1
|
Coronado I, Pachade S, Trucco E, Abdelkhaleq R, Yan J, Salazar-Marioni S, Jagolino-Cole A, Bahrainian M, Channa R, Sheth SA, Giancardo L. Author Correction: Synthetic OCT-A blood vessel maps using fundus images and generative adversarial networks. Sci Rep 2023; 13:16234. [PMID: 37758775 PMCID: PMC10533481 DOI: 10.1038/s41598-023-43285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- Ivan Coronado
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Samiksha Pachade
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanuele Trucco
- VAMPIRE project, School of Science and Engineering (Computing), University of Dundee, Dundee, Scotland, UK
| | - Rania Abdelkhaleq
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Juntao Yan
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sergio Salazar-Marioni
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Jagolino-Cole
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mozhdeh Bahrainian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Sunil A Sheth
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luca Giancardo
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
| |
Collapse
|
2
|
Coronado I, Pachade S, Trucco E, Abdelkhaleq R, Yan J, Salazar-Marioni S, Jagolino-Cole A, Bahrainian M, Channa R, Sheth SA, Giancardo L. Synthetic OCT-A blood vessel maps using fundus images and generative adversarial networks. Sci Rep 2023; 13:15325. [PMID: 37714881 PMCID: PMC10504307 DOI: 10.1038/s41598-023-42062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
Vessel segmentation in fundus images permits understanding retinal diseases and computing image-based biomarkers. However, manual vessel segmentation is a time-consuming process. Optical coherence tomography angiography (OCT-A) allows direct, non-invasive estimation of retinal vessels. Unfortunately, compared to fundus images, OCT-A cameras are more expensive, less portable, and have a reduced field of view. We present an automated strategy relying on generative adversarial networks to create vascular maps from fundus images without training using manual vessel segmentation maps. Further post-processing used for standard en face OCT-A allows obtaining a vessel segmentation map. We compare our approach to state-of-the-art vessel segmentation algorithms trained on manual vessel segmentation maps and vessel segmentations derived from OCT-A. We evaluate them from an automatic vascular segmentation perspective and as vessel density estimators, i.e., the most common imaging biomarker for OCT-A used in studies. Using OCT-A as a training target over manual vessel delineations yields improved vascular maps for the optic disc area and compares to the best-performing vessel segmentation algorithm in the macular region. This technique could reduce the cost and effort incurred when training vessel segmentation algorithms. To incentivize research in this field, we will make the dataset publicly available to the scientific community.
Collapse
Affiliation(s)
- Ivan Coronado
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Samiksha Pachade
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emanuele Trucco
- VAMPIRE project, School of Science and Engineering (Computing), University of Dundee, Dundee, Scotland, UK
| | - Rania Abdelkhaleq
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Juntao Yan
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sergio Salazar-Marioni
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda Jagolino-Cole
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mozhdeh Bahrainian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Sunil A Sheth
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Luca Giancardo
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
| |
Collapse
|
3
|
Coronado I, Pachade S, Dawoodally H, Salazar Marioni S, Yan J, Abdelkhaleq R, Bahrainian M, Jagolino-Cole A, Channa R, Sheth SA, Giancardo L. Foveal avascular zone segmentation using deep learning-driven image-level optimization and fundus photographs. Proc IEEE Int Symp Biomed Imaging 2023; 2023:10.1109/isbi53787.2023.10230410. [PMID: 37706193 PMCID: PMC10498664 DOI: 10.1109/isbi53787.2023.10230410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The foveal avascular zone (FAZ) is a retinal area devoid of capillaries and associated with multiple retinal pathologies and visual acuity. Optical Coherence Tomography Angiography (OCT-A) is a very effective means of visualizing retinal vascular and avascular areas, but its use remains limited to research settings due to its complex optics limiting availability. On the other hand, fundus photography is widely available and often adopted in population studies. In this work, we test the feasibility of estimating the FAZ from fundus photos using three different approaches. The first two approaches rely on pixel-level and image-level FAZ information to segment FAZ pixels and regress FAZ area, respectively. The third is a training mask-free pipeline combining saliency maps with an active contours approach to segment FAZ pixels while being trained on image-level measures of the FAZ areas. This enables training FAZ segmentation methods without manual alignment of fundus and OCT-A images, a time-consuming process, which limits the dataset that can be used for training. Segmentation methods trained on pixel-level labels and image-level labels had good agreement with masks from a human grader (respectively DICE of 0.45 and 0.4). Results indicate the feasibility of using fundus images as a proxy to estimate the FAZ when angiography data is not available.
Collapse
Affiliation(s)
- I Coronado
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - S Pachade
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - H Dawoodally
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | | | - J Yan
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | | | - M Bahrainian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, WI, USA
| | | | - R Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, WI, USA
| | - S A Sheth
- McGovern Medical School, UTHealth, Houston, TX, USA
| | - L Giancardo
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), TX, USA
| |
Collapse
|
4
|
Pachade S, Coronado I, Abdelkhaleq R, Yan J, Salazar-Marioni S, Jagolino A, Green C, Bahrainian M, Channa R, Sheth SA, Giancardo L. Detection of Stroke with Retinal Microvascular Density and Self-Supervised Learning Using OCT-A and Fundus Imaging. J Clin Med 2022; 11:jcm11247408. [PMID: 36556024 PMCID: PMC9788382 DOI: 10.3390/jcm11247408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Acute cerebral stroke is a leading cause of disability and death, which could be reduced with a prompt diagnosis during patient transportation to the hospital. A portable retina imaging system could enable this by measuring vascular information and blood perfusion in the retina and, due to the homology between retinal and cerebral vessels, infer if a cerebral stroke is underway. However, the feasibility of this strategy, the imaging features, and retina imaging modalities to do this are not clear. In this work, we show initial evidence of the feasibility of this approach by training machine learning models using feature engineering and self-supervised learning retina features extracted from OCT-A and fundus images to classify controls and acute stroke patients. Models based on macular microvasculature density features achieved an area under the receiver operating characteristic curve (AUC) of 0.87-0.88. Self-supervised deep learning models were able to generate features resulting in AUCs ranging from 0.66 to 0.81. While further work is needed for the final proof for a diagnostic system, these results indicate that microvasculature density features from OCT-A images have the potential to be used to diagnose acute cerebral stroke from the retina.
Collapse
Affiliation(s)
- Samiksha Pachade
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Ivan Coronado
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Rania Abdelkhaleq
- Department of Neurology, UTHealth McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Juntao Yan
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
| | - Sergio Salazar-Marioni
- Department of Neurology, UTHealth McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Amanda Jagolino
- Department of Neurology, UTHealth McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Charles Green
- Institute for Stroke and Cerebrovascular Diseases, UTHealth, Houston, TX 77030, USA
- Center for Clinical Research and Evidence-Based Medicine, UTHealth McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Mozhdeh Bahrainian
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Sunil A. Sheth
- Department of Neurology, UTHealth McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Luca Giancardo
- Center for Precision Health, School of Biomedical Informatics, University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA
- Institute for Stroke and Cerebrovascular Diseases, UTHealth, Houston, TX 77030, USA
- Correspondence:
| |
Collapse
|
5
|
Zhou P, Eltemsah L, Bahrainian M, Prichett L, Liu TYA, Wolf RM, Channa R. Assessment of Trained Image Grader Performance in Screening for Retinopathy Among Youth With Diabetes. J Diabetes Sci Technol 2022; 16:1580-1581. [PMID: 36047654 PMCID: PMC9631538 DOI: 10.1177/19322968221120240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Philip Zhou
- Department of Ophthalmology, Baylor College
of Medicine, Houston, TX, USA
| | - Loaah Eltemsah
- Department of Pediatric Endocrinology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mozhdeh Bahrainian
- Department of Ophthalmology and Visual
Sciences, University of Wisconsin–Madison, Madison, WI, USA
| | - Laura Prichett
- Department of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - T. Y. Alvin Liu
- Wilmer Eye Institute, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
| | - Risa M. Wolf
- Department of Pediatric Endocrinology, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual
Sciences, University of Wisconsin–Madison, Madison, WI, USA
| |
Collapse
|
6
|
Banghart M, Lee K, Bahrainian M, Staggers K, Amos C, Liu Y, Domalpally A, Frankfort BJ, Sohn EH, Abramoff M, Channa R. Total retinal thickness: a neglected factor in the evaluation of inner retinal thickness. BMJ Open Ophthalmol 2022; 7:e001061. [PMID: 36329022 PMCID: PMC9528673 DOI: 10.1136/bmjophth-2022-001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022] Open
Abstract
AIM To determine whether macular retinal nerve fibre layer (mRNFL) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses vary by ethnicity after accounting for total retinal thickness. METHODS We included healthy participants from the UK Biobank cohort who underwent macula-centred spectral domain-optical coherence tomography scans. mRNFL and GC-IPL thicknesses were determined for groups from different self-reported ethnic backgrounds. Multivariable regression models adjusting for covariables including age, gender, ethnicity and refractive error were built, with and without adjusting for total retinal thickness. RESULTS 20237 participants were analysed. Prior to accounting for total retinal thickness, mRNFL thickness was on average 0.9 μm (-1.2, -0.6; p<0.001) lower among Asians and 1.5 μm (-2.3, -0.6; p<0.001) lower among black participants compared with white participants. Prior to accounting for total retinal thickness, the average GC-IPL thickness was 1.9 μm (-2.5, -1.4; p<0.001) lower among Asians compared with white participants, and 2.4 μm (-3.9, -1.0; p=0.001) lower among black participants compared with white participants. After accounting for total retinal thickness, the layer thicknesses were not significantly different among ethnic groups. When considered as a proportion of total retinal thickness, mRNFL thickness was ~0.1 and GC-IPL thickness was ~0.2 across age, gender and ethnic groups. CONCLUSIONS The previously reported ethnic differences in layer thickness among groups are likely driven by differences in total retinal thickness. Our results suggest using layer thickness ratio (retinal layer thicknesses/total retinal thickness) rather than absolute thickness values when comparing retinal layer thicknesses across groups.
Collapse
Affiliation(s)
- Mark Banghart
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Kyungmoo Lee
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Mozhdeh Bahrainian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Kristen Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| | - Benjamin J Frankfort
- Departments of Ophthalmology and Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
- Institute for Vision Research, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Welham G, Bahrainian M, Hess T, Crnich C. Influence of Patient Factors on the Appropriateness of Antibiotic Prescribing in Nursing Homes. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Grace Welham
- Department of Medicine, University of Wisconsin School of Medicine and Population Health, Madison, Wisconsin
| | - Mozhdeh Bahrainian
- University of Wisconsin School of Medicine and Population Health, Madison, Wisconsin
| | - Timothy Hess
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Christopher Crnich
- Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
8
|
Barrett B, Brown RL, Mundt MP, Thomas GR, Barlow SK, Highstrom AD, Bahrainian M. Validation of a short form Wisconsin Upper Respiratory Symptom Survey (WURSS-21). Health Qual Life Outcomes 2009; 7:76. [PMID: 19674476 PMCID: PMC2748069 DOI: 10.1186/1477-7525-7-76] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 08/12/2009] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Wisconsin Upper Respiratory Symptom Survey (WURSS) is an illness-specific health-related quality-of-life questionnaire outcomes instrument. OBJECTIVES Research questions were: 1) How well does the WURSS-21 assess the symptoms and functional impairments associated with common cold? 2) How well can this instrument measure change over time (responsiveness)? 3) What is the minimal important difference (MID) that can be detected by the WURSS-21? 4) What are the descriptive statistics for area under the time severity curve (AUC)? 5) What sample sizes would trials require to detect MID or AUC criteria? 6) What does factor analysis tell us about the underlying dimensional structure of the common cold? 7) How reliable are items, domains, and summary scores represented in WURSS? 8) For each of these considerations, how well does the WURSS-21 compare to the WURSS-44, Jackson, and SF-8? STUDY DESIGN AND SETTING People with Jackson-defined colds were recruited from the community in and around Madison, Wisconsin. Participants were enrolled within 48 hours of first cold symptom and monitored for up to 14 days of illness. Half the sample filled out the WURSS-21 in the morning and the WURSS-44 in the evening, with the other half reversing the daily order. External comparators were the SF-8, a 24-hour recall general health measure yielding separate physical and mental health scores, and the eight-item Jackson cold index, which assesses symptoms, but not functional impairment or quality of life. RESULTS In all, 230 participants were monitored for 2,457 person-days. Participants were aged 14 to 83 years (mean 34.1, SD 13.6), majority female (66.5%), mostly white (86.0%), and represented substantive education and income diversity. WURSS-21 items demonstrated similar performance when embedded within the WURSS-44 or in the stand-alone WURSS-21. Minimal important difference (MID) and Guyatt's responsiveness index were 10.3, 0.71 for the WURSS-21 and 18.5, 0.75 for the WURSS-44. Factorial analysis suggested an eight dimension structure for the WURSS-44 and a three dimension structure for the WURSS-21, with composite reliability coefficients ranging from 0.87 to 0.97, and Cronbach's alpha ranging from 0.76 to 0.96. Both WURSS versions correlated significantly with the Jackson scale (W-21 R=0.85; W-44 R=0.88), with the SF-8 physical health (W-21 R=-0.79; W-44 R=-0.80) and SF-8 mental health (W-21 R=-0.55; W-44 R=-0.60). CONCLUSION The WURSS-44 and WURSS-21 perform well as illness-specific quality-of-life evaluative outcome instruments. Construct validity is supported by the data presented here. While the WURSS-44 covers more symptoms, the WURSS-21 exhibits similar performance in terms of reliability, responsiveness, importance-to-patients, and convergence with other measures.
Collapse
Affiliation(s)
- Bruce Barrett
- Department of Family Medicine, University of Wisconsin-Madison 1100 Delaplaine Ct., Madison, WI 53715 USA
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison K6/287 Clinical Science Center, Madison, WI 53792 USA
| | - Marlon P Mundt
- Department of Family Medicine, University of Wisconsin-Madison 1100 Delaplaine Ct., Madison, WI 53715 USA
| | - Gay R Thomas
- School of Nursing, University of Wisconsin-Madison K6/287 Clinical Science Center, Madison, WI 53792 USA
| | - Shari K Barlow
- Department of Family Medicine, University of Wisconsin-Madison 1100 Delaplaine Ct., Madison, WI 53715 USA
| | - Alex D Highstrom
- Department of Family Medicine, University of Wisconsin-Madison 1100 Delaplaine Ct., Madison, WI 53715 USA
| | - Mozhdeh Bahrainian
- Department of Family Medicine, University of Wisconsin-Madison 1100 Delaplaine Ct., Madison, WI 53715 USA
| |
Collapse
|
9
|
Low R, Ahsan MW, Chou H, Bahrainian M, Singh A, Kumar A. Central-line-related septic shock: early appropriate antimicrobial therapy and rapid source control reduce mortality. Crit Care 2008; 12. [PMCID: PMC4088768 DOI: 10.1186/cc6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Low
- University of Manitoba, Winnipeg, MB, Canada
| | - MW Ahsan
- University of Manitoba, Winnipeg, MB, Canada
| | - H Chou
- University of British Columbia, Vancouver, BC, Canada
| | - M Bahrainian
- University of Wisconsin–Madison, Madison, WI, USA
| | - A Singh
- University of Manitoba, Winnipeg, MB, Canada
| | - A Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
10
|
Abstract
For many years, breast-feeding was forbidden if antithyroid drugs were being used. Recently, limited studies have shown the relative safety of propylthiouracil and methimazole (MMI). It is not known whether MMI therapy of lactating mothers for 1 yr is safe for breast-fed infants and does not cause alterations in thyroid function and intellectual development. Between 1988 and 1998, 139 thyrotoxic lactating mothers and their infants were studied. Fifty-one thyrotoxic lactating mothers were treated with MMI during pregnancy, and MMI was continued during breast-feeding. Eighty-eight mothers were given 10 mg MMI (n 46) or 20 mg MMI (n = 42) daily for 1 month, 10 mg daily for the second month, and 5-10 mg daily thereafter. Serum T4, T3, and TSH concentrations were measured in thyrotoxic lactating mothers and their infants, before and at 1, 2, 4, 8, and 12 months. Serum MMI was measured in the infants of thyrotoxic lactating mothers taking 20 mg MMI. Thyroid function, urinary iodine, thyroid antibodies, intelligence quotient (IQ), verbal and functional components (Wechsler and Goodenough tests) were performed on 14 children of thyrotoxic lactating mothers between 48 and 74 months of age and on 17 controls. Mean +/- SD of FT4I in thyrotoxic lactating mothers treated with 10 mg MMI for 1 month decreased from 19.4 +/- 4.1 to 11.6 +/- 4.4 and from 20.5 +/- 4.7 to 9.8 +/- 1.5 when treated with 20 mg MMI. Values for FT3I decreased from 462 +/- 52 to 194 +/- 52 with 10 mg MMI and from 481 +/- 92 to 171 +/- 38 with 20 mg MMI. FT4I and FT3I were normal from the third to the twelfth months. In all infants FT4I, FT3I, and TSH concentrations were normal before and up to 12 months of MMI therapy in their lactating mothers. The lowest T4 and T3 values were 108 and 1.87 nmol/L, and the highest TSH value was 4.0 mU/L. Serum MMI levels in infants were less than 0.03 microg/mL. Six mothers receiving 20 mg MMI had increased serum TSH concentrations ranging from 26-135 mU/L after 1 month of treatment. Their infants were euthyroid with serum TSH values less than 2.6 mU/L. At 48-74 months of age, height, weight, FT4I, FT3I, TSH, and antithyroid antibody titers were not different than controls. The mean IQ was 107 +/- 14 vs. 106 +/- 16 (Goodenough test) and 103 +/- 10 vs. 103 +/- 16 (Wechsler test) for infants of thyrotoxic lactating mothers and control infants, respectively. Similarly, there was no difference in verbal and performance IQ and their components between infants of thyrotoxic lactating mothers and control children. No deleterious effects occur in thyroid function and physical and intellectual development of breast-fed infants whose lactating mothers were treated with doses of MMI up to 20 mg daily.
Collapse
Affiliation(s)
- F Azizi
- Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, I.R. Iran
| | | | | | | |
Collapse
|
11
|
Dahabra S, Ashton CH, Bahrainian M, Britton PG, Ferrier IN, McAllister VA, Marsh VR, Moore PB. Structural and functional abnormalities in elderly patients clinically recovered from early- and late-onset depression. Biol Psychiatry 1998; 44:34-46. [PMID: 9646881 DOI: 10.1016/s0006-3223(98)00003-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Structural and functional brain changes have been described in elderly patients with unipolar affective disorder. Changes appear to be more marked in patients with late-onset depression, but the reversibility of such changes after clinical recovery is not known. METHODS Magnetic resonance imaging, electroencephalography (EEG), and cognitive tests were performed in 23 elderly patients (mean age 66.5 years) clinically recovered from major depression. Twelve had late-onset depression (first episode over 55 years of age); 11 had early onset (first episode before 50 years). EEG and cognitive testing were also performed on 15 control subjects. RESULTS Patients with late-onset depression had larger third and lateral ventricles, increased ventricular-brain ratio, and greater frequency and severity of subcortical white matter lesions than those with early onset. There was no difference between early- and late-onset patients in EEG and cognitive measures, but compared with controls patients showed significant changes in EEG evoked potentials and increased slow-wave activity, slowed reaction times, and global impairments in cognitive function. CONCLUSIONS These results suggest that structural changes are greater in patients with late-onset depression, and that EEG and cognitive impairments persist after recovery, regardless of age of onset of depression, and are independent of structural changes.
Collapse
Affiliation(s)
- S Dahabra
- Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|