An Effective Deep Learning Model for Health Monitoring and Detection of COVID-19 Infected Patients: An End-to-End Solution.

The COVID-19 infection is the greatest danger to humankind right now because of the devastation it causes to the lives of its victims. It is important that infected people be tested in a timely manner in order to halt the spread of the disease. Physical approaches are time-consuming, expensive, and tedious. As a result, there is a pressing need for a cost-effective and efficient automated tool. A convolutional neural network is presented in this paper for analysing X-ray pictures of patients' chests. For the analysis of COVID-19 infections, this study investigates the most suitable pretrained deep learning models, which can be integrated with mobile or online apps and support the mobility of diagnostic instruments in the form of a portable tool. Patients can use the smartphone app to find the nearest healthcare testing facility, book an appointment, and get instantaneous results, while healthcare professionals can keep track of the details thanks to the web and mobile applications built for this study. Medical practitioners can apply the COVID-19 detection model for chest frontal X-ray pictures with ease. A user-friendly interface is created to make our end-to-end solution paradigm work. Based on the data, it appears that the model could be useful in the real world.

A single centre experience of percutaneous nephrolithotomy in infants and its long-term outcomes.

BACKGROUND: Renal stones in infants requiring Percutaneous nephrolithotomy (PCNL) is rare. There is insufficient literature on the long-term implications of PCNL in growing kidneys of these children. OBJECTIVES: To review our experience of PCNL amongst infants i.e., < 1year of age and to analyse the safety and efficacy of this procedure and assess its long-term renal outcomes. STUDY DESIGN: This was a retrospective analysis of a prospectively maintained data base between 2005 and 2020. All infants with unilateral renal stones >12 mm underwent PCNL. Changes in the serum creatinine, estimated glomerular filtration rate and renal size prior to the PCNL and at the last follow up were monitored. The demographics, clinical profile, operative details, post-operative complications and follow up data were collated and analyzed. RESULTS: 86 children were diagnosed with renal stones of whom, 24 infants met our inclusion criteria and were included in the review. The average age was 9.75 months with fever being the commonest presenting symptom. Five infants were diagnosed with metabolic abnormalities, hypercalciuria being the commonest. Majority of the infants (22) had single stones and the lower calyx was the commonest site (50%). The mean stone burden was 19.5 mm. The stone free rate was 91% during the primary PCNL, which increased to 100% after re-do PCNL. The overall complication rate was 16% which was graded by the modified Clavien Dindo scale for surgical complications. The median follow up period was 144 months and average age at the last follow up was 10.5 years. At the last follow up, a mean serum creatinine of 0.4 mg/dl, mean estimated glomerular filtration rate of 98 ml/min/1.72 m2 and a mean renal size of 8.3 cm was recorded, which was comparable to that of a normal child, thus signifying no deterioration of renal functions and renal growth. Three children showed the presence of cortical scars on an isotope scan at follow up. However, all the 24 operated renal units demonstrated preserved renal functions. DISCUSSION & CONCLUSION: PCNL performed during infancy does not hinder the growth potential of the kidney. Each of the 24 children achieved the target renal size and estimated glomerular filtration rate corresponding to the duration and body size at the end of the follow-up. Thus, PCNL in infants <1 year of age is safe and effective with no adverse effects at long term follow-up.

Delivery approaches for CRISPR/Cas9 therapeutics in vivo: advances and challenges.

INTRODUCTION: Therapeutic gene editing is becoming a viable biomedical tool with the emergence of the CRISPR/Cas9 system. CRISPR-based technologies have promise as a therapeutic platform for many human genetic diseases previously considered untreatable, providing a flexible approach to high-fidelity gene editing. For many diseases, such as sickle-cell disease and beta thalassemia, curative therapy may already be on the horizon, with CRISPR-based clinical trials slated for the next few years. Translation of CRISPR-based therapy to in vivo application however, is no small feat, and major hurdles remain for efficacious use of the CRISPR/Cas9 system in clinical contexts. AREAS COVERED: In this topical review, we highlight recent advances to in vivo delivery of the CRISPR/Cas9 system using various packaging formats, including viral, mRNA, plasmid, and protein-based approaches. We also discuss some of the barriers which have yet to be overcome for successful translation of this technology. EXPERT OPINION: This review focuses on the challenges to efficacy for various delivery formats, with specific emphasis on overcoming these challenges through the development of carrier vehicles for transient approaches to CRISPR/Cas9 delivery in vivo.

Treatment of AVN Using Autologous BM Stem Cells and Activated Platelet-Derived Growth Factor Concentrates.

BACKGROUND: Avascular Necrosis (AVN) of hip is a devastating condition seen in younger individuals. It is the ischemic death of the constituents of the bone cartilage of the hip. The femoral head (FH) is the most common site for AVN. It results from interruption of the normal blood flow to the FH that fits into the hip socket. Earlier studies using autologous bone marrow stem cell concentrate injections have shown encouraging results with average success rates. The current study was designed to improve significantly the cartilage regeneration and clinical outcome. METHODS: Total of 48 patients underwent autologous bone marrow stem cell and activated platelet-rich plasma derived growth factor concentrate (PRP-GFC) therapy for early and advanced stages AVN of femoral head in a single multi-specialty center. The total treatment was divided into three phases. In the phase I, all the clinical diagnostic measurements such as magnetic resonance imaging (MRI), computed tomography (CT) etc. with respect to the AVN patients and bone marrow aspiration from posterior iliac spine from the patients were carried out. In the phase II, isolation of stem cells and preparation from the patients were performed. Subsequently, in phase III, the stem cells and PRP- GFCs were transplanted in the enrolled patients. RESULTS: Ninety three percent of the enrolled AVN patients showed marked enhancement in the hip bone joint space (more than 3mm) after combined stem cells and PRP-GFC treatment as evidenced by comparison of the pre- and post-treatment MRI data thus indicative of regeneration of cartilage. The treated patients showed significant improvement in their motor function, cartilage regrowth (3 to 10mm), and high satisfaction in the two-year follow-up. CONCLUSION: Combination of stem cell and PRP-GFC therapy has shown promising cartilage regeneration in 45 out of 48 patients of AVN. This study clearly demonstrates the safety and efficacy of this treatment. Larger numbers of patients need to be evaluated to better understand the efficacy of the combined stem cell and PRP-GFC therapy on AVN patients.

A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy.

OBJECTIVE: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. MATERIALS AND METHODS: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. RESULTS: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. CONCLUSIONS: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.

Inflammatory pseudotumor of kidney masquerading as renal carcinoma.

Inflammatory pseudotumor also known as inflammatory fibroblastic tumor is a rare benign tumor, which commonly affects the lung. It is very rarely seen in the genitourinary tract. As the preoperative diagnosis, clinically and radiologically is inconclusive, it is imperative to surgically remove and confirm it on histopathologic examination. We report a case of inflammatory pseudotumor in a 51-year-old male who presented with flank pain and was treated with nephrectomy.

A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy

ABSTRACT Objective: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. Materials and Methods: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. Results: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. Conclusions: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.

Laparoscopic extravesical detrusorraphy, a minimally invasive treatment option for vesicoureteral reflux: a single centre experience.

INTRODUCTION: Laparoscopy in pediatric patients offers more benefits than was earlier presumed and these widely reported benefits significantly outweigh any concerns regarding the technical difficulties. Laparoscopic correction of vesicoureteral reflux aims to duplicate the excellent results of open surgery while at the same time reducing perioperative morbidity and analgesic requirements, improving cosmesis and shortening hospital stay. OBJECTIVE: To share our experience of laparoscopic extravesical detrusorraphy, highlight our technical modification of intraoperative minimal "atraumatic" ureteric handling of the ureter, which we hypothesize may decrease ureteral complications, and report our results. STUDY DESIGN: This was a retrospective chart review of 76 toilet-trained children (98 refluxing units), in the age group of 3-16 years, with Grade I-IV reflux, who underwent laparoscopic detrusorraphy from June 2006 to January 2014. A ureteric catheter is inserted into the refluxing ureter and is tied to the Foleys to drain into a common bag. A three port technique is used. During ureteral dissection, a vascular sling in the form of a Rumel loop is used for atraumatic handling of the ureter. A detrusor tunnel is created with hook electrocautery. A stay suture is later passed through the abdominal wall and slings around the dissected ureter, which helps in holding the ureter approximated against the mucosal trough during detrusorraphy. Detrusor fibers are approximated with 5-0 Vicryl. No drain is placed and the Foley and ureteric catheter(s) are removed after 24 h. Intravenous ketorolac is given every 6 h for the first 24 h. Oral paracetamol is used for analgesia after the first 24 h. Adequate bladder emptying is ensured by assessment of post void residual urine before discharge. Renal USG alone is performed 2 weeks post operatively and repeated after 3 months along with a VCUG (voiding cystourethrography). Success was defined as absence of reflux in the follow-up VCUG done at 3 months. RESULTS: Mean operative time was 102 ± 26.5 min for unilateral detrusorraphy and 165 ± 18 min for bilateral extravesical detrusorraphy. The mean duration of hospital stay was 1.5 ± 1.7 days. There was one case of urinary retention that was managed with temporary recatheterization. There were no cases of ureteral ischemia, obstruction, hematuria or bladder spasms. Surgery was successful in 97.9% of the refluxing units (96/98). In two patients with grade IV reflux, there was downgrading to grade II on VCUG done at 3 months' follow-up. The reflux resolved at 8 and 14 months' follow-up, respectively. DISCUSSION: Our technique of atraumatic handling of the ureter, initially with the help of a vascular sling and later with the help of a stay suture passed percutaneously through the abdominal wall, resulted in no ureteric injuries. The postoperative morbidity of this procedure is low because the bladder is not opened, the ureter is not transected, no new UVJ is created and there is no need for placement of a drain. The risk of postoperative bowel adhesions is low as the ureter is dissected out through a narrow peritoneal window, which is again extraperitonealized at the end of the procedure (see figure). The postoperative complications of gross hematuria and bladder spasms, which may be especially encountered in patients undergoing laparoscopic Cohen's, were not seen in our case series. CONCLUSION: Laparoscopic extravesical detrusorraphy provides a minimally invasive treatment option for treatment of unilateral/bilateral grade I-IV vesicoureteral reflux. The postoperative morbidity is low and the success rate is favorable. Our technical modification of a "vascular sling" around the ureter facilitates atraumatic ureteric handling, which may reduce distal ureteral complications like ureteral ischemia and obstruction.

Bleeding ureter: endometriosis mascarading as a ureteral malignancy - a case report.

Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. As the diagnosis is elusive, a heavy clinical suspicion is necessary. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Here, we are presenting a rare case of bleeding ureter in a young lady who had endometriosis of the ureter.

Fetus in bladder.

This is the first reported case of vesicouterine fistula presenting with a fully formed dead fetus in the urinary bladder.

Hepatic and adrenal hemangioendothelioma-a case report.

Haemangioendothelioma (HE) liver is a mesenchymal vascular tumour, intermediate between a haemangioma and an angiosarcoma. It has a variable clinical course, is a low grade malignancy and is associated with long-term survival. It has a characteristic histologic appearance. Immunohistochemical studies have shown that the neoplastic cells in HE are of endothelial derivation. These are essential to distinguish HE from metastatic carcinoma and primary epithelial liver tumour. We report a case of a 36-year-old male with HE of the liver with adrenal involvement, probably metastatic, with tuberculosis as an incidental finding. To our knowledge this is the first such case reported in literature. The confirmation of diagnosis was done by immunohistochemical study.

Discrete stochastic models for compliance analysis based on an AIDS Clinical Trial Group (ACTG) study.

Compliance is the extent to which a patient follows the prescribed regimen. Here we investigate the statistical properties of two popular measures of compliance - percentage of compliant days and percentage of doses taken. We use a stationary Markov chain to model the dependence structure of successive data points for each subject. We illustrate our model using discrete compliance data collected from an AIDS Clinical Trial Group study (ACTG 398). We check the model assumptions and evaluate the small sample as well as large sample properties of our estimators. We show that ignoring the within-subject dependence will usually underestimate the standard errors of the estimates of these compliance measures. Our model allows the application of meta-analytic approaches to assess the variation across subjects in these compliance indices and changes in them due to intervention.

Recurrent renal cell carcinoma presenting as gastrointestinal bleed. A case report.

Recurrence in renal carcinoma after primary therapy is a rare but known event. The recurrences are often asymptomatic, but could manifest in varied forms depending on the organ involved. In this report, we present a case wherein the recurrent tumor had ulcerated into the duodenal lumen manifesting as an upper gastrointestinal bleed. A 58-year-old male patient underwent radical nephrectomy on the right side for renal cell carcinoma (T2, N0, M0). Three years and 5 months later, the patient presented with an acute episode of upper gastrointestinal bleed. The recurrence was diagnosed by biopsy through endoscopy and evaluated by computed tomography (CT) scan. The patient was managed with an en bloc pancreatico-duodenectomy after metastatic evaluation and is disease free for 2 years. Recurrences in renal cell carcinoma can show varied presentation. Only 2 cases of gastrointestinal bleed of recurrent renal cell carcinoma are reported. High index of suspicion and long term follow-up are required. Aggressive surgical management for recurrence of renal cell carcinoma is warranted as good prognosis could be expected in the absence of metastasis.

Chromosome aberration analysis in radiotherapy patients and simulated partial body exposures: biological dosimetry for non-uniform exposures.

Chromosome aberration analysis was carried out in peripheral blood lymphocytes of cancer patients following radiotherapy of lungs, cervix and spine. Radiotherapy in the pelvic region involving large doses (6 Gy) showed an overdispersed distribution of dicentrics. However, when the doses were fractionated (three fractions of 2 Gy) distribution was found to be near Poisson. Spine irradiation covering almost all the lymphocytes pools, indicated a Poisson distribution. The data show that depending on the sites of exposure, the distribution of dicentrics in cells varies and hence there is a non-uniform distribution of lymphocytes in the body. The average dose to the lymphocytes was found to be one sixth of the partial body dose. Based on the non-Poisson distribution of aberrations, the fraction of lymphocytes irradiated, mean dose to the fraction and part of the body exposed was calculated in a case of acute 6 Gy pelvic irradiation. The fraction of cells irradiated was calculated to be 4.11% and the portion of the body exposed was approximately 16.8%. The dose to the irradiated fraction was found to be 5.4 Gy, which is in agreement with the given dose of 6 Gy. In simulated exposures the u values increased systematically with the decrease in fraction of irradiated cells and the calculated dose to the fraction was also in good agreement with the true dose.

Laparoscopic management of neonatal ovarian cysts.

A laparoscopic approach was used in four infants with antenatally diagnosed ovarian cysts requiring surgical intervention. Operating time ranged from 60 to 90 minutes, there were no intraoperative or postoperative complications, and all infants were discharged within 23 hours after surgery. If performed by experienced practitioners, microendoscopy is an alternative to laparotomy in neonates requiring surgical intervention for ovarian cysts.

Acquisition and analysis of brainstem auditory evoked responses of normal and diseased subjects by spectral estimation.

Human brainstem auditory evoked responses (BAERs) are sensory evoked potentials that can be recorded within a few milliseconds following a transient acoustic stimulus (click signal). This paper suggests a novel technique to clearly demarcate normals and patients with complaints of vertigo and deafness by computing hitherto unused power spectral parameters from the BAER signals recorded on them. The BAER spectrum of normal subjects contains three main frequency components, i.e. low-, mid- and high-frequency components around 100, 500 and 1000 Hz, respectively, which is not so in the case of diseased subjects. The spectral parameters, i.e. the mean power frequency, median frequency, the ratios of the integrated power at dominant frequencies to that of the total power in spectrum and change in spectral power (CP) between these dominant frequency components are used to classify the recorded BAER signals into those of normals and the patients, and aid the clinician in quick and better diagnosis. The ranges of CP are estimated for the different groups and appear to be the most dominant parameter in the classification of the BAER signals.

Congenital long segment tracheal stenosis presenting with tachypnea.

An infant born at full term presented with tachypnea, tachycardia and fatigue with feedings. Blood gases revealed hypoventilation. A rigid bronchoscopy using the Karl-Storz telescopic system revealed severe tracheal stenosis. Follow-up three-dimensional computerized tomography scans of the neck and chest revealed a long segment, funnel-shaped tracheal stenosis extending up to the left bronchial orifice. The patient underwent tracheal reconstruction, but died three weeks later from postoperative complications. It is unusual for severe tracheal stenosis to present without stridor, apnea, cyanosis and wheezing. Infants with unexplained tachypnea should be worked-up for congenital deformities of the upper airways.

Pseudoappendicitis preceding infectious mononucleosis.

In patients with infectious mononucleosis, abdominal pain is usually attributed to visceral enlargement. A teenage girl with symptoms of appendicitis was found at laparotomy to have mesenteric adenitis. Postoperatively, she developed classic features of Epstein-Barr virus (EBV)-induced mononucleosis. The lymphoproliferation characteristic of EBV infection can cause severe localized abdominal pain that predates the onset of mononucleosis.

Complicated cannula insertions and cannula dislodgments associated with extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation therapy remains a life saving modality for neonates with cardiopulmonary disease that is unresponsive to conventional therapy. Vital to its success is the insertion and maintenance of appropriately sized vascular cannulas. Problematic insertion and accidental dislodgments can be life threatening. To determine the treatment and outcome of these complications, a survey of participating Extracorporeal Life Support Organization centers was undertaken. Venous cannulation complications (13 patients) were due to inadequate vein size or tearing during initial attempts at cannulation. Proximal and alternative site cannulation were used. Difficult arterial cannulations (seven patients) were most often due to creation of an intimal flap that was corrected by proximal cannulation of the same vessel. The 10 cases of accidental dislodgment were most often associated with changes in position. Despite copious hemorrhage in many instances, 6 of 10 patients survived with intact neurologic status. Methods for dealing with these life threatening cannula related complications are described.