A Learning Algorithm based on High School Teaching Wisdom

A learning algorithm based on primary school teaching and learning is presented. The methodology is to continuously evaluate a student and to give them training on the examples for which they repeatedly fail, until, they can correctly answer all types of questions. This incremental learning procedure produces better learning curves by demanding the student to optimally dedicate their learning time on the failed examples. When used in machine learning, the algorithm is found to train a machine on a data with maximum variance in the feature space so that the generalization ability of the network improves. The algorithm has interesting applications in data mining, model evaluations and rare objects discovery

Comparision of Fibrometer Test with Fibroscan and Its Correlation with Liver Biopsy in Detecting Liver Fibrosis in Patients with Hepatitis B Infection

INTRODUCTION : Hepatitis B is a major health problem affecting more than 350 million people globally. Hepatitis B carriers are defined as persons positive for HBsAg for more than 6 months. The chance of developing sequelae is about 15% to 40% over lifetime, hence evaluation and early treatment is required. The prognosis and management of HBV related liver disease depends on the degree of liver fibrosis AIM : The aim of the study was to detect liver fibrosis in patients with chronic hepatitis B infection using non invasive markers – Fibroscan and Fibrometer test and to compare its efficacy with the gold standard liver biopsy. MATERIALS AND METHODS : This prospective study was conducted in our department, Department of Digestive Health and Disease, Kilpauk Medical College, Chennai. 30 patients were included in our study over a period of six months. Patients with Chronic hepatitis B infection alone were included in the study. Patients with associated HCV/HIV infection, compensated or decompensated cirrhotics were excluded from the study. Detailed history, physical examination was performed and baseline hematologcal investigations, Fibroscan, Fibrometer and Liver biopsy were also done. RESULTS : In our study, out of 30 patients 21 (70%) were males and 9 (30%) were females. 63% of the study population were HBeAg negative and 63.33% of the patients had high viral load of more than 1,00,000 IU/ml. Patients underwent Fibroscan study which showed 14 patients (46.67%) had liver stiffness measurement (LSM) of less than 6.5 kpa suggesting nil fibrosis, 33% had mild fibrosis with a LSM value of 6.5 to 8 and 20% had values above 8 suggesting moderate fibrosis. Similarly Fibrometer test showed 43.33% patients with significant fibrosis. Statistical analysis was done by Pearson co-efficient equation and it showed that Fibroscan value (LSM) of more than 8 kpa had 100% specificity in detecting significant fibrosis correlating with liver biopsy with a p value of 0.005 and ROC of 0.89 (95% confidence interval of 0.76 to 0.90). Fibrometer test also detected significant fibrosis (F2) in 43% of patients and on correlation with liver biopsy had a P value o 0.004 with ROC values of 0.905 and 95% confidence interval of 0.80 – 0.99. CONCLUSION : Fibroscan and Fibrometer is good non-invasive test only in detecting significant fibrosis, with higher values correlating with liver biopsy. Liver biopsy still is the gold standard and is useful in detecting early fibrosis. Both Fibroscan and Fibrometer has similar efficacy and can be used to exclude fibrosis and to detect significant fibrosis

Clinical Profile of Mucormycosis during the Second Wave of COVID-19 in a Tertiary Care Center in India

Objective: To study the clinical profile and treatment outcome of mucormycosis associated with the second wave of COVID-19 pandemic. Methods: An observational study was conducted in a tertiary care center over a period of 12 months, including a 6-month post treatment follow up. Study included all COVID positive patients with a clinical and radiological evidence of rhino-orbito-cerebral mucormycosis during the second wave of COVID-19. All patients underwent further diagnostic workup and confirmed cases underwent surgical debridement and Amphotericin B was started. Results: A total of 59 patients presented with mucormycosis with the mean age being 52.7 years and unilateral facial and orbital edema as the most common symptoms (28.8%). All were diabetic with HbA1c >7 in 54.2%. The mean duration of presentation was 20.7±7.9 days from the onset of COVID-19 infection. Unilateral involvement of the paranasal sinuses was the most common finding in MRI. Early administration of Amphotericin B with prompt surgical debridement was performed in all cases. Orbital exenteration was conducted in nine patients for better fungal load clearance. Patients showed a good response to surgical debridement and prompt medical treatment, with a mortality rate of 27%. Conclusion: COVID-19 associated mucormycosis is difficult to treat and often presents in late stage. Uncontrolled diabetes, immunocompromised state, and steroid-induced immunosuppression were important risk factors. A close surveillance for early identification and initiation of treatment is mandatory. Repeated surgical debridement to clear the dead tissue is effective to control fungal load