A Torn ACL Mapping in Knee MRI Images Using Deep Convolution Neural Network with Inception-v3.

The anterior cruciate ligaments (ACL) are the fundamental structures in preserving the common biomechanics of the knees and most frequently damaged knee ligaments. An ACL injury is a tear or sprain of the ACL, one of the fundamental ligaments in the knee. ACL damage most generally happens during sports, for example, soccer, ball, football, and downhill skiing, which include sudden stops or changes in direction, jumping, and landings. Magnetic resonance imaging (MRI) has a major role in the field of diagnosis these days. Specifically, it is effective for diagnosing the cruciate ligaments and any related meniscal tears. The primary objective of this research is to detect the ACL tear from MRI knee images, which can be useful to determine the knee abnormality. In this research, a Deep Convolution Neural Network (DCNN) based Inception-v3 deep transfer learning (DTL) model was proposed for classifying the ACL tear MRI images. Preprocessing, feature extraction, and classification are the main processes performed in this research. The dataset utilized in this work was collected from the MRNet database. A total of 1,370 knee MRI images are used for evaluation. 70% of data (959 images) are used for training and testing, and 30% of data (411 images) are used in this model for performance analysis. The proposed DCNN with the Inception-v3 DTL model is evaluated and compared with existing deep learning models like VGG16, VGG19, Xception, and Inception ResNet-v28. The performance metrics like accuracy, precision, recall, specificity, and F-measure are evaluated to estimate the performance analysis of the model. The model has obtained 99.04% training accuracy and 95.42% testing accuracy in performance analysis.

MRI-Based Texture Analysis to Differentiate Sinonasal Squamous Cell Carcinoma from Inverted Papilloma.

BACKGROUND AND PURPOSE: Because sinonasal inverted papilloma can harbor squamous cell carcinoma, differentiating these tumors is relevant. The objectives of this study were to determine whether MR imaging-based texture analysis can accurately classify cases of noncoexistent squamous cell carcinoma and inverted papilloma and to compare this classification performance with neuroradiologists' review. MATERIALS AND METHODS: Adult patients who had inverted papilloma or squamous cell carcinoma resected were eligible (coexistent inverted papilloma and squamous cell carcinoma were excluded). Inclusion required tumor size of >1.5 cm and preoperative MR imaging with axial T1, axial T2, and axial T1 postcontrast sequences. Five well-established texture analysis algorithms were applied to an ROI from the largest tumor cross-section. For a training dataset, machine-learning algorithms were used to identify the most accurate model, and performance was also evaluated in a validation dataset. On the basis of 3 separate blinded reviews of the ROI, isolated tumor, and entire images, 2 neuroradiologists predicted tumor type in consensus. RESULTS: The inverted papilloma (n = 24) and squamous cell carcinoma (n = 22) cohorts were matched for age and sex, while squamous cell carcinoma tumor volume was larger (P = .001). The best classification model achieved similar accuracies for training (17 squamous cell carcinomas, 16 inverted papillomas) and validation (7 squamous cell carcinomas, 6 inverted papillomas) datasets of 90.9% and 84.6%, respectively (P = .537). For the combined training and validation cohorts, the machine-learning accuracy (89.1%) was better than that of the neuroradiologists' ROI review (56.5%, P = .0004) but not significantly different from the neuroradiologists' review of the tumors (73.9%, P = .060) or entire images (87.0%, P = .748). CONCLUSIONS: MR imaging-based texture analysis has the potential to differentiate squamous cell carcinoma from inverted papilloma and may, in the future, provide incremental information to the neuroradiologist.

Health-related quality of life among tuberculosis patients under Revised National Tuberculosis Control Programme in rural and urban Puducherry.

BACKGROUND: Globally, tuberculosis (TB) continues to be the major public health problem. Limited research is carried out on the impact of the disease on health-related quality of life (HR-QoL). The study aims to assess the HR-QoL among TB patients during and after Directly Observed Treatment Short-course (DOTS) therapy and to compare the HR-QoL of these patients with matched neighbourhood controls. METHODOLOGY: A community-based longitudinal study was conducted in Ariyankuppam and Bahour communes of Puducherry from January 2014 to April 2015. 92 TB patients registered for DOTS therapy during January-June 2014 were interviewed in their DOTS centres during first visit using the SF-36 questionnaire to assess their HR-QoL. During the second visit, 9 TB patients were lost to follow-up; therefore, a total of 83 patients were interviewed in their houses and, simultaneously, 83 matched neighbourhood controls were interviewed. Non-parametric tests were used to compare the HR-QoL scores. p value <0.05 was considered as statistically significant. RESULTS: The mean HR-QoL scores had improved among TB patients upon completion of DOTS (80.8±20.3), when compared to HR-QoL scores (48.3±30) during treatment with significant difference. The HR-QoL scores of TB patients after DOTS completion (80.8±20.3) had improved to levels comparable to that of non-TB controls (77.5±29.1) without significant difference. CONCLUSION: HR-QoL of patients suffering from TB was low. However, the study provides evidence that DOTS treatment offers a demonstrable improvement of HR-QoL among TB patients almost to the level of general population. The findings can be used in advocating the effectiveness of DOTS in TB control efforts.

Ectopic insulin secreting neuroendocrine tumor of kidney with recurrent hypoglycemia: a diagnostic dilemma.

BACKGROUND: Hypoglycemia secondary to ectopic insulin secretion of non-pancreatic tumors is rare. CASE PRESENTATION: We describe a middle aged woman with recurrent hypoglycemia. On evaluation, she was detected to have hyperinsulinemic hypoglycemia and right sided renal mass lesion. 68Ga-Dotanoc and 99mTc-HYNICTOC scans confirmed the intrarenal mass to be of neuroendocrine origin. Right nephrectomy was done and it turned out to be an insulin secreting neuroendocrine tumour. Neuroendocrine nature of this tumour was further confirmed by ultra-structural examination. Her hypoglycemia did not recur after resection of this tumour. CONCLUSION: Few cases of ectopic insulin secretion have been reported though some are not proven convincingly. This case addresses all the issues raised in previous case reports and proves by clinical, laboratory, functional imaging and immunohistochemical analysis that ectopic origin of insulin by non-pancreatic tumors does occur. To our knowledge, this is the first reported case of ectopic insulinoma arising from the kidney.

Type 2 diabetes mellitus in children and youth.

Type 2 diabetes mellitus (T2DM) which used to be a disease of adults is now seen commonly at an early age in children and adolescents. T2DM is now an important diagnostic consideration in children who present with signs and symptoms of diabetes. The emerging epidemic of obesity in children throughout the world and the resultant insulin resistance contributes to the increasing prevalence of T2DM in this population. The recommended treatment options include metformin and insulin. Optimal glycemic control is essential considering the lifelong nature of the disease and therefore, the increased risk of long term complications - both microvascular and macrovascular. This review article summarizes the classification, diagnosis, pathogenesis, management, complications and screening of T2DM in children, incorporating and contextualizing guidelines from various professional associations.

Intestinal infestation with Fasciolopsis buski leading to acute kidney injury.

Fasciolopsis buski is the largest intestinal fluke infecting human beings. This trematode is endemic in certain parts of the country. Migration poses the risk of spread of the worm to other parts of the country. We report fasciolopsis buski in a migrant from Bihar working in Coimbatore, Tamil Nadu. Acute kidney injury following intestinal obstruction occurred in this case which was never described before.

Bilateral thecoma presenting as premenopausal hirsutism: Laproscopic removal.

Hyperandrogenism is a common disorder among women in the reproductive age group. One of the rare causes for androgen excess is sex cord- stromal tumors of the ovary. These are usually unilateral. Here we report case of a 48 year old woman who presented with hyperandrogenism due to bilateral ovarian thecoma. Androgen levels normalized following resection of the tumor. This, to the best of our knowledge, is the first case of bilateral thecoma presenting as hirsutism in a premenopausal woman.

Psammomatoid juvenile ossifying fibroma of the jaws.

Juvenile ossifying fibroma is an uncommon, benign, bone-forming neoplasm with aggressive local growth that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation and aggressive behavior. Although a benign entity, juvenile ossifying fibroma is known to be locally aggressive and has a high tendency to recur. Two distinctive microscopic patterns have been described: A trabecular variant and a psammomatoid variant. This latter variant is predominantly a craniofacial lesion and occurs rarely in the jaws. We present herein two cases of psammomatoid juvenile ossifying fibroma involving the jaws. The first case was a mandibular lesion in a 31-year-old female whereas the second case presented with maxillary involvement in a 46-year-old female. In addition, the pathology of the lesion was analyzed with confocal laser scanning microscopy.

Measurement of gamma radiation levels in soil samples from Thanjavur using gamma-ray spectrometry and estimation of population exposure.

This study assesses the level of terrestrial gamma radiation and associated dose rates from the naturally occurring radionuclides (232)Th, (238)U and (40)K in 10 soil samples collected from Thanjavur (Tamil Nadu, India) using gamma-ray spectrometry. The activity profile of radionuclides has clearly showed the existence of low level activity in Thanjavur. The geometric mean activity concentrations of (232)Th, (238)U and (40)K is 42.9+/-9.4 Bq.kg(-1), 14.7+/-1.7 Bq.kg(-1) and 149.5+/-3.1 Bq.kg(-1) respectively are derived from all the soil samples studied. The activity concentration of (232)Th, (238)U and (40)K in soil is due to the presence of metamorphic rocks like shale, hornblende-biotite gneiss and quartzofeldspathic gneiss in these areas. Gamma absorbed dose rates in air outdoors were calculated to be in the range between 32 nGy.h(-1) and 59.1 nGy.h(-1) with an arithmetic mean of 43.3 +/-9 nGy.h(-1). This value is lesser than the population weighted world-averaged of 60 nGy.h(-1). Inhabitants of Thanjavur are subjected to external gamma radiation exposure (effective dose) ranging between 39.2 and 72.6 muSv.y(-1) with an arithmetic mean of 53.1+/-11 muSv.y(-1). The values of the external hazard index determined from the soil radioactivity of the study area are less than the recommended safe levels.

Pattern of mandibular fractures in Chennai, India.

We describe the pattern of mandibular fractures in Chennai, and confirm that, as in most other large cities, the main cause is road traffic accidents.

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty.

The perceived benefits of bandaging for 10 days following pinnaplasty have been questioned by previous studies. The problems arising from these dressings are many [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bartley J. How long should ears be bandaged after otoplasty? J Laryngol Otol 1998;112:531-2. Wong MC, Sylaidis P. Head dressings for pinnaplasty: a tradition not supported by evidence. Br J Plast Surg 2001;54:81-2], including their slippage [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100. Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90]. Eighty children were recruited into a prospective randomised controlled trial comparing the use of a head bandage for only 24 h with a standard practise of a 10-day head bandage. A preoperative measurement of the lateral ear projection (LEP) was made. The outcome measures recorded during the two planned postoperative visits at 10 days (visit 1) and 2 months (visit 2) were: patient satisfaction score, LEP, complications and any unscheduled hospital visits associated with the surgery. There was no significant difference in LEP and patient satisfaction between the two groups at both the scheduled postoperative visits. Differences between the groups in the number of unscheduled visits (p=0.21) did not reach statistical significance. The findings indicate that it is safe and effective to use head bandage for only 24 h following surgical correction of prominent ears. This study shows no benefit from the application of a formal head bandage for any longer than 1 day.

Severe extensor tendon attrition and multiple tendon ruptures resulting from Kienböck's disease.

Kienböck's disease is a rare but recognized cause of chronic wrist pain. Occasionally, complications arise leading to tendon rupture. The authors present the first reported case of attrition to all extensors of the hand, and extensor tendon rupture to the little finger in a patient with a 45-year history of Kienböck's disease. This is also the first reported incidence of this complication in whites. Clinical features, surgical management, and the successful outcome are discussed.