Leprosy Skin Lesion Detection: An AI Approach Using Few Shot Learning in a Small Clinical Dataset

This is an exploratory research study to check if artificial intelligence (AI) based image marker tool can aid leprosy screening to detect leprosy cases early in field situation and reduce the financial and personnel burden. We aimed to collect clinical leprosy skin lesion images and develop an AI model to identify and differentiate them. A total of 368 clinically diagnosed leprosy and 28 non-leprosy skin lesions were collected by an expert leprologist from 151 eligible patients using a multimodal imaging protocol. A Siamese-based Few Shot Learning (FSL) model was trained as it is a meta learning approach on an extremely small data set with fewer disease classes (disease conditions as categories). The number of class labels were increased by fine-grained grouping of skin lesions based on skin morphology (Nine leprosy subgroups) and further divided into train-set and test-set. An AI model was successfully developed, and the results indicated an accuracy of 91.25% and 73.12% on train-set and test-set for two-way one-shot task, respectively. The best sensitivity-specificity for the test-set were 72.39%-73.66% (two-way one-shot task). This early research data indicates that the development of AI based leprosy screening application is feasible using the skin lesion image as marker. The FSL method was successfully used in this training the small data set. However, this is a small sample size study, and more leprosy cases need to be enrolled along with an equal number of non- leprosy cases while improving model architecture to reduce overfit or bias problem. Moreover, as of now this tool cannot be used for neural leprosy (having no skin lesion) as well as lepromatous leprosy having diffuse infiltration. This tool will need further development and validation on pictures taken by different categories of common health care workers using available mobile phones.

Therapeutic experience of ticagrelor in Indian patients with acute coronary syndrome: A non-interventional, prospective, and observational study

Objective This observational study was designed to understand the usage pattern of ticagrelor in real-life clinical practice among a large number of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical management (MM). The study also recorded clinical events, i.e., bleeding, dyspnea, and cardiovascular (CV) events, reported by the investigator during the follow-up period. Methods The ACS patients aged ≥18 years hospitalized for ACS and were prescribed ticagrelor upon discharge or ≤1 month and patients who underwent PCI, CABG, or MM for ACS were enrolled. The subjects were followed up for a period of up to 12 months. The data were collected on a case report form. Result The study recruited 2997 subjects from 49 sites in India. Approximately half of the ACS subjects had ST segment elevation myocardial infarction (48.9%), and PCI was used as management in 92.4% subjects. The mean (±SD) duration of use of ticagrelor was 314 (±110.2) days over a period of 12 months. Of 136 subjects (4.5%) who experienced any clinical events, CV deaths were reported in 20 (0.7%), myocardial infraction in 19 (0.6) subjects and ischemic stroke in 23 (0.8%) subjects, and severe dyspnea was reported in 68 (2.2%) subjects. Out of 33 bleeding cases, 25 (0.8%) subjects had thrombolysis in myocardial infarction (TIMI) minimal, seven (0.2%) had TIMI minor, and one TIMI major. Platelet inhibition and patient outcomes (PLATO) major was reported in two subjects and CABG bleed in one subject. The incidence of PLATO defined major and minimal bleeding were lower in subjects undergoing fibrinolysis than overall population. Conclusion Ticagrelor has been used across ACS types and in different management strategies in real world settings in India. The incidence of clinical events was lower as compared with data in literature.

The study of aluminium phosphide poisoning in a Tertiary Care Hospital - Amritsar.

Trend of poisoning had been constantly changing throughout the world, as the advent of new agents, has always replaced the older one due to their innumerable merits and demerits. Similarly in India, the pattern of ingested poisons has also changed. A number of chemical substances which are developed to save the agricultural product from rodents and pests are in fact themselves proving to be disastrous for mankind. Recently in the last two decades aluminium phosphide [Alphos] used as pesticide, rodenticide, fumigant for storage of food grains has created havoc with the human lives differently i.e. suicidal, accidental and very rarely homicidal poisoning agent. Alphos, a solid fumigant used for storage of food grains, freely accessible in the market is commonly used suicidal agent with high mortality rate as no antidote or specific treatment is available. The present study of 50 cases of aluminium phosphide poisoning showed male dominance, common in sikhs and educated persons. Heart is the first organ to be affected. Shock was present in majority of cases. Sufficient time was available for recording dying declaration.

Trends of poisoning in Faridkot region of Punjab- A retrospective study of one year.

Since immemorial times, poisonous substances have been reported to be adversely affecting human life, both in terms of morbidity and mortality. Evolution in fields like agriculture, industry etc has made wide and easy availability of various poisonous substances. The present study is a retrospective study of one year which is related to poisoning cases that were admitted in the emergency department of G.G. S. Medical College, Faridkot from 1st January 1996 to 31st December 1996. The analysis of the data revealed that out of 78 patients admitted in the hospital, 31 patients died. The maxi-mum incidence was seen in the age group of 21-30 years with males outnumbering the females. The commonest poison used was organophosphorus group of compounds.

Cost of medical treatment triggering homicide on attempted suicide.

Modern science has opened lot of venues to save the precious lives. The media is responsible for wide spread acquaintance of these developments even to the economically down trodden. These highly advanced methods of intensive care are definitely very costly are beyond the reach of even a middle class family but this notion do not immediately restrict anybody from obtaining such kind of aids.

Medicolegal study of mechanical injuries in culpable homicides (excluding deaths due to rash and negligent act).

Trend of homicides by different means keeps on changing with the passage of time and development in different parts of the world. A study was conducted on 200 alleged cases of homicides (excluding deaths due to rash and negligent act). Different profiles from demographic and medicolegal aspects were evaluated. The incidence of homicidal deaths was observed as 12.03%, with male preponderant (82.5%) and the commonest age affected was 21 to 40 yrs (51.5%). Rural population was mainly affected. The blunt weapon (50.88%) was commonly used to inflict the injuries and 'abrasion' was the commonest manifestation (32.73%). The defence wounds were present in 36% cases. Head was the main seat of injury (13.65%). The cause of death in most cases was hemorrhage and shock (31.5%), followed by injury to brain (28.5%). Only 16% cases of these received hospital care. This necessitates the prompt medical care to be provided in the 'Golden Hour' to save valuable human life. Police patrolling for early detection of crime and shifting of injured to hospital/critical care center and provision of prompt ambulance service by state/ private hospital/ NGO's for medical care.

Conversion to hijrah (EUNUCH) is it need based or a crime.

Young boys were allegedly kidnapped and kept under illegal custody for months together. After demoralization had set in due to prolonged confinement, surgery was done on their private parts and female hormones were given to the persons. The converted person were made to wear female garments and performed in groups as a female dancers and earned money while in captivity. After a few years the person approached the police that this heinous crime had been done against their will.

Corpus delicti: A case report.

Genesis of crime is multifactorial. It may have trivial background or may be well planned. With mens rea having all the components like motive, preparation and execution etc. Sometimes identification is big problem in dead bodies and in other cases so right identification altogether changes the scenario of the Crime.

Methylenetetrahydrofolate reductase gene mutation and hyperhomocysteinemia as a risk factor for coronary heart disease in the Indian population.

OBJECTIVE: The screening and therapeutic guidelines for the management of lipid abnormalities are reasonably well established. However, other risk factors like hyperhomocysteinemia (HCA) and single nucleotide polymorphisms involving the angiotensin converting enzyme (ACE) and angiotensinogen genes, various clotting factors etc., have yet to be established firmly as other causative factors of atherothrombotic disease. Our study was aimed at finding the relationship between HCA, folate, vitamins B12 levels, and mutations in the 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine beta-synthase (CBS) genes. METHODS: We studied 230 subjects, which included patients with angiographically documented coronary heart disease (CHD) (n=115) and controls (n=115) with no history of CHD. RESULTS: Elevated levels of plasma homocysteine, above 18 nmoles/ml, were detected in 19.13% and 18.26% of our patients and controls, respectively. Homocysteine was significantly correlated to Apo A1 (r=0.51, p < 0.05) and Apo B (r=0.49, p < 0.05). The heterozygous MTHFR mutation was found to be 54.5% (12/22) in our patients with HCA. Of these, 31.8% (7/22) were deficient for plasma folate. Heterozygosity for T833C mutation in the CBS gene was observed in 9.99% (2/22) of our patients with HCA. Both these patients were also deficient for plasma folate and vitamin B12. CONCLUSION: In our study, heterozygosity for the thermolabile MTHFR mutation was found to be associated with hyperhomocysteinemia (HCA). This genetic predisposition to HCA could be risk factor for CHD and can be correlated with vitamin supplementation. To the best of our knowledge this is the first report from India on plasma homocysteine levels and its genetic aspect in patients with CHD.