A Robust User Authentication Technique in Online Examination

User authentication in the online environment is promoting a hugely challenging issue. This has contributed to the realization of a user authentication where the exams can be performed over the Internet at any time and from any place and by using any digital device. Consequently, further investigations are required to focus on improving user authentication methods to enhance online security mechanisms, especially in the field of e-exams. This research proposes a new user authentication technique based on the user interface (UI). The novel idea is created based on the design preferences of candidates who are taking the e-exams. Several design features are used to design a special user interface for e-exams, for example, the font attributes, back colour, number of questions per page, group categories for questions based on difficulties, and timer setting. The introduced technique can be used to support the user authentication process in the e-exams environment. Furthermore, the proposed technique provides the ability to login to the e-exam without the need to remember the login information, but to select what the student prefers according to his/her personal information. Based on the literature review, a primary evaluation claiming that the students have differences in their preferences and that each user has stable design preferences within different sessions is revealed. In regard to these facts, they become the resource and essence of this research. The security performance of the proposed method is evaluated. The results of the experiments show a false positive (FP) rate of 0.416% and a false negative (FN) rate of 0%.

The Design of an Intelligent Robotic Wheelchair Supporting People with Special Needs, including for Their Visual System

The paper aims to study the applicability and limitations of the solution resulting from a design process for an intelligent system supporting people with special needs who are not physically able to control a wheelchair using classical systems. The intelligent system uses information from smart sensors and offers a control system that replaces the use of a joystick. The necessary movements of the chair in the environment can be determined by an intelligent vision system analyzing the direction of the patient’s gaze and point of view, as well as the actions of the head. In this approach, an important task is to detect the destination target in the 3D workspace. This solution has been evaluated, outdoor and indoor, under different lighting conditions. In order to design the intelligent wheelchair, and because sometimes people with special needs also have specific problems with their optical system (e.g., strabismus, Nystagmus) the system was tested on different subjects, some of them wearing eyeglasses. During the design process of the intelligent system, all the tests involving human subjects were performed in accordance with specific rules of medical security and ethics. In this sense, the process was supervised by a company specialized in health activities that involve people with special needs. The main results and findings are as follows: validation of the proposed solution for all indoor lightning conditions; methodology to create personal profiles, used to improve the HMI efficiency and to adapt it to each subject needs; a primary evaluation and validation for the use of personal profiles in real life, indoor conditions. The conclusion is that the proposed solution can be used for persons who are not physically able to control a wheelchair using classical systems, having with minor vision deficiencies or major vision impairment affecting one of the eyes.

The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.

FINE NEEDLE ASPIRATION CYTOLOGY AS AN INITIAL DIAGNOSTIC AID FOR PRIMARY EVALUATION OF HEAD-NECK PATHOLOGY: FIVE INTERESTING CASES WITH UNUSUAL CLINICAL IMPLICATIONS

Fine Needle Aspiration Cytology is now-a-days the preferred diagnostic modality in primary investigation of Head-neck Pathology, especially for that of parotid and thyroid lesions. However, FNAC nding some time reveals such phenomenal ndings, which lies outside even in the wildest realm of imagination, both in case of pathologist and the clinician. Five of such unusual cases are described here, each one having peculiar clinical presentation with cytology ndings posing considerable diagnostic challenge.

Vein-first Lobectomy for Lung Cancer Assessed According to the Status of Clustered Circulating Tumour Cells

Background/Aim: Vein-first lobectomy (VFL) in lung cancer might reduce shedding of circulating tumour cells (CTCs). This study assessed the clinical significance of VFL. Patients and Methods: Lung cancer patients undergoing lobectomy and CTC testing were evaluated. The primary evaluation item was postoperative clustered CTC detection, and the secondary outcome measures were the 2-year overall survival and recurrence-free survival rates according to the status of VFL and postoperative clustered CTC. Results: Eighty-six patients with similar backgrounds, except for lobe resection and pulmonary vein dissection time, showed postoperative clustered CTC identification rates of 43.8% and 37.9% in the VFL group (n=57) and no-VFL group (n=29), respectively. However, prognosis was not significantly different, although the presence of clustered CTC after surgery was a predictor of recurrence. Conclusion: The status of postoperative clustered CTC was similar regardless of VFL or not, although the detection of clustered CTC was a predictor of recurrence.

Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center

Background To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. Methods Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1–2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. Results Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. Conclusion Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. Trial registration The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589).

Recent Advances in Drugs and Vaccines for COVID-19

Several potential COVID-19 therapeutic approaches and SARS-CoV-2 vaccines have been investigated, and final clinical reports are gradually becoming available. In this mini-review, we discussed the history of selected potential therapeutic drugs and newly designed vaccines, as well as other approaches for the COVID-19 treatment, and made a primary evaluation of their clinical effects. Finally, according to the nature of coronavirus we posed a promising design to against the SARS-CoV-2 by the chemi-physical methods through carbon nano-materials modification.

COVID-19 Animal Models and Vaccines: Current Landscape and Future Prospects

The worldwide pandemic of coronavirus disease 2019 (COVID-19) has become an unprecedented challenge to global public health. With the intensification of the COVID-19 epidemic, the development of vaccines and therapeutic drugs against the etiological agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also widespread. To prove the effectiveness and safety of these preventive vaccines and therapeutic drugs, available animal models that faithfully recapitulate clinical hallmarks of COVID-19 are urgently needed. Currently, animal models including mice, golden hamsters, ferrets, nonhuman primates, and other susceptible animals have been involved in the study of COVID-19. Moreover, 117 vaccine candidates have entered clinical trials after the primary evaluation in animal models, of which inactivated vaccines, subunit vaccines, virus-vectored vaccines, and messenger ribonucleic acid (mRNA) vaccines are promising vaccine candidates. In this review, we summarize the landscape of animal models for COVID-19 vaccine evaluation and advanced vaccines with an efficacy range from about 50% to more than 95%. In addition, we point out future directions for COVID-19 animal models and vaccine development, aiming at providing valuable information and accelerating the breakthroughs confronting SARS-CoV-2.

Copper-induced Haemolytic Anaemia

Acute copper toxicity is uncommon in Western countries and is often the result of accidental consumption or a suicide attempt. We report the case of a 65-year-old man presenting to the accident and emergency department after a suicide attempt with ingestion of Bordeaux mixture, ibuprofen, acetaminophen and bleach. Primary evaluation showed caustic oesophagitis, toxic hepatitis and acute renal injury, which were treated with supportive care. During admission, he developed a non-immune haemolytic anaemia associated with high levels of copper in urine and blood. Chelation treatment with penicillamine was started and evolution was favourable after 1 month of treatment. Copper poisoning can be lethal. Prompt diagnosis and treatment are key for a favourable prognosis.

The Value of Targeted Ultrasound for the Primary Evaluation of Breast Symptoms in Pregnant Women of All Ages

Objective Data on breast imaging in symptomatic pregnant women are limited. Our aim was to assess the value of targeted breast US for the primary evaluation of breast symptoms in pregnant women of all ages. Methods This IRB-approved retrospective study included all pregnant patients who underwent targeted US for focal breast symptoms at an academic imaging facility over an 18-year period (2000–2018). Clinical, imaging, and pathology results were reviewed. Malignant outcomes were determined by histology. Benign outcomes were confirmed by pathology or ≥2 years of follow-up. Descriptive statistics and 2 × 2 contingency table analyses were performed at the presentation level. Results The study cohort comprised 178 presentations in 175 pregnant women. Mean age was 34.7 years (standard deviation, 5.2). The majority (153/178, 86.0%) were more than 30 years old. At presentation, 42.1% (75/178) were in the first trimester of pregnancy, 27.0% (48/178) in the second, and 29.8% (53/178) in the third. The most common presenting symptom was a palpable lump (162/178, 91.0%), followed by focal pain (7/178, 3.9%). The vast majority (174/178, 97.8%) of cases were non-malignant. However, targeted US detected all 4 malignancies (cancer detection rate, 22/1000; negative predictive value 136/136, 100%). Sensitivity and specificity were 100% (4/4) and 78.2% (136/174), respectively. Conclusion Benign causes of symptoms in pregnant women were far more common; malignancy was rare, accounting for only 2.2% (4/178) of cases. Targeted breast US detected all malignancies, supporting US as the primary imaging modality for evaluating symptomatic pregnant women, regardless of age.