A comparison of hysterosalpingography and laparoscopy in the evaluation of tubal factors in female infertility

Background: WHO defines infertility as “failure to conceive after having regular, unprotected intercourse for one year. Factors responsible - male factors (20-30%), female factors (40-55%), combined male and female factors (10-40%) and unexplained infertility (10-20%). Amongst female factors, tubal factors are responsible for 25-30% of infertility. Hysterosalpingography and diagnostic laparoscopy with chromopertubation are widely used in the evaluation of tubal factors of infertility. The aim of this study was to compare findings of HSG and diagnostic laparoscopy with chromopertubation for tubal patency in infertile women.Methods: An observational study, done on a total of 125 females suffering from primary and secondary infertility who underwent HSG and then 97 patients who gave consent, underwent diagnostic laparoscopy with chromopertubation. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0.Results: Primary infertility cases were more than secondary infertility cases. Mean age of patients was found to be 28.92±5.33 years. Most common tubal abnormality found on hysterosalpingography and chromopertubation was bilateral tubal block. Inter rater kappa agreement used and significant agreement found between hysterosalpingography and chromopertubation with kappa value of 0.612.Conclusions: From this study authors conclude that HSG and laparoscopy with chromopertubation are complimentary to each other. Laparoscopy helps in identification of tubal and non-tubal factors like intra-abdominal and pelvic adhesions, endometriosis etc. and simultaneously they can be treated while HSG helps in evaluation of tubal factors as well as of intra-uterine factors like synechiae, polyps etc

Sustainability and ultra-processed foods: role of youth

The objective of this research is to study and look at the ways how processed food affects human and environmental health and to find alternatives to processed food.  Sustainability refers to the efforts made to meet the needs of the present generation without compromising the ability of future generations to fulfil their requirements. Sustainability aims at environment-friendly progress and development. World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Processed food is any food that has been changed in its form and nature by using certain processing techniques such as freezing, canning and dehydrating. The focus of this research is “ultra-processed foods”. Ultra-processed foods are the final food product that is processed by using chemicals and unnatural preservatives.  As defined by the United Nations, youth refers to the young people who fall in the age group of 15-24 years.The problem: ultra-processed foods and its impact on human and environmental wellbeing. The food processing industry is largely driven by profit-making objectives owing to the intense competition in the market. The manufacturers of food processing have to ensure that they don’t lose out their customers to their competitors. To maintain their consumer base the manufacturers work to make their processed food desirable and attractive. In the process, they resort to the usage of such products that are unnatural and unhealthy for both the human body as well as the environment. Some of the examples of such ingredients include chemicals used for preserving, colouring, and adding texture and flavour to the natural food, refined carbohydrates, sweeteners, and processed vegetable oils.Due to the use of above-mentioned ingredients, the consumption of ultra-processed foods becomes harmful to the human body. It has been found out through research that their consumption does not add any nutritional value to the human body. Moreover, it becomes very difficult for the human body to digest ultra-processed foods. Some people become addicted to such food and it has been studied that some food products are more addictive than drugs. Apart from this, the intake of the ultra-processed foods increases the instances of several diseases such as heart ailments, diabetes, high blood pressure and obesity.Processed food also impacts the natural environment. The waste generated after the processing of the food and the handling of the waste affects the air, water and soil. The process of handling and packaging of the product results in the release of harmful chemicals and toxins in the environment. This not only affects the natural environment but also human health. The solution to this problem is to create awareness about the harmful effects of ultra-processed foods and to promote sustainable alternatives to it. The youth can play a very important role in spreading awareness about the ill-effects as well as the alternatives to the ultra-processed foods. The sample of our study is the young consumers of ultra-processed foods of the University of Delhi. This is because the youth is the largest consumer of the ultra-processed foods and they can work towards promoting more sustainable and healthy food choices and habits amongst people. The research questions are: 1) What are the different kinds of ultra-processed foods that are consumed by people? 2) How does the food processing industry work? 3) How can the youth be made aware about the ill-effects of ultra-processed foods? 4) What are the sustainable alternatives to ultra-processed foods? 5) What role youth can play in promoting sustainable alternatives? The hypothesis are: 1) Ultra-processed foods affect the environment and human well-being negatively. 2) The youth can play a positive role in promoting alternatives to ultra-processed foods.The research methodology, is the theoretical and empirical analysis of the study. The nudge theory would be applied to understand how alternatives can be promoted by the youth. Richard Thaler and Cass Sunstein introduced the concept of nudging and defined a nudge as “any aspect of the choice, architecture that predictably alters people’s behaviour without forbidding any options or significantly changing their economic incentives.” It doesn’t mean restricting the options available to the people but it means regulating their behaviour. The questionnaires and surveys to assess the consuming habits of the people and the use of pictorial and graphical representation of the data collected through the surveys and questionnaires are used. Despite the study focuses on the role of the youth, the surveys were conducted with youth as well as adults to make the study more inclusive and comprehensive

A Pilot Study Indicating Valuation of C‑Reactive Protein for Disease Outcome in Sickle Hemoglobin Patients of Central India

Evidences support the fact that sickle cell disease (SCD) is associated with a chronic inflammatory state characterized by haemolysis. C-reactive protein level (CRP) and white blood cell (WBC) count considered as biomarkers for inflammation. Also, elevation of serum total lactate dehydrogenase (LDH) levels are found to be associated with haemolysis, this makes LDH a nonspecific marker which has to be interpreted in a context of other markers of disease. The present study aims to assess the role of CRP levels, WBC counts, RBC counts, haemoglobin (Hb) concentrations and LDH levels in sickle hemoglobin (HbS) patients. Blood samples of 10 HbS patients (six females and four males) attending M.Y. Hospital, Indore during the period of Aug to Oct 2019 were screened for CRP, LDH and Hb levels and RBC and WBC counts using latex enhanced immune-turbidimetric assay, LDH optimize DGKC kinetic and differential automated hematology analyzer respectively. Data (mean ± SEM) was analyzed using Graphpad Prism software using Tukey’s multiple comparison post-hoc test. The mean Hb levels (7.73 ± 0.81 g/dl) and RBC counts (3.21 ± 0.53 million/µl) were found to be significantly decreased (p˂ 0.001 and 0.01 respectively) and mean WBC counts (15214.28 ± 1893.40 per mm3), CRP levels (85.73 ± 23.23 mg/l) and LDH levels (1334.00 ± 418.49 U/l) were found to be significantly increased (p˂ 0.0001, 0.01 and 0.01 respectively) in HbS patients in comparison with their respective controls. The variations in serum LDH and CRP levels are accompanied by changes in hematological parameters in HbS patients. These parameters may be considered as indicator of the severity of the disease. Keywords: C-reactive protein, LDH, Sickle cell diseas

Bioactive Component of Licorice as an Antileishmanial Agent

The term leishmaniasis encompasses a spectrum of vector-borne protozoan parasitic diseases ranging from self-healing cutaneous to fatal visceral leishmaniasis. The disease affects 12 million people worldwide with 0.5 million new cases per annum. Present antileishmanial chemotherapeutic drugs project limitations because of severe toxicity, lengthy regime and occurrence of resistance, thereby making development of newer, gentler and efficacious therapeutics an urgent need for treatment of leishmaniasis. Application of medicinal plants in treatment of refractory diseases is valued for its clinical efficacy and nontoxicity. The biologically active components derived from them continue to play important roles as chemopreventive agents. Licorice has been known for its medicinal property from ancient times for treatment of various ailments. 18β-Glycyrrhetinic acid, glycyrrhizic acid and licochalcone A are the most extensively studied constituents of licorice in terms of antileishmanial agent. Overall, this chapter is dedicated to highlight the current understanding of the mechanism of these bioactive constituents of licorice, which potentiates them as antileishmanial agents. Furthermore, it also brings to light the importance of folk medicine in curing diseases and thereby gives impetus to explore ancient medicines and thier mode of actions to use them progressively to cure diseases

Effect of Ignoring Eccentricity in Testing General Relativity with Gravitational Waves

Detections of gravitational waves emitted from binary black hole coalescences allow us to probe the strong-field dynamics of general relativity (GR). One can compare the observed gravitational-wave signals with theoretical waveform models to constrain possible deviations from GR. Any physics that is not included in these waveform models might show up as apparent GR deviations. The waveform models used in current tests of GR describe binaries on quasicircular orbits, since most of the binaries detected by ground-based gravitational-wave detectors are expected to have negligible eccentricities. Thus, a signal from an eccentric binary in GR is likely to show up as a deviation from GR in the current implementation of these tests. We study the response of four standard tests of GR to eccentric binary black hole signals with the forecast O4 sensitivity of the LIGO-Virgo network. Specifically, we consider two parameterized tests (TIGER and FTI), the modified dispersion relation test, and the inspiral-merger-ringdown consistency test. To model eccentric signals, we use non-spinning numerical relativity simulations from the SXS catalog with three mass ratios $(1,2,3)$, which we scale to a redshifted total mass of $80M_\odot$ and luminosity distance of $400$ Mpc. For each of these mass ratios, we consider signals with eccentricities of $\sim0.05$ and $\sim 0.1$ at $17$ Hz. We find that signals with larger eccentricity lead to very significant false GR deviations in most tests while signals having smaller eccentricity lead to significant deviations in some tests. For the larger eccentricity cases, one would even get a deviation from GR with TIGER at $\sim 90\%$ credibility at a distance of $\gtrsim 1.5$ Gpc. Thus, it will be necessary to exclude the possibility of an eccentric binary in order to make any claim about detecting a deviation from GR.Comment: 16 pages, 6 figures, version accepted by PR

Understanding local food systems in South Asia: An assessment approach and design

Home to one-quarter of humanity—one-fifth of whom are youth—South Asia has the world’s largest concentration of poverty and malnutrition (1–3). Despite producing one-quarter of the world’s consumed food, the region’s agrifood systems face formidable challenges in producing an adequate and affordable supply of the diverse foods needed for sustainable healthy diets (4,5). Unhealthy food consumption is rising, and farming systems are threatened by unsustainable groundwater withdrawal due to poorly developed food and energy policies. In addition, South Asia’s farmers are both contributors and victims of climate change and extreme weather, which contributes to rural out-migration—particularly of youth—resulting in rising labor scarcity and increased production costs. TAFSSA (Transforming Agrifood Systems in South Asia), a CGIAR Regional Integrated Initiative, aims to address these challenges by delivering actionable evidence and scalable innovations across these regions through a coordinated program of research and engagement from farmer to consumer. One of the roadblocks to addressing these challenges is the lack of credible and high-resolution data on food systems in the region. The TAFSSA food systems assessment aims to provide a reliable, accessible and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management in Bangladesh, India, Nepal and Pakistan. It is intended to be a multi-year assessment

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt