Subject(s)
Graft vs Host Disease/etiology , Lung Transplantation/adverse effects , Mouth Diseases/etiology , Mouth Mucosa/pathology , Female , Graft vs Host Disease/pathology , Humans , Lichen Planus, Oral/etiology , Lichen Planus, Oral/immunology , Middle Aged , Mouth Diseases/immunology , Mouth Diseases/pathology , Salivary Gland Diseases/etiology , Salivary Gland Diseases/immunologySubject(s)
Keratosis, Actinic/diagnosis , Photography , Physical Examination/methods , Adult , Aged , Clinical Trials as Topic , Confidence Intervals , Female , Humans , Keratosis, Actinic/epidemiology , Keratosis, Actinic/etiology , Male , Middle Aged , Observer Variation , Precancerous Conditions/diagnosis , Precancerous Conditions/epidemiology , Precancerous Conditions/etiology , Sampling Studies , Sensitivity and Specificity , Sunlight/adverse effectsABSTRACT
BACKGROUND: Clinical diagnosis of actinic keratosis is known to have intra- and inter-observer variability, and there is currently no non-invasive and objective measure to diagnose these lesions. OBJECTIVE: The aim of this pilot study was to determine if automatically detecting and circumscribing actinic keratoses in clinical photographs is feasible. METHODS: Photographs of the face and dorsal forearms were acquired in 20 volunteers from two groups: the first with at least on actinic keratosis present on the face and each arm, the second with no actinic keratoses. The photographs were automatically analysed using colour space transforms and morphological features to detect erythema. The automated output was compared with a senior consultant dermatologist's assessment of the photographs, including the intra-observer variability. Performance was assessed by the correlation between total lesions detected by automated method and dermatologist, and whether the individual lesions detected were in the same location as the dermatologist identified lesions. Additionally, the ability to limit false positives was assessed by automatic assessment of the photographs from the no actinic keratosis group in comparison to the high actinic keratosis group. RESULTS: The correlation between the automatic and dermatologist counts was 0.62 on the face and 0.51 on the arms, compared to the dermatologist's intra-observer variation of 0.83 and 0.93 for the same. Sensitivity of automatic detection was 39.5% on the face, 53.1% on the arms. Positive predictive values were 13.9% on the face and 39.8% on the arms. Significantly more lesions (p<0.0001) were detected in the high actinic keratosis group compared to the no actinic keratosis group. CONCLUSIONS: The proposed method was inferior to assessment by the dermatologist in terms of sensitivity and positive predictive value. However, this pilot study used only a single simple feature and was still able to achieve sensitivity of detection of 53.1% on the arms.This suggests that image analysis is a feasible avenue of investigation for overcoming variability in clinical assessment. Future studies should focus on more sophisticated features to improve sensitivity for actinic keratoses without erythema and limit false positives associated with the anatomical structures on the face.
Subject(s)
Image Enhancement/methods , Keratosis, Actinic/diagnosis , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
BACKGROUND: Disseminated tuberculosis (TB) accounts for 1 to 3% of all TB cases. This retrospective study reviews the clinical, radiological, laboratory findings and outcome in patients with disseminated tuberculosis in an endemic area. METHODS: Medical records were reviewed for patients with disseminated TB admitted to two tertiary centers in Tehran, Iran between 1999 and 2006. RESULTS: Fifty patients were found to have disseminated TB. A miliary pattern was documented in the chest x-ray of 34 patients. Hematologic abnormalities including anemia, leukopenia, and thrombocytopenia were frequently observed. Death occurred in nine of the cases. The mortality rate was significantly higher in diabetic patients, injection drug users, and patients with hematologic abnormalities; however, steroid usage and human immunodeficiency virus infection were not significantly associated with a higher mortality rate. Clinical improvement occurred in 41 patients following treatment. CONCLUSION: Disseminated TB could have different manifestations. Hematologic abnormalities are common and are considered poor prognostic signs in these patients.
