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.

A hospital-based study on COVID-19 patients with rhino-orbital mucormycosis

Coronavirus diseases 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 virus produce opportunistic fungal infections. Mucormycosis is an acute onset rapidly progressive fatal infection. Incidence of rhino-orbital mucormycosis raised during the second wave of COVID-19 pandemic in India. Diabetes, steroid therapy, cancer, prolonged hospitalization, and metabolic acidosis are the risk factors of post-COVID-19 mucormycosis. Objectives of this study were to suggest the risk factors, clinical features, investigations, and treatment of post-COVID-19 rhino-orbital mucormycosis. This study will guide the future research and the clinician will be aware about this complication of COVID-19. After getting permission from the Institutional Ethical Committee and consent from patients, we studied 10 cases of post-COVID-19 rhino-orbital mucormycosis from April to September 2021 during our duty in COVID-19 admission desk and COVID-19 ward in NRS Medical College, Kolkata. After taking history, we observed the clinical features, investigations, and treatment of the patients. Symptoms of the patients were nasal discharge, nasal block, headache, facial swelling, and blackish discoloration of skin. Most of the patients were diabetic. Magnetic resonance imaging (MRI)-PNS was showed sinonasal mass. Amphotericin-B was used and debridement was the main surgical procedure. Microscopy showed broad aseptate hyphae suggesting mucor. Early diagnosis and proper treatment will reduce the morbidity and mortality of the patient with post-COVID rhino-orbital mucormycosis.

Study of histopathology reports of loop electrosurgical excision procedure of cervical transformation zone and their correlation with preprocedural cervical biopsy and/or cytology: An audit

Introduction: Loop electrosurgical procedure of the transformation zone of the cervix (LEEP) is the preferred method for many investigators for early detection and treatment of high grade intraepithelial neoplasia(HGCIN). Histopathology reports of LEEP should contain information about the diagnosis, presence or absence of neoplasia ( with its grade) and comment on excison margins. Aim: Our aim was to study LEEP reports for its contents and to see their correlation with preprocudure histology and/or cytology report. Results: Between 2011 and 2017, 44 LEEP reports were archived and studied for their contents from our records. Slides were not reviewed. Mean age was 47.66 years (median 47 years). Forty two (( 95.45%) reports mentioned that all the tissue was examined. Deep cut examination was mentioned in 17/44 cases (38.64%). The concordance rate between LEEP and preprocudure histology and /or cytology for CIN II plus diagnosis is 65.9%. A strict definition is used. If, however, diagnoses between inflammation and CIN I, ASC-H and inflammation, and ASC-H and CIN I are considered non discordant, then the concordance rate rises to 72.7 %. The breakup of discordant cases is given. Conclusion: Literature shows wide range of concordance due to variable definitions and variety of reasons; possible reasons are discussed.

Superficial CD34-positive fibroblastic tumor in the forearm of a middle-aged patient: A newly described, rare soft-tissue tumor

Superficial CD34-positive fibroblastic tumor is a recently described soft-tissue tumor entity. A 48 year-old-male presented with a gradually increasing soft-tissue mass in his right forearm of 2 years' duration, along with multiple subcutaneous soft-tissue nodular lesions, and reminiscent of lipomas over his body. He underwent a wide excision of his forearm mass. Microscopic sections showed a circumscribed tumor in the dermis and subcutaneous fat, composed of spindle cells, inflammatory cells, including lymphocytes, plasma cells, and eosinophils, along with interspersed markedly pleomorphic giant cells containing moderate-to-abundant “glassy” cytoplasm, vesicular nuclei, exhibiting prominent nucleoli, and intranuclear pseudoinclusions. There were no significant mitotic figures, areas of hemorrhage, necrosis, or pigment histiocytes. By immunohistochemistry, the tumor cells were diffusely positive for CD34 while negative for cytokeratin (CK), pan CK (AE1/AE3), S100 protein, CD30, and CD31. MIB1/Ki-67 was low and highlighted 4%–5% tumor nuclei. Diagnosis of superficial CD34-positive fibroblastic tumor was offered. Sections from the various resection margins were free of tumor. Postresection, the patient is alive with no evidence of disease for the past 8 months. This constitutes as one of the first case reports of this rare tumor entity from our country. Its diagnostic and treatment implications are discussed herewith.

Nutritional status of children attending OPD at tertiary care hospital in Katihar, Bihar.

Background: Despite India’s remarkable economic growth over the last decade, many children still struggle to meet their basic needs, include access to sufficient food and health care .In this context it was important to get a more recent data on child nutritional status. Aims & Objective: (1) Prevalence of malnutrition in children under 5 years of age coming to Pediatric OPD at Katihar medical college; (2) Age and sex most severely affected by malnutrition; (3) Identify major risk factors associated with malnutrition in the population under study. Material and Methods: Institution based cross-sectional study was carried out in Pediatric OPD of Katihar medical college The median weight for height, height for age and weight for height of NCHS standard were used as references anthropometric indices. A total of 260 randomly selected children were covered in the study of 20 days. Results: Prevalence of underweight (30%), stunted (74.2%) and wasting (41.9%). The major risk factors affecting nutritional status include mother’s age, mothers and fathers education, monthly per capita income, pre lacteal feeds, birth order and duration of breast feeding. The study demonstrates multiple risk factors affecting nutrition status. Conclusion: The study demonstrates multiple risk factors affecting nutrition status. A more elaborate community based study would help to find out prevalence of malnutrition in children of Katihar and it should be done at regular interval in order to monitor the situation.

Pulmonary disease due to mycobacterium massiliense.

We report a case of a patient suffering from multidrug-resistant pulmonary tuberculosis (MDR-PTB) who later developed an invasive infection of the respiratory tract with a rapidly growing non-tuberculous mycobacteria (NTM), recently identified as Mycobacterium massiliense, closely related to M. abscessus. To the best of our knowledge, this is the first case of M. massiliense infection being reported from India.

Monthly variation in night time noise levels at residential areas of Asansol city (India).

Intense vehicular movement and industrial activities are the major noise producing sources in the Asansol city. Ambient night time noise levels were monitored in ten residential areas from August 2002 to July 2003, to study the existing quality of noise and their impact in the local community. Based on the monitored noise levels in the area, traffic-social survey was also conducted. About 39% of individuals surveyed were highly annoyed with noise pollution from different origins. The study revealed that night time noise levels (10.00 pm - 6.00 am) in all the locations exceeded the limit prescribed by Central Pollution Control Board. The day time noise level was much higher at all locations in respect of the night time noise level. The Day-Night equivalent noise level (Ldn) was determined and ranged between 67.16 dB(A) and 89.44 dB(A). The percentile noise level (L90) exceeded the CPCB standard in all cases and varied from 72.36 dB(A) to 102.45 dB(A). Based on the results of the study, it can be concluded that the local community is exposed to high noise environment.

Epidemiological aspects of acute childhood poisoning among patients attending a hospital at Kolkata.

A retrospective study from a tertiary care teaching hospital in Kolkata revealed 3.6% of total paediatric admissions were due to poisoning. Majority of the cases included oral/chemical poisoning followed by biological/envennomation. Kerosene was the commonest among all poisoning. Most of the cases were accidental.

Effect of tight glycaemic control on fetal complications in diabetic pregnancies.

AIMS: To find the incidence of fetal complications in Indian diabetic mothers with tight glycaemic control (TC), its comparison with other levels of glycaemic control, i.e., acceptable control (AC), uncontrolled (UC), and relevant international data. METHODS: A total of 240 mothers with diabetes mellitus (DM) and pregnancy were risk-matched and selected from the Antenatal Clinic of NRS Medical College, 176 of whom had gestational diabetes mellitus (GDM) and 64 had pregestational diabetes mellitus (PGDM), and were put on exercise, diet and or insulin therapy. Glycaemic parameters monitored include fasting plasma glucose (FPG), 2 hr. postprandial plasma glucose (PPPG) and HbA1C. TC had - FPG < 70 mg/dl, PPPG < 100 mg/dl, HBA1C < 6.5%; AC with FPG 70-95 mg/dl, 2 hr. PPPG 100-120, HBA1C 6.5-7.5% and UC had FPG > 95 mg/ dl, 2 hr. PPPG > 120 mg/dl and HBA1C > 7.5%. Fetal parameters monitored included large-for-date babies (LGA), small-for-date babies (SFD), birth asphyxia, perinatal death, neonatal hypoglycemia, neonatal hypocalcaemia and congenital anomalies. RESULTS: (i) LGA-AC had the best results (0% vs. 12.5 and 22.29%); (ii) SFD-TC and AC had worst results (16.7% and 18.18% vs. 0%); (iii) Birth asphyxia-AC fared worse 18.18% vs. 4.16% and 0%; (iv) perinatal death and congenital anomalies showed significant reduction with tight control (4.16% and 0% respectively); (v) Neonatal hypoglycemia is lowered in TC compared with UC while neonatal hypocalcaemia does not show any alteration. For PGDM patients there is little intra-group variability of the parameters. The UC subgroups of GDM fared better than PGDM as far as all complications and congenital anomalies were concerned. Compared with international data, there is a dichotomy of the results of GDM and PGDM. CONCLUSION: For GDM patients all parameters may not be uniformly affected by the same degree of glycaemic control. A tight control may not be theonly factor to decide on the outcomes for PGDM patients.

Study of primary amenorrhoea with special reference to cytogenetic evaluation.

An attempt has been made to find out the proportion of genetic causes in cases of primary amenorrhoea and to analyse different chromosomal pattern. Cases were analysed according to clinical profile, X-ray, laparoscopy/pneumography, hormone profile, USG, Gonadal Biopsy and Cytogenetic study including Sex Chromatin (Barr body) and Karyotyping. Among the 72 cases studied, the aetiological factors were Mullerian duct abnormalities in 27 cases (37.5%) Gonadal agenesis in 13 cases (18.05%). Turner stigmata in 18 cases (25%), Y cell line in 6 cases (8.33%). Delayed menarche in 4 cases (5.55%), systemic disease like Tuberculosis and Idiopathic 2 cases (2.77%) each. Chromosomal aberration was seen in 24 cases (33.33%) and it comes second most common cause of primary amenorrhoea after mullerian duct abnormalities.

Cholelithiasis in a child--an unusual presentation of Wilson's disease.

A nine year old mentally retarded girl with moderate splenomegaly and ascites presented with chronic cholelithiasis. The presence of Kayser-Fleischer rings and low serum ceruloplasmin level confirmed the diagnosis of Wilson's disease. Cirrhosis of liver and recurrent episodes of hemolysis--these two common complications of Wilson's disease make an ideal setting for gall stone formation. Only three such cases have been reported worldwide and ours is the first case report from India. We suggest that cholelithiasis and splenomegaly in a child without evidence of congenital hemolytic disease should be taken as a suspect of Wilson's disease.

Interface between drug use and sex work in Manipur.

BACKGROUND: In India, drug use is seen predominantly as a problem among men. This study attempts to address the interface between drug use and sex work among women drug users in Manipur and the prevalence of HIV, hepatitis B and other sexually transmitted infections in them. METHODS: This cross-sectional survey was conducted between April and October 1997 at the time of an ethnic clash in imphal, the capital of Manipur. Sixty-nine women drug users were interviewed through street-based outreach workers; 38 women (55%) were injecting drug users. Data were generated with the help of a semi-structured questionnaire on sociodemography, drug use practice and health issues after obtaining informed consent from the participants. Subsequently, consent was also obtained from 60 respondents for collecting blood for unlinked anonymous tests for HIV and hepatitis B surface antigen. Clinical examination for reproductive tract infections, offered to all the study participants, generated data on sexually transmitted diseases. RESULTS: The prevalence of HIV infection in injecting drug users was 57% (20/35) compared to 20% (5/25) among non-injecting drug users (p = 0.001), although the prevalence of hepatitis B surface antigen was similar in the two groups, 48% v. 56%, respectively. Eighty per cent of the respondents, many of whom migrated following the ethnic clash, reported having sex with non-regular partners, two-thirds reported sex in exchange for money or drugs. Eighty-one per cent (29/36) of women who agreed to have a clinical examination had abnormal vaginal discharge, of which 10 had endocervical discharge. The presence of infection was confirmed in only 24% of those with vaginal discharge--4 had bacterial vaginosis and 3 trichomoniasis. CONCLUSION: Environmental interventions to reduce civil unrest and forced migration have an important role to play in HIV containment. The high rate of HIV infection, and the probability of a high rate of sexually transmitted infections in women drug users suggests that a targeted intervention in this population group is a public health need. An innovative outreach strategy should be designed for effective implementation of interventions among women injecting drug users and non-injecting drug users who operate from the streets as sex workers to support their drug habit as well as livelihood.

A study of mycetoma in eastern India.

Forty consecutive cases of mycetoma were studied with respect to clinico-epidemiological, histopathological and radiological features. The age of the patients ranged from 17 to 57 years mean being 32.4 +/- 8.68. The disease was equally distributed amongst the sexes. Most of the patients had a rural background and the disease occurred mainly among farmers and housewives. Actinomycetes (32 cases. 80%) were found to be the main pathogenic organism and Eumycetes in 4 cases (20%) only. Clinical features were more or less the same irrespective of the aetiologic agent, consisting of local swelling with discharging sinuses. History of trauma was present in only 20% cases and 80% were incidental. Foot (28/40 i.e. 70%) was the commonest site of infection. Radiological bony involvement was detected in 14 out of 18 cases examined (38.88%). Out of the 32 radiographed patients of actinomyetoma 10(31.25%) showed bony involvement whereas all the four. Eumycetoma cases radiographed, had bony involvement. The notable bony changes were sclerosis, erosions, periosteal thickening and osteoporosis.

Cytogenetic study of primary amenorrhoea.

A study of chromosomal pattern was done in 60 cases of primary amenorrhoea of different age groups to determine the incidences of chromosomal abnormalities in them and to detect those cases of classical 45, X Turner's syndrome and Turner mosaics that do not bear the Turner stigmata. Buccal smears were examined for sex chromatin followed by karyotype using leucocyte culture method. Majority (63.3%) of cases were found chromosomally incompetent of which the major abnormality was 45, X/46, XX mosaicism (33.3%) followed by 45, X Turner's syndrome (26.6%). But only 43.7% of these Turner's syndrome had classical Turner stigmata. Two cases of complete testicular feminisation syndrome with male genotype (46,XY) and inguinal testis were also detected.