Wrong Diagnosis Research Articles

Machine learning and deep learning for breast cancer risk prediction and diagnosis: a Survey

Breast cancer is the widest spreading disease among women globally. The prevalence rate of breast cancer continued to rise in the last few decades. The mitotic count is a relevant factor for grading invasive breast cancer. Early analysis is an extremely imperative step in treatment. However, it is not an easy one due to several skepticisms in detection which employ mammograms. Since it is subject to human prone error, requires more time for completion and the nuclei look similar during all stages of mitosis, automatic detection of mitosis is a good solution to overcome these problems. Detailed analysis of breast cancer normally requires medical images of different methods. The sensitivity and specificity of the diagnosis largely depend on the experiences of the radiologists, and uncertain diagnosis is quite frequent because of resolution limitations and the concerns of lawsuits arisen from wrong diagnosis or undetected lesions. In this paper, the top methodologies used for mitosis detection are analyzed. There are many algorithms for classification and prediction of breast cancer: Support Vector Machine (SVM), Decision Tree (CART), k Nearest Neighbors (KNN), Random Forest (RF), and Bayesian Networks (BN). The Wisconsin data set was used to analyze breast cancer as a training set to assess and measure the performance of the three ML classifiers in terms of key frameworks such as accuracy, recall, precision, and ROC. The outcome obtained in this paper provides a critique of the stateofart ML techniques for breast cancer detection. It was also found that the ensemble classifier gives better performance. A preliminary experiment conducted on cascaded RF and Artificial Neural Network (ANN) results in better accuracy than individual classifiers. The paper shows how we can use deep learning technology diagnosis of breast cancer using MIAS Dataset. A deep learning approach is almost used for immense task objective Image processing, Computer Vision, Medical Diagnosis, and Neural Language Processing.

Diagnostic difficulties of small intestinal neuroendocrine tumors: clinical case

The objective of the study was to demonstrate the difficulties of diagnosing the neuroendocrine tumor (NET) of the small intestine at the example of a concrete clinical case. In the case presented, clinical manifestations of the disease were nonspecific and the examination began from a low-informative method multispiral computed tomography (MSCT) without a bolus contrast study that was the reason of wrong diagnosis for 7 months. The detection of the swollen lymph node in the mesentery was interpreted incorrectly; additionally, only endoscopic investigation of the stomach and large intestine was used. By means of MSCT-angiography we succeeded to diagnose not only the lymph node conglomerate in the mesentery, but to reveal a tumor sized 915 cm in the ileac wall. Laparoscopy with lymph node biopsy after its morphological study permitted to verify the diagnosis before the surgery.
 To reduce the period of diagnostics of small intestinal NET, general practitioners should be informed on specific features of clinical manifestations of the disease and rational diagnostic methods. MSCT-angiography showed its efficiency in detection of small-sized small intestinal NET, and laparoscopy with biopsy of the mesentery lymph node will permit to verify the diagnosis before surgery.

Benign Mullerian Glandular Inclusions in Men: A Metastatic Carcinoma Mimic

Abstract Introduction/Objective Benign mullerian glandular inclusions (MGI) in lymph nodes is a well documented finding in women. However, it can also very rarely occur in men and mimic metastatic carcinoma. To our knowledge, only seven cases of benign MGI in men have been reported in the literature. Methods/Case Report We here-in present a case of a 62-year-old male with a three-year history of prostatic adenocarcinoma Gleason score 6, initially diagnosed on needle core biopsies. Subsequently, the patient underwent a radical prostatectomy with bilateral pelvic lymph node dissection. Histological evaluation of the right pelvic lymph node demonstrated cystically dilated glands beneath the capsule composed of cuboidal to columnar cells with minimal atypia raising concern for metastatic carcinoma to the lymph node. Immunohistochemical (IHC) stains showed the glandular cells to be positive for estrogen, progesterone, PAX-8 and WT-1; while negative for calretinin and PSA immunostains. This IHC profile in conjunction with the morphological findings are consistent with the diagnosis of benign mullerian-type glandular inclusions within the lymph node. Results (if a Case Study enter NA) NA. Conclusion As benign MGI is a rare finding in men and can easily be mistaken for metastatic carcinoma, this case demonstrates that clinical awareness of this entity is essential to avoid wrongful diagnosis of metastatic carcinoma and unnecessary therapeutic treatment. Utilizing immunohistochemical stains to further characterize the glands is critical to obtain the correct diagnosis.

The Well-informed Patient: a Survey on Patients' Initiative in Seeking Disease-related Information

Internet and print media are frequently used by laypersons to learn about health issues. The objective of this study was to find out whether people with mental disorders showed a special pattern of usage. Where and why do they seek for information about their disorder? How do they experience their search? In semi-standardized interviews, we surveyed 200 psychiatric inpatients. Only patients of the following diagnostic groups were included: 1. Schizophrenia, schizotypal and delusional disorders (F20-F29), 2. Affective disorders (F30-F39) and 3. Disorders of adult personality and behavior (F60-F69). We focused on the sources the patients had used and the experiences they had in the course of their internet search. The vast majority had already searched for information about psychiatry, psychology or medication via internet or in print media. Most participants described positive emotions while reading. More than two-thirds rated the information as useful. Only 10 participants discontinued or rejected therapeutic measures due to information they had gained. Patients with personality disorders were significantly more likely than other patients to attribute their symptoms to a wrong diagnosis after seeking for information. Overall, psychiatric patients mostly experience helpful effects of reading medical information. In rare cases there are negative effects, e. g. negative emotions, discontinuation of therapy or an incorrect assessment of one's own illness. Further research is required in order to find out how the use of internet by people with mental disorders, which is already successful in many cases, can be improved even further.

Analysis of Savitzky-Golay Filter for Electrocardiogram De-Noising Using Daubechies Wavelets

Electrocardiogram (ECG) examination is of great importance in medical diagnosis of the cardiac disease, but wrong interpretation due to noise interference in the signal could be dangerous as this may lead to wrong diagnoses of patient’s heart condition. De-noising helps to reduce the noise level for a better interpretation of the signals. In this study, an analysis of Savitzky-Golay (S-G) filter for ECG de-noising using Daubechies wavelets has been carried out using MATLAB version 2015a. Noisy ECG signals downloaded from physionet.org under MIT-BIH arrhythmia database was de-noised using S-G filter of polynomial order 9 to data frames of length 21 displayed in both time and frequency domains while a quantitative evaluation was carried out to check the performance of the filter under signal-to-noise ratio (SNR), mean square error (MSE) and signal-to-interference ratio (SIR). Results show that de-noising using S-G filter for SNR, MSE, and SIR gives an average value of 32.78dB, 0.0001 and 1852.358dB respectively. This implies that the S-G filter helps eliminates the background noise as well as maintaining a good fit for our data, and also do not allow co-channel interference from other radio transmitters, which makes it an excellent filter for ECG signal de-noising. Hospitals management and cardiac health centers most understand the importance of these parameters in the selection of de-noising filters for good quality ECG in diagnosis and treatment of cardiac patients.

Monkeypox and Psychotic Manifestations: Possible But Little Recognized Clinical Manifestations

The pox virus is an important pathogen that can cause disease in humans. Monkeypox is a unique type of pox infection. The WHO has acknowledged the seriousness of a massive monkeypox outbreak in 2022. The disease usually presents as an acute febrile illness with skin lesions. The patient usually has many painful vesicular lesions, and this is a common cause of complaint for patients visiting the physician. The patient usually has a history of contact with an infected case and gets the disease. However, sometimes fever or skin damage cannot be detected. Without the special appearance, doctors may miss the problem and make the wrong diagnosis. Basically, clinical diagnosis is the simplest procedure and must be used by practitioners. Laboratory methods can help confirm the diagnosis. The gold standard for diagnosis is molecular-based diagnosis. However, it is important to recognize the atypical clinical problems of monkeypox. In this article, the authors discuss the psychiatric manifestations of monkeypox, a clinical issue that is somewhat addressed. In brief, mental problems are possible in monkeypox. The mental disorder might be the first clinical presentation. In rare cases, patients might have confusion and it is difficult to diagnose. Awareness of the problem is needed. Additionally, the stigma is an important problem for patients with monkeypox. Some patients might have suicidal attempts. Therefore, it is necessary to have good mental health monitoring and support for patients with monkeypox. Last, similar to the previous COVID-19 situation, the influx of new data on monkeypox has occurred and it might be the cause of panic for general people. It is necessary to prepare for control of fake news and provide mental health support to the general public during the outbreak of monkeypox.

Let’s Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse

BackgroundChildren with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent–clinician communication, however, efforts to reduce overprescribing have only indirectly targeted...

A prospective study on the relevance of crush or squash cytology of central nervous system lesions, in the present-day surgery

Background: The intra-operative cytology in the evaluation of central nervous system (CNS) lesions is a simple and rapid technique, and a useful tool. There is not much literature available on the value of crush cytology during the operation. The current study was planned to assess the feasibility and efficacy of intra-operative squash cytology as standalone method in the rapid intra-operative diagnosis of intracranial tumor.Methods: A prospective observational study was carried out in the department of neurology in collaboration with department of pathology, Medanta: The Medicity, Gurugram, for a period of six months from January 2019 to June 2019, on randomly selected 60 patients, aged: 18 years and above. Two to three tissue bits, from different sites of the mass, were taken to prepare squash cytology smear.Results: Out of 60 patients operated, 54 had neoplastic and 6 had non-neoplastic lesions. Neoplastic benign lesions were observed in 41 patients and neoplastic malignant lesions were diagnosed in 13 patients. There was 17.67% offering a wrong diagnosis on crush cytology. Out of the 13 cases of meningioma, there was a discrepancy in 3 (three) cases.Conclusions: Crush cytology is a useful adjunct to the diagnosis in neurosurgical practice. This study suggests and confirms the reliability of squash cytology, but further multicentre studies with larger number of patients may help to decide its use in clinical practice.

Call to Action: Creating Resources for Radiology Technologists to Capture Higher Quality Portable Chest X-rays.

Background Patient rotation, foreign body overlying anatomy, and anatomy out of field of view can have detrimental impacts on the diagnostic quality of portable chest x-rays (PCXRs), especially as the number of PCXR imaging increases due to the coronavirus disease 2019 (COVID-19) pandemic. Although preventable, these "quality failures" are common and may lead to interpretative and diagnostic errors for the radiologist. Aims In this study, we present a baseline quality failure rate of PCXR imaging as observed at our institution. We also conducta focus group highlighting the key issues that lead to the problematic images and discuss potential interventions targeting technologists that can be implemented to addressimagingquality failure rate. Materials and methods A total of 500 PCXRs for adult patients admitted to a large university hospital between July 12, 2021, and July 25, 2021, were obtained for evaluation of quality. The PCXRs were evaluated by radiology residents for failures in technical image quality. The images were categorized into various metrics including the degree of rotation and obstruction of anatomical structures. After collecting the data, a focus group involving six managers of the technologist department at our university hospital was conducted to further illuminate the key barriers to quality PCXRs faced at our institution.. Results Out of the 500 PCXRs evaluated, 231 were problematic (46.2%). 43.5% of the problematic films with a repeat PCXR within one week showed that there was a technical problem impacting the ability to detect pathology. Most problematic films also occurred during the night shift (48%).Key issues that lead to poor image quality included improper patient positioning, foreign objects covering anatomy, and variances in technologists' training. Three interventions were proposed to optimize technologist performance that can lower quality failure rates of PCXRs. These include a longitudinal educational curriculum involving didactic sessions, adding nursing support to assist technologists, and adding an extra layer of verification by internal medicine residents before sending the films to the radiologist. The rationale for these interventions is discussed in detail so that a modified version can be implemented in other hospital systems. Conclusion This study illustrates the high baseline error rate in image quality of PCXRs at our institution and demonstrates the need to improve on image quality. Poor image quality negatively impacts the interpretive accuracy of radiologists and therefore leads to wrong diagnoses. Increasing educational resources and support for technologists can lead to higher image quality and radiologist accuracy.

Challenges and opportunities of smallholder pig production systems in Rwanda.

To decipher the dynamics, challenges, and opportunities of smallholder pig farming in Rwanda, a household survey was conducted in ten districts of the country. A total of 900 households selected randomly across four provinces and one city, 12 districts, 28 sectors, and villages were interviewed using a pretested printed questionnaire. Most of the respondents were heads of household: 70.9% for western, 63.5% in eastern, 54.1% in northern, and 52.5% in southern province, and their mean age was 46.7years and had widely varying education levels. Crossbred pig genotypes were the most preferred due to their high growth rate and produce large litters compared to local pigs, as well as their high resistance to disease, and can better utilize low-quality feeds compared to pure exotic pigs. Piglets and sows were the biggest populations on most farms. Production of piglets for sale was the main purpose of rearing pigs in 63.7% of the farms. Natural mating was almost (99.1%) exclusive on all farms, implying that artificial insemination is yet to take root in Rwanda. Weeds were reported to be the main feed resource used particularly in wet season, while cereal grain mashes and concentrates were used by very few farmers due to high costs. Dominant challenges related to limited pig and pork markets, high taxation, limited extension services, and disease outbreak were highlighted. The most common diseases affecting pigs were swine erysipelas and internal parasites. Access to veterinary services by the households was limited especially in northern province (20%) leading to wrong diagnosis. Capacity building and provision of access to quality animal health services as well as setting up of markets were proposed as strategies to improve pig production by smallholders in Rwanda and grab a share of the lucrative pork market in the region.

SPECTRUM OF PATHOLOGIES IN PATIENTS WITH ENLARGED PROSTATE

Objective: To ascertain the frequency of various pathological disorders related to prostate so that benign lesions of prostate can be distinguished from adenocarcinoma prostate to avoid wrong diagnosis. Material and Methods: This study (descriptive cross sectional) was carried out in the Histopathology Department, Foundation University Medical College, DHA Islamabad from 1st August 2019 to 31st July 2020. A total 200 biopsy specimens from patients between 50 to 92 years of age were fixed in 10 % formalin. The samples were grossed and routinely processed under standard conditions for paraffin embedding. Haematoxylin and Eosin stains were used to stain the slides while special stains were used as per requirement. Microscopic evaluation was done by consultant histopathologists after correlating histopathological findings with clinical data. Results: Total 200 individuals were incorporated in this study. Age of patients ranged from 50 to 92 years. The mean age of study subjects was found to be 67 +9.64 years. Majority (37%) of individuals in the study belonged to age group of 61-70 years. Out of total 200 patients, 179 patients (89.5%) had diagnosis of Benign Prostatic Hyperplasia (BPH). Twenty patients (10%) were diagnosed with Adenocarcinoma prostate. One out of 200 patients (0.5%) was diagnosed as a case of Prostatitis with no other finding. Conclusion: Benign prostatic hyperplasia is most frequent pathology of patients with prostate enlargement. Prostate cancer needs to be distinguished from spectrum of benign lesions to avoid wrong diagnosis. Key Words: Adenocarcinoma prostate, Benign prostatic hyperplasia (BPH), Prostatitis.

P1.15-01 Differential Diagnosis of Pneumonitis in Metastatic NSCLC (Non-Small Cell Lung Cancer) Patients Receiving Immunotherapy With Radiomics

Immunotherapy-induced pneumonitis (IIP) is a rare side effect but decreases patients’ quality of life and often leads to permanent Immunotherapy (ICI) cessation. The diagnostic challenge is the overlapping clinical manifestations of IIP and Other types of Pneumonitis (OP), such as infectious pneumonitis. A wrong diagnosis may lead to inappropriate toxic treatment (high-dose steroids) or needless cessation of ICI. We developed a combined radiomic and clinic model to support a better differential diagnosis.

Associations among Stroke, Myocardial Infarction, and Amaurosis Fugax in a Tertiary Referral Hospital in Taiwan.

Background: To determine the associations among carotid stenosis, stroke, and myocardial infarction (MI) in patients with amaurosis fugax (AF). Methods: We retrospectively reviewed the records of patients diagnosed as having AF between January 2000 and December 2019. Among 14,857 patients with AF initially reviewed in the database, only 173 were ultimately enrolled, after excluding patients with wrong diagnosis, insufficient medical records, or loss of follow-up. Results: Of the 173 patients with AF, 61 (35.3%) had carotid stenosis, and among them, 18 (10.4%) had severe stenosis. In multivariate regression analysis, carotid stenosis was significantly associated with age (p = 0.009), male sex (p = 0.006), and ischemic heart disease (p = 0.039). Sixteen (9.2%) patients experienced a stroke after AF diagnosis (mean time to stroke: 23.1 ± 31.1 months, range: 1 day~85 month), 11 (68.8%) of whom had carotid artery stenosis (p = 0.003). Three (1.7%) patients had MI after AF (mean time to MI: 24.8 ± 35.9 months, range: 12 days~66 months), none of whom had carotid artery stenosis (p = 0.553). Four (2.3%) patients had central retinal artery occlusion (CRAO) after AF, all of whom had carotid artery stenosis (p = 0.034). Conclusions: A high incidence of internal carotid artery stenosis was observed after AF attack and was significantly associated with stroke. The incidence of MI and CRAO after AF was low. Among them, only CRAO was associated with carotid artery stenosis.

Left-sided appendicitis due to anatomical variation: A case report

IntroductionLeft-sided appendicitis is a rare condition, and we report a patient with left abdominal heterotopia of the right colon complicated by acute appendicitis in the left lower quadrant.Case presentationA 39-year-old male was admitted to hospital following left lower abdominal pain for 1 day. Imaging examination by abdominal CT showed that the appendix was not clearly seen, and a mass was found in the left lower abdomen. Because the patient's abdominal pain was severe and the current diagnosis was not clear, after soliciting the patient's consent, we performed laparoscopic exploration. This exploration revealed that the cecum and ascending colon were located in the left iliac fossa, the appendix was swollen, the length of the appendix was approximately 6 cm, the diameter of the appendix was approximately 1 cm, and there was pus moss attached to the surface. We performed a laparoscopic appendectomy; the procedure was uneventful and the patient was discharged 3 days after the procedure.ConclusionLeft-sided appendicitis is a rare condition and is therefore easy to misdiagnose. Wrong diagnosis can lead to serious complications and endanger the patient's life. Therefore, a full combination of laboratory tests and CT scan is required. If still no diagnosis can be made correctly, a laparoscopic exploration needs to be performed in a timely manner. This case teaches us that when we encounter a patient with severe left abdominal pain that cannot be definitely diagnosed, we need to be vigilant and perform timely laparoscopic exploration when necessary.

Ultrasound and Magnetic Resonance Imaging of Burned-Out Testicular Tumours: The Diagnostic Keys Based on 48 Cases.

Simple SummaryIn rare cases, testicular cancers regress spontaneously. This is known as a burned-out testicular tumour. Few data have been published regarding the radiological appearance of these lesions. In this study, we describe the lesions observed in 48 patients using several imaging techniques (conventional ultrasound, advanced ultrasound techniques and MRI). In both ultrasound and MRI, there are features that allow the recognition of such lesions and may help in the correct management of these patients by proposing orchiectomy.The spontaneous regression of testicular germ-cell tumours is a rare event whose mechanisms have yet to be elucidated. In the majority of published cases, tumour regression is concomitant with the metastatic development of the disease. Residual lesions, often referred to as burned-out testicular tumours (BOTTs), are difficult to diagnose due to the paucity of published data, especially in the field of imaging. The aim of this article is to describe the radiological signs of BOTTs on multimodal ultrasound and multiparametric MRI from a series of 48 patients whose diagnosis was confirmed histologically. The demographic, clinical and laboratory characteristics of the patients are studied, as well as the data of the imaging examinations, including conventional scrotal ultrasound, shear-wave elastography, contrast-enhanced ultrasound (CEUS) and multiparametric MRI. A total of 27 out of 48 patients were referred for investigation of primary testicular lesion following the discovery of retroperitoneal metastases, 18/48 patients were referred because of lesions suspected on an ultrasound that was performed for an infertility work-up, and 3/48 were referred because of scrotal clinical signs. Of these last 21 patients (infertility work-up/scrotal clinical sign), 6 were found to be metastatic on the extension work-up. Of the 48 orchiectomy specimens, tumour involution was complete in 41 cases, and a small active contingent remained in 7 cases, with 6 suspected upon advanced US and MRI. Typically, BOTTs appear on a conventional ultrasound as ill-delineated, hypoechoic and hypovascular nodular areas. Clustered microliths (60.4%) and macrocalcifications (35.4%) were frequent. Shear-wave elastography showed areas of focal induration (13.5 ± 8.4 vs. 2.7 ± 1.2 kPa for normal parenchyma, p < 0.01) in 92.5% of the patients for whom it was performed, and contrast ultrasonography demonstrated hypoperfusion of these lesions. Of the 42 MRIs performed, BOTTs corresponded to nodules on T2-weighted sequences (hyposignal) with significantly increased ADC values compared with healthy parenchyma (2 ± 0.3 versus 1.3 ± 0.3 × 10−3 mm2/s, p < 0.01) and an enhancement defect after injection. This enhancement defect overlapped the lesions visible on T2-weighted sequences in most cases. In the case of predominant partial regression, an enhanced portion after contrast injection was visible on MRI in all seven patients of our series, and in six of them a focal diffusion restriction zone was also present. Spontaneously involuted testicular germ-cell tumours have specific radiological signs, and all of the mentioned examinations contribute to this difficult diagnosis, even histologically, because there is no tumour cell left. These signs are similar whether the patient is initially symptomatic metastatic or whether the discovery is fortuitous on the occasion of an infertility work-up, and whatever the seminomatous or non-seminomatous nature of the germ-cell tumour, when this can be determined. The appearance of regressed germ-cell tumours is often trivialized, which can lead to the wrong diagnosis of an extra gonadal germ-cell tumour (in metastatic patients) or of scarring from an acute event such as trauma or infection, which is not recognized or forgotten. In our series, two patients had an unrecognized diagnosis in their history, with local and/or distant recurrence. An improvement in diagnosing burned-out tumours, combining advanced US and MRI, is necessary in order to optimize patient management, with special attention paid to asymptomatic patients, to prompt extension screening and orchiectomy with analysis of the whole testis. This may reveal a persistent viable tumour or lesions of germinal neoplasia in situ, which are precursors of testicular germ-cell tumours.

CRANet: a comprehensive residual attention network for intracranial aneurysm image classification

Rupture of intracranial aneurysm is the first cause of subarachnoid hemorrhage, second only to cerebral thrombosis and hypertensive cerebral hemorrhage, and the mortality rate is very high. MRI technology plays an irreplaceable role in the early detection and diagnosis of intracranial aneurysms and supports evaluating the size and structure of aneurysms. The increase in many aneurysm images, may be a massive workload for the doctors, which is likely to produce a wrong diagnosis. Therefore, we proposed a simple and effective comprehensive residual attention network (CRANet) to improve the accuracy of aneurysm detection, using a residual network to extract the features of an aneurysm. Many experiments have shown that the proposed CRANet model could detect aneurysms effectively. In addition, on the test set, the accuracy and recall rates reached 97.81% and 94%, which significantly improved the detection rate of aneurysms.

AI-driven deep and handcrafted features selection approach for Covid-19 and chest related diseases identification.

To identify various pneumonia types, a gap of 15% value is being created every five years. To fill this gap, accurate detection of chest disease is required in the healthcare department to avoid any serious issues in the future. Testing the affected lungs to detect a Coronavirus 2019 (COVID-19) using the same imaging modalities may detect some other chest diseases. This wrong diagnosis strongly needs a multidisciplinary approach to the right diagnosis of chest-related diseases. Only a few works till now are targeting pathological x-ray images. Many studies target only a single chest disease that is not enough to automate chest disease detection. Only a few studies regarding the observation of the COVID-19, but more cases are those where it can be misclassified as detecting techniques not providing any generic solution for all types of chest diseases. However, the existing studies can only detect if the person has COVID-19 or not. The proposed work significantly contributes to detecting COVID-19 and other chest diseases by providing useful analysis of chest-related diseases. One of our testing approaches achieves 90.22% accuracy for 15 types of chest disease with 100% correct classification of COVID-19. Though it analyzes the perfect detection as the accuracy level is high enough, but it would be an excellent decision to consider the proposed study until doctors can visually inspect the input images used by models that lead to its detection.

A Rare Case of Haemoglobin J-Toronto in a Child

Introduction: India is an ethnically diverse country with marked regional variation. This diversity is often reflected in the presence of different Hemoglobin variants. Hb variants arise due to mutations in the genes encoding for the α-chain and β-chain. Hb J is an infrequently found α-globin variant. It is a Fast moving hemoglobin. Haemoglobin J (Hb-J) was first described by Thorup et al. in an African-American patient (1956) and since then more than 50 variants of Hb-J are identified. Hb J-Toronto [alpha5(A3) Ala&gt;Asp] is one of the rare variants identified. Case report: Blood sample of one year old child for high-performance liquid chromatography was received. The HPLC showed an abnormally high peak in P3 window on BIO RAD D10 machine. The high-performance liquid chromatography showed normal hemoglobin Hb F and Hb A2, but showed elevated levels of P3 (31.7%) which indicates presence of a Hb J variant. Conclusion: Hb J-Toronto is a rare variant of abnormal hemoglobin. It has little clinical significance in heterozygous state but when combined with other variants, they may give rise to severe disease.Prenatal analysis, especially by HPLC, is a key screening method to avoid hemoglobinopathies in off springs. One important clinical condition which may lead to a wrong diagnosis of FMH’s is uncontrolled diabetes mellitus.

Semiologic differences between bilateral tonic-clonic seizures of focal onset and generalized onset

BackgroundFocal semiologies have been described in idiopathic generalized epilepsies (IGE) and generalized-onset bilateral tonic-clonic seizures (GBTCS). These focal signs may lead to wrong diagnosis and inappropriate choice of antiseizure medications. We sought to investigate the differences in focal semiologic features between GBTCS and focal-onset bilateral tonic-clonic seizures (FBTCS). MethodsWe retrospectively reviewed video-EEG data of captured GBTCS and FBTCS over a period of five years. The presence or absence of 12 focal signs as well seizure duration and time to head version was tabulated for each seizure. We used the chi-square test for independence and Fisher’s exact test to investigate the occurrence of each focal sign in FBTCS compared with GBTCS. Additionally, we used receiver operating characteristic (ROC) curves to explore if the seizure duration and time to head version from the ictal onset can reliably differentiate between FBTCS and GBTCS. Finally, we employed hierarchical cluster analysis to visualize how these focal signs appear in combination. ResultsHead version (p <.001), preceding automatisms (p <.001), eye version (p <.001), unilateral facial clonic activity (p <.001), and mouth deviation (p =.004) were found to be significantly more frequent in FBTCS. Longer seizures were highly in favor of FBTCS whereas shorter time to head version from the ictal onset indicated GBTCS in the ROC curve analysis. ConclusionsThough focal signs occur in GBTCS, careful evaluation of semiology can help the clinician distinguish FBTCS from GBTCS.

Cancer Detection using Deep Learning: A Survey

Cancer refers to a group of diseases that are defined by abnormal cell proliferation and can spread to other parts of the body. Pancreatic cancer originates in the organ behind the lower stomach called the pancreas. The pancreas secretes digestive enzymes as well as hormones that help regulate sugar metabolism. Pancreas cancer is usually discovered late, spreads quickly, and has a poor prognosis. Cancer-specific symptoms may not appear until later stages, and there are no reliable screening techniques to identify high-risk patients. The manual method of checking whether a patient has Pancreatic cancer or not can be time-consuming and it can be tedious because it required experience in Radiologist interpretation; to avoid poor decisions by giving wrong diagnoses to patients. One of the leading causes of cancer death is pancreatic cancer; however, if found early enough, it can be treated. To solve this issue, an Artificial Neural Network (ANN) has been developed, trained, and tested using an abdominal Computed Tomography (CT) scan images dataset to detect pancreatic tumors by many authors. To detect the tumor, it employs image processing techniques of a convolution neural network to detect the tumorous area in the image after it has been pre-processed. It was observed that the technique gives better accuracy in tumor detection.&#x0D;