Association of multiple sclerosis and sudden sensorineural hearing loss

Peer reviewe

Deriving modified rankin scores from medical records

<p><b>Background and Purpose:</b> Modified Rankin score (mRS) is traditionally graded using a face-to-face or telephone interview. Certain stroke assessment scales can be derived from a review of a patient’s case-record alone. We hypothesized that mRS could be successfully derived from the narrative within patient case-records.</p> <p><b>Methods:</b> Sequential patients attending our cerebrovascular outpatient clinic were included. Two independent, blinded clinicians, trained in mRS, assessed case-records to derive mRS. They scored “certainty” of their grading on a 5-point Likert scale. Agreement between derived and traditional face-to-face mRS was calculated using attribute agreement analysis.</p> <p><b>Results:</b> Fifty patients with a range of disabilities were included. Case-record appraisers were poor at deriving mRS (k=0.34 against standard). Derived mRS grades showed poor agreement between observers (k=0.33). There was no relationship between certainty of derived mRS and proportion of correct grades (P=0.727).</p> <p><b>Conclusion:</b> Accurate mRS cannot be derived from standard hospital records. Direct mRS interview is still required for clinical trials.</p&gt

Navigation and Control of Automated Guided Vehicle using Fuzzy Inference System and Neural Network Technique

Automatic motion planning and navigation is the primary task of an Automated Guided Vehicle (AGV) or mobile robot. All such navigation systems consist of a data collection system, a decision making system and a hardware control system. Artificial Intelligence based decision making systems have become increasingly more successful as they are capable of handling large complex calculations and have a good performance under unpredictable and imprecise environments. This research focuses on developing Fuzzy Logic and Neural Network based implementations for the navigation of an AGV by using heading angle and obstacle distances as inputs to generate the velocity and steering angle as output. The Gaussian, Triangular and Trapezoidal membership functions for the Fuzzy Inference System and the Feed forward back propagation were developed, modelled and simulated on MATLAB. The reserach presents an evaluation of the four different decision making systems and a study has been conducted to compare their performances. The hardware control for an AGV should be robust and precise. For practical implementation a prototype, that functions via DC servo motors and a gear systems, was constructed and installed on a commercial vehicle

Cavernous haemangioma of male breast

We report a rare case of a cavernous hemangioma arising in a male breast. A 53 year old man first noticed 1×1 cm nodule just below his left nipple since 2 years. It was enlarging over a period to the present size. He came to our hospital, it was size of (2×1 cm), was a firm and cystic with a rather smooth surface, and mobile with in breast just medial to left nipple. Fine needle aspiration cytology (FNA) failed to obtain proper material except for old bloody fluid or necrotic connective tissue, precluding a correct diagnosis preoperatively suggesting cystic lesion with bloody aspirate. Lumpectomy or excision biopsy was subsequently performed. Histological, it was found to be a cavernous hemangioma. In such a case, complete excision is recommended to exclude the possibility of an underlying malignant lesion

A Risk-Averse Mechanism for Suicidality Assessment on Social Media

Recent studies have shown that social media has increasingly become a platform for users to express suicidal thoughts outside traditional clinical settings. With advances in Natural Language Processing strategies, it is now possible to design automated systems to assess suicide risk. However, such systems may generate uncertain predictions, leading to severe consequences. We hence reformulate suicide risk assessment as a selective prioritized prediction problem over the Columbia Suicide Severity Risk Scale (C-SSRS). We propose SASI, a risk-averse and self-aware transformer-based hierarchical attention classifier, augmented to refrain from making uncertain predictions. We show that SASI is able to refrain from 83% of incorrect predictions on real-world Reddit data. Furthermore, we discuss the qualitative, practical, and ethical aspects of SASI for suicide risk assessment as a human-in-the-loop framework

Stroke outcome in clinical trial patients deriving from different countries

<p><b>Background and Purpose:</b> Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix.</p> <p><b>Methods:</b> We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment.</p> <p><b>Results</b> Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998.</p> <p><b>Conclusion:</b> We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.</p&gt

Kielisyöpä - varhainen toteaminen parantaa ennustetta

English summar

Preoperative evaluation and treatment consideration of parotid gland tumors

Background: The nature of parotid tumors often remains unknown preoperatively and final histopathology may reveal unexpected malignancy. Still, the use of fine-needle aspiration cytology (FNAC) and imaging varies in the management of these tumors. Methods: We evaluated the preoperative examinations and management of all 195 parotid gland tumors diagnosed within our catchment area of 1.6 million people during 2015. Results: Altogether 171 (88%) tumors were classified as true salivary gland neoplasms. FNAC showed no false malignant findings, but it was false benign in 5 (2.6%) cases. Preoperative MRI was utilized in 48 patients (25%). Twenty (10%) malignancies included 16 salivary gland carcinomas. Pleomorphic adenomas accounted for 52% of all adenomas. For 24 (40%) Warthin tumors, surgery was omitted. Conclusion: The proportion of malignancies was lower than generally presented. Our proposed guidelines include ultrasound-guided FNAC with certain limitations. MRI is warranted in selected cases, but seems unnecessary routinely.Peer reviewe

Meretojan taudista uutta tietoa kansallisen potilasrekisterin avulla

Tiedot Meretojan taudin eli suomalaisen perinnöllisen gelsoliiniamyloidoosin taudinkulusta ovat tähän saakka perustuneet suhteellisen pieniin potilassarjoihin. Uuden kansallisen FIN-GAR-potilasrekisterin avulla voidaan paremmin kartoittaa taudin oireita ja niiden yleisyyttä sekä sen luonnollista kulkua. Potilasrekisteriin on tähän mennessä kerätty tiedot 235 potilaasta, ja siihen toivotaan edelleen täydennystä. Rekisterin mukaan ensioireet alkavat yleensä silmistä. Taudin ensisijainen diagnostinen löydös on potilaalle tyypillisesti jo 20–30-vuotiaana kehittyvä sarveiskalvon verkkomainen rappeuma. Muut oireet ja löydökset kehittyvät suurin piirtein samanaikaisesti, mediaanien osuessa 50 ja 60 ikävuoden välille. Naisilla oireet kehittyvät keskimäärin aiemmin ja erityisesti silmäoireet ovat yleisempiä kuin miehillä. Rannekanavaoireyhtymä, sydämentahdistin ja munuaisensiirrot ovat rekisterin potilailla huomattavasti yleisempiä kuin normaaliväestössä. Näiden tarkkaa patologista yhteyttä Meretojan tautiin tutkitaan ­parhaillaan.Peer reviewe

Management of clinically N0 neck in oropharyngeal carcinoma

PurposeOnly a minority of patients with oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed without regional metastasis (cN0). Studies focusing on the management of cN0 neck in OPSCC are scarce.MethodsWe reviewed all OPSCC patients treated at our institution with cN0 neck between 2000 and 2009. The treatment of neck and pattern of regional control was analyzed. Median follow-up was 5years (range 3.5-9.0) or until death.ResultsOf the total 313 OPSCC patients treated within the period, 56 (18%) presented with cN0 neck. Of them, 51 (91%) received completed treatment with curative intent: 46 (90%) underwent elective neck treatment with either neck dissection (chemo)radiotherapy (C)RT (n=23) or (C)RT (n=23). A regional recurrence occurred in three patients (6%) and they all had a p16-negative soft palate midline primary tumor. Two of these patients had received RT on the neck.Conclusions While the overall prognosis of OPSCC is generally favorable and regional recurrences are infrequent, soft palate tumors, that are usually p16 negative, may form an subgroup warranting more aggressive treatment despite the clinical appearance of early stage.Peer reviewe