Grinker's myelinopathy: The rarely reported consequence of hypoxic brain injury.

A 68-year-old woman presented with chest pain and loss of consciousness following an anterior wall myocardial infarction. Magnetic resonance imaging of brain showed features of hypoxic brain injury. She subsequently developed memory deficits, drowsiness and behavioral changes. Magnetic resonance imaging of brain done 4 months after ischemic insult showed evidence of delayed posthypoxic leukoencephalopathy also known as Grinker's myelinopathy.

A Deep Learning Approach for Estimating Traffic Density Using Data Obtained from Connected and Autonomous Probes.

The focus of this research is on the estimation of traffic density from data obtained from Connected and Autonomous Probes (CAPs). CAPs pose an advantage over expensive and invasive infrastructure such as loop detectors. CAPs maneuver their driving trajectories, sensing the presence of adjacent vehicles and distances to them by means of several electronic sensors, whose data can be used for more sophisticated traffic density estimation techniques. Traffic density has a highly nonlinear nature during on-congestion and queue-clearing conditions. Closed-mathematical forms of the traditional density estimation techniques are incapable of dealing with complex nonlinearities, which opens the door for data-driven approaches such as machine learning techniques. Deep learning algorithms excel in data-rich contexts, which recognize nonlinear and highly situation-dependent patterns. Our research is based on an LSTM (Long short-term memory) neural network for the nonlinearity associated with time dynamics of traffic flow. The proposed method is designed to learn the input-output relation of Edie's definition. At the same time, the method recognizes a temporally nonlinear pattern of traffic. We evaluate our algorithm by using a microscopic simulation program (PARAMICS) and demonstrate that our model accurately estimates traffic density in Free-flow, Transition, and Congested conditions.

Vein Size and Disease Severity in Chronic Venous Diseases.

Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold ( p < 0.01) more risk of edema and 5.71-fold ( p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51-6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.

Lessons learned from the endovascular management of blunt thoracic aortic injuries: A single-centre experience.

BACKGROUND: Blunt thoracic aortic injuries (BTAIs) remain a leading cause of death after blunt trauma. In severe injuries, thoracic endovascular aortic repair (TEVAR) has provided a less invasive alternative to conventional open repair. OBJECTIVE: To report the TEVAR-related complications and uncertainties in patients who presented with traumatic pseudoaneurysms (grade III BTAI). METHODS: From April 2004 to February 2012, 55 patients (42 male, mean age 34.7 years) with severe BTAI were treated with stent grafts. Computed tomography (CT) was used to diagnose the injuries, and follow-up scans were planned at 6 and 12 months. We report the complications and the technical uncertainties related to the procedure. RESULTS: Successful sealing of the injury sites was achieved in all patients, either with a thoracic stent graft (53/55) or infrarenal aortic aneurysm extender cuffs (2/55). During hospitalisation, 13 patients died after TEVAR (mean 14 days). Procedure-related complications included left common carotid artery coverage (1/55), ischaemic left leg (1/55) and graft collapse (1/55). The procedurerelated uncertainties included excessive graft oversizing (15/55), poor graft apposition to the inner curve of the aorta (19/55) and left subclavian artery coverage (24/55). CONCLUSION: Stent grafts appear safe and effective in treating pseudoaneurysms caused by BTAI. However, they are likely to be associated with long-term complications and monitoring strategies of >30 years may be necessary.

Microfoam Sclerotherapy for Varicose Veins: a Retrospective Analysis of a Modified Technique.

Varicose veins (VVs) are generally characterized by their elongated, twisted, bulging, superficial appearance on the lower extremities and usually present with acute or chronic venous diseases. Despite diagnostic and surgical advances in the management of VV, patients suffer from post-therapeutic complications and recurrence. We present findings from a retrospective study of a modified treatment modality in patients with varicose veins who attended St. Thomas Institute of Research on Venous Diseases, Changanassery, Kerala. The hospital caters to patients from India and outside. Out of 14,707 patients treated from 1997 till May 2013, 6,350 patients from January to March 2011 were selected for the study from the routine clinical practice (mid-segment) to facilitate follow-up. They were categorized according to Clinical Etiologic Anatomic Pathophysiologic (CEAP) clinical classification system. Baseline data were accrued using a questionnaire. Patients were treated by microfoam sclerotherapy giving a maximum importance to smaller veins, depicting a modified technique of microfoam sclerotherapy (MMFST). This is based on the significance of microscopic venous valves (MVVs) in the development of chronic venous disease (CVD). Follow-up was according to a predefined schedule, and improvements and complications were recorded. A positive family history of VVs was reported in 85.23 % of patients. Half the study population belonged to CEAP clinical class IV. There were no significant complications in patients throughout the 2 to 6 years of follow-up. Recurrence was rarely reported during follow-up and was corrected by repeating the procedure as required during follow-up. MMFST is an innovation in the treatment of VVs based on new principles, with the potential to control and revert the symptoms of CVD, with minimal complications.

Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India.

OBJECTIVES: An attempt was made to understand the nicotine dependence of smokers selected for an ongoing smoking cessation intervention programme in rural Kerala, India. METHODS: Data were collected from resident males in the age group of 18 to 60 years from 4 randomly allocated community development blocks of rural Thiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activist workers were utilised to collect data from all groups through face to face interview. Nicotine dependence among participants was assessed by means of the six-item Fagerstrom Test for Nicotine Dependence (FTND) translated into the local language. The internal consistency of FTND was computed using Cronbach's alpha coefficient. Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation of smoking and cumulative smoking volume in pack-years. RESULTS: Among the 928 smokers identified, 474 subjects were in the intervention area (mean age =44.6 years, SD =9.66 years) and 454 in the control area (mean age= 44.5 years, SD =10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scores in the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scores increased with age and decreased with higher literacy and socioeconomic status. The average FTND score was high among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yielded a Cronbach's alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of the scale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001). CONCLUSION: A moderate level of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategies could be made more cost effective and productive if a baseline assessment of nicotine dependence is completed before any intervention.

A community based smoking cessation intervention trial for rural Kerala, India.

OBJECTIVES: An attempt was made to compare tobacco prevalence and socioeconomic factors of two groups (intervention and control) from a selected rural community in Thiruvananthapuram, Kerala, India. METHODS: Data were collected from resident males in the age group of 18.0 to 60.0 years from 4 randomly allocated Community Development Blocks of rural Thiruvananthapuram district (2 intervention and control groups). Trained Accredited Social Health Activists workers were utilised to collect data from both the groups through a face to face interview. RESULTS: Among 3304 subjects were interviewed, the overall prevalence of smokers was 28% (n=928) (mean age=44.4 years, SD=9.2 years). Socio-economic status (SES) score points indicated that majority of smokers belonged to the upper lower SES category (61%) (mean SES score =10, SD= 3) and among non-smokers, the participants mainly belonged to the lower middle SES score (45%) (mean SES score =12, SD= 3) (p-value=0.0001). Among the 928 smokers, 474 subjects were in the intervention area (mean age =44.56 years, SD =9.66 years) and 454 in the control area (mean age= 44.47 years, SD =10.30 years). No significant difference was found between the intervention and control groups according to age (p=0.89) and SES (p=0.11). Majority of smokers in the intervention and control areas were from the upper lower SES group (64.14% and 57.17%). CONCLUSION: Smoking continues to be a predominant public health problem among males in rural Kerala particularly among lower socio-economic population. Apart from strengthening legislation, multiple cost effective intervention approaches are required to reduce tobacco consumption in the community.

Non-Hodgkin's lymphoma of the hard palate.

Non-Hodgkin's lymphoma usually involves lymph nodes, but can involve extranodal sites. Oral lymphomas are relatively rare and often difficult to diagnose in a clinical setting. A case of non-Hodgkin's lymphoma of the hard palate who had undergone external beam radiation therapy and was found to be well one year following treatment is reported.