Background Post COVID-19 syndrome (PCS) has emerged as a major roadblock in the recovery of patients infected with SARS-CoV-2. Amongst many symptoms like myalgia, headache, cough, breathless; fatigue is one of the major symptoms which makes the patient severely debilitated. Research on PCS, in particular fatigue, in patients with diabetes has not been done. Methodology In this prospective study, we included patients with type 2 diabetes (T2D) who had COVID-19 infection (mild to moderate severity), and matched T2D patients who did not suffer from COVID-19 infection. Demography, anthropometry, glycemic measures, treatment, COVID-19 infection details were recorded. Symptoms were scored using Chalder Fatigue Scale (reported as fatigue score, FS) and handgrip strength (in kg) was recorded by Jamar Hydraulic Hand Dynamometer. Results A total of 108 patients were included (cases, 52, controls, 56). Both groups were matched for age, duration of diabetes, BMI, TSH and vitamin D levels. T2D patients with COVID-19 infection had significant more fatigue when compared with patients without COVID-19 infection but comparable handgrip strength. Furthermore, patients with T2D with previous COVID-19 infection and who had FS >4 have had significant higher inflammation markers during acute illness, and post COVID-19, had increased post prandial blood glucose levels, lost more weight, had reduced physical activity and significantly lower handgrip strength as compared to those with FS <4. Conclusion Patients with T2D who had COVID-19 infection as compared to those without had significantly more fatigue after the acute illness, and those with higher fatigue score had reduced handgrip strength indicating sarcopenia. Rehabilitation of those with FS >4 after acute infection would require careful attention to nutrition, glycemic control and graduated physical activity protocol.

Nephropathy is a life-threatening complication of diabetes mellitus and is the leading cause of end-stage renal disease. The rate of rise in Serum Creatinine (SrCr) is a well-accepted marker for the progression of Diabetic Nephropathy (DN). The objective of this paper is to estimate the DN onset times and for this a retrospective data from 132 type 2 diabetic patients were collected as per American Diabetes Association (ADA) standards. This data is divided into four groups: Less Advance DN (LADN) group (1.4mg/dl ≤ SrCr ≤ 1.9 mg/dl), Advance DN (ADN) group (SrCr > 1.9 mg/dl), Non-Informative group (SrCr < 1.4 mg/dl & duration of diabetes ≤ 15 years) and Controlled group (SrCr < 1.4 mg/dl & duration of diabetes >15 years). For estimating the time of onset of DN for each group we have applied Bayesian approach and Bayes estimate is obtained under squared error loss function for the unknown scale parameter. We found that patients with DN as complication will reach less advance and advance stages of DN in approximately 15.012 years and 16.890 years respectively. And it was also found that patients with duration of diabetes less than 15 years (non-informative group) will be free from DN for at least 7.781 years. And, patients with duration of diabetes greater than 15 years (controlled group) will not develop any complication up to 20.109 years. This estimation can be used to predict the future onset times of new type 2 diabetic patients.

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Psychological states unfold dynamically; to understand and measure mental health at scale we need to detect and measure these changes from sequences of online posts. We evaluate two approaches to capturing psychological changes in text: the first relies on computing the difference between the embedding of a message with the one that precedes it, the second relies on a "human-aware" multi-level recurrent transformer (HaRT). The mood changes of timeline posts of users were annotated into three classes, 'ordinary,' 'switching' (positive to negative or vice versa) and 'escalations' (increasing in intensity). For classifying these mood changes, the difference-between-embeddings technique -applied to RoBERTa embeddings -showed the highest overall F1 score (0.61) across the three different classes on the test set. The technique particularly outperformed the HaRT transformer (and other baselines) in the detection of switches (F1 = .33) and escalations (F1 = .61). Consistent with the literature, the language use patterns associated with mental-health related constructs in prior work (including depression, stress, anger and anxiety) predicted both mood switches and escalations.

Mixed adenoneuroendocrine carcinoma (MANEC) of the gastrointestinal tract is uncommon with about 100 cases reported involving esophagus, stomach, colon, rectum, and biliary tree. The aggressive behavior of these tumors is usually dictated by the high-grade neuroendocrine carcinoma (NEC) component, which raises the possibility that these may represent areas of dedifferentiation. We here report an 88-year-old male presenting with rectal bleeding. Colonoscopy identified a fungating, villous, and partially circumferential cecal mass. Biopsy revealed tubular adenoma with focal high-grade dysplasia. However, excision was recommended given the impression of a mass. A right hemicolectomy revealed an 8.7-cm friable and ulcerated mass in the cecum. Initially, eight sections (one per cm) of the tumor were examined and revealed intramucosal adenocarcinoma. However, one of the lymph nodes was replaced by a high-grade poorly differentiated tumor, immunophenotypically consistent with NEC. In search for a primary, the rest of the mass was submitted and subsequent histologic examination revealed areas of transition from villous adenoma to intramucosal and muscle invasive adenocarcinoma in addition to deeply invasive NEC showing marked cytological atypia, brisk mitotic activity (Ki-67 >90%), and lymphovascular invasion. Three lymph nodes had metastatic adenocarcinoma and NEC along with several tumor deposits. Following an uneventful postoperative course, the patient received adjuvant chemotherapy. Our case recapitulates the classic description of MANEC where NEC is usually associated with a differentiated adenocarcinoma, commonly arising from an adenoma. The currently proposed pathogenesis is a collision tumor (previously known as mixed exocrine/endocrine carcinomas). However, we propose viewing MANEC as one tumor rather than two colliding tumors utilizing the concept of dedifferentiation, which has been extensively studied in the GYN literature. In a prior study, we found neuroendocrine expression in 41% of undifferentiated endometrial carcinomas. We therefore propose revisiting larger case series of MANEC with this concept in mind.