Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

Background: The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.Methods: Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.Results: It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.Conclusions: Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority.  

Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

Background: The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.Methods: Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.Results: It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.Conclusions: The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications

Fairness-Oriented Semichaotic Genetic Algorithm-Based Channel Assignment Technique for Node Starvation Problem in Wireless Mesh Networks

Wireless Mesh Networks (WMNs) have emerged as a scalable, reliable, and agile wireless network that supports many types of innovative technologies such as the Internet of Things (IoT), Wireless Sensor Networks (WSN), and Internet of Vehicles (IoV). Due to the limited number of orthogonal channels, interference between channels adversely affects the fair distribution of bandwidth among mesh clients, causing node starvation in terms of insufficient bandwidth distribution, which impedes the adoption of WMN as an efficient access technology. Therefore, a fair channel assignment is crucial for the mesh clients to utilize the available resources. However, the node starvation problem due to unfair channel distribution has been vastly overlooked during channel assignment by the extant research. Instead, existing channel assignment algorithms equally distribute the interference reduction on the links to achieve fairness which neither guarantees a fair distribution of the network bandwidth nor eliminates node starvation. In addition, the metaheuristic-based solutions such as genetic algorithm, which is commonly used for WMN, use randomness in creating initial population and selecting the new generation which usually leads the search to local minima. To this end, this study proposes a Fairness-Oriented Semi-Chaotic Genetic Algorithm-Based Channel Assignment Technique (FA-SCGA-CAA) to solve Nodes Starvation Problem in Wireless Mesh Networks. FA-SCGA-CAA maximizes link fairness while minimizing link interference using a Genetic Algorithm (GA) with a novel nonlinear fairness-oriented fitness function. The primary chromosome with powerful genes is created based on multi-criterion links ranking channel assignment algorithm. Such a chromosome was used with a proposed semi-chaotic technique to create a strong population that directs the search towards the global minima effectively and efficiently. The proposed semi-chaotic was also used during the mutation and parent selection of the new genes. Extensive experiments were conducted to evaluate the proposed algorithm. Comparison with related work shows that the proposed FA_SCGA_CAA reduced the potential node starvation by 22% and improved network capacity utilization by 23%. It can be concluded that the proposed FA_SCGA_CAA is reliable to maintain high node-level fairness while maximizing the utilization of the network resources, which is the ultimate goal of many wireless networks

Imaging in chronic pancreatitis: State of the art review

Chronic pancreatitis (CP) is an important gastrointestinal cause of morbidity worldwide. It can severely impair the quality of life besides life-threatening acute and long-term complications. Pain and pancreatic exocrine insufficiency (leading to malnutrition) impact the quality of life. Acute complications include pseudocysts, pancreatic ascites, and vascular complications. Long-term complications are diabetes mellitus and pancreatic cancer. Early diagnosis of CP is crucial to alter the natural course of the disease. However, majority of the cases are diagnosed in the advanced stage. The role of various imaging techniques in the diagnosis of CP is discussed in this review

Breast Abscess Mimicking Breast Carcinoma in Male

Male breast can show almost all pathological entities described in female breast. Inflammatory conditions of the breast in male are not common; however, occasionally, it can be encountered in the form of an abscess. Clinically, gynecomastia always presents as a symmetric unilateral or bilateral lump in the retroareolar region, and any irregular asymmetric lump raises a possibility of malignancy. Radiology should be used as a part of the triple assessment protocol for breast lump along with fine-needle aspiration cytology for definite diagnosis and proper management

Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features

Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed

Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis

Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH. Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups. Results The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection (p = 0.036), the maximum dimension of collection (p = 0.004), volume of collection (p = 0.019), biliary dilatation (p = 0.011), and the presence of moderate-to-severe pleural effusion (p = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant. Conclusion CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP

Cholesterol depletion associated with Leishmania major infection alters macrophage CD40 signalosome composition and effector function

CD40, a costimulatory molecule expressed on macrophages, induces expression of interleukin 12 (IL-12) in uninfected macrophages and IL-10 in macrophages infected with Leishmania major. IL-12 suppresses, whereas IL-10 enhances, L. major infection. The mechanisms that regulate this difference in CD40-induced cytokine production remain unclear, but it is known that L. major depletes cholesterol. Here we show that cholesterol influenced the assembly of distinct CD40 signalosomes. Depletion of membrane cholesterol inhibited the assembly of an IL-12-inducing CD40 signalosome containing the adaptors TRAF2, TRAF3 and TRAF5 and the kinase Lyn and promoted the assembly of an IL-10-inducing CD40 signalosome containing the adaptor TRAF6 and the kinase Syk. Thus, cholesterol depletion might represent an immune-evasion strategy used by L. major

Enhancing Optical Character Recognition on Images with Mixed Text Using Semantic Segmentation

Optical Character Recognition has made large strides in the field of recognizing printed and properly formatted text. However, the effort attributed to developing systems that are able to reliably apply OCR to both printed as well as handwritten text simultaneously, such as hand-filled forms, is lackadaisical. As Machine printed/typed text follows specific formats and fonts while handwritten texts are variable and non-uniform, it is very hard to classify and recognize using traditional OCR only. A pre-processing methodology employing semantic segmentation to identify, segment and crop boxes containing relevant text on a given image in order to improve the results of conventional online-available OCR engines is proposed here. In this paper, the authors have also provided a comparison of popular OCR engines like Microsoft Cognitive Services, Google Cloud Vision and AWS recognitions. We have proposed a pixel-wise classification technique to accurately identify the area of an image containing relevant text, to feed them to a conventional OCR engine in the hopes of improving the quality of the output. The proposed methodology also supports the digitization of mixed typed text documents with amended performance. The experimental study shows that the proposed pipeline architecture provides reliable and quality inputs through complex image preprocessing to Conventional OCR, which results in better accuracy and improved performance