Internet of Medical Things-Based COVID-19 Detection in CT Images Fused with Fuzzy Ensemble and Transfer Learning Models.

One of the most difficult research areas in today's healthcare industry to combat the coronavirus pandemic is accurate COVID-19 detection. Because of its low infection miss rate and high sensitivity, chest computed tomography (CT) imaging has been recommended as a viable technique for COVID-19 diagnosis in a number of recent clinical investigations. This article presents an Internet of Medical Things (IoMT)-based platform for improving and speeding up COVID-19 identification. Clinical devices are connected to network resources in the suggested IoMT platform using cloud computing. The method enables patients and healthcare experts to work together in real time to diagnose and treat COVID-19, potentially saving time and effort for both patients and physicians. In this paper, we introduce a technique for classifying chest CT scan images into COVID, pneumonia, and normal classes that use a Sugeno fuzzy integral ensemble across three transfer learning models, namely SqueezeNet, DenseNet-201, and MobileNetV2. The suggested fuzzy ensemble techniques outperform each individual transfer learning methodology as well as trainable ensemble strategies in terms of accuracy. The suggested MobileNetV2 fused with Sugeno fuzzy integral ensemble model has a 99.15% accuracy rate. In the present research, this framework was utilized to identify COVID-19, but it may also be implemented and used for medical imaging analyses of other disorders.

Correlation of cochlear nerve cross-sectional area and auditory performance after cochlear implantation in prelingual children with bilateral profound hearing loss.

OBJECTIVE: To assess whether cochlear nerve (CN) cross-sectional area as measured with parasagittal magnetic resonance imaging (MRI) in prelingual pediatric deaf patients correlates with auditory performance after cochlear implantation. STUDY DESIGN: Prospective Cohort study. METHODS: Thirty-two prelingual children with bilateral profound sensorineural hearing loss (SNHL) who received unilateral cochlear implant were included in this study. Diameters of CN at Internal auditory canal (IAC) fundus and mid-point of IAC were retrospectively measured on parasagittal images of FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence MRI by two independent observers. Cross-sectional areas [π (Height/2) (Width/2)] were then correlated with post-operative CAPS (Categories of Auditory Performance) and IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) scores regularly assessed at 3 monthly intervals post device activation. RESULTS: The cochlear nerve was identified in all the 32 patients. Mean cross-sectional areas (CSA) of cochlear nerve were 0.71 ± 0.16 mm2 at IAC fundus and 0.73 ± 0.18 mm2 at mid-point of IAC. The correlation value between CSA at mid-point of IAC and CAPS score at 6 months was 0.271 (p-value- 0.140) and correlation value between CSA at mid-point of IAC and IT-MAIS score at 6 months was 0.282 (p-value- 0.124) which were statistically not significant. CONCLUSION: There was no significant correlation between the cross-sectional areas of the cochlear nerve on MRI and postoperative auditory scores as measured by CAPS and IT-MAIS scores at six months from the device activation. Hence, we conclude that above an adequate diameter, which can affect the minimum required neurons, the changes in the diameter do not have significant bearing on auditory outcomes after cochlear implantation.

Post-rhinoplasty outcomes in an Indian population assessed using the FACE-Q appraisal scales: a prospective observational study.

OBJECTIVES: The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. METHODS: Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. RESULTS: Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. CONCLUSION: The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.

Metameric spinal AVM: Long-term symptomatic relief achieved by embolization of the extradural component.

BACKGROUND: Metameric spinal cord arteriovenous malformations (AVMs) are rare lesions characterized by an intradural and extradural component. They are difficult to treat surgically by the endovascular route. We report a case in which symptomatic relief was achieved by embolization of the extradural component only. CASE PRESENTATION: A 35-year-old woman presented with acute worsening of back pain, weakness in the left leg and urinary retention. Spinal angiography showed a metameric spinal cord AVM with partial common venous drainage of the extradural and intradural components. CONCLUSIONS: Targeted embolization of the extradural component led to dramatic improvement of the patient's symptoms, probably by achieving venous decongestion. She remains neurologically stable at two years' follow-up.

Development and validation of a stability-indicating RP-HPLC method for estimation of atazanavir sulfate in bulk.

A stability-indicating reverse phase-high performance liquid chromatography (RP-HPLC) method was developed and validated for the determination of atazanavir sulfate in tablet dosage forms using C18 column Phenomenix (250 mm×4.6 mm, 5 µm) with a mobile phase consisting of 900 mL of HPLC grade methanol and 100 mL of water of HPLC grade. The pH was adjusted to 3.55 with acetic acid. The mobile phase was sonicated for 10 min and filtered through a 0.45 µm membrane filter at a flow rate of 0.5 mL/min. The detection was carried out at 249 nm and retention time of atazanavir sulfate was found to be 8.323 min. Linearity was observed from 10 to 90 µg/mL (coefficient of determination R2 was 0.999) with equation, y=23.427x+37.732. Atazanavir sulfate was subjected to stress conditions including acidic, alkaline, oxidation, photolysis and thermal degradation, and the results showed that it was more sensitive towards acidic degradation. The method was validated as per ICH guidelines.

Botryomycosis.

Botryomycosis is a rare chronic bacterial granulomatous disease that usually involves skin and rarely viscera. Main etiological agent is Staphylococcus aureus and less commonly Pseudomonas spp., Escherichia coli, Proteus spp., Streptococcus spp. We here report a case of 32-year-old male with polymicrobial botryomycosis on forehead and on frontal scalp. Culture from lesions revealed growth of S. aureus initially. Partial resolution was achieved with cefadroxyl and clavulanic acid, rifampicin, and linezolid. Subsequent repeat culture revealed E. coli sensitive to netilmycin. Slow and steady resolution was achieved with surgical debridement and combination therapy of injectable netilmycin and oral sufomethoxazole and trimethoprim for a prolonged period.

A case of ophthalmoplegic migraine: some observations.

We describe a 43-year-old man with a long-standing history of headache and ophthalmoplegia. Brain MRI showed a nodular enhancing lesion at the root exit zone of the left oculomotor nerve. Contrast enhancement on follow-up MRI and clinical symptoms showed a partial resolution on starting prophylactic anti-migraine medications. This was confirmed to be a case of ophthalmoplegic migraine. Here we describe a rare case of OM in an adult patient with its characteristic imaging pattern and the differential diagnosis considered.

Role of diffusion tensor imaging in differentiating subtypes of meningiomas.

PURPOSE: Meningiomas are the most common extraaxial intracranial type of tumor, and their management and prognosis depend on their grade and histology. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are two new imaging techniques that have proved helpful in elucidating the microarchitecture of brain tumors. The aim of the present study was to assess the role of diffusion and diffusion tensor metrics in the identification and classification of meningioma grades and subtypes. METHODS AND MATERIALS: A total of 21 consecutive patients with meningioma were included in this retrospective study, of whom 16 had benign meningiomas (three fibroblastic, 11 transitional/mixed, two meningothelial) and five had atypical meningiomas. Tumor mean diffusivity (Dav), fractional anisotropy (FA), linear anisotropy (CL), planar anisotropy (CP), spherical anisotropy (CS) and eigenvalues (e1, e2, e3) were measured in all cases, and differences in diffusion tensor metrics between atypical, fibroblastic and other benign (transitional, meningothelial) meningiomas were statistically analyzed using the Mann-Whitney test. RESULTS: No statistically significant differences were found among the mean Dav values for atypical, fibroblastic and other benign meningiomas. Both atypical and fibroblastic meningiomas showed significantly higher mean FA values and lower mean CS values compared with other meningiomas (P<0.01), but no statistically significant difference in these values between each other. Atypical meningiomas showed higher CL values compared with fibroblastic and other benign meningiomas but, again, the difference was not statistically significant. Both atypical and fibroblastic meningiomas showed statistically significantly higher CP values and lower e3 values compared with transitional meningiomas (P<0.01). CONCLUSION: These results suggest that diffusion tensor metrics may be helpful in the differentiation of atypical, fibroblastic and other benign meningiomas.

Uncommon presentation of intracranial cryptococcal infection mimicking tuberculous infection in two immunocompetent patients.

Cryptococcal infection of the brain is commonly seen in immunocompromised patients but rarely considered as the differential diagnosis in immunocompetent patients. We present two cases of cryptococcosis involving the brain in immunocompetent patients, which strongly mimicked tuberculous infection in both conventional as well as advanced magnetic resonance (MR) imaging, and the disease was only confirmed after histopathological/cerebrospinal fluid serological study. One patient was a 52-year-old woman, and the second patient was a 23-year-old man. These two cases highlight the need for workup of fungal infections in immunocompetent patients from the tuberculous endemic regions, even when the imaging is highly suspicious of tuberculous lesions. The imaging findings in advanced MR imaging techniques such as diffusion, perfusion, susceptibility-weighted imaging and MR spectroscopy are discussed.

Subfrontal gangliocytoma masquerading as olfactory groove meningioma.

We describe a rare case of an unusually located gangliocytoma. The conventional magnetic resonance imaging (MRI) appearance was suggestive of an olfactory groove meningioma. However, advanced MRI sequences (diffusion-weighted imaging--DWI; perfusion MRI; susceptibility-weighted imaging--SWI; MR spectroscopy--MRS) revealed features more consistent with a glial neoplasm.

Right Third Nerve Palsy Caused by Extra-axial Cavernoma in a Patient with Multiple Intracranial Cavernomas.

We report an unusual case of a 54-year-old man with third nerve palsy caused by an extra-axial cavernoma in relation to the cisternal portion of the oculomotor nerve. In addition to this lesion, the patient had multiple intracranial cavernomas. Interestingly, an initial MRI without T2* gradient sequence missed the multiple cavernomas. A subsequent MRI done after one month showed an increase in size with fluid level within the extra-axial cavernoma.

Self-interaction chromatography: a tool for the study of protein-protein interactions in bioprocessing environments.

We describe a new protein characterization technique called self-interaction chromatography (SIC), which exploits the specificity of protein-protein interactions that is common to protein aggregates and enables the rapid screening of protein formulation additives as physical stabilizers against aggregation. This technique also enables the identification of specific interaction sites and the determination of their relative importance for self-association. Mannitol, glycine, and dextran 40 were tested for their stabilizing effect toward the model protein lysozyme. Dextran 40 exhibited a poor stabilizing effect. While mannitol stabilized both the native and acid-denatured forms of lysozyme, glycine stabilized the native form with respect to the denatured species. These results are in good agreement with findings in the formulation literature. The SIC shows tremendous potential as a rapid formulation development tool. We also screened two putative interaction sites for involvement in the self-association of lysozyme and estimated the associated binding energies using a binding isotherm model that we developed. The sites screened consisted of residues 41-48 and 125-128 and were selected based on their apparent importance in forming crystal contacts in several different crystal forms of lysozyme. Of the two sites, only residues 125-128 were found to influence self-association under the conditions we employed. Because the success of this technique depends on the exploitation of self-interactions between native species, several important applications are also suggested such as separating native from misfolded or variant species and probing site utilization in aggregation versus crystallization phenomena.

Simulations of reversible protein aggregate and crystal structure.

We simulated the structure of reversible protein aggregates as a function of protein surface characteristics, protein-protein interaction energies, and the entropic penalty accompanying the immobilization of protein in a solid phase. These simulations represent an extension of our previous work on kinetically irreversible protein aggregate structure and are based on an explicit accounting of the specific protein-protein interactions that occur within reversible aggregates and crystals. We considered protein monomers with a mixture of hydrophobic and hydrophilic surface regions suspended in a polar solvent; the energetic driving force for aggregation is provided by the burial of solvent-exposed hydrophobic surface area. We analyzed the physical properties of the generated aggregates, including density, protein-protein contact distributions, solvent accessible surface area, porosity, and order, and compared our results with the protein crystallization literature as well as with the kinetically irreversible case. The physical properties of reversible aggregates were consonant with those observed for the irreversible aggregates, although in general, reversible aggregates were more stable energetically and were more crystal-like in their order content than their irreversible counterparts. The reversible aggregates were less dense than the irreversible aggregates, indicating that the increased energetic stability is derived primarily from the optimality rather than the density of the packing in the solid phase. The extent of hydrophobic protein-protein contacts and solvent-exposed surface area within the aggregate phase depended on the aggregation pathway: reversible aggregates tended to have a greater proportion of hydrophobic-hydrophobic contacts and a smaller fraction of hydrophobic solvent-exposed surface area. Furthermore, the arrangement of hydrophobic patches on the protein surface played a major role in the distribution of protein contacts and solvent content. This was readily reflected in the order of the aggregates: the greater the contiguity of the hydrophobic patches on the monomer surface, the less ordered the aggregates became, despite the opportunities for rearrangement offered by a reversible pathway. These simulations have enhanced our understanding of the impact of protein structural motifs on aggregate properties and on the demarcation between aggregation and crystallization.

Secondary structure characterization of microparticulate insulin powders.

The secondary structure content of microparticulate insulin powders produced by the supercritical antisolvent (SAS) precipitation technique was investigated via Raman spectroscopy. Precipitate samples were generated at 25 and 35 degrees C processing temperatures. Both precipitate samples gave amide I band spectra that were shifted roughly +10 cm-1 relative to the commercial powder. The corresponding secondary structure estimates had significantly increased beta-sheet contents with concomitant decreases in alpha-helix contents relative to the commercial protein; the sum of beta-turn and random coil content remained essentially unchanged. The magnitude of the perturbation was slightly greater for the 35 degrees C sample. Dissolution of the commercial powder and precipitates in 0.01 M HCl yielded solution structure estimates similar to that of the commercial powder. An analysis of insulin in dimethyl sulfoxide, the suspending solvent in the SAS process, indicated that some, but not all, of the structural change observed for the precipitate samples may be attributed to solvent exposure. These results are suggestive of extensive beta-sheet-mediated intermolecular interactions in precipitate states, consistent with analyses of irreversible protein aggregate/fibril states. Interestingly, unlike irreversible protein aggregates, the insulin powders recover essentially full biological activity on reconstitution.

Simulations of kinetically irreversible protein aggregate structure.

We have simulated the structure of kinetically irreversible protein aggregates in two-dimensional space using a lattice-based Monte-Carlo routine. Our model specifically accounts for the intermolecular interactions between hydrophobic and hydrophilic protein surfaces and a polar solvent. The simulations provide information about the aggregate density, the types of inter-monomer contacts and solvent content within the aggregates, the type and extent of solvent exposed perimeter, and the short- and long-range order all as a function of (i) the extent of monomer hydrophobic surface area and its distribution on the model protein surface and (ii) the magnitude of the hydrophobic-hydrophobic contact energy. An increase in the extent of monomer hydrophobic surface area resulted in increased aggregate densities with concomitant decreased system free energies. These effects are accompanied by increases in the number of hydrophobic-hydrophobic contacts and decreases in the solvent-exposed hydrophobic surface area of the aggregates. Grouping monomer hydrophobic surfaces in a single contiguous stretch resulted in lower aggregate densities and lower short range order. More favorable hydrophobic-hydrophobic contact energies produced structures with higher densities but the number of unfavorable protein-protein contacts was also observed to increase; greater configurational entropy produced the opposite effect. Properties predicted by our model are in good qualitative agreement with available experimental observations.

Elephantiasis of the penis and scrotum. A review of 350 cases.

Three hundred fifty patients with elephantiasis of the penis and scrotum were surgically treated by excision of all elephantoid skin and subcutaneous tissues. Before attempting to excise the extensive elephantoid tissues, the spermatic cord and testes with their coverings were taken out by two small lateral incisions, which made the operation easier and less time-consuming and minimized the complications. The skin of the scrotal neck was found to be the best for reconstruction of the scrotum to accommodate the two testes. The fascial penis is an ideal bed for intermediate split-thickness skin grafts. There was mechanical improvement in the physical disability, restoration of potency and sexual habits, and reduction of mental anguish.

Surgery for large hydrocele.

Nine hundred fifty cases of moderate to large hydrocele were surgically treated by excising the skin, dartos, spermatic fascia, sac, and the median septum, leaving sufficient scrotal skin to construct a new scrotum--just enough to accommodate both the testes. The cure was complete, and the postoperative complications were minimal. The redundant skin and subcutaneous tissues were removed because they would otherwise hang and flop against the inner aspect of the patient's thighs, resulting in great difficulty and dissatisfaction in walking. This method of skin excision can also be applied to a huge inguinoscrotal hernia after its repair.