Deep learning-based recognition system for pashto handwritten text: benchmark on PHTI.

This article introduces a recognition system for handwritten text in the Pashto language, representing the first attempt to establish a baseline system using the Pashto Handwritten Text Imagebase (PHTI) dataset. Initially, the PHTI dataset underwent pre-processed to eliminate unwanted characters, subsequently, the dataset was divided into training 70%, validation 15%, and test sets 15%. The proposed recognition system is based on multi-dimensional long short-term memory (MD-LSTM) networks. A comprehensive empirical analysis was conducted to determine the optimal parameters for the proposed MD-LSTM architecture; Counter experiments were used to evaluate the performance of the proposed system comparing with the state-of-the-art models on the PHTI dataset. The novelty of our proposed model, compared to other state of the art models, lies in its hidden layer size (i.e., 10, 20, 80) and its Tanh layer size (i.e., 20, 40). The system achieves a Character Error Rate (CER) of 20.77% as a baseline on the test set. The top 20 confusions are reported to check the performance and limitations of the proposed model. The results highlight complications and future perspective of the Pashto language towards the digital transition.

Hankel determinant for certain new classes of analytic functions associated the activation functions.

In this article, we introduce two new classes of analytic functions Jtanh and JSG which are associated with the activation functions and defined by the ratio of analytic representations of convex and starlike functions. For functions in these classes, our primary goal is to determine the sharp upper bounds of second and third Hankel determinants.

Real-World Driver Stress Recognition and Diagnosis Based on Multimodal Deep Learning and Fuzzy EDAS Approaches.

Mental stress is known as a prime factor in road crashes. The devastation of these crashes often results in damage to humans, vehicles, and infrastructure. Likewise, persistent mental stress could lead to the development of mental, cardiovascular, and abdominal disorders. Preceding research in this domain mostly focuses on feature engineering and conventional machine learning approaches. These approaches recognize different levels of stress based on handcrafted features extracted from various modalities including physiological, physical, and contextual data. Acquiring good quality features from these modalities using feature engineering is often a difficult job. Recent developments in the form of deep learning (DL) algorithms have relieved feature engineering by automatically extracting and learning resilient features. This paper proposes different CNN and CNN-LSTSM-based fusion models using physiological signals (SRAD dataset) and multimodal data (AffectiveROAD dataset) for the driver's two and three stress levels. The fuzzy EDAS (evaluation based on distance from average solution) approach is used to evaluate the performance of the proposed models based on different classification metrics (accuracy, recall, precision, F-score, and specificity). Fuzzy EDAS performance estimation shows that the proposed CNN and hybrid CNN-LSTM models achieved the first ranks based on the fusion of BH, E4-Left (E4-L), and E4-Right (E4-R). Results showed the significance of multimodal data for designing an accurate and trustworthy stress recognition diagnosing model for real-world driving conditions. The proposed model can also be used for the diagnosis of the stress level of a subject during other daily life activities.

Enhancing Localization Efficiency and Accuracy in Wireless Sensor Networks.

Accuracy is the vital indicator in location estimation used in many scenarios, such as warehousing, tracking, monitoring, security surveillance, etc., in a wireless sensor network (WSN). The conventional range-free DV-Hop algorithm uses hop distance to estimate sensor node positions but has limitations in terms of accuracy. To address the issues of low accuracy and high energy consumption of DV-Hop-based localization in static WSNs, this paper proposes an enhanced DV-Hop algorithm for efficient and accurate localization with reduced energy consumption. The proposed method consists of three steps: first, the single-hop distance is corrected using the RSSI value for a specific radius; second, the average hop distance between unknown nodes and anchors is modified based on the difference between actual and estimated distances; and finally, the least-squares approach is used to estimate the location of each unknown node. The proposed algorithm, named Hop-correction and energy-efficient DV-Hop (HCEDV-Hop), is executed and evaluated in MATLAB to compare its performance with benchmark schemes. The results show that HCEDV-Hop improves localization accuracy by an average of 81.36%, 77.99%, 39.72%, and 9.96% compared to basic DV-Hop, WCL, improved DV-maxHop, and improved DV-Hop, respectively. In terms of message communication, the proposed algorithm reduces energy usage by 28% compared to DV-Hop and 17% compared to WCL.

A Gait-Based Real-Time Gender Classification System Using Whole Body Joints.

Gait-based gender classification is a challenging task since people may walk in different directions with varying speed, gait style, and occluded joints. The majority of research studies in the literature focused on gender-specific joints, while there is less attention on the comparison of all of a body's joints. To consider all of the joints, it is essential to determine a person's gender based on their gait using a Kinect sensor. This paper proposes a logistic-regression-based machine learning model using whole body joints for gender classification. The proposed method consists of different phases including gait feature extraction based on three dimensional (3D) positions, feature selection, and classification of human gender. The Kinect sensor is used to extract 3D features of different joints. Different statistical tools such as Cronbach's alpha, correlation, t-test, and ANOVA techniques are exploited to select significant joints. The Coronbach's alpha technique yields an average result of 99.74%, which indicates the reliability of joints. Similarly, the correlation results indicate that there is significant difference between male and female joints during gait. t-test and ANOVA approaches demonstrate that all twenty joints are statistically significant for gender classification, because the p-value for each joint is zero and less than 1%. Finally, classification is performed based on the selected features using binary logistic regression model. A total of hundred (100) volunteers participated in the experiments in real scenario. The suggested method successfully classifies gender based on 3D features recorded in real-time using machine learning classifier with an accuracy of 98.0% using all body joints. The proposed method outperformed the existing systems which mostly rely on digital images.

Automatic detection of motor unit innervation zones of the external anal sphincter by multichannel surface EMG.

A method to detect automatically the location of innervation zones (IZs) from 16-channel surface EMG (sEMG) recordings from the external anal sphincter (EAS) muscle is presented in order to guide episiotomy during child delivery. The new algorithm (2DCorr) is applied to individual motor unit action potential (MUAP) templates and is based on bidimensional cross correlation between the interpolated image of each MUAP template and two images obtained by flipping upside-down (around a horizontal axis) and left-right (around a vertical axis) the original one. The method was tested on 640 simulated MUAP templates of the sphincter muscle and compared with previously developed algorithms (Radon Transform, RT; Template Match, TM). Experimental signals were detected from the EAS of 150 subjects using an intra-anal probe with 16 equally spaced circumferential electrodes. The results of the three algorithms were compared with the actual IZ location (simulated signal) and with IZ location provided by visual analysis (VA) (experimental signals). For simulated signals, the inter quartile error range (IQR) between the estimated and the actual locations of the IZ was 0.20, 0.23, 0.42, and 2.32 interelectrode distances (IED) for the VA, 2DCorr, RT and TM methods respectively.

Rare causes of persistent wheeze that mimic poorly controlled asthma.

Upper airway obstruction can present with stridor or expiratory or inspiratory wheeze and is commonly misdiagnosed as asthma. As asthma is common, such cases can remain hidden among patients with lower airway obstruction who attend primary care or respiratory clinics. We describe four causes of upper airway obstruction (paradoxical vocal cord movement, subglottic stenosis, retrosternal goitre and double aortic arch) which were misdiagnosed as 'poorly controlled asthma'.

A case series of patients on chemotherapy with dyspnoea and pulmonary infiltrates.

Clinicians often assume that patients who develop pulmonary symptoms and radiographic infiltrates while receiving cytotoxic chemotherapy have opportunistic pulmonary infection or chemotherapy-related interstitial lung disease. We describe two cases of rare complications of commonly used chemotherapeutic agents (gemcitabine-induced eosinophilic pneumonia and rituximab-induced hypersensitivity pneumonitis) that vindicate this assumption but a third case of scleroderma-associated interstitial lung disease that became clinically manifest in a patient who was receiving chemotherapy. The latter case highlights the need for vigilance for other causes of interstitial lung disease in patients receiving chemotherapy.

Multiple cutaneous nodules as the presenting sign of small cell lung cancer.

We describe a 67-year-old male smoker who presented with an 8 week history of productive cough, dyspnoea on minimal exertion, weight loss of 8 kg and multiple painful cutaneous nodules of varying size and morphology. A chest radiograph showed a mass at the right hilum. A CT examination showed extensive mediastinal lymphadenopathy with encasement of the lower trachea, carina and left main bronchus. The left main bronchus was 95% stenosed and there were multiple liver metastases. Innumerable cutaneous nodules were also seen. A biopsy of one of the cutaneous nodules confirmed metastases from a neuroendocrine lung primary tumour, consistent with extensive stage small cell lung cancer. The patient died soon after diagnosis.

Relapsed diffuse large B-cell lymphoma treated by reduced-intensity allogeneic stem cell transplantation with donor lymphocyte infusion.

A 42 years old male with relapsed diffuse large B-cell lymphoma was given second-line chemotherapy followed by reduced intensity allogeneic stem cell transplantation from HLA matched brother. Twelve weeks posttransplant, his disease relapsed evidenced by the appearance of lymphoma cells in the peripheral blood and declining donor chimerism. Donor lymphocyte infusion was given that induced complete lymphoma remission. The patient is well 3 years posttransplant with his disease in complete remission.

Post-transplant outcome in chronic myeloid leukaemia.

OBJECTIVE: To determine post-transplant survival in chronic myeloid leukaemia patients undergoing allogeneic stem cell transplant. STUDY DESIGN: Longitudinal, descriptive study. PLACE AND DURATION OF STUDY: Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, between April 2002 and August 2007. METHODOLOGY: All patients of chronic myeloid leukaemia in chronic phase having HLA identical donor and age under 55 years, normal hepatic, renal and cardiac functions with good performance status were selected. Patients in accelerated phase or blast crisis, poor performance status, impaired hepatic, renal, cardiac functions or pregnancy were excluded. Survival was calculated from the date of transplant to death or last follow-up according to Kaplan-Meier and Cox (proportional hazard) regression analysis methods. RESULTS: Thirty seven patients with chronic myeloid leukaemia underwent allogeneic stem cell transplant from HLA identical sibling donors. Thirty two patients were male and five were females. Median age of patients was 28 years. All patients and donors were CMV positive. Post-transplant complications encountered were acute GvHD (Grade II-IV) (n=13, 35.1%), chronic GvHD in 18.9% (n=7), Veno Occlusive Disease (VOD) in 5.4% (n=2), acute renal failure in 2.7% (n=1), haemorrhagic cystitis in 2.7% (n=1), bacterial infections in 40.5% (n=15), fungal infections in 16.2% (n=6), CMV infection in 5.4% (n=2), tuberculosis in 5.4% (n=2), Herpes Zoster infection 2.7% (n=1) and relapse in 2.7% (n=1). Mortality was observed in 27% (n=10). Major causes of mortality were GvHD, VOD, septicemia, CMV infection and disseminated Aspergillosis. Overall Disease Free Survival (DFS) was 73% with a median duration of follow-up of 47.4 +/-12 months. DFS was 81% in standard risk and 54.5% in high-risk group. CONCLUSION: Results of allogeneic stem cell transplant in standard risk group CML patients were good and comparable with other international centres, however, results in high-risk CML patients need further improvement, although, number of patients in this group is small.

Comparison of anthracycline-based combination chemotherapy with or without all-trans retinoic acid in acute promyelocytic leukemia.

OBJECTIVE: To compare survival in Acute Promyelocytic Leukemia (APL) patients treated with or without All-Trans Retinoic Acid (ATRA). STUDY DESIGN: Longitudinal, comparative study. PLACE AND DURATION OF STUDY: The Armed Forces Bone Marrow Transplant Centre (AFBMTC), Rawalpindi, Pakistan from May 2001 to April 2007. METHODOLOGY: All consecutive newly diagnosed patients of acute promyelocytic leukemia, treated at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, between May 2001 and April 2007, were included and given chemotherapy according to availability of ATRA. Diagnosis was confirmed on morphology/ karyotyping/ molecular analysis. Eligibility criteria included confirmed morphologic diagnosis and/or by demonstration of t(15;17) and/or PML/RAR proportional to re-arrangement, no prior chemotherapy, normal hepatic and renal function, Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 2 and no contraindications to ATRA (history of sensitivity to Vit. A or other retinoids). All patients having history of cardiac failure (LVEF < 50) and arrhythmias, ECOG performance status 3 and 4, relapse / refractory disease, ALT twice normal values, serum creatinine > 150 micromol/L and pregnancy were excluded from this study. Survival was calculated from the date of chemotherapy to death or last follow-up according to Kaplan-Meier and Cox (Proportional hazard) regression analysis methods. RESULTS: During the 6 years study period, 31 newly diagnosed patients with acute promyelocytic leukemia received treatment at AFBMTC. Seventeen patients received anthracycline-based remission induction and consolidation chemotherapy, while 14 received ATRA-based remission induction, consolidation and by two years maintenance therapy. Overall Survival (OS), Disease Free Survival (DFS) and mortality were 29.4%, 29.4% and 70.6% respectively in 17 patients who received anthracycline based chemotherapy, whereas in patients who received ATRA-based chemotherapy OS, DFS and mortality was 71.4%, 64.2% and 28.6% respectively. Major causes of mortality were septicemia and chemotherapy related toxicity. CONCLUSION: Response to ATRA-based chemotherapy in patient cohort was better as compared with anthracycline based chemotherapy (71.4% vs. 29.4%) in terms of survival and mortality.

Bone marrow transplant cure for beta-thalassaemia major: initial experience from a developing country.

Between July 2001 and June 2007, 48 consecutive patients with beta-thalassaemia major received allogeneic haematopoietic stem cell transplants (allo HSCT) from human-leukocyte-antigen-matched siblings at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, using standard conditioning regimens. The median age of the patient cohort was 4 years (range, 1-14 years). Thirty-one patients were in risk class I, 11 in class II and six patients were in class III. Engraftment was achieved in all patients. Survival was calculated from the date of transplant to death or last follow-up. Major post-transplant complications encountered were acute graft versus host disease (Ac GvHD) (grades II-IV), 35.4%; chronic GvHD, 8.3%; haemorrhagic cystitis, 12.5%; veno-occlusive disease (VOD) of the liver, 6.2%; bacterial infections, 37.5%; fungal infections, 19%; cytomegalovirus (CMV) infection, 6.2%; herpes infection, 6.2%; and tuberculosis in 2% of patients. Graft rejection was observed in five patients. Three patients received second transplants. Mortality was observed in 20.8% of patients. Major fatal complications included GvHD, VOD, intracranial haemorrhage, septicaema, CMV disease and disseminated tuberculosis. Overall survival and disease-free survival were 79% and 75%, respectively, at 6 years post-HSCT.

Post-transplant infections: single center experience from the developing world.

OBJECTIVE: To describe our experience of post-transplant infections in allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. METHODS: From July 2001 to September 2006, patients with malignant and non-malignant hematological disorders having human leukocyte antigen (HLA)-matched sibling donors were selected for transplant. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. After admission to the hospital, patients were kept in protective isolation rooms, equipped with a HEPA filter positive-pressure laminar airflow ventilation system. Bone marrow and/or peripheral blood stem cells were used as the stem cell source. Cyclosporin and prednisolone were used as prophylaxis against graft-versus-host disease (GVHD). The engraftment was monitored with cytogenetic/molecular analysis and change of blood group. Survival was calculated from the date of transplant to death or last follow-up. RESULTS: One hundred and fifty-four patients received allogeneic stem cell transplants from HLA-matched siblings for various hematological disorders at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan between July 2001 and September 2006. Indications for transplant included aplastic anemia (n=66), beta-thalassemia major (n=40), chronic myeloid leukemia (n=33), acute leukemia (n=8), and miscellaneous disorders (n=7). One hundred and twenty patients were male and 34 were female. The median age of the patient cohort was 14 years (range 1 1/4-54 years). One hundred and thirty-six patients and 135 donors were cytomegalovirus (CMV) IgG-positive. One hundred and forty patients (90.9%) developed febrile episodes in different phases of post-transplant recovery. Infective organisms were isolated in 150 microbiological culture specimens out of 651 specimens from different sites of infections (23.0% culture positivity). Post-transplant infections were confirmed in 120 patients (77.9%) on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections was 13.0%. Fatal infections included CMV disease (100% mortality, 6/6), disseminated aspergillosis (66.7% mortality, 4/6), pseudomonas septicemia (42.9% mortality, 9/21), and tuberculosis (25% mortality, 1/4). CONCLUSIONS: More than 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively, however CMV, aspergillosis, and pseudomonas infections remained problematic with high mortality.

Pulmonary tuberculosis in allogeneic stem cell transplant recipients.

Mycobacterium tuberculosis is a serious, but rare infectious complication after allogeneic bone marrow transplantation. Tuberculosis is a major problem in South East Asia, particularly in India and Pakistan. We describe here infection due to mycobacterium tuberculosis in four patients after allogeneic stem cell transplantation (Allo SCT). The diagnosis was made on the bases of clinical findings, sputum / blood / pleural and pericardial fluids / broncho alveolar lavage (BAL) and tissue biopsy examination. Anti tuberculosis therapy (ATT) was started immediately after diagnosis. Three patients responded to antituberculosis therapy, where as one patient developed severe infective respiratory complications and died at six months post transplant. Mycobacterial infection should be considered in patients post allo SCT with unexplained fever, cough or pleuritic chest pain. These patients at diagnosis should be promptly treated with ATT.

Management of acute myeloid leukaemia--5 years experience at Armed Forces Bone Marrow Transplant Centre, Rawalpindi.

OBJECTIVE: To evaluate the outcome in denovo AML patients treated with different remission induction and consolidation chemotherapy regimens in our population. METHODS: A retrospective study on acute myeloid leukaemia (AML) patients was carried out at Armed Forces Bone Marrow Transplant Centre Rawalpindi Pakistan between July 2001 and June 2006. During 5 years period 46 patients received treatment for AML at our centre. Twenty nine patients were males and 17 were females. Median age of patients was 21 years (range: 7-56 years). These 46 patients were categorized into two groups on the basis of type of leukaemia and chemotherapy given. In group-I 40 patients (group Ia: 23 patients of M1-M6, less M3 group Ib: 17 patients of AML M3) received anthracycline and cytarabin based chemotherapy. In group-II, six patients (AML- M3) received all trans retinoic acid (ATRA) based chemotherapy. RESULTS: In group Ia, out of 23 patients, 14 patients (60.8%) achieved complete remission (CR) after remission induction chemotherapy, 10 patients remained in CR after 3rd and 4th consolidation. Eleven patients died and five patients relapsed during treatment and follow up. In this group overall CR, relapse rate (RR) and mortality was 30.4% (7/23), 21.7% (5/23) & 48% (11/23) respectively. In group Ib out of 17 patients, 9 patients (53%) achieved CR after remission induction. Eleven patients died during treatment while one patient relapsed in this group. Overall CR, RR & mortality was 29.4% (5/17), 6% (1/17) & 55% (11/17) respectively. In group II all patients achieved CR (100%) after 1st course of chemotherapy. Two of these patients unfortunately died of uncontrolled sepsis during 1st consolidation, while remaining 4 patients 66.6% are on maintenance chemotherapy and are still in CR. CONCLUSION: Overall CR, RR and mortality in all groups was 35% (16/46), 13% (6/46) and 52% (24/46) respectively at a median follow-up of 36 + 8 months. Survival in AML-M3 patients treated with ATRA based chemotherapy is significantly superior than anthracycline based chemotherapy (66.6% vs. 29.4%). Infection and chemotherapy toxicity being major causes of mortality.

Successful allogeneic stem cells transplantation in severe aplastic anaemia complicated by dengue Fever.

Aplastic anaemia is characterized by severe compromise of haematopoiesis and hypocellular bone marrow. Haemorrhagic episodes in patients with aplastic anemia occur usually secondary to thrombocytopenia and require frequent support with platelet concentrates and other blood products. Infection with dengue virus (particularly dengue sero type-2 of South Asian genotype) is associated with dengue haemorrhagic fever. Dengue infection further worsens the disease process in patients with aplastic anaemia due to uncontrolled haemorrhagic diathesis and major organ failure, which may prove fatal in these already immunocompromised patients, if not treated in time. Recent epidemics of dengue haemorrhagic fever has not only affected the southern region of our country but also spread to other areas of the country. With this background, we report a case of aplastic anaemia complicated by dengue haemorrhagic fever who achieved successful engraftment after allogeneic stem cell transplantation from sibling brother and is having normal healthy post transplant life.

Deep vein thrombosis--a rare post transplant complication.

Deep vein thrombosis (DVT) is a rare post transplant multifactorial disease and often results from a combination of risk factors causing venous stasis. Venography and doppler ultrasound are reliable and accurate procedures for detecting venous thrombosis. Once DVT has been established, these patients should be treated with anticoagulants at least for a limited duration particularly in high risk post transplant patients with previous episodes of thrombotic events. We report here a case of a 7 years old boy with B-thalassaemia major, who developed deep vein thrombosis at 04 month post SCT. He was treated with low molecular weight heparin and oral warfarin sodium and INR was stabilized between 2.5 - 3.0. Two months later, he presented with bleeding diathesis and died intracranial haemorrhage. Excessive unchecked anticoagulation was the cause of death. It is recommended that patients on anticoagulation therapy require strict monitoring with PT/INR to avoid bleeding complications related to unchecked over anticoagulation.

Cardiac complications after stem cell transplantation.

Cardiac insufficiency / toxicity has been recognized as a complication of intensive cytotoxic therapy used in stem cell transplant setting. The incidence of clinically significant cardiac toxicity following high dose chemotherapy ranges between 2 - 43% with mortality of 2 - 9%. Two patients are reported who developed life-threatening cardiac complications following cyclophosphamide and busulphan therapy requiring pericardiocentesis and pericardiectomy.

Cyclosporine induced neurotoxicity in a stem cell transplant recipient.

Neurological complications are quite frequent in stem cell transplant (SCT) recipients. Major causes are conditioning regimen toxicity, metabolic and electrolyte disturbances, viral infections and cyclosporine related toxicity. Cyclosporine induced neurotoxicity is a well documented complication in stem cell transplant recipients. These patients usually present with seizures which are easily controlled with anti-convulsants and by reducing/withholding the drug. However uncontrolled seizures requiring ventilatory support are rarely reported. Here we present a case report of cyclosporine induced uncontrolled seizures in a young female after allogeneic SCT which was unresponsive to anti-convulsive therapy but was successfully treated with mechanical ventilatory support.