Coxsackieviruses are members of a group of viruses called the enteroviruses, which may cause respiratory and gastrointestinal symptoms, erythema, meningoencephalitis, myocarditis, pericarditis, and myositis. Unilateral acute idiopathic maculopathy caused by coxsackievirus A16 has been associated with hand, foot, and mouth disease, but only a few reports describe retinitis associated with coxsackievirus serotype B3 or B4. We report a case of bilateral multifocal obstructive retinal vasculitis that developed after coxsackievirus A4 infection. A 60-year-old woman was referred to our department with bilateral visual disturbance that developed following flu-like symptoms. At the initial examination, best corrected visual acuity was 20/200 in the right eye and 20/50 in the left eye. The critical flicker frequency (CFF) was 23 Hz in the right eye and 27 Hz in the left eye. Fine white keratic precipitates with infiltrating cells were presented in the anterior chamber of both eyes, and multifocal retinal ischemic lesions were observed in the macula and posterior pole of both eyes. The retinal lesions corresponded with scotomas observed in Goldmann visual field test. On spectral domain-optical coherence tomography (SD-OCT), retinal lesions were depicted as hyper-reflective regions in the inner retina layers in both eyes, and disruption of ellipsoid line in the left eye., Fluorescein angiography exhibited findings indicative of multifocal obstructive retinal vasculitis. The patient had a history of current hypertension treated with oral therapy and glaucoma treated with latanoprost eye drops. Blood test for coxsackievirus antibody titers revealed that A4, A6, A9, B1, B2, B3, and B5 were positive (titers: 8–32). Abdominal skin biopsy of necrotic tissue suggested vascular damage caused by coxsackievirus. The general symptoms improved after 6 weeks, and the multifocal retinal ischemic lesions were partially resolved with residual slightly hard exudates. Only coxsackievirus A4 antibody titer increased from 4 to 32-fold after 14 months. However, hyper-reflective regions and disruption of the inner retinal layers on SD-OCT persisted especially in the right eye, and residual paracentral scotoma was observed in the right eye. The present case suggests that coxsackievirus A4 causes bilateral multifocal obstructive retinal vasculitis with irreversible inner retinal damage.

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Bilateral idiopathic retinal vasculitis following coxsackievirus A4 infection: a case report

OBJECTIVE\nTo describe the clinical features and imaging characteristics in unilateral acute idiopathic maculopathy.\n\n\nMETHODS\nRetrospective review of 4 patients with a diagnosis of unilateral acute idiopathic maculopathy. Clinical characteristics (age, symptoms, Snellen visual acuity, and funduscopic features) and images from spectral-domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were analyzed.\n\n\nRESULTS\nThe median (range) age at presentation was 31 (27-52) years. The median (range) interval between symptom onset and presentation was 4 (1-20) weeks. Associated systemic findings included a viral prodrome (50%), orchitis (50%), hand-foot-mouth disease (25%), and positive coxsackievirus titers (50%). The median (range) visual acuity at initial examination was 20/400 (20/70 to 1/400), which improved to 20/30 (20/20 to 20/60) at final follow-up. The median (range) follow-up time was 8 (8-13) weeks. Early in the disease course, the central macula developed irregular, circular areas of white-gray discoloration. Following recovery, the macula had a stippled retinal pigment epithelium characterized by rarefaction and hyperplasia. Fluorescein angiography demonstrated irregular early hyperfluorescence and late subretinal hyperfluorescence. Spectral-domain optical coherence tomography showed a partially reversible disruption of the outer photoreceptor layer. Fundus autofluorescence initially revealed stippled autofluorescence that eventually became more hypoautofluorescent. Indocyanine green angiography showed \"moth-eaten\"-appearing choroidal vasculature, suggestive of choroidal inflammation.\n\n\nCONCLUSIONS\nThe imaging characteristics highlight the structural changes during the active and resolution phases of unilateral acute idiopathic maculopathy. The visual recovery correlates with structural changes and suggests that the pathogenesis involves inflammation of the inner choroid, retinal pigment epithelium, and outer photoreceptor complex that is partially reversible.

Multimodality Diagnostic Imaging in Unilateral Acute Idiopathic Maculopathy

Hand, foot, and mouth disease (HFMD) is a common systemic infection that is caused by an enterovirus, normally Coxsackie A16. Generally, it affects children or immunocompromised adults. Only a few reports have described pseudomembranous conjunctivitis associated with HFMD. We aim to describe the clinical outcomes and ocular findings of a 37-year-old female with HFMD and concurrent severe pseudomembranous conjunctivitis, who was 28 weeks pregnant. A female patient who was 28-weeks pregnant was referred for an ophthalmological review due to pain and injection in both eyes. The patient was hospitalized under obstetrics and gynecology and evaluated for Behcet’s disease with oral and perineal ulcers. In an ophthalmic examination, both eyes were observed to have a conjunctival injection. Behcet’s disease-associated conjunctivitis was diagnosed. Topical steroids and antibiotics were administered every 6 h. Two days after her presentation, a maculopapular eruption occurred on her palms. Enterovirus type 71 was detected in a serum virus antibody test, and the patient was diagnosed with HFMD. After 7 days, severe pseudomembranous conjunctivitis and corneal epithelial defects occurred in both eyes. Topical steroids were administered every 3 h, and the pseudomembrane was removed every 2 to 3 days. The pseudomembrane did not occur after 3 weeks, but corneal erosion persisted. After 3 months, the corneal erosion had completely resolved. HFMD-associated conjunctivitis is a rare complication in adults, however it can appear as a severe pseudomembranous conjunctivitis. In this case, the removal of the pseudomembrane and topical steroids helped improve the symptoms.

/pdf/pseudomembranous-conjunctivitis-with-hand-foot-and-mouth-1mwrwbcsyh.pdf

Pseudomembranous conjunctivitis with hand, foot and mouth disease in a pregnant woman : a case report

Purpose:To report the case of a 33-year old man who disclosed the first case of bilateral ocular involvement of hand, foot, and mouth disease (HFMD) with a different stage of the disease in each ey...

Is choriocapillaris the early target in acute maculopathy secondary to hand, foot, and mouth disease? A case report.

Edge computing constitutes a promising paradigm of managing and processing the massive amounts of data generated by Internet of Things (IoT) devices. Data and computation are moved closer to the client, thus enabling latency- and bandwidth-sensitive applications. However, the distributed and heterogeneous nature of the edge as well as its limited resource capabilities pose several challenges in implementing or choosing an efficient edge-enabled storage system. Therefore, it is imperative for the research community to contribute to the clarification of the purposes and highlight the advantages and disadvantages of various edge-enabled storage systems. This work aspires to contribute toward this direction by presenting a performance analysis of three different storage systems, namely MinIO, BigchainDB, and the IPFS. We selected these three systems as they have been proven to be valid candidates for edge computing infrastructures. In addition, as the three evaluated systems belong to different types of storage, we evaluated a wide range of storage systems, increasing the variability of the results. The performance evaluation is performed using a set of resource utilization and Quality of Service (QoS) metrics. Each storage system is deployed and installed on a Raspberry Pi (small single-board computers), which serves as an edge device, able to optimize the overall efficiency with minimum power and minimum cost. The experimental results revealed that MinIO has the best overall performance regarding query response times, RAM consumption, disk IO time, and transaction rate. The results presented in this paper are intended for researchers in the field of edge computing and database systems.

/pdf/performance-analysis-of-storage-systems-in-edge-computing-1k42iycf.pdf

Performance Analysis of Storage Systems in Edge Computing Infrastructures

Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery.

Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease

By the development and advancement of blockchain technique, Internet of Things (IoT) proliferation driven devices and the application of blockchain-enabled IoT alter the view and operating infrastructure of the smart networks. The blockchain is responsible for supporting decentralized systems and offers secured means of authentication, management, and access to IoT system thereby deploying smart contracts offered by Ethereum. The increasing demand and the blockchain expansion generate huge volume of sensitive data. The growing demand and expansion of blockchain-IoT systems is generating large volume of sensitive data. Furthermore, distributed denial-of-service (DDoS) attacks are regarded as the most promising threats for smart contracts in the blockchain-based systems. Therefore, there is a need to detect and classify the attack type and the data should be stored in server more securely with the use of blockchain and data aggregation method. For this purpose, this presented technique aims at introducing decentralized consensus blockchain and Interplanetary file system (IPFS) based data aggregation for effective classification and data storage. The attack is detected using meta-hyperparameter random forest (MHP-RF) classifier. Once the attack is detected, the transaction information is stored in server securely by means of smart contract-based blockchain system. The transaction handling stage classifies the transaction type as normal or abnormal one which then followed by execution of business logic by smart contract thereby appending the transaction of blockchain in the network cloud. The consensus blockchain technique is employed with the use of PoW-enabled scheme integrated with Elgamal-based data aggregation. Therefore, the system security is improved and the intrusion is prevented greatly. The performance analysis of the system is analyzed in terms of accuracy, precision, recall, F-score, Encryption time, decryption time, execution time, and space complexity. The attained outcomes are compared with traditional approaches to prove the effectiveness of proposed strategy. The proposed system is said to be effective in time consumption, classifier performance, and in overcoming space complexity issues.

Decentralized Consensus Blockchain and IPFS-Based Data Aggregation for Efficient Data Storage Scheme

— For data privacy, system reliability, and security, Blockchain technologies have become more popular in recent years. Despite its usefulness, the blockchain is vulnerable to cyber assaults; for example, in January 2019 a 51% attack on Ethereum Classic successfully exposed flaws in the platform's security. From a statistical point of view, attacks represent a highly unusual occurrence that deviates significantly from the norm. Blockchain attack detection may benefit from Deep Learning, a field of study whose aim is to discover insights, patterns, and anomalies within massive data repositories. In this work, we define an trusted two way intrusion detection system based on a Hierarchical weighed fuzzy algorithm and self-organized stacked network (SOSN) deep learning model, that is trained exploiting aggregate information extracted by monitoring blockchain activities. Here initially the smart contract handles the node authentication. The purpose of authenticating the node is to ensure that only specific nodes can submit and retrieve the information. We implement Hierarchical weighed fuzzy algorithm to evaluate the trustability of the transaction nodes. Then the transaction verification step ensures that all malicious transactions or activities on the submitted transaction by self-organized stacked network deep learning model. The whole experimentation was carried out under matlab environment. Extensive experimental results confirm that our suggested detection method has better performance over important indicators (such as Precision, Recall, F-Score, overhead )

Gnanavelu N Subathra

Papers

Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease

Decentralized Consensus Blockchain and IPFS-Based Data Aggregation for Efficient Data Storage Scheme

Detection Of Insider Attacks In Block Chain Network Using The Trusted Two Way Intrusion Detection System