A study to determine socio demographic corelates of reproductive tract infection amongst women of reproductive age group

Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Thickness dependent structural, optical, and electrical properties of ZnSe thin films

396-401In present work, nanostructured films of ZnSe are synthesized on glass substrates by using electron beam vacuum evaporation technique. To enhance the luminescence performance and electrical conductivity, the optimal film thickness are investigated for which films of thickness 250 nm and 500 nm are grown on glass substrates. Additionally, films’ crystal structures are also characterized. The XRD pattern revealed that the synthesized films exhibit preferred orientation of ZnSe (111) lattice which exhibits polycrystalline state having cubic zinc blende structure. Various structural parameters such as their crystallite sizes, strain developed in films, and their dislocation densities are also calculated. UV/VIS/NIR spectrophotometer indicates that visible transmittance decreased while the infrared transmittance switching efficiency increased as the film thickness increased from 250 nm to 500 nm. Moreover, the optical energy gaps of ZnSe films were in a range of 2.1-2.20 eV which is comparatively smaller in comparison to their bulk counterparts revealing their confinement in nano-dimensions. The study of their luminescence properties yields that the film of thickness 250 nm yield better results in blue spectral region which is also illustrated through CIE plots. The reason could be that for smaller film thickness electrons can easily jump to excited states for similar excitations owning to smaller crystallite sizes and thus showed greater luminescence. However, from the analysis of its electrical characteristics, the enhanced electrical conductivity is captured for the films having thickness of 500 nm. Therefore, the enhanced blue emission in the optimized film thickness indicates that these films can be utilized as luminescent materials

Prevalence of signs and symptoms of temporomandibular disorders in urban and rural children of northern hilly state, Himachal Pradesh, India: A cross sectional survey

Background: Temporomandibular disorders (TMDs) have been recognized as a common orofacial painful condition. Many epidemiological studies of TMDs in children and adolescents have been performed. However, the results of such studies have varied, and a comprehensive view of the prevalence and severity of symptoms and signs is difficult to obtain. Objectives: To determine the prevalence of signs and symptoms of TMDs among school children of Himachal Pradesh and to establish a baseline for comparison with future studies. Study Design: Cross sectional. Materials and Methods: A sample of 1188 school children in the age group of 9 and 12 years (males n = 650 and females n = 538), from randomly selected schools of rural and urban areas of Himachal Pradesh were included as study subjects. The survey was done according to the WHO Oral Health Assessment Form (modified). Results: The results of TMDs, i.e., clicking, tenderness and reduced jaw mobility showed that overall prevalence was 2.5% and the rest 96.5% were not suffering from these disorders. In 9 years age group, the prevalence was 1.6% whereas it was more than double, 3.5% in 12 years age group. Signs and symptoms of TMDs were determined to assess their oral health status. Statistical Analysis: SPSS version 15. Conclusion: This study contrasts with what is found in the other societies regarding the high prevalence of TMDs disorders

A Novel Approach to Design SRAM Cells for Low Leakage and Improved Stability

The semiconductor electronic industry is advancing at a very fast pace. The size of portable and handheld devices are shrinking day by day and the demand for longer battery backup is also increasing. With these requirements, the leakage power in stand-by mode becomes a critical concern for researchers. In most of these devices, memory is an integral part and its size also scales down as the device size is reduced. So, low power and high speed memory design is a prime concern. Another crucial factor is the stability of static random-access memory (SRAM) cells. This paper combines multi threshold and fingering techniques to propose a modified 6T SRAM cell which has high speed, improved stability and low leakage current in stand-by mode of the memory cell. The simulations are done using the Cadence Virtuoso tool on UMC 55 nm technology

A study of Knowledge, Attitude, Behaviour and Practice (KABP) among the attendees of Integrated Counselling and Testing Centre of Tertiary Care Hospital of Northern Hilly State of India

Background: In India, low knowledge of HIV/AIDS and low utilization of voluntary counseling and testing (VCT), is a problem especially in the rural areas. Aims: To assess the knowledge, attitude, behaviour and practices (KABP) of HIV seropositive and HIV seronegative clients attending Integrated and testing centre (ICTC) in a tertiary hospital of Shimla, Himachal Pradesh. Settings and Design: Cross-sectional study. Material and Methods: A total of 525 attendees, in the age group of 15 to < 50 years, who attended ICTC consecutively either voluntarily or referred from different departments of tertiary hospital and from other districts were included as study subjects. After counselling and confirmation of HIV status according to NACO; diagnosis of TB was done as per RNTCP guidelines. The questionnaire was administered to each client to evaluate risky behaviour and KABP about HIV/AIDS. Statistical analysis: SPSS version 11 was used. Results: 53.5% of seropositives; wherein 35.2% seronegatives demonstrated good knowledge and modes of transmission of HIV/AIDS. However, 15.6% of seropositives whereas 22% seronegatives did not know how HIV/AIDS spreads. 21.4% seronegatives, whereas 15.7% seropositives knew about protection imparted by condom. All the seropositives were sexually active and 63.4% of them had multiple partners in comparison to 82.2% of seronegatives had sexual experience and 8% multiple sexual partners (P < .00001). Moreover, condom usage was nil among both the groups. 20% of seropositives; only 2.8% of seronegatives had sex with commercial sex workers (CSWs) (p < .00001). Conclusions: There is need to enhance knowledge and scale up VCT services