Rapid and automatic burned area detection using sentinel-2 time-series images in google earth engine cloud platform: a case study over the Andika and Behbahan Regions, Iran.

For proper forest management, accurate detection and mapping of burned areas are needed, yet the practice is difficult to perform due to the lack of an appropriate method, time, and expense. It is also critical to obtain accurate information about the density and distribution of burned areas in a large forest and vegetated areas. For the most efficient and up-to-date mapping of large areas, remote sensing is one of the best technologies. However, the complex image scenario and the similar spectral behavior of classes in multispectral satellite images may lead to many false-positive mistakes, making it challenging to extract the burned areas accurately. This research aims to develop an automated framework in the Google Earth Engine (GEE) cloud computing platform for detecting burned areas in Andika and Behbahan, located in the south and southwest of Iran, using Sentinel-2 time-series images. After importing the images and applying the necessary preprocessing, the Sentinel-2 Burned Areas Index (BAIS2) was used to create a map of the Primary Burned Areas (PBA). Detection accuracy was then improved by masking out disturbing classes (vegetation and water) on the PBA map, which resulted in Final Burned Areas (FBA). The unimodal method is used to calculate the ideal thresholds of indices to make the proposed method automatic. The final results demonstrated that the proposed method performed well in both homogeneous and heterogeneous areas for detecting the burned areas. Based on a test dataset, maps of burned areas were produced in the Andika and Behbahan regions with an overall accuracy of 90.11% and 92.40% and a kappa coefficient of 0.87 and 0.88, respectively, which were highly accurate when compared to the BAIS2, Normalized Burn Ratio (NBR), Normalized Difference Vegetation Index (NDVI), Mid-Infrared Bispectral Index (MIRBI), and Normalized Difference SWIR (NDSWIR) indices. Based on the results, accurate determination of vegetation classes and water zones and eliminating them from the map of burned areas led to a considerable increase in the accuracy of the obtained final map from the BAIS2 spectral index.

Central nervous system manifestations in COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: At the end of December 2019, a novel respiratory infection, initially reported in China, known as COVID-19 initially reported in China, and later known as COVID-19, led to a global pandemic. Despite many studies reporting respiratory infections as the primary manifestations of this illness, an increasing number of investigations have focused on the central nervous system (CNS) manifestations in COVID-19. In this study, we aimed to evaluate the CNS presentations in COVID-19 patients in an attempt to identify the common CNS features and provide a better overview to tackle this new pandemic. METHODS: In this systematic review and meta-analysis, we searched PubMed, Web of Science, Ovid, EMBASE, Scopus, and Google Scholar. Included studies were publications that reported the CNS features between 1 January 2020 and 20 April 2020. The data of selected studies were screened and extracted independently by four reviewers. Extracted data analyzed by using STATA statistical software. The study protocol registered with PROSPERO (CRD42020184456). RESULTS: Of 2,353 retrieved studies, we selected 64 studies with 11,687 patients after screening. Most of the studies were conducted in China (58 studies). The most common CNS symptom of COVID-19 was headache (8.69%, 95%CI: 6.76%-10.82%), dizziness (5.94%, 95%CI: 3.66%-8.22%), and impaired consciousness (1.90%, 95%CI: 1.0%-2.79%). CONCLUSIONS: The growing number of studies has reported COVID-19, CNS presentations as remarkable manifestations that happen. Hence, understanding the CNS characteristics of COVID-19 can help us for better diagnosis and ultimately prevention of worse outcomes.

Colchicine Myopathy: A Case Series Including Muscle MRI and ABCB1 Polymorphism Data.

Colchicine is a medication most commonly used in the treatment of gout and familial mediterannean fever. A rare complication of therapy is toxicity causing proximal myopathy and polyneuropathy. Colchicine myopathy has been associated with the coadministration of other medications with colchicine, such as statins or tacrolimus, and is more common in patients with renal impairment. Otherwise, it is unclear which patients are at greatest risk of developing this adverse drug reaction. ABCB1 is important to the metabolism of colchicine, so we speculated that it was possible that colchicine myopathy patients may have a particular genotype that is associated with this side effect. We describe two cases of colchicine myopathy which occurred with co-administration of rosuvastatin. From one case, we present the first published data on muscle MRI in this condition. We additionally present an analysis of four genetic polymorphisms in ABCB1 and transcript levels in muscle tissue, and demonstrate the descriptive finding of reduced ABCB1 transcript levels in the colchicine myopathy patients.

Ultrasound in Multifocal Motor Neuropathy: Clinical and Electrophysiological Correlations.

OBJECTIVES: Multifocal motor neuropathy (MMN) is a treatable autoimmune polyneuropathy, which may prove challenging diagnostically in the setting of absent conduction blocks or advanced axonal loss. Relatively few studies have examined the role of ultrasound (US) in MMN. METHODS: Retrospective, cross-sectional study of patients with MMN who underwent peripheral nerve US. Charts were reviewed to extract clinical, sonographic, and electrophysiological data. RESULTS: Eleven patients with MMN underwent US between 2013 and 2015; of these 11 patients, 7 had ≥3 abnormal nerve segments, and 6 had ≥5 sites of increased cross-sectional area (CSA). There was moderate correlation between the degree of amplitude drop observed in the median and ulnar motor nerves, and CSA. Significant correlation between CSA and limb strength was only observed for the median nerve. CONCLUSIONS: Peripheral nerve US shows promise as a diagnostic tool in MMN and may be helpful to distinguish MMN from motor neuron disease.

Novel functional polymorphism in IGF-1 gene associated with multiple sclerosis: A new insight to MS.

BACKGROUND: Interactions between several genes and environment may play a role in susceptibility to multiple sclerosis (MS). The IGF-1 plays a key role in proliferation, maintenance and survival of nerve cells. Therefore, we hypothesized that IGF-1 may be a target for prediction and control MS. We aimed to analysis IGF-1 gene promoter sequence, to investigate the effect of the single nucleotide variants on IGF-1 expression and its association with MS. METHODS: We enrolled 339 MS patients and 431 healthy controls. A specific region in IGF-1 gene promoter was investigated by SSCP analysis. All samples were genotyped by SSP-PCR. In-vitro and in-vivo IGF-1 production was measured by ELISA assay. IGF-1 expression in PBMCs was measured using real-time PCR. RESULTS: We identified a T to C single nucleotide substitution at position -1089 and a C to T at position -383 from transcription start site in the IGF-1 gene promoter. There was a significant association between MS and genotypes IGF-1(-383) C/T (p=0.001) and IGF-1(-383) C/C (p<0.001). There was also a significant association between IGF-1(-383) allele C and MS (p=0.001). In-vitro and in-vivo IGF-1 level showed that IGF-1 production in samples with genotype IGF-1(-383) C/C significantly was less than T/T (p=0.004) but not T/C (p=0.220). CONCLUSION: According to IGF-1 roles in CNS and our results, this study suggests that low IGF-1 level may be associated with susceptibility to MS.

Peripheral nerve high-resolution ultrasound in diabetes.

INTRODUCTION: High-resolution ultrasound (HRU) is used in the diagnosis of peripheral neuropathies. There are conflicting data regarding HRU findings in patients with diabetic sensorimotor polyneuropathy (DSP). Our purpose in this study was to measure nerve cross-sectional areas (CSAs) in patients with diabetes, with and without DSP. METHODS: We performed a prospective peripheral nerve HRU study of 100 diabetic subjects, assessed the CSA at predefined sites, and compared the results with those of 100 normal subjects. We evaluated the use of individual CSA values and various summary scores for diagnosis of DSP. RESULTS: Diabetic subjects had higher CSA values than healthy volunteers, and those with DSP had higher CSA values. Three or more enlarged CSA sites predicted DSP with 64% sensitivity and 77% specificity. CONCLUSIONS: Peripheral nerves are enlarged diffusely in diabetic patients, including sites not susceptible to bony compression. The number of enlarged CSA values can help predict the presence of DSP. Muscle Nerve, 2016 Muscle Nerve 55: 171-178, 2017.

Reference values for ultrasonograpy of peripheral nerves.

INTRODUCTION: High-resolution ultrasonography (HRU) is a novel method that provides morphological information about peripheral nerves. We aimed to determine reference values for nerve cross-sectional area (CSA) on HRU. METHODS: One hundred healthy volunteers had HRU of median, radial, ulnar, fibular, tibial, sural, and superficial fibular nerves at defined sites. The CSA was measured and the effects of age, gender, and body mass index (BMI) were evaluated. RESULTS: CSA values in healthy subjects are described. CSA is larger in lower limb motor nerves than in sensory nerves at similar sites, and the CSA tends to be symmetrical. The strongest effect on CSA was for age, although gender and BMI had some effects. CONCLUSIONS: This study provides normative values for HRU, and it suggests that further research with age- and gender-specific distributions must be a key priority in the development of HRU for use as a diagnostic test for peripheral nerve diseases.

Association of interleukin-1 gene cluster polymorphisms and haplotypes with multiple sclerosis in an Iranian population.

Multiple sclerosis (MS) is a multi-factorial autoimmune disease of the central nervous system. The exact etiology of MS is still unknown. Due to the important roles that cytokines play as mediators in immune and inflammatory responses, we have evaluated the association of IL-1 gene cluster polymorphisms and haplotypes with MS susceptibility in 306 unrelated MS patients and 312 healthy matched controls. A significant association was found for the IL-1ß +3953 T allele [OR=1.43, 95% CI (1.14-1.79), P value=0.002, Pc=0.01] and for IL-1ß +3953 T/T genotype and MS risk [OR=1.92, 95% CI (1.25-2.96), P value=0.005, Pc=0.01]. Interestingly, the genotypes of the polymorphisms remained significant under recessive, co-recessive and dominant models. However, no significant differences were found between MS patients and controls in the genotype and allele frequencies of the IL-1ß -511, -31 and IL-1Ra polymorphisms. Haplotype analysis for IL-1ß -31 and IL-1ß -511, with moderate linkage disequilibrium (LD), using the EM algorithm revealed a significant global association of haplotype differences between the two groups. Lower presence of two haplotypes (H3: C-T and H4: T-C) was observed in the MS patients than healthy controls. However, after applying Bonferroni's correction the differences were not significant. To our knowledge, this is the first study reporting the association of the IL-1ß +3953 gene polymorphism and MS susceptibility.

Peripheral Nerve Ultrasound in Small Fiber Polyneuropathy.

Routine nerve conduction studies are normal in patients with small fiber neuropathy (SFN), and a definitive diagnosis is based on skin biopsy revealing reduced intra-epidermal nerve fiber density (IENFD). In large fiber polyneuropathy, ultrasound (US) parameters indicate enlargement in cross-sectional area (CSA). This study was aimed at determining if similar changes in large fibers on US are apparent in patients with SFN. Twenty-five patients with SFN diagnosed by reduced IENFD and 25 age- and body mass index (BMI)-matched healthy controls underwent US studies of sural and superficial peroneal sensory nerves. The mean CSA of the sural nerve in SFN patients was 3.2 ± 0.8 mm(2), and in controls, 2.7 ± 0.6 mm(2) (p < 0.0070), and this was independent of sex. There was no difference in the thickness-to-width ratio or echogenicity of the nerves. US of the sural nerve in patients diagnosed with small fiber neuropathy reveals an enlarged cross-sectional area similar to that in large fiber polyneuropathy.

Characteristics of muscle cramps in patients with polyneuropathy.

Muscle cramps are common in the general population and can be disabling for patients, but there is little evidence comprehensively evaluating cramp characteristics in patients with polyneuropathy. This study describes the prevalence and characteristics of muscle cramps in this patient group. Patients over 18 diagnosed with polyneuropathy were invited to join the study. Patients completed nerve conduction studies, the Toronto Clinical Neuropathy score, neuropathy-specific Vickrey's Quality of Life Assessment and a self-administered questionnaire examining demographics, neuropathy symptoms and cramp characteristics. Two hundred and twenty-five participants were enrolled (28.0% female). Sixty-three percent of patients experienced cramps, occurring on average 6 times per week, lasting 10.5 min and scoring 6 out of 10 on a pain scale and described as disabling by 43.6% of patients. No significant difference was found in cramp prevalence according to underlying pathophysiology (p = 0.52) or fiber type (p = 0.41). Patients with disabling cramps rated their physical (p < 0.0001) and mental (p = 0.04) quality of life lower than patients without disabling cramps. This study confirms that muscle cramps are common, disabling and associated with reduced quality of life in patients with polyneuropathy. Similar prevalence of cramps across predominant nerve fiber type suggests a role of sensory afferents in cramp generation, although this needs to be confirmed in larger cohorts.

The characteristics of chronic inflammatory demyelinating polyneuropathy in patients with and without diabetes--an observational study.

INTRODUCTION: We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury, and response to treatment differed in patients diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) with and without diabetes. METHODS: CIDP patients with diabetes (CIDP+DM) (n = 67) and without diabetes (CIDP-DM) (n = 67) underwent clinical examination and nerve conduction studies (NCS). CIDP-DM patients were selected using age and gender matching with the existing CIDP+DM cohort. Patients treated with immunotherapies were classified as responders (R) (n = 46) or non-responders (NR) (n = 54) based on clinical response to treatment. The groups were compared using analysis of variance, contingency tables and Kruskal-Wallis analyses. RESULTS: CIDP+DM subjects had more severe neuropathy based on higher lower limb vibration potential thresholds (VPT)(p = 0.004), higher Toronto Clinical Neuropathy Score (TCNS) (p = 0.0009), more proximal weakness (p = 0.03), more gait abnormality (p = 0.03) and more abnormal NCS. CIDP+DM subjects had more abnormal sural NCS with lower sural sensory nerve action potential amplitudes (2.4±3.0 µV, 6.6±6.0 µV, p<0.0001) and slower sural nerve conduction velocities (38.6±5.4 m/s, 41.0±5.3 m/s, p = 0.04). CIDP-DM subjects were more likely to receive immune therapies (93% vs 57%, p = <0.0001), despite no significant differences in treatment responder rates (p = 0.71). Patients who responded to therapy had shorter duration of CIDP than non-responders (8.0±6.0 y vs 11.9±7.6 y, p = 0.004). DISCUSSION: The clinical phenotype and electrophysiological profile of CIDP patients differs according to the presence or absence of diabetes. Despite CIDP+DM patients having more severe clinical and electrophysiological neuropathy, they are less likely to receive disease-modifying/specific therapy, yet have similar response rates to treatment as those without diabetes. Specifically, the duration of neuropathy - not diabetes status - was associated with treatment response.

Comparison of diabetes patients with "demyelinating" diabetic sensorimotor polyneuropathy to those diagnosed with CIDP.

BACKGROUND: We have previously identified a subset of diabetic sensorimotor polyneuropathy (DSP) patients with probable demyelination related to poor glycemic control. We aimed to determine whether the clinical characteristics and electrodiagnostic classification of nerve injury in diabetes patients with "demyelinating" DSP (D-DSP) differed from those diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) (CIDP + diabetes mellitus [DM]). METHODS: D-DSP (56) and CIDP + DM (67) subjects underwent clinical examination and nerve conduction studies (NCS), and were compared using analysis of variance, contingency tables, and Kruskal-Wallis analyses. RESULTS: Of the 123 subjects with a mean age of 60.5 ± 15.6 years and mean hemoglobin A1c (HbA1c) of 8.2 ± 2.2%, 54% had CIDP + DM and 46% had D-DSP. CIDP + DM subjects were older (P = 0.0003), had shorter duration of diabetes (P = 0.005), and more severe neuropathy as indicated by Toronto Clinical Neuropathy Score (TCNS) (P = 0.003), deep tendon reflexes (P = 0.02), and vibration perception thresholds (VPT) (P = 0.01, P = 0.02). The mean HbA1c value for D-DSP subjects (8.9 ± 2.3%) was higher than in CIDP + DM subjects (7.7 ± 2.0%, P = 0.02). CONCLUSIONS: The clinical phenotype and electrophysiological profile of CIDP + DM patients is marked by more severe neuropathy and better glycemic control than in patients with D-DSP. These findings indicate that these two conditions - despite similarities in their electrophysiological pattern of demyelination - likely differ in etiology.

Conduction slowing in diabetic sensorimotor polyneuropathy.

OBJECTIVE: Mild demyelination may contribute more to the pathophysiology of nerve fiber injury in diabetic sensorimotor polyneuropathy (DSP) than previously thought. We investigated the clinical and electrodiagnostic classifications of nerve injury in diabetic patients to detect evidence of conduction slowing in DSP. RESEARCH DESIGN AND METHODS: Type 1 diabetic subjects (n = 62) and type 2 diabetic subjects (n = 111) with a broad spectrum of DSP underwent clinical examination and nerve conduction studies (NCS). Patients were classified as having axonal (group A), conduction slowing (group D), or combined (group C) DSP based on electrodiagnostic criteria. Patients with chronic immune-mediated neuropathies were not included. The groups were compared using ANOVA, contingency tables, and Kruskal-Wallis analyses. RESULTS: Of the 173 type 1 and type 2 diabetic subjects with a mean age of 59.1 ± 13.6 years and hemoglobin A1c (HbA1c) of 8.0 ± 1.8% (64 ± 19.7 mmol/mol), 46% were in group A, 32% were in group D, and 22% were in group C. The severity of DSP increased across groups A, D, and C, respectively, based on clinical and NCS parameters. The mean HbA1c for group D subjects (8.9 ± 2.3% [74 ± 25.1 mmol/mol]) was higher than for group A and group C subjects (7.7 ± 1.4% [61 ± 15.3 mmol/mol] and 7.5 ± 1.3% [58 ± 14.2 mmol/mol]; P = 0.003), and this difference was observed in those with type 1 diabetes. CONCLUSIONS: The presence of conduction slowing in patients with suboptimally controlled type 1 diabetes indicates the possibility that this stage of DSP may be amenable to intervention via improved glycemic control.

Safety of plasma exchange therapy in patients with myasthenia gravis.

INTRODUCTION: Plasma exchange (PLEX) is effective in myasthenia gravis (MG), but there are concerns about its safety. METHODS: We collected data prospectively from 42 patients randomized to PLEX treatment in a comparison study with intravenous immunoglobulin (IVIg). Detailed information on the PLEX treatment methodology and adverse events are reported. RESULTS: Forty of 42 patients completed PLEX. Ninety percent were treated in an outpatient setting. Fifty-five percent had no complications, and 45% had mild-moderate reactions that did not require stopping treatment; the majority were citrate reactions and peripheral vascular issues that were easily treated. Fifty-seven percent of patients responded to treatment, and 83% completed PLEX via peripheral venous access. Two patients had severe adverse events: 1 related and 1 unrelated to PLEX. Comorbid disease and age did not predict reactions. CONCLUSION: PLEX is safe, effective, and well tolerated in patients with MG. Our results do not raise concerns about the safety of PLEX in patients with moderate-severe MG.

Evaluation of proxy tests for SFSN: evidence for mixed small and large fiber dysfunction.

BACKGROUND: Though intra-epidermal nerve fiber density (IENFD) is considered the gold standard for diagnosis of small fiber sensory neuropathy (SFSN), we aimed to determine if novel threshold values derived from standard tests of small or large fiber function could serve as diagnostic alternatives. METHODS: Seventy-four consecutive patients with painful polyneuropathy and normal nerve conduction studies (NCS) were defined as SFSN cases or controls by distal IENFD <5.4 and ≥5.4 fibers/mm, respectively. Diagnostic performance of small fiber [cooling (CDT) and heat perception (HP) thresholds, axon reflex-mediated neurogenic vasodilatation] and large fiber function tests [vibration perception thresholds (VPT) and sural nerve conduction parameters] were determined by receiver operating-characteristic (ROC) curve analyses. RESULTS: The 26(35%) SFSN cases had mean IENFD 3.3±1.7 fibers/mm and the 48(65%) controls 9.9±2.9 fibers/mm. Male gender (p = 0.02) and older age (p = 0.02) were associated with SFSN cases compared to controls. VPT were higher and CDT lower in SFSN cases, but the largest magnitude of differences was observed for sural nerve amplitude. It had the greatest area under the ROC curve (0.75) compared to all other tests (p<0.001 for all comparisons) and the optimal threshold value of ≤12 µV defined SFSN cases with 80% sensitivity and 72% specificity. CONCLUSION: In patients presenting with polyneuropathy manifestations and normal NCS, though small fiber function tests were intuitively considered the best alternative measures to predict reduced IENFD, their diagnostic performance was poor. Instead, novel threshold values within the normal range for large fiber tests should be considered as an alternative strategy to select subjects for skin biopsy in diagnostic protocols for SFSN.

Unilateral hypoglossal nerve palsy: as the only presentation of tuberculosis.

Tuberculous spondylitis is not an uncommon disease of the spine. Near one percent of all cases of spinal tuberculosis (TB) involves craniocervical junction. Hypoglossal nerve palsy is not an uncommon neurological finding, but isolated involvement of the hypoglossal nerve is rare and limited to case reports or small case series. Here, we report a case of craniocervical junction tuberculosis presenting with unilateral hypoglossal nerve palsy. Case is a 41-year-old woman with neck and suboccipital pain since one month and unilateral right hypoglossal nerve palsy since one week. All laboratory tests were unremarkable except raised ESR level. Involvement of C1-C2 and hypoglossal canal were demonstrated by CT scan of craniocervical junction. Tissue diagnosis of TB was established by open biopsy of the craniocervical junction.

High frequency of the IL-2 -330 T/HLA-DRB1*1501 haplotype in patients with multiple sclerosis.

We have evaluated the role of the HLA-DRB1*1501 allele and the IL-2 -330 T/G polymorphism and their interaction in susceptibility to multiple sclerosis on 360 patients and 426 matched healthy individuals. We used the SSP-PCR method to determine the alleles. Fisher's exact test was used to analyses. We observed a significant increase in the T allele at IL-2 -330 position in patients (OR=1.34, P<0.05), and the T/T and T/G genotypes were more frequent among patients than controls. The HLA-DRB1*1501 allele was overrepresented in patients as compared to the control group (OR=1.7, P=0.0006). The two-locus analysis of the interaction between the IL-2 promoter polymorphism and the HLA-DRB1 allele showed that the HLA-DRB1*1501/T haplotype was more frequent in patients than controls (OR=16, P<0.0001). Our findings support previous findings about the role of the HLA-DRB1*1501 allele in susceptibility to MS. This work also provides new findings about the importance of gene-gene interactions in the development of MS.

CCR5-delta 32 allele is associated with the risk of developing multiple sclerosis in the Iranian population.

The 32-base pair deletion on the C-C chemokine receptor 5 gene (CCR5-delta 32) is known as a protective allele against immune system disorders. We have studied this variation in Iranian multiple sclerosis (MS) patients and healthy controls. DNA samples were prepared from the whole blood of 254 patients with MS and 380 healthy controls. We amplified the fragment including the CCR5-delta 32 polymorphism and visualized the products in a documentation system after agarose gel electrophoresis. Data were analysed using one-way ANOVA and Fisher's exact tests with SPSS-v13 and STATA-v8 software. The delta 32 allele was more frequent in MS patients when compared with controls (OR = 2.3, P < 0.0001). Also, we found a significant difference in the frequency of the delta 32/delta 32 genotype among patients and controls (OR = 7.4, P < 0.001). The mean age at onset and progression index was not significantly different between patients with various genotypes. According to our study, the delta 32 allele of the CCR5 gene might be a predisposing factor for MS development in the Iranian population. However, there were no associations between this polymorphism and the clinical course of the disease in this study.

An integrated photogrammetric and spatial database management system for producing fully structured data using aerial and remote sensing images.

3D spatial data acquired from aerial and remote sensing images by photogrammetric techniques is one of the most accurate and economic data sources for GIS, map production, and spatial data updating. However, there are still many problems concerning storage, structuring and appropriate management of spatial data obtained using these techniques. According to the capabilities of spatial database management systems (SDBMSs); direct integration of photogrammetric and spatial database management systems can save time and cost of producing and updating digital maps. This integration is accomplished by replacing digital maps with a single spatial database. Applying spatial databases overcomes the problem of managing spatial and attributes data in a coupled approach. This management approach is one of the main problems in GISs for using map products of photogrammetric workstations. Also by the means of these integrated systems, providing structured spatial data, based on OGC (Open GIS Consortium) standards and topological relations between different feature classes, is possible at the time of feature digitizing process. In this paper, the integration of photogrammetric systems and SDBMSs is evaluated. Then, different levels of integration are described. Finally design, implementation and test of a software package called Integrated Photogrammetric and Oracle Spatial Systems (IPOSS) is presented.