Using meta-analysis methodology, we compared the clinical outcomes for 769 patients with hepatic cystic echinococcosis treated with percutaneous aspiration-injection-reaspiration (PAIR) plus albendazole or mebendazole (group 1) with 952 era-matched historical control subjects undergoing surgical intervention (group 2). The rate of clinical and parasitologic cure (P<.0001) was greater in patients receiving PAIR plus chemotherapy. Disease recurrence (P<.0001), major complications (anaphylaxis, biliary fistula, cyst infection, liver/intra-abdominal abscess, and sepsis; P<.0001), minor complications (P<.0001), and death (P<.0824) occurred more frequently among surgical control subjects. Fever (P<.002) and minor allergic reactions subjects (P<.0001) were more common among PAIR-treated subjects. The mean durations of hospital stay were 2.4 days for group 1 and 15.0 days for group 2 (P<.001). Compared with surgery, PAIR plus chemotherapy is associated with greater clinical and parasitologic efficacy; lower rates of morbidity, mortality, and disease recurrence; and shorter hospital stays.

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OBJECTIVE:To investigate how important treatment for emotional distress is to primary care patients in general and to primary care patients with depression, and to evaluate the types of mental health interventions they desire. DESIGN: Patient surveys.SETTING: Five private primary care practices. MEASUREMENTS AND MAIN RESULTS:Patients' desire for treatment of emotional distress and for specific types of mental health interventions were measured, as well as patients' ratings of the impact of emotional distress, the frequency of depressive symptoms, and mental health functioning. Of the 403 patients, 33% felt that it was "somewhat important" and 30% thought it was "extremely important" that their physician tries to help them with their emotional distress. Patient desire for this help was significantly related to a diagnosis of depression ( p Ͻ .001), perceptions about the impact of emotional distress ( p Ͻ .001), and mental health functioning ( p Ͻ .001). Among patients with presumptive diagnoses of major and minor depression, 84% and 79%, respectively, felt that it was at least somewhat important that they receive this help from their physician. Sixty-one percent of all primary care patients surveyed and 89% of depressed patients desired counseling; 23% of all patients and 33% of depressed patients wanted a medication; and 11% of all patients and 5% of depressed patients desired a referral to a mental health specialist. CONCLUSIONS:A majority of these primary care patients and almost all of the depressed patients felt that it was at least somewhat important to receive help from their physician for emotional distress. The desire for this help seems to be related to the severity of the mental health problem. Most of the patients wanted counseling, but relatively few desired a referral to a mental health specialist.

Diabetic Retinopathy (DR) harm retinal blood vessels in the eye causing visual deficiency. The appearance and structure of blood vessels in retinal images play an essential part in the diagnoses of an eye sicknesses. We proposed a less computational unsupervised automated technique with promising results for detection of retinal vasculature by using morphological hessian based approach and region based Otsu thresholding. Contrast Limited Adaptive Histogram Equalization (CLAHE) and morphological filters have been used for enhancement and to remove low frequency noise or geometrical objects, respectively. The hessian matrix and eigenvalues approach used has been in a modified form at two different scales to extract wide and thin vessel enhanced images separately. Otsu thresholding has been further applied in a novel way to classify vessel and non-vessel pixels from both enhanced images. Finally, postprocessing steps has been used to eliminate the unwanted region/segment, non-vessel pixels, disease abnormalities and noise, to obtain a final segmented image. The proposed technique has been analyzed on the openly accessible DRIVE (Digital Retinal Images for Vessel Extraction) and STARE (STructured Analysis of the REtina) databases along with the ground truth data that has been precisely marked by the experts.

This review article provides information about the origins, history, evolution and current status of the Saudi healthcare system, which is currently being transformed from a publicly financed and managed welfare system to a market-oriented, employment-based, insurance-driven system. Since its inception in the 1920s, the system has provided free healthcare to all Saudi nationals at publicly owned facilities run by government-employed administrators and healthcare providers. For millions of foreign workers in the country, healthcare at privately owned for-profit facilities has been paid for either by the employer or by the individual. At the completion of the three-stage transition, everyone in the country, whether employed in the public or private sector, is expected to have insurance coverage provided by the employer. All Ministry of Health-owned hospitals will be divested to the private sector, whereas primary health centres are likely to be retained by the government. Many of the operational details of the transition are unclear at this stage and will be worked out in the coming years. This paper provides a context for these changes and highlights some of the existing issues and weaknesses. The article also points to some of the future challenges and cautions against pitfalls involved in the complete transformation of the system.

The visual exploration of retinal blood vessels assists ophthalmologists in the diagnoses of different abnormalities of the eyes such as diabetic retinopathy, glaucoma, cardiovascular ailment, high blood pressure, arteriosclerosis, and age-related macular degeneration. The manual inspection of retinal vasculature is an extremely challenging and tedious task for medical experts due to the complex structure of an eye, tiny blood vessels, and variation in vessels width. Several automatic retinal vessels extraction techniques have been proposed in contemporary literature, which assist ophthalmologists in the timely identification of an eye disorders. However, due to the fast evolution of such techniques, a comprehensive survey is needed. This survey presents a comprehensive review of such techniques, strategies, and algorithms presented to date. The techniques are classified into logical groups based on the underlying methodology employed for retinal vessel extraction. The performance of existing techniques is reported on the publicly accessible datasets in term of various performance measures, providing a valuable comparison among the techniques. Thus, this survey presents a valuable resource for researchers working toward automatic extraction of retinal vessels.

Abstract.The relationship between quantitative Plasmodium falciparum or P. vivax parasitemia and clinical illness has not been defined in Pakistan or in other areas where malaria transmission is not highly endemic. Standardized questionnaires were given to and physical examinations and parasitologic tests were performed in 8,941 subjects seen in outpatient clinics in 4 villages for 13 consecutive months in the Punjab region of Pakistan. The results, based on multivariable analysis, showed that a clinical diagnosis of malaria, a history of fever, rigors, headache, myalgia, elevated temperature, and a palpable spleen among children were all strongly associated with the presence and density of P. falciparum or P. vivax malaria in a monotonic dose-response fashion. The malaria attributable fraction of a clinical diagnosis of malaria, and the same symptoms and signs also increased with increasing P. falciparum and, to a lesser extent, P. vivax, parasitemia. Unlike in sub-Saharan Africa, clinical illness due to malaria often occurs in the Punjab among adolescents and adults and in patients with parasite densities less than 1,000/l. Clinical guidelines based upon parasitemia and symptomatology must be adjusted according to the intensity of transmission and be specific for each geographic area. Morbidity and mortality have been strongly linked toPlasmodium falciparum parasite density and guidelines have been introduced for etiologic classification of febrile illnesses and for therapeutic regimens based upon density of parasites in the blood. While P. falciparum is the predominant species in sub-Saharan Africa, where most of the studies comparing clinical illness with intensity of infection have been conducted, 1-6 malaria in southern Asia and many other endemic areas is caused by both P. falciparum and P. vivax and is characterized by a much lower sporozoite inoculation rate. The relationship between parasite density and clinical illness in such an environment has not been defined as it has been in Africa. Also, the impact of increasing P. vivax parasite density on clinical disease has not been studied as rigorously as has P. falciparum.

PURPOSE:To compare the resource utilization and clinical outcomes of medical care delivered on general internal medicine inpatient services at teaching and nonteaching services at an academic hospital. METHODS:From February to October 2002, 2189 patients admitted to a 450-bed university-affiliated community hospital were assigned either to a resident-staffed teaching service (n ϭ 1637) or to a hospitalist-or clinic-based internist nonteaching service (n ϭ 552). We compared total hospital costs per patient, length of hospital stay (LOS), hospital readmission within 30 days, in-hospital mortality, and costs for pharmacy, laboratory, radiology, and others between teaching and nonteaching services. RESULTS:Care on a teaching service was not associated with increased overall patient care costs ($5572 vs. $5576; P ϭ .99), LOS (4.92 days vs. 5.10 days; P ϭ .43), readmission rate (12.3% vs. 10.3%; P ϭ .21), or in-hospital mortality (3.7% vs. 4.5%; P ϭ .40). Mean laboratory and radiology costs were higher on the teaching service, but costs for the pharmacy and for speech therapy, occupational therapy, physical therapy, respiratory therapy, pulmonary function testing, and GI endoscopy procedures were not statistically different between the 2 services, and residents did not order more tests or procedures. Case mix and illness severity, as reflected by the distribution of the most frequent DRGs and mean number of secondary diagnoses per patient and DRG-specific LOS, were similar on the 2 services. CONCLUSIONS: