Human Monkeypox Classification from Skin Lesion Images with Deep Pre-trained Network using Mobile Application.

Recently, human monkeypox outbreaks have been reported in many countries. According to the reports and studies, quick determination and isolation of infected people are essential to reduce the spread rate. This study presents an Android mobile application that uses deep learning to assist this situation. The application has been developed with Android Studio using Java programming language and Android SDK 12. Video images gathered through the mobile device's camera are dispatched to a deep convolutional neural network that runs on the same device. Camera2 API of the Android platform has been used for camera access and operations. The network then classifies images as positive or negative for monkeypox detection. The network's training has been carried out using skin lesion images of monkeypox-infected people and other skin lesion images. For this purpose, a publicly available dataset and a deep transfer learning approach have been used. All training and testing steps have been applied on Matlab using different pre-trained networks. Then, the network that has the best accuracy has been recreated and trained using TensorFlow. The TensorFlow model has been adapted to mobile devices by converting to the TensorFlow Lite model. The TensorFlow Lite model has been then embedded into the mobile application together with the TensorFlow Lite library for monkeypox detection. The application has been run on three devices successfully. During the run-time, the inference times have been gathered. 197 ms, 91 ms, and 138 ms average inference times have been observed. The presented system allows people with body lesions to quickly make a preliminary diagnosis. Thus, monkeypox-infected people can be encouraged to act rapidly to see an expert for a definitive diagnosis. According to the test results, the system can classify the images with 91.11% accuracy. In addition, the proposed mobile application can be trained for the preliminary diagnosis of other skin diseases.

Long-Term Functional Results of Patients Operated for Isolated Discrete Subaortic Stenosis.

BACKGROUND: This study aimed to examine the long-term functional results of patients with isolated discrete subaortic stenosis who underwent subaortic membrane resection and myectomy, using transthoracic M-mode echocardiography and 2D speckle-tracking echocardiography. METHODS: Twenty patients operated for isolated discrete subaortic stenosis and 31 controls were included in the study. Patients underwent subaortic membrane resection and myectomy. During the long-term follow up, patients were evaluated with transthoracic M-mode echocardiography and 2D speckle-tracking echocardiography for functional assessment. RESULTS: The mean age at operation and mean duration of follow up was 8.1±5.6 years and 7.2±3.3 years, respectively. Interventricular septal thickness at diastole (0.9±0.1 vs. 0.8±0.1 cm, P = 0.001), ejection time (285.7±26.2 vs. 261.2±24.3 msec, P = 0.001), and aortic strain (15.6±3.7 vs. 10.5±4.0, P < 0.001) were significantly higher in patients. On the other hand, ejection fraction (64.9±6.1 vs. 75.1±5.4 %, P < 0.001), fractional shortening (35.0±5.1 vs. 43.7±5.1, P < 0.001), and corrected velocity circumferential fiber shortening (0.12±0.02 vs. 0.17±0.03, P < 0.001) were significantly lower, when compared with the controls. Longitudinal strain value significantly differed among the groups, with patients having significantly lower strain (18.8±1.8 vs. 20.1±2.1, P = 0.021). CONCLUSION: In patients operated for isolated discrete subaortic stenosis, aortic gradient seems to continue in the long-term, with the persistence of low longitudinal strain.

Previous chronic cerebral infarction is predictive for new cerebral ischemia after carotid endarterectomy.

BACKGROUND: The purpose of this study was to investigate the relation between preoperative chronic cerebral ischemia and postoperative new cerebral ischemia in patients undergoing carotid endarterectomy (CEA). METHODS: We reviewed the diffusion weighted magnetic resonance images (DWI) of the 51 patients (37 men, mean age 68.8 ± 8.4 years) undergoing isolated CEA in the preoperative and early postoperative period. The number, anatomic location and the size of new ischemic lesions were recorded. RESULTS: In the preoperative period, 28 (54.9 %) patients were symptomatic. There was chronic cerebral infarction in the preoperative DWI images of 17 patients (33.3 %). In the postoperative period, there was newly developed cerebral ischemia in postoperative DWI images of eight (15.7 %) patients. Six of the eight patients with newly developed cerebral ischemia had chronic cerebral infarction in their preoperative DWI images. The incidence of newly developed cerebral ischemia after CEA in patients with preoperative chronic cerebral ischemia was significantly higher than the incidence in patients without preoperative chronic cerebral ischemia (p = 0.01). CONCLUSION: The results of the present study suggest that preoperative chronic cerebral ischemia may aggravate postoperative newly developed cerebral ischemia in patients undergoing CEA.

Preoperative CRP levels is not predictive early renal dysfunction after coronary artery bypass surgery.

BACKGROUND: The aim of this retrospective study is to determine the correlation between preoperative CRP levels and the early renal dysfunction after cardiac surgery. METHODS: From January 2012 to December 2013, values for preoperative CRP were available for 546 unselected patients undergoing cardiac operations. CRP was used to divide this cohort in two groups: a normal CRP levels group (Group I) of 432 patients with CRP of less than 0.5 mg/dL, and a high CRP levels group (group II) of 114 patients with a CRP of 0.5 mg/dL or more. RESULTS: Median CRP preoperative values were significantly different in the group II (2.49±1.03 mg/dL) than in the group I (0.32±0.14 mg/dL; P < 0.0001). Median CRP postoperative values were significantly different in the group I (17.62±2.99) than in the group II (23.13±3.01; P < 0.0001). Preoperative levels of serum blood urea nitrogen (BUN), creatinine and CrCl were not significantly different between group I and group II. Postoperative levels of BUN, Cr and CrCl between the two groups were not significantly different. CONCLUSIONS: The early Cr and CrCl levels after surgery are not significantly different in group I and group II. The early renal function after CABG is not correlated with the preoperative CRP levels.

The importance of contrast volume/glomerular filtration rate ratio in contrast-induced nephropathy patients after transcatheter aortic valve implantation.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated. METHODS: Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN-patients were classified into two groups. The χ(2) test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses. RESULTS: CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity. CONCLUSION: After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR.

Multiple coronary fistulae to left ventricle, with acute myocardial infarction.

A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect.

Evaluation of myocardial contractility determination with tissue tracking echocardiography after levosimendan infusion in patients with poor left ventricular function and hemodynamics.

BACKGROUND: The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery. METHODS: We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ≤% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 µg/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 µg/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 ± 4.72 years). Dopamine at 10 µg/kg/min and/or dobutamine at 10 µg/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 ± 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and χ2 test were used for statistical analyses. RESULTS: There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II. CONCLUSION: Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.

Effects of single aortic clamping versus partial aortic clamping techniques on post-operative stroke during coronary artery bypass surgery.

BACKGROUND: The aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery. METHODS: Between December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43-78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41-81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed. RESULTS: For both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46). CONCLUSION: In patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.

Alpha lipoic acid attenuates inflammatory response during extracorporeal circulation.

AIM: Extracorporeal circulation (ECC) of blood during cardiopulmonary surgery has been shown to stimulate various proinflammatory molecules such as cytokines and chemokines. The biochemical oxidation/reduction pathways of α-lipoic acid suggest that it may have antioxidant properties. METHODS: In this study we aimed to evaluate only patients with coronary heart disease and those planned for coronary artery bypass graft operation. Blood samples were obtained from the patients before the operation (P1) and one (P2), four (P3), 24 (P4) and 48 hours (P5) after administration of α-lipoic acid (LA). The patients were divided into two groups, control and LA treatment group. Levels of interleukin- 6 (IL-6) and -8 (IL-8), complement 3 (C3) and 4 (C4), anti-streptolysin (ASO), C-reactive protein (CRP) and haptoglobin were assessed in the blood samples. RESULTS: Cytokine IL-6 and IL-8 levels were significantly higher after surgery. Compared with the control groups, LA significantly decreased IL-6 and IL-8 levels in a time-dependent manner. CRP levels did not show significant variation in the first three time periods. CRP levels were higher after surgery, especially in the later periods. These results demonstrate that CRP formation depends on cytokine release. C3 and C4 levels were significantly higher after surgery than in the pre-operative period. LA treatment decreased C3 and C4 levels. Therefore, LA administration may be useful for the treatment of diseases and processes where excessive cytokine release could cause oxidative damage. CONCLUSION: Our findings suggest a possible benefit of using LA during cardiac surgery to reduce cytokine levels.

Does oral hygiene trigger carotid artery intima-media thickness?

BACKGROUND AND PURPOSE: The aim of this study was to evaluate whether poor oral hygiene is associated with the intima-media thickness of the carotid arteries, which is one of the predictors of future progression of subclinical atherosclerosis. METHODS: We selected 108 patients during periodontal examinations according to their oral hygiene. The patients had no history of atherosclerotic disease. The results of carotid artery B-mode ultrasonography examinations were analyzed at baseline and after a mean of 7.8 months. Patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into 2 groups according to DMFT and SLI criteria. Group I had a DMFT index of 0 to 3 and an SLI score of 0 or 1; group II had a DMFT index of 4 to 28 and an SLI score of 2 or 3. RESULTS: Dental status and oral hygiene were significantly associated with carotid artery intima-media thickness. Patients with increasing DMFT and SLI indices were correlated with intima-media thickness of the carotid artery. CONCLUSIONS: Chronic poor oral hygiene and tooth loss are related to subclinical atherosclerotic changes in the carotid arteries and might be indicative of future progression of atherosclerosis.

Carotid and popliteal artery intima-media thickness in patients with poor oral hygiene and the association with acute-phase reactants.

PURPOSE: The aim of this study was to evaluate whether poor oral hygiene is associated with carotid and popliteal arterial intima-media thickness, which is one of the predictors of future progression of sub-clinical atherosclerosis, and highsensitivity C-reactive protein (hsCRP) and fibrinogen levels. METHODS: A specialised dentist checked the patients and selected 550 patients during periodontal examinations, according to their oral hygiene. The patients had no history of atherosclerotic disease. Carotid and popliteal artery B-mode ultrasonographic examinations and hsCRP and fibrinogen levels were analysed at baseline and after a mean of 6.2 months. The patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into two groups using the DMFT and SLI criteria. Group I had a DMFT index score from 0 to 3 and SLI index score of 0 or 1. Group II had a DMFT index score from 4 to 28 and SLI index score of 2 or 3. RESULTS: A significant association was observed between dental status, oral hygiene, carotid and popliteal artery intima-media thickness and hsCRP level. Patients with increasing DMFT and SLI scores correlated with increasing carotid artery intima-media thickness. CONCLUSIONS: The results clearly showed that chronic poor oral hygiene and tooth loss are related to sub-clinical atherosclerotic changes in the carotid arteries and may be indicative of future progression of atherosclerosis.

Decision making and results of coronary artery bypass grafting for patients with poor left ventricular function.

BACKGROUND: The aim of this study is to determine the results of coronary artery bypass surgery in patients with a low ejection fraction. Between January 2007 and January 2011, 3556 consecutive patients who underwent coronary artery bypass grafting at the Cardiovascular Surgery Clinic at Sifa University Hospital, Izmir, Turkey, were analyzed retrospectively. METHODS: The patients were divided into 2 groups. Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction; Patients in Group I had an ejection fraction between 20% and 35% with poor left ventricular function (n = 1246; 695 men and 551 women; mean age, 62.25 ± 5.72 years, range, 47-78 years). Control patients in Group II underwent elective coronary artery bypass grafting at the same time and had left ventricular ejection fraction between 36% and 49% (n = 2310; 1211 men and 1099 women; mean age, 61.83 ± 8.12 years, range, 41-81 years). The mean follow-up time for all patients was 24 ± 9.4 months (range, 12-48 months). Patients were followed postoperatively at the end of the first month and every 6 months. The left ventricular ejection fraction was assessed by transthoracic echocardiography. RESULTS: The mean number of distal anastomoses, myocardial infarction, and mean age was not significantly different between the 2 groups; however, cross-clamp time was longer in Group I. Patient recovery time was significantly longer in Group I. Morbidity (14.5% in Group I versus 7.4% in Group II, P < .005) and mortality (1.76% versus 0.30%, P < .005) were higher in Group I. During late follow-up, the 2-year survival rate (85.1% versus 94.5%) and 2-year event-free rate (77.6% versus 86.9%) were significantly lower in Group I when compared to Group II. Postoperative left ventricular ejection fraction values were significantly superior in Group I compared to Group II. CONCLUSION: Coronary artery bypass grafting can be safely performed in patients with low ejection fraction with minimal postoperative morbidity and mortality. The viable myocardium could be reliably determined by positron emission tomography. Low ejection fraction patients could greatly benefit from coronary bypass surgery regarding postoperative ejection fraction, increased long-term survival, improvement in New York Heart Association classification, and higher quality of life.

Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting.

Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

Effect of iloprost on renal function in patients undergoing coronary artery bypass grafting: a clinical study.

PURPOSE: Renal dysfunction remains a serious complication of coronary artery bypass grafting (CABG) surgery and is associated with increased mortality and morbidity. To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it, but none of them proves the excellent result. METHODS: Between April 2009 to September 2011, 185 consecutive patients with multivessel coronary artery disease undergoing elective CABG were included the study. Iloprost was given with the onset of rewarming period at a dose of 1.25-2.5 ng/kg/min and it was ended together with the ending of CPB in 94 patients and remaining were in the control group. Creatinine clearance (CCr) and GFR were measured at the time of hospitalisation and on day first and fifth postoperatively. Serum potassium level was determined every 6 hours, during the first 24 hours postoperatively, and every 12 hours for the next 72 hours, and glomerular filtration rate was estimated. RESULTS: There was no statistically significant difference in preoperative comorbidity. There were no significant differences in postoperative morbidity or mortality between either of the two groups that completed the study. However, urine output during the operation was significantly higher in the study group. An increase in creatine levels was more common in the control group. Development of a new CCr less than 50 ml/min was also significantly higher in the control group, postoperatively. CONCLUSION: Our study demonstrates that prophylactic intravenous iloprost administration after initiation of a rewarming period during CPB in patients undergoing CABG surgery is associated with improved renal function, compared with conventional treatment in well-hydrated patients. It also has a good safety profile and is generally well tolerated.

The relation between blood and tissue magnesium levels and development of atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: Atrial fibrillation (AF) is a common complication of cardiovascular surgery and its mechanisms are not well understood. The aim of our study was a prospective investigation of the relationship between AF development and tissue or blood magnesium levels. METHODS: This prospective observational study evaluated 20 patients undergoing elective initial coronary artery bypass graft (CABG) surgery. Right atrial appendage and skeletal muscle samples were obtained for tissue magnesium level analysis before, during (at 60th minute) and 30 minutes after cardiopulmonary bypass (CPB) with simultaneous blood samples. Daily measurements of blood Mg levels and continuous monitoring for AF were performed for 7 postoperative days. Statistical analyses were performed using ANOVA, independent samples t and Chi-square tests. RESULTS: AF developed in 5 out of 20 patients during postoperative period (25%). Patients with or without AF did not differ in terms of tissue and blood magnesium levels during and early after CPB and during 7 days after the operation. Blood magnesium levels were significantly higher in the whole study population on postoperative days 3 through 7 (day 3 - 1.13±0.11 mmol/L; day 4-, 1.18±0.07 mmol/L; day 5-1.15±0.10 mmol/L; day 6-1.17±0.08 mmol/L; and day 7, 1.22±0.08 mmol/L) compared to day 1 and day 2 (day 1-0.96±0.13 mmol/L and day 2-1.02±0.12 mmol/L; p=0.002 for all comparisons). CONCLUSION: Although patients with and without AF did not significantly differ with regard to blood and tissue magnesium levels, the coincidence of an early postoperative reduction in magnesium levels in all patients and occurrence of all AF incidences at this time period suggests a potential association deserving further investigation.

Massive right atrial myxoma causing right ventricular inflow obstruction: an unusual presentation of myxoma.

We describe a case of a massive right atrial myxoma, causing right ventricular inflow obstruction. The tumor was detected by echocardiography and resected along with a section of the tricuspid septal leaflet, followed by primary repair, resulting in relief of her symptoms.

A modified combined approach to operative carotid and coronary artery disease: 82 cases in 8 years.

BACKGROUND: A significant number of patients undergoing coronary artery surgery have severe carotid artery disease. It is also true that up to half of the patients undergoing carotid endarterectomy (CEA) have severe treatable coronary lesions. This study aims to review data regarding 82 patients of combined approach in 8 years; the second half consists of 44 patients whose CEA was performed under local anesthesia. It compares results of the conventional and the modified approaches to simultaneous surgery. METHODS: All 82 patients who planned to have a concomitant procedure were recorded prospectively between 1995 and 2003. From 1998, the surgical technique has been modified to switch to local anesthesia for CEA, rather than perform under a single general anesthetic period. All pre-and perioperative data as well as in-hospital and outpatient control (mid- to long-term) data were recorded. A P-value of less than .05 was considered as significant. Analysis of survival was performed by using the Kaplan-Meier method and the log-rank test. RESULTS: The 30-day follow-up was 100% complete for all patients. All patients were followed for 59.59 to 114 months) months postoperatively. Three patients (6.8%) in the modified and 2 (5.2%) in the standard group had intraluminal shunting (P > .05). In the standard group, 3 patients expired and 3 had perioperative stroke; only 1 patient had a stroke in the modified group and two expired (P > .05). Mean survival time according to Kaplan-Meier test was 109.97, SE 2.84, 95% CI (104.41-115.52) months for the former group, whereas it was 62.79, SE 1.20, 95% CI (60.4565.13) months for the latter. Actuarial estimates of survival during ten-year follow up were 94.44% SE 3.83 in ten-year follow-ups and 97.67% SE 2.30 in 5-year follow-ups for the modified group (P > .05). CONCLUSIONS: Avoidance from extended periods of general anesthesia and cardiopulmonary bypass periods as well as immediate recognition of impaired cerebral flow during CEA and the time it provides to take preventive measures are the most important benefits of the modified technique without significantly changing hospital and long-term mortality and stroke. It may also reduce the cost and the waiting period for the suffering patient.