Parapharyngeal Space Tumors-What Lies in This Hidden Space?

The parapharyngeal or the lateral pharyngeal space is a potential anatomical space in the lateral neck extending from skull base to the hyoid bone. The fascial attachment between the styloid process and tensor veli palatini muscle divides this space into two compartments - pre styloid and post styloid. Primary tumors arising from this hidden space are quite rare and demand reasonable doubts and advanced surgical expertise in management. We describe our experience in managing these tumors and the varied surgical approaches.

Efficacy of Virtual Cognitive Behavioral Therapy on COVID-19 Pandemic Related Anxiety in a Middle Eastern Country: An Interventional Study.

Introduction: Emotional stress and anxiety during COVID-19 pandemic has gained a lot of attention. The capacity to withstand from the manipulated thinking and COVID-19 related stress and anxiety depends on the resilience level of an individual. Cognitive behavioral therapy (CBT) has patronizing benefits for people affected with altered mental health. Relieving COVID-19 related anxiety using CBT has beneficial impact on health and improves quality of life of people. Objective: Aimed to relieve the anxiety of Omani population during COVID-19 pandemic using CBT. Methods: This research utilized a pre-experimental one group pre-test post-test design. A non-probability convenient sampling technique was used to select 96 Omani people who fulfilled the inclusion criteria. The pre-anxiety level was assessed using CAS (Corona virus Anxiety Scale). The participants who scored above nine in the scale were given three sessions of CBT. Post-anxiety level was assessed using CAS after three CBT sessions. Results: The study revealed that the level of anxiety reduced during post-test (6.35) after intervention when compared to pre-test (13.22). The CBT intervention was effective in reducing the anxiety in the post-test at p ≤ .000. Conclusion: CBT is effective in reducing COVID-19 related anxiety among the Omani population. Therefore, this strategy is highly recommended in people having mental health issues.

ABC Fractional Order Vaccination Model for Covid-19 with Self-Protective Measures.

A mathematical model delineating the control strategies in transference of Covid-19 pandemic is examined through Atangana-Baleanu Caputo type fractional derivatives. The total count of people under observation is classified into Susceptible, Vaccinated, Infected and Protected groups (SVIP). The designed model studies the efficiency of vaccination and personal precautions incorporated qualitatively by every individual via fixed point theorem. Stability of the system has been investigated with spectral characterisation of Ulam Hyer's kind. Numerical interpolation has been derived by Adam's semi-analytical technique and we have approximated the solution. We have proved the theoretical analysis through graphical simulations that vaccination and self protective interventions are the significant role to decrease the contagious expansion of the virus among the people in process.

Unusual manifestations of extra-pulmonary tuberculosis: a pictorial essay.

Purpose: Tuberculosis is quite common in India. About 40% of all Indians are infected with mycobacterium tuberculosis, with 2.5 million active tuberculosis cases. Tuberculosis primarily affects the lungs, but it can affect any organ. Extra-pulmonary involvement occurs 15-20% of cases in immune-competent patients and in more than 50% in HIV patients. The most common extra-pulmonary sites are lymph nodes, pleura, abdomen, genitourinary tract, skin, joints and bones, or meninges. Case reports: In this pictorial review article we present 8 atypical cases of tuberculosis and describe their imaging features and histopathology. Conclusions: Extra-pulmonary tuberculosis can affect virtually any organ and can mimic various inflammatory and neoplastic disorders apart from other infective conditions. A strong index of suspicion is required particularly in those countries endemic to tuberculosis.

ADID-UNET-a segmentation model for COVID-19 infection from lung CT scans.

Currently, the new coronavirus disease (COVID-19) is one of the biggest health crises threatening the world. Automatic detection from computed tomography (CT) scans is a classic method to detect lung infection, but it faces problems such as high variations in intensity, indistinct edges near lung infected region and noise due to data acquisition process. Therefore, this article proposes a new COVID-19 pulmonary infection segmentation depth network referred as the Attention Gate-Dense Network- Improved Dilation Convolution-UNET (ADID-UNET). The dense network replaces convolution and maximum pooling function to enhance feature propagation and solves gradient disappearance problem. An improved dilation convolution is used to increase the receptive field of the encoder output to further obtain more edge features from the small infected regions. The integration of attention gate into the model suppresses the background and improves prediction accuracy. The experimental results show that the ADID-UNET model can accurately segment COVID-19 lung infected areas, with performance measures greater than 80% for metrics like Accuracy, Specificity and Dice Coefficient (DC). Further when compared to other state-of-the-art architectures, the proposed model showed excellent segmentation effects with a high DC and F1 score of 0.8031 and 0.82 respectively.

An integrated feature frame work for automated segmentation of COVID-19 infection from lung CT images.

The novel coronavirus disease (SARS-CoV-2 or COVID-19) is spreading across the world and is affecting public health and the world economy. Artificial Intelligence (AI) can play a key role in enhancing COVID-19 detection. However, lung infection by COVID-19 is not quantifiable due to a lack of studies and the difficulty involved in the collection of large datasets. Segmentation is a preferred technique to quantify and contour the COVID-19 region on the lungs using computed tomography (CT) scan images. To address the dataset problem, we propose a deep neural network (DNN) model trained on a limited dataset where features are selected using a region-specific approach. Specifically, we apply the Zernike moment (ZM) and gray level co-occurrence matrix (GLCM) to extract the unique shape and texture features. The feature vectors computed from these techniques enable segmentation that illustrates the severity of the COVID-19 infection. The proposed algorithm was compared with other existing state-of-the-art deep neural networks using the Radiopedia and COVID-19 CT Segmentation datasets presented specificity, sensitivity, sensitivity, mean absolute error (MAE), enhance-alignment measure (EMφ), and structure measure (S m) of 0.942, 0.701, 0.082, 0.867, and 0.783, respectively. The metrics demonstrate the performance of the model in quantifying the COVID-19 infection with limited datasets.

Nipple Localization in Automated Whole Breast Ultrasound Coronal Scans Using Ensemble Learning.

Nipple is a vital landmark in the breast lesion diagnosis. Although there are advanced computer-aided detection (CADe) systems for nipple detection in breast mediolateral oblique (MLO) views of mammogram images, few academic works address the coronal views of breast ultrasound (BUS) images. This paper addresses a novel CADe system to locate the Nipple Shadow Area (NSA) in ultrasound images. Here the Hu Moments and Gray-level Co-occurrence Matrix (GLCM) were calculated through an iterative sliding window for the extraction of shape and texture features. These features are then concatenated and fed into an Artificial Neural Network (ANN) to obtain probable NSA's. Later, contour features, such as shape complexity through fractal dimension, edge distance from the periphery and contour area, were computed and passed into a Support Vector Machine (SVM) to identify the accurate NSA in each case. The coronal plane BUS dataset is built upon our own, which consists of 64 images from 13 patients. The test results show that the proposed CADe system achieves 91.99% accuracy, 97.55% specificity, 82.46% sensitivity and 88% F-score on our dataset.

Does the morbidity management and disability prevention (MMDP) clinic serve the filarial lymphedema (FLE) patients' preeminent expectation?

Advocacy and training on "Home care" for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 - 1935) at first visit of the observation period which reduced to 645ml (IQR 215- 1666) and 752ml (IQR 215 - 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.

Variations in the retromandibular approach to the condyle-transparotid versus anteroparotid transmasseteric - a prospective clinical comparative study.

BACKGROUND: The management of mandibular condylar fracture remains controversial many surgeons still favour the open reduction and internal fixation (ORIF) which provides good result and immediate functioning as compared to closed reduction. With proven consensus for ORIF, dilemma remains in choosing the surgical approach to condyle due to proximity of complex and important anatomic structure. Various extra-oral surgical approaches are available for ORIF including preauricular, submandibular, retromandibular, transmasseteric anteroparotid etc. Variations in retromandibular approach such as transparotid, retro-parotid and anteroparotid are reported in literature. In our study we compared the retromandibular transparotid and retromandibular anteroparotid transmasseteric variations. METHODOLOGY: Thirty condylar fracture in 26 patients, 15 in each group (group A - Retromandibular transparotid approach & group B - Retromandibular anteroparotid approach) were treated under general anaesthesia with naos-tracheal intubation and by the same surgeon having 20 years of experience in maxillofacial surgeries. We evaluated time taken for the procedure, amount of bone exposure, intra-operative haemorrhage. Postoperative presence of infection, sinus and fistula formation at the incision site, parotid fistula formation, facial nerve functioning using House-Brackman scale in immediate postoperative period, 3rd month postoperatively and 6 month postoperatively. RESULT: The mean average time taken for group A was 78.2minutes and mean average time taken for group B was 64.8minutes. None of the patient had haemorrhage intra-operatively in both the groups. Exposure was sufficient in both the groups with same length of the incision. None of the patient suffered from postoperative infection in both the groups. Parotid fistula formation was present in 2 patients in group A while none of the patient had parotid fistula in group B. Three patients out of 15 had the transient facial nerve weakness in group A which got resolved in 6 month while none of the patient had facial nerve weakness in group B. All patients had adequate mouth opening with no occlusal discrepancies. CONCLUSION: Retromandibular anteroparotid approach as described in this study has proven to be an extremely useful approach provides good access, and associated with minimal complications and morbidity compare to retromandibular transparotid approach. It is hence safe to say that this approach is relatively useful for an inexperienced and novice surgeon as well.

Missing teeth after maxillofacial trauma:a case report and management protocol

Management of maxillofacial trauma includes primary care, in which diagnosis and management of dentoalveolar injury play a vital role. Due to the impact sustained during a maxillofacial injury (whether direct or indirect), dentoalveolar injuries can occur, leading to fracture and displacement of teeth and associated alveolar bone into the surrounding soft tissues and associated structures, such as the maxillary sinus, nasal cavity, upper respiratory tract, tracheobronchial tree, or gastrointestinal tract. Undiagnosed displaced teeth may cause complications such as airway obstruction. This paper reports a case of displaced teeth in the nasal cavity and gastrointestinal tract and highlights the management protocol for displaced teeth secondary to maxillofacial trauma.

Does the morbidity management and disability prevention (MMDP) clinic serve the filarial lymphedema (FLE) patients’ preeminent expectation?

@#Advocacy and training on “Home care” for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 – 1935) at first visit of the observation period which reduced to 645ml (IQR 2151666) and 752ml (IQR 215 – 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.

Missing teeth after maxillofacial trauma:a case report and management protocol

Management of maxillofacial trauma includes primary care, in which diagnosis and management of dentoalveolar injury play a vital role. Due to the impact sustained during a maxillofacial injury (whether direct or indirect), dentoalveolar injuries can occur, leading to fracture and displacement of teeth and associated alveolar bone into the surrounding soft tissues and associated structures, such as the maxillary sinus, nasal cavity, upper respiratory tract, tracheobronchial tree, or gastrointestinal tract. Undiagnosed displaced teeth may cause complications such as airway obstruction. This paper reports a case of displaced teeth in the nasal cavity and gastrointestinal tract and highlights the management protocol for displaced teeth secondary to maxillofacial trauma.

An RDAU-NET model for lesion segmentation in breast ultrasound images.

Breast cancer is a common gynecological disease that poses a great threat to women health due to its high malignant rate. Breast cancer screening tests are used to find any warning signs or symptoms for early detection and currently, Ultrasound screening is the preferred method for breast cancer diagnosis. The localization and segmentation of the lesions in breast ultrasound (BUS) images are helpful for clinical diagnosis of the disease. In this paper, an RDAU-NET (Residual-Dilated-Attention-Gate-UNet) model is proposed and employed to segment the tumors in BUS images. The model is based on the conventional U-Net, but the plain neural units are replaced with residual units to enhance the edge information and overcome the network performance degradation problem associated with deep networks. To increase the receptive field and acquire more characteristic information, dilated convolutions were used to process the feature maps obtained from the encoder stages. The traditional cropping and copying between the encoder-decoder pipelines were replaced by the Attention Gate modules which enhanced the learning capabilities through suppression of background information. The model, when tested with BUS images with benign and malignant tumor presented excellent segmentation results as compared to other Deep Networks. A variety of quantitative indicators including Accuracy, Dice coefficient, AUC(Area-Under-Curve), Precision, Sensitivity, Specificity, Recall, F1score and M-IOU (Mean-Intersection-Over-Union) provided performances above 80%. The experimental results illustrate that the proposed RDAU-NET model can accurately segment breast lesions when compared to other deep learning models and thus has a good prospect for clinical diagnosis.

A Multi-Sensor System for Silkworm Cocoon Gender Classification via Image Processing and Support Vector Machine.

Sericulture is traditionally a labor-intensive rural-based industry. In modern contexts, the development of process automation faces new challenges related to quality and efficiency. During the silkworm farming life cycle, a common issue is represented by the gender classification of the cocoons. Improper cocoon separation negatively affects quantity and quality of the yield resulting in disruptive bottlenecks for the productivity. To tackle this issue, this paper proposes a multi sensor system for silkworm cocoons gender classification and separation. Utilizing a load sensor and a digital camera, the system acquires weight and digital images from individual silkworm cocoons. An image processing procedure is then applied to extract significant shape-related features from each image instance, which, combined with the weight data, are provided as inputs to train a Support Vector Machine-based pattern classifier for gender classification. Subsequently, an air blower mechanism and a conveyor system sort the cocoons into their respective bins. The developed system was trained and tested on two different types of silkworm cocoons breeds, respectively CSR2 and Pure Mysore. The system performances are finally discussed in terms of accuracy, robustness and computation time.

Virilization in a Postmenopausal Female Due to Androgen Secreting Ovarian Dermoid Cyst.

Virilizing ovarian dermoid cysts are very rare. The source of androgen in these cysts may be tumors such as Sertoli-Leydig cell tumor or Leydig cell hyperplasia. A 52-year-old postmenopausal female with virilization was found to have an ovarian dermoid cyst on ultrasound. Her serum testosterone levels were elevated. Leydig cell hyperplasia within the dermoid cyst was found to be the source of androgen in this patient.

Enhanced efficacy of sequential administration of Albendazole for the clearance of Wuchereria bancrofti infection: Double blind RCT.

Till today, there is no effective treatment protocol for the complete clearance of Wuchereria bancrofti (W.b) infection that causes secondary lymphoedema. In a double blind randomized control trial (RCT), 146 asymptomatic W. b infected individuals were randomly assigned to one of the four regimens for 12 days, DEC 300 mg + Doxycycline 100 mg coadministration or DEC 300 mg + Albendazole 400 mg co-administration or DEC 300 mg + Albendazole 400 mg sequential administration or control regimen DEC 300 mg and were followed up at 13, 26 and 52 weeks post-treatment for the clearance of infection. At intake, there was no significant variation in mf counts (F(3,137)=0.044; P=0.988) and antigen levels (F(3,137)=1.433; P=0.236) between the regimens. Primary outcome analysis showed that DEC + Albendazole sequential administration has an enhanced efficacy over DEC + Albendazole co-administration (80.6 Vs 64.7%), and this regimen is significantly different when compared to DEC + doxycycline co-administration and control (P<0.05), in clearing microfilaria in 13 weeks. Secondary outcome analysis showed that, all the trial regimens were comparable to control regimen in clearing antigen (F(3, 109)=0.405; P=0.750). Therefore, DEC + Albendazole sequential administration appears to be a better option for rapid clearance of W. b microfilariae in 13 weeks time. (Clinical trials.gov identifier - NCT02005653).

Enhanced efficacy of sequential administration of Albendazole for the clearance of Wuchereria bancrofti infection: Double blind RCT

Till today, there is no effective treatment protocol for the complete clearance of Wuchereria bancrofti (W.b) infection that causes secondary lymphoedema. In a double blind randomized control trial (RCT), 146 asymptomatic W. b infected individuals were randomly assigned to one of the four regimens for 12 days, DEC 300 mg + Doxycycline 100 mg coadministration or DEC 300 mg + Albendazole 400 mg co-administration or DEC 300 mg + Albendazole 400 mg sequential administration or control regimen DEC 300 mg and were followed up at 13, 26 and 52 weeks post-treatment for the clearance of infection. At intake, there was no significant variation in mf counts (F(3,137)=0.044; P=0.988) and antigen levels (F(3,137)=1.433; P=0.236) between the regimens. Primary outcome analysis showed that DEC + Albendazole sequential administration has an enhanced efficacy over DEC + Albendazole co-administration (80.6 Vs 64.7%), and this regimen is significantly different when compared to DEC + doxycycline co-administration and control (P<0.05), in clearing microfilaria in 13 weeks. Secondary outcome analysis showed that, all the trial regimens were comparable to control regimen in clearing antigen (F(3, 109)=0.405; P=0.750). Therefore, DEC + Albendazole sequential administration appears to be a better option for rapid clearance of W. b microfilariae in 13 weeks time. (Clinical trials.gov identifier – NCT02005653)

Marker assisted selection of low phytic acid trait in maize (Zea mays L.).

Maize is the third important major food crop. Breeding for low phytate maize genotypes is an effective strategy for decreasing the content of kernel phytic acid (a chelator of cations such as Ca(2+) and Fe(3+) ) and thereby increasing the bioavailability of nutritive minerals in human diet and animal feed. Previous studies have established that a mutant plant with a lpa2-2 allele accumulates less phytic acid in seeds. Therefore, the marker assisted backcross breeding (MABB), which involves introgression of lpa2-2 recessive allele (which confer low phytate trait) from a lpa2-2 mutant line into a well-adapted line using backcrosses and selection of lines possessing lpa2-2 allele in each backcross population using molecular markers, is an effective strategy for developing low phytate maize. So far, no studies have developed any lpa2-2 allele specific molecular markers for this purpose. Here, using backcross and selfed progenies, obtained by crossing low phytate mutant line 'EC 659418' (i.e. donor of lpa2-2 allele) into agronomically superior line 'UMI395', we have validated that a SSR marker 'umc2230', located 0.4 cM downstream of lpa2-2, cosegregate, in a Mendelian fashion, with low phytic acid trait. Therefore umc2230 can be dependably used in MABB for the development of low phytate maize.

Molt cycle related changes and effect of short term starvation on the biochemical constituents of the blue swimmer crab Portunus pelagicus.

Synthesis and hardening of a new exoskeleton are essential to the arthropod molting process. The present study emphasizes the variations in the levels of hemolymph total free sugars, hepatopancreas glycogen and cuticular proteins during the molting stages of Portunus pelagicus. It also reports the effect of short-term starvation conditions on the biochemical constituents of the hemolymph. Intermolt crabs were subjected to 6 days of starvation and hemolymph samples were taken. Standard biochemical procedures were followed toward the quantification of total proteins, total free sugars and total lipids. The total free sugar level in the hemolymph of P. pelagicus was observed to increase during early premolt D0 (3.108 ± 0.032 g/ml) and a gradual decrease till late postmolt B stage (0.552 ± 0.124 g/ml), suggesting the need for total free sugars to provide energy for the apolysis process. Increase in the levels of hepatopancreas glycogen was observed from 1225 ± 0.04 µg/mg in early premolt D0 to 1700 ± 0.3 µg/mg in late premolt D2-3. This is in correlation with the decreased levels of free sugars during premolt stages, suggesting an increase in the storage of glycogen reserves in the hepatopancreas. Cuticular proteins increased during stage B (2.702 ± 0.093 g/ml) and stage C (3.065 ± 0.012 g/ml), indicating exoskeleton hardening and mineralization. Results of the starvation studies clearly showed a steady decline in the level of total free sugars till day 6 (0.099 ± 0.00 g/ml) when compared to the control (8.646 ± 0.08 g/ml). Gradual decrease of total lipids was also observed from the first day of the experiment (6.088 ± 2.44 g/ml) to the last day of the study (0.401 ± 0.20 g/ml) which was 85% lesser than the control (8.450 ± 0.49 g/ml)suggesting the efficient usage of total sugars to consolidate the loss of energy reserves during starvation. The knowledge of Molt-cycle events can be used as a tool for the evaluation of the developmental state providing a morphological reference system for physiological and biochemical studies related to crab aquaculture. Starvation studies enlightens that increasing carbohydrate levels in crab feed together with good protein content could alleviate the natural effects of starvation, improve farm productivity and reduce the deleterious impact of nitrogen pollution generated by rich-protein feeds used in crab farming.

Influence of processing parameters on the quality of soycurd (tofu).

Tofu, a non-fermented soybean curd is a nutritious and digestible product with a high quality protein. Tofu making procedure includes soaking of beans, grinding, filtering, boiling, coagulating and moulding. The flavour, quality and the texture of tofu produced is significantly influenced by its processing parameters. Studies were carried out on the processing parameters like solid content of milk, thermal treatment of soybeans with sodium bicarbonate, stirring time after adding coagulant and moulding of tofu on the texture and quality of tofu. Our studies showed that the texture of the final product depended on the solid content of milk before coagulation. Pretreatment of soybeans with sodium bicarbonate, for 10 min and milk obtained with low solid content of 7° Brix resulted in regular, smooth textured tofu with less beany flavour. Duration of stirring during coagulation and moulding parameters had a significant effect on the yield of tofu. Stirring the milk after adding the coagulant for 5 s before settling and pressing the tofu with a load of 1,000 g initially for 15 min followed by 500 g for another 15 min, yielded (22.6 g/100 ml of milk) soft textured firm tofu.