Semi-automatic 3D Segmentation Of Costal Cartilage In CT Data From Pectus Excavatum Patients

One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69±0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.

Assessment and prediction of asthma and its severity in the pediatric community

Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (r s= .36) and treatment (r s= .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p= .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.

Learning techniques for automatic email message tagging

A organização automática de mensagens de correio electrónico é um desafio actual na área da aprendizagem automática. O número excessivo de mensagens afecta cada vez mais utilizadores, especialmente os que usam o correio electrónico como ferramenta de comunicação e trabalho. Esta tese aborda o problema da organização automática de mensagens de correio electrónico propondo uma solução que tem como objectivo a etiquetagem automática de mensagens. A etiquetagem automática é feita com recurso às pastas de correio electrónico anteriormente criadas pelos utilizadores, tratando-as como etiquetas, e à sugestão de múltiplas etiquetas para cada mensagem (top-N). São estudadas várias técnicas de aprendizagem e os vários campos que compõe uma mensagem de correio electrónico são analisados de forma a determinar a sua adequação como elementos de classificação. O foco deste trabalho recai sobre os campos textuais (o assunto e o corpo das mensagens), estudando-se diferentes formas de representação, selecção de características e algoritmos de classificação. É ainda efectuada a avaliação dos campos de participantes através de algoritmos de classificação que os representam usando o modelo vectorial ou como um grafo. Os vários campos são combinados para classificação utilizando a técnica de combinação de classificadores Votação por Maioria. Os testes são efectuados com um subconjunto de mensagens de correio electrónico da Enron e um conjunto de dados privados disponibilizados pelo Institute for Systems and Technologies of Information, Control and Communication (INSTICC). Estes conjuntos são analisados de forma a perceber as características dos dados. A avaliação do sistema é realizada através da percentagem de acerto dos classificadores. Os resultados obtidos apresentam melhorias significativas em comparação com os trabalhos relacionados.

Estudo de dislipidemias familiares monogénicas raras

A dislipidemia é um distúrbio do perfil lipídico, seja por elevação ou diminuição de partículas lipídicas. O objetivo deste trabalho é fazer uma revisão dos casos com dislipidemia rara em estudo no Instituto Nacional de Saúde Doutor Ricardo Jorge, apresentando os dados clínicos e moleculares mais relevantes. O perfil lipídico foi determinado para cada caso índex e familiares e o estudo molecular dos genes envolvidos foi realizado por amplificação por PCR e sequenciação de Sanger. Foram estudados, ou está em curso o estudo, de 14 casos índex com os seguintes diagnósticos clínicos: Deficiência familiar em lipoproteína lípase (3), Lipodistrofia familiar parcial de Dunningan Tipo 2 (1), Deficiência em lípase ácida lisossomal (3), Abeta/hipobetalipoproteinemia (2), Deficiência em HDL (1), Hipertrigliceridemia autossómica recessiva (3), Sitosterolemia (1). O fenótipo clínico de cada caso índex é variável dependendo de cada condição. Foi encontrada a causa genética da doença em 8/14 doentes, estando os restantes ainda em estudo. Doentes com as várias dislipidemias raras apresentadas têm um risco acrescido de ter outras doenças graves como pancreatite, doença cardiovascular ou complicações neurológicas e devem, por esta razão, ser identificados o mais precocemente possível, de forma a minimizar ou prevenir os efeitos nefastos destas condições.

Valor preditivo do "Clinical Risk Index for Babies" para o risco de mortalidade neonatal

OBJETIVO: Comparar o valor preditivo do CRIB (Clinical Risk Index for Babies) para o risco de mortalidade neonatal ao peso de nascimento (PN) e idade gestacional (IG). MÉTODO: Numa coorte prospectiva foram estudados, durante o ano de 1996, 71 recém-nascidos admitidos na unidade de terapia intensiva, com PN < 1.500 g e/ou IG < 31 semanas. RESULTADOS: A taxa de mortalidade foi de 29,6%; para PN < 1.000 g ou IG < 29 semanas foi de 60%, enquanto que para o escore de CRIB > 10 foi de 100%. CONCLUSÕES: O escore de CRIB > 10 correspondeu a maiores especificidade e valor preditivo positivo em relação aos demais parâmetros. A área determinada pela "receiver operating characteristic" relativa ao CRIB também foi superior. O CRIB mostrou-se um marcador mais acurado na previsão de risco de mortalidade quando comparado ao PN ou IG isoladamente.

Clinical and laboratory parameters in dapsone acute intoxication

OBJECTIVE: To determine the severity of dapsone (DDS) acute intoxication – an uncommon medical event – using clinical and laboratory parameters. METHODS: Two hundred and seventy four patients with acute DDS intoxication, aged 1 month to 50 years old, were studied and classified into four age groups. Clinical evaluation was assessed through a protocol and correlated with laboratory parameters. Spectrophotometric methods were used to analyze methemoglobinemia (MHbp) and dapsonemia (DDSp). RESULTS: The most prevalent clinical sign of intoxication was cyanosis, seen in 65.7% of the patients and in 100% of children less than 5 years of age. According to laboratory criteria, MHbp-related severe clinical intoxication was seen in 56.2% and DDSp-related occurred in 58% of the patients. Regarding DDSp, intoxication was considered severe when 20 tablets (100 mg each) were ingested, a median of 29 mug/ml. Regarding MHbp, intoxication was severe when 7.5 tablets were ingested, a median of 38% of the total Hb. The correlation between MHbp and DDSp was statistically significant (n=144, r=0.32, p<0.05). Negative correlation was observed between MHbp and the time elapsed since DDS intake (n=124, r=-0.34, p<0.001). There was also a negative correlation between DDSp and the time elapsed since DDS intake (n=63, r=-0.35, p<0.0001). CONCLUSIONS: Longitudinal analysis showed a significant association between methemoglobinemia and the time elapsed after the intake (t), according to the equation: Dapsonemia = 12.9256 - 0.0682t + 0.234 methemoglobinemia

Short-term Feature Space and Music Genre Classification

In music genre classification, most approaches rely on statistical characteristics of low-level features computed on short audio frames. In these methods, it is implicitly considered that frames carry equally relevant information loads and that either individual frames, or distributions thereof, somehow capture the specificities of each genre. In this paper we study the representation space defined by short-term audio features with respect to class boundaries, and compare different processing techniques to partition this space. These partitions are evaluated in terms of accuracy on two genre classification tasks, with several types of classifiers. Experiments show that a randomized and unsupervised partition of the space, used in conjunction with a Markov Model classifier lead to accuracies comparable to the state of the art. We also show that unsupervised partitions of the space tend to create less hubs.

Trypanosoma cruzi prevalence and clinical forms in blood donor candidates in Brazil

The prevalence and clinical forms of Trypanosoma cruzi were evaluated among blood donor candidates attended at a general hospital in Rio de Janeiro, Brazil, from January 1997 to April 1999. The investigation was done by means of the indirect hemagglutination test and was confirmed via ELISA. Data were collected from clinical examinations, conventional electrocardiogram, chest radiography and echocar-diography. The results showed that despite Trypanosoma cruzi prevalence of 1.17% (128 patients), mainly in males aged 40 years or over, 70.8% of these patients, mainly males aged 19 to 39 years, demonstrated abnormalities that allowed the diagnosis of cardiopathy and/or esophagopathy. This once again corroborates the importance of Trypanosoma cruzi infection in urban centers.

Clinical Education - a fundamental curricular unit for all health practitioners

Clinical education is recognized as being crucial for the training of health professionals. This subject is debated amongst teachers, students and professionals. Besides the clinical and research skills, we look for other competencies such as oratory, creative thinking or leadership. We present the results of a study with 4th graders. It’s a exploratory study; the main purpose was to evaluate the outcomes of a unit of clinical education prepared according a new set of competencies and methodologies. The competencies were seen as valuable. Organization, leading or supporting a colleague, rethinking a program to serve client and family are equally important.

Novel method using a laser scanning cytometer for detection of Mycobacteria in clinical samples

In order to evaluate the capacity of laser scanning cytometry (LSC) to detect acid-fast bacilli directly on clinical samples, a comparison between Kinyoun-stained smears analyzed under light microscopy and propidium iodide-auramine-stained smears analyzed by LSC was performed. The results were compared with those for culture on BACTEC MGIT 960. LSC is a new, reliable methodology to detect Mycobacteria.

Validade da versão em português da Clinical Dementia Rating

OBJETIVO: Analisar a validade da versão em português da Clinical Dementia Rating para classificar a função cognitiva de idosos. MÉTODOS: Utilizou-se o instrumento Mini-Mental State Examination para rastreamento de déficit cognitivo em coorte composta por 424 idosos. Foram selecionados todos que obtiveram escores <26 (108 idosos) e 48 idosos com escores >26. Os 156 idosos selecionados foram submetidos a uma avaliação clínica e testes neuropsicológicos para diagnóstico de casos de demência. Tanto os casos como os não-casos foram classificados segundo a versão em português da Clinical Dementia Rating em: normais, casos questionáveis e casos de demência leve, moderada ou grave. RESULTADOS: Entre os 156 avaliados, 122 eram não-casos, destes 62 (51%) foram classificados como normais (CDR=0) e questionáveis 60 (49%) (CDR=0,5). Entre os 34 casos de demência, 17 (50%) foram classificados como demência leve (CDR=1), 8 (23%) moderada (CDR=2) e 6 (18%) grave (CDR=3). Apenas três (9%) dos casos foram considerados questionáveis pelo Clinical Dementia Rating. Sua sensibilidade foi de 91,2% e a especificidade de 100%, com valor preditivo positivo de 100% e negativo de 97,6%. As pontuações no Mini-Mental State Examination declinaram significativamente conforme o grau de demência. CONCLUSÕES: O Clinical Dementia Rating mostrou ser instrumento válido para classificar o grau de demência entre idosos. Quase metade dos não-casos foram casos questionáveis pelo Clinical Dementia Rating e podem corresponder a casos de transtorno cognitivo leve, com maior risco de conversão em demência.

HIV infection and AIDS in a small municipality in Southeast Brazil

OBJECTIVE: Studies on the aspects of HIV infection in small Brazilian municipalities are invaluable to appropriately design control strategies, better allocate resources, and improve health care services. The objective of the study was to assess the clinical and epidemiological aspects of HIV infection in a small municipality. METHODS: A descriptive study was carried out in Miracema, a small municipality in the northwestern area of the state of Rio de Janeiro, Brazil, between July 1999 and December 2003. All HIV-infected adult patients followed up at the local HIV/AIDS Program were included. Clinical and epidemiologic characteristics were prospectively assessed through standardized questionnaires. RESULTS: A total of 65 adult patients who attended the local HIV/AIDS Program were analyzed. Most (34) were women (male to female ratio: 0.9). An absolute predominance of patients who were born in Miracema or neighboring municipalities (94%), lived in Miracema (90.7%), were single (70.8%), attributed the acquisition of HIV infection to unprotected heterosexual intercourse (72.3%) and had a past history of snorting cocaine (27.7) was found Central nervous system disorders (including five cases of cryptococcal meningitis) and acute pulmonary pneumocystosis-like respiratory failure were major causes of morbidity. Most patients (56.9%) were at presented in advanced stages of HIV infection. CONCLUSIONS: The predominance of patients on advanced stages of HIV infection suggest the existence of a large pool of undiagnosed cases in the community. A major feature of the cohort was an inverted male to female ratio. Further investigations over a broader geographic area are urgently needed for better understanding the clinical and epidemiological characteristics of HIV infection in small Brazilian municipalities and rural areas.

Reliability of nasal auscultation and their relation to middle ear condition – a clinical interest to pediatrics respiratory physiotherapy

Background: Acute respiratory infections are usual in children under three years old occurring in upper respiratory tract, having an impact on child and caregiver’s quality of life predisposing to otitis media or bronchiolitis. There are few valid and reliable measures to determine the child’s respiratory condition and to guide the physiotherapy intervention. Aim: To assess the intra and inter rater reliability of nasal auscultation, to analyze the relation between sounds’ classification and middle ear’s pressure and compliance as well as with the Clinical Severity Score. Methods: A cross-sectional observational study was composed by 125 nursery children aged up to three years old. Tympanometry, pulmonary and nasal auscultation and application of Clinical Severity Score were performed to each child. Nasal auscultation sounds’ were recorded and sent to 3 blinded experts, that classified, as “obstructed” and “unobstructed”, with a 48 hours interval, in order to analyze inter and intra rater reliability. Results: Nasal auscultation revealed a substantial inter and intra rater reliability (=0,749 and evaluator A - K= 0,691; evaluator B - K= 0,605 and evaluator C - K= 0,724, respectively). Both ears’ pressure was significantly lower in children with an "unobstructed" nasal sound when compared with an “obstructed” nasal sound (t=-3,599, p<0,001 in left ear; t=-2,258, p=0,026 in right ear). Compliance in both ears was significantly lower in children with an "obstructed" nasal sound when compared with “unobstructed” nasal sound (t=-2,728, p=0,007 in left ear; t=-3,830, p<0,001 in right ear). There was a statistically significant association between sounds’ classification and tympanograms types in both ear’s (=11,437, p=0,003 in left ear; =13,535, p=0,001 in right ear). There was a trend to children with an "unobstructed" nasal sound that had a lower clinical severity score when compared with “obstructed” children. Conclusion: It was observed a good intra and substantial inter reliability for nasal auscultation. Nasal auscultation sounds’ classification was related to middle ears’ pressure and compliance.

Molecular imaging agents for detection of β-amyloid plaques in Alzheimer’s disease

The formation of amyloid structures is a neuropathological feature that characterizes several neurodegenerative disorders, such as Alzheimer´s and Parkinson´s disease. Up to now, the definitive diagnosis of these diseases can only be accomplished by immunostaining of post mortem brain tissues with dyes such Thioflavin T and congo red. Aiming at early in vivo diagnosis of Alzheimer´s disease (AD), several amyloid-avid radioprobes have been developed for b-amyloid imaging by positron emission tomography (PET) and single-photon emission computed tomography (SPECT). The aim of this paper is to present a perspective of the available amyloid imaging agents, special those that have been selected for clinical trials and are at the different stages of the US Food and Drugs Administration (FDA) approval.