Response to the Letter to the Editor Regarding "Survey among Medical Students during COVID-19 Lockdown: The Online Class Dilemma"

We thank the editor for allowing us to respond to the comments by Akshara et al. The authors concur with us on unpreparedness and goes on to highlight how female doctors are over-worked during the pandemic. In this response, we also discuss why providing free data will not bring about significant change in students’ perception of online classes. We then advise how students can learn basic examination skills during the pandemic. Finally, we express our views on government and universities and finish with a recommendation that would help future doctors in times like the COVID-19 pandemic. &nbsp

Glucometers for Patients with Type 2 Diabetes Mellitus: Are they helpful?

Background: The effectiveness of self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) patients is debated in the literature. We aimed at elucidating the association and patterns of complications between SMBG use and plasma glucose values. Methods: This cross-sectional study comprised 303 participants from outpatient departments with T2DM for over 12 months. We analyzed sociodemographic and clinical variables including: anthropometry, SMBG use, disease duration, treatment modality, complications, plasma glucose level, and glycated hemoglobin level (%). Results: The mean duration of T2DM was 93 ± 76 months. Participants were grouped into SMBG users (n=115, 38%) and non-SMBG users (n=188, 62%). The mean fasting plasma glucose levels of SMBG and non-SMBG users were 140.7±42.7 (95% Confidence Interval [95%CI]: 132.72;148.67) mg/dl and 145.4±50 (95%CI: 138.12;152.67) mg/dl (p=0.03), respectively. The mean post-prandial plasma glucose levels of the SMBG and non-SMBG groups were 202 ± 63.42 (95%CI: 190.23;213.76) mg/dl and 209±84.54 (95%CI: 196.56;221.43) mg/dl (p=0.002), respectively. The mean difference in HbA1c among the groups were 8.14±1.69% (95%CI: 7.59;8.68) and 8.15±1.98% (95%CI: 7.27;9.02) (p=0.4), respectively. Hypoglycemia (n=50, 43.5%) was the most common complication. The prevalence of neuropathy (n=5, 4.3%, p=0.036) and cardiovascular disease (n=21, 18.3%, p=0.042) were significantly higher in the SMBG group. Conclusion: Although plasma glucose values were significantly lower in the SMBG group, its clinical significance remains questionable. Furthermore, many participants in both groups had shortfalls in awareness, monitoring, and glycemic control. SMBG use needs to be evaluated in a cohort of patients with T2DM with adequate health awareness

BK virus infection and outcome following kidney transplantation in childhood.

BK virus associated nephropathy (BKN) is an important cause of kidney allograft failure. In a cohort of paediatric kidney transplant recipients, we aimed to understand the incidence and clinical outcome associated with BKN, as well as identify risk factors for BKN and BK viraemia development. We retrospectively analysed all patients who received a kidney transplant and received follow up care in our centre between 2009-2019. Among 106 patients included in the study (mean follow up 4.5 years), 32/106 (30.2%) patients experienced BK viraemia. The incidence of BKN was 7/106 (6.6%). The median time of BK viraemia development post-transplant was 279.5 days compared to 90.0 days for BKN. Development of BKN was associated with younger age at transplantation (p = 0.013). Development of BK viraemia was associated with negative recipient serology for cytomegalovirus (CMV) at time of transplantation (p = 0.012) and a higher net level of immunosuppression (p = 0.039). There was no difference in graft function at latest follow up between those who experienced BKN and those without BKN. This study demonstrates that BK virus infection is associated with younger age at transplantation, CMV negative recipient serostatus and higher levels of immunosuppression. Judicious monitoring of BK viraemia in paediatric transplant recipients, coupled with timely clinical intervention can result in similar long-term outcomes for BKN patients compared to controls

Diagnostic utility of fecal calprotectin as a biomarker of gut inflammation in neonates to predict necrotizing enterocolitis: A prospective study

Background: Necrotizing enterocolitis (NEC) is a neonatal emergency that affects preterm newborns during the 1st weeks of life.Diagnosis is made mainly by clinical criteria since no specific diagnostic tests are available. Objective: The objective was to evaluatefecal calprotectin (fCal) as a biomarker of gut inflammation to predict NEC in preterm neonates. Methods: Design: Diagnostic testevaluation. Inclusion criteria: 102 preterm neonates <36 weeks gestation and within 7 days of birth admitted in Level III neonatalintensive care unit (NICU) were recruited from January 2010 to May 2011. Exclusion criteria: Congenital anomalies and overt infection.Paired stool samples at day 3 and 7 were analyzed by lateral quantum blue rapid calprotectin assay. Cut-off values of fCal weredetermined among 30 term healthy infants. A structured questionnaire which included gestational age, symptoms at admission, andmodified Bell’s staging was used to record NEC episodes on day 3 and 7 of admission. Septic screen and radiological tools were doneas per NICU protocol. Results: 48% were above 34 weeks gestation; 31.3% were of very low birth weight. As per modified Bell’sstaging on day 3 and 7, 22 and 11 neonates had 1a or above stage, respectively. 15 had features of NEC; of these, 12 were managedappropriately and discharged and 3 died. In the receiver-operated curve with fCal >279 μg/g as cutoff, the area under the curve was0.652 (95% confidence interval: 0.516-0.789). Day 3 fCal levels were high in 65.7% neonates. Using NEC as outcome, sensitivity of thetest was 93.3%; specificity was 39%; positive predictive value was 20.8% and negative predictive value was 97.14%. Conclusion: fCalhas high sensitivity for diagnosing NEC in preterm neonates. However, further research is needed to establish its clinical usefulness

Aspect term extraction for sentiment analysis in large movie reviews using Gini Index feature selection method and SVM classifier

With the rapid development of the World Wide Web, electronic word-of-mouth interaction has made consumers active participants. Nowadays, a large number of reviews posted by the consumers on the Web provide valuable information to other consumers. Such information is highly essential for decision making and hence popular among the internet users. This information is very valuable not only for prospective consumers to make decisions but also for businesses in predicting the success and sustainability. In this paper, a Gini Index based feature selection method with Support Vector Machine (SVM) classifier is proposed for sentiment classification for large movie review data set. The results show that our Gini Index method has better classification performance in terms of reduced error rate and accuracy

Butorphanol for Post-Operative Analgesia - A Comparative Clinical Study with Ketorolac

Introduction: Butorphanol, an opioid derivative has been shown to have, in addition to its analgesic properties, several other advantageous effects like antistressor, sedative and anti-shivering action. The efficacy and safety profile of ketorolac, yet another widely used post-operative analgesic is well documented. This study aims to compare the two analgesics. Aims and objectives: This study was conducted to compare the analgesic efficacy and other effects of butorphanol and ketorolac, administered intramuscularly, in post-operative patients who have undergone lower abdominal and pelvic surgeries. Materials and methods: 50 patients undergoing lower abdominal and pelvic surgeries under general or spinal anaesthesia were randomly divided into two Groups (25 each). At a particular level of post-operative pain, the patients Groups I and II were administered intramuscular ketorolac 30mg and butorphanol 2mg respectively. The analgesic effect was studied using Visual Analogue Scale (VAS) and the verbal category scale. Patients were monitored for the sedative action, respiratory status and other vital parameters for 300 minutes and for other adverse reactions over the next twelve hours. Observations: Butorphanol provided better analgesia within the first two hours of administration, while ketorolac was more effective at 4-5 hours. Better sedative action without any significant respiratory depressant effect was demonstrated with butorphanol. There were no clinically significant hemodynamic fluctuations or adverse reactions with butorphanol or ketorolac. Conclusions: Butorphanol provides better early analgesia as compared to ketorolac with a desirable and safe sedative effect in post-operative patients who have undergone lower abdominal and pelvic surgeries

Robust outlier detection by de-biasing VAE likelihoods

Deep networks often make confident, yet, incorrect, predictions when tested with outlier data that is far removed from their training distributions. Likelihoods computed by deep generative models (DGMs) are a candidate metric for outlier detection with unlabeled data. Yet, previous studies have shown that DGM likelihoods are unreliable and can be easily biased by simple transformations to input data. Here, we examine outlier detection with variational autoencoders (VAEs), among the simplest of DGMs. We propose novel analytical and algorithmic approaches to ameliorate key biases with VAE likelihoods. Our bias corrections are sample-specific, computationally inexpensive, and readily computed for various decoder visible distributions. Next, we show that a well-known image pre-processing technique -- contrast stretching -- extends the effectiveness of bias correction to further improve outlier detection. Our approach achieves state-of-the-art accuracies with nine grayscale and natural image datasets, and demonstrates significant advantages -- both with speed and performance -- over four recent, competing approaches. In summary, lightweight remedies suffice to achieve robust outlier detection with VAEs.Comment: To appear at CVPR 2022. 20 pages and 19 figure

Adolescent Obesity and Type 2 Diabetes Mellitus: Synaptics and Heuristics

The adolescent population is the foundation for a Nation’s progress. Their shoulders therefore must be emboldened with health and dignity to ensure a developed Nation. However, the multitude of prevailing epidemics have left nostone unturned to enfeeble their strength. Type 2 diabetes mellitus (T2DM) and obesity stand amongst the top shotguns. There is a dire need to execute preventive as well as therapeutic actions to contain the epidemic, for which one must be well versed with the attributable risk factors. In this article, we will understand the synaptics of adolescent obesity and T2DM and what strategies are recommended by the health authorities to prevent and overcome this rising epidemic

Dapagliflozin in the Landscape of Type 2 Diabetes Management

As per current statistics, India accounts for more than 74 million individuals living with diabetes. Many of these individualshave associated cardiovascular disease (CVD) and chronic kidney disease (CKD) comorbidities. Optimal glycemic managementis important because uncontrolled glycemia may accelerate the macrovascular and microvascular complications, furtheraggravating the comorbid conditions. Metformin is used as the first-line therapy in most persons. However, there are somewho do not tolerate metformin, are unable to achieve required glycemic targets or require greater efforts for cardiovascular(CV) risk reduction. These patients require an alternative hypoglycemic agent to be used as either monotherapy or ascombination treatment with metformin, respectively. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are one such novelclass of drugs that can be used as either monotherapy or as part of two drug (dual) or three drug (triple) combinations withother oral hypoglycemic agents or insulin. Dapagliflozin is a promising option for managing type 2 diabetes with CV andrenal benefits, weight and blood pressure reducing properties. A low risk of hypoglycemia and drug-drug interactions are theadded advantages. In this article, the authors have reviewed the existing clinical evidences on dapagliflozin and highlightedits place in the diabetes management landscape