Prevalence and association of obesity with self-reported comorbidity: a cross-sectional study of 1321 adult participants in Lasbela, Balochistan

Association of fatness with chronic metabolic diseases is a well-established fact, and a high prevalence of risk factors for these disorders has increasingly been reported in the third world. In order to incorporate any preventive strategies for such risk factors into clinical practice, decision-makers require objective evidence about the associated burden of disease. A cross-sectional study of 1321 adults from one of the districts of Balochistan, among the most economically challenged areas of Pakistan, was carried out for the measures of fatness and self-reported comorbidities. Body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) were measured and demographic information and self-reported comorbidities were documented.The prevalence of obesity was 4.8% (95% CI: [3.8, 6.1]) and 21.7% (95% CI: [19.5, 24.0]), as defined by the World Health Organization (WHO) international and Asia/Asia-Pacific BMI cut-offs, respectively. The proportion exhibiting comorbidity increased with increasing levels of fatness in a dose-response relationship

Linear and Nonlinear Noise Characterisation of Dual Stage Broadband Discrete Raman Amplifiers

We characterise the linear and nonlinear noise of dual stage broadband discrete Raman amplifiers (DRAs) based on conventional Raman gain fibres. Also, we propose an optimised dual stage DRA setup that lowers the impact of nonlinear noise (generated in the amplifier) on the performance of a transmission link (with 100-km amplifier spacing). We numerically analyse the design of a backward pumped cascaded dual stage 100-nm DRA with high gain (∼20 dB) and high saturated output power (>23 dBm). We show that the noise figure (NF) of the dual stage DRA is mainly dominated by the first stage irrespective of the type of gain fibre chosen in the second stage, and we also demonstrate that optimising the length and the type of Raman gain fibre can have significant impact on the size of inter/intrasignal nonlinearities generated. Here, we report a theoretical model to calculate the nonlinear noise power generated in transmission spans with dual stage DRAs considering piecewise signal power evolution through the Raman gain fibres. The predicted signal-to-noise ratio (SNR) performances are calculated from the combined contributions from NF and nonlinear product power obtained using the proposed analytical model for transmission systems deployed with 100-km transmission span compensated by different dual stage DRAs. Finally, an optimised IDF 6 km-SMF 10 km dual stage configuration has been identified using the theoretical model, which allows maximum SNR of 14.6 dB at 1000 km for 1 THz Nyquist wavelength division multiplexed signal and maximum transmission reach of 3400 km at optimum launch power assuming 8.5 dB HD-FEC limit of the Nyquist PM-QPSK signal

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Pharmacies in informal settlements:a retrospective, cross-sectional household and health facility survey in four countries

Background: Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods: We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results: We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions: Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor

The Alzheimer&apos;s Association external quality control program for cerebrospinal fluid biomarkers

Background: The cerebrospinal fluid (CSF) biomarkers amyloid β (Aβ)-42, total-tau (T-tau), and phosphorylated-tau (P-tau) demonstrate good diagnostic accuracy for Alzheimer&apos;s disease (AD). However, there are large variations in biomarker measurements between studies, and between and within laboratories. The Alzheimer&apos;s Association has initiated a global quality control program to estimate and monitor variability of measurements, quantify batch-to-batch assay variations, and identify sources of variability. In this article, we present the results from the first two rounds of the program. Methods: The program is open for laboratories using commercially available kits for Aβ, T-tau, or P-tau. CSF samples (aliquots of pooled CSF) are sent for analysis several times a year from the Clinical Neurochemistry Laboratory at the Mölndal campus of the University of Gothenburg, Sweden. Each round consists of three quality control samples. Results: Forty laboratories participated. Twenty-six used INNOTEST enzyme-linked immunosorbent assay kits, 14 used Luminex xMAP with the INNO-BIA AlzBio3 kit (both measure Aβ-(1-42), P-tau(181P), and T-tau), and 5 used Meso Scale Discovery with the Aβ triplex (AβN-42, AβN-40, and AβN-38) or T-tau kits. The total coefficients of variation between the laboratories were 13% to 36%. Five laboratories analyzed the samples six times on different occasions. Within-laboratory precisions differed considerably between biomarkers within individual laboratories. Conclusions: Measurements of CSF AD biomarkers show large between-laboratory variability, likely caused by factors related to analytical procedures and the analytical kits. Standardization of laboratory procedures and efforts by kit vendors to increase kit performance might lower variability, and will likely increase the usefulness of CSF AD biomarkers. © 2011 The Alzheimer&apos;s Association. All rights reserved