Mean platelet volume as an indicator of severity of hypertensive retinopathy in hypertensive subjects

Background: Hypertensive retinopathy (HR) represents the ophthalmic findings of end-organ damage secondary to systemic arterial hypertension. Platelets play a crucial role in the pathogenesis of atherosclerotic complications, contributing to thrombus formation or apposition after plaque rupture. The aim of our study was to investigate whether Mean platelet volume (MPV) is associated with the severity of hypertensive retinopathy in hypertensive patients.Methods: This cross-sectional study was conducted in Department of Medicine of SAMC and PGI, Indore. Total 250 adult hypertensive patients (BP >140/90 mm Hg or taking antihypertensive drugs) recruited for the study.Results: Of the 250 subjects, 158 (63.2%) were male and 92 (36.8%) were female. Elevated MPV >11.5 femtoliter was observed in 84 cases (33.6%). There was statistically significant relationship between the grade of retinopathy and elevated MPV in hypertensive subjects. (r = 0.52, P <0.001).Conclusions: We described a relation between MPV and HR (probably first time in Indian patients). Measurement of MPV is easy to establish and therefore might serve as a valuable predictor of a worse outcome in microvascular complications

Study of maternal and prenatal outcome in pregnant women with acute hepatitis E viral infection

Background: Hepatitis E Virus (HEV) is a major aspect of hepatitis and death in the developing countries and asymmetrical source of deaths in among of pregnant women. The objective of this study was to determine the maternal and prenatal outcome in pregnant women with acute hepatitis E viral infection in Malwa, India.Methods: Observational, cross-sectional study. The study population was pregnant women with acute hepatitis E infection confirmed by ELISA technique. Pregnant women with other hepatic viral infections were excluded. All medical and obstetric conditions and mortality were noted on the predesigned proforma.Results: Out of the total 105 admitted pregnant women with hepatitis E viral infection, 21.90% women had severe morbidity, 24.17% perinatal death and 14 (13.3%) expired before delivery. The yellowish discoloration of urine or sclera was observed in 91.42% with abdominal pain in 76.19%. Maternal mortality was higher in patients with primi (47.82%) and patients presented in second trimester (56.50%).Conclusions: The acute viral hepatitis E infection in pregnant women is associated with maternal morbidities and high mortality rate

Neonatal, 1–59 month, and under-5 mortality in 597 Indian districts, 2001 to 2012: estimates from national demographic and mortality surveys

Background India has the largest number of child deaths of any country in the world, and has wide local variation in under-5 mortality. Worldwide achievement of the UN 2015 Millennium Development Goal for under-5 mortality (MDG 4) will depend on progress in the subregions of India. We aimed to estimate neonatal, 1–59 months, and overall under-5 mortality by sex for 597 Indian districts and to assess whether India is on track to achieve MDG 4. Methods We divided the 2012 UN sex-specifi c birth and mortality totals for India into state totals using relative birth rates and mortality from recent demographic surveys of 24 million people, and divided state totals into totals for the 597 districts using 3 million birth histories. We then split the results into neonatal mortality and 1–59 month mortality using data for 109 000 deaths in children younger than 5 years from six national surveys. We compared results with the 2001 census for each district. Findings Under-5 mortality fell at a mean rate of 3·7% (IQR 3·2–4·9) per year between 2001 and 2012. 222 (37%) of 597 districts are on track to achieve the MDG 4 of 38 deaths in children younger than 5 years per 1000 livebirths by 2015, but an equal number (222 [37%]) will achieve MDG 4 only after 2020. These 222 lagging districts are home to 41% of India’s livebirths and 56% of all deaths in children younger than 5 years. More districts lag behind the relevant goal for neonatal mortality (251 [42%]) than for 1–59 month mortality (197 [33%]). Just 81 (14%) districts account for 37% of deaths in children younger than 5 years nationally. Female mortality at ages 1–59 months exceeded male mortality by 25% in 303 districts in nearly all states of India, totalling about 74 000 excess deaths in girls. Interpretation At current rates of progress, MDG 4 will be met by India around 2020—by the richer states around 2015 and by the poorer states around 2023. Accelerated progress to reduce mortality during the neonatal period and at ages 1–59 months is needed in most Indian districts. Funding Disease Control Priorities 3, Canadian Institutes of Health Research, International Development Research Centre, US National Institutes of Health

Factors Associated with Physician Agreement and Coding Choices of Cause of Death Using Verbal Autopsies for 1130 Maternal Deaths in India

The Indian Sample Registration System (SRS) with verbal autopsy methods provides estimations of cause specific mortality for maternal deaths, where the majority of deaths occur at home, unregistered. We aim to examine factors that influence physician agreement and coding choices in assigning causes of death from verbal autopsies.Among adult deaths identified in the SRS, pregnancy-related deaths recorded in 2001-2003 were assigned ICD-10 codes by two independent physicians. Inter-rater reliability was estimated using Landis Koch Kappa classification ≤0.4--poor to fair agreement; >0.4 ≤0.6--moderate agreement; >0.6 ≤0.8--substantial agreement; >8--high agreement. We identified factors associated with physician agreement using multivariate logistic regression. A central consensus panel reviewed cases for errors and reclassified as needed based on 2011 ICD-10 coding guidelines. Of 1130 pregnancy-related deaths, 1040 were assigned ICD-10 codes by two physicians. We found substantial agreement regardless of the woman's residence, whether the death was registered, religion, respondent's or deceased's education, age, hospital admission or gestational age. Physician agreement was not influenced by the above variables, with the exception of greater agreement in cases where the respondent did not live with the deceased, or early gestational age at the time of death. A central consensus panel reviewed all cases and recoded 10% of cases due to insufficient use of information in the verbal autopsy by the coding physicians and rationale for this reclassification are discussed.In the absence of complete vital registration and universal healthcare services, physician coded verbal autopsies continues to be heavily relied upon to ascertain pregnancy-related death. From this study, two independent physicians had good inter-rater reliability for assigning pregnancy-related causes of death in a nationally-represented sample, and physician coding does not appear to be heavily influenced by case characteristics or demographics

Factors Associated with Physician Agreement on Verbal Autopsy of over 27000 Childhood Deaths in India

Each year, more than 10 million children younger than five years of age die. The large majority of these deaths occur in the developing world. The verbal autopsy (VA) is a tool designed to ascertain cause of death in such settings. While VA has been validated against hospital diagnosed cause of death, there has been no research conducted to better understand the factors that may influence individual physicians in determining cause of death from VA.This study uses data from over 27,000 neonatal and childhood deaths from The Million Death Study in which 6.3 million people in India were monitored for vital status between 1998 and 2003. The main outcome variable was physician agreement or disagreement of category of death and the variables were assessed for association using the kappa statistic, univariate and multivariate logistic regression using a conceptual hierarchical model, and a sensitivity and specificity analysis using the final VA category of mortality as the gold standard. The main variables found to be significantly associated with increased physician agreement included older ages and male gender of the deceased. When taking into account confounding factors in the multivariate analysis, we did not find consistent significant differences in physician agreement based on the death being in a rural or urban area, at home or in a health care facility, registered or not, or the respondent's gender, religion, relationship to the deceased, or whether or not the respondent lived with the deceased.Factors influencing physician agreement/disagreement to the greatest degree are the gender and age of the deceased; specifically, physicians tend to be less likely to agree on a common category of death in female children and in younger ages, particularly neonates. Additional training of physician reviewers and continued adaptation of the VA itself, with a focus on gender and age of the deceased, may be useful in increasing rates of physician agreement in these groups

Leaching of Korean monazite for the recovery of rare earth metals

The technological innovations resulted in various applications using rare earth metals (REM), which lead to a steep increase in their demand. Monazite is the second most essential naturally occurring phosphate mineral containing REM. The present work reports the recovery of REM from Korean monazite which contained mainly 50.12% rare earth oxide and 29.4% phosphate. For the recovery of REM from monazite, the hydrometallurgical process consisting of alkaline leaching of phosphate followed by acid dissolution of REM has been reported. As the presence of phosphate decreases the leaching efficiency of REM from monazite, the studies were carried out initially for hot digestion of phosphate present in the monazite in an autoclave using sodium hydroxide, which resulted in the formation of RE oxide and soluble sodium phosphate. To get the optimum condition for phosphate decomposition by alkaline leaching, the various process parameters such as concentration of sodium hydroxide, temperature, mixing time and pulp density were studied. The obtained slurry was washed with hot water and filtered to get sodium phosphate in the solution. A maximum of 99% phosphate was removed from monazite concentrate using 50% sodium hydroxide solutions (wt./vol.) at 170oC in 4 h mixing time maintaining the pulp density of 100 g/L. From the phosphate free monazite sample, REM was leached out using hydrochloric acid. More than 95% of REM was found to be leached out using 6M HCl at constant pulp density 100 g/L, temperature 90oC and mixing time 2 h. Further studies are in progress to obtain pure solution and salts of REM from chloride leach liquor using recipitation/ solvent extraction/ ion-exchange techniques

Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the Indian Million Death Study.

BACKGROUND: Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India's ongoing, nationally-representative Indian Million Death Study (MDS). METHODS: Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions. RESULTS: The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding. CONCLUSIONS: Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available