Reproductive age mortality survey: a tool to determine level of underreporting of maternal mortality

Background: For achieving sustainable development goals, tracking all maternal deaths without missing any is a crucial step. Underreporting of maternal deaths is an issue especially in developing countries like India. Objectives of this study were to estimate maternal deaths using Reproductive Age Mortality Survey (RAMOS) methodology in a district of North India and to study medical causes responsible for maternal deaths.Methods: A Reproductive Age Mortality Study (RAMOS) was carried out in a district of North India for the period 2009 to 2012. Records of female deaths in the reproductive age group were reviewed using multiple sources and verbal autopsy was conducted. Maternal deaths thus identified were compared with the officially reported maternal deaths for the same period for finding out the under reporting. Verbal autopsy was conducted to find out causes of maternal deaths.Results: A total of 16 women were identified as maternal deaths using RAMOS methodology. The officially reported maternal deaths were 8, thus under reporting of 100%. The 16 maternal deaths consisted of 14 (87.5%) direct maternal deaths and 2 (12.5%) indirect maternal deaths. One or the other form of delay was recognized in 8 of 16 maternal deaths. There was delay in recognizing the warning signs for urgent health care requirement (first delay) in 4 of 16 maternal deaths. There was delay on part of health facility to diagnose the complication and act appropriately (third delay) in 4 cases.Conclusions: It is concluded that the reporting system for maternal deaths need to be strengthened. Health workers should be adequately trained on reporting maternal death cases. On this foundation verbal autopsy should be conducted for all the reported deaths of women of reproductive age group to know the circumstances leading to maternal deaths.

Situational analysis of ‘Virtual evaluation,’ amidst the COVID-19 pandemic for future exploration! - An experience from a single-center study

It was 30th January 2020 when India reported its first COVID 19 in Kerala. Soon, the pandemic of SARS-CoV-2 was inevitably knocking at the doors of the small hilly state of Himachal Pradesh (HP). On 20th March 2020, HP reported its first two cases of SARS-CoV-2 in Kangra district. Since then, although the COVID-19 pandemic was ensuing in the state, the epidemic was well contained due to the extensive collective efforts of the health department and other stakeholders. COVID 19 pandemic has emerged as a significant barrier, hampering all the regular activities and impacting all spheres of life. Particularly in HP, health care services were predominantly delivered through government services across the state.  As program managers, post-graduates of Community Medicine are the critical stakeholders of health care delivery at the peripheral level and integral implementers of Flu-Clinic, Contact Tracing, Surveillance and field survey teams. Ensuing pandemic enforces the need for the early placement of trained workforce in the periphery for apt delivery of specialized services amongst the community

Machine learning based framework for network intrusion detection system using stacking ensemble technique

Cybersecurity issues are increasing day by day, and it is becoming essential to address them aggressively. An efficient IDS system should be placed to identify abnormal behaviour by dynamically tracing the network traffic pattern. In this work, we proposed a framework for Network Intrusion Detection System using stacking ensemble technique of machine learning, which is testified on Random Forest Regressor and Extra Tree Classifier approaches for feature selections from the subjected dataset. The extensive experimentation has been done by applying 11 states of the art and hybrid machine learning algorithms to select the best performing algorithms. During the investigation, Random Forest, ID3 and XGBoost algorithms are found as best performers among different machine learning algorithms based on accuracy, precision, recall, F1-score and time to increase real-time attack detection performance. Three case studies have been carried out. Our results indicate that the proposed stacking ensemble-based framework of NIDS outperformed compared to the different state of art machine learning algorithms with average 0.99 prediction accuracy

Status of maternal care and immunisation services in a hilly state of north India: a cross sectional study

Background: Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, ill-health and even death. The objective of this study was to assess the utilisation of maternal health care services and coverage of maternal Tetanus immunisation in six districts of Himachal Pradesh, India.Methods: A cross-sectional study was conducted using the WHO cluster sampling method during the period October 2015 to January 2016 among children of 0-11 month age covering 1,260 children in total.Results: A total of 21,097 households were surveyed in 180 clusters. Card availability was 81.1% and 95.9% recalled receiving the antenatal card and tetanus immunisation during their respective pregnancies. Out of the total of 1,260 infants surveyed, 1,255 (99.6%) were found to be fully protected against neonatal tetanus and only 5 (0.39%) were found not to be fully protected. 1,241 (98.5%) of the mothers had undergone full Antenatal check-ups (ANC) during their pregnancy. 210 (100%) had at least one ANC. All had undergone the ANC at the nearest government health facility. 1055 (83.7%) deliveries were institutional deliveries and 201 (16%) were home deliveries. Overall, deliveries conducted by skilled personnel stood at 91.3%.Conclusions: Overall, the utilisation of maternal health services and immunisation against maternal and neonatal Tetanus are excellent in the state. The coverage targets for key RMNCH and A, an interventions have been well achieved in the state. Further, sustained efforts with Supportive Supervision are required to achieve 100% universal coverage of immunisation and full utilisation of maternal health care services

Search for electroweak production of single top quarks in ppˉp\bar{p} collisions.

We present a search for electroweak production of single top quarks in the electron+jets and muon+jets decay channels. The measurements use ~90 pb^-1 of data from Run 1 of the Fermilab Tevatron collider, collected at 1.8 TeV with the DZero detector between 1992 and 1995. We use events that include a tagging muon, implying the presence of a b jet, to set an upper limit at the 95% confidence level on the cross section for the s-channel process ppbar->tb+X of 39 pb. The upper limit for the t-channel process ppbar->tqb+X is 58 pb. (arXiv

Search for first-generation scalar and vector leptoquarks

We describe a search for the pair production of first-generation scalar and vector leptoquarks in the eejj and enujj channels by the D0 Collaboration. The data are from the 1992--1996 ppbar run at sqrt{s} = 1.8 TeV at the Fermilab Tevatron collider. We find no evidence for leptoquark production; in addition, no kinematically interesting events are observed using relaxed selection criteria. The results from the eejj and enujj channels are combined with those from a previous D0 analysis of the nunujj channel to obtain 95% confidence level (C.L.) upper limits on the leptoquark pair-production cross section as a function of mass and of beta, the branching fraction to a charged lepton. These limits are compared to next-to-leading-order theory to set 95% C.L. lower limits on the mass of a first-generation scalar leptoquark of 225, 204, and 79 GeV/c^2 for beta=1, 1/2, and 0, respectively. For vector leptoquarks with gauge (Yang-Mills) couplings, 95% C.L. lower limits of 345, 337, and 206 GeV/c^2 are set on the mass for beta=1, 1/2, and 0, respectively. Mass limits for vector leptoquarks are also set for anomalous vector couplings

Prevalence and severity of disordered mineral metabolism in patients with chronic kidney disease: A study from a tertiary care hospital in India

Background: Disordered mineral metabolism is common complications of chronic kidney disease (CKD). However, there are limited data on the pattern of these disturbances in Indian CKD population. Materials and Methods: This was a prospective observational study of CKD-mineral and bone disorder (CKD-MBD) over a period of 3 years. The biochemical markers of CKD-MBD, namely, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), and 25-hydoxyvitamin Vitamin D3 (25OHD), were measured in newly diagnosed CKD Stage 3–5 and prevalent CKD Stage 5D adult patients. Results: A total of 462 patients of CKD Stage 3–5D were studied. The frequency of various biochemical abnormalities was hypocalcemia (23.8%), hypercalcemia (5.4%), hypophosphatemia (2.8%), hyperphosphatemia (55.4%), raised alkaline phosphatase (56.9%), secondary hyperparathyroidism (82.7%), and hypoparathyroidism (1.5%). 25OHD was done in 335 (72.5%) patients and 90.4% were found to have Vitamin D deficiency. About 70.6% of the patients had iPTH levels were above kidney disease outcomes quality initiative (KDOQI) target range. Nondiabetic CKD as compared to diabetic CKD had a higher alkaline phosphatase (P = 0.016), a higher iPTH (P = 0.001) a higher proportion of patients with iPTH above KDOQI target range (P = 0.09), and an elevated alkaline phosphatase (P = 0.004). The 25OHD levels were suggestive of severe Vitamin D deficiency in 33.7%, Vitamin D deficiency in 45.4%, and Vitamin D insufficiency in 11.3% patients. There was a significant positive correlation between iPTH with alkaline phosphatase (r = 0.572, P = 0.001), creatinine (r = 0.424, P = 0.001), and phosphorus (r = 0.241, P = 0.001) and a significant negative correlation with hemoglobin (r = −0.325, 0.001), age (r = −0.169, P = 0.002), and 25OHD (r = −0.126, P = 0.021). On multivariate logistic regression analysis, an elevated alkaline phosphatase was a significant predictor of hyperparathyroidism (odds ratio 9.7, 95% confidence interval 4.9–19.2, P = 0.001). Conclusions: There was a high prevalence of CKD-MBD in Indian CKD patients. CKD-MBD is more common and more severe and has an early onset as compared to the western populations

Autosomal dominant polycystic kidney disease: Study of clinical characteristics in an Indian population

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary form of kidney disease. Clinical data on this multisystem disorder are scarce from developing countries. We conducted a prospective observational study of the clinical profile of ADPKD patients at a single center over a period of six years. A total of 208 patients were studied. Majority were male (60.6%) and the mean age was 45.8 ± 14.5 years. About 61.5% had early stage (Stages 1-3) of chronic kidney disease (CKD) and 38.5% had advanced CKD (Stages 4 and 5). Clinical features observed included pain abdomen (46.2%), nocturia (65.9%), hematuria (21.6%), nephrolithiasis (38.9%), urinary tract infection (UTI) (38.9%), hypertension (69.5%), and raised serum creatinine (54.3%). The prevalence of nocturia, hypertension, and renal dysfunction showed a significant increase with age (P = 0.001). Extrarenal manifestations were polycystic liver disease in 77 patients (37%), cysts in pancreas in two (1%), and stroke in three (1.5%) (hemorrhage in 2 and infarct in 1). There was significantly higher prevalence of hypertension (P = 0.027) and nephrolithiasis (P = 0.044) in males compared to females. Ninety-two patients (44.2%) had a positive family history for ADPKD. Fifteen (7.2%) had kidney failure at the diagnosis of ADPKD, were hospitalized, and underwent emergency dialysis. A total of 20 patients (9.6%) developed end-stage kidney disease during the study period. The age at diagnosis was higher, and there was a high prevalence of hypertension, nocturia, abdominal pain, nephrolithiasis, UTI, and renal dysfunction in Indian ADPKD patients

How Active is Our Young Generation: An Assessment of Physical Activities among Youth in a City of Northern India

Background: Low level of physical activity among young population has been reported worldwide. A decrease in the physical activity level has been associated with various chronic diseases. This study has been conducted in order to find out the level and pattern of physical activities among youth in urban setting.Methods: A community-based cross-sectional study was conducted among 603 participants of age group 15-24 years using global physical activity questionnaire (GPAQ). GPAQ guideline developed by WHO has been used to determine various levels of physical activities and their association with demographic variables has been described.Results: 64% (95% CI 59-67%) of the participants had low level of physical activities. 23.5% and 10% of the participants were found to be involved in the activities of moderate and vigorous intensity respectively. Less than 3% of the participants were regularly practicing Yoga activities. Prevalence of physical inactivity was found significantly higher among females (72.70%) as compared to males (54.94%).Conclusion: Physical activity among youth in the current study is alarmingly low which needs to be addressed urgently. This study provides important baseline information that can be used for future planning as well as for evaluation

Morbidity pattern and health-seeking behavior of aged population residing in Shimla hills of north India: A cross-sectional study

Background: Population aging is a global phenomenon. In India, the size of the elderly population is growing fast. Many older adults have multiple medical conditions. Understanding elderly health problems and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. Objectives: To assess the morbidity pattern and study the health-seeking behavior of the elderly people of Shimla district in Himachal Pradesh. Materials and Methods: A total of 400 elderly people aged 60 years and above were selected from urban and rural areas of Shimla hills in North India by simple random sampling. Statistical software Epi info software version 3.2 was used for analyzing data. Descriptive statistics were used to describe sociodemographic and morbidity variables. Results: The most common morbidity identified among them were musculoskeletal problems (55.0%) followed by hypertension (40.5%). Two third were seeking treatment for their health problems. Among older persons not seeking treatment for their medical condition, most considered these morbidities as an age-related phenomenon. Many perceived that the health services were too far. Conclusion: The high morbidity load among elderly in the present study stresses for efforts to provide better health care to them and thus ensure that they remain active members of our society. Residence emerged out to be most significant determinant of healthcare-seeking behavior. Policy makers must focus on rural elderly and their beliefs which prevent them from seeking healthcare