Epidemiology of monosymptomatic optic neuritis in Rijeka County, Croatia: meteorological aspects

In order to analyze the meteorological factors possibly influencing the monosymptomatic optic neuritis in Rijeka County, northwestern part of Croatia, retrospective analysis of all cases diagnosed in Rijeka County in period from 1977 to 2001, was done. Meteorological data on monthly and yearly temperature, humidity, insolation in Rijeka County were collected from Croatian Meteorological and Hydrological Service. In the observed period there were 173 cases of monosymptomatic optic neuritis, female/male ratio was 1.66, and overall incidence was 2.18/100,000 inhabitants. There was no correlation of incidence with average yearly and monthly temperature, humidity, insolation, or month of birth. This is the first study on meteorological factors and optic neuritis in Croatia.     

HLA class I and class II polymorphism in the population of Rijeka,Croatia

The aim of the study was to examine frequencies of HLA-A, -B, -DR antigens and haplotypes in population of Rijeka and to compare them with general Croatian and European populations. The subjects were 117 unrelated healthy blood donors. The antigens with the highest frequencies were: A2 (27.2%), A9 (16.3%), B5 (14.8%), B12 (11.8%), B18 (11.8%), DR5 (21.6%) and DR6 (13.8%). Comparison of HLA antigens frequencies has shown statistically significant difference in 1 antigen with Croatian population and in 8 antigens with European population. The HLA haplotypes with high frequencies included HLA-A2, B5 (6.84%), HLA-A2, B12 (6.84%), HLA-A2, B18 (6.84%), HLA-B12, DR2 (9.78%) and HLA-B18, DR5 (6.84%). The antigen B5 showed strongest association with DR5 (6.41%; LD = 1.30) as in general Croatian and in some European populations. The results have shown great diversity of HLA haplotypes in Rijeka population which can be the result of admixture with neighborhood immigrating populations during the history.     

Use of mobile screening unit for diabetic retinopathy in rural and urban areas.

OBJECTIVES--To compare the effectiveness of a mobile screening unit with a non-mydriatic polaroid camera in detecting diabetic retinopathy in rural and urban areas. To estimate the cost of the service. DESIGN--Prospective data collection over two years of screening for diabetic retinopathy throughout Tayside. SETTING--Tayside region, population 390,000, area 7770 km2. SUBJECTS--961 patients in rural areas and 1225 in urban areas who presented for screening. MAIN OUTCOME MEASURES--Presence of diabetic retinopathy, need for laser photocoagulation, age, duration of diabetes, and diabetic treatment. RESULTS--Compared with diabetic patients in urban areas, those in rural areas were less likely to attend a hospital based diabetic clinic (46% (442) v 86% (1054), p < 0.001); less likely to be receiving insulin (260 (27%) v 416 (34%), p < 0.001 and also after correction for differences in age distribution); more likely to have advanced (maculopathy or proliferative retinopathy) diabetic retinopathy (13% (122) v 7% (89), p < 0.001); and more likely to require urgent laser photocoagulation for previously unrecognised retinopathy (1.4% (13) v 0.5% (6), p < 0.02). The screening programme cost 10 pounds per patient screened and 1000 pounds per patient requiring laser treatment. CONCLUSION--The mobile diabetic eye screening programme detected a greater prevalence of advanced retinopathy in diabetic patients living in rural areas. Patients in rural areas were also more likely to need urgent laser photocoagulation. Present screening procedures seem to be less effective in rural areas and rural patients may benefit more from mobile screening units than urban patients.     

Non-mydriatic Polaroid photography in screening for diabetic retinopathy: evaluation in a clinical setting

Because of fears that Polaroid colour prints produced with a non-mydriatic fundus camera may not detect important sight threatening lesions in diabetes a study was conducted comparing retinal images obtained on Polaroid prints taken in “field” conditions with those on 35 mm transparencies and fluorescein angiograms. Almost one in five (22/127) Polaroid prints could not be assessed owing to poor quality compared with 3 (2.4%) 35 mm transparencies and 2 (1.6%) fluorescein angiograms. The pick up rate of microaneurysms, haemorrhages, and hard and soft (cotton wool spots) exudates was equivalent for Polaroid prints and 35 mm transparencies of equivalent quality. In two cases with disc new vessels, however, these were not seen on the Polaroid prints.The widespread use of Polaroid colour prints obtained with a non-mydriatic camera without the necessary operative and interpretive skills further limits the usefulness of the technique.     

Prevention of blindness by screening for diabetic retinopathy: a quantitative assessment.

Diabetic retinopathy is an important cause of blindness in the Western World. A review of the randomised trials of laser photocoagulation of the retina as a method of preventing blindness from this disorder showed that this treatment is very effective, reducing the risk of blindness by 61% in a treated eye. As only one eye is needed for sight the reduction in blindness in a population will be greater than 61% because the effect of treatment in one eye is not always identical with the effect in the other eye. For analysis this reduction was taken as 73%, representing the average of the minimum and maximum estimates (61% and 85%). The effectiveness of this treatment suggests that there is the potential for a national screening programme to bring about a major reduction in blindness from this cause. A quantitative assessment of the effect of screening indicated that a programme in which patients with diabetes mellitus are systematically referred to ophthalmic opticians for a retinal examination could detect 88% of all diabetics with serious retinopathy and that 87% of these cases would be treatable. Screening and early treatment of retinopathy would prevent deterioration of visual acuity and could reduce the risk of blindness due to diabetic retinopathy by an estimated 56% (0.73 X 0.88 X 0.87). The findings suggest that an effectively managed community based screening programme encompassing detection, referral, treatment, and follow up would prevent about 260 new cases of blindness in diabetics under the age of 70 each year in England and Wales. This would represent over 10% of all cases of blindness in adults in this age group.     

Assessment of automated disease detection in diabetic retinopathy screening using two-field photography

Aim

To assess the performance of automated disease detection in diabetic retinopathy screening using two field mydriatic photography.

Methods

Images from 8,271 sequential patient screening episodes from a South London diabetic retinopathy screening service were processed by the Medalytix iGrading™ automated grading system. For each screening episode macular-centred and disc-centred images of both eyes were acquired and independently graded according to the English national grading scheme. Where discrepancies were found between the automated result and original manual grade, internal and external arbitration was used to determine the final study grades. Two versions of the software were used: one that detected microaneurysms alone, and one that detected blot haemorrhages and exudates in addition to microaneurysms. Results for each version were calculated once using both fields and once using the macula-centred field alone.

Results

Of the 8,271 episodes, 346 (4.2%) were considered unassessable. Referable disease was detected in 587 episodes (7.1%). The sensitivity of the automated system for detecting unassessable images ranged from 97.4% to 99.1% depending on configuration. The sensitivity of the automated system for referable episodes ranged from 98.3% to 99.3%. All the episodes that included proliferative or pre-proliferative retinopathy were detected by the automated system regardless of configuration (192/192, 95% confidence interval 98.0% to 100%). If implemented as the first step in grading, the automated system would have reduced the manual grading effort by between 2,183 and 3,147 patient episodes (26.4% to 38.1%).

Conclusion

Automated grading can safely reduce the workload of manual grading using two field, mydriatic photography in a routine screening service.     

HPV testing for cervical cancer screening in Croatia

Opportunistic screening based on the Pap smear has been undertaken in Croatia since 1953. However, cervical cancer remains an important health problem in Croatia when compared to European countries with organised screening programmes. In Croatia, in addition to screening based on well established cytology, Human papillomavirus (HPV) testing is widely used as secondary test as a triage to borderline cytology and as a follow-up after treatment of severe cervical lesions. Many different approaches for HPV testing arose in Croatia over the last decade depending on the needs of each medical institution involved. Presently, there is an urgent need for better networking between the laboratories, the implementation of quality assessment and the adaptation of a uniform system of referring to and reporting of HPV testing. In conclusion, the best possible organisation for HPV testing would be essential for implementation of HPV testing as primary screening test in Croatia, an thus ultimately and hopefully, the more successful cervical cancer control.     

Automatic non-proliferative diabetic retinopathy screening system based on color fundus image

Background

Non-proliferative diabetic retinopathy is the early stage of diabetic retinopathy. Automatic detection of non-proliferative diabetic retinopathy is significant for clinical diagnosis, early screening and course progression of patients.

Methods

This paper introduces the design and implementation of an automatic system for screening non-proliferative diabetic retinopathy based on color fundus images. Firstly, the fundus structures, including blood vessels, optic disc and macula, are extracted and located, respectively. In particular, a new optic disc localization method using parabolic fitting is proposed based on the physiological structure characteristics of optic disc and blood vessels. Then, early lesions, such as microaneurysms, hemorrhages and hard exudates, are detected based on their respective characteristics. An equivalent optical model simulating human eyes is designed based on the anatomical structure of retina. Main structures and early lesions are reconstructed in the 3D space for better visualization. Finally, the severity of each image is evaluated based on the international criteria of diabetic retinopathy.

Results

The system has been tested on public databases and images from hospitals. Experimental results demonstrate that the proposed system achieves high accuracy for main structures and early lesions detection. The results of severity classification for non-proliferative diabetic retinopathy are also accurate and suitable.

Conclusions

Our system can assist ophthalmologists for clinical diagnosis, automatic screening and course progression of patients.

     

Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.

OBJECTIVE--To evaluate whether adding retinal photography improved community screening for diabetic retinopathy. SETTING--Mobile screening unit at rural and urban general practices in south west England. SUBJECTS--1010 diabetic patients from primary care. DESIGN--Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist. MAIN OUTCOME MEASURES--Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist. RESULTS--Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners'' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians'' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%. CONCLUSIONS--Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.     

Organization of the "Marine Colony" for children with tuberculosis in Rijeka (Croatia): entanglement between medicine and politics

Tuberculosis was a major public health concern in the beginning of the 20th century. Since medications were not available at the time, therapy in general was based on health education, healing effects of climate, nutrition and rest. The Marine Colony was founded in 1924 in Rijeka, a city with turbulent political history, by the Antitubercular Consortium which was part of a planned program for the fight against tuberculosis on a national level in the whole of Italy. The Colony in Rijeka, Croatia specialised in care of children with clinical tuberculosis or under greater risk of developing disease. This article gives an overview of the medical treatment provided for children in Colony, as well as pointing out the political-agenda at that period.