Three-dimensional printed flow phantom model of the carotid artery in preterm infants for training and research

The aim of this study was to perform flow volume measurements with Doppler ultrasound using novel 3D printed flow phantom models of carotid artery in preterm infants with varying characteristics. Clinical data from cerebral blood flow measurements using Doppler ultrasound of the right common carotid artery from premature newborn infants were used to produce a 3D printed Doppler flow phantom model with three different vessel diameters; 0.158 cm, 0.196 cm and 0.244 cm. Leading edge to centre was used to measure vessel diameter. Two observers performed flow volume measurements using continuous and pulsatile flow. Agreement between observers was examined using Bland-Altman plots. 24 measurements were performed. 18 (75%) measurements were performed using continuous flow. Pulsatile flow measurements were performed on lumen diameter of 0.244 cm only using physiological rates. Bland-Altman analysis for continuous flow measurements for observer 1 and 2 were -0.007 (95%LOA -4.3 to 4.3) ml/min and 3.2 (95%LOA -2.7 to 9.1) ml/min. Bias for pulsatile flow measurements for observer 1 and 2 were 1.5 (95%LOA -0.8 to 3.8) ml/min and 4.6 (0.7 to 8.5) ml/min respectively. Inter and intra-observer reliability was excellent for majority of measurements. The mean coefficient of variation for inter observer diameter measurements was 1.2% and intra observer measurements were between 1.5% to 3.9% for both observers. Flow volume measurements performed using 3D printed materials resulted in realistic echogenicities mimicking biological tissues. Validity and reliability studies, within and between, observers showed acceptable results. Researchers and clinicians can use this model for further training and simulation.

TOWARDS GLOBAL OPTIMIZATION OF NEURAL NETWORK: A COMPARATIVE ANALYSIS USING GENETIC AND WHALE OPTIMIZATION ALGORITHMS

The intelligence and adaptability features of the neural network has made it a technique that is widely used to solve problems in diverse areas such as; detection, monitoring, prediction, diagnostics, data mining, classification, recognition, robotics, biomedicine, etc. However, determination of the optimal number of hidden layers of neural network and other parameters are still a difficult task. Usually, these parameters are decided by trial-and-error which increases the computational complexity and it is human dependent in obtaining the optimal model and parameters alike for any particular task. Optimization has received enormous attention in recent years, primarily because of the rapid progress in computer technology, including the development and availability of user-friendly software, high-speed and parallel processors, and artificial neural networks. This research work is to propose a neuro-evolutionary model using the computational intelligence techniques by combining ANN, GA and WOA for binary classification problems. The proposed optimized ANN-GA and WOA models is to circumvent the problem that is characterized in the trade-off between smoothness and accuracies in selecting the models and optimal parameters of neural network.

Evaluation of Eye Lens Dose Reduction Technics in Head CT

The purpose of this study is to find the best protocol to reduce the X-ray dose to the eye lens during head diagnostic computed tomography (CT) without decreasing image quality in the organs of interest according to the type of scanner. The lens of the eye is one of radiosensitive tissues in the body. Radiation induced cataract has been demonstrated among staff involved in interventional procedures using X-rays. This study compares the absorbed dose and image quality of several dose reduction technics to the eye lens during head CT exam namely bismuth shielding, organ-based dose modulation, tube current modulation, tube voltage modulation and the combination of a number of these techniques. Compared to the reference scan (Fixed tube current without bismuth shielding), the dose to the eye lens was reduced by 29.91% with bismuth shield, 14.55% with tube current modulation, 37.76% with tube current modulation and bismuth shield. The combination of organ-based dose modulation with tube voltage modulation reduced the dose by 44.93% that of tube current modulation with tube voltage modulation reduced by 19.03% and that of tube current modulation with tube voltage modulation and shield by 46.73%. The combination of organ-based dose with tube voltage modulation provided superior image quality than that of tube current modulation with tube voltage modulation and shield while similarly reducing dose to the eye lens.

Role of fine needle aspiration cytology (FNAC) in diagnosing Pancreatic lesions in a tertiary care institution

OBJECTIVE- FNAC is an accurate and rapid technique for diagnosing pancreatic masses. Pancreatic carcinoma represents the seventh leading cause of cancer death in the world, responsible for more than 300,000 deaths per year.[1] Worldwide, both the incidence and death rates of pancreatic cancer are increasing. The aim of this study was early diagnosis of these lesions and to evaluate its burden and study the global, regional, and national patterns. These would further aid in policy making , better resource allocation for controlling pancreatic cancer risk factors and formulating more effective treatments.[2] METHODS- This was a retrospective observational study performed at a tertiary care hospital over a period of one and a half year. A total of 86 patients with pancreatic lesions were subjected to image guided FNA . 35 of these patients underwent diagnostic histopathology in addition to FNA. RESULTS- The 86 cases analyzed were in the age group of 61-70 years with mean age distribution of 57.34 years. Male predominance was seen with M:F ratio of 2.18:1. Head was the most common area to be aspirated followed by tail and least number of lesions were in body of pancreas. Maximum cases were found to be malignant (55) in etiology. Only 2 were non diagnostic because one of them had insufficient cellularity and other had necrosis mainly on histopathology. Adenocarcinoma was the most common malignancy found followed by one case each of lymphoma and solid pseudo papillary neoplasm of pancreas. Histo pathological correlation was obtained in 91.42% cases proving that FNA is a very useful tool in early diagnosing pancreatic lesions.

One-Time Cortical Lamina: A New Technique for Horizontal Ridge Augmentation. A Case Series

The aim of this case series is to introduce the One-Time Cortical Lamina Technique, a simplification of the F.I.R.S.T. (Fibrinogen-Induced Regeneration Sealing Technique) in cases where only horizontal augmentation is needed. The indications for this technique are ASA2 and ASA1 anxious patients. Pre-requisites for this surgical technique are: a good amount of keratinized tissue, sufficient alveolar ridge width for placement of implants, thickness of vestibular bone at CBCT planning less than 1 mm with risk of threads exposure. Five patients with horizontal deficiencies were selected to test the efficacy of this approach. The defects were augmented using a porcine cortical bone lamina in combination with collagenated porcine bone mixed with fibrin sealant. The cortical lamina was placed only buccal to the implants and stabilized with fibrin sealant, without pins or screws. Upon completion of the implant surgery, healing abutments were connected to the implants and the soft tissue sutured around them. The healing was uneventful in all cases. Six months after surgery impressions for final restorations were taken and screwed crowns delivered. The new volume had hard consistency and the follow-up CBCT measured an average of 4.17 mm of horizontal bone augmentation. One to three years of follow up demonstrated the maintenance of vestibular volume, hard consistency and clinical stability. Intraoral X-rays showed no marginal bone loss. An advantage of this technique could be the one stage surgery that creates a stable environment for regeneration from day one.

Diameter measurements in three-dimensional printed flow phantom model of the carotid artery in preterm infants

Diameter form an integral part of blood flow measurement. This study aimed to explore different three-dimensional (3D) printed materials to develop flow phantom models of the carotid artery in preterm newborn infants and to investigate ideal diameter measurement points using ultrasound that reflected accurate lumen diameter measurement. Cerebral blood flow measurements data using Doppler ultrasound of the right common carotid artery from 21 randomly selected preterm infants were used to produce a 3D printed Doppler flow phantom model with three different vessel diameters. Diameters were measured by multiple observers blinded to phantom vessel characteristics and each other’s measurements. 9 measurement points were studied. Agreement between observers, inter and intra observer reliability and coefficient of variation (CoV) was examined. Of the 63 diameter measurements, 45 (71%) were performed on flow phantoms with vessel diameter of 0.196 cm. Bland-Altman plots revealed that measurement performed using leading edge to centre (mean bias 1.8% {95%LOA -4.1% to 7.7%}) and centre to trailing edge (mean bias 1.1% {95%LOA -5.4% to 7.8%}) resulted in the most accurate lumen diameter measurements. Inter and intra-observer reliability was excellent. The mean CoV for inter observer measurements was 1.7% and intra observer measurements was 1.6% and 1.8% for each observer. We successfully produced a 3D printed flow phantom model of the carotid artery in preterm infants and identified two measurement methods that result in reliable and accurate lumen diameter measurement. Researchers and clinicians can use this information for further studies involving ultrasound diameter measurements in small calibre vessels.

Management of Avascular necrosis of femur head with the help of Arthrox- A case study.

Osteonecrosis or bone infarction, which is a death of bone tissue due to interruption of the blood supply, is also called as avascular necrosis (AVN) and the most commonly affected bone is femur. Line of treatment may include some medication, bed rest, stretching, physiotherapy and surgery. As many as 20,000 people develop AVN each year, most ages between 20 and 50 commonest being in male then in female. Due to lack of promising results patient search for alternative therapies and remedies. We can apply basic principles of Ayurveda to treat any modern disease like AVN. This disease can be correlated with Asthi majja gata vata described in the Samhitas and Asthivaha srotodushti vikaras. ). In this article a male patient diagnosed as Asthi Majja gata vata is treated with Arthrox treatment which includes Virechana, Karma Basti and Hip dhara. His symptoms were assessed by two methods: Visual Analog Scale (VAS) change in pain and Harris Hip Score. Both help to ascertain overall quality of life. The patient was also given customized herbal remedies, manufactured by Ayushakti Ayurveda. With the help of this we can avoid the surgery, we can reduce the pain and we can serve a better quality of life for the patients with avascular necrosis of femur head. The recovery in this case was promising and was worth for documentation.

Chronic Whiplash Syndrome: Associated Disorders and Physiotherapy Management – A Literature Review

Purpose: The purpose of the current literature review is to present the Whiplash Associated-Disorders through diagnosis, scales, physical examination and to identify the most suitable physiotherapy management of these conditions. The long-term effectiveness of physiotherapy interventions is also examined. Methods: Sixteen randomized controlled trials (RCTs) and seven case-control and cohort studies related to chronic WAD fulfilled the inclusion and exclusion criteria. The design, diagnosis, population, methodology, results, methodological quality and physiotherapy management were examined. The PEDro Scale and the Newcastle-Ottawa Scale were used for the examination of the methodological quality. Results: The methodological quality of the studies used, were high. Significantly important on minimizing the symptoms of chronic WAD were the combination of Exercise therapy & Advice both at 6 and 12 months follow up. Other interventions such as Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not equally effective in the long-term. Conclusion: The most suitable intervention for the physiotherapy management of chronic WAD, with long-term effectiveness was the combination of Exercise & Advice, which was established with various outcome measures, such as NDI, VAS, NRI and SF-36. On the contrary, Exercise therapy, Interdisciplinary approach and Multimodal physiotherapy treatment, Spinal Manual therapy and Advice were not that effective on minimizing the symptoms of chronic WAD in the long-term.

The Use of Doppler Ultrasound to Diagnose Deep Vein Thrombosis of the Lower Limbs

In most cases of pulmonary embolism, death occurs as a result of deep vein thrombosis (DVT) of the lower extremities. Therefore, to avoid DVT complications and sequel, DVT must be diagnosed as early as possible and this can be achieved via B-mode and colour Doppler imaging. The present paper seeks to investigate the suitability of the imaging method of ultrasound for lower extremity DVT diagnosis and to explore the outcomes of the use of this method in DVT cases. To this end, the paper undertakes a retrospective descriptive study of 50 cases of ultrasound-based diagnosis of DVT at King Khalid Hospital in the period between January 2019 and August 2020. Half of the cases were subjected to compression, colour, and duplex ultrasound, 14 cases were subjected to compression and duplex ultrasound, and 11 cases were subjected to compression and colour Doppler. The mean age across all cases was 46.2±19.9 years. The majority of cases (56%) were in the age range 22-41 years old (n=28), while 28% of cases were in the age range 42-61 years old (n=14), 6% of cases were in the age range 62-81 years old (n=3), and 10% of cases were in the age range 82-102 years old (n=5). Regarding sex, females accounted for 60% of cases, while males accounted for the rest of 40%. Furthermore, in 90% of cases (n=45), just one lower extremity was affected, whereas in 10% of cases (n=5), both lower extremities were affected. Regarding thrombus location, it was found mostly in the area above the knee, particularly the popliteal vein (34%), common femoral vein (18%), and superficial femoral vein (20%). Moreover, 2% of cases presented thrombus in the calf vein. In 26% of cases, multiple veins were affected. DVT was acute in 76% of cases (n=38) and chronic in 24% of cases (n=12). It is concluded that symptomatic and at-risk cases benefit from the use of ultrasound for DVT diagnosis. The suitability of this method stems from its lack of invasiveness and capability to assess thrombus location, magnitude, and stage.

The Effect Of Health Service On Patient Satisfaction In Haji Hospital, Medan City

The study aimed to determine the effect of quality and the dominant variables affecting service on patient satisfaction at the Haji Hospital-Medan in 2020. Quantitative research was conducted through a survey analytic research approach with a cross sectional study approach. Test through logistic regression on independent variables, namely; Reliability, Responsiveness, Assurance, Empathy and Tangible from the questionnaire data of respondents as many as 80 samples. The results showed that there was a significant effect of service quality on patient satisfaction from four variables, namely; the reliability of the p value is 0.000 (p <0.05), the responsiveness of the p value is 0.038 (p <0.05), the empathy p value is 0.016 (p <0.05), the tangible p value is 0.001 (p <0.05). The assurance variable, there is no effect of the quality of health services on patient satisfaction with a p value of 0.696 (p> 0.05). The dominant variable affecting patient satisfaction is the variable of empathy with an odds ratio of 0.2120.