Publications by authors named "Vipul Mishra"

6 Publications

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A transfer learning with structured filter pruning approach for improved breast cancer classification on point-of-care devices.

Comput Biol Med 2021 Apr 30;134:104432. Epub 2021 Apr 30.

Missouri University of Science and Technology, Rolla, MO, 65409, USA. Electronic address:

Background And Objective: A significant progress has been made in automated medical diagnosis with the advent of deep learning methods in recent years. However, deploying a deep learning model for mobile and small-scale, low-cost devices is a major bottleneck. Further, breast cancer is more prevalent currently, and ductal carcinoma being its most common type. Although many machine/deep learning methods have already been investigated, still, there is a need for further improvement.

Method: This paper proposes a novel deep convolutional neural network (CNN) based transfer learning approach complemented with structured filter pruning for histopathological image classification, and to bring down the run-time resource requirement of the trained deep learning models. In the proposed method, first, the less important filters are pruned from the convolutional layers and then the pruned models are trained on the histopathological image dataset.

Results: We performed extensive experiments using three popular pre-trained CNNs, VGG19, ResNet34, and ResNet50. With VGG19 pruned model, we achieved an accuracy of 91.25% outperforming earlier methods on the same dataset and architecture while reducing 63.46% FLOPs. Whereas, with the ResNet34 pruned model, the accuracy increases to 91.80% with 40.63% fewer FLOPs. Moreover, with the ResNet50 model, we achieved an accuracy of 92.07% with 30.97% less FLOPs.

Conclusion: The experimental results reveal that the pre-trained model's performance complemented with filter pruning exceeds original pre-trained models. Another important outcome of the research is that the pruned model with reduced resource requirements can be deployed in point-of-care devices for automated diagnosis applications with ease.
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http://dx.doi.org/10.1016/j.compbiomed.2021.104432DOI Listing
April 2021

Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial.

Lancet Respir Med 2021 05 4;9(5):511-521. Epub 2021 Mar 4.

University Hospitals Bristol NHS Foundation Trust and Translational Health Sciences, Bristol Medical School, Bristol, UK.

Background: Global randomised controlled trials of the anti-IL-6 receptor antibody tocilizumab in patients admitted to hospital with COVID-19 have shown conflicting results but potential decreases in time to discharge and burden on intensive care. Tocilizumab reduced progression to mechanical ventilation and death in a trial population enriched for racial and ethnic minorities. We aimed to investigate whether tocilizumab treatment could prevent COVID-19 progression in the first multicentre randomised controlled trial of tocilizumab done entirely in a lower-middle-income country.

Methods: COVINTOC is an open-label, multicentre, randomised, controlled, phase 3 trial done at 12 public and private hospitals across India. Adults (aged ≥18 years) admitted to hospital with moderate to severe COVID-19 (Indian Ministry of Health grading) confirmed by positive SARS-CoV-2 PCR result were randomly assigned (1:1 block randomisation) to receive tocilizumab 6 mg/kg plus standard care (the tocilizumab group) or standard care alone (the standard care group). The primary endpoint was progression of COVID-19 (from moderate to severe or from severe to death) up to day 14 in the modified intention-to-treat population of all participants who had at least one post-baseline assessment for the primary endpoint. Safety was assessed in all randomly assigned patients. The trial is completed and registered with the Clinical Trials Registry India (CTRI/2020/05/025369).

Findings: 180 patients were recruited between May 30, 2020, and Aug 31, 2020, and randomly assigned to the tocilizumab group (n=90) or the standard care group (n=90). One patient randomly assigned to the standard care group inadvertently received tocilizumab at baseline and was included in the tocilizumab group for all analyses. One patient randomly assigned to the standard care group withdrew consent after the baseline visit and did not receive any study medication and was not included in the modified intention-to-treat population but was still included in safety analyses. 75 (82%) of 91 in the tocilizumab group and 68 (76%) of 89 in the standard care group completed 28 days of follow-up. Progression of COVID-19 up to day 14 occurred in eight (9%) of 91 patients in the tocilizumab group and 11 (13%) of 88 in the standard care group (difference -3·71 [95% CI -18·23 to 11·19]; p=0·42). 33 (36%) of 91 patients in the tocilizumab group and 22 (25%) of 89 patients in the standard care group had adverse events; 18 (20%) and 15 (17%) had serious adverse events. The most common adverse event was acute respiratory distress syndrome, reported in seven (8%) patients in each group. Grade 3 adverse events were reported in two (2%) patients in the tocilizumab group and five (6%) patients in the standard care group. There were no grade 4 adverse events. Serious adverse events were reported in 18 (20%) patients in the tocilizumab group and 15 (17%) in the standard care group; 13 (14%) and 15 (17%) patients died during the study.

Interpretation: Routine use of tocilizumab in patients admitted to hospital with moderate to severe COVID-19 is not supported. However, post-hoc evidence from this study suggests tocilizumab might still be effective in patients with severe COVID-19 and so should be investigated further in future studies.

Funding: Medanta Institute of Education and Research, Roche India, Cipla India, and Action COVID-19 India.
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http://dx.doi.org/10.1016/S2213-2600(21)00081-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078880PMC
May 2021

Regulation of ascorbate-glutathione cycle by exogenous nitric oxide and hydrogen peroxide in soybean roots under arsenate stress.

J Hazard Mater 2021 05 15;409:123686. Epub 2020 Aug 15.

Plant Physiology Laboratory, Department of Botany, C.M.P. Degree College, A Constituent Post Graduate College of University of Allahabad, Prayagraj, 211002, India. Electronic address:

The role of nitric oxide (NO) and hydrogen peroxide (HO) is well known for regulating plant abiotic stress responses. However, underlying mechanisms are still poorly understood. Therefore, the present study investigated the involvement of NO and HO signalling in the regulation of arsenate toxicity (As) in soybean roots employing a pharmacological approach. Results show that As toxicity declined root length and biomass due to greater As accumulation in the cell wall and cellular organelles. Arsenate induced cell death due to enhanced levels of reactive oxygen species, lipid and protein oxidation and down-regulation in ascorbate-glutathione cycle and redox states of ascorbate and glutathione. These results correlate with lower endogenous level of NO. Interestingly, addition of L-NAME increased As toxicity. However, addition of SNP reverses effect of L-NAME, suggesting that endogenous NO has a role in mitigating As toxicity. Exogenous HO also demonstrated capability of alleviating As stress, while NAC reversed the protective effect of HO. Furthermore, DPI application further increased As toxicity, suggesting that endogenous HO is also implicated in mitigating As stress. SNP was not able to mitigate As toxicity in the presence of DPI, suggesting that HO might have acted downstream of NO in accomplishing amelioration of As toxicity.
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http://dx.doi.org/10.1016/j.jhazmat.2020.123686DOI Listing
May 2021

COVID-19 Pneumonia with Delayed Viral Clearance in a Patient with Active Drug-resistant Pulmonary Tuberculosis.

Indian J Crit Care Med 2020 Nov;24(11):1132-1134

Critical Care Department, Nayati Hospital, Mathura, Uttar Pradesh, India.

COVID pneumonia patient presents with fever, cough, and breathing difficulty. Many respiratory pathogens have such clinical presentations and pulmonary tuberculosis (PTB) is one of them, which is prevalent in the Indian subcontinent. Herein, we are presenting a case of dual infection with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and drug-resistant PTB [likely multidrug resistance (MDR)] in a patient with chronic kidney disease (CKD) and type 2 diabetes mellitus, a clinical course further complicated by a prolonged viral clearance.

How To Cite This Article: Sarma U, Mishra V, Goel J, Yadav S, Sharma S, Sherawat RK. COVID-19 Pneumonia with Delayed Viral Clearance in a Patient with Active Drug-resistant Pulmonary Tuberculosis. Indian J Crit Care Med 2020;24(11):1132-1134.
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http://dx.doi.org/10.5005/jp-journals-10071-23662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751040PMC
November 2020

Isolated pulmonary mucormycosis.

BMJ Case Rep 2017 Feb 16;2017. Epub 2017 Feb 16.

Department of Histopathology, Nayati Multi Super Speciality Hospital, Mathura, Uttar Pradesh, India.

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http://dx.doi.org/10.1136/bcr-2017-219342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318590PMC
February 2017

Pulmonary actinomycosis: a clinical surprise!

BMJ Case Rep 2017 Jan 27;2017. Epub 2017 Jan 27.

Department of Pulmonology Critical Care, Nayati Multi Super Speciality Hospital, Mathura, India.

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http://dx.doi.org/10.1136/bcr-2016-218959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278323PMC
January 2017