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Action recognition based on skeleton key joints has gained popularity due to its cost effectiveness and low complexity. Existing Convolutional Neural Network (CNN) based models mostly fail to capture various aspects of the skeleton sequence. To this end, four feature representations, which capture complementary characteristics of the sequence of key joints, are extracted with novel contribution of features estimated from angular information, and kinematics of the human actions. Single channel grayscale images are used to encode these features for classification using four CNNs, with the complementary nature verified through Kullback-Leibler (KL) and Jensen-Shannon (JS) divergences. As opposed to straightforward classifier combination generally used in existing literature, fuzzy fusion through the Choquet integral leverages the degree of uncertainty of decision scores obtained from four CNNs. Experimental results support the efficacy of fuzzy combination of CNNs to adaptively generate final decision score based upon confidence of each information source. Impressive results on the challenging UTD-MHAD, HDM05, G3D, and NTU RGB+D 60 and 120 datasets demonstrate the effectiveness of the proposed method. The source code for our method is available at https://github.com/theavicaster/fuzzy-integral-cnn-fusion-3d-har

Patients with renal failure and on maintenance hemodialysis (HD) have a higher propensity toward cardiovascular and infectious diseases. The aim of this study was to find the causes for hospital admission in patients suffering from kidney failure and on maintenance HD. This cross-sectional, observational study was conducted in a tertiary care hospital in West Bengal, India, from January to December, 2015. Patients with chronic kidney disease stage 5 for more than one year and on HD with arteriovenous fistula admitted for other than HD were included in the study. Days of hospital stay and current diagnosis were stored for further analysis. Data were expressed in mean, standard deviation, percentage, and frequency. All the statistical tests were carried out in GraphPad prism 6.01. Data of total 49 (30 male, 19 female) patients with mean age 55.8 ± 10.98 years (range 27-75 years) were analyzed. Eighteen (36.73%) and 48 (97.96%) patients were suffering from type 2 diabetes mellitus and hypertension (HTN), respectively. Average stay in hospital was 10.31 ± 6.07 days (range: 5-43 days). Most common causes for hospitalization were left ventricular failure (LVF) (59.18%) followed by respiratory tract infection (RTI) (14.29%). In patients with renal failure receiving maintenance HD, LVF is the most common cause for hospital admission followed by RTI. Hence, the management of HTN and preventive measures for RTI should be stressed in HD patients.

Biomedical images contain a large volume of sensor measurements, which can reveal the descriptors of the disease under investigation. Computer-based analysis of such measurements helps detect the disease, and thereby swiftly aid medical professionals to choose adequate therapy. In this paper, we propose a robust deep learning ensemble framework known as COVID Fuzzy Ensemble Network, or COFE-Net. This strategy is proposed for the task of COVID-19 screening from chest X-rays (CXR) and CT Scans, as a part of Computer-Aided Detection (CADe) for medical practitioners. We leverage the strategy of Transfer Learning for Convolutional Neural Networks (CNNs) widely adopted in recent literature, and further propose an efficient ensemble network for their combination. The principles of fuzzy logic have been leveraged to combine the measured decision scores generated by three state-of-the-art CNNs – Inception V3, Inception ResNet V2 and DenseNet 201 – through the Choquet fuzzy integral. Experimental results support the efficacy of our approach over empirical ensembling, as the fuzzy ensembling strategy for biomedical measurement consists of dynamic refactoring of the classifier ensemble weights on the fly, based upon the confidence scores for coalitions of inputs. This is the chief advantage of our biomedical measurement strategy over others as other methods do not adjust to the multiple generated measurements dynamically unlike ours.Impressive results on multiple datasets demonstrate the effectiveness of the proposed method. The source code of our proposed method is made available at: https://github.com/theavicaster/covid-cade-ensemble .

Introduction: Biopsy registries are important in studying the frequency of kidney diseases, their trends over time and allow comparison of data from different geographical regions. Objectives: We report the spectrum of biopsy-proven glomerular and tubular diseases in a single centre in Eastern India. Patients and Methods: Medical records of 1293 patients with biopsy-proven glomerular diseases (GDs) and tubular diseases over a period of three years (March 2013 to March 2016) were retrospectively analysed. All biopsy specimens were examined by the same pathologist with light and immunofluorescence microscopy. Electron microscopic (EM) analysis was performed only in selected cases. Histologic spectrum of various GDs was studied along with its correlation with the clinical and laboratory parameters. Results: The clinical diagnosis was nephrotic syndrome (NS) in 820 (63.41%), rapidly progressive glomerulonephritis in 194 (15.2%), asymptomatic urinary abnormalities (AUA) in 108 (8%), acute kidney injury (AKI)/acute nephritic syndrome in 118 (9.3%), and macroscopic hematuria (MH) in 3 (0.43%) patients. Male: Female ratio was 0.95. Around 22.42% were < 18 years, 72.2% were between 18to 59 years, and 5.3% were ≥ 60 years of age. The most common GD overall as well as primary glomerular disease (PGD) was minimal change disease (MCD) (21.6 and 83.44%). Secondary GD was present in 20.87%; most common being lupus nephritis (84.58%). Among the NS, the most common GD was MCD (33.17%), followed by FSGS (17.56%), membranous nephropathy (MN) (13.90%), lupus nephritis (LN) (9.39%), IgA-nephropathy (0.49%), and MPGN (7.32%). Thrombotic microangiopathy (TMA) constituted 24.6% of AKI presentation particularly common in pregnancy. Diffuse proliferative glomerulonephritis (DPGN) with severe renal dysfunction was present in 14% of elderly patients. Conclusion: The spectrum of GD varies according to the area of study and changes over time. Some entities which have not been reported earlier from this region that are uncommon but are significant were pregnancy associated TMA, C3 glomerulopathy (C3G) and DPGN in adults.

We present our case of a 16 year old boy presenting to us with shortness of breath and having features of both nephritic and nephrotic syndrome leading to intubation and ventilation due to pulmonary embolism. Nephrotic syndrome is characterised by heavy proteinuria (>3g/24hrs), hypertension, hypercholesterolemia, hypoalbuminemia, anasarca and microscopic hematuria whereas nephritic syndrome is characterised by the presence of proteinuria (1-2g/24hrs), hematuria, pyuria, hypertension, red blood cell casts, fluid retention, rise in serum creatinine with reduction in glomerular filtration rate. Both the diseases are separate entities however in certain cases, there can be overlapping of the components of both this syndrome.

Introduction: A Significant proportion of steroid-resistant nephrotic syndrome (SRNS) patients who do not achieve remission will progress to end-stage renal disease (ESRD). Objectives: Calcineurin inhibitors (CNIs) are recommended as a first line therapy in SRNS but the data on tacrolimus (TAC) and its potential nephrotoxicity in SRNS patients is limited. Patients and Methods: This is a prospective single arm study conducted at IPGMER Kolkata from August 2013 to December 2015. All SRNS patients underwent kidney biopsy before the initiation of therapy. Patients with identified secondary causes of FSGS, eGFR ≤ 45 mL/min/1.73 m2, or more than 5% of interstitial fibrosis and tubular atrophy (IFTA) on biopsy were excluded. TAC was given 0.075 mg/kg (adjusted to maintain TAC trough level i.e. T0 of 5-7 ng/mL) with low-dose steroids. Those who completed 12 months of TAC underwent second biopsy. Primary outcome was a percent of partial or complete remission (CR) or refractory. Secondary outcome was time to achieve remission, relapses, and proportion of patients who had adverse effects. Results: Thirty-two patients were enrolled. Overall remission was seen in 28 patients (87.5%). CR was seen in 17 (53.13%) and partial remission (PR) was seen in 11 (34.38%). Four patients (12.5%) were refractory to therapy. Average time to achieve PR was 72.53 ± 62.57days while average time to achieve CR was 63.84 ± 27.32 days. Mean TAC dose required was 1.75 ±0.86 mg. Thirteen patients (40.63%) had relapses. One patient needed admission for diarrhea. All other adverse effects were managed on outdoor basis. None required discontinuation of TAC therapy. Compared with the baseline biopsy two patients had increase in IFTA and another one developed IFTA on one year protocol biopsy. Conclusion: Low dose TAC maintaining trough levels (T0) of 5 to 7 ng/mL with low dose steroid is an effective option for patients with SRNS. It is well tolerated and efficacious in achieving remission.

This is a case report of occurrence of paroxysmal atrial fibrillation (AF) in a previously healthy 50-year-old man after suffering from a nonfatal electrical injury. The patient developed palpitation and sustained nonfatal electrical burn in his right hand after coming in contact with 440 voltage alternating current. His electrocardiogram done at the emergency revealed AF. However he was hemodynamically stable and hence put under conservative therapy. He reverted back to sinus rhythm within 24 h of admission and continued to remain so. Although ventricular arrhythmia is common after electrical injury, AF has been rarely reported in literature.

This study was undertaken to find out the characteristics of clinical, radiological and functional changes affecting the respiratory system in patients with systemic sclerosis (SSc) from eastern India, and the association of these characteristics with pulmonary hypertension.This was a cross-sectional, observational study involving 46 patients. Other than the routine tests, anti-nuclear antibody (ANA), spirometry, diffusing capacity of lung for carbon monoxide (DLCO) measurement, chest radiograph, high-resolution computed tomography (HRCT) of thorax, 6-minute walk test and echocardiography were done.Out of a total of 46 patients, 27 patients had diffuse cutaneous SSc (dcSSc) and 19 had limited cuteaneous SSc (lcSSc). Eleven patients had pulmonary hypertension. The HRCT revealed diffuse parenchymal lung disease (DPLD) in 32 (65%) cases. The ANA was positive in 83% cases. Anti-Scl70 was found in 41% of patients with dcSSc and anti-centromere antibody was found in 47% of patients with lcSSc. Spirometry revealed restrictive pattern in 30 patients; 9 had obstruction; and the rest were normal. The DLCO was abnormal in 38 patients. A strong correlation was found between reduction in DLCO and pulmonary artery systolic pressure (PASP). Also, a strong association was observed between a drop of4% in oxygen saturation on 6-minute walk test and presence of pulmonary arterial hypertension (PAH).Majority of the patients with SSc had restrictive lung disease with abnormal DLCO and features resembling non-specific interstitial pneumonia. Nucleolar ANA was predominantly found in patients having PAH. Presence of DPLD had a negative association with presence of anti-centromere antibody. Reduction in DLCO and a fall of4% in oxygen saturation on 6-minute walk test may be used as predictors of PAH in asymptomatic individuals.

Accidental exposure to chemicals and toxins is an important cause of acute kidney injury in the tropics. We report a case of a 26-year-old female who presented with acute kidney injury following a history of accidental ingestion of some white powder mistaken for table salt. Urine microscopy revealed the presence of calcium oxalate crystals. Because accidental poisoning was suspected despite normal 24-h oxalate excretion, renal biopsy was performed, which showed acute tubular injury with occasional refractile oxalate crystals. The patient improved symptomatically with conservative management and did not require haemodialysis. Subsequently, renal functioning showed an improving trend. Oxalic acid poisoning is relatively rare but is an emerging sporadic as well as epidemic poison in some regions.

Background: This study was undertaken to find out if metabolic syndrome (MetS) in the elderly was associated with cognitive decline and also if this association was modified by the presence of inflammation. Materials and Methods: 100 patients more than 60 years of age were divided into 2 groups of 50 each and were age and sex matched. Group 1 and 2 had patients with and without MetS, respectively. The individual components of MetS were measured in each patient. Cognitive decline was measured by Modified Mini-Mental Score (3MS) of Teng. Inflammation was measured by high-sensitivity C-reactive protein (hs-CRP). Results: Fasting hyperglycemia was the most common component of MetS (60% of group 1). The mean serum hs-CRP in patients of group 1 was 6.56 ± 9.72 while that in the patients of group 2 was 1.95 ± 1.93. In the group-1, 36% (n = 18) patients were having a decreased 3MS, whereas in group-2, 22% (n = 11) were having a decreased 3MS. MetS was associated with an odd's ratio of 1.99 for developing cognitive decline. 3MS had a negative correlation with hs-CRP values. Regression analysis showed a significant association of hs-CRP and MetS with cognitive decline in the elderly population. Conclusion: Cognitive decline in the elderly is associated with the presence of inflammation and MetS. Hence, early identification of the high-risk groups may offer benefit by disease course modification and better caregiving.