Automated verbal autopsy: from research to routine use in civil registration and vita statistics systems

BACKGROUND: The majority of low- and middle-income countries (LMICs) do not have adequate civil registration and vital statistics (CRVS) systems to properly support health policy formulation. Verbal autopsy (VA), long used in research, can provide useful information on the cause of death (COD) in populations where physicians are not available to complete medical certificates of COD. Here, we report on the application of the SmartVA tool for the collection and analysis of data in several countries as part of routine CRVS activities. METHODS: Data from VA interviews conducted in 4 of 12 countries supported by the Bloomberg Philanthropies Data for Health (D4H) Initiative, and at different stages of health statistical development, were analysed and assessed for plausibility: Myanmar, Papua New Guinea (PNG), Bangladesh and the Philippines. Analyses by age- and cause-specific mortality fractions were compared to the Global Burden of Disease (GBD) study data by country. VA interviews were analysed using SmartVA-Analyze-automated software that was designed for use in CRVS systems. The method in the Philippines differed from the other sites in that the VA output was used as a decision support tool for health officers. RESULTS: Country strategies for VA implementation are described in detail. Comparisons between VA data and country GBD estimates by age and cause revealed generally similar patterns and distributions. The main discrepancy was higher infectious disease mortality and lower non-communicable disease mortality at the PNG VA sites, compared to the GBD country models, which critical appraisal suggests may highlight real differences rather than implausible VA results. CONCLUSION: Automated VA is the only feasible method for generating COD data for many populations. The results of implementation in four countries, reported here under the D4H Initiative, confirm that these methods are acceptable for wide-scale implementation and can produce reliable COD information on community deaths for which little was previously known

A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

<p>Abstract</p> <p>Background</p> <p>Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.</p> <p>Methods</p> <p>The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.</p> <p>Results</p> <p>As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.</p> <p>Conclusions</p> <p>As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.</p

ICAR: endoscopic skull‐base surgery

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Heat transfer augmentation in a circular tube with perforated double counter twisted tape inserts

© 2016 Elsevier Ltd.The present study explored the effects of perforated double counter twisted tapes on heat transfer and fluid friction characteristics in a heat exchanger tube. The twisted tapes with four different porosities of Rp = 1.2, 4.6, 10.4 and 18.6% were used as counter-swirl flow generators in the test section. The experiments were conducted in a circular tube in turbulent flow regime with Reynolds number ranging from 7200 to 50,000 using air as the working fluid under uniform wall heat flux boundary condition. The experimental results demonstrated that the Nusselt number, friction factor and thermal enhancement efficiency were increased with decreasing porosity except porosity of 1.2%. The results also revealed that the heat transfer rate of the tube fitted with tapes were significantly increased with corresponding increase in friction factor. In the range of the present investigation, heat transfer rate and friction factor were obtained to be around 80 to 290% and 111 to 335% higher than those of the plain tube values, respectively. Based on constant blower power, the highest thermal enhancement efficiency of 1.44 was achieved. In addition, the empirical correlations of Nusselt number, friction factor and thermal enhancement efficiency were developed based on the experimental data

Pharmacokinetics study of Pioglitazone (30 mg) tablets in healthy volunteers

Pioglitazone, an excellent insulin sensitizer, is used for the treatment of type 2 diabetes mellitus (T2DM). The present investigation demonstrated a single dose pharmacokinetic study of pioglitazone tablet in 24 healthy male volunteers in a randomized protocol. Blood samples were collected before and 0.5 to 24.0 h after a single oral dose of a 30 mg pioglitazone tablet. Plasma pioglitazone level was determined using a validated method of reversed phase binary high performance liquid chromatography (HPLC). The pharmacokinetic parameters determined were 1.117 ± 0.315 (?g/ml), 2.5 ± 0.735 (h), 9.014 ± 3.385 (?g.h/ml), 8.081 ± 3.407 (?g. h/ml), 1.315 ± 0.964 (h), 0.707 ± 1.636 (h-1), 0.078 ± 0.02 (h-1) and 8.884 ± 03.808 (h) for Cmax, Tmax, AUC0-?, AUC0-24, Ka, T1/2 (?), Kel, and T1/2(?), respectively. Variation of pioglitazone pharmacokinetic parameters in Bangladeshi population compared to Chinese, Thai and German population may indicate the polymorphic variation in the pioglitazone responsive metabolizing gene CYP3A4 and CYP2C19 in our population. DOI: http://dx.doi.org/10.3329/dujps.v13i2.21896 Dhaka Univ. J. Pharm. Sci. 13(2): 181-186, 2014 (December)</jats:p

Comparative Situation Analysis of Childhood Asthma Incidence in Selected Hospitals Inside and Outside Dhaka City

Asthma is a common chronic and long-term condition accompanied by coughing, wheezing, chest tightness and breathlessness and affects mainly the lungs. This study was aimed to explore the prevailing situation of asthma among the paediatric patients and its management inside and outside Dhaka city. The study was conducted on 420 asthma patients inside (n = 210) and outside (n = 210) Dhaka. Data were collected using a structured questionnaire from patients or their parents, during the period of January 2015 to June 2015. Most of the patients inside Dhaka reported that their children had frequent asthma attack than outside Dhaka (p&lt;0.001). Wheezing symptoms were also high in Dhaka (p&lt;0.001). We observed better management of the disease inside Dhaka as compared with outside (p&lt;0.001). However, no seasonal variation in terms of exacerbations of symptoms was seen. Moreover, despite greater incidence of childhood asthma in Dhaka city, its management was better here. Mass awareness among parents regarding the incidence and the necessity of continuation of medication as per the advice of physicians are mandatory to reduce the occurrence.&#x0D; Bangladesh Pharmaceutical Journal 23(1): 32-38, 2020</jats:p

Original Articles CYTOTOXIC ACTIVITY OF TWO LIMONOIDS ISOLATED FROM SWIETENIA MAHAGONI BY USING BRINE SHRIMP LETHALITY BIOASSAY

Solvent partitioning followed by column chromatography of the MeOH extract of the seeds of Swietenia mahagoni afforded two limonoids, swietenolide (compound 1) and 2-hydroxy-3-O-tigloylswietenolide (compound 2), later one is new compound. The compounds were identified by spectroscopic means. The cytotoxic activity of these compounds was assessed by using the conventional brine shrimp lethality bioassay. While both compounds were found to have moderate cytotoxic activity, compound 2 displayed overall more potent activity than compound 1

Safe placement of Central Venous Catheter via right Internal Jugular Vein: Calculation of insertion depth by individual body height

Background: Cardiac tamponade is a serious complication of central venous catheter (CVC) placement. Current guidelines strongly suggest that CVC tip should lie in the superior vena cava (SVC) outside the pericardial sac. Various landmarks and sophisticated techniques such as right atrial electrocardiography (ECG) and transoesophageal echocardiography (TEE) have been recommended to decide a proper insertion depth (ID) of CVC. The purpose of this study was to devise a simple formula to determine the proper insertion depth based on an individual patient&rsquo;s height when cannulation is via the right internal jugular vein (RIJV).Patients and Methods: We studied 100 patients. The right internal jugular vein was punctured by an anterior approach using the sternocleidomastoid muscle as a landmark midway between the mastoid process and the sternal notch. Insertion depth was theoretically determined as one-tenth of the patient&rsquo;s height in cm. Post insertion bedside chest x-ray (CXR) was done to see the CVC tip position in relation to the level of the carina.Results: In 74.22% of the cases the tips of the CVCs were at or above the level of the carina. In the rest of the 25.78% patients the tips were within 2 cm below the level of carina. The standard error of proportion (SEP) between these two groups of observations was 4.4. It means the tip of the CVC will be positioned at or above the level of carina in 65% to 83% of the population (95% CI). Conclusion: Thus to place all the CVC tips above the pericardial reflection we propose a simple formula as: Insertion Depth in cm = (Patient&rsquo;s height in cm/10) - 2cm, for cannulation via the right internal jugular vein when the puncture site is midway between the mastoid process and the sternal notch.Keywords: central venous catheter, internal jugular vein, insertion depth, carin

Antifungal Drug Resistance of Dermatophytes Causing Superficial Fungal Infections

Background: Superficial fungal infections (SFI) are common skin diseases that were largely simple to treat. However, due to increasing antimicrobial resistance (AMR) of dermatophytes to antifungal drugs, treatment of SFI has become difficult. This study aims to analyze the AMR of dermatophytes and to correlate with the clinical response of antifungal drugs. Methods: A cross‑sectional evaluation was undertaken of 570 consecutive patients with SFI such as tinea corporis, tinea cruris, tinea faciei, and tinea pedis, who were treated with any of the oral antifungal drugs fluconazole, itraconazole and terbinafine. Clinical response was taken within 1 month of stopping the therapy. Microscopic as well as culture and antimicrobial sensitivity analysis were done to characterize and determine the susceptibility of dermatophytes to antifungal drugs aforementioned. Results: Among the 570 patients with SFI, the ratio of male (n=360, 63.16%) to female (n=210, 36.84%) was 1.7:1. The common age group affected by SFI was 31-40 years (27.71%, n=158). The tinea corporis was the most predominant (51.05%) followed by tinea cruris (13.68%). Clinical response analysis showed that the percentage of relapse of SFI after completion of treatment with fluconazole, itraconazole and terbinafine was about 55, 45 and 19, respectively. Culture and antimicrobial sensitivity analysis revealed that the percentage of resistance of dermatophytes from patients of SFI to fluconazole, itraconozole and terbinafine was approximately 70, 55 and 20, respectively. Conclusion: Results reported herein support the notion that the antifungal resistance is evolving in dermatophytes causing SFI, and about 20% dermatophytes are multidrug resistant.</jats:p