A study of prevalence of Vitamin D deficiency among pregnant women and its impact on feto maternal outcome

Background: The aim of our study was to determine the prevalence of vitamin D among pregnant women and its impact on feto maternal outcome.Methods: An observational study was conducted among 80 pregnant women at PESIMSR, Kuppam over a period of one month from first September 2014 to 30th September 2014. Our primary outcome was to study prevalence of Vitamin D deficiency in pregnant women and secondary outcome to study maternal and fetal outcome in pregnant women with Vitamin D deficiency. The subjects participating in the study were requested to complete a questionnaire that covered socio-demographic data, religion, obstetric history, lifestyle, dietary habits and psychosocial factors. Reliable serum 25-hydroxyvitamin D (25(OH) D) level was measured using an enzyme immunoassay method in the extra nine ml blood sample. Data on date of delivery, baby sex, birth weight, length and gestational age (based on ultrasound or on the timing of the last menstrual period) were collected prospectively.Results: In the study period of the 80 women recruited, 3.8% were Christians, 78.8% were Hindus and 17.4% were Muslims. All women recruited for the study were >32 wks gestation. It was found that 53.8% had insufficient serum 25 (OH) D concentrations and 13.8% were deficient for vitamin D. The lowest 25(OH) D concentrations (insufficient levels) were found in those with only one-two hours of sun exposure (65.1%), and 54.5% had deficient levels. Highest concentrations (11.5%) were found in those with two-four hours of sun exposure. There were no significant associations between 25(OH) D concentrations and maternal outcome. The analysis showed a significant association between a deficient vitamin D status (45.5%) and low birth weight (<2.5Kg) compared to 15.4% who had normal vitamin D levels. An insufficient vitamin D status was also related to a lower birth weight, but the association was not statistically significant. Among babies born to study subjects 84.6% had a normal birth weight of 2.5-3.5 kg with normal maternal vitamin D levels, when compared to 36.4% with deficient maternal vitamin D levels. We did not find any significant association between Vitamin D levels and neonatal complications.Conclusions: In our pilot study we found that prevalence of vitamin D deficiency was very high. Our sample size was too small to comment on impact of vitamin D deficiency on fetomaternal outcome. Hence we stopped our study and considered universal supplementation to all pregnant women

INTERNET OF THINGS BASED SMART HELMET FOR ALERTING ACCIDENT

Abstract This article is about a smart helmet, a novel idea that increases the safety of motorcycle riding. In order to stop vehicles from starting while the driver is not wearing a helmet, this technique was developed. or is inebriated. Furthermore, with the help of a GPS GSM-based tracking system, it detects accidents and sends SMS notifications to particular persons showing the bike's location and speed just before the collision, assisting ambulances in arriving at the precise spot. We want to integrate all of the sensors into the helmet, which will wirelessly transmit data to the module attached to the bike engine. There will be two modules in this smart motorcycle helmet system with one helmet and one motorcycle. The bike module has a vibration sensor, GPS, and GSM, whilst the helmet module has an alcohol sensor, a helmet sensor, and a switch. Both of these modules connect wirelessly using an Arduino as a microcontroller and an RF transmitter and receiver with encoder and decoder

Biochemical & Hematological parameters to predict severity and mortality in COVID 19 patients – a retrospective study

Introduction: Coronavirus diseases (COVID-19), the global pandemic has posed a serious threat to the health of individuals across the world and is associated with increased morbidity and mortality. Several biochemical and hematological parameters are found to be altered in these patients and there is a need to identify a suitable biomarker that can help in better risk stratification of these patients. Hence in this study, we intend to evaluate the clinical utility of these parameters to predict severity and mortality in COVID-19 patients. Material & Methods: A retrospective, observational study was conducted in a tertiary care hospital involving Reverse Transcription Polymerase Chain Reaction (RT-PCR) positive COVID-19 patients (n-322). Data about patient\u27s age, gender, co-morbidities, duration of hospital and intensive care unit (ICU) stay, need for mechanical ventilation and laboratory investigations were obtained from the Hospital Information System (HIS). Results: The average duration of hospital stay was 10 days, and the ICU stay of these patients was 6.5 days.[M1] [DSS2] There was a statistically significant increase in C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), neutrophils, and neutrophil/lymphocyte ratio (NLR), and lower mean lymphocytic count (p=0.05), in patients who required ICU admission when compared to those who didn’t and[M3] [DSS4] also among non-survivors compared to survivors. Conclusion: Among the various biochemical & hematological markers, CRP, ferritin, LDH AST, and NLR were found to be better predictors of severity and mortality in COVID 19 patients. Timely monitoring of these markers would therefore help in better management and improved outcome for these patients

Pedestrians moving in dark: Balancing measures and playing games on lattices

We present two conceptually new modeling approaches aimed at describing the motion of pedestrians in obscured corridors: * a Becker-D\"{o}ring-type dynamics * a probabilistic cellular automaton model. In both models the group formation is affected by a threshold. The pedestrians are supposed to have very limited knowledge about their current position and their neighborhood; they can form groups up to a certain size and they can leave them. Their main goal is to find the exit of the corridor. Although being of mathematically different character, the discussion of both models shows that it seems to be a disadvantage for the individual to adhere to larger groups. We illustrate this effect numerically by solving both model systems. Finally we list some of our main open questions and conjectures

Co-producing an intervention for tobacco cessation and improvement of oral health among diabetic patients in Bangladesh

Abstract Background Tobacco consumption is a major risk factor for many diseases including diabetes and has deleterious effects on oral health. Diabetic patients are vulnerable to developing certain oral conditions. So far, no studies have attempted to co-develop a tobacco cessation intervention to be delivered in dental clinics for people with diabetes in Bangladesh. Aim To co-produce a tobacco cessation intervention for people with diabetes for use in dental clinics in Bangladesh. Objectives To assess: (1) tobacco use (patterns) and perceptions about receiving tobacco cessation support from dentists among people with diabetes attending the dental department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) who smoke or use smokeless tobacco (ST) (2) current tobacco cessation support provision by the dentists of the dental department of BIRDEM (3) barriers and facilitators of delivering a tobacco cessation intervention at a dental clinic, and (4) to co-produce a tobacco cessation intervention with people with diabetes, and dentists to be used in the proposed context. Methods The study was undertaken in two stages in the dental department of BIRDEM, which is the largest diabetic hospital in Bangladesh. Stage 1 (July–August 2019) consisted of a cross-sectional survey among people with diabetes who use tobacco to address objective 1, and a survey and workshop with dentists working in BIRDEM, and consultations with patients to address objectives 2 and 3. Stage 2 (January 2020) consisted of consultations with patients attending BIRDEM, and a workshop with dentists to co-produce the intervention. Result All survey participants (n = 35) were interested in receiving tobacco cessation support from their dentist. We identified important barriers and facilitators to deliver tobacco cessation intervention within dental services. Barriers reported by dentists included lack of a structured support system and lack of training. As a facilitator, we identified that dentists were willing to provide support and it would be feasible to deliver tobacco cessation intervention if properly designed and embedded in the routine functioning of the dental department of BIRDEM. Through the workshops and consultations at stage 2, a tobacco cessation intervention was co-developed. The intervention included elements of brief cessation advice (using a flipbook and a short video on the harmful effects of tobacco) and pharmacotherapy. Conclusion Incorporation of tobacco cessation within dental care for people with diabetes was considered feasible and would provide a valuable opportunity to support this vulnerable group in quitting tobacco

Echocardiographic Measures of Cardiac Structure and Function Are Associated with Risk of Atrial Fibrillation in Blacks: The Atherosclerosis Risk in Communities (ARIC) Study

BackgroundSeveral studies have examined the link between atrial fibrillation (AF) and various echocardiographic measures of cardiac structure and function in whites and other racial groups but not in blacks. Exploring AF risk factors in blacks is important given that the lower incidence of AF in this racial group despite higher risk factors, is not completely explained.MethodsWe examined the association of echocardiographic measures with AF incidence in 2283 blacks (64.5% women, mean age 58.8 years) free of diagnosed AF and enrolled in the Jackson cohort of Atherosclerosis Risk in Communities (ARIC) study, a prospective study of cardiovascular disease. Echocardiography was performed in 1993–1995, and incident AF was determined by electrocardiograms at a follow-up study exam, hospitalization discharge codes and death certificates through the end of 2009. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals for AF associated with the echocardiographic measures, adjusting for age, sex, and known AF risk factors.ResultsDuring an average follow-up of 13.5 years, 191 (8.4%) individuals developed AF. Left ventricular (LV) internal diameter 2-D (diastole) and percent fractional shortening of LV diameter displayed a U-shaped relationship with risk of AF, while left atrial diameter displayed a J-shaped nonlinear association. LV mass index was associated positively with AF. E/A ratio 1.5 and ejection fraction (EF <50%) were also associated with higher AF risk. These measures improved risk stratification for AF in addition to traditional risk factors, although not significantly {C-statistic of 0.767 (0.714–0.819) vs. 0.744 (0.691–0.797)}.ConclusionsIn a community-based population of blacks, echocardiographic measures of cardiac structure and function are significantly associated with an increased risk of AF

Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique

Rationale and Design of a Multicenter Echocardiographic Study to Assess the Relationship Between Cardiac Structure and Function and Heart Failure Risk in a Biracial Cohort of Community-Dwelling Elderly Persons: The Atherosclerosis Risk in Communities Study

Heart failure (HF) is an important public health concern particularly among persons over 65 years of age. Women and African Americans are critically understudied populations that carry a sizeable portion of the HF burden. Limited normative and prognostic data exist regarding measures of cardiac structure, diastolic function, and novel measures of systolic deformation in older adults living in the community

Cellular mechanisms by which proinsulin C-peptide prevents insulin-induced neointima formation in human saphenous vein

AIMS/HYPOTHESIS: Endothelial cells (ECs) and smooth muscle cells (SMCs) play key roles in the development of intimal hyperplasia in saphenous vein (SV) bypass grafts. In diabetic patients, insulin administration controls hyperglycaemia but cardiovascular complications remain. Insulin is synthesised as a pro-peptide, from which C-peptide is cleaved and released into the circulation with insulin; exogenous insulin lacks C-peptide. Here we investigate modulation of human SV neointima formation and SV-EC and SV-SMC function by insulin and C-peptide. METHODS: Effects of insulin and C-peptide on neointima formation (organ cultures), EC and SMC proliferation (cell counting), EC migration (scratch wound), SMC migration (Boyden chamber) and signalling (immunoblotting) were examined. A real-time RT-PCR array identified insulin-responsive genes, and results were confirmed by real-time RT-PCR. Targeted gene silencing (siRNA) was used to assess functional relevance. RESULTS: Insulin (100 nmol/l) augmented SV neointimal thickening (70% increase, 14 days), SMC proliferation (55% increase, 7 days) and migration (150% increase, 6 h); effects were abrogated by 10 nmol/l C-peptide. C-peptide did not affect insulin-induced Akt or extracellular signal-regulated kinase signalling (15 min), but array data and gene silencing implicated sterol regulatory element binding transcription factor 1 (SREBF1). Insulin (1-100 nmol/l) did not modify EC proliferation or migration, whereas 10 nmol/l C-peptide stimulated EC proliferation by 40% (5 days). CONCLUSIONS/INTERPRETATION: Our data support a causative role for insulin in human SV neointima formation with a novel counter-regulatory effect of proinsulin C-peptide. Thus, C-peptide can limit the detrimental effects of insulin on SMC function. Co-supplementing insulin therapy with C-peptide could improve therapy in insulin-treated patients

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program