Energy efficient gateway based routing with maximized node coverage in a UAV assisted wireless sensor network.

Ad-hoc wireless sensor networks face challenges of optimized node deployment for maximizing coverage and efficiently routing data to control centers in post disaster events. These challenges impact the outcome for extending the lifetime of wireless sensor networks. This study presents a uav assisted reactive zone based EHGR (energy efficient hierarchical gateway routing protocol) that is deployed in a situation where the natural calamity has caused communication and infrastructure damage to a major portion of the sensor network. EHGR is a hybrid multi layer routing protocol for large heterogeneous sensor nodes (smart nodes, basic nodes, user handheld devices etc.) EHGR is tailored to meet two important concerns for a disaster hit wsn ie. optimized deployment and energy efficient routing. The first part of EGHR focuses on maximized coverage during node deployments. Maximized coverage is an important aspect to be considered during the event of disaster since most of the nodes loose coverage and are detached from the wireless sensor network. The first part of EHGR uses state of the art game theory approach to build a model that maximizes the coverage of nodes during the deployment phase from all participating entities i.e. nodes and uavs. Rather than fixing the cluster head as is the case in traditional cluster-based approaches EHGR uses the energy centroid nodes. Energy centroid nodes evolve on the basis of aggregated energy of the zone. This approach is superior to simply electing cluster head nodes on the basis of some probability function. The nodes that fail to achieve any successful outcome from the game theory matching model fail to get any association. These nodes will use multi hop d2d relay approach to reach the energy centroid nodes. Gateway relay nodes used with the game theory approach during the deployment of the uav assisted wsn improves the overall coverage by 25% against traditional leach based hierarchical approaches. Once the optimum deployment phase is completed the routing phase is initiated. Aggregated data is sent by the energy centroid nodes from the ECN nodes to the servicing micro controller enabled un manned aerial vehicles. The routing process places partial burden of zone formation and data transmission to the control center for each phase on the servicing uavs. Energy centroid nodes engage only in the data aggregation process and transmission of data to servicing uav. Servicing-uavs reduce energy dissipated of the entire zone which result in gradual decrease of energy for the zone thus increasing the network lifetime. Node deployment phase and the routing phase of EHGR utilize the computations provide by the mirco controller enabled unmanned aerial vehicles such that the computationally intensive calculations are offloaded to the servicing uav. Experiment results indicate an increase in the first dead node report, half dead node report, and last dead node report. Network lifetime is extended to approximately 1800 rounds which is an increase by ratio of 100% against the traditional leach approach and increase by 50% percent against the latest approaches as highlighted in the literature.

Deep learning, radiomics and radiogenomics applications in the digital breast tomosynthesis: a systematic review.

BACKGROUND: Recent advancements in computing power and state-of-the-art algorithms have helped in more accessible and accurate diagnosis of numerous diseases. In addition, the development of de novo areas in imaging science, such as radiomics and radiogenomics, have been adding more to personalize healthcare to stratify patients better. These techniques associate imaging phenotypes with the related disease genes. Various imaging modalities have been used for years to diagnose breast cancer. Nonetheless, digital breast tomosynthesis (DBT), a state-of-the-art technique, has produced promising results comparatively. DBT, a 3D mammography, is replacing conventional 2D mammography rapidly. This technological advancement is key to AI algorithms for accurately interpreting medical images. OBJECTIVE AND METHODS: This paper presents a comprehensive review of deep learning (DL), radiomics and radiogenomics in breast image analysis. This review focuses on DBT, its extracted synthetic mammography (SM), and full-field digital mammography (FFDM). Furthermore, this survey provides systematic knowledge about DL, radiomics, and radiogenomics for beginners and advanced-level researchers. RESULTS: A total of 500 articles were identified, with 30 studies included as the set criteria. Parallel benchmarking of radiomics, radiogenomics, and DL models applied to the DBT images could allow clinicians and researchers alike to have greater awareness as they consider clinical deployment or development of new models. This review provides a comprehensive guide to understanding the current state of early breast cancer detection using DBT images. CONCLUSION: Using this survey, investigators with various backgrounds can easily seek interdisciplinary science and new DL, radiomics, and radiogenomics directions towards DBT.

Functional Outcome Of Delayed Presenting Fracture Neck Of Femur Managed By Cannulated Screw And Fibular Graft.

BACKGROUND: Delayed presenting Fracture neck of femur is one of the complex and challenging fracture to treat. Multiple treatment options are available with varying results. This study was conducted to assess the functional outcome of fracture neck of femur seeking medical attention several days after injury that are managed by cannulated screw and fibular. METHODS: A total of 35 patients were included in the cross-sectional study performed at orthopaedic surgery department of United Medical & dental college Karachi. Adults aged 18 years and over both male and female with fracture neck of femur presenting 14 days after the injury for medical treatment were included in the study. Ethical approval was obtained from the ethical review committee and patients who provided written informed consent were included in study. Data analysis was performed through SPSS version 20. RESULTS: Thirty-five patients with fracture neck of femur of both sexes 25 (71.4%) male and 10 (28.6%) females were included in study. out of which 14 (40%) of the patients had sub-capital fracture and 21 (60%) patients had trans-cervical fracture neck of femur. Mean age of patients was 32.14±10.20 years. Twenty-eight (80%) patients out of 35 had excellent and good outcome, 4 (11.4%) cases had fair and 3 (8.5%) had poor outcome. CONCLUSIONS: Cannulated screw fixation along with non-vascularized fibular graft is effective technique to management of delayed presenting fracture neck of femur as it is easy, inexpensive and does not require any special instrumentation or expertise.

Functional Outcome of Intraarticular Fracture of Distal Radius Managed by Volar Locking Plate.

Objective This study's main purpose is to determine the functional outcome of volar locking plates in the management of intraarticular fracture of the distal radius. Methodology This cross-sectional study was conducted from August 2016 to August 2019. Forty-nine patients with the intraarticular distal radius fractures managed by the volar locking plate were included in the study. Patients with open fractures, ipsilateral other limb injuries, polytrauma patients, pathological fractures, and patients having neurovascular injuries were excluded from the study. AO Classification was used to classify fractures. The fracture was approached through the volar approach and fixed by the volar locking plate. A modified mayo wrist score evaluated the functional outcome. All the data were recorded on predesigned performa, and Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) was used to analyze the data. Results A total of 49 patients with intraarticular fractures of the distal radius were included in the study. The mean age of the patient was 37.20 ± 10.05 years. Out of 49 patients, 29 (59.2%) were males, and 20 (40.8%) were females. Union was achieved in almost all fractures except one case, which went into non-union despite the adequate initial reduction, and the mean time of union was 11.98 ± 1.64 weeks. With respect to the stratification of functional outcome very good and good functional outcome was achieved in 46 patients (93.8%) in both the groups, the satisfactory outcome was achieved in two (4.1%) cases and one patient had a bad outcome in which union was not achieved and went into non-union. Conclusion Open reduction and internal fixation of intraarticular fracture of the distal radius using a volar locking plate is a good option for managing these fractures as it provides stable fixation, and good to excellent outcomes can be achieved by using these plates.

Assessment of Vitamin D Levels in Patients Presenting With Chronic Low Back Pain at a Tertiary Care Hospital.

Objective To evaluate the association of chronic low back pain with levels of vitamin D in the affected population. Methodology This observational study was carried out from August 2016 to August 2019 at Khairpur Medical College and Shaheed Mohatarma Benazir Bhutto Medical College, Karachi, Pakistan. Patients aged 18 years and above suffering from chronic low back pain with pain persisting for more than 12 weeks were the study participants after written consent and prior approval from the ethical review committee was obtained for conducting the study. Data was recorded on predesigned performa and analyzed on SPSS Version 20 (IBM Corp.). Results There were 1,152 cases with chronic lower back pain, of whom 632 (54.9%) were females and 520 (45.1%) were males. The mean age of the patients was 41.76 ± 11.18 years. The mean visual analog scale (VAS) level was 5.36 ± 1.65; 707 cases (61.4%) had moderate pain according to VAS, 292 (25.3%) had severe pain, and 153 (13.3%) had mild pain. Concerning vitamin D levels, the mean levels were 22.74 ± 13.80, with 599 (52%) of the patients having deficient levels of vitamin D, 347 (30.1%) having insufficient levels, and only 204 (17.7%) of the cases having normal vitamin D levels. Conclusions Lower back pain is one of the common presenting problems in orthopedic clinics. We found no relationship between chronic lower back pain and vitamin D levels in our study.

Proximal Fibular Osteotomy in the Management of Osteoarthritis of Medial Compartment of Knee Joint.

INTRODUCTION: This study was conducted to evaluate the efficacy of proximal fibular osteotomy (PFO) in terms of pain relief, and improvement in function in medial compartment osteoarthritis (OA) of the knee joint. MATERIALS AND METHODS: This case series study was conducted at the Shaheed Mohtarma Benazir Bhutto Medical College Lyari and United Medical and Dental College of Karachi. Patients with medial compartment knee joint OA were included in the study and patients with bicompartmental or tricompartmental OA, inflammatory joint disease, valgus knee deformity, morbid obesity, or any infectious pathology involving the knee joint were excluded from the study. The medial and lateral joint spaces were measured and recorded preoperatively and postoperatively. Pre- and postoperative values of visual analog scale (VAS) results and the Oxford knee score were recorded. A PFO was performed after getting informed written consent. RESULTS:  A total of 60 patients were enrolled in the study; 16 (26.7%) were men, and 44 (73.3%) were women. The mean age of patients was 51.8 ± 4.1 years. The mean preoperative medial joint space measurement on standard anteroposterior radiograph was 1.45 ± 0.28 mm. The mean preoperative lateral joint space was 8.86 ± 1.27 mm. The recorded mean preoperative Oxford knee score was 20.82 ± 1.97 mm. Recorded levels of mean postoperative medial joint space improved to 4.63 ± 0.668 mm, and mean postoperative lateral joint space was 4.72 ± 0.79 mm. Mean recorded levels of VAS for pain postoperatively were 2.32 ± 0.792, which improved significantly from 7.90 ± 0.79. CONCLUSIONS:  PFO is a good surgical technique for pain relief and functional improvement in patients suffering from medial compartment OA.

Patient related factors associated with delayed reporting in oral cavity and oropharyngeal cancer.

BACKGROUND: Delayed reporting resulting in advanced stage disease is a common problem in Indian cancer patients. This study analysed the impact of various sociodemographic and psychosocial factors on the delayed reporting to Healthcare Professional (HCP) in oral and oropharyngeal cancer patients. METHODS: This cross sectional observational study was conducted using a structured questionnaire. Questionnaire included questions to assess socio-demographic and psychosocial factors associated with delay. Delay was defined as time intervals of more than 3 month from first symptom recognition to first medical consultation to a HCP. Association of delay with these factors was analyzed using logistic regression analysis. RESULTS: Final analysis was done on 259 patients. Delay in reporting to HCP was present in 156 (60%) patients. Among sociodemographic factors delayed reporting was highly significant with older age group (P = 0.001), low socioeconomic status (P = 0.02), rural residence (P = 0.026) and with insufficient knowledge of Head and Neck cancer (P = 0.014). Sex and marital status were statistically insignificant factor for delay. Among psychosocial factors attribution of symptoms as minor (P = 0.011), absence of fear (P = <.001) and use of alternate therapy (P = 0.001) were significant factors responsible for delay. Disclosure to other and motivation were statistically insignificant in our study. CONCLUSIONS: The results of this study provide guidance towards interventions to reduce patient delay. Interventions should target the rural, older age group and lower socioeconomic population for educating them and to change their psychosocial behavior for oral and oropharyngeal cancer.

Ryanodine receptors of pancreatic beta-cells mediate a distinct context-dependent signal for insulin secretion.

The ryanodine (RY) receptors in beta-cells amplify signals by Ca2+-induced Ca2+ release (CICR). The role of CICR in insulin secretion remains unclear in spite of the fact that caffeine is known to stimulate secretion. This effect of caffeine is attributed solely to the inhibition of cAMP-phosphodiesterases (cAMP-PDEs). We demonstrate that stimulation of insulin secretion by caffeine is due to a sensitization of the RY receptors. The dose-response relationship of caffeine-induced inhibition of cAMP-PDEs was not correlated with the stimulation of insulin secretion. Sensitization of the RY receptors stimulated insulin secretion in a context-dependent manner, that is, only in the presence of a high concentration of glucose. This effect of caffeine depended on an increase in [Ca2+]i. Confocal images of beta-cells demonstrated an increase in [Ca2+]i induced by caffeine but not by forskolin. 9-Methyl-7-bromoeudistomin D (MBED), which sensitizes RY receptors, did not inhibit cAMP-PDEs, but it stimulated secretion in a glucose-dependent manner. The stimulation of secretion by caffeine and MBED involved both the first and the second phases of secretion. We conclude that the RY receptors of beta-cells mediate a distinct glucose-dependent signal for insulin secretion and may be a target for developing drugs that will stimulate insulin secretion only in a glucose-dependent manner.

Antimicrobial activity of Penicillins in common paediatric infections.

Pediatric bacterial infections are very rapidly growing in developing countries. Bacterial resistance to antimicrobial agents is a serious problem in the treatment of Pediatric bacterial infection. One of the most effective ways to control antibiotic resistance, is the development of surveillance programs. For this purpose isolates were collected from paediatric wards of different hospitals. The result shows that isolates were highly resistant against majority of selected antibiotics with increase in the MIC's. In Penicillin group, the most effective agent is Amoxicillin and Clavulanic acid, more than 90% isolates of Staphylococcus aureus were susceptible while other agents, as Cloxacillin, Ampicillin and Amoxicillin alone shows moderate activity against Staphylococcus aureus and Escherichia coli.

Comparative antimicrobial evaluation of Cephalosporins and Quinolones in common paediatric infections.

More than 90% of world's children are born each year in the developing world. Each year 12.9 million children die. Twenty eight percent of death are caused by pneumonia, 23% by diarrheal disease and 16% by vaccine-preventable diseases. Thirty-five thousand die each day, most from common and preventable problems. Health and illness are the result of a complex dynamic of environmental, social, political and economic factors. Bacterial resistance to antimicrobial agents is a continuing serious problem in the treatment of infections. Although this problem was recognized shortly after the commercial introduction of antimicrobial agents, it means that resistance is now emerging at a more rapid rate than ever before. To start with, during the present study an effort has been made to accomplish this task, 84 clinical isolates of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were collected from different hospitals in Karachi. An in vitro study of these isolates was carried out by Agar dilution method using eleven antimicrobial agents and their combination (Lorian, 1991). Among Cephalosporins, third generation Cephalosporin, Cefotaxime was highly effective against Gram positive and Gram negative bacteria. Cefotaxime was active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. 1.19% isolates of Staphylococcus aureus, 19% isolates of Escherichia coli and 10% isolates of Pseudomonas aeruginosa were resistant against Cefotaxime. In Quinolone group, Ofloxacin was highly active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Whereas 28% isolates of Staphylococcus aureus, 26% isolates of Escherichia coli and 11% isolates of Pseudomonas aeruginosa were resistant to Ofloxacin. Twenty six percent isolates of Staphylococcus aureus and 58% isolates Escherichia coli were resistant against Ciprofloxacin.