Eye Fundus Research Articles

Atypical Form of Ocular Toxoplasmosis

We present the case of a girl, aged 7 years, from rural area, admitted to our clinic with frontal and occipital headache and intermittent ocular pain, which started three weeks before admission; no pathologic antecedents. When admitted, weight=51 kg, height=124 cm (BMI=36.16), no fever but with modified general state, excessive subcutaneous cellular tissue, normal cardio-pulmonary and digestive state, without meningeal symptoms. BP= 90/62 mmHg, HR= 80 b/min.; eye fundus examination at admission: both eyes - papillae with a faded, prominent contour/lineament, multiple hemorrhages with a peripapillary location and several soft exudates (RE > LE), maculae with preserved reflex; diagnosis: papillary edema. Head computed tomography, normal cerebral and cervical spine NMR, and normal aspect in hypophysis NMR; hemogram, renal and hepatic investigations, ionogram, glycaemia – normal values; the TORCH test pointed out increased values for IgM Toxoplasma 1.24 UI/ml (N= 0-0.8) and for IgG Toxoplasma 36.31 UI/ml (n=0-10). We excluded: cerebral edema, malformations, hypophysis or optical chiasma tumors, Arnold-Chiari malformation. We decided for the ocular toxoplasmosis diagnosis and the patient was sent to the infectious disease physician for an antiparasitic treatment. Before starting it, the patient no longer complained of headaches and the eye fundus exam was normal, most likely because of seroconversion, with a decrease of IgM and an increase of IgG Toxoplasmosis, as shown by the TORCH test. The patient remained in our clinic’s evidence, returning for regular ophthalmologic examination, and with a good evolution.

Evaluation of butyric acid as a potential supportive treatment in anterior uveitis

Background: The aim of the study was to evaluate the anti-inflammatory effect of topically administered aqueous sodium butyrate solution in an endotoxin-induced uveitis rat model and compare the results with corticosteroid treatment. Material and methods: Forty female Lewis rats were randomly divided into five groups. Uveitis was induced by a single lipopolysaccharide (LPS) injection into each footpad of each LPS+ rat. Group I (naive) received saline injected into the footpad of each rat at a dose of 0.1 mL/each footpad; Group II (LPS+) received saline solution topically. Group III (LPS+ Dex) — an aqueous dexamethasone sodium phosphate solution topically; Group IV (LPS+ But 0.5 mM) — 0.5 mM aqueous sodium butyrate solution topically, Group V (LPS+ But 1 mM) — 1.0 mM aqueous sodium butyrate solution topically. Clinical scoring of inflammation in rat eyes was evaluated before LPS injection and after 24 hours. The iris involvement, posterior synechiae presence, and insight into the eye fundus were clinicallyassessed. A histopathological examination was also performed. The rats were euthanatized 24 hours after LPS injection, and aqueous humor (AqH) was collected from the eyes by anterior chamber puncture. Levels of inflammatory cytokines and chemokines in the AqH were determined with commercially available Luminex assays. Results: Development of iris hyperemia associated with miosis and poor visibility of fundus details occurred 24 hours after LPS injection. Compared to the LPS+ group, the clinical scores were strongly suppressed in rats treated with Dexamethasone and moderately diminished in LPS+ But 0.5 mM. These clinical features were not observed in the controls (Group 1 — naive). Data from inflammatory cytokines evaluation indicates no significant differences between the LPS+ group (Group 2) and the LPS+ But groups (Groups 4 and 5). Histopathological examinations suggest that hyperemia, corneal stratification, and lesions were less common in the group of animals treated with BA in a lower concentration. Conclusion: Topical administration of sodium butyrate as a therapeutic agent might alleviate the severity of intraocular inflammation in eyes with uveitis. The effect of sodium butyrate was slight but clinically significant in 0.5 mM dose, so other doses of topically administered sodium butyrate should be considered and evaluated in further research.

Study of diagnostic value of congenital hypertrophy of retinal pigment epithelium in Chinese familial adenomatous polyposis patients.

Congenital hypertrophy of retinal pigment epithelium (CHRPE) is an important characteristic of familial adenomatous polyposis (FAP) patients. However, more evidence about its sensitivity, specificity, and diagnostic value for FAP is needed to determine whether CHRPE is a reliable marker. Clinical features of FAP patients were investigated using in-person evaluations. Family members of FAP patients were evaluated with an indirect ophthalmoscope to determine whether they had CHRPE. We defined three diagnostic criteria for CHRPE (criteria A, B and C) based on their shape, quantity and size. Those with negative colonoscopy results and gene mutation results were classified as healthy controls. Of a total of 23 FAP families, 21 families were CHRPE-positive (91.3%). Among those 21 families, 47 individuals had CHRPE, including 33 FAP patients, 9 APC gene mutation carriers, and 5 individuals younger than 18 years who were later confirmed to have FAP. Fifty individuals had no CHRPE (5 FAP patients and 45 individuals without APC gene mutations and colorectal adenoma). The average number of CHRPE lesions per person was 5.81, and CHRPE was located mostly in the posterior pole in the eye fundus; 76.7% of individuals had CHRPE in both eyes. The sensitivity of the three CHRPE criteria ranged from 78.8 to 90.4%, with the highest sensitivity found for criterion A (90.4%), which had a specificity of 100% for healthy controls and sporadic colorectal cancer patients. CHRPE has vital diagnostic and screening value because of its high sensitivity for discovering FAP and APC gene mutation carriers.

Световая чувствительность зрительной системы как функциональный биомаркер нейрональных повреждений при рассеянном склерозе у пациентов с перенесенным острым ретробульбарным оптическим невритом и без него

Цель исследования — оценка контрастно-цветовой чувствительности в центральной области поля зрения, контрастно-частотной чувствительности и динамической остроты зрения у здоровых испытуемых, в больных и здоровых глазах при рассеянном склерозе (РС) у пациентов с перенесенным ретробульбарным оптическим невритом (РБН) и без него. Материал и методы. Исследование зрительных функций проведено в 150 глазах 114 здоровых испытуемых, 49 глазах 36 пациентов с РС, перенесших острый РБН, и 43 глазах 29 пациентов с РС без перенесенного РБН. У всех испытуемых перед исследованием показателей световой чувствительности проводились определение статической остроты зрения, рефракции и офтальмоскопия глазного дна. Результаты и заключение. На основании анализа показателей контрастно-цветовой чувствительности, контрастно-частотной чувствительности и динамической остроты зрения проведена оценка изменений световой чувствительности больных и здоровых глаз у пациентов с РС с перенесенным РБН и без него. Выявлено, что световая чувствительность снижена во вторых — здоровых глазах при РС с перенесенным монокулярным РБН и что снижение световой чувствительности в глазах при РС с перенесенным РБН более глубокое. Световая чувствительность остается сниженной, несмотря на восстановление статической остроты зрения после перенесенного РБН. Различия показателей cветовой чувствительности зрительной системы используются для обсуждения связи острой демиелинизирующей оптической нейропатии с нейрональными повреждениями и характером течения рассеянного склероза. Обсуждается также возможность использования данных о снижении световой чувствительности для ранней диагностики и оценки нейрональных нарушений в зрительной системе при РС.

Management and pathophysiology of meningiomas during pregnancy. Literature review and case report

Introduction: Intracranial tumors diagnosed during pregnancy can cause complications and aggravation for both pregnant and the baby. Tumors are often confused with the diagnosis of eclampsia, therefore involve cautious analysis. Thus, characteristics such as high blood pressure, seizures, intracranial hypertension increase the level of severity of the tumors in question. Fast and efficient diagnosis is of paramount importance for the best outcomes in cases of intracranial tumors in pregnancy. Case Presentation: A 33-year-old primiparous patient G1P0A0, previously healthy, diagnosed with gestational hypertension, evolved during pregnancy with pre-eclampsia refractory to drug treatment. Computed tomography scan of the skull showed a giant sphenoid wing meningioma. At 38 weeks of gestation, the patient presented with a seizure and was admitted to the maternity ward, the examination of eye fundus showed edema of the papillae. In the week following delivery, the patient underwent craniectomy with total meningioma resection. Methods: We performed a literature review on Medline database using as keywords “meningiomas” and “pregnancy” to carry out our search, and 211 articles were found, with only 6 used in this paper, which were further compared with our case. Conclusion: Meningiomas diagnosed during pregnancy, although rare, require several precautions to preserve mother and baby’s lives. Furthermore, given the gestational period and hormonal changes, tumors undergo changes in their functional and anatomical characteristics. Treatment and diagnosis must be quick and efficient, taking into account the gestation time and tumor location.

Ранний прогноз риска преэклампсии с учетом зрительных расстройств и изменений системы гемостаза

Aim: to analyze subjective and objective parameters of eye functioning and evaluate the role of hemostasis abnormalities for shaping groups of high risk for preeclampsia. Patients and Methods: 58 women were examined (history taking, eye and obstetric-gynecological exams, lab tests) to assess their ocular, somatic, and reproductive status and pregnancy course in the third trimester. Twenty-five women were diagnosed with preeclampsia: 13 women without ametropia at baseline were included in group 2, and 12 women with myopia prior to pregnancy were included in group 3. Controls were pregnant women without preeclampsia, i.e., 18 women with healthy pregnancy but no myopia, and 15 pregnant women without preeclampsia but with myopia. In addition, fibrinogen, activated partial thromboplastin time (APTT), soluble fibrin monomer complex (SFMC), and platelets were measured. Results: subjective and objective symptoms of visual disorders in pregnant women associated with hemostatic abnormalities were identified. These signs are considered preeclampsia predictors. The history of reproductive loss, headaches, and visual disorders during pregnancy are typical for preeclampsia women. Most susceptible individuals are women with preeclampsia and myopia who present with complaints of floaters, scotomas, photopsia, and diplopia. These signs illustrate vascular ischemia. Other relevant parameters are reduced platelet count (p<0.01) and APTT (p<0.01), and increased fibrinogen (p<0.01) and SFMC (p<0.002). Conclusion: careful diagnosis of cerebral neurological signs and visual disorders allows for timely diagnostic search and valid peripheral blood and hemostasis testing to improve management of these women and shape risk groups of preeclampsia without lethal complications. KEYWORDS: eye, eye fundus, myopia, photopsia, scotoma, diplopia, reproductive loss, preeclampsia, hemostasis. FOR CITATION: Kudinova E.G., Mozharina K.I. Early prognosis of preeclampsia risk based on visual disorders and hemostatic abnormalities. Russian Journal of Woman and Child Health. 2022;5(2):100–105 (in Russ.). DOI: 10.32364/2618-8430-2022-5-2-100-105

Ischemic Retinal Vasculitis after Previous Toxoplasma Chorioretinitis

Introduction: Ischemic retinal vasculitis is an inflammatory disease affecting the retinal vessels. Visual acuity decreases due to macular ischemia, macular edema, neovascularization leading to vitreous hemorrhage, fibrovascular proliferation or tractional retinal detachment. Purpose: To present the case of a patient with ischemic retinal vasculitis. Material and Methods: The case involves a 34-year-old woman. The following tests were performed: complete blood count, biochemistry, coagulogram, rheumatological tests, serum calcium level, angiotensin-converting enzyme, CT of the lungs, MRI of the brain and spine, serological tests for: cytomegalovirus, herpes simplex virus (type 1 and 2), varicella-zoster virus, toxoplasmosis, tuberculosis, syphilis, as well as fluorescein angiography and optical coherence tomography. Results and Discussion: The patient was admitted to the hospital with visual acuity of the right eye, 0.8/0.9, and of the left eye, 1.0. The intraocular pressure in both eyes was normal: 14 mmHg in the right eye and 15 mmHg in the left eye. The following pathological finding was detected in the right eye fundus: an old chorioretinal cicatrix under the inferior temporal vascular arch with an ischemic exudate next to it, occlusion of the inferior temporal retinal arterial and venous branches, neovascularization and a preretinal hemorrhage. Fluorescein angiography showed delayed filling of the affected vessels, neovascularization, and major ischemia in the lower temporal part of the retina. The results of the serological tests for varicella zoster virus, herpes simplex virus type 1 and toxoplasmosis were outside the reference ranges. The patient was treated with Clindamycin and Acyclovir. Emergency laser therapy was performed in the ischemic retina area. Previous toxoplasma chorioretinitis was diagnosed, which had led to ischemic retinal vasculitis with sectoral involvement of the retinal vessels. The patient has been monitored over 3 - 4 month periods, showing high visual acuity and stable ocular condition. Conclusion: Patients with ischemic retinal vasculitis are a challenge when it comes to clarifying the etiological diagnosis. Treatment on time prevents severe and irreversible loss of vision. Occlusive vasculitis is a rare complication of ocular toxoplasmosis, but must be taken into consideration when young patients are involved.

Diabetic db/db mouse presents intravitreal vessels protruding from the optic disc

AbstractPurposeIt is widely known that the main lesions that occur in diabetic retinopathy are oedema and neovascularization, but, still, there is not an accurate model that can reproduce both. In this study, we used a well‐established model of type 2 diabetes, the db/db mice, to assess the presence of retinal oedema and/or neovascularization.Methods12 weeks old db/+ and db/db mouse (n=8) were used in this study. We studied blood retinal barrier integrity by means of vascular leakage in fundus angiography by fluorescein injection and immunocytochemistry against albumin. Furthermore, we used transmitted electron microscopy to observe tight junction status. Finally, to visualize and assess retinal vascularization, eye fundus angiography and histology were performed.ResultsFluorescein and albumin remained inside the vessels proving the integrity of blood retinal barrier, in both controls and db/db retinas. However, retinal fundus angiography revealed that 50% of db/db mice presented intravitreal vessels protruding from the optic disc. Moreover, histological analysis showed a significant increment in the number of vessels in the db/db vitreous compared to db/+, in accordance with the angiography findings.ConclusionsRetinal fundus angiography and histological analysis showed the presence of intravitreal vessels in diabetic db/db mice, suggesting the existence of a current angiogenic process. However, apparently, twelve old week’s db/db mice did not show signs of retinal oedema.

Weakly supervised training for eye fundus lesion segmentation in patients with diabetic retinopathy.

Diabetic retinopathy is the leading cause of vision loss in working-age adults. Early screening and diagnosis can help to facilitate subsequent treatment and prevent vision loss. Deep learning has been applied in various fields of medical identification. However, current deep learning-based lesion segmentation techniques rely on a large amount of pixel-level labeled ground truth data, which limits their performance and application. In this work, we present a weakly supervised deep learning framework for eye fundus lesion segmentation in patients with diabetic retinopathy. First, an efficient segmentation algorithm based on grayscale and morphological features is proposed for rapid coarse segmentation of lesions. Then, a deep learning model named Residual-Attention Unet (RAUNet) is proposed for eye fundus lesion segmentation. Finally, a data sample of fundus images with labeled lesions and unlabeled images with coarse segmentation results is jointly used to train RAUNet to broaden the diversity of lesion samples and increase the robustness of the segmentation model. A dataset containing 582 fundus images with labels verified by doctors, including hemorrhage (HE), microaneurysm (MA), hard exudate (EX) and soft exudate (SE), and 903 images without labels was used to evaluate the model. In ablation test, the proposed RAUNet achieved the highest intersection over union (IOU) on the labeled dataset, and the proposed attention and residual modules both improved the IOU of the UNet benchmark. Using both the images labeled by doctors and the proposed coarse segmentation method, the weakly supervised framework based on RAUNet architecture significantly improved the mean segmentation accuracy by over 7% on the lesions. This study demonstrates that combining unlabeled medical images with coarse segmentation results can effectively improve the robustness of the lesion segmentation model and proposes a practical framework for improving the performance of medical image segmentation given limited labeled data samples.

La retina, una ventana de la enfermedad cerebrovascular en la diabetes

Cerebrovascular disease is one of the complications of long-term diabetes mellitus. While the structure and function of the great cerebral vessels may be more easily studied, the cerebral microcirculation is difficult to assess. However, a simple eye fundus examination with an ophthalmoscope enables to visualize the microvascular abnormalities that characterize diabetic retinopathy, which isth e most common microvascular complication of diabetes. The anatomical and functional similarity between retinal and cerebral microcirculation supports the hypothesis that alterations in retinal vascular reactivity could be considered as an early marker of cerebral microvascular dysfunction in diabetes. The initiating factor of diabetic angiopathies is endothelial dysfunction. Endothelial dysfunction results in a reduced bioavailability of nitric oxide (NO), as a consequence of decreased NO synthesis and/or increased production of free oxygen radicals that are NO scavengers. Diabetes also stimulates the production of endothelial-derived contractile factors such as superoxide anions and hydroxyl radicals, endothelin and certain cyclooxygenase (COX) derivatives. COX activation is related to a high level of oxidative stress. Oxidative stress participates in the inflammatory response involved in the diabetic vascular dysfunction. These pathogenic mechanisms have been shown in both cerebral and retinal arteries, mainly through in vitro vascular reactivity studies, suggesting that diabetes induces a profound change in microvascular regulatory mechanisms. The association between the degree of retinal perfusion, brain injuries and altered cognitive function indicates a certain parallelism in the degree of impairment of both retinal and brain circulations. In addition, prospective studies conclude that diabetic retinopathy predicts ischemic cerebrovascular disease independently of other risk factors, supporting the importance of cerebral microvascular disease in diabetics. Further research on the vascular abnormalities is needed to understand the pathogenic mechanisms underlying retinopathies and cerebrovascular disease in diabetes. In the near future, the use of fully automated methods to detect signs of retinopathy will not only facilitate the efficient evaluation of vascular changes in the retina but will also help to reduce cerebral vascular morbidity and mortality.

A novel JAYA algorithm for optic disc localisation in eye fundus images

Retinal images are extensively used for the disclosure of retinal vascular disorders like diabetic retinopathy, glaucoma, age-related macular degeneration and optic neuritis. The analysis of a diagnostic retinal image using a computer is necessary to ease the optometrist for automating the load screening mechanism to identify these disorders. The primary step in technology aided diagnoses is optic disc segmentation and it is considered as an interesting search problem. The proposed methodology involves pre-processing of fundus images and optic disc localisation using Jaya algorithm. A new fitness function is proposed in order to improve the accuracy of the optic disc localisation. The efficiency of the proposed methodology is examined on different datasets such as DIARETDB1, DIARETDB0, CHASEDB1, DRIONS and DRIVE. The results infer that the proposed methodology has achieved a 99% of location accuracy and shows its superiority in localising the optic disc by comparing it with existing literature.

Результаты анализа сетчатки при сочетанной патологии миопии средней степени и возрастной макулярной дегенерации. Подходы к лечению

Aim: to assess retinal status in comorbid ocular disorders (moderate myopia and age-related macular degeneration/AMD of various stages) using modern diagnostic tools. Patients and Methods: 48 patients (96 eyes) with moderate myopia and dry AMD were enrolled. Best-corrected visual acuity (BCVA), mean deviation/MD (characterizes mean reduction of sensitivity), pattern standard deviation/PSD (characterizes the severity of local visual field defects), central macular thickness (CMT), and axial length (AL) were measured. The macular zone was investigated by optical coherence tomography (OCT) using B scan and fundus autofluorescence (FAF) regimens. Results: in moderate myopia associated with dry AMD (AREDS categories 1,2,3), a significant reduction in the mean BCVA (20/25) was detected in 54.2% (26 patients, 52 eyes). Retinal photosensitivity indices (MD and PSD) were also significantly reduced to 2.19 dB (р<0.001) and 2.14 dB (р<0.001), respectively. AL was significantly increased (25.11 mm, р<0.001). No significant differences in CMT values were revealed (233 mcm, p=0.123). In comorbid ocular disorders, severe defects and focuses of RPE atrophy, extensive areas of the IS/OS junction line damage, and drusen are seen among morphological abnormalities of the eye fundus. FAF identified certain pathological patterns, e.g., focal hypo- and hyperautofluorescence, hyperautofluorescent halo at the border of staphyloma, linear hypoautofluorescent bands surrounded with hyperautofluorescence, reticular pattern, patches, focal and multifocal areas of geographic atrophy. Conclusion: our findings on visual field loss (MD, PSD) in AMD depending on stage and OCT findings in AMD are in line with the results of other authors. Meanwhile, we investigated a comorbid variant (AMD in association with moderate myopia), compared morphological and functional parameters, and addressed the relevance of FAF. Keywords: myopia, age-related macular degeneration, optical coherence tomography, autofluorescence. For citation: Moshetova L.K., Alekseev I.B., Vorob’eva I.V., Nam Yu.A. Retinal status in moderate myopia and age-related macular degeneration. Management strategies. Russian Journal of Clinical Ophthalmology. 2022;22(2):91–98 (in Russ.). DOI: 10.32364/2311- 7729-2022-22-2-91-98.

A novel JAYA algorithm for optic disc localisation in eye fundus images

Retinal images are extensively used for the disclosure of retinal vascular disorders like diabetic retinopathy, glaucoma, age-related macular degeneration and optic neuritis. The analysis of a diagnostic retinal image using a computer is necessary to ease the optometrist for automating the load screening mechanism to identify these disorders. The primary step in technology aided diagnoses is optic disc segmentation and it is considered as an interesting search problem. The proposed methodology involves pre-processing of fundus images and optic disc localisation using Jaya algorithm. A new fitness function is proposed in order to improve the accuracy of the optic disc localisation. The efficiency of the proposed methodology is examined on different datasets such as DIARETDB1, DIARETDB0, CHASEDB1, DRIONS and DRIVE. The results infer that the proposed methodology has achieved a 99% of location accuracy and shows its superiority in localising the optic disc by comparing it with existing literature.

A Comprehensive Review of Deep Learning Strategies in Retinal Disease Diagnosis Using Fundus Images

In recent years, there has been an unprecedented growth in computer vision and deep learning implementation owing to the exponential rise of computation infrastructure. The same was also reflected in retinal image analysis and successful artificial intelligence models were developed for various retinal disease diagnoses using a wide variety of visual markers obtained from eye fundus images. This article presents a comprehensive study of different deep learning strategies employed in recent times for the diagnosis of five major eye diseases, i.e., Diabetic retinopathy, Glaucoma, age-related macular degeneration, Cataract, and Retinopathy of prematurity. This article is organized according to the deep learning implementation process pipeline, where commonly used datasets, evaluation metrics, image pre-processing techniques, and deep learning backbone models are first illustrated followed by an extensive review of different strategies for each of the five mentioned retinal diseases is presented. Finally, this article summarizes eight major research directions available in the field of retinal disease diagnosis and outlines key challenges and future scope for the present research community.

Artificial Intelligence-Based Teleopthalmology Application for Diagnosis of Diabetics Retinopathy.

Diabetic Retinopathy (DR) is one of the leading causes of blindness for people who have diabetes in the world. However, early detection of this disease can essentially decrease its effects on the patient. The recent breakthroughs in technologies, including the use of smart health systems based on Artificial intelligence, IoT and Blockchain are trying to improve the early diagnosis and treatment of diabetic retinopathy. In this study, we presented an AI-based smart teleopthalmology application for diagnosis of diabetic retinopathy. The app has the ability to facilitate the analyses of eye fundus images via deep learning from the Kaggle database using Tensor Flow mathematical library. The app would be useful in promoting mHealth and timely treatment of diabetic retinopathy by clinicians. With the AI-based application presented in this paper, patients can easily get supports and physicians and researchers can also mine or predict data on diabetic retinopathy and reports generated could assist doctors to determine the level of severity of the disease among the people.

Knowledges, Attitudes and Practices of Diabetic Patients Face to Diabetic Retinopathy in Parakou in 2019

Introduction: Diabetic retinopathy is one of the main causes of blindness. Preventive measures and screening will reduce its impact. Objective: Study the knowledges, attitudes and practices of diabetic patients about diabetic retinopathy from 03 hospitals in the District of Parakou in 2019. Methods: The study was carried out in 03 hospitals in northern Benin (University and Regional Health Center of Borgou and Alibori, Army Health Center of Parakou, and the Diabetes Center of Benin. This was a descriptive and analytical cross-sectional prospective study that covered a period of 03 months from 15th May to 20th August, 2019. The sampling method was non-probability. Selection of diabetic patients was exhaustive taking care for the consent of each patient. The aged group was at least 18 years old and above, resident in Parakou and followed up in one of the above heath centers. We enrolled 150 patients after submitted them to some questionnaires. Results: From the total number of 150 patients, 59.33% were male. The mean age was 55.07 ± 11.62 years. The participants were predominantly married (87.33%) and 62% of them were literate. 48% of patients said diabetes mellitus is responsible of eye complications. 52% and 12% of patients reported that balancing blood sugar and normalizing blood pressure, respectively, are preventative factors for diabetic retinopathy. 27.33% of patients reported the need for a regular eye fundus exam. 12.67% of patients have a regular annual eye fundus examination and 56.67% of patients have never had one. Education and gender were associated with level of knowledges; education and low income were associated with level of practices. Conclusion: Reducing the impact of diabetic retinopathy requires better involvement of the diabetic patient, the ophthalmologist, the endocrinologist and the authorities of the Ministry of Health.

End-to-end multi-task learning for simultaneous optic disc and cup segmentation and glaucoma classification in eye fundus images

The automated analysis of eye fundus images is crucial towards facilitating the screening and early diagnosis of glaucoma. Nowadays, there are two common alternatives for the diagnosis of this disease using deep neural networks. One is the segmentation of the optic disc and cup followed by the morphological analysis of these structures. The other is to directly address the diagnosis as an image classification task. The segmentation approach presents the advantage of using pixel-level labels with precise morphological information for training. However, while this detailed training feedback is not available for the classification approach, in this case the image-level labels may allow the discovery of additional non-morphological cues that are also relevant for the diagnosis.In this work, we propose a novel multi-task approach for the simultaneous classification of glaucoma and segmentation of the optic disc and cup. This approach can improve the overall performance by taking advantage of both pixel-level and image-level labels during the network training. Additionally, the segmentation maps that are predicted together with the diagnosis allow the extraction of relevant biomarkers such as the cup-to-disc ratio. The proposed methodology presents two relevant technical novelties. First, a network architecture for simultaneous segmentation and classification that increases the number of shared parameters between both tasks. Second, a multi-adaptive optimization strategy that ensures that both tasks contribute similarly to the parameter updates during training, avoiding the use of loss weighting hyperparameters.To validate our proposal, an exhaustive experimentation was performed on the public REFUGE and DRISHTI-GS datasets. The results show that our proposal outperforms comparable multi-task baselines and is highly competitive with existing state-of-the-art approaches. Additionally, the provided ablation study shows that both the network architecture and the optimization approach are independently advantageous for multi-task learning.

Effect of 7DH biotherapic of Toxoplasma gondii in mice infected with the protozoan

Introduction: Toxoplasmosis is a zoonosis caused by Toxoplasma gondii worldwide distributed [1]. In both, men and animals, the infection with T. gondii can lead to important pathologies [2]. The study of alternative treatments is important to set new therapeutic protocols, especially for the prevention of congenital toxoplasmosis.
 
 Aim: This study evaluated the effect of a biotherapic 7DH T. gondii in mice infected with T. gondii.
 
 Material and methods: The study was approved by the Ethics Committee for Animal Experimentation of the Universidade Estadual de Maringá – Protocol n° 036/2009. Fourteen mice were used – swiss male aged 57 days divided into two groups according to the treatment (or its diluent biotherapic): BIOT-200DH and Control (cereal alcohol-7%).The biotherapic was prepared with homogenized mouse brain (20 cysts of T.gondii/100μL-average 242 bradyzoites / cyst), according to the Brazilian Homeopathic Pharmacopoeia [3] in laminar flow. The experiment was performed as a blind randomized controlled trial. The animals were treated for 3 days immediately prior to infection. The oral treatment schedule was of 0.1mL/4x/ day, on the first day, followed by 2x/day. Animals aged 57 – 59 days were treated with biotherapic and were clinically evaluated. The animals were orally infected at the age of 60 days (20 cysts ME49-T. gondii). Within18-21 days of infection the clinical parameters were evaluated. On the 55th day of infection the eye fundus was examined (Ophthalmoscope Welch Allyn ®) and the intraocular pressure was measured (Tonometer TONO-PEN ® XL). After 60 days of post-infection the animals were killed in a chamber saturated with halothane, the brains were homogenized and resuspended in 1 ml of saline solution. The cysts were counted according to a rate of 25 mL of suspension, covered with 24x24 mm glass, examined in its full length.
 
 Results and discussion: The table 1 summarizes the clinical data. There was no significant difference among the groups for clinical parameters during treatment, although it was recorded the death of an animal in the biotherapic 7DH group. The dead animal presented distended stomach and liquid feces in the intestine. After the infection it was observed reduction of water consumption (p

Biotherapic 200 DH reduces of parasitism in mice infected with cerebral Toxoplasma gondii

Introduction: Toxoplasmosis is a zoonosis that represents a serious public health problem, worldwide distributed. Pregnant women are part of the most risky group due to congenital sequels. The necessity of a preventive treatment for congenital infections is of great importance [1] Biotherapics, highly diluted medicines prepared with T. gondii according to the Brazilian Homeopathic Pharmacopoeia [2], is an important prevention strategy, ensuring a safe and cheap approach to protozoan infections [3]. However, little is known about the effects of different potencies and treatment schedules.
 
 Aim: To evaluate the effect of biotherapic 200DH in mice infected with Toxoplasma gondii.
 
 Material and methods: The study was approved by the Ethics Committee for Animal Experimentation of the Universidade Estadual de Maringá – Protocol n° 036/2009. Fourteen mice were used – swiss male aged 57 days divided into two groups according to the treatment (or its diluent biotherapic): BIOT-200DH and Control (cereal alcohol-7%). The biotherapic was prepared with homogenized mouse brain (20 cysts of T.gondii/100μL-average 242 bradyzoites / cyst), according to the Brazilian Homeopathic Pharmacopoeia in laminar flow. The experiment was performed as a blind randomized controlled trial. The animals were treated for 3 days immediately prior to infection. The treatment schedule was of 0.1mL/single dose/ day, by gavage. Animals aged 57 – 59 days were treated with biotherapic and were clinically evaluated. The animals were orally infected at the age of 60 days (20 cysts ME49-T. gondii). Within18-21 days of infection the clinical parameters were evaluated. On the 55th day of infection the eye fundus was Examined (Ophthalmoscope Welch Allyn ®) and the intraocular pressure was measured (Tonometer TONO-PEN ® XL). After 60 days of post-infection the animals were killed in a chamber saturated with halothane, the brains were homogenized and resuspended in 1 ml of saline solution. The cysts were counted according to a rate of 25 mL of suspension, covered with 24x24 mm glass, examined in its full length.
 
 Results and discussion: The number of brain cysts was compared among groups using the Mann-Whitney test with 5% of significance. Although there was no significant difference among the groups (p =0.2943), the results are interesting: the number of cysts - average ± standard deviation –was of the 4.5 ± 3.3 in the BIOT-200DH group and of 9.7 ± 12.8 in the control group. It is necessary to emphasize the great variability within the control group expressed by the standard deviation.
 
 Likewise, there was no significant difference among the average of intraocular pressure observed in the control group (8.9 ± 3.8) and the group BIOT-200DH (8.0 ± 2.6). Regarding fundoscopy, the control group presented 57.14% of the animals without changes and 42.86% with discreet subretinal hemorrhage. While in the BIOT-200DH group, 50% of the animals showed no change and 50% showed discreet subretinal hemorrhage. Compared with the results from the use of other biotherapic T. gondii potencies [4], these results indicate that mice infected with the protozoan reacted better to the potency 200DH, Although mortality. This better response may the chronic aspect of the infection and/ or the characteristics of host-parasite relationship in the infection with T. gondii that involves alterations in the central nervous system.
 
 Conclusion: The highly diluted biotherapic 200DH T. gondii caused mortality in one animal in group however caused no significant difference other clinical and parasitological parameters evaluated although there was a decrease of parasitism brain of mice infected with the protozoan compared to control group.

Diagnostic challenges of an incidental finding: case report of definitely-congenital glioblastoma multiforme in a very preterm infant

BackgroundCongenital brain tumors are extremely rare in the neonatal population, and often associated with a poor prognosis. The diagnostic suspicion is often aroused at antenatal scans or postnatally, if clinical signs and symptoms of increased intracranial pressure become evident. We present a case of definitely congenital glioblastoma multiforme incidentally diagnosed in a preterm infant, aiming to raise clinical awareness on this condition and to highlight the challenges of the related diagnostic work-up.Case presentationThis female infant was born at 31 weeks’ gestation after an uneventful pregnancy. No abnormalities were detected at antenatal ultrasound scans and genetic tests. Head circumference at birth was on the 25th centile. A routine brain ultrasound scan performed on day 1 revealed a large, inhomogeneous lesion in the right cerebral hemisphere, with contralateral midline shift, which was confirmed by brain magnetic resonance imaging (MRI). Eye fundus and routine blood exams, including platelets count, coagulation screening and C-reactive protein, were normal.Given the high risk of complications, surgical biopsy of the lesion was temporarily hold and a daily sonographic follow-up was undertaken. Although head circumference growth was steady on the 25th centile, progressive changes of the lesion were detected by cranial ultrasound.The repeat MRI scans showed a significant enlargement of the mass, with contralateral midline shift and signs of intralesional and intraventricular bleeding. In view of this worsening, surgical resection was performed. The histological examination of the lesion biopsy documented a GFAP+ highly cellular neoplasm, with no mutation on SMARCB1 gene. At the molecular analysis, mutations on IDH and H3F3A genes were absent, whereas MGMT promoter was unmethylated. The diagnosis was grade IV glioblastoma IDH wild-type.ConclusionsCongenital glioblastoma multiforme is an extremely rare but highly aggressive neoplasm. Since intralesional biopsy is not often feasible in affected neonates, knowledge of the associated clinical and neuroradiological features is particularly important, as they can also add useful information on the neoplasm behavior. Specimens from open surgical resection allow to perform a definite histological analysis and an extended molecular characterization, with relevant prognostic implications.