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.

An Enhanced Focused Web Crawler for Biomedical Topics Using Attention Enhanced Siamese Long Short Term Memory Networks

Abstract The Internet is chosen to be one among the primary source of biomedical information. To retrieve necessary biomedical information, the search engine needs an efficient, focused crawler mechanism. But the area of research concerned with the focused crawler for biomedical topics is notably scanty. However, the quantity, momentum, diversity, and quality of the available online biomedical information, challenges and calls for enhanced aid to crawl. This paper surmounts the challenges and proposes a new learning approach for focused web crawling adopting Attention Enhanced Siamese Long Short Term Memory (AE-SLSTM) Networks with peephole connections which predicts topical relevance of the web page. The proposed AE-SLSTM model accurately computes the semantic similarity between the topic and the web pages. The performance of the newly designed crawler is assessed using two well known metrics namely harvest rate ( h r a t e ) and irrelevance ratio ( p r a t e ). The presented crawler surpass the existing focused crawlers with an average h r a t e of 0.39 and an average p r a t e of 0.61 after crawling 5,000 web pages relating to biomedical topics. The results clearly depicts that the proposed methodology aids to download more relevant biomedical web pages related to the particular topic from the internet.

Transient skin and fur color change after trichotomy of the sacrococcygeal region for epidural anesthesia in a domestic cat (Felis catus) / Mudança transitória da cor da pele e pelo após tricotomia da região sacrococcígea para anestesia epidural em gata doméstica (Felis catus)

A clinical case in which skin and hair color change occurred after sacrococcygeal epidural anesthesia in a nine-month-old Siamese cross queen undergoing ovariohysterectomy (OHE) is described. Six weeks after surgery, during a re-check, it was noted that in the sacrococcygeal region the color of the skin and new hair growth was dark with a color comparable to the color present on the body extremities (muzzle, pinnae, legs, and tail). The skin and new hair growth of the shaved abdomen presented a standard color. The key enzyme of the melanogenic pathway in mammals is tyrosinase (TYR), and the Siamese temperature-sensitive phenotype is the result of genetic mutations that makes TYR function thermolabile. The activity of TYR in these cats is limited to the extremities where the temperature is lower while pigment production is impaired in the other body areas. The trichotomy of the sacrococcygeal region performed during wintertime in an outdoor cat was probably the trigger for increased activity of TYR in this area promoting pigment production. The absence of the same alterations in the abdominal area may be justified by less exposure of that region to the external environment, as well as to the feline habits of sedentarism, that avoid significant cooling in these regions. This report highlights the importance of taking this type of occurrence into account when performing an epidural in the Siamese cat breed. Also, to avoid skin color change in this breed, the authors recommend a midline abdominal instead of a flank approach to perform OHE.(AU)

Descreve-se um caso clínico no qual ocorreu mudança na cor da pele e do pelo após anestesia epidural sacrococcígea numa gata cruzada de raça Siamês de nove meses submetida à ovariohisterectomia (OVH). Seis semanas após a cirurgia, durante uma avaliação pós-operatória, notou-se que na região sacrococcígea, a cor da pele e o crescimento do pelo apresentavam uma cor escura, comparável à das extremidades do corpo (face, orelhas, membros e cauda). A pele e o crescimento do pelo do abdómen, que também havia sido tosquiado, apresentavam uma cor padrão. A enzima chave da via melanogênica em mamíferos é a tirosinase (TYR) e o fenótipo siamês sensível à temperatura é o resultado de mutações genéticas que tornam a função TYR termolábil. A atividade da TYR nestes gatos é limitada às extremidades onde a temperatura é mais baixa, enquanto a produção de pigmento é prejudicada em outras áreas do corpo. A tricotomia da região sacrococcígea realizada durante o inverno nesta gata com acesso livre ao ambiente externo, provavelmente determinou um aumento da atividade da TYR nesta área, promovendo a produção de pigmento. A ausência das mesmas alterações na região abdominal pode ser justificada pela menor exposição desta área do corpo ao ambiente externo, também devido aos hábitos felinos de sedentarismo, que evitam resfriamento significativo nestas regiões. Este relato destaca a importância de se levar em consideração a possibilidade deste tipo de ocorrência quando da realização de uma anestesia epidural nesta raça de gatos. Além disso, os autores recomendam uma abordagem abdominal na linha média ao invés de uma abordagem de flanco para realizar a OVH nesta raça, a fim de evitar a alteração da cor da pele.(AU)

Siameses toracópagos: Reporte de un caso / Thoracic Siamese: Case Report

Los gemelos siameses son una entidad rara, cuya incidencia varía de 1 en 50.000 a 1 en 100.000 nacidos vivos; solo el 18 % sobrevive y aproximadamente el 35 % de los nacidos vivos muere en las primeras 24 horas. Se reportó un caso de siameses toracópagos, con diagnóstico prenatal mediante ultrasonografía a las 32.1 semanas de gestación, cuyas cabezas y extremidades son individuales; poseen genitales femeninos; a nivel del tórax se observó la existencia de un corazón que envía un vaso arterial a lo que se asemeja a una masa cardiaca inerte y rudimentaria al feto contralateral; comparten los órganos abdominales. El embarazo se interrumpió a las 32.1 semanas de gestación y los pacientes sobrevivieron dos horas, luego de lo cual fallecieron por la cardiopatía compleja.

Siamese twins are rare, occurring 1 in 50 000 to 1 in 100 000 live births; only 18% survive and approximately 35% of live births die in the first 24 hours. We report a case of thoracopagu twins. The prenatal diagnosis was made by ultrasound at 32 weeks of gestation. They had separated heads and extremities; they were females; at the joint thorax there was a single heart that sent an arterial vessel to what resembles a rudimentary cardiac mass in the contralateral fetus. They shared abdominal organs. Pregnancy was interrupted at 32.1 weeks of gestation; patients survived 2 hours.

Presentación de un caso de siameses cefalópagos / A case report of cephalopagus siamese

Se denominan siameses a aquellos gemelos que comparten estructuras anatómicas en grado variable. La incidencia varía entre 1:50 000 a 1:100 000 embarazos, 1:4 de los casos fallecen in utero y 40-60 por ciento mueren poco después del parto.Los hallazgos en autopsias médico-científicas de gemelos unidos cefalópagos, que son aquellos que presentan fusión cefálica con dos hemicaras, son el cuarto tipo de siameses en ocurrencia y su incidencia está estimada en 1 por cada 3'000.000 de embarazos o 1/58 siameses. El objetivo es presentar los hallazgos de una autopsia médico-científica de gemelos unidos cefalópagos. Se trata de gemelos cefalópagos, con terminación de embarazo por incompatibilidad con la vida extrauterina. Presentan cordón umbilical único de cinco vasos, tenían cráneos fusionados a nivel frontofacial con dos caras en lados opuestos de la cabeza (Janiceps), con fusión ventro-ventral de los ejes somáticos hasta debajo del ombligo sobre la pelvis, con sistemas respiratorios, cardiaco y genitourinario independientes, el sistema digestivo superior esta fusionado hasta el intestino medio, con duplicación a partir de la tercera porción del duodeno. Los gemelos siameses cefalópagos no son los más infrecuentes, pero es difícil encontrar series de casos y revisiones sistemáticas de sus características y patogénesis en Latinoamérica. Son escasas las estadísticas sobre siameses y no se ha descrito previamente ningún caso como éste. Se hace necesaria la realización de estudios de autopsias para mejorar la descripción y caracterización de estos casos y poder determinar si existen otras condiciones asociadas además de las teorías de unión embriológica(AU)

It is denominated siamese to those twins that share anatomical structures to a variable degree. The incidence varies between 1/50.000 and 1/100.000 pregnancies, 1:4 of the cases die in the uterus and 40-60 percent die shortly after birth. Findings in a medical-scientific autopsies of conjoined cephalopagus twins, those that presenting cephalic fusion with two hemi faces, are the fourth type of Siamese in occurrence and their incidence is estimated in 1 every 3´000.000 pregnancies or 1/58 siamese. It is about cephalopagus twins, with termination of pregnancy due to incompatibility with extrauterine life. They presented a five vessels common umbilical cord, fused craniums at frontofacial level with two faces in opposed sides of the head (Janiceps), ventro-ventral fusion of the somatic axis until below the umbilicus and above the pelvis, independent respiratory, cardiac and genitourinary systems. The superior digestive system was fused until the medium intestine, with duplication parting from the third portion of the duodenum. Conjoined cephalopagus twins are not the most frequent but it is hard to find a series of cases and systemic revisions of their characteristics and pathogenesis in Latin America. Statistics on Siamese twins are scarce and it has not been previously described any case like this one. Autopsy studies becomes necessary to improve the description and characterization of these cases and to determine the existence of any other associated conditions different to those of the embryologic union theory(AU)

Awareness and Knowledge of Oral Cancer among Siamese Ethnic Group in Tumpat, Kelantan

ntroduction: Oral cancer is a life-threatening disease. Lack of public awareness is a potent barrier for the early detection of oral cancer, especially for high-risk populations. Objective: This study aimed to determine the awareness and knowledge of the signs, symptoms and risk factors of oral cancer among a Siamese ethnic group in Tumpat, Kelantan. Methods: A cross-sectional study was conducted, using a guided questionnaire on sociodemography, habits, awareness and knowledge of the signs, symptoms and risk factors of oral cancer. Individuals under 18 years old and who had been diagnosed with oral cancer were excluded from this study. Results: A total of 195 respondents participated, 61.5% were female and the mean age was 46 (1.64). About 41% of the respondents had received secondary education and 35.4% were illiterate. Most respondents were self-employed (21.5%), followed by farmers (19.5%) and housewives (20%). The majority of them had a monthly income that fell below the poverty level of RM 830 (76.9%). Among the respondents, 22.6% had the habit of smoking, 25.6% consumed alcohol, 8.2% were betel quid chewers and 2.6% chewed tobacco. Out of 195 respondents, only 6.7% were aware of oral cancer. About 16.9% of the respondents correctly answered all of the questions regarding the signs and symptoms of oral cancer and only 4.1% knew the risk factors of oral cancer. Conclusion: The awareness and knowledge of oral cancer in this targeted population were unsatisfactory. Future effective health promotion programs and education should be emphasised.

Duplicación cráneo-facial (diprosopus) con trioftalmos diagnosticado mediante ecografía obstétrica 3D / Craniofacial duplication (diprosopus) with trioftalmos, diagnosed by 3D obstetric ultrasound

La duplicación cráneo-facial (diprosopus) es el resultado de la forma menos común de gemelos acoplados. La utilización de la ecografía 3D para el diagnóstico de esta patología ha sido reportada. Se presenta el segundo caso de esta patología en Colombia. Caso clínico de hijo de madre de 28 años a quien se le realizó diagnóstico prenatal con ecografía 3D, de duplicación craneofacial y de la columna vertebral. Cariotipo prenatal bandeo G: 46, XX. Al nacimiento se encontró feto de sexo femenino con duplicación craneofacial con la presencia de tres ojos, dos narices y dos bocas, con presencia de columna vertebral duplicada hasta la región cervical con espina bífida a nivel cervical. La utilización de ecografía 3D, permite realizar un diagnóstico oportuno de esta patología, lo que permite un abordaje multidisciplinario de las gestantes(AU)

Craniofacial duplication (diprosopus) is the result of the less common form of coupled twins. The use of 3D ultrasound for diagnosis of this disease has been reported.A second case of this disease occurs in Colombia. A clinical case of a son of 28-year-old mother, who underwent prenatal diagnosis with 3D ultrasound of craniofacial duplication and spine.Prenatal karyotype banding G: 46XX. At birth, a female fetus was found with craniofacial duplication, the presence of three eyes, two noses and two mouths, the presence of duplicate backbone up to the cervical region, and spina bifida at the cervical level. The use of 3D ultrasound allows early diagnosis of this disease, allowing a multidisciplinary approach of pregnant women(AU)

Contribuição à psicanálise: irmãos e lutas fratricidas. psicossomática / Aporte al psicoanálisis: hermanos y lucha fratricida. psicosomática / Contributions to psychoanalysis: brothers and fratricidal struggle. psychosomatic

Neste artigo, veremos duas questões. Por um lado, a partir de Freud, sintetizo a perspectiva psicossomática, que considera que todos os seres humanos constituem uma unidade psicofísica e que todo o processo físico tem seu correlato afetivo específico. Como exemplo, destaco a importância do DNA mitocondrial, herdado somente da mãe. A outra questão que desenvolvo é seu correlato psíquico. Para isso, diferentemente de Freud, considero que a verdadeira horda primitiva é a família consanguínea (todos com todos, inclusive a própria mãe), e que – na filogenia – depois de se estabelecer a primeira proibição do incesto, começou a luta fratricida (todos contra todos). Estas marcas filogenéticas ganham força através da experiência ontogenética universal: estado pré-natal em e com a mãe, vinculo denominado siamês. O representante pós-natal dessa poderosa díade é a criança indômita. Nós a expressamos quando aspiramos restabelecer aquela segurança original, quando empreendemos lutas fratricidas para recuperar um lugar em e com equivalentes maternos (cônjuge, filhos, netos, líderes empresariais, institucionais, partidos políticos, etc.). Proponho adicionar às fases de desenvolvimento evolutivo o complexo prévio: estado siamês em e com a mãe-criança indômita-luta fratricida. E interpretar sua transferência em todas as biografias.

In this work I refer to two issues. First, from Freud, I synthesize a psychosomatic perspective, which considers that all human beings constitute a psychophysical unity and that every physical process has its specific affective correlate. As an example I focus on the importance of mitochondrial DNA, inherited only from the mother. The other issue is its psychical correlate. For this, unlike Freud, I rescue that the true primitive horde was the consanguineous family (everybody with everybody, even with their own mother). Thus – in the phylogeny – after establishing the first prohibition of incest, fratricide struggle began (all against all). These phylogenetic footprints gain strength by universal ontogenetic experience: prenatal state in and with mom, relationship that I call siamese. The postnatal representative of this powerful dyad is the indomitable child. We express it when we wish to restore that original security, when we establish fraternal struggles to regain a place in and with maternal equivalents (partners, children, grandchildren, business and institutional leaders, political parties, etc.). I propose to add in evolutionary developmental stages to this prior complex: siamese state in and with mom-indomitable child-fratricidal struggle. And interpret their transfer in all biographies.

En este trabajo me refiero a dos cuestiones. Por un lado, a partir de Freud sintetizo la perspectiva psicosomática que considera que todos los seres humanos constituimos una unidad psicofísica y que todo proceso físico posee su específico correlato afectivo. Como ejemplo me centro en la importancia del ADN mitocondrial, heredado solo por vía materna. Así, la otra cuestión que desarrollo es su correlato psíquico. Para eso, a diferencia de Freud, rescato que la verdadera horda primitiva fue la familia consanguínea (todos con todos, incluso la propia madre), y que – en la filogenia – luego de establecer la primera prohibición del incesto, comenzó la lucha fratricida (todos contra todos). Estas huellas filogenéticas cobran fuerza por la experiencia ontogenética universal: el estado prenatal en y con mamá, vínculo que denomino siamés. El representante postnatal de esta poderosa díada lo denomino niño indómito. Lo expresamos cuando aspiramos a restablecer aquella originaria seguridad, cuando establecemos luchas fraternas para reconquistar un lugar en y con equivalentes maternos (pareja, hijos, nietos, líderes empresariales, institucionales, partidos políticos, etc.). Propongo agregar en las fases del desarrollo evolutivo el complejo previo: estado siamés em y con mamá-niño indómito-lucha fratricida. E interpretar su transferencia en todas las biografias.

Anticlastogenic potential of Thai vegetable, Siamese cassia, using mouse erythrocyte micronucleus assay.

Background: Some Thai vegetables may enhance the activities of some phase II enzymes and decrease activities of phase I enzymes. Thus, they may possess cancer chemo-preventive potentials. Objective: Determine the anti-clastogenic activity of Thai vegetable, Siamese cassia (SC), against an indirectacting clastogens, cyclophosphamide (CYP), and 7, 12-dimethylbenz(a)anthracene (DMBA). Methods: Male mice were fed either with semi-purified diet, containing 2% or 4% of ground lyophilized SC leaves, for two weeks prior to administration of clastogens. The anti-clastogenicity of SC leaves using the in vivo erythrocyte micronucleus assay in mice was performed. Blood samples were collected and counted for reticulocytes with and without a micronucleus using the fluorescent microscope. Results: Feeding SC leaves at 2% or 4% in the diets reduced the number of micronucleated peripheral reticulocytes (MNRETs) induced by both CYP and DMBA. However, the effect was statistically significant only at 4% in CYPinduced mice. Conclusion: Siamese cassia leaves possess anti-clastogenic activity against clastogens in mice, particularly in a high dose.

Siameses: reporte de un caso

Se describe un caso de gemelos unidos, tipo toracópagos, con diagnóstico antenatal mediante ecografía. En una paciente de 14 años de edad, primigesta, se informó gestación gemelar variedad toracópago-xifópago de 23,4 semanas por ecografía. Ingresó al Hospital Madre-Niño San Bartolomé, donde se realizó cesárea corporal clásica más técnica B. Lynch, obteniendo recién nacidos vivos pretérmino toracópagos, sexo femenino. El diagnóstico se complementó con el estudio anatomopatológico confirmatorio. Se presenta el resumen de la historia clínica y el protocolo de necropsia.

A case of thoracopagus conjoined twins with ultrasound antenatal diagnosis is presented. Ultrasound study in a 14 year-old young mother in her first pregnancy revealed twin pregnancy variety thoracopagus-xiphopagus 23,4 weeks by biometry. She was admitted at Hospital Nacional Madre-Nino San Bartolome where classical corporal cesarean section plus B. Lynch technique were performed and female thoracopagus preterm live newborns were obtained. Pathology confirmed diagnosis. Summary of the clinical history and necropsy protocol are presented.

Dicephalus dibraqui dipus / Dicephalus dibraqui dipus

Uno de los estados más interesantes y a la vez complejos a la hora de enfrentar desde el punto de vista médico de los embarazos múltiples son los gemelos siameses, o simplemente la fusión anatómica parcial en grado variable de sus estructuras orgánicas. En el presente artículo se presentan los datos generales y obstétricos más relevantes de uno de estos embarazos, ocurrido en la Isla de la Juventud en el año 2006, se convirtió en el primer embarazo de este tipo del que se tiene conocimiento en nuestro territorio. El caso resulta interesante a la vez por lo poco común que resultan muchos de los hallazgos encontrados en estos gemelos, en comparación con casos similares recogidos en la literatura, la no concomitancia de este caso con factores de riesgo comunes y la certeza del diagnóstico imagenológico

One of more interesting and at the same time complex challenges the multiple pregnancies is the presence of Siamese twins, or simply, a varying degree partial anatomic fusion of its organic structures. In present paper are included the more relevant general and obstetric data from one of these pregnancies occurred in Isla de la Juventud en 2006, becoming the first pregnancy of this type in our country. This case is interesting too by the unusual findings present in these twins compared to other similar cases present in the literature, the non-concomitance of this case with common risk factors and the accuracy of imaging diagnosis

Diagnóstico muy precoz de siameses: caso clínico y revisión de la literatura / Early diagnosis of conjoined twins: clinical case and literature review

We report a clinical case in which an early ultrasound diagnosis of retained abortion of thoracoomphalopagus siamese twins is performed by embryonic biometry at 9.5 weeks of gestation. 2D and 3D images clearly illustrate the condition and the accuracy of prompt diagnosis of a disease with such a low prevalence among the world population.

Se reporta caso clínico en el cual se realiza el diagnóstico ecográfico precoz de aborto retenido de siameses tóraco onfalópagos de 9 1/2 semanas por biometría embrionaria. Destacables son las imágenes 2D y 3D que ilustran claramente la condición y la precocidad del diagnóstico de una patología tanpoco prevalente en la población mundial.