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BACKGROUND: Retinal and optic disc images are used to assess changes in the retinal vasculature. These can be changes associated with diseases such as diabetic retinopathy and glaucoma or induced using ophthalmodynamometry to measure arterial and venous pressure. Key steps toward automating the assessment of these changes are the segmentation and classification of the veins and arteries. However, such segmentation and classification are still required to be manually labelled by experts. Such automated labelling is challenging because of the complex morphology, anatomical variations, alterations due to disease and scarcity of labelled data for algorithm development. We present a deep machine learning solution called the multiscale guided attention network for retinal artery and vein segmentation and classification (MSGANet-RAV). METHODS: MSGANet-RAV was developed and tested on 383 colour clinical optic disc images from LEI-CENTRAL, constructed in-house and 40 colour fundus images from the AV-DRIVE public dataset. The datasets have a mean optic disc occupancy per image of 60.6% and 2.18%, respectively. MSGANet-RAV is a U-shaped encoder-decoder network, where the encoder extracts multiscale features, and the decoder includes a sequence of self-attention modules. The self-attention modules explore, guide and incorporate vessel-specific structural and contextual feature information to segment and classify central optic disc and retinal vessel pixels. RESULTS: MSGANet-RAV achieved a pixel classification accuracy of 93.15%, sensitivity of 92.19%, and specificity of 94.13% on LEI-CENTRAL, outperforming several reference models. It similarly performed highly on AV-DRIVE with an accuracy, sensitivity and specificity of 95.48%, 93.59% and 97.27%, respectively. CONCLUSION: The results show the efficacy of MSGANet-RAV for identifying central optic disc and retinal arteries and veins. The method can be used in automated systems designed to assess vascular changes in retinal and optic disc images quantitatively.
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Glaucoma , Disco Óptico , Humanos , Disco Óptico/diagnóstico por imagen , Arterias , Vasos Retinianos/diagnóstico por imagen , Retina , Glaucoma/diagnósticoRESUMEN
Osteoarthritis (OA) is a chronic, progressive disease involving the degeneration of cartilage and joint tissue, resulting in pain and disability. Bilateral total knee arthroplasty (TKA) is is an effective intervention that improves quality of life, reduces pain and increases functional capability. This study was performed to compare the functional outcomes between staged and simultaneous total knee arthroplasty. This prospective interventional study was carried out in Arthroscopic and Arthroplasty unit of BSMMU, Dhaka from January 2017 to December 2018. A total of 60 OA patients underwent TKA were included in this study. Thirty patients underwent simultaneous TKA procedure and 30 patients underwent staged TKA procedures performed with 1-6 months between stages were included. Pre-operative and post operative data were collected. Data were analyzed using SPSS 12.0. Numerical data were analyzed using unpaired t test and categorical data were analyzed using Chi-Square test. A value of p<0.05 was considered statistically significant. Mean age of the study subjects was 60.47±10.13 years in staged group and 59.30±9.90 years in simultaneous group. Male to female ratio was 1:1.5 in staged group and 1:2 in simultaneous group. Mean BMI of the study subjects was 30.70±4.91kg/m² in staged group and 30.06±4.79kg/m² in simultaneous group (p>0.05). In both groups, maximum study subjects were housewife (33.3% vs. 33.3%). In staged group 13.3% and 16.7% in simultaneous group were heavy worker; 20.0% in staged group and 16.7% in simultaneous group were medium worker (p>0.05). Pain, motion, stability and function were significantly changed after surgery comparing before surgery.Infection was observed in 10.0% cases in both groups. Stiffness was observed in 10.0% cases in staged group but in 6.7% cases in simultaneous group. Even final outcome showed better in simultaneous procedure, there was no significant difference between two procedures. The outcome of both simultaneous andstaged procedure of bilateral total knee replacement in Advanced Osteoarthritis is similar.
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Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla , Anciano , Bangladesh , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Giant cell tumors (GCT) are usually benign bone tumors with aggressive characteristics. Giant cell tumors have a benign indolent course in most patients, but tumors may recur locally in as many as 50% of cases depending on the type of treatment and initial presentation of the tumor. The aim in the management of long bone GCT is to eradicate the tumor and prevent local recurrences. In this study, we retrospectively assessed the functional outcomes in 5 patients having recurrent GCTs of the distal femur treated with custom made modular endoprosthesis following wide resection of the tumor from January 2017 to December 2018 in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Tumor Society functional score (MSTS) was used to assess the results of our patients. The mean follow-up period was 13.2 months. We achieved good to excellent results with our mean functional score of 80.66%. To the best of our knowledge, probably first started by us using customized modularendoprosthetic massive replacements for recurrent GCTs in our country. The use of custom made modular mega prosthesis is a simple and technically superior method of feeling the bone defects after wide resection in aggressive recurrent GCTs. In our opinion endoprosthesis replacement for recurrent GCTs had early good to excellent functional results 5.
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Neoplasias Femorales/cirugía , Fémur/cirugía , Tumor Óseo de Células Gigantes/cirugía , Recurrencia Local de Neoplasia/cirugía , Implantación de Prótesis , Bangladesh , Fémur/fisiopatología , Humanos , Recurrencia Local de Neoplasia/patología , Prótesis e Implantes , Procedimientos de Cirugía Plástica/efectos adversos , Recuperación de la Función , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Anterior cruciate ligament injury is one of the commonest sports injuries, which often markedly reduces activity and the quality of life. The autologous hamstring double bundle graft and single bundle graft are commonly used for anterior cruciate ligament reconstruction. The choice of graft material for ACL reconstruction is believed to play a major role in the outcome but still there are controversies about the graft selection for primary ACL reconstruction. The aim of this study was to compare the clinical and functional outcome of autologous double bundle (DB) hamstring graft and single bundle (SB) hamstring graft reconstruction for the ACL injury. This prospective observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2017. Total 42 cases of ACL injury that required reconstruction surgery was selected as per inclusion criteria. Total patients were allocated into two groups. One group was treated by single bundle graft and other group was treated by double bundle graft for the ACL reconstruction. In this study, the mean age of double bundle and single bundle groups were 28±6.63 and 30.14±7.55 years respectively and majority of the subjects were male. The post-operative symptoms and signs were more improved in double bundle group than single bundle group during last follow-up period of 6th months. The Lachman test, Anterior drawer test and pivot sift test were more negative in double bundle group than that of single bundle groups. The Lysholm and Tegner activity were better in double bundle group than single bundle group. Again rotational and anterior stability of the knee was better in the double bundle group. However, the differences were not statistically significant and all patients in our study were able to return their activity. Double bundle group showed better rotational stability than the single bundle groups and all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirugía , Tendones/trasplante , Adulto , Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/instrumentación , Bangladesh , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Estudios Prospectivos , Calidad de Vida , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Graft selection for primary anterior cruciate ligament reconstruction is very important part of knee stability. The purpose of this Qasi experimental study was to compare the clinical outcomes after ACL reconstruction using either a BPTB graft or a four-strand hamstrings graft and conducted from January 2012 to December 2013. Patients presented with a symptomatic unilateral ACL rupture who were underwent ACL reconstruction by using either BPTB or Hamstrings graft, IPD of Department of Orthopedics at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka as well as in a private hospital in Dhaka, Bangladesh were selected as study population. Patients were divided into Group A who were treated with the patellar tendon bone graft and Group B patients who were received hamstrings tendon graft. All surgery was performed by the same surgeon and the both procedures were arthroscopically assisted. Operation was performed at least three (03) weeks after initial trauma. All patients were assessed by independent examiner before surgery, at 6 months, 12 months and then annually by clinically. A total number of 70 patients were recruited for this study. The mean age with SD of Group A and Group B were 27.31±10.91 and 26.97±10.10 years respectively (p=0.892). Tegner scores were measured preoperatively and post-operatively. The score were 2.2±1.1 and 2.1±1.0 in preoperatively (p=0.817). In post-operatively the mean score were 6.0±1.7 and 5.8±1.5 in Group A and Group B respectively (p=0.508). Regarding outcome of the operation excellent was 18(51%) cases in both Group A and Group B, good was 15 (43%) and 16(46%) cases in Group A and Group B respectively (p=0.793). In conclusion there was no significant difference between the two groups of the ACL reconstructions cases.
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Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Ligamento Rotuliano , Adolescente , Adulto , Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/métodos , Artroscopía , Bangladesh , Humanos , Ligamento Rotuliano/trasplante , Adulto JovenRESUMEN
Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close fracture shaft of the tibia.
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Fijación Intramedular de Fracturas , Fracturas Cerradas , Fracturas de la Tibia , Clavos Ortopédicos , Fijación Intramedular de Fracturas/métodos , Humanos , Persona de Mediana Edad , Tibia , Fracturas de la Tibia/cirugía , Resultado del TratamientoRESUMEN
The meniscus is the most commonly injured structure in the knee joint. Carefully performed clinical examination can give better diagnosis of meniscal tear. The aim of this study was to find out the correlation between clinical and arthroscopic findings in meniscal tear of knee. This cross sectional observational study was conducted in the Department of Orthopaedic Surgery, BSMMU, Dhaka from July 2012 to June 2014. Thirty patients of meniscal tear were selected as per inclusion and exclusion criteria. After proper evaluation and clinical examination of these patient arthroscopic examinations was done under spinal anesthesia. A total number of 30 patients were recruited in this study. Twenty seven (90%) patients were male and only 3(10%) were female. Mean±SD of age was 26.00±5.55 and range was 17-34 years. Out of 30 patients 19(63.3%) had right knee affected and the rest 11(36.7%) had left knee affected. It was found from clinical diagnosis that most of the patients had MM injury (73.4%) and LM injury was in 26.6% patients. From arthroscopic diagnosis we found most of the patients had multiple types of injury (40.0%) followed by 26.7% patents had isolated MM injury, 16.6% patients had isolated LM injury, 10.0% patients had other injuries like ACL, PCL or MCL and rest 6.7% patients had no injury at all. Sensitivity, specificity, PPV, NPV and accuracy of clinical diagnosis in diagnosis of MM injury were 94.4%, 58.3%, 77.3%, 87.5% and 80.0% respectively. Sensitivity, specificity, PPV, NPV and accuracy of clinical diagnosis in diagnosis of LM injury were 85.7%, 91.3%, 75.0%, 95.5% and 90.0% respectively. Clinical evaluation may diagnose meniscal tear accurately.
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Traumatismos de la Rodilla , Lesiones de Menisco Tibial , Adulto , Artroscopía , Bangladesh , Estudios Transversales , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla , Imagen por Resonancia Magnética , Masculino , Lesiones de Menisco Tibial/diagnóstico por imagen , Adulto JovenRESUMEN
Rupture of the Anterior Cruciate Ligament (ACL) is common, resulting reduced quality of life, increasing the meniscal injury risk, knee instability and early degenerative joint disease. Bone-Patellar Tendon-Bone (BPTB) became the gold standard surgery where conservative management failed. Adding interferential screw provides rigid fixation which is important for early accelerated rehabilitation program in athletes but we have carried out this prospective interventional study in Bangabandhu Sheikh Mujib Medical University (BSMMU) and our private settings from January 2007 to December 2011 to assess whether interferential screws provide any clinical and functional advantage in general population. Sixty six male patients of 21-40 years age, with ACL deficient knees were reconstructed with BPTB graft where 40 cases were augmented by interferential screws and 26 cases without and followed up for minimum 2 years. The clinical and functional outcome (by Lysholm Knee Scoring), post-operative knee stability (by clinical tests) and complications were assessed and recorded. There was significant (p<0.05, paired 't' test) improvement of knee function (limp, walking, stair climbing, squatting, thigh atrophy) in both groups but no significant difference between them (p>0.05, chi squared test) regarding clinical, functional outcome and knee stability. The complications were insignificant (p>0.05, chi squared test) in both groups but there were few cases of screw related complications with augmentation and pronounced anterior knee laxity without it. So, ACL reconstruction by BPTB grafts with or without augmentation results consistent and comparable outcome in general population.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Artroscopía/métodos , Tornillos Óseos , Injertos Hueso-Tendón Rotuliano-Hueso , Adulto , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Humanos , Articulación de la Rodilla/fisiopatología , MasculinoRESUMEN
Large number of patients suffers from medial meniscus injury during athletic activities despite of not being involved in professional sports. Our goal was to compare clinical and functional outcome of arthroscopic partial meniscectomy with results of arthroscopic total meniscectomy of the medial meniscus in these non-professional athletes. The prospective interventional study was carried out in a five years period from January 2007 to December 2011. According to predefined inclusion and exclusion criteria 109 patients were selected and underwent surgery but 29 patients lost from follow-up. Results of 40 cases with Arthroscopic partial meniscectomy (Group-I) and 40 cases with arthroscopic total meniscectomy (Group-II) were analyzed. There were 75 male patients and the predominant age group was 21-30 years. Patients were followed up for a range of 36-60 months. Standard questionnaires of Visual Analogue Score (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner-Lysholm Knee Score (TLKS) and Tapper and Hoover criteria was used to assess and compare the outcomes. Radiological assessment was done to note any changes. Students were sufferers in majority cases and bucket handle tear had been the commonest type. Significant difference of clinical, functional and radiological outcome was observed at minimum 3 years follow up. One case needed revision in Group-II and the infection rates were insignificant. Arthroscopic partial meniscectomy is significantly better method for surgical management of medial meniscus injuries.
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Artroscopía , Traumatismos en Atletas/cirugía , Traumatismos de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Lesiones de Menisco Tibial , Adolescente , Adulto , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/etiología , Niño , Femenino , Humanos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/etiología , Masculino , Estudios Prospectivos , Recuperación de la Función , Resultado del Tratamiento , Adulto JovenRESUMEN
Cemented total hip arthroplasty has been being practiced successfully all over the world for the last 5 decades. Osteoarthritis is the most common indication of total hip arthroplasty. This study was done to observe the outcome of primary total hip arthroplasty by cemented prosthesis in secondary osteoarthritis of the hip joint. This prospective study was conducted at the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University and some private hospitals in Dhaka, Bangladesh from May 2008 to December 2009. Total 21 patients were evaluated. Among them 38.1% had rheumatoid arthritis, 19.1% had ankylosing spondylitis and 42.8% had avascular necrosis. Average duration of postoperative hospital stay was 14.09 days. Regarding the functional outcome, 76.2% patients had excellent, 19.1% had good and 4.8% had fair outcome. So out of 21 cases, 95.2% had satisfactory and 4.8% had unsatisfactory outcome. Cemented total hip arthroplasty is an effective procedure for the management of secondary osteoarthritis of the hip joint.
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Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Osteoartritis de la Cadera/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/etiología , Osteonecrosis/complicaciones , Estudios Prospectivos , Espondilitis Anquilosante/complicacionesRESUMEN
Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.
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Dolor de Hombro/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Estudios Prospectivos , Radiografía , Dolor de Hombro/diagnóstico por imagen , UltrasonografíaRESUMEN
Spinal tumours, which are 5-10% of skeletal tumours, cause considerable morbidity and present challenging situations in their management. Surgery is often used in the treatment of spinal tumours. Now a day only few specialized spinal care centers have developed in Bangladesh. The prospective study regarding surgical management of primary spinal tumour might be beneficial for proper planning and patient management. All patients who underwent surgical resection of a primary tumor of the spine between July 2006 and May 2008, at the Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Patients were uniformly staged before surgery and baseline demographic and surgical variables were recorded, as well as an evaluation of general health related quality of life were done. Thirty-two patients (16 males and 16 females) were eligible for the study. Average age was 43.25 (range 15 to 85). There were 8(25%) vertebral body and pedicle tumors and 3(9.37%) extradural, 16(50%) intradural-extramedullary and 05(15.67%) intradural intramedullary. Only 5(15.63%) developed complication. In this series out of 32 patients, 15(46.88%) achieved excellent result and 10(31.25%) got good result and 5(15.5%) achieved fair and remaining 2(6.25%) patients achieved poor results after the management. Complete neurological involvement of patient did not show complete recovery. In addition to surgery, radiotherapy and chemotherapy are needed to sterilize the tumour bed. Early detection and surgery of primary spinal tumour give satisfactory results and patient can return to their normal life.
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Neoplasias de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Neoplasias de la Columna Vertebral/psicologíaRESUMEN
BACKGROUND: Musculoskeletal disorders are very common among the diabetic patients and frozen shoulder is one of the disabling conditions. The present study was conducted to compare the serum triglyceride level among the patients of type 2 diabetic presented with and without frozen shoulder. METHODOLOGY: This case control study was conducted from January 2008 to December 2009, in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka with an aim to compare the serum triglyceride level among diabetic patients presented with, and without frozen shoulder. Thirty types 2 diabetic patients with frozen shoulder were selected as cases and similar number well matched type 2 diabetic patients without frozen shoulder were selected as control. RESULTS: We prospectively studied 30 diabetes mellitus (type 2) patients with the diagnosis of frozen shoulder. The blood sugar both fasting and 2 hours after breakfast, HbA1c and serum triglyceride levels were measured in all patients and compared with those in 30 diabetic patients without frozen shoulder. The blood sugar, fasting and 2 hours after breakfast, HbA1C and serum triglyceride levels were significantly elevated in the frozen-shoulder group (fasting blood sugar p = 0.012; blood sugar 2 hours after breakfast p < 0.01; HbA1c p < 0.05; and triglyceride p < 0.001). CONCLUSION: Diabetic type 2 patients presented with frozen shoulder had higher serum triglyceride level compare to the diabetic type 2 patients without frozen shoulder.
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Bursitis/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/patología , Articulación del Hombro/patología , Triglicéridos/sangre , Estudios de Casos y Controles , Humanos , Factores de RiesgoRESUMEN
o-Aminonitrile or o-aminoester compounds were cyclized to fused pyrimidines by reacting with ethyl iso(thio)cyanatoacetate in pyridine, and then were methylated, halogenated and subsequently displaced by the amines studied.