A retrospective study on ectopic pregnancy: incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy- one year study

Background: Diagnosis of ectopic pregnancy was frequently missed and rising trend in incidence of ectopic pregnancies necessitates awareness about risk factors, resultant morbidity and mortality. to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Aims and Objectives were to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Methods: Retrospective analysis of ectopic pregnancy was done in Government Medical College Baroda, from September 2021 to August 2022. The following parameters: age, parity, gestational age, risk factors, clinical presentation, diagnostic methods, mode of treatment and morbidity were noted. Results: Out of 7521 deliveries, 74 were ectopic pregnancies (0.98 %). Women with age 20-30 years had highest incidence (62.16%) and with least below 20 years (4%). Ectopic pregnancies were common in multiparous women (78.3%) than primigravida (21.62%). Common symptoms: abdominal pain (82.4%), amennorhea (78.4%), bleeding per vaginum (63.3%), adenexal tenderness (46.2), asymptomatic (12%) patients. Urine pregnancy test positive in 96.4%. Etiology was pelvic infection (15.78%), infertility (7.01%), previous ectopic (8.33%), contraception failure (8.71%), surgeries including LSCS and tubal surgeries (4%). Right sided ectopic was more common. Site of ectopic was common in fallopian tube- ampullary region (88%), cornu (4%) followed by others (8%) then caesarean scar, rudimentary horn pregnancy. About 81.08% of ectopic was ruptured, 3/4th of these patients presented with shock at the time of presentation. Tubal abortions were seen in 4.01% of patients. Most of cases being ruptured ectopic pregnancies, salpingectomy in 72.9% and salpingo-opherectomy in 6.7%. Morbidity was blood transfusion (76.31%), wound complications 4.38 and no mortality. Conclusions: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy

Funding global emergency medicine research-from seed grants to NIH support

BACKGROUND: Funding for global health has grown significantly over the past two decades. Numerous funding opportunities for international development and research work exist; however, they can be difficult to navigate. The 2013 Academic Emergency Medicine consensus conference on global health and emergency care identified the need to strengthen global emergency care research funding, solidify existing funding streams, and expand funding sources. RESULTS: This piece focuses on the various federal funding opportunities available to support emergency physicians conducting international research from seed funding to large institutional grants. In particular, we focus on the application and review processes for the Fulbright and Fogarty programs, National Institutes of Health (NIH) Career development awards, and the Medical Education Partnership Initiative (MEPI), including tips and pathways through each application process. CONCLUSIONS: Lastly, the paper provides an index that may be used as a guide in determining whether the amount of funding provided by a grant is worth the effort in applying

Effect of Abiotic Stress on Crops

Crop yield is mainly influenced by climatic factors, agronomic factors, pests and nutrient availability in the soil. Stress is any adverse environmental condition that hampers proper growth of plant. Abiotic stress creates adverse effect on multiple procedures of morphology, biochemistry and physiology that are directly connected with growth and yield of plant. Abiotic stress are quantitative trait hence genes linked to these traits can be identified and used to select desirable alleles responsible for tolerance in plant. Plants can initiate a number of molecular, cellular and physiological modifications to react to and adapt to abiotic stress. Crop productivity is significantly affected by drought, salinity and cold. Abiotic stress reduce water availability to plant roots by increasing water soluble salts in soil and plants suffer from increased osmotic pressure outside the root. Physiological changes include lowering of leaf osmotic potential, water potential and relative water content, creation of nutritional imbalance, enhancing relative stress injury or one or more combination of these factors. Morphological and biochemical changes include changes in root and shoot length, number of leaves, secondary metabolite (glycine betaine, proline, MDA, abscisic acid) accumulation in plant, source and sink ratio. Proposed chapter will concentrate on enhancing plant response to abiotic stress and contemporary breeding application to increasing stress tolerance

External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

BACKGROUND: Dehydration due to diarrhoea is a leading cause of child death worldwide, yet no clinical tools for assessing dehydration have been validated in resource-limited settings. The Dehydration: Assessing Kids Accurately (DHAKA) score was derived for assessing dehydration in children with diarrhoea in a low-income country setting. In this study, we aimed to externally validate the DHAKA score in a new population of children and compare its accuracy and reliability to the current Integrated Management of Childhood Illness (IMCI) algorithm. METHODS: DHAKA was a prospective cohort study done in children younger than 60 months presenting to the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute diarrhoea (defined by WHO as three or more loose stools per day for less than 14 days). Local nurses assessed children and classified their dehydration status using both the DHAKA score and the IMCI algorithm. Serial weights were obtained and dehydration status was established by percentage weight change with rehydration. We did regression analyses to validate the DHAKA score and compared the accuracy and reliability of the DHAKA score and IMCI algorithm with receiver operator characteristic (ROC) curves and the weighted kappa statistic. This study was registered with ClinicalTrials.gov, number NCT02007733. FINDINGS: Between March 22, 2015, and May 15, 2015, 496 patients were included in our primary analyses. On the basis of our criterion standard, 242 (49%) of 496 children had no dehydration, 184 (37%) of 496 had some dehydration, and 70 (14%) of 496 had severe dehydration. In multivariable regression analyses, each 1-point increase in the DHAKA score predicted an increase of 0.6% in the percentage dehydration of the child and increased the odds of both some and severe dehydration by a factor of 1.4. Both the accuracy and reliability of the DHAKA score were significantly greater than those of the IMCI algorithm. INTERPRETATION: The DHAKA score is the first clinical tool for assessing dehydration in children with acute diarrhoea to be externally validated in a low-income country. Further validation studies in a diverse range of settings and paediatric populations are warranted. FUNDING: National Institutes of Health Fogarty International Center

The Practitioner\u27s Guide to Global Health: an interactive, online, open-access curriculum preparing medical learners for global health experiences

BACKGROUND: Short-term experiences in global health (STEGH) are increasingly common in medical education, as they can provide learners with opportunities for service, learning, and sharing perspectives. Academic institutions need high-quality preparatory curricula and mentorship to prepare learners for potential challenges in ethics, cultural sensitivity, and personal safety; however, availability and quality of these are variable. OBJECTIVE: The objective of this study is to create and evaluate an open-access, interactive massive open online course (MOOC) that prepares learners to safely and effectively participate in STEGH, permits flexible and asynchronous learning, is free of charge, and provides a certificate upon successful completion. METHODS: Global health experts from 8 countries, 42 institutions, and 7 specialties collaborated to create The Practitioner\u27s Guide to Global Health (PGGH): the first course of this kind on the edX platform. Demographic data, pre- and posttests, and course evaluations were collected and analyzed. RESULTS: Within its first year, PGGH enrolled 5935 learners from 163 countries. In a limited sample of 109 learners, mean posttest scores were significantly improved (p \u3c 0.01). In the course\u27s second year, 213 sampled learners had significant improvement (p \u3c 0.001). CONCLUSION: We created and evaluated the first interactive, asynchronous, free-of-charge global health preparation MOOC. The course has had significant interest from US-based and international learners, and posttest scores have shown significant improvement

External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

Background Dehydration due to diarrhoea is a leading cause of child death worldwide, yet no clinical tools for assessing dehydration have been validated in resource-limited settings. The Dehydration: Assessing Kids Accurately (DHAKA) score was derived for assessing dehydration in children with diarrhoea in a low-income country setting. In this study, we aimed to externally validate the DHAKA score in a new population of children and compare its accuracy and reliability to the current Integrated Management of Childhood Illness (IMCI) algorithm. Methods DHAKA was a prospective cohort study done in children younger than 60 months presenting to the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute diarrhoea (defi ned by WHO as three or more loose stools per day for less than 14 days). Local nurses assessed children and classifi ed their dehydration status using both the DHAKA score and the IMCI algorithm. Serial weights were obtained and dehydration status was established by percentage weight change with rehydration. We did regression analyses to validate the DHAKA score and compared the accuracy and reliability of the DHAKA score and IMCI algorithm with receiver operator characteristic (ROC) curves and the weighted κ statistic. This study was registered with ClinicalTrials.gov, number NCT02007733. Findings Between March 22, 2015, and May 15, 2015, 496 patients were included in our primary analyses. On the basis of our criterion standard, 242 (49%) of 496 children had no dehydration, 184 (37%) of 496 had some dehydration, and 70 (14%) of 496 had severe dehydration. In multivariable regression analyses, each 1-point increase in the DHAKA score predicted an increase of 0·6% in the percentage dehydration of the child and increased the odds of both some and severe dehydration by a factor of 1·4. Both the accuracy and reliability of the DHAKA score were signifi cantly greater than those of the IMCI algorithm. Interpretation The DHAKA score is the fi rst clinical tool for assessing dehydration in children with acute diarrhoea to be externally validated in a low-income country. Further validation studies in a diverse range of settings and paediatric populations are warranted

Design and development of a mini scale hot box for thermal efficiency evaluation of an insulation building block prototype used in Bahrain

International audienceBuilding energy consumption is increasing rapidly, demanding urgent improvement of insulation techniques in order to promote the building’s energy efficiency. The Kingdom of Bahrain presents huge energy demands to the residential buildings due to the continuing air-conditioning units’ operation. Due to this reason, in the present paper, we present the design and development of a modified mini scale hot-box experimental apparatus as well as an experimental and an analytical investigation of the used insulation blocks and techniques in Bahrain, with the aim to measure and evaluate the thermal resistance. The experimental process is developed based on a standardized hot-box design and manufactured with appropriate dimensions, in order to measure the temperature distribution according various climatic conditions. Important results and estimations are produced concerning the thermal resistance of insulation blocks, temperature distribution and heat transfer coefficients. The results are accurate enough and these are validated with the corresponding ones of the literature, through analytical calculations as well as with the manufacturer’s values. It seems that the insulation blocks’ efficiency is adapted to the regional climatic conditions and possible reliable solutions can be applied for further improvement

Improving Accessibility in the Emergency Department for Patients with Disabilities: A Qualitative Study

Introduction: The emergency department (ED) is a critical service area for patients living with disabilities in the United States. Despite this, there is limited research on best practices from the patient experience regarding accommodation and accessibility for those with disabilities. In this study we investigate the ED experience from the perspective of patients living with physical and cognitive disability, as well as visual impairment and blindness, to better understand the barriers to accessibility in the ED for these populations.Methods: Twelve individuals with either physical or cognitive disabilities, visual impairments or blindness were interviewed regarding their ED experiences, particularly related to accessibility. Interviews were transcribed and coded for qualitative analysis with generation of significant themes relating to accessibility in the ED.Results: Major themes from coded analysis were as follows: 1) inadequate communication between staff and  patients with visual impairments and physical disabilities; 2) the need for electronic delivery for after-visit summaries for individuals with cognitive and visual disabilities; 3) the importance of mindful listening and patience by healthcare staff; 4) the role of increased hospital support including greeters and volunteers; and 5) comprehensive training with both prehospital and hospital staff around assistive devices and services.Conclusion: This study serves as an important first step toward improving the ED environment to ensure accessibility and inclusivity for patients presenting with various types of disabilities. Implementing specific training, policies, and infrastructure changes may improve the experiences and healthcare of this population

Age and gender estimation from mandible using lateral cephalogram

Background: The mandible is seen as an important tool for radiological identification because of several growth parameters that can be exploited using cephalometric analysis, ease of imaging, and no overlying bony structures. These parameters can be handy in age and gender assessment in extreme situations like mass murders, remains of dead exhumed and murderous mutilations, missing or severely burnt individuals, etc. Material and Methodology: The study was conducted on randomized 90 lateral cephalograms obtained from the Department of Orthodontics. Tracings of the radiographs were done manually and cephalometric points were marked. Three linear measurements of mandibular growth were; mandibular body length, mandibular length and mandibular height. Gonial angle was measured as the angle formed by the ramus line (RL) and mandibular line (ML). The values obtained were statistically analyzed by Student′s t-test using Statistical Package for Social Sciences (SPSS), Version 7.0. Results: An increase in gonial angle was observed with increasing age in the present study but no statistically significant result could be obtained. However, a larger gonial angle was certainly observed in females. In the present study, the maximum mandibular growth rate was observed among females in the age group of 8-12 years. This finding is in accordance with the fact that growth spurt in females is noted at the age of 10-12. A statistically significant increase in the mandibular length (Gn to Go) was observed in females in the age group of 8-12 years (P > 0.05). Conclusion: The linear and angular parameters used in the study, when combined together, might prove to be of importance in studying the growth pattern of mandible in different age groups and gender. Further studies are recommended on a larger sample size of different ethnic inhabitants to derive an unvarying formula of age and gender assessment