Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report

BACKGROUND: Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. CASE PRESENTATION: A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. CONCLUSION: We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging

Bag of Deep Features for Instructor Activity Recognition in Lecture Room

This paper has been presented at : 25th International Conference on MultiMedia Modeling (MMM2019)This research aims to explore contextual visual information in the lecture room, to assist an instructor to articulate the effectiveness of the delivered lecture. The objective is to enable a self-evaluation mechanism for the instructor to improve lecture productivity by understanding their activities. Teacher’s effectiveness has a remarkable impact on uplifting students performance to make them succeed academically and professionally. Therefore, the process of lecture evaluation can significantly contribute to improve academic quality and governance. In this paper, we propose a vision-based framework to recognize the activities of the instructor for self-evaluation of the delivered lectures. The proposed approach uses motion templates of instructor activities and describes them through a Bag-of-Deep features (BoDF) representation. Deep spatio-temporal features extracted from motion templates are utilized to compile a visual vocabulary. The visual vocabulary for instructor activity recognition is quantized to optimize the learning model. A Support Vector Machine classifier is used to generate the model and predict the instructor activities. We evaluated the proposed scheme on a self-captured lecture room dataset, IAVID-1. Eight instructor activities: pointing towards the student, pointing towards board or screen, idle, interacting, sitting, walking, using a mobile phone and using a laptop, are recognized with an 85.41% accuracy. As a result, the proposed framework enables instructor activity recognition without human intervention.Sergio A Velastin has received funding from the Universidad Carlos III de Madrid, the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 600371, el Ministerio de Economía, Industria y Competitividad (COFUND2014-51509) el Ministerio de Educación, Cultura y Deporte (CEI-15-17) and Banco Santander

Estimating progression-free survival in patients with glioblastoma using routinely collected data

Glioblastoma (GBM) represents 80% of all primary malignant brain tumours in adults. Prognosis is poor, and there is a clear correlation between disease progression and deterioration in functional status. In this pilot study we assess whether we can estimate disease progression and progression free survival (PFS) from routinely collected electronic healthcare data. We identified fifty patients with glioblastoma who had chemo-radiotherapy. For each patient we manually collected a reference data set recording demographics, surgery, radiotherapy, chemotherapy, follow-up and death. We also obtained an electronic routine data set for each patient by combining local data on chemotherapy/radiotherapy and hospital admissions. We calculated overall survival (OS) and PFS using the reference data set, and estimated them using the routine data sets using two different methods, and compared the estimated measures with the reference measures. Overall survival was 68% at 1 year and median OS was 12.8 months. The routine data correctly identified progressive disease in 37 of 40 patients and stable disease in 7 of 10 patients. PFS was 7.4 months and the estimated PFS using routine data was 9.1 and 7.8 months with methods 1 and 2 respectively. There was acceptable agreement between reference and routine data in 49 of 50 patients for OS and 35 of 50 patients for PFS. The event of progression, subsequent treatment and OS are well estimated using our approach, but PFS estimation is less accurate. Our approach could refine our understanding of the disease course and allow us to report PFS, OS and treatment nationally

A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan

Background: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. Aim: The study was carried out to identify risk factors for NNT in Karachi. Materials and Methods: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. Statistical Analysis: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. Results: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. Conclusion: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as 'subsequent cord application' along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial

Nickel oxide thin films grown by chemical deposition techniques: Potential and challenges in next‐generation rigid and flexible device applications

Funder: Aziz FoundationFunder: Downing College, CambridgeFunder: Isaac Newton Trust; Id: http://dx.doi.org/10.13039/501100004815Abstract: Nickel oxide (NiO x ), a p‐type oxide semiconductor, has gained significant attention due to its versatile and tunable properties. It has become one of the critical materials in wide range of electronics applications, including resistive switching random access memory devices and highly sensitive and selective sensor applications. In addition, the wide band gap and high work function, coupled with the low electron affinity, have made NiO x widely used in emerging optoelectronics and p‐n heterojunctions. The properties of NiO x thin films depend strongly on the deposition method and conditions. Efficient implementation of NiO x in next‐generation devices will require controllable growth and processing methods that can tailor the morphological and electronic properties of the material, but which are also compatible with flexible substrates. In this review, we link together the fundamental properties of NiO x with the chemical processing methods that have been developed to grow the material as thin films, and with its application in electronic devices. We focus solely on thin films, rather than NiO x incorporated with one‐dimensional or two‐dimensional materials. This review starts by discussing how the p‐type nature of NiO x arises and how its stoichiometry affects its electronic and magnetic properties. We discuss the chemical deposition techniques for growing NiO x thin films, including chemical vapor deposition, atomic layer deposition, and a selection of solution processing approaches, and present examples of recent progress made in the implementation of NiO x thin films in devices, both on rigid and flexible substrates. Furthermore, we discuss the remaining challenges and limitations in the deposition of device‐quality NiO x thin films with chemical growth methods. imag

Case report on the spontaneous resolution of a traumatic intracranial acute subdural haematoma: evaluation of the guidelines

Rapid spontaneous resolution of traumatic acute subdural haematomas (ASDH) can occur but is rare. We present an 88-year-old female who presents with a large left acute subdural haematoma (ASDH) measuring 18 mm in thickness with midline shift of 10.7 mm. We managed her conservatively based upon good consciousness level and absent neurological deficits. Repeat computed tomography (CT) the following day demonstrated near complete resolution of the ASDH and midline shift regression; a further CT confirmed resolution. Most patients with large ASDH require surgical evacuation; however, in rare cases, they can resolve spontaneously with extreme rapidity. Conservative management can be a valid option in carefully selected cases

Chitosan/poly vinyl alcohol/graphene oxide based ph-responsive composite hydrogel films: drug release, anti-microbial and cell viability studies

The composite hydrogels were produced using the solution casting method due to the non-toxic and biocompatible nature of chitosan (CS)/polyvinyl alcohol (PVA). The best composition was chosen and crosslinked with tetraethyl orthosilicate (TEOS), after which different amounts of graphene oxide (GO) were added to develop composite hydrogels. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM) and contact angle was used to analyze the hydrogels. The samples were also evaluated for swelling abilities in various mediums. The drug release profile was studied in phosphate-buffered saline (PBS) at a pH of 7.4. To predict the mechanism of drug release, the data were fitted into kinetic models. Finally, antibacterial activity and cell viability data were obtained. FTIR studies revealed the successful synthesis of CS/PVA hydrogels and GO/CS/PVA in hydrogel composite. SEM showed no phase separation of the polymers, whereas AFM showed a decrease in surface roughness with an increase in GO content. 100 µL of crosslinker was the critical concentration at which the sample displayed excellent swelling and preserved its structure. Both the crosslinked and composite hydrogel showed good swelling. The most acceptable mechanism of drug release is diffusion-controlled, and it obeys Fick’s law of diffusion for drug released. The best fitting of the zero-order, Hixson-Crowell and Higuchi models supported our assumption. The GO/CS/PVA hydrogel composite showed better antibacterial and cell viability behaviors. They can be better biomaterials in biomedical applications

Genetic approaches to understanding the causes of stuttering

Stuttering is a common but poorly understood speech disorder. Evidence accumulated over the past several decades has indicated that genetic factors are involved, and genetic linkage studies have begun to identify specific chromosomal loci at which causative genes are likely to reside. A detailed investigation of one such region on chromosome 12 has identified mutations in the GNPTAB gene that are associated with stuttering in large families and in the general population. Subsequent studies identified mutations in the functionally related GNPTG and NAGPA genes. Mutations in these genes disrupt the lysosomal targeting pathway that generates the Mannose 6-phosphate signal, which directs a diverse group of enzymes to their target location in the lysosome of the cell. While mutations in these three genes can be identified in less than 10% of cases of familial stuttering, this knowledge allows a variety of new studies that can help identify the neuropathology that underlies this disorder

Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning

<p>Abstract</p> <p>Background</p> <p>In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: <it>problem solving </it>and <it>decision making</it>. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies <it>decision theory </it>to the clinical diagnosis, which can be a challenging topic in medical education.</p> <p>This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept <it>of category-oriented likelihood ratio (LR) </it>to propose a new model combining both aforementioned methods.</p> <p>Discussion</p> <p>Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the <it>categories of diseases </it>by using the available clinical findings.</p> <p>Summary</p> <p>To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value <it>category-oriented LR</it>.</p