Search

Background: Melanoma is a type of threatening pigmented skin lesion, and as of now is among the most hazardous existing diseases. Suitable automated diagnosis of skin lesions and Melanoma classification can extraordinarily enhance early identification of melanomas. Methods: However, classification models based on deterministic skin lesion can influence multi-dimensional nonlinear problem which leads to inaccurate and inefficient classification. This paper presents a Deep Convolutional Neural Network (DCNN) classification approach for segmented skin lesions in dermoscopy images. As an initial step, the skin lesion is preprocessed by an automatic preprocessing algorithm together with a fusion hair detection and removal strategy. Also a new probability map based region growing and optimal thresholding algorithm is integrated in our system which yields tremendous accuracy. Results: For obtaining more prominent results a set of features containing ABCD features as well as geometric features are calculated in the feature extraction step to describe the malignancy of the lesion. Conclusions: The experimental result shows that the system is efficient and works well on dermoscopy images, achieving considerable accuracy.

INTRODUCTION: The initial 24-h period following admission to a hospital holds profound significance for pediatric patients, representing a critical window where proactive interventions can substantially influence outcomes. We devised a simple triage system, pediatric simple triage score (PSTS), to see whether rapid triage of sick pediatric patients with fever can be done using the new triage system in the emergency department (ED) to predict hospital admission. METHODS: This was a prospective observational study, conducted at the department of emergency medicine of a tertiary care teaching hospital in southern India. A prospective cohort of children presenting to the ED underwent assessment for temperature, oxygen saturation (SpO2), pulse rate, respiratory rate, sensorium, and hydration status. Sensorium was evaluated based on criteria such as poor cry, poor feeding, or decreased activity, while hydration status was assessed using indicators such as decreased urine output, dry mucous membranes, or reduced skin turgor. Subsequently, participants were triaged according to the National Institute for Health and Care Excellence (NICE) guidelines. We then monitored the admission outcomes, whether they were admitted to the intensive care unit (ICU), the ward, or discharged, based on clinical decisions made by the pediatric consultant. RESULTS: In this study involving 350 participants, the mean age was found to be 2.72 years (standard deviation [SD] ±1.78), with a range from 29 days to 5 years. The study population consisted of 60.86% males with a total of 213 patients. Examining vital signs, the mean heart rate was 135.07 beats/min (SD ± 21.58), with a range of 82–200 beats/min. The mean temperature was 37.57°C (SD ± 0.52), with values ranging from 36.80°C to 39.20°C. The mean respiratory rate was 36.28 breaths/min (SD ± 14.06), varying from 20 to 90 breaths/min. SpO2 averaged at 96.31% (SD ± 3.64), with values ranging between 70% and 100%. Abnormal sensorium was observed in 10.86% of the participants, while seizures were reported in 2.57%. Dehydration was present in 3.71% of the study population. Among the study participants, 24.57% were admitted to the ICU, 30.57% to the ward, and 44.86% were treated as outpatients. According to PSTS, 192 (54.86%) participants were triaged to green, 119 (34%) participants to yellow, and 39 (11.14%) participants to red. The PSTS demonstrated a sensitivity of 59.59% and a specificity of 72.61% in predicting hospital admission. The NICE triage system had a sensitivity of 80.31%, in predicting the admission (either ward/ICU), with a specificity of 72.61%. CONCLUSION: The PSTS demonstrated fair agreement with the NICE; it exhibited lower sensitivity and positive predictive value. However, the simplicity of the new system renders it potentially useful, especially in resource-limited settings.

Cyclical program reviews (CPRs), also called periodic or academic reviews at institutions of higher education, are undertaken to ensure that academic programs meet a variety of objectives related to teaching and learning, as well as professional credentialing, quality assurance, and institutional requirements. Preparing, reviewing, and implementing a CPR requires significant time and effort for those assigned to this task, especially if the program has never previously been through a CPR. Much has been written on how to undertake a CPR (Bresciani, 2006), what measures are useful in assessing programs (Jayachandran et al., 2019), and some of the problems that external reviewers encounter with CPRs (Halonen & Dunn, 2017). This article, however, provides new insights concerning important considerations that should be addressed when preparing to undertake a CPR--from the perspectives of both administrators and faculty at smaller institutions where the number of faculty may be small and resources for the CPR process are often limited. Drawing on a case study of CPRs in several social sciences programs and a broader survey of those involved in CPRs from 2015-2020 at a small Western Canadian university, the authors identify key issues in preparing a CPR, such as the timing of the review, the advantages and disadvantages of an individual approach versus a team approach in preparing the CPR, the role of administrators in the CPR process, the importance of institutional templates in preparing the CPR, and the need for clearly identified program learning outcomes to guide the CPR process. This article also examines how a pandemic can impact the CPR process.

Introduction: Congenital hypothyroidism (CH) is the most common preventable cause of mental retardation, and the two important causes of CH are thyroid dysgenesis and dyshormonogenesis. Thyroid imaging is an integral part of identifying the specific aetiology of CH. We aimed to study the aetiological profile of CH and compare the imaging findings of ultrasonography (USG) and nuclear scintigraphy. Methods: It is a prospective, cross-sectional study conducted over 3 years. The clinical, USG, and technetium-99 m (99 mTc) scintigraphy reports of CH children were analysed. Results: Sixty-two CH children were included in the study with an equal male-to-female ratio (1.1:1). There was a significant association between parental consanguinity and CH observed in 35.5% of cases (P = 0.006). In USG neck, 44 (71%) had normal and/or enlarged thyroid glands at the eutopic location, 16 (27.4%) cases had an absent gland, and ectopic as well as hypoplastic unilateral gland was observed in one (1.6%) each. Among 35 children, who underwent scintigraphy, 12 (34.3%) had absent uptake, 4 (11.4%) had ectopic uptake, and 1 (2.8%) child had unilateral normal uptake. The remaining 18 (51.5%) children, whose scintigraphy showed normal or avid uptakes, were diagnosed with dyshormonogenesis. Three cases were diagnosed as apparent athyreosis. Conclusion: Dyshormonogeneis is the more commonly observed etiology of CH as compared to thyroid agenesis in the present study. A combined imaging approach with scintigraphy and USG is needed to delineate the specific etiology of CH. We need long-term Indian data to know the paradigm shift in the etiological pattern of CH as compared to Western studies.

The gamma radiation processing facilities (GRAPFs) qualify to obtain the license of operation on the basis of the radiological safety of the facility and the accurate radiation dosimetry in the product. The theoretical dose evaluations in the product are carried out using Monte Carlo simulations in this work. This is required for optimizing the source loading configuration with the best combination of averaged dose rate and dose uniformity ratio (DUR) to maximize the efficiency of the facility. Three different GRAPFs are chosen for the study. The theoretical results of DUR are validated against the commissioning dosimetry with a variation of

Drug repositioning investigates new uses for existing drugs, including both approved and discontinued medications. This strategy offers lower failure risks, faster development times and higher success rates while reducing reliance on antibiotics. Current treatments for periodontitis focus on modulating the immune response to combat pathogens. A promising approach involves using pharmaceuticals to reduce inflammation, which is the main cause of bone resorption, and to promote regeneration. Metformin, an antidiabetic drug, can enhance alveolar bone formation. Statins, known for lowering cholesterol levels, possess antimicrobial and anti-infective properties. Bisphosphonates, used to improve bone density, can affect osteoblast and osteoclast morphology and have antibacterial properties. Melatonin, typically used for sleep disorders, is an antioxidant that reduces the expression of proinflammatory cytokines. The present review explores the multifaceted benefits of repurposing these drugs for the management of periodontal disease.

Background Periodontitis poses a significant public health challenge globally due to its substantial contribution to tooth loss and its links to numerous systemic diseases. Sleep, being a complex biological process crucial for overall mental and physical well-being, intersects with this concern. However, recent studies have yielded conflicting findings on the potential connection between chronic periodontitis and sleep quality, likely due to the shared inflammation characteristic in both conditions. Aim The study aims to examine the correlation between the quality of sleep and chronic periodontitis. Materials and Methods This study involved 100 participants who underwent a thorough clinical periodontal examination. The sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Univariate and multivariate logistic regression analyses were conducted to assess the impact of various factors in the presence of periodontitis. Statistical analysis was performed, with statistical significance at P ≤ 0.05. Results In the current study, 29% of the participants exhibited poor sleep quality, and 75.8% were in the periodontitis group. Poor sleep quality was associated with periodontitis in univariate (crude odds ratio = 1.83, 95% confidence interval = 0.655–0.847; P = 0.004) analyzed. Patients’ age showed a positive correlation with periodontitis. Other variables do not show a statistically significant level. Conclusion The present study shows that there lies a significant correlation between chronic periodontitis and poor sleep quality. Among the measured covariables, only age showed a significant relationship with periodontitis.

Background: Musculocutaneous nerve (MCN) is a mixed nerve arising from the lateral cord of brachial plexus having root values C5, 6, and 7. It supplies the muscles of the flexor compartment of the arm namely; coracobrachialis, most part of brachialis and both heads of biceps brachii. It is cutaneous to the lower lateral part of forearm. Variations in the origin, course, branching pattern, termination, and connections of MCN are very common. Knowledge about these variations is important while evaluating unusual presentations of peripheral nerve injuries, during surgical procedures such as arthroscopy of shoulder joint, corrections of fracture humerus, brachial plexus block, and so on. Aims and Objectives: The study was conducted to find out any variations in the origin, course, branching pattern of the MCN. The secondary objective was to understand about the communication of the MCN with any other nerve. Materials and Methods: A descriptive study was conducted in 60 upper limb specimens dissected from 10% formalin embalmed 30 cadavers (adult) in the Department of Anatomy, Government Medical College, Kottayam. All limbs were carefully dissected and studied about the origin, course, termination, and variations of MCN. Results: Out of 60 specimens studied, in 46 specimens MCN Originate from lateral cord, eight from medial cord, and in six from the lateral root of the median nerve (MN). In 52 specimens, MCN supplies coracobrachialis but only in 34 it pierces this muscle. In four specimens, there is a communication between MCN and MN was seen. Conclusion: The MCN has significant variations and knowledge of these variations is clinically important in diagnosis and management of peripheral nerve injuries as well as surgical interventions in the arm.

Background Immune checkpoint inhibitors (ICIs) are recommended to treat patients with deficient mismatch repair/microsatellite instability high (dMMR/MSI-H) metastatic colorectal cancer (mCRC). Pivotal trials have fixed a maximum ICI duration of 2 years, without a compelling rationale. A shorter treatment duration has the potential to improve patients' quality of life and reduce both toxicity and cost without compromising efficacy. Here we examine whether early treatment discontinuation (ETD) before 13 months in patients without progressive disease (PD) can lead to similar long-term disease control compared with a longer treatment duration (LTD).Methods To assess whether ETD is associated with similar outcomes compared with LTD, we assembled an international cohort of patients with dMMR/MSI-H mCRC treated with ICIs who stopped treatment for a reason other than PD within 395 days (ETD group) and compared them to those who continued for >395 days (LTD group). Outcomes were adjusted for patient/tumor characteristics. Primary endpoint was progression-free survival (PFS) and secondary endpoints were objective response rate (ORR), overall survival (OS) and safety.Results Of 976 patients, 137 and 394 were allocated to the ETD and LTD groups, respectively. In the ETD group, treatment was discontinued due to toxicity (n=56), objective response (n=43), surgery (n=28), patient decision (n=2) or other reasons (n=8). Baseline characteristics were well balanced between the two groups: 22% in both groups received both anti-programmed death-(ligand) 1 (anti-PD-(L)1) + anti-cytotoxic T-lymphocyte antigen-4 (anti-CTLA-4); all others received anti-PD-(L)1 monotherapy. ORR to ICIs was 81% in both groups. Median duration of treatment was ~7 months in the ETD and ~24 months in the LTD group. After a median follow-up of 44 months (IQR: 30–67), similar PFS (HR: 0.92, 95% CI: 0.60 to 1.40, p=0.69) and OS (HR: 1.15, 95% CI: 0.66 to 1.99, p=0.62) from the start of ICIs were observed in ETD and LTD patients. In the ETD group, 28 (20%) patients had a PFS event and 9 restarted ICIs with a disease control rate of 66%.Conclusions In our international series of dMMR/MSI-H mCRC, ETD of ICIs in the absence of PD did not seem detrimental in terms of PFS and OS compared with continuing treatment beyond 1 year. Randomized clinical trials to compare short and long treatment duration are now warranted.

The proliferation of digital information necessitates advanced techniques for multiple document summarization, capable of distilling vast textual data efficiently. Traditional approaches often struggle with coherence, integration of multimodal data, and suboptimal learning strategies. To address these challenges, this work introduces novel neural architectures and methodologies. At its core is recursive transformer networks (ReTran), merging recursive neural networks with transformer architectures for superior comprehension of textual dependencies, projecting a 5–10% improvement in ROUGE scores. Cross-modal summarization employs a multimodal transformer with cross-modal attention, amalgamating text, images, and metadata for more holistic summaries, expecting an 8 to 12% enhancement in quality metrics. Actor-critic reinforcement learning refines training by optimizing summary quality, surpassing Q-learning-based strategies by 5–8%. Meta-learning for zero-shot summarization addresses summarizing unseen domains, projecting a 6–10% uptick in performance. Knowledge-enhanced transformer integrates external knowledge for improved semantic coherence, potentially boosting ROUGE scores by 7 to 12%. These advancements not only improve numerical performance but also produce more informative and coherent summaries across diverse domains and modalities. This work represents a significant stride in multiple document summarization, setting a new benchmark for future research and applications.