Impacts on functional and oncological outcomes of Robotic-assisted Radical Prostatectomy 10 years after the US Preventive Service Taskforce recommendations against PSA screening

ABSTRACT Objective: In the following years after the United States Preventive Service Task Force (USPSTF) recommendation against prostate cancer screening with PSA in 2012, several authors worldwide described an increase in higher grades and aggressive prostate tumors. In this scenario, we aim to evaluate the potential impacts of USPSTF recommendations on the functional and oncological outcomes in patients undergoing robotic-assisted radical prostatectomy (RARP) in a referral center. Material and Methods: We included 11396 patients who underwent RARP between 2008 and 2021. Each patient had at least a 12-month follow-up. The cohort was divided into two groups based on an inflection point in the outcomes at the end of 2012 and the beginning of 2013. The inflection point period was detected by Bayesian regression with multiple change points and regression with unknown breakpoints. We reported continuous variables as median and interquartile range (IQR) and categorical variables as absolute and relative percent frequencies. Results: Group 1 had 4760 patients, and Group 2 had 6636 patients, with a median follow-up of 109 and 38 months, respectively. In the final pathology, Group 2 had 9.5% increase in tumor volume, 24% increase on Gleason ≥ 4+3 (ISUP 3), and 18% increase on ≥ pT3. This translated to a 6% increase in positive surgical margins and 24% reduction in full nerve sparing in response to the worsening pathology. There was a significant decline in post-operative outcomes in Group 2, including a 12-month continence reduction of 9%, reduction in potency by 27%, and reduction of trifecta by 22%. Conclusions: The increasing number of high-risk patients has led to worse functional and oncologic outcomes. The initial rapid rise in PSM was leveled by the move towards more partial nerve sparing. Among some historical changes in prostate cancer diagnosis and management in the period of our study, the USPSTF recommendation coincided with worse outcomes of prostate cancer treatment in a population who could benefit from PSA screening at the appropriate time.

Cancer immunotherapy with enveloped self-amplifying mRNA CARG-2020 that modulates IL-12, IL-17 and PD-L1 pathways to prevent tumor recurrence

Targeting multiple immune mechanisms may overcome therapy resistance and further improve cancer immunotherapy for humans. Here, we describe the application of virus-like vesicles (VLV) for delivery of three immunomodulators alone and in combination, as a promising approach for cancer immunotherapy. VLV vectors were designed to deliver single chain interleukin (IL)-12, short-hairpin RNA (shRNA) targeting programmed death ligand 1 (PD-L1), and a dominant-negative form of IL-17 receptor A (dn-IL17RA) as a single payload or as a combination payload. Intralesional delivery of the VLV vector expressing IL-12 alone, as well as the trivalent vector (designated CARG-2020) eradicated large established tumors. However, only CARG-2020 prevented tumor recurrence and provided long-term survival benefit to the tumor-bearing mice, indicating a benefit of the combined immunomodulation. The abscopal effects of CARG-2020 on the non-injected contralateral tumors, as well as protection from the tumor cell re-challenge, suggest immune-mediated mechanism of protection and establishment of immunological memory. Mechanistically, CARG-2020 potently activates Th1 immune mechanisms and inhibits expression of genes related to T cell exhaustion and cancer-promoting inflammation. The ability of CARG-2020 to prevent tumor recurrence and to provide survival benefit makes it a promising candidate for its development for human cancer immunotherapy.

Apoptotic effect of Bulbine Natalensis and Chlorophytum Comosum in myelogenous Leukemia K562 cell line

Abstract Bulbine natalensis and Chorophytum comosum are potential medicinal source for the treatment of cancers. Chronic myeloid leukaemia is a hematopoietic stem cells disorder treated by tyrosine kinase inhibitors but often cause recurrence of the leukaemia after cessation of therapy, hence require alternative treatment. This study determines the anti-cancer effect of leaf, root and bulb methanolic and aqueous extracts of B. natalensis and C. comosum in chronic human myelogenous leukaemia (K562) cell line by MTT, Hoechst bis-benzimide nuclear and annexin V stain assays. The root methanolic extract of B. natalensis and C. comosum showed a high cytotoxicity of 8.6% and 16.7% respectively on the K562 cell line at 1,000 g/ml concentration. Morphological loss of cell membrane integrity causing degradation of the cell and fragmentation were observed in the root methanolic extract of both plants. A high apoptosis (p 0.0001) was induced in the K562 cells by both leaf and root extracts of the C. comosum compared to the B. natalensis. This study shows both plants possess apoptotic effect against in vitro myelogenous leukaemia which contributes to the overall anti-cancer properties of B. natalensis and C. comosum to justify future therapeutic applications against chronic myelogenous leukaemia blood cancer.

Resumo Bulbine natalensis Baker e Chorophytum comosum (Thunb.) Jacques são potenciais fontes medicinais para o tratamento de cânceres. A Leucemia Mieloide Crônica (LMC) é um distúrbio das células-tronco hematopoiéticas que é tratado com inibidores da tirosina quinase, mas frequentemente, causa recorrência da leucemia após a interrupção da terapia, portanto, requer um tratamento alternativo. Este estudo determinou o efeito anticancerígeno de extratos metanólicos e aquosos de folha, raiz e bulbo de B. natalensis e C. comosum na linhagem celular de leucemia mieloide humana crônica (K562) por ensaios de MTT, Hoechst bis-benzimida nuclear e anexina V. O extrato metanólico da raiz de B. natalensis e C. comosum apresentou alta citotoxidade de 8,6% e 16,7% respectivamente, na linhagem celular K562 com a concentração de 1,000 g / ml. Perda morfológica da integridade da membrana celular causando degradação dos núcleos, citoplasma e encolhimento celular foi observada no extrato metanólico da raiz de ambas as plantas. Uma alta apoptose (p 0,0001) foi induzida nas células K562 por extratos de folhas e raízes de C. comosum em comparação com B. natalensis. Este estudo mostrou que ambas as plantas possuem efeito apoptótico contra leucemia mieloide in vitro que contribui para as propriedades anticâncer gerais de B. natalensis e C. comosum para justificar futuras aplicações terapêuticas contra câncer de sangue de LMC.

Apoptotic effect of Bulbine Natalensis and Chlorophytum Comosum in myelogenous Leukemia K562 cell line / Efeito apoptótico da natalensia bulbina e do clorofito comoso na linhagem celular mielogênea da leucemia K562

Abstract Bulbine natalensis and Chorophytum comosum are potential medicinal source for the treatment of cancers. Chronic myeloid leukaemia is a hematopoietic stem cells disorder treated by tyrosine kinase inhibitors but often cause recurrence of the leukaemia after cessation of therapy, hence require alternative treatment. This study determines the anti-cancer effect of leaf, root and bulb methanolic and aqueous extracts of B. natalensis and C. comosum in chronic human myelogenous leukaemia (K562) cell line by MTT, Hoechst bis-benzimide nuclear and annexin V stain assays. The root methanolic extract of B. natalensis and C. comosum showed a high cytotoxicity of 8.6% and 16.7% respectively on the K562 cell line at 1,000 μg/ml concentration. Morphological loss of cell membrane integrity causing degradation of the cell and fragmentation were observed in the root methanolic extract of both plants. A high apoptosis (p < 0.0001) was induced in the K562 cells by both leaf and root extracts of the C. comosum compared to the B. natalensis. This study shows both plants possess apoptotic effect against in vitro myelogenous leukaemia which contributes to the overall anti-cancer properties of B. natalensis and C. comosum to justify future therapeutic applications against chronic myelogenous leukaemia blood cancer.

Resumo Bulbine natalensis Baker e Chorophytum comosum (Thunb.) Jacques são potenciais fontes medicinais para o tratamento de cânceres. A Leucemia Mieloide Crônica (LMC) é um distúrbio das células-tronco hematopoiéticas que é tratado com inibidores da tirosina quinase, mas frequentemente, causa recorrência da leucemia após a interrupção da terapia, portanto, requer um tratamento alternativo. Este estudo determinou o efeito anticancerígeno de extratos metanólicos e aquosos de folha, raiz e bulbo de B. natalensis e C. comosum na linhagem celular de leucemia mieloide humana crônica (K562) por ensaios de MTT, Hoechst bis-benzimida nuclear e anexina V. O extrato metanólico da raiz de B. natalensis e C. comosum apresentou alta citotoxidade de 8,6% e 16,7% respectivamente, na linhagem celular K562 com a concentração de 1,000 μg / ml. Perda morfológica da integridade da membrana celular causando degradação dos núcleos, citoplasma e encolhimento celular foi observada no extrato metanólico da raiz de ambas as plantas. Uma alta apoptose (p <0,0001) foi induzida nas células K562 por extratos de folhas e raízes de C. comosum em comparação com B. natalensis. Este estudo mostrou que ambas as plantas possuem efeito apoptótico contra leucemia mieloide in vitro que contribui para as propriedades anticâncer gerais de B. natalensis e C. comosum para justificar futuras aplicações terapêuticas contra câncer de sangue de LMC.

Status de expressão do receptor de leptina e adiponectina no carcinoma colorretal: A cross-estudo prospectivo seccional / Correlation of leptin and adiponectin receptor expression with clinicopathological parameters in colorectal carcinoma - a cross-sectional prospective study

ABSTRACT Background: Colorectal carcinoma (CRC) is one of the common carcinomas with a rising incidence of metastasis due to its advanced stage of presentation. The existing biomarkers such as CEA (Carcinoembryonic antigen) etc., for prognosis, have low sensitivity and specificity. Hence a need for a newer definitive biomarker. Obesity is the leading cause of CRC. Leptin and adiponectin secreted by adipose tissue have been studied as potential biomarkers in the field of CRC. The present study helps to understand the association of leptin and adiponectin receptors with clinicopathological parameters. Objective: To correlate the various clinicopathological parameters with the tissue expression of leptin and adiponectin receptors in CRC. Methods: It is a cross-sectional prospective study conducted at a tertiary care hospital. Formalin fixed paraffin blocks of all radical resection CRC cases were collected and immunohistochemistry (IHC)was carried out on tumor tissue for leptin and adiponectin receptor. Tumor characteristics and clinical parameters were collected from the hospital medical records. Pearson's correlation coefficient test was used. Results: Immunohistochemistry was performed on 60 cases of CRC. Significant positive correlation of leptin was observed with size, lymph node metastasis, advanced stage, and grade of tumor (P<0.05). A significant correlation between adiponectin receptor and CRC was observed concerning age, stage, lymph node metastasis, distant metastasis and grade of tumor. Conclusion: Positive expression of leptin and negative expression of adiponectin receptors in CRC helps to predict the risk of metastasis.

RESUMO Contexto: O carcinoma colorretal (CCR) é um dos carcinomas comuns com incidência crescente de metástases devido ao seu estágio avançado de apresentação. Os biomarcadores existentes como CEA (antígeno carcinoembrionário) etc., para prognóstico, apresentam baixa sensibilidade e especificidade. Daí a necessidade de um biomarcador definitivo mais recente. A obesidade é a principal causa do CCR. A leptina e a adiponectina secretadas pelo tecido adiposo têm sido estudadas como potenciais biomarcadores na área do CCR. O presente estudo ajuda a compreender a associação dos receptores de leptina e adiponectina com parâmetros clinicopatológicos. Objetivo: Correlacionar os diversos parâmetros clinicopatológicos com a expressão tecidual dos receptores de leptina e adiponectina no CCR. Métodos: Trata-se de um estudo transversal, prospectivo, realizado em um hospital terciário. Blocos de parafina fixados em formalina de todos os casos de CCR de ressecção radical foram coletados e a imuno-histoquímica (IHQ) foi realizada no tecido tumoral para receptor de leptina e adiponectina. As características do tumor e os parâmetros clínicos foram coletados dos prontuários médicos do hospital. Foi utilizado o teste do coeficiente de correlação de Pearson. Resultados: A imunohistoquímica foi realizada em 60 casos de CCR. Correlação positiva significativa da leptina foi observada com tamanho e metástase linfonodal, estágio avançado e grau do tumor (P<0,01). Foi observada uma correlação significativa entre o receptor de adiponectina e o CCR em relação à idade, estágio, metástase linfonodal, metástase à distância e grau do tumor. Conclusão: A expressão positiva de leptina e a expressão negativa de receptores de adiponectina no CCR ajudam a prever o risco de metástase.

An Experience in Laboratory Diagnosis of Fungal Infections in COVID-19 Patients

Abstract Introduction Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has cast a gloom spell on healthcare worldwide, infecting millions of people. Objective The aim of the present study is to determine the prevalence and review the contributing comorbidities and the precipitating factors leading to the emergence of the fungal infections in COVID-19-affected patients. To assess the utility of different laboratory techniques for confirmation of fungal infections. To assess the strengths and limitations of the diagnostic methods. Methods We have studied 252 clinical samples obtained from 121 COVID-positive patients. Results Among the 121 patients clinically diagnosed with fungal infections, 88 had diabetes and were given steroids for treatment (p-value = 0.001). Ninety-five patients (78.5%) had a positive laboratory diagnosis (either culture positive, potassium hydroxide [KOH]-positive or positive histopathology report). Fungal culture was positive in 75 (61.9%) patients and histopathology report was positive in 62 (51.2%). Histopathology was positive in 7 (5.8%) patients in whom culture and KOH were negative. Conclusion Aggressive treatment methods, administration of immune suppressants, and antibiotics, with an intention to salvage, have made patients susceptible to the benign fungus, causing it to evade the host immunity, thus leading to invasive infections. Applying different laboratory modalities would not only aid in providing fast and valuable information but also help in understanding the pathology which would assist the clinician in selecting the correct treatment for the patient.

Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study

Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

Psychological distress among South African healthcare workers during the COVID-19 pandemic

Background: The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). Objectives: This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. Method: The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. Results: A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Conclusion: Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs. Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.

Medico-legal autopsies after sunset: Ethical issues

From the British era, regular medico-legal autopsies have never been done in India after sunset, except for those specially permitted by the law enforcement agencies. The Ministry of Health and Family Welfare, Government of India, issued a notification on November 15, 2021, regarding the “Conduct of post-mortem in hospitals after sunset”. This has given rise to much debate on whether post-mortems can be conducted after sunset in an ethical manner. Here, we briefly discuss the various issues related to the carrying out of post-mortems after sunset in India.

Randomized comparison between transversus abdominis and erector spinae blocks in cesarean section

Introduction: Transversus abdominis plane (TAP) block provides somatic analgesia postoperatively in cesarean sections, however erector spinae plane (ESP) block has shown to provide both somatic and visceral analgesia. Objective: To compare the efficacy of TAP and ESP blocks for pain control after cesarean section under spinal anesthesia. Methods: In a double-blind superiority trial, pregnant patients undergoing cesarean section were randomized into either bilateral TAP or ESP block groups. Primary outcome was total consumption of patient-controlled analgesia (PCA) tramadol in the first 24 hours. Secondary outcomes included time required for first rescue analgesia, post-surgery visual analog score (VAS) for pain, patient satisfaction, and adverse effects. Results: 50 pregnant patients were randomized into TAP and ESP blocks. There was no difference in the amount of PCA tramadol within the first 24 hours between both groups [100mg (63-125) in TAP group vs 75mg (38-100) ESP group]. Pain score at rest and on movement and patient satisfaction were comparable in both groups, with no difference in adverse effects. There was a slight difference in the median time for first rescue analgesia [210min (135-315) in TAP group and 270min (225-405) ESP group] (p=0.03). Conclusions: TAP and ESP blocks provide similar analgesia with comparable consumption of tramadol in the first 24 hours post-cesarean section and no difference in pain scores at rest/on movement.

Introducción: El bloqueo del plano transverso abdominal (TAP - por sus siglas en inglés), ofrece analgesia somática postoperatoria en cesárea; sin embargo, el bloqueo del plano erector de la espina (ESP - por sus siglas en inglés) ha demostrado proporcionar analgesia tanto somática, como visceral. Objetivo: Comparar la eficacia de los bloqueos TAP y ESP para el control del dolor posterior a la cesárea, bajo anestesia raquídea. Métodos: En un estudio de superioridad doble ciego, las pacientes embarazadas sometidas a cesárea se aleatorizaron bien sea al grupo de bloqueo bilateral TAP o ESP? El desenlace principal fue el consumo total de analgesia controlada por la paciente (PCA - por sus siglas en inglés) con tramadol en las primeras 24 horas. Los desenlaces secundarios incluyeron el tiempo transcurrido para la primera analgesia de rescate, el puntaje en la escala visual analógica (EVA) para dolor, la satisfacción del paciente y los efectos adversos. Resultados: 50 pacientes embarazadas se aleatorizaron entre bloqueo TAP y bloqueo ESP. No hubo diferencia en la cantidad de tramadol de la PCA dentro de las primeras 24 horas entre los dos grupos [100mg (63-125) en el grupo TAP vs 75mg (38-100) en el grupo ESP]. El puntaje de dolor en reposo y en movimiento y la satisfacción de la paciente fueron comparables en ambos grupos, sin diferencia en los efectos adversos. Hubo una ligera diferencia en la media de tiempo hasta la primera analgesia de rescate [210 min (135-315) en el grupo de TAP y 270 min (225-405) en el grupo ESP] (p=0,03). Conclusiones: Los bloqueos TAP y ESP ofrecen una analgesia similar, con un consumo comparable de tramadol en las primeras 24 horas posteriores a la cesárea y no hay diferencia en los puntajes de dolor en reposo, o en movimiento.

Comparison of clinical outcomes of Eyecryl toric and Alcon toric intra-ocular lenses – A real world study

Purpose: To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra?ocular lenses (IOLs). Methods: This retrospective, observational study included 143 eyes of 141 patients who underwent phaco?emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post?op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed. Results: The mean pre?op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post?op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post?op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post?op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02). Conclusion: Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post?operative outcomes in terms of UCVA and residual astigmatism. The post?op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group

Plaque brachytherapy – Radiating positivity

Background: Plaque brachytherapy is an evolving, yet effective globe and vision-sparing modality for the treatment of intraocular tumors by transscleral irradiation of the tumor base with a radioactive implant. The American Brachytherapy Society (ABS) along with the collaboration of the international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to reach a consensus regarding establishing practice guidelines and setting standards of care for intraocular tumors. The advent of plaque brachytherapy has revolutionized the outcomes of intraocular tumors, thus ensuring globe salvage, reducing morbidity and mortality, and avoiding cosmetic disfigurement. A well-planned dosimetry for plaque brachytherapy results in achieving local tumor control and excellent prognosis. Purpose: This technique provides the advantage of focal radiation, thus eliminating the damage to the adjacent structures, minimal periorbital tissue damage, absence of cosmetic disfigurement owing to lack of retarded bone growth as seen in external beam radiotherapy. Thus, it reduces the risk of metastasis, and with the recent advances, it provides a shorter duration of treatment. Synopsis: In this video, we shall display the concept of plaque brachytherapy, the various types of plaques available, different radiations sources, planning dosimetry and calculations, target disease spectrum, surgical placement, and post-radiation outcomes in terms of local tumor control and prognosis. Highlights: This video highlights the history, basic principles and techniques of plaque brachytherapy and provides an understanding of its applications in the world of ocular oncology.

Biphenotypic sinonasal sarcoma—A recently described entity with many mimics: A case report

Biphenotypic sinonasal sarcoma (BSNS) is a recently described, low-grade, slow-growing sarcoma with neural and myogenic features with exclusive location in sinonasal track and characteristic PAX3- MAML3 gene fusion. Differentiating this tumor from its commoner mimics needs knowledge of this entity to avoid over treatment. This tumor has unique morphology, clinical course, and genetics. We report this in a 47-year-old female who was diagnosed with such a rare, solitary fibrous tumor—hemangiopericytoma (HPC-SFT) on limited initial biopsy. On subsequent excision, typical morphology and immunohistochemistry helped to clinch the diagnosis.

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.

MICROBIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY OF BACTERIAL PATHOGENS ISOLATED FROM PAPER CURRENCIES CIRCULATING IN SOME RESTAURANTS AND BUTCHERIES IN HAWASSA, SIDAMA, ETHIOPIA, 2020-21

Currency notes could play a signicant role in transmitting pathogenic microorganisms amongst individuals in the society. This study was aimed to determine the microbial prole and Antibiotic susceptibility of bacterial pathogens isolated from Ethiopian paper notes in circulation. 64 currency paper notes of different denomination were tested for bacterial contamination using standard microbiological methods. Antibiotic susceptibility proles of the isolates were determined with approved methods. Results were analyzed using descriptive statistics. Overall mean AMBC was 4.08 log units, with the highest 6.58 log units recorded from denomination 5 followed by 4.50, 3.03, 2.20 log units from denominations 10, 50 and 100 respectively. Total Coliforms (TC) displayed the same pattern with the highest mean counts of 6.52 log units, from denomination 5 and lowest counts of 2.19 log units from denomination 100. Out of 64 currency notes, 35 (54.7%) were contaminated with bacteria. The predominant bacteria isolates were E. coli (60.5%), Salmonella spp. (23.6%) and Shigella spp. (13.2%). Each isolate was resistant to four or more antibiotics tested. All isolates were resistant against Cefepime and Tetracycline and sensitive to Ceftriaxone. This study revealed that currency notes are contaminated with pathogenic bacteria and in most cases these bacterial isolates were resistant to commonly prescribed antibiotics. Therefore, contaminated notes are identied as potential public health threat, because pathogens can be spread by circulating the notes and become source of infection. Awareness creation is important among public in this regard.

ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

Role Of Scrape Cytology In The Intraoperative Diagnosis Of Tumour

Background: Intra operative pathological assessment has offered a very valuable service in patient management. The present study was done to evaluate the status of intraoperative cytology as a diagnostic and supportive investigation for various tumours. To evaluate the utility of imprint /scrape cytology for the rapid diagnosis ofAim and objectives: surgically removed specimens. 70 surgically removed specimens from various organs andMaterials and Methods: systems were studied. Smears were taken from each specimen before formalin fixation and stained by modified rapid H&E and Papanicolaou staining. Cytological diagnosis was made and then results were compared with the histological diagnosis taking the latter as the gold standard. Out of the 70 cases sampled, 70 were satisfactory forResults: evaluation. Overall accuracy rate was 87.14 % .Six cases of false positive diagnosis and 3 false negative diagnosis were made .Positive predictive value was 75% and negative predictive value was 93.47%. Imprint /scrapeConclusions: cytology is a good complement for the rapid diagnosis in histopathological study of tumor/tumor like lesions and intra operative cytology can be used an adjunct to frozen section.

Cytokines in Oral Submucous Fibrosis: A Bird’s Eye View

Introduction: Oral Submucous Fibrosis (OSF) is a chronic fibrosis condition of oral cavity. It is a multifactorial condition, are- canut chewing being the prime etiologic factors. Objectives: Arecanut alkaloids stimulate the oral tissue initiating the inflammatory response. As an inflammatory response, cells release cytokines activating the cascade of different fibrinogenic pathways leading to fibrosis. Conclusion: This review briefs about the various cytokines studied in Oral Submucous Fibrosis.