Joy John Mammen

Automated Segmentation of Nuclei in Breast Cancer Histopathology Images.

The process of Nuclei detection in high-grade breast cancer images is quite challenging in the case of image processing techniques due to certain heterogeneous characteristics of cancer nuclei such as enlarged and irregularly shaped nuclei, highly coarse chromatin marginalized to the nuclei periphery and visible nucleoli. Recent reviews state that existing techniques show appreciable segmentation accuracy on breast histopathology images whose nuclei are dispersed and regular in texture and shape; however, typical cancer nuclei are often clustered and have irregular texture and shape properties. This paper proposes a novel segmentation algorithm for detecting individual nuclei from Hematoxylin and Eosin (H&E) stained breast histopathology images. This detection framework estimates a nuclei saliency map using tensor voting followed by boundary extraction of the nuclei on the saliency map using a Loopy Back Propagation (LBP) algorithm on a Markov Random Field (MRF). The method was tested on both whole-slide images and frames of breast cancer histopathology images. Experimental results demonstrate high segmentation performance with efficient precision, recall and dice-coefficient rates, upon testing high-grade breast cancer images containing several thousand nuclei. In addition to the optimal performance on the highly complex images presented in this paper, this method also gave appreciable results in comparison with two recently published methods—Wienert et al. (2012) and Veta et al. (2013), which were tested using their own datasets.

HLA match likelihoods for Indian patients seeking unrelated donor transplantation grafts: a population-based study

BACKGROUND For patients who do not have a suitable human leukocyte antigen (HLA)-matched family donor, unrelated donor registries of adult volunteers and banked umbilical cord blood (UCB) units provide the potential for successful haemopoietic stem-cell transplantation. The size and genetic composition of such registries determines the proportion of patients who will be able to find a suitable match. We aimed to assess the proportion of positive matches for Indian patients. METHODS Using HLA data from ten existing donor and UCB registries and clinical transplant centres in India, we built population-based genetic models for 14 Indian regions to model Indian registry growth to predict the likelihood of identifying a suitable donor-either an adult donor or UCB-for Indian patients. We computed ranking tables of the top ten haplotypes in each regional group and compared these with four US samples from the National Marrow Donor Program (NMDP) registry. FINDINGS The mean proportion of individuals who would have a 10/10 adult donor match within India ranged from 14·4% with a registry size of 25 000 to 60·6% with a registry size of 1 000 000. Only when donor registries increased to 250 000 did the match rate within India exceed that found by searching the US-NMDP registry combined with an Indian registry of 25 000 donors. The proportion of matches increased logarithmically with increased registry size (R(2)=0·993). For a UCB registry size of 25 000, 96·4% of individuals would find a 4/6 match; however, only 18·3% would have a 6/6 match. INTERPRETATION Serial match modelling and follow-up comparisons can identify the relative and progressively greater value of an India-based donor registry and UCB banking network to serve the Indian population. Understanding regional HLA haplotype diversity could guide registry growth and maximise benefit to patients. Similar modelling could guide planning for the needs of other ethnically distinct populations. FUNDING University of Minnesota and the Indian Council for Medical Research.

Successful surgical haemostasis in patients with von Willebrand disease with Koate®DVI

Summary.  This report describes our experience with Koate®DVI, a factor VIII (FVIII) concentrate containing von Willebrand factor (VWF) for surgery in patients with von Willebrand’s disease (VWD). Twenty‐one patients underwent 26 procedures, 10 of which were major and 16 were minor. The median age was 27 years (3–55) and the mean weight was 52 kg (16–88). Among the ten patients (type 2–5; type 3–5) who underwent major procedures, the pre‐operative dose was 35 IU kg−1 of FVIII followed by 10–20 IU kg−1 once daily depending on FVIII:C levels. The mean total dose of FVIII used per procedures was 106 IU kg−1 (30–190) over a mean duration of 7 days (3–11). In this group, pre‐infusion FVIII:C, VWF:Ag and VWF: ristocetin cofactor (RCoF) level that were 19.5% (1–64), 20 U dL−1 (0–96) and 12% (0–66) increased to 72% (54–198), 131 U dL−1 (68–206) and 68% (27–108) postinfusion, respectively. Sixteen minor procedures were performed in 11 patients (type 1–3, type 2–6, type 3–2). The preparative dose of FVIII was 10–20 IU kg−1. The average duration of factor support was 2 days (1–3) for a mean total dose of 23 IU kg−1 (9–60). The pre‐infusion levels of FVIII:C, VWF:Ag and VWF:ristocetin cofactor (RCo) which were 31% (22–64), 25.5 U dL−1 (0–63) and 21% (0–76), respectively, increased to 76% (27–111), 73 U dL−1 (30–137) and 45% (2–106) postinfusion. Whereas surgical haemostasis was achieved in all patients, minor postoperative bleeding occurred after one procedure in each group. Both were controlled with additional doses of factor replacement. We conclude that Koate®DVI in modest doses provide adequate haemostasis for surgery in patients with VWD.

Detection of Plasmodium Falciparum in Peripheral Blood Smear Images

Malaria is a mosquito-borne infectious disease caused by the parasite Plasmodium, which requires accurate and early diagnosis for effective containment. In order to diagnose malaria in a patient, timely detection of malaria parasites in blood smear images is vital. The traditional methods are time–consuming, tedious and the quality of detection is highly subjective to the individual who performs the analysis. These results can clearly be improved upon by using image processing techniques. The malaria parasite appears in four stages, namely the ring, trophozoite, schizont, and gametocyte. The ring and the gametocyte stage are the ones seen in a peripheral blood smear and hence detecting these two stages, would help in the accurate diagnosis of malaria. The proposed work aims at automating the analysis of the blood smear images using appropriate segmentation techniques, thereby detecting infected red blood cells as well as the gametocytes found in the blood.

Segmentation and reversible watermarking of peripheral blood smear images

This paper proposes an automated method for the segmentation of peripheral blood smear images, depicting the differential count of white blood cells. It also proposes a reversible fragile watermarking technique, in which the watermark-related information is embedded in the Region of Non-Interest (RONI) of the image. Image authenticity and integrity, is maintained by embedding the Input message along with the Hash Message Authentication Codes (HMAC) of the image and the message itself.

Quality laboratory issues in bleeding disorders.

Selected quality issues pertinent to the determination of accurate results in the haemostasis laboratory are discussed. Specifically, the implementation of a successful external quality‐assessment scheme is described, including its impact on result accuracy as well as the programmes unique challenges and opportunities. Errors in the preanalytical phase of laboratory testing represent the greatest source for reporting incorrect test results. Some of the most common preanalytical errors are described including those that necessitate sample rejection. Analytical means to identify potential sources of error and analytical means to overcome particular interferences are described. Representing the most important clinical complication in the treatment of patients with haemophilia, quality issues related to determination of the presence of inhibitory antibodies against factor VIII (FVIII) are reviewed. Heat treatment of patient plasma prior to testing, particularly in patients receiving replacement FVIII concentrate or during induction of immune tolerance to achieve more accurate results is recommended, while screening activated partial thromboplastin time‐based mixing tests to rule out inhibitor presence is discouraged. The initiatives presented in this review can be implemented in robust and resource restricted settings to improve the quality of laboratory testing in patients with bleeding disorders.

Automatic Detection of Tubules in Breast Histopathological Images

Histopathological examination of tissues enables pathologists to quantify the morphological features and spatial relationships of the tissue components. This process aids them in detecting and grading diseases, such as cancer. Quite often this system leads to observer variability and therefore affects patient prognosis. Hence quantitative image-analysis techniques can be used in processing the histopathology images and to perform automatic detection and grading. This paper proposes a segmentation algorithm to segment all the objects in a breast histopathology image and identify the tubules in them. The objects including the tubules and fatty regions are identified using K-means clustering. Lumen belonging to tubules is differentiated from the fatty regions by detecting the single layered nuclei surrounding them. This is done through grid analysis and level set segmentation. Identification of tubules is important because the percentage of tubular formation is one of the parameters used in breast cancer detection and grading.

Segmentation of sputum smear images for detection of tuberculosis bacilli

Background Tuberculosis (TB) is a common and lethal infectious disease, which requires accurate and early diagnosis for effective containment. Essential for the diagnosis of pulmonary infection is the detection of the bacilli through the manual microscopic examination of ZN-stained sputum smear, which is a time-consuming, complex process necessitating at least 8-10 minutes per slide. Moreover, the quality of the detection is highly subjective to the individual who performs the analysis. These results can clearly be improved upon by using image processing techniques. The proposed work uses the segmentation techniques to automate the analysis of the sputum smear images and to detect the presence of tuberculosis bacilli in them.

Mean reticulocyte volume enhances the utility of red cell mean sphered cell volume in differentiating peripheral blood spherocytes of hereditary spherocytosis from other causes

CONTEXT Mean sphered cell volume (MSCV) and mean reticulocyte volume (MRV) are additional reticulocyte parameters generated while processing the blood samples on Beckman coulter LH 755 in the reticulocyte mode using the volume, conductivity and scatter technology. It has been observed that the difference between mean corpuscular volume (MCV) and MSCV is higher in the cases of hereditary spherocytosis (HS) and this difference is increasingly being utilized as a screening tool for spherocytes. In addition now there have been new observations that reticulocyte volume in cases of HS is less as compared to normal reticulocyte. AIMS Our aim was to test the usefulness of reticulocyte parameters like MSCV and MRV in distinguishing cases of HS and autoimmune hemolytic anemia (AIHA). MATERIALS AND METHODS This is a retrospective and partly prospective study where peripheral blood ethylenediaminetetraacetic acid samples from cases of HS (n = 57) and AIHA (n = 29) were processed on LH 755 in both the differential and the reticulocyte mode. The data generated were analyzed and compared with data from normal healthy donors (n = 46). RESULTS Using an algorithm of MCV - MSCV >10 and MRV - MSCV <25, a sensitivity of 84.2% and specificity of 94.7% was observed in cases of HS. CONCLUSIONS With the reticulocyte analysis, we may now have a simple and cheap additional tool for screening of HS.

Ahead to 100% of voluntary nonremunerated blood donation at a tertiary referral hospital blood bank in South India

Sir, Recruitment and retention of new blood donor is an important task for blood banks for self-sufficient of blood and blood products. Availability of blood and blood products has been a universal problem for a long time. Blood is a scarce resource and it is the responsibility of Blood Banks to ensure that blood supply is safe, adequate, and available to meet needs of our patient populations. Motivation, recruitment, and retention of voluntary blood donors are important criteria to achieve safe blood donation. [1] Voluntary nonremunerated blood donors are considered to be safest source. [2] Converting first-time donors to become regular donors continues to be a challenge for blood banks. [3] Indian blood donation system currently operates using bloods from both voluntary and replacement donors. Indian government has aimed to evacuate the replacement blood donors to achieve 100% voluntary nonremunerated blood donation due to safety concerns. Voluntary blood donors are continuously necessary for patients because the demand for donor blood is never ending. Over a million blood units are collected every year; and many more millions still need to be collected to meet the global demand and ensure sufficient and timely provision of blood. [4]