A hybrid CNN with transfer learning for skin cancer disease detection.

The leading cause of cancer-related deaths worldwide is skin cancer. Effective therapy depends on the early diagnosis of skin cancer through the precise classification of skin lesions. However, dermatologists may find it difficult and time-consuming to accurately classify skin lesions. The use of transfer learning to boost skin cancer classification model precision is a promising strategy. In this work, we proposed a hybrid CNN with a transfer learning model and a random forest classifier for skin cancer disease detection. To evaluate the efficacy of the proposed model, it was verified over two datasets of benign skin moles and malignant skin moles. The proposed model is able to classify images with an accuracy of up to 90.11%. The empirical results and analysis assure the feasibility and effectiveness of the proposed model for skin cancer classification.

Platelet Count/Spleen Length Ratio to Predict the Presence of Esophageal Varices in Patients with Cirrhosis.

Esophageal variceal bleeding remains the leading cause of acute mortality in patients with cirrhosis. As per guidelines, upper gastrointestinal screening endoscopy is recommended for all patients with cirrhosis to rule out esophageal varices. However, only 50% of newly diagnosed patients with cirrhosis have Esophageal varices. Hence there is a need for non-invasive parameters to predict the presence of esophageal varices to restrict the endoscopic studies to those with a high probability of having varices. In this study, we aimed to identify the effectiveness of Platelet Count/Spleen Length Ratio as a non-invasive predictor of esophageal varices. MATERIAL: An observational cross-sectional study was conducted including 52 patients with liver cirrhosis without a previous history of upper GI bleeding. Relevant clinical parameters were assessed including complete hemogram, upper GI endoscopy, and ultrasonographic measurement of spleen length. Patients were divided into two groups, one with esophageal varices and the other without esophageal varices. Platelet Count/Spleen Length Ratio was compared between these two groups. OBSERVATION: Out of the study population 65.38% of the patients had Oesophageal varices. The following observations were made in oesophageal variceal group and non-variceal group respectively; Mean spleen length was 156.26 ± 13.64 mm and 126.06 ± 6.40 mm(p<0.001), mean platelet count was 102882 ± 20188/mm3 and 156000 ± 36378 mm3 (p<0.001), Platelet Count/Spleen Length Ratio was 672.82 ± 188.06 and 1243.55 ± 307.53 (p<0.001). Platelet Count/Spleen Length Ratio of <926 was found to have a sensitivity of 91% in predicting varices and the specificity was 78%. CONCLUSION: Platelet Count/Spleen Length RATIO can be used as a predictor of esophageal varices and also to identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, to reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies.

Pneumonia classification using quaternion deep learning.

Pneumonia is an infection in one or both the lungs because of virus or bacteria through breathing air. It inflames air sacs in lungs which fill with fluid which further leads to problems in respiration. Pneumonia is interpreted by radiologists by observing abnormality in lungs in case of fluid in Chest X-Rays. Computer Aided Detection Diagnosis (CAD) tools can assist radiologists by improving their diagnostic accuracy. Such CAD tools use neural networks which are trained on Chest X-Ray dataset to classify a Chest X-Ray into normal or infected with Pneumonia. Convolution neural networks have shown remarkable performance in object detection in an image. Quaternion Convolution neural network (QCNN) is a generalization of conventional convolution neural networks. QCNN treats all three channels (R, G, B) of color image as a single unit and it extracts better representative features and which further improves classification. In this paper, we have trained Quaternion residual network on a publicly available large Chest X-Ray dataset on Kaggle repository and obtained classification accuracy of 93.75% and F-score of .94. We have also compared our performance with other CNN architectures. We found that classification accuracy was higher with Quaternion Residual network when we compared it with a real valued Residual network.

Evaluation of Aspartate Aminotransferase-to-Platelet Ratio Index as a Non-Invasive Marker for Liver Cirrhosis.

INTRODUCTION: Liver biopsy is considered as a gold standard for the diagnosis of cirrhosis. Till date there is no non-invasive marker to replace it. AIM: To investigate the effectiveness of Aspartate aminotransferase-to-platelet ratio index (APRI) as a non-invasive marker for liver cirrhosis. MATERIALS AND METHODS: Fifty-one patients with cirrhosis, identified on USG abdomen were included in study. Platelet count and Aspartate aminotransferase (AST) were done using haematology automatic analyser and automatic HITACHI-912 Auto Analyser respectively. APRI was calculated for every patient using the formula {(AST / ULN) x 100}/platelet count (10(9)/L). Predictive accuracy was evaluated with a receiver-operating characteristics (ROC) curve. RESULTS: APRI correctly classified 49 (96.1%) patients of cirrhosis with area under the ROC curve of 0.973 (95% CI) at cut-off 0.65 with negative predictive value (NPV) and Positive predictive value (PPV) of 96% and 96.1% respectively. The sensitivity and specificity of the test was found to be 96% and 96.1% respectively. CONCLUSION: APRI could identify cirrhosis with high degree of accuracy in the studied patients.

Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity.

BACKGROUND & OBJECTIVES: Early neurological deterioration (END) occurs in about 20 to 40 per cent of patients with acute ischaemic stroke and results in increased mortality and functional disability. In recent studies relative dehydration has been found to be associated with END in patients with acute ischaemic stroke. This study was conducted to identify factors useful for predicting END and to assess the role of blood urea nitrogen/creatinine ratio (BUN/creatinine) and urine specific gravity (USG) as predictors of END in patients with acute ischaemic stroke. METHODS: The present study was an observational prospective study. Various parameters comprising demographic, clinical, laboratory and radiological variables along with stroke severity were assessed and studied as predictors of early neurological deterioration in 114 consecutive patients presenting to the Emergency department during 2012. BUN/creatinine >15 and USG >1.010 were studied as markers of relative dehydration contributing to END. RESULTS: Of the 114 patients enrolled in the study, END was observed in 25 (21.9%) patients. National Institutes Health Stroke Scale score (NIHSS) ≥ 12 at admission was found to be an independent risk factor for END. Amongst markers of relative dehydration, BUN/creatinine >15 at admission was found to be an independent risk factor for END, as also USG >1.010. Also, cerebral oedema and size of hypodensity >1/3 rd of the middle cerebral artery territory on cranial CT were observed to be independent risk factors for END. INTERPRETATION & CONCLUSIONS: Our study findings highlighted a possible association of relative dehydration, as indicated by BUN/creatinine ratio >15, with END along with other parameters like stroke severity at presentation, extent of hypodensity >1/3 rd of the middle cerebral artery (MCA) territory and cerebral oedema. Dehydration being a treatable condition, the use of BUN/creatinine >15 as a marker of relative dehydration, can be helpful in detecting patients with dehydration early and thus play a role in preventing END.

Supersensitive detection of T-2 toxin by the in situ synthesized π-conjugated molecularly imprinted nanopatterns. An in situ investigation by surface plasmon resonance combined with electrochemistry.

A π-conjugated molecularly imprinted polymer (MIP) with nanopatterns for T-2 toxin (T-2) was prepared on SPR chip by in situ electropolymerization of 3-aminophenylboronicacid (3-APBA) with T-2. The complete removal of T-2 from polymer was confirmed in situ by SPR and EIS and also ex situ by SEM, EDAX, fluorescence microscopy and Raman spectroscopy. SEM image of T-2 MIP exhibited nanopatterns due to imprinting of T-2. The MIP of T-2 showed a linear response for T-2 from 2.1 fM to 33.6 fM with a detection limit of 0.1 fM (0.05 pg/mL). In this study, thermodynamic parameters such as change in Gibb's free energy (ΔG), change in enthalpy (ΔH) and change in entropy (ΔS) were determined and the values revealed that the interaction between T-2 and T-2 MIP as spontaneous, endothermic and entropy driven one. Moreover, interactions of very high concentration of interferents with T-2 MIP showed very less response due to the presence of nanopatterns of T-2 in the T-2 MIP. Equilibrium constant (12.7 fM) obtained in this study indicates the super binding affinity of T-2 with T-2 MIP. Moreover, the present methodology provides an outline to develop field-detection equipment capable of detecting T-2 toxin at or well below the guideline concentrations recommended by American subcommittee on military field drinking water.

Coagulation profile in diabetes and its association with diabetic microvascular complications.

OBJECTIVES: To investigate the haemostatic parameters and to assesss their relationship with microvascular complications in type 2 diabetes mellitus. MATERIALS AND METHODS: Coagulation and fibrinolysis parameters were measured in 60 type 2 diabetic patients (M:F 1:1) with (n=40) and without (n=20) diabetic microvascular complications and in 30 nondiabetic healthy subjects (M:F 1:1). RESULTS: The mean age of diabetic patients and healthy controls was 56.9 +/- 8.78 and 53.2 +/- 7.58 respectively (p = 0.05). The plasma levels of PAI-1 (22.6 +/- 6.85 vs 44.8 +/- 20.8, p = 0.00), serum fibrinogen (227.5 +/- 22.8 vs. 252.75 +/- 40.23, p = 0.002) and vWF activity (99.4 +/- 28.18 vs. 144.78 +/- 36.21, p = 0.00) were found to be increased in diabetics compared to healthy controls. Plasma PAI-1 levels (37.15 +/- 15.18 vs 48.65 +/- 22.29, p = 0.0) and vWF activity (123.19 +/- 29.63 vs. 155.57 +/- 34.61, p = 0.007) were significantly increased in diabetic patients with microvascular complications than those without microvascular complications.Amongst the diabetic patients, protein S activity (63.05 +/- 16.85 vs. 51.59 +/- 10.7, p = 0.002) was significantly lower in patients with microvascular complications than in patients without these complications. Diabetic retinopathy was associated with decreased protein S levels (63.05 +/- 16.85 vs. 48.48 +/- 8.72, p = 0.005) and vWF activity (123.19 +/- 29.63 vs. 151.85 +/- 29.74, p = 0.009). Diabetic nephropathy was associated with increased PAI-1 levels (39.55 +/- 13.20 vs. 51.69 +/- 26.53, p = 0.02) and vWF activity (134.99 +/- 32.54 vs. 157.57 +/- 37.37, p = 0.007). Diabetic neuropathy did not show any significant relationship with any of the haemostatic variables. CONCLUSION: Hypercoagulable state as indicated by decreased fibrinolysis and increased coagulability is responsible as one of the factors for the development of microvascular complications of diabetes mellitus.

Diabetic gastroparesis.

Our understanding of gastric motility disorder--diabetic gastroparesis has advanced in the last ten to fifteen years, but the published data regarding pathogenesis are confusing and show conflicting results. The pathogenesis is sometimes linked with hyperglycemia, autonomic neuropathy, gastrointestinal hormone or myogenic mechanism. Antral hypomotility is often associated with hyperglycemia which is often accompanied by reduction in duodenal waves. Varying level of motilin, a gastrokinetic hormone has been reported. However none of the mechanism could explain the exact pathogenesis. The relationship of this mortality disorder with clinical symptoms is not always established, however nausea and vomiting lasting for days or weeks are the prominent symptoms. Other symptoms are post-prandial fullness, early satiety, bloating, belching, and vague abdominal discomfort. In a few cases, it may be the cause of poor nutrition, uncontrolled diabetes and recurrent ketoacidosis. Last one or two decades have seen some advancement in the investigational procedures like scintigraphy, radio-opaque markers, breath test, electrogastrography and MRI. Which can lead to a proper diagnosis. Such objective assessment is all the more important as nearly half of the patients do not have any symptom. Symptomatic improvement of gastroparetic patients should be the aim and in asymptomatic patients, treatment is often not recommended. Some dietary advice and prokinetic agents like metoclopramide, cisapride etc. are often prescribed but much needs to be further known as management is not always uniformly rewarding.

Experience in adult population in dengue outbreak in Delhi.

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.

Ovarian and body weight responses of female redheaded bunting to ultra-short photoperiods: demonstration of circadian involvement.

Ultra-short photoperiods, of 3 h less than the threshold photoperiodic demand of female redheaded bunting, when used in variable time cycles (T cycles) cause ovarian growth and an increase in body weight depending upon the period of the cycle. The cycles of period 24 h or close to that (22 h and 26 h) were non-stimulatory whereas 18 h, 20 h, 28 h and 30 h were photo-stimulatory. These results indicate the presence of a circadian component within the bird which regulates their photoperiodic responses.

Circadian control of photoperiodic responses in a female migratory bunting (Emberiza bruniceps).

The photoperiodic response of female redheaded bunting (Emberiza bruniceps) was investigated in photosensitive and photorefractory birds exposed to resonance lighting cycles. Ovarian growth was stimulated in resonance cycles where light was present during the predicted photoinducible phase. Photorefractoriness was dissipated by resonance cycles in which light did not fall at times corresponding to the photoinducible phase. It is concluded that photosensitive and photorefractory female redheaded bunting monitor the photoperiodic time by means of a circadian rhythm.

Effects of exogenous prolactin on ovarian growth and fattening in the redheaded bunting, Emberiza bruniceps.

Subcutaneous daily injections of ovine prolactin (PRL) inhibit photoperiodic induction of gonads and fattening in the female redheaded bunting (Emberiza bruniceps). However, birds respond to the same photoperiod (15L:9D) after withdrawal of the exogenous PRL. Further, PRL injections given in late hours during the subjective days induce ovarian regression in the photostimulated females. The results suggest that the PRL has an inhibitory role on gonadal photoperiodic responses in redheaded buntings, and extend our understanding of the regulatory function of PRL in migratory birds.