Deep learning based detection of monkeypox virus using skin lesion images.

As we set into the second half of 2022, the world is still recovering from the two-year COVID-19 pandemic. However, over the past three months, the outbreak of the Monkeypox Virus (MPV) has led to fifty-two thousand confirmed cases and over one hundred deaths. This caused the World Health Organisation to declare the outbreak a Public Health Emergency of International Concern (PHEIC). If this outbreak worsens, we could be looking at the Monkeypox virus causing the next global pandemic. As Monkeypox affects the human skin, the symptoms can be captured with regular imaging. Large samples of these images can be used as a training dataset for machine learning-based detection tools. Using a regular camera to capture the skin image of the infected person and running it against computer vision models is beneficial. In this research, we use deep learning to diagnose monkeypox from skin lesion images. Using a publicly available dataset, we tested the dataset on five pre-trained deep neural networks: GoogLeNet, Places365-GoogLeNet, SqueezeNet, AlexNet and ResNet-18. Hyperparameter was done to choose the best parameters. Performance metrics such as accuracy, precision, recall, f1-score and AUC were considered. Among the above models, ResNet18 was able to obtain the highest accuracy of 99.49%. The modified models obtained validation accuracies above 95%. The results prove that deep learning models such as the proposed model based on ResNet-18 can be deployed and can be crucial in battling the monkeypox virus. Since the used networks are optimized for efficiency, they can be used on performance limited devices such as smartphones with cameras. The addition of explainable artificial intelligence techniques LIME and GradCAM enables visual interpretation of the prediction made, helping health professionals using the model.

Tricortical iliac crest graft as a salvageable option in the reconstruction of comminuted posterior wall acetabular fractures: our experience from a level 1 trauma centre.

BACKGROUND: Comminuted fractures of the posterior acetabular wall, pose a significant challenge in the reduction and fixation of the fracture fragments and usually result in dubious functional outcomes. Primary reconstruction of the severely comminuted posterior wall using the autologous tricortical iliac crest graft has shown promising results, especially in fractures not amenable for anatomical reduction and fixation. Thus, the present study analyses the functional and radiological outcomes of severely comminuted posterior wall acetabular fractures, primarily reconstructed with an autologous tricortical iliac crest graft. METHODOLOGY: This is a retrospective study, where all cases of comminuted posterior wall acetabulum fractures treated primarily with reconstruction using ipsilateral autologous tricortical iliac crest graft between January 2011 and November 2018 were included. The data of patients were retrieved from the hospital records and all the patients were assessed clinically and radiologically at the final follow-up. RESULTS: Fourteen patients (ten males and four females) were operated on with a mean operative time of 160 min (range 125 to 190 min) and a mean blood loss of 410 ml (range 320 ml to 830 ml). At 2 years of follow-up, 11 patients (78.57%) had good to excellent functional outcomes based on the modified Merle d'Aubigne and Postel scoring system. The radiological assessment using Matta's criteria indicated excellent outcomes in two patients (14.48%), good in six patients (42.85%), fair in six patients (42.85%). CONCLUSION: Primary reconstruction of the comminuted posterior wall acetabulum fractures is a potential alternative and salvageable option with favourable outcomes. However, it ought to be considered in severely comminuted fractures where anatomical reduction and internal fixation is not feasible.

Chronic Osteochondral Fractures of the Patella Managed with Open Reduction and Internal Fixation Yields Excellent Knee Function.

Currently, the management of acute osteochondral fractures (OCFs) of the patella is well established. However, the management of chronic OCFs remains debatable, as it is not clear whether such lesions can be accurately reduced or whether they will reliably heal. With well proven results of open reduction and internal fixation (ORIF) with headless compression screws (HCS) for acute OCFs, the application of this technique in late presenting cases is inconclusive. Thus, we present the clinicoradiological outcome of patients with chronic osteochondral injuries managed with ORIF. Fifteen patients who underwent surgical fixation by ORIF with HCS for chronic OCFs of the patella, between February 2013 and June 2018, were retrospectively analyzed after a mean follow-up of 3.8 years (range: 2-7 years). The mode of injury, size of the osteochondral fragment, and knee range of motion along with Kujala's scoring were examined clinically and radiological assessment was done by X-rays and magnetic resonance imaging (MRI) scans. Fifteen patients (11 males and 4 females), with a mean age of 17 years with chronic OCF of patella were enrolled. Noncontact twisting injuries were the most common mode of injury seen in 86.66% of patients and postcontact injuries in two patients (13.33%). The mean time from trauma to presentation was 7 weeks (range: 6-14 weeks). The mean preoperative Kujala's score improved from 44 to 84.8 at 6 months and 92.6 at 2 years, postoperatively. Intraoperatively, the lesion was found in medial patellar facet in 12 patients and 3 had lesions in the central facet. The mean size of the lesion was 20 mm × 18 mm. Radiological union was observed in all patients, at a mean duration of 16 weeks (range: 12-20 weeks). One patient underwent implant removal 1 year after initial surgery for mechanical symptoms. ORIF of OCFs of the patella using headless cannulated screws is simple, reliable, reproducible, and provides satisfactory outcomes. This technique can be considered for fixation of fragments with adequate subchondral bone.

Medial femoral Condyle Stress Fracture: A Case Report.

Introduction: Stress fractures are common in athletics and military recruits exposed to repetitive mechanical stresses. They are usually located in the weight-bearing lower limb and foot bone, usually in the metatarsals and tibial shaft. The medial femoral condyle is an unusual site for a stress fracture so reporting such a case is imperative. Case Report: We report a case of a medial femoral condyle stress fracture in a young adult without any athletic or military background, which was managed conservatively by cast application. Conclusion: Stress fractures of the medial femoral condyle are an infrequent phenomenon in individuals without any military or athletic background. Surgeons should have to be very vigilant when dealing with cases of indistinct knee pain.

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach.

BACKGROUND: As the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures. METHODS: Twenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d'Aubigne and Postel score with a mean follow up of 15.13 months. RESULTS: The clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively. CONCLUSIONS: Minimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.