Evaluating the toxicity of capecitabine-cisplatin versus gemcitabine-cisplatin regimens for palliative chemotherapy in advanced biliary tract carcinoma

Background: Advanced biliary tract carcinoma is a malignancy associated with poor prognosis and limited treatment options. This study aimed to compare the treatment effects in terms of toxicities of Capecitabine-Cisplatin and Gemcitabine-Cisplatin regimens as palliative chemotherapy for ABTC in Bangladesh. Methods: This quasi-experimental study was conducted at the Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, involving 78 patients with histopathologically confirmed ABTC (AJCC Stage IV). Participants were divided into two groups: Arm-A received Capecitabine-Cisplatin, and Arm-B received Gemcitabine-Cisplatin. Treatment response, hematological and non-hematological toxicities were assessed and compared between the two groups. Results: No significant differences in baseline demographic and clinical characteristics were observed between the two groups. Arm-A demonstrated a higher rate of partial response in the final assessment (51.28% vs. 41.03%, p=0.029). Acute hematological toxicities were more frequent in Arm-B, with a higher incidence of Grade 2 and 3 anemia, neutropenia, and leukopenia (p<0.05). Non-hematological toxicities were comparable, except for Hand-Foot Syndrome, which was significantly higher in Arm-A (p=0.03). Conclusions: The Capecitabine-Cisplatin regimen exhibited a different toxicity profile compared to the Gemcitabine-Cisplatin regimen for palliative chemotherapy in advanced biliary tract carcinoma. While both regimens were generally well-tolerated, the Capecitabine-Cisplatin regimen demonstrated lower incidences of hematological toxicities. These findings emphasize the importance of considering toxicity profiles when selecting treatment options for patients with advanced biliary tract carcinoma

Web Search Engine Misinformation Notifier Extension (SEMiNExt): A Machine Learning Based Approach during COVID-19 Pandemic

Misinformation such as on coronavirus disease 2019 (COVID-19) drugs, vaccination or presentation of its treatment from untrusted sources have shown dramatic consequences on public health. Authorities have deployed several surveillance tools to detect and slow down the rapid misinformation spread online. Large quantities of unverified information are available online and at present there is no real-time tool available to alert a user about false information during online health inquiries over a web search engine. To bridge this gap, we propose a web search engine misinformation notifier extension (SEMiNExt). Natural language processing (NLP) and machine learning algorithm have been successfully integrated into the extension. This enables SEMiNExt to read the user query from the search bar, classify the veracity of the query and notify the authenticity of the query to the user, all in real-time to prevent the spread of misinformation. Our results show that SEMiNExt under artificial neural network (ANN) works best with an accuracy of 93%, F1-score of 92%, precision of 92% and a recall of 93% when 80% of the data is trained. Moreover, ANN is able to predict with a very high accuracy even for a small training data size. This is very important for an early detection of new misinformation from a small data sample available online that can significantly reduce the spread of misinformation and maximize public health safety. The SEMiNExt approach has introduced the possibility to improve online health management system by showing misinformation notifications in real-time, enabling safer web-based searching on health-related issues

Domestic violence and decision-making power of married women in Myanmar: analysis of a nationally representative sample

BACKGROUND: Women in Myanmar are not considered decision makers in the community and the physical and psychological effect of violence makes them more vulnerable. There is a strong negative reaction, usually violent, to any economic activity generated by women among poorer and middle-class families in Myanmar because a woman's income is not considered necessary for basic survival. OBJECTIVE: Explore the relationship between domestic violence on the decision-making power of married women in Myanmar. DESIGN: Cross-sectional. SETTING: National, both urban and rural areas of Myanmar. PATIENTS AND METHODS: Data from the Myanmar Demographic and Health Survey 2015-16 were used in this analysis. In that survey, married women aged between 15 to 49 years were selected for interview using a multistage cluster sampling technique. The dependent variables were domestic violence and the decision-making power of women. Independent variables were age of the respondents, educational level, place of residence, employment status, number of children younger than 5 years of age and wealth index. MAIN OUTCOME MEASURES: Domestic violence and decision-making power of women. SAMPLE SIZE: 7870 currently married women. RESULTS: About 50% respondents were 35 to 49 years of age and the mean (SD) age was 35 (8.4) years. Women's place of residence and employment status had a significant impact on decision-making power whereas age group and decision-making power of women had a relationship with domestic violence. CONCLUSION: Giving women decision making power will be indispensable for the achievement of sustainable development goals. Government and other stakeholders should emphasize this to eliminate violence against women. LIMITATIONS: Use of secondary data analysis of cross-sectional study design and cross-sectional studies are not suitable design to assess this causality. Secondly the self-reported data on violence may be subject to recall bias. CONFLICT OF INTEREST: None

Depression among the post stroke patients in the Tertiary hospital and Rehabilitation centre of Bangladesh

A cross sectional study was carried out to see the magnitude of depression as public health problem among purposively selected 291 stroke patients attending for physiotherapy at outpatient department of Physical Medicine Department of Dhaka Medical College Hospital and Center for the Rehabilitation of the Paralyzed, Dhaka. Data were collected through face to face interview using a pretested questionnaire and document review. Depressive symptoms were measured using the Hamilton Depression Rating scale at cut-off value 10 for mild, 14 for moderate and 18 for severe depression. The proportion of depression among the study population was 65% which included 30% with severe depression and rest 17% mild, 18% moderate depression and 35% had no depression. People with ischaemic stroke were more depressed (75.9%) than other types of stroke (p<0.00l). With the duration of stroke both the proportion and level of depression had been increased (p<0.00l. Most of the respondents from low income group were suffering from some level of depression (p<0.05). Both diabetes mellitus (p<0.00l) and hypertension (p<0.005) had significant role in depressive state. This study identified depression among stroke patients as a significant public health problem. Therefore, while planning therapeutic approaches for stroke patients, depression always should be taken into consideration for effective management and improvement of the compliance

Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011

This article was published in PLoS ONE [© 2015 Public Library of Science] and the definite version is available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120309Background and Methods Monitoring use-inequity is important to measure progress in efforts to address healthinequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS), we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011. Findings Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5%) for any antenatal care (ANC), 11.9%(11.1%-12.7%) for institutional delivery, and 18.9% (17.3%-20.5%) for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29) to 0.15 (0.14-0.16) for ANC, and from 0.65 (0.60-0.71) to 0.39 (0.37-0.41) for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75) to 0.47 (0.45-0.49). In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All sociodemographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health. Conclusion Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.Publishe

Improving quality of care for maternal and newborn health: a pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh.

BackgroundBangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices.MethodThe SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives.ResultAfter checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61-1.81).ConclusionImplementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation

Trend in use of ANC, facility delivery and C-section1991–2011.

<p>Trend in use of ANC, facility delivery and C-section1991–2011.</p

Inequity in use of facility delivery over time.

<p>Inequity in use of facility delivery over time.</p