Automated characterization and detection of fibromyalgia using slow wave sleep EEG signals with glucose pattern and D'hondt pooling technique.

Fibromyalgia is a soft tissue rheumatism with significant qualitative and quantitative impact on sleep macro and micro architecture. The primary objective of this study is to analyze and identify automatically healthy individuals and those with fibromyalgia using sleep electroencephalography (EEG) signals. The study focused on the automatic detection and interpretation of EEG signals obtained from fibromyalgia patients. In this work, the sleep EEG signals are divided into 15-s and a total of 5358 (3411 healthy control and 1947 fibromyalgia) EEG segments are obtained from 16 fibromyalgia and 16 normal subjects. Our developed model has advanced multilevel feature extraction architecture and hence, we used a new feature extractor called GluPat, inspired by the glucose chemical, with a new pooling approach inspired by the D'hondt selection system. Furthermore, our proposed method incorporated feature selection techniques using iterative neighborhood component analysis and iterative Chi2 methods. These selection mechanisms enabled the identification of discriminative features for accurate classification. In the classification phase, we employed a support vector machine and k-nearest neighbor algorithms to classify the EEG signals with leave-one-record-out (LORO) and tenfold cross-validation (CV) techniques. All results are calculated channel-wise and iterative majority voting is used to obtain generalized results. The best results were determined using the greedy algorithm. The developed model achieved a detection accuracy of 100% and 91.83% with a tenfold and LORO CV strategies, respectively using sleep stage (2 + 3) EEG signals. Our generated model is simple and has linear time complexity.

Framing of Poly(arylene-ethynylene) around Carbon Nanotubes and Iodine Doping for the Electrochemical Detection of Dopamine.

Dopamine (DA), an organic biomolecule that acts as both a hormone and a neurotransmitter, is essential in regulating emotions and metabolism in living organisms. The accurate determination of DA is important because it indicates early signs of serious neurological disorders. Covalent organic frameworks (COFs) and metal-organic frameworks (MOFs) have received considerable attention in recent years as promising porous materials with an unrivaled degree of tunability for electrochemical biosensing applications. This study adopted a solvothermal strategy for the synthesis of a conjugated microporous poly(arylene ethynylene)-4 (CMP-4) network using the Sonagashira-Hagihara cross-coupling reaction. To increase the crystallinity and electrical conductivity of the material, CMP-4 was enveloped around carbon nanotubes (CNTs), followed by iodine doping. When used as an electrochemical probe, the as-synthesized material (I2-CMP-CNT-4) exhibited excellent selectivity and sensitivity to dopamine in the phosphate-buffered solution. The detection limits of the electrochemical sensor were 1 and 1.7 µM based on cyclic voltammetry (CV) and differential pulse voltammetry (DPV).

Nephrocolocutaneous fistula from a staghorn calculus.

Fistula formation between the kidney, colon and the skin is an extremely rare complication arising from renal infections secondary to renal stone formation. During the 1980s, reports of nephrocolic fistulas, with or without involvement of the skin, were commonly caused by genitourinary tuberculosis. Due to improvements in diagnosis and specifically the development of anti-Koch's therapy, the incidence of nephrocolic or nephrocolocutaneous fistulas has become uncommon especially in developed countries.We report a case of a patient residing in a developing country, presenting with a 20-year history of a left flank lesion extruding minimal purulent output daily. He was seen at the emergency department due to weakness and was managed as a case of urosepsis. Contrast-enhanced CT scan and fistulogram showed a staghorn calculus in the left kidney with connections to the descending colon and skin. The patient eventually underwent a left hemicolectomy with en bloc excision of the kidney and fistula tract.

Quantification of oral neutrophil counts in periodontal health and disease utilising a standardised oral rinse.

Background and Objectives: Polymorphonuclear neutrophils are the most abundant leukocytes in humans and are key host cells in defence against invading microorganisms. The oral neutrophil count may be an indicator of the periodontal health status, which correlates with the severity of periodontal disease. This study attempts to quantify orogranulocytes utilising an oral rinse and to assess the usefulness of this method in evaluating the oral inflammatory load much the same way the circulating neutrophils are used to screen for patients with infection in extra-oral sites. Methods: A total of 125 participants were divided into five groups with 25 subjects in each group. The groups consisted of healthy, gingivitis, mild periodontitis, moderate periodontitis, and severe periodontitis. Participants were asked to rinse with 10 mL of 0.9% saline for 30 s and to expectorate. Samples were centrifuged at 2000 RPM for 10 min. The supernatant removed was suspended in 5 mL of Hanks's balanced salt solution. One millilitre of this suspension was mixed with 4 µL of acridine orange. A 10 µL aliquot of this suspension was then assessed on a haemocytometer, and the oral PMNs were counted using fluorescence microscopy. Results: The mean number of oral neutrophils (100,000 cells/mL) was the lowest in the healthy group and increased in ascending order across the different groups with the highest for severe periodontitis group. Conclusion: The oral neutrophil counts increased with the severity of periodontal inflammation. This is an easy, safe, reliable, and non-invasive method of quantification of oral neutrophils.

Perianal basal cell carcinoma managed with wide excision and random flap reconstruction.

Basal cell carcinoma (BCC) is a common skin malignancy and usually occurs in sun-exposed areas like the head and neck. Occurrence in the perianal area is rare, accounting for only 0.08% of all BCC, and 0.2% of anorectal malignancies.We present a case of a hypertensive woman in her 60s who had a 1-year history of a gradually enlarging mass on the left perianal region. Initial biopsy revealed a carcinoma with basaloid features and was confirmed on immunohistochemistry to be nodular BCC. Proctoscopy showed no intraluminal involvement. Contrast-enhanced chest and abdominal CT scans revealed no nodal or distant metastasis. MRI showed a 7.5 mm fat plane between the mass and the external sphincter muscles, projecting adequate surgical margins.A wide excision with at least 4 mm margins was performed. Reconstruction of the resulting defect was performed with a local random cutaneous flap.

Sigmoid Squamous Cell Carcinoma presenting as a bladder mass: A case report

@#Primary squamous cell carcinoma (SCC) of the colon and rectum is a rare malignancy, with an incidence of less than 1 in 1,000 diagnosed colorectal cancers. This is a case of a 59-year-old male who presented with a three-month history of urinary symptoms. Work-up, however, revealed a locally-advanced, partially-obstructing primary sigmoid squamous cell carcinoma with extension to the urinary bladder. He subsequently underwent a proximal bowel diversion after extensive carcinomatosis was discovered on diagnostic laparoscopy. Colon SCC represents less than 0.5% of all colorectal tumors, and its incidence is estimated to be 0.1%. Clinically, it presents with similar signs and symptoms as colorectal adenocarcinoma. No standardized management approach has been established yet. A multidisciplinary team approach is essential in dealing with such cases. Keen attention and further investigation are warranted to clearly define the management approach to achieve better outcomes.

Pancreaticoduodenal artery aneurysm associated with polyarteritis nodosa presenting as massive upper gastrointestinal bleeding.

The pancreaticoduodenal arteries are rare sites for true aneurysm formation, but these may develop in association with occlusion of the coeliac circulation, degenerative conditions or inflammatory vascular disorders. These have a high risk of rupture regardless of size or other factors. One identified cause is polyarteritis nodosa (PAN), which is an autoimmune necrotising vascular condition that affects small-sized and medium-sized arteries. We report a case of a 40-year-old man with massive gastrointestinal tract bleeding from a ruptured pancreaticoduodenal artery aneurysm secondary to PAN. This was managed with emergent open aneurysm ligation followed by high-dose corticosteroids and cyclophosphamide pulse therapy. Only three other cases of PAN-associated pancreaticoduodenal artery aneurysms have been reported in the literature.

Disinfection and Electrostatic Recovery of N95 Respirators by Corona Discharge for Safe Reuse.

With the COVID-19 pandemic surging, the demand for masks is challenging, especially in less-developed areas across the world. Billions of used masks are threatening the environment as a new source of plastic pollution. In this paper, corona discharge (CD) was explored as a safe and reliable method for mask reuse to alleviate the situation. CD can disinfect masks and simultaneously restore electrostatic charges to prevent filtration efficiency deterioration. Electric field, ions, and reactive species generated by CD cause DNA damage and protein denaturation to effectively disinfect N95 respirators. Log reduction of 2-3 against Escherichia coli can be easily reached within 7.5 min. Log reduction of up to 6 can be reached after three cycles of treatment with optimized parameters. CD disinfection is a broad spectrum with log reduction >1 against yeast and >2.5 against spores. N95 respirators can be recharged within 30 s of treatment and the charges can be retained at a higher level than brand-new masks for at least 5 days. The filtration efficiency of masks was maintained at ∼95% after 15 cycles of treatment. CD can provide at least 10 cycles of safe reuse with benefits of high safety, affordability, accessibility, and device scalability/portability.

Sulfa-induced acute eosinophilic pneumonia.

Acute eosinophilic pneumonia (AEP) is an infrequently seen interstitial lung disease secondary to medications. We report a series of 3 case of severe AEP which developed as a result of sulfa medication. 2 patients had received treatment with sulfamethoxazole for acne and 1 was treated with sulfasalazine for colitis. Patients were on sulfa medication for 1-3 weeks prior to presentation. All patients presented with fever, acute onset bilateral pulmonary infiltrates as well as marked peripheral eosinophilia. Mean eosinophil count was 2.21 × 109/L. There was a lack of response to steroids. One patient required extracorporeal membrane oxygenation and prolonged mechanical ventilation via tracheostomy. 2 patients underwent successful lung transplantation (1 bilateral living-related lobar lung transplant and 1 orthotropic cardiopulmonary allotransplantation). In all cases lung biopsy and explants showed acute and organizing diffuse alveolar damage with increased interstitial and airspace eosinophils. To our knowledge, our series is the first to show the clinical features of sulfa induced AEP in an adolescent population.

Abdominotransanal resection of a strangulated rectal carcinosarcoma.

This is a case of a 75-year-old man who presented with a 7-month history of a reducible rectal mass. The patient came to the emergency department with a prolapsed necrotic bowel involving a strangulated segment with the rectal mass. He underwent an abdominotransanal resection through a combined abdominal and perineal approach. His postoperative course was unremarkable. Histopathological and immunohistochemical studies showed a rectal carcinosarcoma. Because of a state-mandated lockdown due to the COVID-19 pandemic, the patient failed to follow-up. He was later seen to have metastatic progression. Owing to the poor functional status of the patient, the shared decision of the multidisciplinary team, the patient and his family was to manage him with palliative intent.

Appendiceal intussusception from endometriosis.

An asymptomatic 39-year-old woman was noted to have occult bleeding by faecal immunohistochemical test. Investigations showed a 3 cm×2 cm caecal lesion by colonoscopy that was consistent with abdominal CT scan findings of a 1.6 cm×1.9 cm×2.3 cm enhancing focus in the medial caecal wall. The patient underwent laparoscopic right hemicolectomy after diagnostic laparoscopy and intraoperative colonoscopy revealed an intussuscepted appendix. The final histopathology was an appendiceal intussusception secondary to endometriosis.

Idiopathic megacolon and megarectum in an adult treated with laparoscopic modified Duhamel procedure.

Idiopathic megacolon (IMC) and idiopathic megarectum (IMR) describe an abnormality of the colon or rectum, characterised by a permanent dilatation of the bowel diameter in the absence of an identifiable cause. We present a 23-year-old woman with chronic constipation and excessive straining during defecation who presented at the emergency department in partial gut obstruction with a palpable fecaloma. Manual faecal disimpaction and a sigmoid loop colostomy was initially done. A full thickness rectal biopsy was positive for ganglion cells. Further workup led to the diagnosis of chronic IMC and IMR. The patient underwent laparoscopic modified Duhamel procedure, with an uneventful postoperative course.

En bloc resection of cervical adenocarcinoma with late recurrence to the iliopsoas.

This is a case of a 50-year-old woman diagnosed with recurrent cervical adenocarcinoma presenting with chronic and persistent low back pain. She underwent myomectomy for myoma uteri 8 years prior. Histopathology report revealed cervical cancer. She underwent chemotherapy, brachytherapy and external beam radiotherapy. All surveillance work-up, over the years, were negative until she was found to have a solitary recurrent lesion in the right iliopsoas muscle on CT scan. A multidisciplinary team of surgeons collaborated to perform wide excision of pelvic recurrence en bloc right internal hemipelvectomy, right hemicolectomy en bloc resection of external iliac artery and vein, external ilio-iliac artery interposition graft and external iliac vein-common femoral vein bypass. Final histopathologic results showed adenocarcinoma with endometrioid features with associated poorly differentiated high-grade carcinoma involving the iliopsoas, cecum and terminal ileum. Two months postoperatively, the patient is ambulating with minimal assistance.

Aggressive angiomyxoma presenting as an ischiorectal fossa tumour.

This is a case of a young healthy woman who presented with left groin pain. On work-up, she was found to have a large, well-defined mass in the ischiorectal fossa with a percutaneous biopsy of only a benign mesenchymal mass. A multidisciplinary team of surgeons (ie, colorectal, orthopaedic, vascular and urological surgery) collaborated in planning and performing the extirpation of the tumour. Final histopathology identified the tumour to be an aggressive angiomyxoma, a benign tumour with a high predilection for local recurrence. The patient had an uneventful postoperative course, with maintenance of good functional status.

Characterization of fibromyalgia using sleep EEG signals with nonlinear dynamical features.

Fibromyalgia is an intense musculoskeletal pain causing sleep, fatigue, and mood problems. Sleep studies have suggested that 70%-80% of fibromyalgia patients complain of non-restorative sleep. The abnormalities in sleep have been implicated as both a cause and effect of the disease. In this paper, the electroencephalogram (EEG) signals of sleep stages 2 and 3 are used to classify the normal and fibromyalgia classes automatically. We have used various nonlinear parameters, namely sample entropy (SampEn), fractal dimension (FD), higher order spectra (HOS), largest Lyapunov exponent (LLE), Kolmogorov complexity (KC), Hurst exponent (HE), energy, and power in various frequency bands from the EEG signals. Then these features are subjected to Student's t-test to select the clinically significant features, and are classified using the support vector machine (SVM) classifier. Our proposed method can classify normal and fibromyalgia subjects using the stage 2 sleep EEG signals with an accuracy of 96.15%, sensitivity and specificity of 96.88% and 95.65%, respectively. Performance of the developed system can be improved further by adding more subjects in each class, and can be employed for clinical use.

An Assessment of Correlation between Dermatoglyphic Patterns and Sagittal Skeletal Discrepancies.

INTRODUCTION: Investigators over years have been fascinated by dermatoglyphic patterns which has led to the development of dermatoglyphics as a science with numerous applications in various fields other than being the best and most widely used method for personal identification. AIM: To assess the correlation between dermatoglyphic patterns and sagittal skeletal discrepancies. MATERIALS AND METHODS: A total of 180 patients, aged 18-40 years, were selected from those who attended the outpatient clinic of the Deparment of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental College, Kothamangalam, Kerala, India. The fingerprints of both hands were taken by ink and stamp method after proper hand washing. The patterns of arches, loops and whorls in fingerprints were assessed. The total ridge count was also evaluated. Data was also sent to the fingerprint experts for expert evaluation. The sagittal jaw relation was determined from the patient's lateral cephalogram. The collected data was then statistically analyzed using Chi-square tests, ANOVA and Post-hoc tests and a Multinomial regression prediction was also done. RESULTS: A significant association was observed between the dermatoglyphic pattern exhibited by eight fingers and the sagittal skeletal discrepancies (p<0.05). An increased distribution of whorl pattern was observed in the skeletal Class II with maxillary excess group and skeletal Class II with mandibular deficiency group while an increased distribution of loop pattern was seen in the skeletal Class III with mandibular excess group and skeletal Class III with maxillary deficiency group. Higher mean of total ridge count was also seen in the groups of skeletal Class II with maxillary excess and skeletal Class II with mandibular deficiency. Multinomial regression predicting skeletal pattern with respect to the fingerprint pattern showed that the left thumb impression fits the best model for predicting the skeletal pattern. CONCLUSION: There was a significant association between dermatoglyphic patterns and sagittal skeletal discrepancies. Dermatoglyphics could serve as a cost effective screening tool of these craniofacial problems.

Histological and Histometrical Evaluation of two Synthetic Hydroxyapatite Based Biomaterials in the Experimental Periodontal Defects in Dogs.

AIM: The present study was to evaluate histologically and histometrically the efficacy of Chitra granules in the regeneration of alveolar bone and to compare it with that of OsteoGenR (HA Resorb)(TM) in iatrogenically created alveolar bone defects in mongrel dogs. MATERIALS AND METHODS: Four dogs (16 sites) were used for this split-mouth study. The animals were divided randomly into two groups of two animals. Same animals were used as control and test. Each dog had four implantation sites. The periodontal defects were prepared by acute defect model. Animals were sacrificed at 3 months (n=2), 6 months (n=2) and histologic and histometric evaluation was carried out. STATISTICAL ANALYSIS: The data was analysed using statistical package Graph pad Software. Comparison of the hard and soft tissue parameters in the two groups was done using the Wilcoxan (Man Whitney), two tailed t-test. A p-value less than 0.05 were considered significant. RESULTS: Maturing bone with immature periodontal ligament fibers were observed at three months and advanced osteogenesis at six months with both the types of bone graft materials. The mean values showed that amount of new bone formed with OsteoGenR (HA Resorb)(TM) was slightly more than that obtained by Chitra granules in histometric evaluation. CONCLUSION: Histological study showed similar healing pattern with both the types of bone graft materials with maturing bone at 3 months and advanced osteogenesis at six months in experimental intraosseous periodontal defects in dogs. However, histological evaluation for longer period is necessary to determine the time taken for complete replacement of the bone graft materials with new bone.

A case report of cerebral air embolism after esophagogastroduodenoscopy: diagnosis and management in the emergency department.

BACKGROUND: Esophagogastroduodenoscopy (EGD) is a rare cause of cerebral air embolism (CAE). To our knowledge, there are only eight previously reported such cases in the history of the procedure. OBJECTIVE: To identify clinical causes of CAE that can present to the emergency department (ED) and to understand the appropriate management of CAE. CASE REPORT: A 71-year-old man presented with new-onset left-sided hemiparesis and dysarthria 2h after undergoing an outpatient EGD. The patient was diagnosed with CAE in the ED after undergoing a computed tomography scan of the brain without contrast. CONCLUSION: The diagnosis of CAE is based on a thorough history and obtaining urgent radiographic imaging of the brain. The definitive treatment of CAE involves hyperbaric oxygen.