A review of social background profiling of speakers from speech accents.

Social background profiling of speakers is heavily used in areas, such as, speech forensics, and tuning speech recognition for accuracy improvement. This article provides a survey of recent research in speaker background profiling in terms of accent classification and analyses the datasets, speech features, and classification models used for the classification tasks. The aim is to provide a comprehensive overview of recent research related to speaker background profiling and to present a comparative analysis of the achieved performance measures. Comprehensive descriptions of the datasets, speech features, and classification models used in recent research for accent classification have been presented, with a comparative analysis made on the performance measures of the different methods. This analysis provides insights into the strengths and weaknesses of the different methods for accent classification. Subsequently, research gaps have been identified, which serve as a useful resource for researchers looking to advance the field.

An Ensembled Framework for Human Breast Cancer Survivability Prediction Using Deep Learning.

Breast cancer is categorized as an aggressive disease, and it is one of the leading causes of death. Accurate survival predictions for both long-term and short-term survivors, when delivered on time, can help physicians make effective treatment decisions for their patients. Therefore, there is a dire need to design an efficient and rapid computational model for breast cancer prognosis. In this study, we propose an ensemble model for breast cancer survivability prediction (EBCSP) that utilizes multi-modal data and stacks the output of multiple neural networks. Specifically, we design a convolutional neural network (CNN) for clinical modalities, a deep neural network (DNN) for copy number variations (CNV), and a long short-term memory (LSTM) architecture for gene expression modalities to effectively handle multi-dimensional data. The independent models' results are then used for binary classification (long term > 5 years and short term < 5 years) based on survivability using the random forest method. The EBCSP model's successful application outperforms models that utilize a single data modality for prediction and existing benchmarks.

A transformer fine-tuning strategy for text dialect identification.

Online medical consultation can significantly improve the efficiency of primary health care. Recently, many online medical question-answer services have been developed that connect the patients with relevant medical consultants based on their questions. Considering the linguistic variety in their question, social background identification of patients can improve the referral system by selecting a medical consultant with a similar social origin for efficient communication. This paper has proposed a novel fine-tuning strategy for the pre-trained transformers to identify the social origin of text authors. When fused with the existing adapter model, the proposed methods achieve an overall accuracy of 53.96% for the Arabic dialect identification task on the Nuanced Arabic Dialect Identification (NADI) dataset. The overall accuracy is 0.54% higher than the previous best for the same dataset, which establishes the utility of custom fine-tuning strategies for pre-trained transformer models.

Temporal intermittent rhythmic theta activity (TIRTA): A marker of epileptogenicity?

Objective: To describe a novel EEG rhythm, temporal intermittent rhythmic theta activity (TIRTA), and its potential association with epilepsy. Methods: We report TIRTA on scalp EEG in a series of 12 patients, all of whom were found to have epilepsy. The clinical and electroencephalographic characteristics of each patient were reviewed. In addition, features that may distinguish TIRTA from benign EEG patterns, including rhythmic temporal theta bursts of drowsiness (RTTBD), were identified. Results: TIRTA was unilateral in all cases. For all patients, TIRTA was seen in the awake and drowsy states. Eight patients also had TIRTA observed during N2 sleep. The average frequency of TIRTA was 5.5 Hz and the average duration of a train of TIRTA was 5.25 s. In seven cases the morphology was notched in appearance. Temporal intermittent rhythmic delta activity (TIRDA) was seen in seven patients on the same side as TIRTA. Eleven patients also had ipsilateral temporal sharp waves. Abnormal MRI (6/12) and or PET (5/5) findings were ipsilateral to TIRTA. Conclusions: In this preliminary report we suggest that TIRTA may be a novel marker of potential epileptogenicity, possibly representing a higher frequency variant of TIRDA.

Spatial position constraint for unsupervised learning of speech representations.

The success of supervised learning techniques for automatic speech processing does not always extend to problems with limited annotated speech. Unsupervised representation learning aims at utilizing unlabelled data to learn a transformation that makes speech easily distinguishable for classification tasks, whereby deep auto-encoder variants have been most successful in finding such representations. This paper proposes a novel mechanism to incorporate geometric position of speech samples within the global structure of an unlabelled feature set. Regression to the geometric position is also added as an additional constraint for the representation learning auto-encoder. The representation learnt by the proposed model has been evaluated over a supervised classification task for limited vocabulary keyword spotting, with the proposed representation outperforming the commonly used cepstral features by about 9% in terms of classification accuracy, despite using a limited amount of labels during supervision. Furthermore, a small keyword dataset has been collected for Kadazan, an indigenous, low-resourced Southeast Asian language. Analysis for the Kadazan dataset also confirms the superiority of the proposed representation for limited annotation. The results are significant as they confirm that the proposed method can learn unsupervised speech representations effectively for classification tasks with scarce labelled data.

Antisynthetase syndrome presenting as interstitial lung disease: a case report.

BACKGROUND: Antisynthetase syndrome is a relatively uncommon entity, and can be easily missed if not specifically looked for in adults whose initial presentation is with interstitial lung disease. Its presentation with interstitial lung disease alters its prognosis. CASE PRESENTATION: This case report describes a 27-year-old Pakistani, Asian man, a medical student, with no previous comorbidities or significant family history who presented with a 3 months' history of low grade fever and lower respiratory tract infections, associated with exertional dyspnea, arthralgias, and gradual weight loss. During these 3 months, he had received multiple orally administered antibiotics for suspected community-acquired pneumonia. When he presented to us, he was pale and febrile. A chest examination was significant for bi-basal end-inspiratory crackles. Preliminary investigations revealed raised erythrocyte sedimentation rate. High resolution computed tomography of his chest showed fine ground-glass attenuation in posterior basal segments of both lower lobes suggestive of interstitial lung disease. He was started on dexamethasone, to which he responded and showed improvement. However, during the course of events, he developed progressive proximal muscle weakness. Further investigations revealed raised creatinine phosphokinase and lactate dehydrogenase. A thorough autoimmune profile was carried out which showed positive anti-Jo-1 antibodies in high titers. A muscle biopsy was consistent with inflammatory myopathy. Clinical, radiological, serological, and histopathological markers aided in making the definitive diagnosis of antisynthetase syndrome. Antisynthetase syndrome is a variant of polymyositis but with visceral involvement, that is, interstitial lung disease and positive anti-Jo-1 antibodies. Our patient responded very well to glucocorticoids and azathioprine. CONCLUSION: Antisynthetase syndrome is a rare clinical entity which apart from clinical presentation requires specific serological investigations for diagnosis. Concomitant association of interstitial lung disease gives it a guarded prognosis.

Case Report: Cerebral leukodystrophy and the gonadal endocrinopathy: a rare but real association.

A 30 year old married Pakistani woman presented in January 2018 with an eight month history of progressive left sided weakness, ataxia, spasticity, underdeveloped secondary sexual characteristics and primary infertility. She was the elder sister of a 19 year old bed bound woman who was diagnosed with vanishing white matter (VWM) disease 12 months previously. The MRI scan of the brain  demonstrated diffuse leukodystrophy and her hormonal assays were significant for premature ovarian failure. Results from her genetic tests demonstrated a point mutation in eukaryotic initiation factor 2B (EIF2B). Thus, she was the second confirmed case of  VWM from her  family of 12 siblings with normal parents.

Management Of Diabetes In Ramadan.

Ramadan, the ninth month of Islamic calendar brings alongwith it a sense of responsibility to fast among the Muslim adult population. Though patients with chronic illnesses like Diabetes mellitus are exempted from fasting during the month if their health does not allow, they still wish to fast. This creates a challenge for the health care professionals to enable the patients with Diabetes mellitus to fast safely, without developing complications like hypoglycemia, hyperglycemia, ketoacidosis and thrombosis. This article has reviewed multiple articles published over last two decades to develop a consensus plan regarding management of Diabetes mellitus in Ramadan. Insulin sensitizers are a better option than drugs increasing secretion of insulin. Type 2 Diabetic patients can fast much safely as compare to Type 1 Diabetics.

Multiple Osteosclerotic Lesions: ARare Presentation of Hyperparathyroidism Secondary to Hypovitaminosis D.

Hypovitaminosis D is an under-recongnised and important factor responsible for secondary hyperparathyroidism. Hyperparathyroidism mostly presents with osteolytic lesions, especially in secondary hyperparathyroidism with renal failure. There are some rare presentations of hyperparathyroidism as focal or generalized osteosclerotic lesions. The exact mechanism for the osteosclerosis is still unknown, but there are some theories suggesting an exaggerated response of osteoblasts in response to prolonged osteolytic activity in order to restore bone loss. Here, we report a case of secondary hyperparathyroidism secondary to severe Vitamin D deficiency presented as multiple osteosclerotic lesions.

Total Sulfur Amino Acid Requirements Are Not Altered in Children with Chronic Renal Insufficiency, but Minimum Methionine Needs Are Increased.

Background: The total sulfur amino acid (TSAA) and minimum Met requirements have been previously determined in healthy children. TSAA metabolism is altered in kidney disease. Whether TSAA requirements are altered in children with chronic renal insufficiency (CRI) is unknown.Objective: We sought to determine the TSAA (Met in the absence of Cys) requirements and minimum Met (in the presence of excess Cys) requirements in children with CRI.Methods: Five children (4 boys, 1 girl) aged 10 ± 2.6 y with CRI were randomly assigned to receive graded intakes of Met (0, 5, 10, 15, 25, and 35 mg · kg-1 · d-1) with no Cys in the diet. Four of the children (3 boys, 1 girl) were then randomly assigned to receive graded dietary intakes of Met (0, 2.5, 5, 7.5, 10, and 15 mg · kg-1 · d-1) with 21 mg · kg-1 · d-1 Cys. The mean TSAA and minimum Met requirements were determined by measuring the oxidation of l-[1-13C]Phe to 13CO2 (F13CO2). A 2-phase linear-regression crossover analysis of the F13CO2 data identified a breakpoint at minimal F13CO2 Urine samples collected from all study days and from previous studies of healthy children were measured for sulfur metabolites.Results: The mean and population-safe (upper 95% CI) intakes of TSAA and minimum Met in children with CRI were determined to be 12.6 and 15.9 mg · kg-1 · d-1 and 7.3 and 10.9 mg · kg-1 · d-1, respectively. In healthy school-aged children the mean and upper 95% CI intakes of TSAA and minimum Met were determined to be 12.9 and 17.2 mg · kg-1 · d-1 and 5.8 and 7.3 mg · kg-1 · d-1, respectively. A comparison of the minimum Met requirements between healthy children and children with CRI indicated significant (P < 0.05) differences.Conclusion: These results suggest that children with CRI have a similar mean and population-safe TSAA to that of healthy children, suggesting adequate Cys synthesis via transsulfuration, but higher minimum Met requirement, suggesting reduced remethylation rates.

Classic Raymond Syndrome.

Classic Raymond syndrome presents with abducens nerve palsy on the ipsilateral side with contralateral hemiparesis and facial nerve paralysis. A 60-year gentleman presented with deviation of left angle of mouth and right sided weakness. Examination showed that he had left sided abducens nerve palsy, with contralateral central facial paralysis and paresis. MRI of brain confirmed left pontine infarct. These findings were consistent with classic Raymond syndrome. Till now, only a few cases have been reported worldwide, this being the first case reported in South Asia. This case confirms that classic Raymond syndrome is different from the common type of Raymond syndrome in terms of sparing of coritcofacial fibers in the latter type.

Psoriatic Arthritis Is an Indicator of Significant Renal Damage in Patients with Psoriasis: An Observational and Epidemiological Study.

Background. Psoriasis affects joints in around 30% of the patients. Recent studies have demonstrated an increased risk of essential hypertension, ischemic heart disease, and stroke in psoriatic patients. However, the prevalence of renal disease in patients with psoriasis has not been evaluated properly. Objectives. Objectives were to evaluate renal functions in patients with psoriasis and to assess any possible relationship of renal failure with psoriasis and psoriatic arthritis. Methods. In this cross-sectional study, 30 participants were recruited into the following three groups: group-A, psoriatic arthritis; group-B, psoriasis without arthritis; and group-C, healthy subjects. Renal function tests were performed for every participant of each group. The data was analyzed by using SPSS version 16. Chi-squared and one-way ANOVA tests were applied, considering a P value of less than 0.05 as a standard criterion. Results. Serum creatinine, urea, and phosphate were the highest in group-A, higher in group-B, and normal in group-C, P < 0.05. Similarly, GFR was the lowest in group-A, lower in group-B, and normal in group-C. The difference in mean GFR values was statistically significant, F(2) = 355, P < 0.001. Moreover, proteinuria (gm/day) was seen in 96.7% of the patients with psoriatic arthritis, (M = 1.18 ± 0.55, P < 0.05) against 10% of the psoriatic patients without arthritis (M = 0.41 ± 0.10, P < 0.05). Conclusion. Derangement of renal function is more prevalent in psoriatic patients, especially in those with concomitant psoriatic arthritis. Therefore, each psoriatic patient must be routinely screened for an underlying renal failure.

Vanishing White Matter (VWM) Disease Presenting As Neuro-Ovarian Failure.

A 19-year girl was admitted with a one-month history of worsening spastic paraparesis, cerbellar ataxia, visual decline and worsening headaches on a background of walking difficulty, progressive quadriparesis and migraine since the age of 10 years. She had no sensory loss, and cranial nerves examination was notable for optic atrophy with crescent formation only. She had primary amenorrhea and underdeveloped secondary sexual characteristics. Ultrasonograhic studies of the pelvis confirmed small ovaries, and uterus. The magnetic resonance imaging (MRI) of the brain showed diffuse leukodystrophy. A diagnosis of leuko-ovarian syndrome or vanishing white matter (VWM) disease was made on the basis of Van der Knaap criteria. To the best of their knowledge, the authors are most probably reporting the first ever case of this rare clinical entity from Pakistan with special focus on its diagnostic and management challenges in the light of limited retrospective case reviews.

Lujan-Fryns Syndrome (LFS): A Unique Combination of Hypernasality, Marfanoid Body Habitus, and Neuropsychiatric Issues, Presenting as Acute-Onset Dysphagia.

BACKGROUND: Lujan-Fryns syndrome (LFS) is an extremely rare, X-linked disorder, for which the full clinical spectrum is still unknown. Usually, it presents with neuropsychiatric problems such as learning disabilities and behavioral issues in a typical combination with marfanoid features. Often, there is a positive family history for the disorder. However, sporadic cases have also been reported in males. More interestingly, there is no case of LFS presenting with acute-onset dysphagia in the English language medical literature. CASE PRESENTATION: A 17-year-old Pakistani mentally normal school boy was admitted for the workup of acute-onset dysphagia, hypernasal speech, and nasal regurgitation of liquids. He had no neuropsychiatric issues, and his family history was unremarkable. An obvious nasal twang, facial dysmorphism, and marfanoid body habitus were found on examination. The genetic tests revealed a pathogenic missense mutation in the MED12 gene on his X-chromosome. CONCLUSION: LFS can present as acute-onset dysphagia and in the absence of any neuropsychiatric issues or positive family history of the syndrome.

Primary Sjogren's Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome.

A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH) Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU) necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP), formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer's test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks' stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS) presenting as AIP, recovering completely in less than a month time.

Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report.

BACKGROUND: Splenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension. CASE PRESENTATION: A 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein. She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size. CONCLUSION: A giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.

Epithelioid Haemangioendothelioma (EHE) of the Liver.

A45-year previously known hypertensive lady presented with 2-year history of upper abdominal pain, heaviness, and weight loss. Her radiological assessment suggested the possibility of hepatoma or liver metastases. Considering her age, overall good health and absence of cirrhosis, a liver biopsy was taken which showed hepatic epithelioidhaemangioendothelioma (HEHE), a rare and unusual intermediate grade vascular tumor which can easily be confused with hepatoma or metastatic liver disease. To the best of their knowledge, the authors are most probably reporting the first ever case of HEHE from Pakistan with special emphasis on its clinical presentations, clinico-radiological diagnostic clues, and the management options in the light of the limited retrospective studies.

Ferritin Is a Marker of Inflammation rather than Iron Deficiency in Overweight and Obese People.

Background. In clinical practice, serum ferritin is used as a screening tool to detect iron deficiency. However, its reliability in obesity has been questioned. Objectives. To investigate the role of ferritin in overweight and obese people, either as a marker of inflammation or iron deficiency. Methods. On the basis of body mass index (BMI), 150 participants were divided into three equal groups: A: BMI 18.5-25 kg/m2, B: BMI 25-30 kg/m2, and C: BMI > 30 kg/m2. Serum iron, total iron binding capacity (TIBC), transferrin saturation, ferritin, C-reactive protein, and hemoglobin (Hb) were measured for each participant and analyzed through SPSS version 16. One-way ANOVA and Pearson's correlation tests were applied. Results. Ferritin was the highest in group C (M = 163.48 ± 2.23, P < 0.001) and the lowest in group A, (M = 152.78 ± 1.81, P < 0.001). Contrarily to ferritin, transferrin was the lowest in group C, (M = 30.65 ± 1.39, P < 0.001) and the highest in group A, (M = 38.66 ± 2.14, P < 0.001). Ferritin had a strong positive correlation with both BMI (r = 0.86, P < 0.001) and CRP (r = 0.87, P < 0.001) and strong negative correlation with Hb, iron, TIBC, and transferrin saturation (P < 0.001). Conclusion. Ferritin is a marker of inflammation rather than iron status in overweight and obese people. Complete iron profile including transferrin, rather than serum ferritin alone, can truly predict iron deficiency in such people.

Protective Role of G6PD Deficiency in Aluminium Phosphide Poisoning.

A 15-year-old boy was referred to the hospital from the periphery with a history of ingestion of 5 wheat pills (aluminium phosphide) 5 days back. He had been given a stomach wash in his village hospital prior to referral. On arrival, he was jaundiced and had developed haematuria too, but otherwise appeared well in himself. Four days after admission, his haemoglobin showed a marked drop and he was shifted to intensive care, keeping in mind the high mortality rate associated with aluminium phosphide intoxication. His G6PD levels were checked, and he turned out to be G6PD deficient. The patient was given intravenous magnesium sulphate and supportive care and he improved subsequently. Wheat pill poisoning carries a high mortality of 98% in some cases; despite the high mortality, this patient survived. This may mean that G6PD deficiency has a protective role in poisoning due to aluminium phosphide.

Protein requirement of healthy school-age children determined by the indicator amino acid oxidation method.

BACKGROUND: The current Dietary Reference Intake (DRI) recommendations for protein requirements in children are based on a factorial estimate and have not been directly determined. OBJECTIVE: The objective of the current study was to determine the protein requirement in healthy, school-age children by measuring the oxidation of L-[1-(13)C]-phenylalanine to (13)CO(2) [label tracer oxidation (F(13)CO(2))] in response to graded intakes of protein. DESIGN: Seven healthy children (6-11 y old) each randomly received a minimum of 7 protein intakes (range: 0.1-2.56 g · kg(-1) · d(-1)) for a total of 56 studies. The diets provided energy at 1.7 times the resting energy expenditure and were made isocaloric by using carbohydrate. Protein was given as an amino acid mixture on the basis of the egg-protein pattern, except for phenylalanine and tyrosine intakes, which were maintained constant across intakes. The mean protein requirement was determined by applying a 2-phase linear regression crossover analysis on F(13)CO(2) data, which identified a breakpoint (requirement) at minimal F(13)CO(2) in response to graded amounts of protein intake. RESULTS: Mean and population-safe (upper 95% CI) protein requirements were determined to be 1.3 and 1.55 g · kg(-1) · d(-1), respectively. These results are significantly higher than the mean and population-safe protein requirements currently recommended by the DRI 2005 for macronutrients (0.76 and 0.95 g · kg(-1) · d(-1), respectively). CONCLUSION: To our knowledge, this study was the first to directly estimate protein requirements in children by using stable isotopes and indicated that current recommendations are severely underestimated.