Artificial Intelligence and Democratization of the Use of Lung Ultrasound in COVID-19: On the Feasibility of Automatic Calculation of Lung Ultrasound Score

During the COVID-19 pandemic, lung ultrasound has been revealed as a powerful technique for diagnosis and follow-up of pneumonia, the principal complication of SARS-CoV-2 infection. Nevertheless, being a relatively new and unknown technique, the lack of trained personnel has limited its application worldwide. Computer-aided diagnosis could possibly help to reduce the learning curve for less experienced physicians, and to extend such a new technique such as lung ultrasound more quickly. This work presents the preliminary results of the ULTRACOV (Ultrasound in Coronavirus disease) study, aimed to explore the feasibility of a real-time image processing algorithm for automatic calculation of the lung ultrasound score (LUS). A total of 28 patients positive on COVID-19 were recruited and scanned in 12 thorax zones following the lung score protocol, saving a 3 s video at each probe position. Those videos were evaluated by an experienced physician and by a custom developed automated detection algorithm, looking for A-Lines, B-Lines, consolidations, and pleural effusions. The agreement between the findings of the expert and the algorithm was 88.0% for B-Lines, 93.4% for consolidations and 99.7% for pleural effusion detection, and 72.8% for the individual video score. The standard deviation of the patient lung score difference between the expert and the algorithm was ±2.2 points over 36. The exam average time with the ULTRACOV prototype was 5.3 min, while with a conventional scanner was 12.6 min. Conclusion: A good agreement between the algorithm output and an experienced physician was observed, which is a first step on the feasibility of developing a real-time aided-diagnosis lung ultrasound equipment. Additionally, the examination time was reduced to less than half with regard to a conventional ultrasound exam. Acquiring a complete lung ultrasound exam within a few minutes is possible using fairly simple ultrasound machines that are enhanced with artificial intelligence, such as the one we propose. This step is critical to democratize the use of lung ultrasound in these difficult times.

Tele-Ultrasound

Ultrasound is a noninvasive, nonionizing, relatively low-cost imaging modality that has increased in use in all fields of medicine over the past few decades. With growth in internet connectivity as well as marked improvements in ultrasound technology, ultrasound can now help guide remote clinical decision making using either synchronous or asynchronous imaging. Implementing a tele-ultrasound program requires an ultrasound machine with the ability to share or transmit images, a provider to perform the exam, and a remote expert for guidance and/or interpretation. Tele-ultrasound can therefore be used by a variety of health care professionals with less ultrasound training under the remote guidance of an experienced physician trained in ultrasound to help care for patients. Tele-ultrasound enables more advanced care in resource-limited settings. As telehealth continues to grow, the use of tele-ultrasound will undoubtedly have an important role in guiding clinical care.

Preferences of Iranians to select the emergency department physician at the time of service delivery

Background Understanding patient preferences in emergency departments (EDs) can provide useful information to enhance patient-centred care and improve patient’s experience in hospitals. This study sought to find evidence about patients’ preference for physicians when receiving services in EDs in Iran. Methods In this discrete choice experiment survey, 811 respondents completed the scenarios with 5 attributes, including type of physicians, price of services, time to receive services, physician work experience, and physician responsibility. Analyses were conducted for different social and economic groups as well as for the total population. Results This study showed that the willingness to pay (WTP) for being visited by a physician with a high sense of responsibility was 67.104US$. WTP for being visited by an emergency medicine specialist (EMS) was 22.148US$. WTP for receiving ED services 1 min earlier was 0.417US$ and for being visited by 1 year higher experienced physician was 0.866US$. WTP varied across different age groups, sex, health status, education, and income groups. Conclusion As the expertise and experience of providers are important factors in selecting physicians in EDs by the patients, providing this information to patients when they want to select their providers can promote patient-centred care. This information can decrease patients’ uncertainty in the selection of their services and improve their experience in hospitals.

Review Article on Evalution of Endometriosis Disorder

Endometriosis may be a unwellness of adolescents and reproductive-aged ladies characterised by the presence of mucosa tissue outside the cavity and normally related to chronic girdle pain and physiological condition. Recent Findings Early age at start, shorter discharge length, and taller height ar related to the next risk of adenomyosis whereas parity, higher body mass index (BMI), and smoking ar related to reduced risk. adenomyosis usually presents as physiological condition or continuing girdle pain despite treatment with analgesics and cyclic oral contraceptive pill pills. pathology is characterised by the presence of mucous membrane tissues outside the female internal reproductive organ. It affects females in their procreative years, and will be associate degree estrogen-dependent condition. The calculable prevalence of adenomyosis within the general population is as high as increased , and is accumulated in females with subfertility. The diagnosing of pathology is typically suspected clinically and confirmed by transvaginal ultrasound or resonance imaging of the pelvis. The gold normal of diagnosing is surgical visual examination of the girdle organs by associate degree experienced physician throughout laparotomy. A positive microscopic anatomy can make sure the diagnosis; but, a negative microscopic anatomy doesn't exclude it. liquid body substance cancer antigen-125 levels is also accumulated in ladies with adenomyosis, however, it's a poor diagnostic tool compared to laparotomy. The management of adenomyosis depends on whether or not the first drawback is pain or subfertility. Keywords: Introduction of Endometriosis, Pathology, Pain Infertility, Diagnosis, Management, Sign, symptoms, Treatment .

Percutaneous epidural adhesiolysis – treatment method for drug-resistant back pain

Introduction: Percutaneous epidural adhesiolysis (epidural decompressive neuroplasty, percutaneous epidural neuroplasty) is treatment method for drug-resistant back pain, including post-surgery syndrome, sciatica or spinal canal stenosis. Aim: To describe the method and outcomes of epidural adhesiolysis. Material and methods: The review of the literature on the topic of epidural adhesiolysis. Results and discussion: This procedure is usually performed in the lumbo-sacral part of the spine, although it can be also done in the cervical or thoracic parts as well. Its purpose is to administer anesthetic drugs, steroids, saline solution or hyaluronidase into the epidural space via one of the three approaches: caudal, interlaminar and transforaminal. The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. Conclusions: The efficacy of epidural adhesiolysis was proven in numerous randomized controlled trials. When performed by an experienced physician, epidural adhesiolysis is a safe and effective method with infrequent adverse events.

Age at Onset of Menarche and Puberty of Girls in Aydin Region and the Factors Affecting Them

INTRODUCTION: In this study, we aimed to determine the range of mean age at onset of menarche (AOM) and puberty (AOP) of girls living in Aydin province and to determine the factors affecting the onset age of menarche. METHODS: A total of 1891 girls aged between 8 and 16 years attending primary, secondary and high schools in Aydin province were planned to be included in the study. A questionnaire that was prepared in line with the literature was delivered to the parents in a closed envelope. The subjects who accepted to participate in the study were examined by an experienced physician by measuring height and weight and pubertal status was defined according to Tanner scale. BMI values were calculated. RESULTS: In total, 1520 female students were accepted to the study with the permission of their families. The mean AOM of participants was 12.11±1.32 years. The mean AOM was 13.12±1.46 years for their mothers, and 12.73±1.25 years for their sisters. June was the month that menarche occurred most frequently. We observed that the children living in rural areas had an earlier age of menarche. The mean age at onset of puberty was 9.71±1.46 years. DISCUSSION AND CONCLUSION: Our study is important in terms of being the first study conducted in Aydin province that determined the mean AOM and AOP of girls aged between 8 and 16. In our study, we showed that the age of menarche shifted to an early age, while the age of puberty did not shift. The age at onset of menarche and puberty were similar to the results obtained in other studies conducted in neighboring regions. We believe that larger scale studies may contribute to assess the actual mean age at menarche of girls living in Turkey.

Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

Comparative Study of First Order Optimizers for Image Classification Using Convolutional Neural Networks on Histopathology Images

The classification of histopathology images requires an experienced physician with years of experience to classify the histopathology images accurately. In this study, an algorithm was developed to assist physicians in classifying histopathology images; the algorithm receives the histopathology image as an input and produces the percentage of cancer presence. The primary classifier used in this algorithm is the convolutional neural network, which is a state-of-the-art classifier used in image classification as it can classify images without relying on the manual selection of features from each image. The main aim of this research is to improve the robustness of the classifier used by comparing six different first-order stochastic gradient-based optimizers to select the best for this particular dataset. The dataset used to train the classifier is the PatchCamelyon public dataset, which consists of 220,025 images to train the classifier; the dataset is composed of 60% positive images and 40% negative images, and 57,458 images to test its performance. The classifier was trained on 80% of the images and validated on the rest of 20% of the images; then, it was tested on the test set. The optimizers were evaluated based on their AUC of the ROC curve. The results show that the adaptative based optimizers achieved the highest results except for AdaGrad that achieved the lowest results.

A New Measurement Method for the Diagnostic of Different Types of Concealed Penis in Children

Background: Concealed penis is an anomaly in infants and adolescents, accurate diagnosis of different types of which requires extensive experience. In general, an experienced physician can diagnose the type of abnormal penis by careful observation and then provide the corresponding treatment. The appearance of trapped penis and webbed penis is easier to distinguish than that of other abnormal penises. However, congenital concealed penis is easily confused with phimosis and obesity concealed penis, and it is not easy to distinguish clinically, especially for inexperienced physician. Objectives: This study aims to provide an auxiliary measurement method to assist diagnosis of concealed penis types. Methods: This study enrolled 105 children diagnosed as phimosis, 88 as congenital concealed penis, and 78 as obesity concealed penis. Multifunctional protractor was used to measure the foreskin angle and penis-scrotum angle. The foreskin angle was defined as the angle between the ventral and dorsal sides of the penis body and the line extending to the foreskin, which was the sagittal position of the natural state of the penis when the child lies down. The penis-scrotum angle was defined as the angle between the ventral side of penis and the scrotum. All measured data were recorded by professional physicians, and the differences between different groups were compared using t-test. Results: The average foreskin angle in the phimosis, congenital concealed penis, and obesity concealed penis groups were 10.05°, 74.34°, and 8.86°, respectively. The average penis-scrotum angle in the three groups were 6.98°, 118.65°, and 85.59°, respectively. Annular wrinkle numbers in the three groups were 0.26, 0.32, and 2.68, respectively. The difference of the groups was statistically significant (P < 0.05). These results indicated that congenital concealed penis had greater foreskin and penis-scrotum angle. Obesity concealed penis had moderately large penis-scrotum angle and higher number of annular wrinkles. On contrary, the three indicators in phimosis were the lowest. Conclusions: This evaluation system can provide an auxiliary way to help the diagnosis of different types of concealed penis in children and provide a basis for subsequent treatment. In addition, Experienced physicians teaching new physicians/students, can also use this as an auxiliary explanation.

How a Devastating Case of Acanthamoeba Sclerokeratitis Ended up with Serious Systemic Sequelae

A 35-year old soft contact lens wearer with a proven bilateral Acanthamoeba keratitis developed a nodular scleritis. Based on the stepladder approach described by Iovieno et al. [Ophthalmology. 2014 Dec;121(12):2340–7], nonsteroidal anti-inflammatory drugs, methylprednisolone, and later azathioprine were added to the antiamoebic treatment. Unfortunately, there was further deterioration and an endophthalmitis developed. Unbearable pain and concerns of spread to the brain urged an enucleation. Histopathological examination confirmed Acanthamoeba cysts in the cornea, sclera, retina, choroid, and vitreous body. As a side effect of the immunosuppressive treatment, the patient developed myopathy, pulmonary aspergillosis, and an avascular necrosis of the hip. Scleritis is a devastating complication of Acanthamoeba keratitis with a poor prognosis and a high enucleation rate. Acanthamoeba sclerokeratitis is, due to cyst-free biopsies, mostly assigned to an immune-mediated mechanism, justifying the use of immunosuppressive treatment. Scleritis in our case contributed to the extracorneal spread of Acanthamoeba. Our case is the first documented extracorneal spread of Acanthamoeba without previous surgery. Extracorneal spread of Acanthamoeba should be considered, even in the case of false-negative biopsies. We strongly recommend serial sections of the retrieved scleral specimen in case of negative histopathological examination to exclude an infection. Even when an immune-mediated scleritis is suspected, systemic immunosuppressive treatment should always be used with the greatest caution. Awareness of the side effects and monitoring by an experienced physician is mandatory.