Fully Automated Deep Learning System for Bone Age Assessment

Skeletal maturity progresses through discrete phases, a fact that is used routinely in pediatrics where bone age assessments (BAAs) are compared to chronological age in the evaluation of endocrine and metabolic disorders. While central to many disease evaluations, little has changed to improve the tedious process since its introduction in 1950. In this study, we propose a fully automated deep learning pipeline to segment a region of interest, standardize and preprocess input radiographs, and perform BAA. Our models use an ImageNet pretrained, fine-tuned convolutional neural network (CNN) to achieve 57.32 and 61.40% accuracies for the female and male cohorts on our held-out test images. Female test radiographs were assigned a BAA within 1 year 90.39% and within 2 years 98.11% of the time. Male test radiographs were assigned 94.18% within 1 year and 99.00% within 2 years. Using the input occlusion method, attention maps were created which reveal what features the trained model uses to perform BAA. These correspond to what human experts look at when manually performing BAA. Finally, the fully automated BAA system was deployed in the clinical environment as a decision supporting system for more accurate and efficient BAAs at much faster interpretation time (<2 s) than the conventional method.     

Diagnostic value of susceptibility-weighted imaging of abdominal wall endometriomas during the cyclic menstrual changes: A preliminary study

Objective

The purpose of this study is to investigate the value of susceptibility-weighted imaging (SWI) for the evaluation of cyclic morphological and hemorrhagic changes in abdominal wall endometriomas (AWE).

Materials and methods

Fourteen patients with a total of 17 lesions who were admitted with complaints of abdominal wall mass and cyclic pain were evaluated by MRI. Patients were scanned during the first three days of the menstrual cycle and during the mid-cycle phase (day 13–15). In addition to conventional images SWI was performed. The signal changes within the lesions on SWI were compared and graded on both studies.

Results

There was no significant difference in the size of the lesions in the early days of the menstruation compared to the mid-menstrual period. The SWI taken on mid-cycle phase showed that the center was hyperintense and the peripheral zone was hypointense in all lesions. A signal void related to increased blood and the shrinkage of complete disappearance of hyperintensity in the venter of the lesion was seen 15 (88%) of the 17 cases on the SWI series performed during the menstrual phase scan.

Conclusion

SWI is a sensitive technique and has the capability to show hemorrhage and deposition of hemosiderin within the lesions. For patients suspected with AWE, valuable diagnostic findings may be obtained if the MRI examination including SWI is performed during the early and mid phase menstrual cycle.     

Prevalence and Associated Factors of Burnout syndrome among Nurses in Public Hospitals,Southwest Ethiopia

BackgroundThe Burnout syndrome has been defined as a response to the chronic work-related stress typically found in professionals working in care service organizations. Therefore, this study aimed at assessing the prevalence of burnout syndrome and factors associated with burnout syndrome among nurses in public hospitals, Southwest Ethiopia, 2018.MethodAn institutional-based cross-sectional study was conducted from February 1^st, 2018 to April 1^st, 2018. Total number of nurses who fulfill the inclusion criterias were enrolled. Data was collected using the predesigned tool. Data were entered using EPI INFO version 7 and was exported to statistical packages for social science (SPSS) version 21.0 for analysis. Logistic regression was employed and odds ratio with a 95% confidence interval was used. Variables with a P value of less than 0.05 was considered statistically significant.ResultsA total of 282 eligible nurses were enrolled in the study with a mean age of 28.71 [SD ±7.047]. The prevalence of burnout syndrome among nurses was 96(34%). Predictor variables like; educational status, job title, work experience, fatigue, and social support were found to be strong predictor variables for burnout syndrome.ConclusionThis study revealed that a considerable proportion of nurses had burnout syndrome. Therefore, improved educational status and strong social support should be encouraged among nurses working in the health setting for the betterment of health care services, job satisfaction and quality of care in general.     

Serum Vitamin D Level among Multiple Sclerosis Patients in the Tropics: Experience from a Private Clinic in Addis Ababa,Ethiopia

BackgroundMultiple sclerosis (MS) is an immune mediated disabling neurological disorder. Very little is known about MS in Ethiopia. The objective of this study was to determine the prevalence of hypovitaminosis D and associated factors in cohort of MS patients in Ethiopia.MethodA cross-sectional observational study was conducted among 25 multiple sclerosis patients at Yehuleshet Specialty Clinic, Addis Ababa, Ethiopia.ResultsThe prevalence of vitamin D deficiency was 96% (n=24). The average serum vitamin D was 14.8 (±10.4) ng/mL. The mean age was 35.8 (±10) years. Females accounted for 80% (n=20). Relapsing and remitting MS was the commonest variant. Motor, sensory, and mixed symptoms accounted for 40% (n=10), 20% (n=5), and 24% (n=6), respectively. Cold or hot weather and stress were reported as worsening factors in 24% (n=6). Relapse rate was 44% (n=11). Fatigue and seizure disorder were reported by 80% (n=20) and 16% (n=4) respectively. Steroid is the commonest prescribed medication for the patients. A negative correlation was found between serum vitamin D and age (r = -0.062, p = 0.7). Similarly, a negative association was observed between vitamin D and duration of illness (r = -0.311, p = 0.1). Fatigue was reported by those with moderate hypovitaminosis compared to those having severe hypovitaminosis (p=0.002). Seizure was reported more by those with vitamin D below 10ng/mL compared to those having above 10 ng/mL (p=0.004).ConclusionOur study demonstrates a high prevalence of hypovitaminosis D in Ethiopian MS patients. Hypovitaminosis D was associated with increment in age and duration of illness.     

Critical appraisal of currently used oxytocin regimen and prospects

About half a century passed since synthetic oxytocin use to induce or augment labour came in to clinical practice; however, so far there is no international consensus on the dose regimen. In most studies, high dose regimen and long increment interval were found to have much desirable obstetric outcomes (short induction-to-delivery time, low caesarean section rate, less fetal and maternal risk). Although different centres use different starting and increment dose regimen, the stepwise increment till the maximum dose achieved (20 mu/min for low-dose and 42 mu/ min for high dose regimen) is the common feature. The oxytocin regimen practiced in Ethiopia is unique: different regimen is used for nulliparas and multiparas; half dose of induction is for augmentation; the maximum dose achieved at the middle of the cycle is nearly twice (74.3-85.4 mu/min) the maximum dose other centres use (42 mu/ min). Dose increment is also so bizarre and swinging. The maximum dose achieved at the middle of the three cycles is not maintained In general, to the best of author's accessible resources, the origin of this regimen is not clear and can not be traced to any scientific literature. Therefore, easily applicable regimen for Ethiopian set up is presented for clinical trail.     

A Methanol Extract of Adansonia digitata L. Leaves Inhibits Pro-Inflammatory iNOS Possibly via the Inhibition of NF-κB Activation

This study examined the total polyphenol content of eight wild edible plants from Ethiopia and their effect on NO production in Raw264.7 cells. Owing to its relatively high polyphenol concentration and inhibition of NO production, the methanol extract of Adansonia digitata L. leaf (MEAD) was subjected to detailed evaluation of its antioxidant and anti-inflammatory effects. Antioxidant effects were assessed by measuring free-radical-scavenging activity using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and oxygen-radical-absorbance capacity (ORAC) assays, while anti-inflammatory effects were assessed by measuring inducible nitric oxide synthase (iNOS) expression in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. In the ORAC assay, MEAD was 10.2 times more potent than vitamin C at eliminating peroxyl radicals. In DPPH assay, MEAD also showed a strong ROS scavenging effect. MEAD significantly inhibited iNOS activity (IC₅₀=28.6 μg/ml) of LPS-stimulated Raw264.7 cells. We also investigated the relationship between iNOS expression and nuclear factor kappa B (NF-κB) activation. MEAD inhibited IκBα degradation and NF-κB translocation from the cytosol to the nucleus in LPS-induced RAW264.7 cells without significant cytotoxic effects, as confirmed by MTT assay. These results suggest that MEAD inhibits anti-inflammatory iNOS expression, which might be related to the elimination of peroxyl radicals and thus the inhibition of IκBα-mediated NF-κB signal transduction.