Knowledge, Attitude and Practice on Dengue Fever Transmission Among Urban and Periurban Residents of Dhaka City, Bangladesh

ABSTRACTIntroduction: Dengue is one of the most important emerging viral diseases of major public health concern in Bangladesh.Objectives: The purpose of this study is to assess the level of knowledge, attitude and practice on dengue fever transmission and prevention among the residents of Dhaka city, Bangladesh.Methods: A cross-sectional study was done among three hundred and forty three randomly selected residents of urban and periurban regions of Dhaka city in November in 2012 using a pretested and self administered questionnaire.  Data was analyzed by a Chi square test and p value less than 0.05 is considered as significant.Results: The study found that among the respondents 63.3% were female, 48% were married and 37.7% were of age group of 21-30 (mean=31.34, SD=11.758). Majority of the respondents had secondary/higher secondary (50.9%) and students represented 34.1% of the total respondents. It was found most of them had no history of having affected from dengue fever (97.7%) and 53.2% did not travel to the subtropical or tropical region. Television (61.2%) and radio (50.4) were most common source of information of dengue fever. Majority of the respondents had low level of knowledge on dengue (89.1%). It was found that 81% knew that mosquitoes generally lay their eggs on dirty water, 79.6% knew mosquitoes spread dengue from one person to another and 70.6% were aware that dengue can fever is flu like illness that affects infants, young, children and adults. The study revealed 50.1% had neutral attitude towards dengue fever, and there was significant association between age and practice (p=0.031); knowledge and practice (p<0.000) and also attitude and practice (p<0.000). Conclusion: There is a different level of knowledge regarding dengue fever among respondents in the study area. Public awareness is necessary to address the knowledge gap revealed by this study. Hence it is necessary to organize the public education program to prevent the people from the outbreak of dengue by increasing level of Knowledge so that they can attain positive attitude and adopt desired behavioral changes.Keywords: Knowledge, Attitude, Practice, Dengue Fever, Dengue Hemorrhagic Fever, Dengue Shock Syndrome

Comparative study to access coagulation abnormalities in breast cancer

Background: Coagulation abnormalities such as thrombosis and disseminated intravascular coagulation (DIC) are the major factors that play a major role in breast cancer. In this study, coagulation abnormalities were assessed in breast cancer patients to help the clinician in early detection of DIC and management of patients at different stages of breast cancer.Methods: 75 patients were enrolled in the study, 50 were from case group (breast cancer patients) and 25 were selected as control group subjects used to compare the results. All of these subjects undergone, General Hematological analysis i.e. differential leukocyte count hemoglobin, platelets count and total leukocyte count were performed on each of the samples collected from the subjects and Specific Hematological analysis i.e. Activated Partial Thromboplastin Time (APTT), Fibrinogen Assay, Prothrombin Time (PT), D-Dimer Detection and Fibrin Degradation Products (FDPs).Results: PT was found to be comparable in patients with breast cancer when compared with controls. Difference between control group (II) and subjects with breast cancer (I) was non-significant, fibrinogen level was found to be significantly increased (p < 0.01) in patients with different stages of breast cancer when compared with controls. FDPs were found to be significantly increased (p< 0.01) in patients of breast cancer when compared with control group. These increased levels of FDPs may be due to enhanced fibrinolysis. D-Dimers were also found to be significantly increased (p < 0.01) in patients with breast cancer when compared with controls.Conclusion: Patients with breast cancer were associated with compensated DIC state including normal PT and APTT level but increased fibrinogen and platelets count as compared to the controls. Detection of D-Dimers offers a differential analysis over other laboratory tests for DIC

Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Diagnostic Accuracy of Serum Hepatitis B Virus DNA Levels and ALT for Liver Fibrosis

Background: To determine the diagnostic accuracy of combined serum HBV DNA and serum ALT levels for significant liver fibrosis in chronic Hepatitis B patients.Methods: In this cross sectional study confirmed cases of Hepatitis B were enrolled. Inclusion criteria was age more than 20 and both genders, while those cases who had history of Hep C or were on treatment of Hep B were excluded. Patients’samples were taken for HBV DNA and ALT to predict the presence of liver fibrosis.Results: Out of total 130 cases, there were 72 (54.5%) males with a mean age of 43.78± 10.28 years. The results of HBV DNA + ALT showed 51 (38.6%) patients to have fibrosis, whereas endoscopic diagnosis of esophageal varices was confirmed in 40 (30.3%) patients.Sensitivity of HBV DNA + ALT for diagnosis of fibrosis was found to be 55%, specificity 66.6%and diagnostic accuracy 65%.Conclusion: Combined HBV DNA &amp; ALT values can be advised as predictor of liver fibrosis

Robustification of Naïve Bayes Classifier and Its Application for Microarray Gene Expression Data Analysis

The naïve Bayes classifier (NBC) is one of the most popular classifiers for class prediction or pattern recognition from microarray gene expression data (MGED). However, it is very much sensitive to outliers with the classical estimates of the location and scale parameters. It is one of the most important drawbacks for gene expression data analysis by the classical NBC. The gene expression dataset is often contaminated by outliers due to several steps involved in the data generating process from hybridization of DNA samples to image analysis. Therefore, in this paper, an attempt is made to robustify the Gaussian NBC by the minimum β-divergence method. The role of minimum β-divergence method in this article is to produce the robust estimators for the location and scale parameters based on the training dataset and outlier detection and modification in test dataset. The performance of the proposed method depends on the tuning parameter β. It reduces to the traditional naïve Bayes classifier when β→0. We investigated the performance of the proposed beta naïve Bayes classifier (β-NBC) in a comparison with some popular existing classifiers (NBC, KNN, SVM, and AdaBoost) using both simulated and real gene expression datasets. We observed that the proposed method improved the performance over the others in presence of outliers. Otherwise, it keeps almost equal performance