Deep learning classifiers for computer-aided diagnosis of multiple lungs disease.

BACKGROUND: Computer aided diagnosis has gained momentum in the recent past. The advances in deep learning and availability of huge volumes of data along with increased computational capabilities has reshaped the diagnosis and prognosis procedures. OBJECTIVE: These methods are proven to be relatively less expensive and safer alternatives of the otherwise traditional approaches. This study is focused on efficient diagnosis of three very common diseases: lung cancer, pneumonia and Covid-19 using X-ray images. METHODS: Three different deep learning models are designed and developed to perform 4-way classification. Inception V3, Convolutional Neural Networks (CNN) and Long Short Term Memory models (LSTM) are used as building blocks. The performance of these models is evaluated using three publicly available datasets, the first dataset contains images for Lung cancer, second contains images for Covid-19 and third dataset contains images for Pneumonia and normal subjects. Combining three datasets creates a class imbalance problem which is resolved using pre-processing and data augmentation techniques. After data augmentation 1386 subjects are randomly chosen for each class. RESULTS: It is observed that CNN when combined with LSTM (CNN-LSTM) produces significantly improved results (accuracy of 94.5 %) which is better than CNN and InceptionV3-LSTM. 3,5, and 10 fold cross validation is performed to verify all results calculated using three different classifiersConclusions:This research concludes that a single computer-aided diagnosis system can be developed for diagnosing multiple diseases.

Giant ovarian cyst--an unusual finding.

A 16 year old unmarried girl presented with complaints of abdominal distension, vomiting, constipation, difficulty in breathing and restlessness. On examination abdomen was grossly distended with fluid thrill. Ultrasonographic examination revealed that there was a huge cystic collection with internal debris, multiple septations involving the whole abdomen and pelvis originating from right ovary. The left ovary was normal. Her laparatomy was done. A giant ovarian cyst measuring 45 x 32 x 28 cm, which weighed 18 Kg (almost 1/3 of whole body weight), was removed as such like a yoyo balloon. Post-operative recovery was smooth. Histopathological examination revealed that it was mucinous cystadenoma.

Polydioxanone Versus Polypropylene Closure For Midline Abdominal Incisions.

BACKGROUND: Midline laparotomy is the most common technique of abdominal incisions because it is simple, provides adequate exposure to all four quadrants, and is rapid to open. A major problem after midline laparotomy remains the adequate technique of abdominal fascia closure. This study was conducted to see the role of Polydioxanone and Prolene for midline abdominal closure in terms of postoperative wound infection and wound pain. METHODS: This study was carried out at surgical unit II, Federal Government Services Hospital Islamabad. Patients were equally divided in two groups, i.e., A and B. Groups A and B patients undergone midline abdominal closure with Polydioxanone number 1 and Polypropylene number 1 sutures respectively. RESULTS: Total 620 patients were included in this study. Post-operative wound pain score according to Visual analogue scale (VAS) was compared in terms of no pain (0), mild pain (1-3), moderate pain (4-6), severe pain (7-9). In group A (Polydioxanone), the frequency and percentages of no, mild, moderate and severe pain were 101 (32.6%), 95 (30.6%), 81 (26.1%) and 33 (10.6%) respectively, where as in group B (polypropylene) it was 82 (26.5%), 43 (13.9%), 59 (19%) and 126 (40.6%) respectively. Similarly, the frequency and percentages of post-operative wound infection in group A (Polydioxanone) and group B (polypropylene) was 105 (33.9%) and 208 (67.1%) respectively. CONCLUSIONS: Polydioxanone results in less wound pain and wound infection when compared to Polypropylene.

Comparison of unfractionated heparin vs low molecular weight heparin in the treatment of acute deep vein thrombosis.

OBJECTIVE: To compare the results of unfractionated heparin (UFH) with low molecular weight heparin in the treatment of acute deep vein thrombosis of lower limb. DESIGN: Randomized control trial. PLACE AND DURATION OF STUDY: Bolan Medical Complex Hospital, Quetta from January 2002 to July 2003. PATIENTS AND METHODS: Thirty patients who presented with acute deep vein thrombosis of lower limb, confirmed by either Doppler ultrasonography or venography, were selected for the study. Patients were divided randomly into two groups for treatment. Group 1 was started with unfractionated heparin while group 2 with low molecular weight heparin. Comparison of two treatments to determine the efficacy was done by certain criteria like pain improvement, reduction in swelling, alteration in bleeding profile, complications of therapy, recurrence, morbidity and mortality. RESULTS: The age of the patients ranged from 16-82 years. There were 15 females (50.00%) and 15 males (50.00%). Pain and swelling were present in all patients (100%), while temperature and superficial vein dilation in 43.3% and 30% respectively. The distribution of DVT in left lower limb was in 13 patients (43.33%), right lower limb involvement in 12 patients (40.00%) and both limbs involvement in 5 patients (16.67%). In group 1 improvement in pain occurred after 4th day in 13 patients, while in group 2 before 4th day in 8 patients (p-value = 0.068). Improvement in swelling was observed after 6th day in 11 patients (group 1), while before 6th day in 8 patients (group 2) (p-value = 0.171). Bleeding time was prolonged in 5 patients in group 1 and statistically found significant (p-value = 0.014), while in group 2 it was normal. Thromboembolism in 3 patients and major bleeding was observed in 2 patients in group 1, while in group 2 it was normal. Recurrence was reported in 2 patients in group 1 and 1 patient in group 2 (p-value 0.0815). The hospital stay was more than 10 days in group 1 (12 patients), and less than 10 days in group 2 (13 patients). It was found statistically significant (p-value = 0.001). Three patients died in group 1, while no mortality was observed in group 2. CONCLUSION: Treatment with low molecular weight heparin (LMWH) has good patient compliance and is easy to administer. LMWH has an advantage over UFH due to its normal bleeding profile and significantly less hospital stay.

Diagnostic yield of color Doppler ultrasonography in deep vein thrombosis.

OBJECTIVE: To see the diagnostic yield of color Doppler ultrasonography in patients who presented with clinical symptoms and signs of acute deep vein thrombosis of lower limb. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The study was carried out in Bolan Medical Complex Hospital, Quetta from January 2002 to December 2002. SUBJECTS AND METHODS: Twenty five patients, who presented with clinical symptoms and signs of acute deep venous thrombosis of lower limb, were selected. In all patients color Doppler ultrasound and venography was performed to compare the results. RESULTS: The age of the patients ranged from 16-82 +/- 20.33 years. The mean was 49.16, median 50.00 and mode 60.00 There were 15 females (60.00%) and 10 males (40.00%). Left lower limb involvement was seen in 12 patients (48.00% +/- 0.51), right lower limb involvement in 10 patients (40.00% +/- 0.50) and both limbs involvement in 3.0 patients (12.00% +/- 0.33). Color Doppler ultrasound was positive in 16 patients (64.00% +/- 0.48) while venography was positive in 21 patients (84.00% +/- 0.37%). Doppler ultrasonography and venography showed that 11 patients (52.38%) had distal DVT, while 10 patients (47.62%) had distal as well as proximal DVT. Ten patients (100.00%) of proximal as well as distal DVT were diagnosed by CDU and later confirmed by venography. Eleven patients (100.00%) of distal DVT only in whom 6 patients (54.54%) were diagnosed by CDU, while 5 patients (45.46%) had inconclusive findings, which were confirmed by venography. Doppler ultrasonography compared venography showed sensitivity 76.1%, specificity 100%, positive predictive value 100%, negative predictive value 44.45% and accuracy 80.00%. CONCLUSION: Color Doppler ultrasonography is a non-invasive, safe, efficient and cost-effective method in diagnosing acute deep venous thrombosis of lower limb but still it has not 100% accuracy. It is better for diagnosing proximal DVT than distal DVT. 7.

New triterpenoidal alkaloids from Buxus sempervirens.

Phytochemical studies on the ethanolic extract of the roots of Buxus sempervirens of Turkish origin have resulted in the isolation of two new triterpenoidal alkaloids, (+)-16a, 31-diacetylbuxadine (1), (-)-Nb-demethylcyclomikuranine (2) along with three known natural products, (-)-cyclomikuranine (3), (-)-cyclobuxophylline-K (4) and (+)-buxaquamarine (5) isolated for the first time from this species of genus Buxus. The structures of these new natural products were established on the basis of extensive spectroscopic studies. Compound 1 exhibited antibacterial activity against human pathogenic bacteria and weak phytotoxic activity against Lemna minor Linn.

A functional ectopic vaginal anus: a rare clinical entity.

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises.She improved within a month with Wexner score of zero.