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Background Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease with Escherichia coli (E. coli) being the most common aetiology. Infection can involve the renal parenchyma, collecting system and perinephric tissues, and is commonly encountered in patients with uncontrolled diabetes mellitus. EPN complicated by suppurative thrombophlebitis of the inferior vena cava is a rare occurrence. Our case had thrombosis of the right common iliac vein as well, which is frst of its kind reported with EPN. Case presentation We describe a case of a 59-year-old male patient, with uncontrolled diabetes mellitus, who presented to the emergency department with a history of high-grade fever and left loin pain. Clinico-laboratory fndings were diagnostic for diabetes mellitus, complicated by upper urinary tract infection with sepsis. A preliminary ultrasound of the abdomen was indicative of left hydronephrosis with features of emphysematous pyelonephritis. Abdominal computed tomography (CT) was done to ascertain the cause of hydronephrosis. Left ureteric calculus complicated by emphysematous pyelonephritis (type 3a) with intraluminal air in the left renal vein and inferior vena cava (IVC). Culture grew E. coli. Patient was started on insulin and intravenous (IV) antibiotics, and bilateral DJ stenting was done. Patient was symptomatically better and was discharged. A month later, he was readmitted with relapse of symptoms; repeat CT showed left perinephric abscess, with left renal vein, inferior vena cava and right common iliac vein thrombosis. Repeat culture grew E. coli, stent was replaced, and subsequently he underwent ultrasoundguided aspiration for left perinephric abscess. Haemodialysis along with IV antibiotics and anticoagulant therapy was started. Conclusion Suppurative thrombophlebitis of the inferior vena cava in association with EPN is rare; however, the same is associated with higher morbidity and mortality. Prompt diagnosis, drainage procedure, antibiotics coupled with anticoagulants are the mainstay of treatment for deep venous thrombophlebitis. [ABSTRACT FROM AUTHOR]

Blockchain-based decentralized infrastructure is intended to achieve peer-to-peer transactions without relying on centralized/trusted third parties. However, most of the existing blockchain systems suffer from several weaknesses including a certain level of centralization, centralized authority (e.g., data miners), and continuous increase in data storage or data bloating. To overcome these issues, in this paper, we propose Octopus, a truly peer-to-peer transactions system, based on Interplanetary File System (IPFS). Here, transactions between two parties take place via a direct peer-to-peer channel while the proofs of transactions are stored in an IPFS cluster. Unlike traditional blockchain-based systems, Octopus does not require blocks, chains, or miners to provide transaction proofs. Octopus offers several features such as horizontal and vertical scalability, data privacy, and high transaction throughput. Performance results from our prototype confirm these properties. [ABSTRACT FROM AUTHOR]

Background: In India, two vaccines received emergent use authorization, namely Covishield (a brand of the Oxford—Astra Zeneca vaccine manufactured by the Serum institute of India) and Covaxin (developed by Bharat Biotech) against COVID-19 disease. Chest CT is an objective way to assess the extent of pulmonary parenchymal involvement. This study aims to estimate the disease severity and outcome due to COVID-19 among vaccinated and non-vaccinated symptomatic patients and compare the same in Covishield versus Covaxin recipients using CT severity score. Results: A total of 306 patients were retrospectively evaluated. The mean age was 62.56 ± 8.9 years, and males [n-208 (67.97%)] were commonly affected. Of 306 patients, 143 were non-vaccinated (47%), 124 were partially vaccinated (40%), and 39 were completely vaccinated (13%). CT severity scores were reduced in both Covishield and Covaxin recipients in comparison with the non-vaccinated group [χ2 (2) = 16.32, p < 0.001]. There is a reduction in LOS among the vaccinated group, predominantly among the Covishield recipients. Conclusion: Vaccination confers protection from severe SARS-CoV2 infection and is associated with an overall reduction in mortality. [ABSTRACT FROM AUTHOR]

Background: Adenoid cystic carcinoma is a rare malignancy. Tumours of palatal region with minor salivary gland origin do not generally present at an early stage as the tumour is submucosal with symptoms prevalent only when there is evidence of perineural spread of the tumour. We report a case of adenoid cystic carcinoma of the palate with rare presentation of left ear discharge and diplopia on left lateral gaze. We discuss the case with emphasis on imaging evaluation mimicking a case of infective etiology with adjacent skull base osteomyelitis on initial presentation. However, on follow-up and further evaluation the patient was diagnosed as adenoid cystic carcinoma of hard palate on left side. Case presentation: A 25-year-old male patient has presented to Jagadguru Sri Shivarathreeswara Hospital in August 2019 with complaints of left ear discharge and diplopia on left lateral gaze since 1 week. The clinical and imaging findings was suggestive of infective etiology and the patient was treated for the same with IV antibiotics. Repeat magnetic resonance imaging was then done which revealed definitive reduction in the severity of inflammation suggestive of response to therapy. Patient was then discharged and was followed up. Three months later, the patient came with complaints of mass in left nasal cavity. Patient was then referred for contrast enhanced computed tomography neck strongly suggestive of neoplastic etiology. The patient was then operated and histopathological examination of the biopsy revealed adenoid cystic carcinoma. Conclusions: Tumours of palatal region with minor salivary gland origin do not generally present at an early stage as the tumour is submucosal with symptoms prevalent only when there is evidence of perineural spread of the tumour. In our case patient presented with lateral rectus palsy, involvement of meckel's cave, trigeminal nerve involvement and cavernous sinus involvement which are strong indicators of the perineural and locoregional spread of the tumour. Hence, it is important for the radiologist and clinician to strongly suspect and evaluate for a primary lesion of the head and neck when such a radiological presentation has been demonstrated. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the prevalence and nature of human embryonic aneuploidy based on the preimplantation genetic testing for aneuploidy (PGT-A), the distribution of aneuploidy across the individual chromosomes, and their relationship to maternal age. Methods: This is a retrospective cohort study conducted at a single center. The study includes subjects who opted for PGT-A in their in vitro fertilization (IVF) cycle from 2016 to 2020. PGT-A was performed on 1501 embryos from 488 patients in 535 cycles. PGT-A was performed using NGS-based technique on Ion Torrent PGM (Life Technologies). Analysis was performed to determine the (i) frequency of the aneuploidy, (ii) the chromosome most commonly affected, (iii) relationship between maternal age and the rate of aneuploidy, and (iv) incidence of segmental aneuploidy. Results: The overall frequency of aneuploidy was observed to be 46.8%. The incidence of aneuploidy rate was ~ 28% at maternal age < 30 years which steadily increased to ~ 67% in women above 40 years. High frequency of aneuploidy was observed in chromosomes 16, 22, 21, and 15. Segmental abnormalities, involving loss or gain of chromosomal fragments, were observed at a frequency of 5.3%, and highest incidence of segmental gain was observed on the q-arm of chromosome 9. Conclusion: The study provides important information regarding the frequency of the aneuploidy in IVF cohort and the most frequent chromosomal abnormality. The study further emphasizes the relationship between maternal age and aneuploidy. This study has important implications which help clinicians and genetic counselors in providing information in patient counseling. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics, clinical features, and treatment outcomes with systemic steroids in eyes presenting with post-fever retinitis (PFR) from Central India. Methods: Single-center, retrospective analysis of 147 eyes of 98 PFR cases between 2011 and 2019. Results: Mean age of the study cohort was 33.46 ± 12.76 years, with 72 males and 26 females. The mean interval between the onset of fever and the diminution of vision was 21.10 ± 13.54 days (range 0–60 days). The number of PFR cases increased over the nine years with 89 cases (90.1%) presenting during winters. Unilateral involvement was seen in 49 cases, while 49 had bilateral involvement. Clinical characteristics included: multifocal retinitis (n = 122; 61.2%), hemorrhages (n = 132; 89.8%), disc edema (n = 57; 38.8%), anterior chamber reaction (n = 28; 19%), and vitritis (n = 103; 70.1%). Treatment included intravenous followed by oral steroids in 70 patients and oral steroids exclusively in 23; five patients denied treatment. The visual acuity improved from 1.09 ± 0.52 LogMAR to 0.29 ± 0.42 LogMAR (p < 0.05). Conclusion: There has been an increase in the prevalence of PFR cases over the last decade with clustering during the winters. Multifocal retinitis, retinal hemorrhages, and vitritis were the most common clinical findings in our series. The retinitis resolved with improvement in vision following steroid therapy in all eyes. [ABSTRACT FROM AUTHOR]

There is paucity of published data related to eosinophilic gastroenteritis (EGE). We aimed to study the clinical characteristics, management, and follow-up of EGE. From March 2014 to December 2018, patients with gastrointestinal (GI) symptoms suspected to have EGE were investigated. This is a retrospective study. Complete blood count, upper GI endoscopy (UGIE), and biopsy were done. Contrast-enhanced computed tomography (CECT) abdomen was done when intestinal obstruction was suspected. Laparoscopic small bowel resection or stricturoplasty and full-thickness biopsy were obtained. EGE was diagnosed if the biopsies showed eosinophilic infiltration of one or more regions of the GI tract (> 30 eosinophils per high power field [HPF]). Patients were treated with immunosuppressive therapy and if indicated surgery. Clinical response to therapy was assessed and patients were followed up for 1 year. Forty-one patients (mean age 34.8 years, median age 32, range 25–70 years, 29 males) had EGE. Upper abdominal pain was the most common symptom. Peripheral eosinophilia was present in 82.9% patients. On UGIE, duodenal lesions were observed in 75% patients. EGE was confirmed in 37 patients by endoscopic duodenal biopsies, in 2 patients by jejunal mucosal biopsies using enteroscopy, and in 2 patients by full thickness surgical biopsies. Forty-one patients were treated with oral corticosteroids inclusive of 4 patients who underwent surgery. Of the 37 patients, 6 were lost to follow-up; 31 patients were followed up for a period of 1 year. All the patients who were treated with corticosteroids responded to initial therapy. Over a follow-up period one case had frequent relapses. EGE should be suspected in patients with upper abdominal pain. Peripheral eosinophilia occurs in the majority. Tissue diagnosis showing eosinophilic infiltration is diagnostic. Oral corticosteroid therapy is highly effective and relapse is rare. [ABSTRACT FROM AUTHOR]

Background: The typical CT manifestations of COVID-19 pneumonia include ground-glass opacity (GGO) with or without consolidation and superimposed interlobular septal thickening. These are often rounded in morphology and frequently bilateral, multilobar, posterior, peripheral, and basilar in distribution. The various atypical CT features of COVID-19 are seldom described in the literature. The study aims to enumerate the atypical pulmonary CT features in patients with COVID-19 pneumonia in correlation with the disease severity. Results: A total of 298 confirmed cases of COVID-19 pneumonia with positive reverse transcription polymerase chain reaction (RT-PCR) who underwent chest CT scans were retrospectively evaluated. The cohort included 234 (78.5%) men and 64 (21.5%) women and the mean age was 53.48 ± 15.74 years. The most common presenting symptoms were fever [n = 197 (66.1%)] and cough [n = 139 (46.6%)]. Out of 298 cases of COVID-19 pneumonia, 218 cases (73.1%) showed typical CT features while 63 cases (21.1%) showed atypical CT features with concurrent classical findings and the remaining 17 cases (5.8%) were normal. Among the atypical CT features, the most common was pulmonary cysts [n = 27 (9%)]. The other features in the order of frequency included pleural effusion [n = 17 (5.7%)], nodules [n = 13 (4.3%)], bull's eye/target sign[n = 4 (1.3%)], cavitation [n = 3 (1.0%)], spontaneous pneumothorax [n = 2 (0.6%)], hilar lymphadenopathy [n = 2 (0.6%)], spontaneous pneumo-mediastinum with subcutaneous emphysema [n = 1 (0.3%)], Halo sign [n = 1 (0.3%)], empyema [n = 1 (0.3%)] and necrotizing pneumonia with abscess [n = 1 (0.3%)]. Conclusion: CT imaging features of COVID-19 pneumonia while in a vast majority of cases is classical, atypical diverse patterns are also encountered. A comprehensive knowledge of various atypical presentations on imaging plays an important role in the early diagnosis and management of COVID-19. [ABSTRACT FROM AUTHOR]

Network attacks are serious concerns in today's increasingly interconnected society. Recent studies have applied conventional machine learning to network attack detection by learning the patterns of the network behaviors and training a classification model. These models usually require large labeled datasets; however, the rapid pace and unpredictability of cyber attacks make this labeling impossible in real time. To address these problems, we proposed utilizing transfer learning for detecting new and unseen attacks by transferring the knowledge of the known attacks. In our previous work, we have proposed a transfer learning-enabled framework and approach, called HeTL, which can find the common latent subspace of two different attacks and learn an optimized representation, which was invariant to attack behaviors' changes. However, HeTL relied on manual pre-settings of hyper-parameters such as relativeness between the source and target attacks. In this paper, we extended this study by proposing a clustering-enhanced transfer learning approach, called CeHTL, which can automatically find the relation between the new attack and known attack. We evaluated these approaches by stimulating scenarios where the testing dataset contains different attack types or subtypes from the training set. We chose several conventional classification models such as decision trees, random forests, KNN, and other novel transfer learning approaches as strong baselines. Results showed that proposed HeTL and CeHTL improved the performance remarkably. CeHTL performed best, demonstrating the effectiveness of transfer learning in detecting new network attacks. [ABSTRACT FROM AUTHOR]

MEC (Multi-access Edge Computing) is vital in 5G and beyond (B5G) for reducing latency and enhancing network efficiency through local processing, crucial for real-time applications and improved security. This drives the adoption of advanced architectures like Fog Radio Access Network (F-RAN), which uses distributed resources from Radio Resource Heads (RRHs) or fog nodes to enable parallel computation. Each user equipment (UE) task can be processed by RRHs, fog access points, cloud servers, or the UE itself, depending on resource capacities. We propose MoNoR, a centralized approach for optimal task processing in F-RAN. MoNoR optimizes the selection of offloading modes, assignment of tasks to computation nodes, and allocation of radio resources using global network information. Given the computational complexity of this endeavor, we employ an evolutionary optimization technique rooted in Genetic Algorithms to address the problem efficiently. Simulations show MoNoR's superiority in minimizing latency over previous F-RAN offloading strategies. [ABSTRACT FROM AUTHOR]