Ethics in Palliative Care

In 1959, Victor Frankl considered universal facts of life to be suffering, death and existential guilt and called it the “tragic triad”. Life is suffering, as Lord Buddha concluded. Palliative care tries to reduce this suffering which increases even more near the end of life. Severe pain can compromise the quality of life. Ethicist will guard against counter phobic determination to treat pain as health care team undertreats the pain are worried about excessive sedation and concern for hastening death. Palliative care is best for controlling the symptoms in these difficult situations. Even when goals of care are so clear, still there are lots of ethical question. Most common reasons are conflicts in values between physician and patient or patient and his family. There can also be conflict in expectations. Here we have described ethical issues with ethical analysis with few common clinical scenarios to help the reader associate these in their practice

Role of transdermal testosterone gel pre-treatment on IVF outcome: a prospective randomized controlled trial with active control

Background: Dealing with poor ovarian responders is the newest challenge for the present-day reproductive physicians. Androgens are said to increase pregnancy outcomes due to enhanced oocyte retrieval in poor responders. The aim of the study was to measure the effect of transdermal testosterone gel in women with unexplained poor ovarian response.Methods: It was a prospective randomized controlled trial with active control conducted at ART centre, department of obstetrics and gynaecology, AIIMS, New Delhi from August 2017-August 2018. Seventy women with previously failed IVF/ICSI who had ≤5 oocyte retrieval in previous cycle having normal ovarian reserve with normal or low testosterone levels were randomized. Study arm (N=35) received testosterone gel pre-treatment whereas the control arm (N=35) received standard treatment. GnRH antagonist stimulation protocol was followed. The number of oocytes retrieved and pregnancy outcomes were studied.Results: Of the 70 women in the study, the number of oocytes retrieved was significantly higher (6.5±5.8 vs 3.1±2.1; p=0.002), cycle cancellation rate was lower (8.6% vs 22.9%; p=0.094), implantation rate (8.2% vs 2.6%; p=0.228), clinical pregnancy, ongoing pregnancy, live birth rates (14.7% vs 2.9%; p=0.092) and take home baby rates (17.6% vs 2.9%; p=0.049) were higher in testosterone group compared to controls. One woman in testosterone group developed mild OHSS.Conclusions: The study shows that transdermal testosterone gel is found to improve oocyte retrieval significantly in unexpected poor responders, although there was not a significant improvement in pregnancy outcomes. Hence further studies are of utmost importance to establish the effectiveness of the gel

EXTRACTING ACCURATE DATA FROM MULTIPLE CONFLICTING INFORMATION ON WEB SOURCES

For The World-Wide Web has become the most important information source for most of us. As different websites often provide conflicting information there is no guarantee for the correctness of the data. Among multiple conflict results, can we automatically identify which one is likely the true fact?, In this paper our experiments show that Fact finder, a supporter for user to resolve the problem, successfully finds true facts among conflicting information, and identifies Trust worthy websites better than the popular search engines. In our paper we give ratings based on two things- popularity or the hits & number of occurrences of same data. As we can’t give preference only to popularity, we have considered another rating i.e. about number of occurrences of same data in several other websites, which are less popular. This paper helps user to get resolved by conflicting facts from multiple websites on two basis. Further by considering few more relations we can develop a search engine that truly helps the user to resolve the Veracity problem

Determinants of Severe Acute Malnutrition in under-five children in Dibrugarh District, Assam

Background: Malnutrition is a major public health problem and leading determinant of morbidity and mortality in under-five children in India. Aim & Objective: To assess determinants of Severe Acute Malnutrition (SAM) in under-five children of Dibrugarh district, to assess knowledge and practice of Infant, Young Child Feeding Practices (IYCF) and to assess the knowledge and practice of identification of SAM of Anganwadi workers. Settings and Design: Dibrugarh district, Assam. Mixed method study. Methods and Material: It was a case-control study that interviewed mothers of children between 6-59 months between June 2021 to May 2022. Using a pre-tested semi-structured questionnaire Interviews of a total of 164 under-five children’s mothers (82 cases and 82 controls)] were done. Qualitative data was also collected by in-depth interviews of Anganwadi workers (AWWs). Statistical analysis used: SPSS version 25.0. Chi-Square test, unadjusted OR for Bivariate analysis and adjusted odds ratio using Multiple logistic regression was calculated. Results: Determinants of severe acute malnutrition were joint family (AOR 3.08, 95% CI 1.02-9.31, p= 0.046); birth weight less than 2.5 kg (AOR 20.6, 95% CI 4.50-94.03, p=<0.0001); mothers with less than 4 antenatal check-ups (AOR 5.13, 95% CI 1.28-29.47, p=0.021); partial immunization (AOR 9.2, 95%CI 1.83-46.59, p=0.007); and irregular utilization of ICDS services (AOR 27.36, 95%CI 5.73-130.66, p=<0.0001). Problems faced by AWWs during service delivery were communication barriers, community resistance during home visits, and increased workload during COVID-19. Conclusions: IYCF practices need to be promoted with screening and growth monitoring for early detection and timely referral of malnutrition along referred back and linkages of services so that home-based and community-based management can be done to prevent severe acute malnutrition

Determining the Validity of Methods Used in Meat Iron Analysis

The validity of the Homsey method for heme iron, modified Schricker and sodium pyrophosphate extraction methods for nonheme iron and atomic absorption spectrophotometry (AAS) and ferrozine methods for total iron were determined using spikes of hemoglobin, ground beef baked to different degrees of doneness, proportional beef liver:catfish mixtures and National Institute of Science and Technology reference materials. The mean spike recoveries of 0.0lg and 0.02g Hb in raw beef and raw chicken samples were 96.7% of the heme iron for the Homsey method, 97.9% of the total iron for the ferrozine method, and 85.7% of the total iron for the AAS technique. In ground beef patties baked rare, medium and well-done, the nonheme iron values increased with Heme and nonheme iron values were plotted against beef liver concentrations in the beef liver:catfish mixtures, and the correlation coefficients obtained were 0.994 for the Homsey method, 0.991 for the modified Schricker method, and 0.995 for the sodium pyrophosphate method. Heme iron plus nonheme iron equalled total iron for all the mixtures. Student\u27s t test revealed no significant difference between ferrozine total iron values and NIST-certified concentrations, but the AAS total iron values were significantly (p\u3c.05) The Hornsey method was validated for all samples except well-done beef. The two nonheme iron methods were reliable and accurate. While the fenozine technique was consistent, reliable and accurate, the AAS method was able to detect, on an average, only 80-85% of the total iron present. There was no interference of the sample mineral matrix with the detection ability of the AAS method

Satellite Image Fusion in Various Domains

In order to find out the fusion algorithm which is best suited for the panchromatic and multispectral images, fusion algorithms, such as PCA and wavelet algorithms have been employed and analyzed. In this paper, performance evaluation criteria are also used for quantitative assessment of the fusion performance. The spectral quality of fused images is evaluated by the ERGAS and Q4. The analysis indicates that the DWT fusion scheme has the best definition as well as spectral fidelity, and has better performance with regard to the high textural information absorption. Therefore, as the study area is concerned, it is most suited for the panchromatic and multispectral image fusion. an image fusion algorithm based on wavelet transform is proposed for Multispectral and panchromatic satellite image by using fusion in spatial and transform domains. In the proposed scheme, the images to be processed are decomposed into sub-images with the same resolution at same levels and different resolution at different levels and then the information fusion is performed using high-frequency sub-images under the Multi-resolution image fusion scheme based on wavelets produces better fused image than that by the MS or WA schemes

Maternal Immune Activation Causes Behavioral Impairments and Altered Cerebellar Cytokine and Synaptic Protein Expression

Emerging epidemiology studies indicate that maternal immune activation (MIA) resulting from inflammatory stimuli such as viral or bacterial infections during pregnancy serves as a risk factor for multiple neurodevelopmental disorders including autism spectrum disorders and schizophrenia. Although alterations in the cortex and hippocampus of MIA offspring have been described, less evidence exists on the impact on the cerebellum. Here, we report altered expression of cytokines and chemokines in the cerebellum of MIA offspring, including increase in the neuroinflammatory cytokine TNFα and its receptor TNFR1. We also report reduced expression of the synaptic organizing proteins cerebellin-1 and GluRδ2. These synaptic protein alterations are associated with a deficit in the ability of cerebellar neurons to form synapses and an increased number of dendritic spines that are not in contact with a presynaptic terminal. These impairments are likely contributing to the behavioral deficits in the MIA exposed offspring

Maternal Immune Activation Causes Behavioral Impairments and Altered Cerebellar Cytokine and Synaptic Protein Expression

Emerging epidemiology studies indicate that maternal immune activation (MIA) resulting from inflammatory stimuli such as viral or bacterial infections during pregnancy serves as a risk factor for multiple neurodevelopmental disorders including autism spectrum disorders and schizophrenia. Although alterations in the cortex and hippocampus of MIA offspring have been described, less evidence exists on the impact on the cerebellum. Here, we report altered expression of cytokines and chemokines in the cerebellum of MIA offspring, including increase in the neuroinflammatory cytokine TNFα and its receptor TNFR1. We also report reduced expression of the synaptic organizing proteins cerebellin-1 and GluRδ2. These synaptic protein alterations are associated with a deficit in the ability of cerebellar neurons to form synapses and an increased number of dendritic spines that are not in contact with a presynaptic terminal. These impairments are likely contributing to the behavioral deficits in the MIA exposed offspring