines of Endocrine Society, The World Professional Association for Transgender Health guidelines, the Sappho Good Practice Guide of India and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel are not gender specialists by training but have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement on medical management provides protocols for the prescribing clinician relating to diagnosis, baseline evaluation and counselling, prescription planning for feminizing hormone therapy and anti-androgen therapy, targets for monitoring hormone therapy, choice of therapy, clinical and biochemical monitoring, recommending sex reaffirmation surgery and peri-operative hormone therapy. The recommendations made in this document should not be perceived as a rigid set of guidelines and the treating clinicians are encouraged to modify our suggested protocols to address emerging issues.
ABSTRACT
This study evaluated the effectiveness of fine needle aspiration of thyroid nodules to reliably diagnose thyroid malignancy, using histopathology as the 'gold standard'. Out of 126 patients, 106 underwent surgery. The sensitivity, specificity and positive predictive value of fine needle aspiraton cytology to diagnose a papillary carcinoma in this study were 80.7%, 96.5% and 87.0% respectively. The accuracy of fine needle aspiraton cytylogy was 80.9%. Six cases that were benign by fine needle aspiraton cytology were confirmed to have malignant lesion by histopathological examination. High resolution ultrasonography could be useful in these situations for considering surgery.
