A deep learning approach for classification of COVID and pneumonia using DenseNet-201.

In the present paper, our model consists of deep learning approach: DenseNet201 for detection of COVID and Pneumonia using the Chest X-ray Images. The model is a framework consisting of the modeling software which assists in Health Insurance Portability and Accountability Act Compliance which protects and secures the Protected Health Information . The need of the proposed framework in medical facilities shall give the feedback to the radiologist for detecting COVID and pneumonia though the transfer learning methods. A Graphical User Interface tool allows the technician to upload the chest X-ray Image. The software then uploads chest X-ray radiograph (CXR) to the developed detection model for the detection. Once the radiographs are processed, the radiologist shall receive the Classification of the disease which further aids them to verify the similar CXR Images and draw the conclusion. Our model consists of the dataset from Kaggle and if we observe the results, we get an accuracy of 99.1%, sensitivity of 98.5%, and specificity of 98.95%. The proposed Bio-Medical Innovation is a user-ready framework which assists the medical providers in providing the patients with the best-suited medication regimen by looking into the previous CXR Images and confirming the results. There is a motivation to design more such applications for Medical Image Analysis in the future to serve the community and improve the patient care.

A Comprehensive Update on the Treatment and Management of Postdural Puncture Headache.

PURPOSE OF REVIEW: The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis. RECENT FINDINGS: PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. Various prophylactic measures have been studied; however, more studies have been recommended to be undertaken in order to establish a proven benefit. For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.

Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions.

Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively non-pharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.

A Comprehensive Update of Adhesive Capsulitis and Minimally Invasive Treatment Options.

Background: Adhesive capsulitis of the shoulder (AC) is characterized by fibrosis and contracture of the glenohumeral joint capsule, resulting in progressive stiffness, pain, and restriction of motion of the shoulder. The prevalence of AC is estimated to be 2-5% of the general population. Patients with AC typically have an insidious onset of pain and can progress to severe limitation of the shoulder leading to significant disability and decreased quality of life. Objectives: The objective of this manuscript is to provide a comprehensive review of AC with a focus on clinical presentation, natural history, pathophysiology, and various treatment modalities. Study Design: A review article. Setting: A review of literature. Methods: A search was made on the Pubmed database using the keywords of adhesive capsulitis, frozen shoulder, shoulder capsulitis, arthrofibrosis, shoulder pain, shoulder stiffness. Results: Our search identified numerous studies in order to provide a comprehensive review of the current understanding of the treatment and management of AC. Limitations: There remains limited evidence in literature about the understanding of AC and optimal treatment. Conclusion: AC is an important cause of chronic pain and disability. There is currently no consensus on treatment. Initial treatment modalities revolve around conservative measures as well as aggressive physical therapy. Further treatment options include intraarticular injections, hydro-dilation, nerve blocks, and for more refractory cases, surgical interventions such as arthroscopic capsulotomy.

Off-label Antidepressant Use for Treatment and Management of Chronic Pain: Evolving Understanding and Comprehensive Review.

PURPOSE OF REVIEW: While clinicians have been using antidepressants for off-label indications in the treatment of chronic pain in recent years, newer studies have proven effectiveness and provided additional mechanistic understanding and defined potential adverse effects. As depression and chronic pain are frequently comorbid conditions, the use of antidepressants has allowed for treatment of both conditions concomitantly in the same patient population. RECENT FINDINGS: The most commonly used antidepressants for chronic pain are tricyclic antidepressants (TCAs), though selective serotonin or noradrenaline reuptake inhibitors and other atypical antidepressants have been shown to be effective at treating chronic pain. In addition to neuropathic pain, bupropion has also demonstrated effectiveness in treating chronic pain caused by inflammatory bowel disease. Selective norepinephrine receptor inhibitors (SNRIs), including duloxetine, serve to suppress neuropathic pain by altering recovery of the noradrenergic descending inhibitory system in the spinal cord. While the direct mechanism of action is largely unknown, TCAs may suppress the noradrenergic descending inhibitory system to produce an antihyperalgesic effect. The use of antidepressants offers alternative and adjunctive therapy options for patients suffering from chronic pain from various modalities. TCAs, mono-amine oxidase inhibitors, selective serotonin receptor inhibitors, SNRIs, and atypical antidepressants have been shown to have analgesic and sometimes antiinflammatory capabilities that are independent of their mood-stabilizing effects. Further studies are warranted to establish better safety profiles and efficacy of antidepressant use in chronic pain.

Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain.

Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for patients having persistent, chronic pain following knee surgery. Extracorporeal shockwave therapy is another modality growing in use that may offer short-term symptomatic relief. In this review, we will discuss widely used minimally invasive interventional options for the symptomatic management of osteoarthritic chronic knee pain.

The Crush Index: Orthopedic Trauma as an Economic Indicator.

The purpose of this study was to evaluate the relationship between economic activity and the incidence of high-energy orthopedic trauma. California's Office of Statewide Health Planning and Development patient discharge database was queried to identify monthly orthopedic trauma incidence from 1995 to 2010. Patient inclusion required 1 diagnosis code and 1 associated procedural code for fractures of the femur, tibia, ankle, pelvis, or acetabulum. Data on composite market indices, energy and transportation use, and unemployment were obtained from government sources. Statistical analysis was performed using univariate and multivariate linear regression. The average monthly incidence of orthopedic trauma was 2.92 cases per 100,000 people. Of 15 economic indicators analyzed with univariate regression, 7 variables correlated with trauma incidence to statistical significance. Dow Jones Industrial Average (P=.032), Standard & Poor's 500 (P=.034), vehicle miles driven (P<.001), personal disposable income (P=.033), Coincident Economic Activity Index for California (P=.007), and vehicles purchased (P<.001) were positively correlated with trauma incidence. Unemployment (P<.001) was inversely correlated with trauma incidence. Multivariate regression was used to compute a combination of independent predictors of trauma volume: personal disposable income (P<.001), vehicles purchased (P=.008), and unemployment (P=.005). This combination of variables was used to develop the Crush Index to model the relationship between economic activity and orthopedic trauma volume. The authors show a positive correlation between economic strength and activity and the monthly volume of high-energy orthopedic trauma. The Crush Index serves as a proof of concept that may be useful in guiding preparedness among practitioners and health care system administrators. [Orthopedics. 2017; 40(4):248-255.].

Malignant sublingual gland tumors: demographics, prognostic factors, and treatment outcomes.

OBJECTIVE: To determine the demographic characteristics, prognostic factors, and optimal treatment modalities of patients diagnosed with malignant primary tumors of the sublingual gland. MATERIALS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry contains 210 patients diagnosed with sublingual gland tumors in the SEER database. Kaplan-Meier and multivariate Cox regression analysis were performed on age, sex, race, histologic subtype, stage, and treatment modality. RESULTS: Kaplan-Meier analysis found an overall survival and disease-specific survival at 5 years of 69% and 83%, respectively. Multivariate analysis demonstrated that age, sex, stage, and surgery were predictors of overall survival, whereas stage was a predictor of disease-specific survival. CONCLUSIONS: Here we report, to our knowledge, the largest study to date investigating demographic characteristics, prognostic factors, and treatment modalities of patients diagnosed with primary malignant tumors of the sublingual gland. Increased age and stage correlated with decreased survival, whereas female gender and surgical therapy correlated with increased survival in the overall population. Radiation therapy for patients diagnosed with adenoid cystic carcinoma in the sublingual gland was correlated with increased survival.

Epidemiology, prognostic factors, and management of malignant odontogenic tumors: an analysis of 295 cases.

OBJECTIVE: To determine the demographic characteristics, prognostic factors, and management for patients diagnosed with a malignant odontogenic tumor (MOT). STUDY DESIGN: The Surveillance, Epidemiology, and End Results (SEER) registry was reviewed for patients diagnosed with MOT from 1973 to 2011. Kaplan-Meier and multivariate Cox regression analyses were performed on patient demographic characteristics and pathologic variables. RESULTS: The SEER database identified 295 MOT patients. The mean age at diagnosis was 50.5 years (range 5-89 years). Of these patients, 61.7% were male and 38.3% were female. The racial composition was 66.4% White, 22% Black, 6.1% Asian, 3.1% Pacific Islander, 0.3% Native American, and 2.1% Other/Unknown. Kaplan-Meier analysis found an overall survival (OS) and disease-specific survival (DSS) at 5 years of 54% and 67%, respectively. Multivariate analysis of the entire cohort found that age and stage were predictors of OS and that age was a predictor for DSS. For stage I/II MOTs, age and surgical therapy were predictors of OS and DSS, respectively. CONCLUSIONS: Here we report the largest study to date investigating demographic characteristics, prognostic factors, and management of MOT patients. Determinants of survival for OS and DSS include age, stage, and surgical therapy.