A Study of Antepartum Cardiotocography in Mothers with Reduced Fetal Movement at Term and Its Correlation with Fetal Outcome

Maternal perception of fetal movement is one of the first signs of fetal life and is regarded as a manifestation of fetal wellbeing. Reduced or absent fetal movements may be a warning sign of impending fetal death. According to the various tracingsobtained on cardiotocography (CTG), categorization can be done into normal, suspicious or abnormal/pathological and therebyfetal jeopardy can be reliably predicted. This study was designed to evaluate the CTG findings in mothers with complaint ofreduced fetal movement and their fetal outcome at term. It was seen that abnormal and suspicious CTG were more commonlyassociated with meconium-stained liquor at delivery; also they were associated with a higher rate of cesarean section with fetaldistress being the most common indication among these two groups

Efficiency of Galanti and Guisti Method of ADA Estimation in Comparison with the Gold Standard

BACKGROUND: Adenosine Deaminase, the key enzyme of purine metabolism catalyzing the irreversible hydrolytic deamination of adenosine to inosine is implicated in a varied spectrum of human diseases ranging from SCID to TB and pneumonia. Estimation of ADA offers an easy, relatively affordable and reliable diagnostic alternative and/ or adjunct (specially in a TB endemic nation) which emphasizes the necessity of a feasible and implementable alternative method to the Diazyme method of ADA estimation requiring high end autoanalyzer and infrastructural setup.METHODS: Sixty body fluids samples (irrespective of gender, age, diagnosis or sample type) received by the Clinical Biochemistry Laboratory, Kasturba Medical College, Manipal for fluid ADA estimation by the Diazyme assay method (cobas 6000) was simultaneously processed by the Galanti and Guisti manual method to estimate the comparability and the aggregability of results obtained by the two analytical techniques.RESULTS: The Galanti and Guisti manual method of ADA estimation showed aggregability with the Diazyme autoanalyzer method for 90% of the assayed study samples with the manual method uniformly showing higher values when compared to the analyzer method. A correction factor of 2.44 was arrived at which could effectively achieve comparability between the two assay methods.CONCLUSION: The Galanti and Guisti manual method of ADA estimation might be a feasible, rapid, reliable and costeffective method for estimation of fluid ADA when compared to the cost and infrastructure intensive autoanalyzer

Prevalence of extended-spectrum beta-lactamases producing isolates obtained from patients of pediatric critical care unit in a tertiary care hospital

Background: Over the past decades, antibiotic-resistant Gram-negative bacteria commonly Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae have increased significantly. These microorganisms have great clinical importance because they increase hospital stay of the patients in the intensive care unit (ICU) leading to high morbidity and mortality. Because of their role in increasing morbidity and mortality, this study was performed to isolate extended-spectrum beta-lactamase (ESBL) producing Gram-negative bacilli screened by phenotypical method and further projected into molecular characterization by polymerase chain reaction. Aims and Objectives: The aims and objectives are to isolate the Gram-negative multidrug-resistant strains from clinically suspected bacterial infections in patients of neonatal, sick newborn, and pediatric ICU and to study antibiotic sensitivity pattern of isolated Gram-negative multidrug-resistant strains with special reference to molecular characterization. Materials and Methods: A total of 100 Gram-negative bacilli were isolated. Screening of ESBL positivity was done by double-disk synergy test (combined disc test method). Their antibiogram profile was interpreted. With the use of designed primers, 26 ESBL isolates each of E. coli and Klebsiella spp. were processed for molecular analysis of beta-lactamase family genes TEM and CTX-M. Results: Within the 100 samples, majority of the isolates (45%) were Klebsiella spp. and 40% was E. coli isolates. Highest ESBL-producing organisms were observed within E. coli (65%). Prevalence bla-TEM gene was highest followed by bla-CTX-M. These ESBL-producing organisms were found to be resistant to multiple classes of antibiotics. With extensive ESBL surveillance and proper usage of antibiotics, this threatening rise of antibiotic resistance can be mitigated. Conclusion: Gram-negative isolates showed high resistance to commonly used antibiotics. Significant proportions of them were MDR strains. Such high antibiotic resistance is associated with significant morbidity and mortality among pediatric population. MDR along with possession of ESBL associated resistance genes among Gram-negative bacilli pose a serious problem in therapeutic management of patients. Our study signifies that there is a high probability of Gram- negative bacilli to be multi-drug resistant and ESBL positive and earliest detection of such cases should be made

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

An Algorithm For Training Multilayer Perceptron (MLP) For Image Reconstruction Using Neural Network Without Overfitting

Abstract: Recently, back propagation neural network (BPNN) has been applied successfully in many areas with excellent generalization results, for example, rule extraction, classification and evaluation. In this paper the Levenberg-Marquardt back-propagation algorithm is used for training the network and reconstructs the image. It is found that Marquardt algorithm is significantly more proficient. A practical problem with MLPs is to select the correct complexity for the model, i.e., the right number of hidden units or correct regularization parameters. In this paper, a study is made to determine the issue of number of neurons in every hidden layer and the quantity of hidden layers needed for getting the high accuracy. We performed regression R analysis to measure the correlation between outputs and targets

Antidiabetic plants and formulations used by folk medicinal practitioners of two villages in Narail and Chuadanga districts, Bangladesh

Diabetes is a debilitating disease affecting millions of people worldwide including Bangladesh. Recent years have witnessed a significant rise of diabetes in both urban and rural areas of Bangladesh because of dietary habits and a more sedentary lifestyle. The disease has no known cure in modern allopathic medicine; in fact modern medicine merely attempts to control the symptoms of diabetes like increased blood sugar levels, and tries to mitigate the various other complicated problems that can arise out of diabetes like increased cardiovascular risks, diabetic retinopathy, diabetic neuropathy, and kidney failure, to name only a few. On the other hand, folk medicinal practitioners of Bangladesh have been treating diabetes for centuries and claim to have effective treatments for the disease as well as treatment for mitigating other symptoms arising from diabetes. The folk medicinal practitioners (known usually as Kavirajes) use both simple and complex formulations of medicinal plants for treatment of the disease. It was the objective of the present survey to conduct a survey among the Kavirajes of two randomly selected villages in Narail and Chuadanga districts, Bangladesh to collect information on medicinal plants and formulations used by the Kavirajes for treatment of diabetes. It was observed that the Kavirajes of the two villages surveyed used a total of 24 medicinal plants or plant parts for treatment. While some treatment formulations consisted of only a single medicinal plant, there were also complex formulations involving multiple plant parts. A perusal of the relevant scientific literature indicated that a number of the plants used by the Kavirajes for treatment of diabetes had been reported to possess antidiabetic properties. The plants reported in the present survey thus present considerable potential for further scientific research towards finding novel lead compounds for treatment of diabetes

Medicinal plants used for preventive medicinal purposes: A survey in Muktipara village, Chuadanga district, Bangladesh

Bangladesh has over 5,000 floral species, approximately a fifth of which are considered as medicinal plants. Such plants form the major base of formulations prescribed by folk medicinal practitioners, otherwise known as Kavirajes, for treatment of diverse ailments. Kavirajes are present in almost every villages of the around 86,000 villages of the country and play a major role in providing primary health care to the rural residents. In our various ethnomedicinal surveys, we noticed that Kavirajes prescribe plants for not only curative but also for preventive purposes. Since such plants can play a major role in avoidance of diseases and so save health-care costs, the objective of the present survey was to document the various plants that were advised by the practicing Kaviraj of Muktipara village in Chuadanga district of Bangladesh. A total of 11 plants distributed into 11 families were found to be advised by the Kaviraj to village residents to be taken at different times of the year towards prevention of several common ailments. The various ailments against which the plants were prescribed included respiratory tract infections like coughs, colds and mucus, syndromes produced by excessive exposure to sun's heat, hemorrhoids, skin disorders, chicken pox, and flatulency or bloating, i.e. formation of excessive gas in the stomach. Interviews with the rural households of the village indicated that the plants do give positive effects for which the plants are advised to be taken, indicating that these plants can form as good sources of preventive medicine. Since prevention of disease is much more desirable than occurrence of a disease followed by its cure, the plants merit considerable potential for studies to establish them as functional foods

A review of scientific literature on anti-diabetic activity in medicinal plants used by folk medicinal practitioners of two villages in Narail and Chuadanga districts, Bangladesh for treatment of diabetes

An ethnomedicinal survey conducted amongst folk medicinal practitioners (Kavirajes) of two villages in Narail and Chuadanga districts of Bangladesh revealed the use of twenty four medicinal plant species for treatment of diabetes or alleviating diabetic symptoms in human patients. Perusal of the available scientific literature on the anti-diabetic plant species showed that out of the twenty four medicinal plants used, fifteen plant species have been reported in the scientific literature to possess considerable anti-diabetic properties directly in the form of ability to reduce blood sugar following administration, or possess properties, which can alleviate diabetic symptoms or reduce the risk factors for diabetes, including anti-oxidant and hypolipidemic properties. Overall, it can be concluded that the considerable expertise gained by the Kavirajes through longterm practice as well as passage of accumulated knowledge from generation to generation has practical validity and is not based on superstitions or myths about these plants. The close coincidences between the use of medicinal plants by the Kavirajes and their real time scientific validity studies suggest that these plants (some of which are yet to be scientifically studied) have considerable potential for discovery of novel anti-diabetic agents. Diabetes is a debilitating disease affecting millions of people worldwide including Bangladesh, and for which allopathic medicine has no known cure. As such, discovery of novel anti-diabetic agents, which even though they may not cause complete cure, but can alleviate various diabetic symptoms in a more efficient manner or reduce the risk factors leading to diabetes will be of considerable benefit to mankind. As such, these medicinal plants used by the Kavirajes need to be scientifically studied in a more rigorous manner, and efforts should be made to collect information from other Kavirajes in other villages and towns of Bangladesh on anti-diabetic plants and formulations for their uses