Wavelet and deep learning-based detection of SARS-nCoV from thoracic X-ray images for rapid and efficient testing.

This paper proposes a wavelet and artificial intelligence-enabled rapid and efficient testing procedure for patients with Severe Acute Respiratory Coronavirus Syndrome (SARS-nCoV) through a deep learning approach from thoracic X-ray images. Presently, the virus infection is diagnosed primarily by a process called the real-time Reverse Transcriptase-Polymerase Chain Reaction (rRT-PCR) based on its genetic prints. This whole procedure takes a substantial amount of time to identify and diagnose the patients infected by the virus. The proposed research uses a wavelet-based convolution neural network architectures to detect SARS-nCoV. CNN is pre-trained on the ImageNet and trained end-to-end using thoracic X-ray images. To execute Discrete Wavelet Transforms (DWT), the available mother wavelet functions from different families, namely Haar, Daubechies, Symlet, Biorthogonal, Coiflet, and Discrete Meyer, were considered. Two-level decomposition via DWT is adopted to extract prominent features peripheral and subpleural ground-glass opacities, often in the lower lobes explicitly from thoracic X-ray images to suppress noise effect, further enhancing the signal to noise ratio. The proposed wavelet-based deep learning models of both, two-class instances (COVID vs. Normal) and four-class instances (COVID-19 vs. PNA bacterial vs. PNA viral vs. Normal) were validated from publicly available databases using k-Fold Cross Validation (k-Fold CV) technique. In addition to these X-ray images, images of recent COVID-19 patients were further used to examine the model's practicality and real-time feasibility in combating the current pandemic situation. It was observed that the Symlet 7 approximation component with two-level manifested the highest test accuracy of 98.87%, followed by Biorthogonal 2.6 with an efficiency of 98.73%. While the test accuracy for Symlet 7 and Biorthogonal 2.6 is high, Haar and Daubechies with two levels have demonstrated excellent validation accuracy on unseen data. It was also observed that the precision, the recall rate, and the dice similarity coefficient for four-class instances were 98%, 98%, and 99%, respectively, using the proposed algorithm.

"Stealth" retro-auricular endoscopic surgery for a submandibular mass.

INTRODUCTION: With the need for increased cosmesis, it is the desire of patients all over the world to avoid an unsightly scar over the neck, face, or any of the exposed areas. This popularised the concept of "stealth" surgery. CASE DETAILS: A 42 year-old gentleman underwent a stealth surgery for a painless progressively growing mass in the left submandibular triangle, which was provisionally diagnosed as a Lymphoma. As he desired a scarless procedure, a linear incision in the neck was avoided, and the surgical team opted for a Retro-Auricular HairLine (RAHL) approach, with a combination of balloon spacing and ultrasonic shears dissection. DISCUSSION: The procedure was performed with perfect hemostasis, and is being reported as the first case of stealth RAHL (scarless) surgery in the United Arab Emirates for a submandibular mass. This article has been reported in line with the SCARE criteria [1]. "Stealth" surgery is becoming increasingly popular as it helps to avoid unsightly incisions in exposed areas of the body. The term was first used by by the paediatric surgical department of John Hopkins hospital, and it caught the fancy of the public as well as the surgeons. CONCLUSION: A retro-auricular endoscopic excision of a submandibular mass is being reported in this article for its feasibility and cosmesis. Following the principles of "stealth" surgery, invisible port site incisions were used to complete the surgery successfully. The purpose of this case report was to illustrate the feasibility and safety of the endoscopic resection using the retro-auricular approach for submandibular mass excision.

Single site laparoscopic simultaneous cholecystectomy, sleeve gastrectomy, and paraumbilical hernia - First case report.

INTRODUCTION: Single site surgery is rapidly gaining popularity for its cosmetic benefits. However it requires immense technical skill due to its challenging ergonomics.We have reported here a case where multiple surgeries have been performed through the same single site,without the usage of special devices.This article has been reported in line with the SCARE criteria [1]. PRESENTATION OF CASE: A 45-year-old obese lady presented with symptomatic cholelithiasis and a para umbilical hernia. She underwent uneventful trans umbilical, single site laparoscopic cholecystectomy, sleeve gastrectomy and paraumbilical hernia repair. DISCUSSION: This article is being published as it is the first reported from the Middle East. Recent development of laparoscopy was represented with introduction of the concept of scarless surgery using Natural Orifice Transluminal Endoscopic Surgery (NOTES), or its Transumbilical counterpart (NOTUS). Unfortunately,these two approaches have not been widely reported, probably due to the need for specialized instruments, learning curve, and prolonged surgery time [2]. CONCLUSION: This single case report is to indicate that it is technically possible and cosmetically appealing to perform such a complex surgery.

Multi-functional FITC-silica@gold nanoparticles conjugated with guar gum succinate, folic acid and doxorubicin for CT/fluorescence dual imaging and combined chemo/PTT of cancer.

A novel type of multi-functional fluorescein isothiocyanate (FITC)-silica (SiO2)@gold (Au) core-shell nanoparticles covered with folic acid (FA)-conjugated guar gum succinate (GGS) and doxorubicin (DOX) (FITC-SiO2@Au-DOX-GGS-FA NPs) was prepared for imaging and therapy of cancer. The physicochemical properties of these NPs were analyzed with 1H NMR, TEM and DLS. The FITC-SiO2@Au-DOX-GGS-FA NPs exhibited the fluorescence and X-ray attenuation properties due to the presence of FITC-SiO2@Au hybrid nanostructure. Due to acid-cleavable hydrazone bond between the DOX and NPs, the quantity of DOX delivered from the FITC-SiO2@Au-DOX-GGS-FA NPs was increased at pH 5.6 than that at pH 7.4. Besides, the multi-functional NPs presented the improved cellular uptake by HeLa cells via FA-receptor-mediated endocytosis due to the existence of FA. The developed NPs also presented the improved cytotoxicity towards the HeLa cells due to its tumor-targetability and DOX/photothermal effect. These results suggested that the FITC-SiO2@Au-DOX-GGS-FA NPs could be ideal for computed tomography (CT)/fluorescence dual imaging and combined chemo/photothermal therapy (PTT) of cancer.

Multi-functional core-shell Fe3O4@Au nanoparticles for cancer diagnosis and therapy.

Multi-functional core-shell Fe3O4@Au nanoparticles (Fe3O4@Au-DOX-mPEG/PEG-FA NPs) conjugated with doxorubicin (DOX), methoxy poly(ethylene glycol) (mPEG), and folic acid-linked poly(ethylene glycol) (PEG-FA) were synthesized for cancer theranostic applications. In the developed NPs, the DOX was chemically conjugated at the surface of core-shell Fe3O4@Au NPs using L-cysteine methyl ester (LCME) as a linker by acid-sensitive hydrazone bond. The formation of Fe3O4@Au-DOX-mPEG/PEG-FA NPs was confirmed by 1H-NMR analysis. The TEM image and DLS studies showed that the mean diameter of the prepared NPs was about 18 and 38 nm, respectively. Due to the existence of superparamagnetic Fe3O4, the Fe3O4@Au-DOX-mPEG/PEG-FA NPs presented the saturation magnetization (Ms) value of 23 emu/g. The developed NPs displayed the maximum amount of drug release in the acidic medium than that in the mild alkaline medium because of the presence of acid-sensitive hydrazone bond. Due to the presence of FA, the Fe3O4@Au-DOX-mPEG/PEG-FA NPs displayed the increased cellular uptake through a folate-receptor-mediated endocytosis, which results in the improved cytotoxic effect on the HeLa cells. Under the laser irradiation, the cytotoxicity of Fe3O4@Au-DOX-mPEG/PEG-FA NPs was found to be improved due to the photothermal effect of Au shell existing in the NPs. These results reveal that the Fe3O4@Au-DOX-mPEG/PEG-FA NPs could be a promising tumour-targeted drug delivery system with the capabilities of combined MR/CT imaging, photothermal, and chemotherapy of tumours.

Software intelligent system for effective solutions for hearing impaired subjects.

PURPOSE: The anatomy and physiology of the ear is complex in nature, which makes it a challenge for audiologists to prescribe solutions for varied hearing-impaired subjects. There is a need to increase the satisfaction level of hearing-aid users by adopting better strategies that involve modern technological advancements. AIM: To design and develop a decision support Software Intelligent System (SIS) that performs audiological investigations to assess the degree of hearing loss and to suggest appropriate hearing-aid gain values. METHODS: SIS is developed based on the study conducted in the Government General Hospital, Chennai, India, between 2013 and 2015. In the study period, audiological investigations were performed on 368 subjects, using the clinical audiometer (Inventis-Piano, Italy) and the SIS. Gain suggestions were recommended for hearing-aid users (Siemens Intuis life & Intuis-SP) using standard prescriptive procedures, alterations made by the audiologists, and by the SIS. It was developed with artificial neural network-based gain predictions. RESULTS: Of the tested subjects, 256 were identified as hearing-impaired. The calculated sensitivity, specificity and accuracy of the computerised audiometer incorporated in the SIS are 93%, 85% and 90% respectively. Furthermore, 86% of the hearing-impaired subjects were satisfied during their first hearing-aid trial with the gain recommendations from SIS. CONCLUSION: The findings suggest that the proposed SIS could be used to perform audiological screening tests and to recommend appropriate hearing-aid gain values to the hearing-impaired subjects. This could eventually be helpful for audiologists in the areas where routine mass audiological screening and fast hearing-aid solution is required.

The Perforation-Operation time Interval; An Important Mortality Indicator in Peptic Ulcer Perforation.

OBJECTIVE: To find out the significance of the Perforation-Operation Interval (POI) with respect to an early prognosis, in patients with peritonitis which is caused by peptic ulcer perforation. STUDY DESIGN: Case series. Place and Duration of the Study: Department of General Surgery, Konaseema Institute of Medical Sciences and RF Amalapuram, Andhra Pradesh, India from 2008-2011. MATERIALS AND METHOD: This study included 150 patients with generalized peritonitis, who were diagnosed to have Perforated Peptic Ulcers (PPUs). The diagnosis of the PPUs was established on the basis of the history , the clinical examination and the radiological findings. The perforation-operation interval was calculated from the time of onset of the symptoms like severe abdominal pain or vomiting till the time the patient was operated. RESULT: Out of the 150 patients 134 were males and 16 were females, with a male : female ratio of 9:1. Their ages ranged between 25-70 years. Out of the 150 patients, 65 patients (43.3%) presented within 24 hours of the onset of severe abdominal pain (Group A), 27 patients (18%) presented between 24-48 hours of the onset of severe abdominal pain (Group B) and 58 patients (38.6%) presented after 48 hours. There was no mortality in Group A and the morbidity was more in Group B and Group C. There were 15 deaths in Group C. CONCLUSION: The problem of peptic ulcer perforation with its complication, can be decreased by decreasing the perforation -operation time interval, which as per our study, appeared to be the single most important mortality and morbidity indicator in peptic ulcer perforation.