Purpose To examine the impact of retinal field of view and magnification on inter-expert reliability of plus disease diagnosis in retinopathy of prematurity (ROP). Methods 15 wide-angle images from infants with ROP were cropped and adjusted in magnification to create two additional image categories: medium-angle (40–50°) and narrow-angle (20–30°). These 45 images were uploaded to a web-based system and interpreted independently by 13 ROP experts using a 3-level (plus, pre-plus, neither) and 2-level (plus, not plus) classification. Absolute agreement and kappa statistics were calculated to compare inter-expert reliability. Results In the 3-level classification, ≥70% experts agreed on the same diagnosis in 8/15 (53%) wide-angle images, but only in 3/15 (20%) medium-angle and 3/15 (20%) narrow-angle images. In the 2-level classification, ≥80% experts agreed on the same diagnosis in 11/15 (73%) wide-angle images, but only in 9/15 (60%) medium-angle and 3/15 (20%) narrow angle images. Mean kappa of each expert compared to all other experts was 0.40–0.59 in 8/13 (62%) experts using wide-angle images, was 0–0.19 in 7/13 (54%) experts using medium-angle images, and was 0.20–0.39 in 9/13 (69%) experts using narrow-angle images. Conclusions Inter-expert agreement in plus disease diagnosis in wide-angle images is higher than from medium-angle and narrow-angle images. Plus disease is defined using a narrow-angle standard published photograph, yet this study suggests that peripheral findings also contribute to diagnosis.

Findings of this study suggest that optic nerve and RNFL morphology is markedly similar between Caribbean blacks and African Americans once adjusted for optic nerve size but cannot be considered equivalent in all measures, particularly in the superior nerve fiber layer.

No abstract

Coexistence of PHPT in patients with thyroid nodules can complicate patient management if associated with undetected hypercalcemia or unrecognized thyroid cancer. It is an uncommonly diagnosed condition, due to overlapping symptoms in developing countries like India and almost all patient get symptomatic treatment. A 47-year-old female patient presented a history of progressively increasing swelling in the thyroid region associated with continuous dull ache and whose was diagnosed as thyroid nodule with parathyroid adenoma. Thyroidectomy with parathyroidectomy is the preferred modality of treatment for thyroid disorder with additional parathyroid adenoma. The thyroid nodules should be carefully evaluated during the preoperative work-up of a patient with primary hyperparathyroidism. Both MIBI and neck USG should be done in the evaluation of patients undergoing thyroidectomy and parathyroid excision simultaneously to locate the parathyroid adenomas.