Optimized hybrid machine learning approach for smartphone based diabetic retinopathy detection.

Diabetic Retinopathy (DR) is defined as the Diabetes Mellitus difficulty that harms the blood vessels in the retina. It is also known as a silent disease and cause mild vision issues or no symptoms. In order to enhance the chances of effective treatment, yearly eye tests are vital for premature discovery. Hence, it uses fundus cameras for capturing retinal images, but due to its size and cost, it is a troublesome for extensive screening. Therefore, the smartphones are utilized for scheming low-power, small-sized, and reasonable retinal imaging schemes to activate automated DR detection and DR screening. In this article, the new DIY (do it yourself) smartphone enabled camera is used for smartphone based DR detection. Initially, the preprocessing like green channel transformation and CLAHE (Contrast Limited Adaptive Histogram Equalization) are performed. Further, the segmentation process starts with optic disc segmentation by WT (watershed transform) and abnormality segmentation (Exudates, microaneurysms, haemorrhages, and IRMA) by Triplet half band filter bank (THFB). Then the different features are extracted by Haralick and ADTCWT (Anisotropic Dual Tree Complex Wavelet Transform) methods. Using life choice-based optimizer (LCBO) algorithm, the optimal features are chosen from the mined features. Then the selected features are applied to the optimized hybrid ML (machine learning) classifier with the combination of NN and DCNN (Deep Convolutional Neural Network) in which the SSD (Social Ski-Driver) is utilized for the best weight values of hybrid classifier to categorize the severity level as mild DR, severe DR, normal, moderate DR, and Proliferative DR. The proposed work is simulated in python environment and to test the efficiency of the proposed scheme the datasets like APTOS-2019-Blindness-Detection, and EyePacs are used. The model has been evaluated using different performance metrics. The simulation results verified that the suggested scheme is provides well accuracy for each dataset than other current approaches.

Evaluation of prognostic factors in patients with Bell's palsy.

BACKGROUND: Bell's palsy is a common neurological problem that leads to peripheral palsy of the facial nerve. Most patients have a favorable response with or without treatment while some are left with significant facial deformity. Identification of factors which influence the outcome in patients with Bell's palsy may help clinicians counsel better. METHODS: A prospective cross-sectional study was carried out in the Department of Neurology Nobel Medical College, Biratnagar, between February 2020 and February 2021 after obtaining ethical clearance from the institutional review committee. Patients were assessed at the time of presentation to hospital and followed up at 1 week, 1 month, and 3 months after the onset of illness to evaluate for recovery. RESULTS: Sixty-two (61.4%) of 101 patients had a favorable outcome at the follow up on the third month, achieving H-B grade 2 or lower, while 33 (32.7%) had moderate dysfunction and 6 (5.9%) had severe dysfunction. The following factors were associated with favorable outcome: younger age of onset (p < .001), lower initial H-B grade of III or IV (p = .001), lesser degree of amplitude reduction on affected side as compared to unaffected side (p = .001) and absence of hypertension and diabetes. The following factors did not influence outcome at three months: duration of Bell's palsy (p = 0.142), side of face affected, and gender (p = .09). CONCLUSIONS: Most of the patients with Bell's palsy have favorable outcomes. Age, hypertension, initial H-B grade, and extent of facial nerve degeneration as recorded by nerve conduction studies are important predictors of outcome.

Ischemic jejunal stricture in patients with extrahepatic portal vein obstruction.

Ischemic jejunal stricture due to mesenteric vein thrombosis (MVT) rarely occurs in patients with extrahepatic portal vein obstruction (EHPVO). This is because the thrombus often occludes only a short segment of superior mesenteric vein adjacent to splenoportal confluence, facilitating development of collateral veins that protect bowel from ischemia. However, ischemic strictures can develop when the thrombus involves jejunal veins, venous arcades or vasa recta. We report three patients with EHPVO, who developed jejunal strictures due to MVT. They presented with symptoms of proximal bowel obstruction. Two of these patients had evidence of recurrent deep vein thrombosis (DVT), suggesting possibility of an underlying prothrombotic state. One of them had completely occluded bilateral iliac veins and inferior vena cava following DVT, 10 years ago. At the same time, he was identified as having a portal cavernoma. Contrast-enhanced computed tomography showed portal cavernoma together with MVT in all the patients. The thrombus was identified in the jejunal veins in two patients and in the entire superior mesenteric vein up to splenic vein in one patient. All three patients were found to have a tight concentric stricture involving a long length of proximal jejunum. Two patients required urgent surgical intervention and one died.

Idiopathic cystic artery aneurysm complicated with hemobilia.

Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a healthy individual who developed hemobilia associated with cystic artery aneurysm. The patient was managed with cholecystectomy and concomitant aneurysm repair. Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization is a common method of treatment for visceral artery aneurysms. Open cholecystectomy and aneurysm repair was performed in our patient due to radiological evidence of associated cholecystitis.

Balloon retrograde transvenous occlusion of fundic varix.

A middle-aged woman presented with massive upper gastrointestinal bleed. The source of bleeding was a large fundic varix; a large splenorenal shunt was also present. The fundic varix was treated safely and effectively with balloon retrograde transvenous occlusion.

Review of surgical ventricular restoration: A procedure to treat cardiac failure.

Severe heart failure refractory to medical treatment necessitates the use of other modalities of treatment. Surgical ventricular restoration (SVR) surgery can provide relief until donour hearts are available or when transplantation is contraindicated. In this review we look at the physiological basis for improvement in cardiac function and cardiac and haemodynamic changes that occur after SVR. We also compile the reported factors affecting surgical outcome, criteria for patient selection and predictors of postoperative mortality. NYHA class, presence of diastolic failure, severe impairment of contractile function and presence of mitral regurgitation were the most important determinants. Various different procedures for achieving SVR are briefly discussed. Importance of mitral valve repair/replacement, coronary artery bypass grafting and intraoperative echocardiography in improving postoperative result is highlighted. Role of perioperative medication (anti-arrhythmics, ACE inhibitors and ß-blockers) is briefly studied at the end of the review.

Profile of chronic small-bowel diarrhea in adults in Western India: a hospital-based study.

BACKGROUND: Small-bowel diarrhea is reported to account for 10% of all cases of chronic diarrhea. Data on the etiology and clinical presentation of chronic small-bowel diarrhea in adult Indians is scarce. METHODS: 50 patients (mean age 32.8 years; 26 men) with chronic small bowel diarrhea were evaluated clinically, and investigated to determine etiology. The diagnosis of small-bowel diarrhea was based on history, stool volume and associated symptoms. RESULTS: Abdominal pain (n=22, 44%) and weight loss (n=37, 74%) were the most common symptoms, apart from diarrhea. Anemia (70%) and hypoalbuminemia (48%) were other important biochemical abnormalities. Intestinal tuberculosis (26%) and celiac disease (26%) were the most common causes of chronic small-bowel diarrhea. CONCLUSION: Tuberculosis of intestine and celiac disease are common causes of small-bowel diarrhea in our population. Tropical sprue seems to be a rare cause.

Endoscopic biliary drainage in patients with amebic liver abscess and biliary communication.

BACKGROUND: Percutaneous drainage or surgery is required when amebic liver abscess (ALA) fails to respond to medical management. In some of these patients, non-response may be due to communication of ALA with the biliary tree. This report describes our experience with the use of endoscopic biliary draining in such patients. METHODS: Medical records of patients with ALA undergoing either needle aspiration or percutaneous pigtail drainage were retrieved; the indications for drainage were: abscess volume exceeding 250 mL, a thin rim of tissue (< 1 cm thick) around the abscess, systemic toxic features and failure to improve on medical treatment. Patients with abscess drain output >25 mL/day persisting for 2 weeks or presence of bile in the drain fluid underwent endoscopic biliary drainage. RESULTS: A total of 115 patients with ALA underwent percutaneous treatment. None of the 25 patients with needle aspiration needed any further treatment. Of the 90 who underwent catheter drainage, the catheter could be removed within one week in 77 patients; the remaining 13 patients (median age 42 years, range 24-65; all men) had an abscess-biliary communication. In them, the median catheter output was 88 mL/day (range 45-347) and 54 mL/day (28-177) at 2 days and 2 weeks after catheter placement. The drain fluid contained bile in all 13 patients and in addition contained pus in 10 patients. Eleven patients had a solitary abscess and two had multiple abscesses. Cholangiogram showed biliary communication in all 13 patients. All patients were treated with placement of 10F biliary endoprosthesis or 10F nasobiliary drain. Pigtail catheter was removed within 1 week in 11 of 13 patients. CONCLUSION: In patients with amebic liver abscess communicating with the biliary tree, biliary stenting may hasten clinical recovery and allow early removal of liver abscess catheter drain.