Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh

BACKGROUND AND OBJECTIVES

Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh.

METHODS

Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed.

RESULTS

Around 32% (95% CI: 29.7-34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities.

CONCLUSION

Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of 'low' to 'very low' quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

Retraction notice to “Impact of Nutrition Interventions for Reduction of Anemia in Women of Reproductive Age in Low- and Middle-Income Countries: A Meta-Review” [Curr Dev Nutr (2022) 6(12) nzac134]

[This retracts the article DOI: 10.1093/cdn/nzac134.].

Mapping the range of policies relevant to care of small and nutritionally at-risk infants under 6 months and their mothers in Ethiopia: a scoping review protocol

INTRODUCTION

Evidence gaps limit management of small and/or nutritionally at-risk infants under 6 months and their mothers, who are at higher risk of death, illness, malnutrition and poor growth and development. These infants may be low birth weight, wasted, stunted and/or underweight. An integrated care model to guide their management (MAMI Care Pathway) is being tested in a randomised controlled trial in Ethiopia. Evaluating the extent to which an innovation is consistent with national policies and priorities will aid evidence uptake and plan for scale.

METHODS AND ANALYSIS

This review will evaluate the extent to which the MAMI Care Pathway is consistent with national policies that relate to the care of at-risk infants under 6 months and their mothers in Ethiopia. The objectives are to describe the range and characteristics, concepts, strategic interventions, coherence and alignment of existing policies and identify opportunities and gaps. It will be conducted in accordance with the JBI methodology for scoping reviews (PRISMA-ScR). Eligible documents include infant and maternal health, nutrition, child development, food and social welfare-related policies publicly available in English and Amharic. The protocol was registered on the Open Science Framework Registry on 20 June 2022 (https://osf.io/m4jt6).Grey literature will be identified through government and agency websites, national and subnational contacts and Google Scholar, and published policies through electronic database searches (MEDLINE, EMBASE and Global and Health Information). The searches will take place between October 2023 and March 2024. A standardised data extraction tool will be used. Descriptive analysis of data will be undertaken. Data will be mapped visually and tabulated. Results will be described in narrative form. National stakeholder discussions will inform conclusions and recommendations.

ETHICS AND DISSEMINATION

Ethical approval is not required as data consist solely of publicly available material. Findings will be used to evidence national and international policy and practice.

Contribution of socio-economic and demographic factors to maternal and child malnutrition in Bangladesh: Insights from a nationwide survey

Background: Malnutrition is a major global public health issue, especially for under five children and their mothers. Objective: This study examined the relationships between socio-economic and demographic characteristics and under- and over-nutrition in mothers and children of Bangladesh. Method: Using the Nationally representative Bangladesh Demographic and Health Survey (2017-18) data, we performed the multiple logistic regression analysis to assess the relationships between key outcome variables and predictors. The analysis included 8321 children aged 0-59 months and 7800 mothers aged 15-49 years. Findings: The prevalence of stunting, wasting, and overweight among children under five was 30.72%, 8.44%, and 2.21% respectively. About 2.74% of the children were both stunted and wasted, while 0.56% of the children were both stunted and overweight. The prevalence of underweight and overweight among mother was 14.09% and 26.35% respectively. Children who are stunted are significantly associated with the mother's BMI status, mothers' education, fathers' education, and wealth index, while children who are wasted are significantly associated with the mother's BMI status and the child's sex. A child's sex and birth order are significantly associated with children being overweight. Mother's age, mother's education, father's education, place of residence and wealth index are significant determinants for mothers being underweight, whereas mother's age, mother's occupation, father's education, father's occupation, place of residence and wealth index are significant determinants for mothers being overweight. Conclusion: In addition to essential nutrition interventions, it is vital to address the basic social-economic and demographic determinants.

Development and validation of simultaneous quantification method for gemcitabine and betulinic acid: augmenting industrial application

Combinatorial treatment utilizing a nucleoside analogue gemcitabine (GEM), with a characteristic pentacyclic triterpenoid betulinic acid (BET), has exhibited empowering adequacy in the therapy of cancer. It lessens the advancement of collagen and upgrades the saturation of tumour medicines. With the advancement in nanotechnology, the co-loaded formulation urges for a validated method of estimation. The purposed work entails a robust, simple, and economical analytical method for the simultaneous estimation of GEM and BET through RP-HPLC. Orthophosphoric acid (0.1%)-acetonitrile was considered as the mobile phase for the detection of GEM and BET at 248 nm and 210 nm with retention times of 5 min and 13 min, respectively. The method was further validated as per the regulatory guidelines with all the parameters found within the limit. The developed method with adequate resolution and quantification was found to be linear, accurate, precise, robust, and stable with an intra- and inter-day variability of less than 2%. The method was found specific for GEM and BET with no matrix interference of drug-spiked FBS samples. To demonstrate the applicability of the developed method, a nano-formulation containing GEM and BET was prepared and assessed for various parameters including encapsulation efficiency, loading efficiency, drug release, and drug stability. The method developed can be a possible tool for the simultaneous quantification of GEM-BET in analytical and biological samples.

Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update

(1) Background: The current evidence on management of infants under six months (u6m) with growth faltering is limited and of low quality. This review aimed at updating an existing review to inform the WHO guideline update on prevention and management of growth faltering in infants u6m. The objective is to synthesise evidence on interventions to manage breastfeeding difficulties in mothers or caregivers of infants u6m with growth faltering to improve breastfeeding practices and breastmilk intake. (2) Methods: We searched PubMed, CINAHL, and Cochrane Library from December 2018 to December 2021 for experimental studies. Using RoB 2.0 and ROBINS-I tools, we assessed study quality and results were synthesised narratively. Using the GRADE approach, we assessed the quality of evidence for four outcome domains-breastfeeding (critical), anthropometric (important), mortality (important), and morbidity (important). (3) Results: We identified seven studies, conducted among neonates (mainly preterm, n = 14 to 607), and assessed the following interventions: (a) non-nutritive sucking (NNS) on breast (n = 2) and (b) alternative supplemental feeding techniques (n = 5, cup feeding, spoon feeding, supplemental feeding tube device, and syringe feeding), and reported breastfeeding and anthropometric outcomes. None of the studies reported mortality and morbidity outcomes. The reported breastfeeding outcomes included LATCH (Latch, Audible swallowing, Type of nipple, Comfort, Hold) total score, PIBBS (Preterm Infants Breastfeeding Behaviour Scale) total score, EBF (exclusive breastfeeding) at various time points and time to transition to full breastfeeding, and reported anthropometric outcomes included weight gain and weight at different time points. Studies had 'serious' indirectness and 'serious' to 'very serious' risks of bias. From the limited studies we found, NNS on breast compared to NNS on finger may have some benefits on PIBBS total score; NNS on breast compared to NNS on pacifier may have some benefits on EBF at discharge; and cup feeding compared to bottle feeding may have some benefits on EBF at discharge, at three months and at six months. (4) Conclusions: Evidence on the effectiveness of interventions to manage breastfeeding difficulties in mothers or caregivers of infants u6m with growth faltering to improve breastfeeding practices and increase breastmilk intake is 'limited' and of 'low' to 'very low' quality. As the majority of the infants in the included studies were neonates, no new recommendations can be made for infants from one to six months due to lack of evidence in this population. We need more studies targeting infants from one to six months of age. The review was registered with PROSPERO (CRD42022309001).

Impact of Nutrition Interventions for Reduction of Anemia in Women of Reproductive Age in Low- and Middle-Income Countries: A Meta-Review

Background

The UN Sustainable Development Goal aims at a 50% reduction of anemia in women of reproductive age (WRA) by 2030. Several nutrition-specific and sensitive interventions are targeted across low- and middle-income countries (LMICs) to reduce anemia.

Objectives

In this meta-review we comprehensively assessed the effectiveness of nutrition-specific and -sensitive interventions on hemoglobin (Hb) and serum ferritin (SF) concentrations and the prevalence of iron deficiency and anemia among WRA, pregnant women, and lactating women from LMICs.

Method

The preparation of the present meta-review followed a double-blinded synthesis process with 3 stages: screening, quality appraisal, and data extraction in Eppi Reviewer. A comprehensive search was performed for systematic reviews (SRs) published between January 2000 and May 2022 using 21 international, national, and regional databases. The methodological quality appraisal of included studies was conducted using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist.

Results

A total of 23 SRs evaluated the effects of various nutrition-specific interventions included in the final synthesis. The included SRs included analyses of nutrition-specific interventions such as supplementation of the nutrients iron (n = 7), iron and folic acid (n = 4), vitamin A (n = 3), calcium (n = 2), multiple micronutrients (n = 7), and intravenous iron sucrose (n = 2). Also, SRs on fortification of nutrients included multiple micronutrients (n = 6), iron and folic acid (n = 4), and iron (n = 4). Of the 23 SRs, 22 were of high quality. Iron with or without folic acid supplementation and fortification and vitamin A supplementation consistently showed positive effects on either reduction in the prevalence of anemia or iron deficiency and improving the Hb or SF concentrations in WRA and pregnant women from LMICs.

Conclusion

The comprehensive meta-review reported the beneficial effects of iron with or without folic acid, multiple micronutrient supplementation/fortification, and vitamin A supplementation in reducing the prevalence of anemia or iron deficiency and increasing Hb or SF concentrations in WRA from LMICs.

Carers’ and health workers’ perspectives on malnutrition in infants aged under six months in rural Ethiopia: A qualitative study

Objectives

Supporting small and nutritionally at-risk (potentially malnourished) infants under six months is a global health priority, albeit with a weak evidence-base. To inform policy and research in this area, we aimed to assess the perceptions and understanding of infant malnutrition and its management among carers, communities, and healthcare workers in rural Ethiopia.

Methods

We conducted in-depth and key-informant interviews, from May-August 2020 in Jimma Zone and Deder District, Ethiopia. We used purposive sampling to recruit the participants. Interviews were transcribed into Amharic or Afaan Oromo and then translated into English. Atlas ti-7 was used to support data analysis. Findings were narrated based on the different themes arising from the interviews.

Results

Carers/community members and healthcare workers reported on five different themes: 1) Perceptions about health and well-being: an ‘ideal infant’ slept well, fed well, was active and looked ‘fat’; 2)Perceptions of feeding: overall knowledge of key recommendations like exclusive breastfeeding was good but practices were suboptimal, notably a cultural practice to give water to young infants; 3)Awareness about malnutrition: a key limitation was knowledge of exactly how to identify small and nutritionally at-risk infants; 4) Reasons for malnutrition: levels of understanding varied and included feeding problems and caregiver’s work pressures resulting in the premature introduction of complementary feeds; 5) Perceptions about identification & treatment: carers prefer treatment close to home but were concerned about the quality of community-based services.

Conclusion

To succeed, research projects that investigate programes that manage small and nutritionally at-risk infants under six months should understand and be responsive to the culture and context in which they operate. They should build on community strengths and tackle misunderstandings and barriers. Interventions beyond just focusing on knowledge and attitude of the carers and health workers are necessary to tackle the challenges around infants under 6 months of age at risk of malnutrition. Moreover, stakeholders beyond the health sector should also be involved in order to support the infants under 6 months and their mothers as some of the key reasons behind the at-risk infants are just beyond the capacity of the health sector or health system. Our list of themes could be used to inform infant nutrition work not just in Ethiopia but also in many others.

Mid-Upper Arm Circumference Tapes and Measurement Discrepancies: Time to Standardize Product Specifications and Reporting

Mid-upper arm circumference (MUAC) is a widely used anthropometric measure to identify children with acute malnutrition. The use of different tapes of varied materials and thicknesses to measure MUAC has led to discrepancies. This indicates the need for global standardization of MUAC tape design.

In recent years, community-based management of acute malnutrition (CMAM) has revolutionized the care for children by increasing treatment coverage. Critical to the success of CMAM is early case identification. Mid-upper arm circumference (MUAC) measurement is a widely used, practical anthropometric measure used at the community level for the identification and admission of cases to appropriate treatment services. Globally, many organizations and government services use MUAC tapes for early case detection. However, there is no one universal MUAC tape specification, and it has been observed that using different MUAC tapes results in different measurements. In this article, we aim to: (1) present the measurement discrepancies; (2) discuss design specifications and their effect on case identification and admissions; (3) present a call to action to agree on common design specifications and standardized reporting. We hope this article will catalyze discussion and practical actions among nutrition and health stakeholders to ensure we have common MUAC tape design specifications so that all eligible at-risk children will get an equal chance to be identified early for critical treatment.

Comparative evaluation of effects of natural antioxidants on the shear bond strength of composite resin to bleached enamel

Context

The use of antioxidants immediately after bleaching showed increased bond strength.

Aims

This study aimed to compare the effects of natural antioxidants on the shear bond strength of composite resin to bleached enamel.

Materials and Methods

Fifty extracted single-rooted upper incisors were decoronated by sectioning the roots 2 mm below the cementoenamel junction, and then, crowns were embedded in autopolymerizing acrylic resin block (3.0 cm × 3.0 cm × 3.0 cm) with the labial surface exposed. They were randomly divided into five groups, depending on the type of antioxidant used (n = 10): (i) Group 1: control (no bleaching), (ii) Group 2: bleaching only, (iii) Group 3: bleaching + 10% sodium ascorbate (antioxidant), (iv) Group 4: bleaching + green tea, and (v) Group 5: bleaching + white tea. Labial surfaces of 40 teeth were bleached with 38% hydrogen peroxide for 20 min following manufacturer's instructions. After that, the experimental groups (Groups 3, 4, and 5) were treated with respective antioxidant solutions before composite restorations were done using a cylindrical plastic mold (3 mm × 5 mm). Shear bond strength of the specimens was tested under universal testing machine.

Statistical Analysis

Data were analyzed with ANOVA and Tukey's post hoc test.

Results

There were statistically significant differences between shear bond strength of control groups (Groups 1 and 2) and experimental groups (P < 0.05), but no significant difference in bond strength was observed among the antioxidants used.

Conclusion

Application of antioxidants immediately after bleaching showed increased bond strength. Green tea and white tea extract can be used as alternative antioxidants in improving the bond strength of enamel.

Improving Adolescent Health: Learnings from an Interventional Study in Gujarat, India

BACKGROUND

There are multiple risk factors during adolescence, which become precursors of various diseases and injuries inflicting high morbidity, mortality, and disability. There are several gaps in adolescent health research in India; one among them is that programs targeting adolescent health are constrained by the absence of rigorous interventional research informing interventions for improving adolescent health. This study aims to document the effectiveness of intervention on adolescent health and knowledge change on the risk factors among adolescents in one of the selected districts in Gujarat, India.

METHODS

This was an interventional study with quasi-experimental design executed in one of the blocks of Gujarat. Baseline was conducted in 2013-2014 followed by intervention and the end line during 2016-2017. A structured validated questionnaire after pilot testing was executed to collect information on sociodemographic profile, nutrition status, menstrual hygiene practices, reproductive and sexual health, substance abuse, program awareness and utilization, and empowerment through life skills of adolescents in baseline and end line survey. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp).

RESULTS

This study documented increased awareness regarding anemia, knowledge about STD and HIV/AIDS, reduced addiction to tobacco, improved practices during menstrual hygiene and engagement with adolescent services/schemes in the intervention site.

CONCLUSION

This study concludes that evidence-based interventions lead to increase in knowledge and practices; however, some improvements have also been documented in the nonintervention site. Therefore, changes due to interventions could not be attributed completely for improving adolescent health. Further long term interventional studies are required to develop a robust evidence on improving health of adolescents in India.

UDAY: A comprehensive diabetes and hypertension prevention and management program in India

INTRODUCTION

Diabetes and hypertension are two leading non-communicable conditions, which are suboptimally managed in India. Thus, innovative comprehensive approaches that can concomitantly improve their detection, prevention and control are warranted.

METHODS AND ANALYSIS

UDAY, a 5-year initiative, aims to reduce the risk of diabetes and hypertension and improve management by implementing a comprehensive intervention programme in the two selected study sites, Sonipat and Visakhapatnam (Vizag). It has a pre-post evaluation design with representative cross-sectional surveys before and after intervention. Within these two sites, urban and rural subsites each with a total population of approximately 100 000 people each were selected and a baseline and postintervention assessment was conducted deploying five surveys [among general population (including body measurements or biosamples), patients, healthcare providers including physicians and pharmacists, health facilities], which will determine the knowledge levels about diabetes and hypertension, the proportion treated and controlled; the patient knowledge and self-management skills; healthcare providers' management practices; the level of access and barriers to obtaining care.The interventions will include: tailored health promotion for improving public knowledge; screening of adults aged ≥ 30 years for identifying those at high risk of diabetes and/or hypertension for linkage to the healthcare system; patient education using technology enabled community health workers, geographic information system (GIS) based mapping of the communities, healthcare provider training on management guidelines, community based diabetes registry and; advocacy to improve access to healthcare. The baseline surveys have been completed, the study areas mapped using GIS and the interventions are being implemented. UDAY is expected to increase over baseline the levels of: public knowledge about diabetes and hypertension; those treated and controlled; patient self-management skills; the use of guideline based management by providers and; access to healthcare, leading to improved health outcomes and inform development of a India relevant chronic care model.

ETHICS AND DISSEMINATION

Ethical clearance for conduct of the study was obtained from the Institutional Ethics Committee (IEC) of the Public Health Foundation of India. The findings will be targeted primarily at public health policymakers and advocates, but will be disseminated widely through other mechanisms including conference presentations and peer-reviewed publications, as well as to the participating communities.

Anti-scatter grid artifact elimination for high-resolution x-ray imaging detectors without a prior scatter distribution profile

Using anti-scatter grids with high-resolution imaging detectors could result in grid-line artifacts, with increasing severity as detector resolution improves. Grid-line mask subtraction can result in residual artifacts that are due to residual scatter penetrating the grid and not subtracted. By subtracting this residual scatter, the grid artifacts can be minimized. In the previous works, an initial residual-scatter estimate was derived by placing lead markers on a test object; however, any change in the object geometry requires a new scatter estimate. Such a method is impractical to implement during a clinical procedure. In this work, we present a new method to derive the initial scatter estimate to eliminate grid-line artifacts during a procedure. A standard stationary Smit-Roentgen x-ray grid (line density - 70 lines/cm, grid ratio - 13:1) was used with a high-resolution CMOS detector (Dexela Model 1207, pixel size - 75 μm) to image an anthropomorphic head phantom. The initial scatter estimate was derived from the image itself and the grid artifacts were eliminated using recursive correction estimation; this result was compared to that with the estimate derived from placing lead markers on the phantom. In both cases, the contrast-to-noise ratio (CNR) was improved compared to the original image with grid artifacts. Percentage differences in CNR's for three regions between the images corrected with the two estimates were less than 5%. With the new method no a priori scatter distribution profiles are needed, eliminating the need to have libraries of pre-calculated scatter profiles and making the implementation more clinically practical.

Histopathological Analysis of Neoplastic and Non-Neoplastic Lesions of Ovary : A 4 Year Study in Eastern Nepal

IntroductionOvarian neoplastic and nontineoplastic lesions form a pelvic mass and cause gynaecological problems. Therefore, proper recognization and classification is important for appropriate therapy.ObjectiveTo study the morphological patiern and classify the neoplastic and nontineoplastic ovarian lesions in terms of age and size.MethodologyA retrospective study conducted at Sriram Diagnostic Clinic, Biratnagar, Nepal and Birat Medical College, Tankisinwari, Morang, Nepal during a period of March 2012 to February 2016. All abdominal hysterectomy specimens with bilateral or unilateral salpingo-oophorectomy and all ovarian surgeries presenting with either solid or cystic ovarian lesions were included in the study for histopathological analysis. Normal appearing ovaries on gross and microscopic examination were excluded from the study.ResultsA total of 522 cases were studied. Out of which 329 (63%) were non-neoplastic and 193 (37%) were neoplastic. Follicular cysts comprised of 112 (34%) cases, and it was the most common non neoplastic lesion. The age of patients with non-neoplastic lesions and neoplastic lesions varied from 16-54 years and 13-72 years respectively. Size of nonneoplastic and neoplastic lesions varied from 2-12 cm and 2- 19 cm respectively. Among the 193 neoplastic ovarian lesions, 181 (94 %) were benign, as well as 4 (2%) were borderline and 8 (4 %) were malignant. Mature cystic teratoma was the commonest benign tumor followed by Serous cystadenoma. Serous cystadenocarcinoma was the commonest occurring malignant tumor followed by Mucinouscystadenocarcinoma.ConclusionVarying types of both non neoplastic and neoplastic ovarian lesion were seen. Among the non-neoplastic and neoplastic lesion, the most commonly encountered lesion was follicular cyst and mature cystic teratoma respectively.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, Page: 168-174

Blood Bank Service: An Experience at Newly Established Birat Medical College and Teaching Hospital, Tankisinuwari, Morang, Nepal

IntroductionBlood bank service facility of blood collection, storage and dispatching began from 19 June 2016 in the new blood bank and transfusion service unit, at Birat Medical College & Teaching Hospital, Tankisinuwari, Morang, Nepal, with the support of Nepal Red Cross Society. As the supply of blood is finite, the inappropriate use of blood transfusion units and its component in the world exist, hence there is a need to monitor and regulate these services.ObjectivesThe objective of this study is to know and identify different blood groups and its utilization pattern to meet the demand for future preparedness and to identify the total blood unit, which are being, replaced back.MethodologyThis retrospective study was conducted at BMCTH, Tankisinuwari, Morang for component dispatches from 19th June, 2016 to 19th February, 2017. Requisitions for whole blood requirement for patients from various departments were reviewed regarding the department request, the whole blood requested and whether being replaced, blood group and socio-demographic profile.ResultsOut of 193 transfusion units dispatched, 28 patients were male and 165 patients were females respectively B positive blood groups were most common, followed by A positive, O positive, AB positive, both AB and O negate respectively. The largest numbers of requisitions were from Gynecology and Obstetrics ward in the hospital, while 22 requisites were from other health centers. Majority of the requisitions were for 51- 60 years age group from the local district Morang. The total number of blood units replaced were 38, out of which 5 for males and 33 for females respectively.ConclusionB positive was the predominant requested blood group, with Gynecology and Obstetrics ward demanding the most requests, among 51-60 years age group from Morang district. The total blood units being replaced were very less in number with some requisition forms, which lacked essential details.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 98-101

Effect of Green Coffee Bean Extract on Streptococcus mutans Count: A Randomised Control Trial

INTRODUCTION

Mouth rinses have been popularly used as a supplementary oral hygiene aid. A lot of commercially available mouth rinses possess few adverse effects, which has necessitated the search for alternative and herbal mouth rinses.

AIM

The aim of the study was to assess the effect of rinsing with green coffee bean extract in comparison with chlorhexidine mouthwash and sterile water on salivary Streptococcus mutans count.

MATERIALS AND METHODS

A randomized parallel controlled clinical trial was planned and 45 subjects aged between 18-22 years were selected. The subjects were divided into three groups (n=15 in each group): Group A: Study group: 2% Green coffee bean extract, Group B: Positive control: 0.2% Chlorhexidine (CHX), Group C: Negative control: Sterile water. Group A subjects rinsed mouth with 5 ml of 2% Green coffee bean extract for one minute. Group B subjects rinsed mouth with 5 ml 0.2% CHX mouthwash for one minute. Group C subjects rinsed mouth with 5 ml of Sterile water for one minute twice daily for two weeks. Baseline samples (Pre rinse) were collected on day 1 and post rinsing saliva samples were collected after 14 days. The samples were cultured using Mitis Salivarius Agar enriched with Bacitracin and colonies were counted using a hand held digital colony counter. The statistical analysis was done using paired t-test, One-way variance ANOVA and Post-Hoc tests.

RESULTS

The Green coffee bean extract group showed a statistical significant reduction in Streptococcus mutans colony count before and after intervention which was comparable with CHX group.

CONCLUSION

Green coffee bean extract as a mouthwash can be explored as a safe and effective alternative to CHX mouthwash.

Sclerosing Stromal Tumor of Ovary: A Case Report

A case of 32 year old female of pelvic pain for one month and with past history of hysterectomy performed two year back. Clinical examination revealed palpable abdominal pelvic mass. Ultrasonography showed right pelvic mass arising from right adnexa measuring 15cm x 15 cm, predominantly solid with some cystic areas. The patient was suspected of having a malignant ovarian tumor and hence operated. A histopathological diagnosis revealed sclerosing stromal tumor of ovary. Sex cord-stromal tumors account for approximately 8% of all ovarian tumor and prevalence of sclerosing stromal tumor of ovary is 1.5% to 6% .This rare neoplasm is not always possible to predict pre-operatively on the basis of clinical and radiological findings. Histologically, it is characterized by several unique features including pseudolobulation, sclerosis, and prominent vascularity. Sclerosing stromal tumor is rare but possibility of this tumor should be considered in young patients with ovarian mass having the characteristic histopathological morphology.Birat Journal of Health Sciences 2016 1(1): 83-86

Real time implementation of anti-scatter grid artifact elimination method for high resolution x-ray imaging CMOS detectors using Graphics Processing Units (GPUs)

Scatter is one of the most important factors effecting image quality in radiography. One of the best scatter reduction methods in dynamic imaging is an anti-scatter grid. However, when used with high resolution imaging detectors these grids may leave grid-line artifacts with increasing severity as detector resolution improves. The presence of such artifacts can mask important details in the image and degrade image quality. We have previously demonstrated that, in order to remove these artifacts, one must first subtract the residual scatter that penetrates through the grid followed by dividing out a reference grid image; however, this correction must be done fast so that corrected images can be provided in real-time to clinicians. In this study, a standard stationary Smit-Rontgen x-ray grid (line density - 70 lines/cm, grid ratio - 13:1) was used with a high-resolution CMOS detector, the Dexela 1207 (pixel size - 75 micron) to image anthropomorphic head phantoms. For a 15 × 15 cm field-of-view (FOV), scatter profiles of the anthropomorphic head phantoms were estimated then iteratively modified to minimize the structured noise due to the varying grid-line artifacts across the FOV. Images of the head phantoms taken with the grid, before and after the corrections, were compared, demonstrating almost total elimination of the artifact over the full FOV. This correction is done fast using Graphics Processing Units (GPUs), with 7-8 iterations and total time taken to obtain the corrected image of only 87 ms, hence, demonstrating the virtually real-time implementation of the grid-artifact correction technique.

A β-galactosidase probe for the detection of cellular senescence by mass cytometry

Enzyme substrates for mass cytometry applications enable new dimensions in multiparametric cellular assays.

A case of recto-sigmoid endometriosis mimicking carcinoma

Introduction

Although endometriosis with sigmoid serosal involvement is not uncommon in women of childbearing age, the mucosal and lymph node involvement is rare and differential diagnosis from colon cancer and diverticulitis may be difficult due to poor diagnostic accuracy of colonoscopy and colonic biopsies.

Case presentation

We present a case of a nulliparous woman presenting with large bowel obstruction. She underwent emergency sigmoid colectomy based on clinical and radiological findings. At operation, the pathology was thought to be primary sigmoid tumour. However, histopathological examination of the sigmoid colon led to the final diagnosis of large intestinal endometriosis.

Conclusion

Rectosigmoid endometriosis is often difficult to diagnose but should be considered in differential diagnosis of child bearing aged women with lower gastrointestinal tract obstruction.

Scatter estimation and removal of anti-scatter grid-line artifacts from anthropomorphic head phantom images taken with a high resolution image detector

In radiography, one of the best methods to eliminate image-degrading scatter radiation is the use of anti-scatter grids. However, with high-resolution dynamic imaging detectors, stationary anti-scatter grids can leave grid-line shadows and moiré patterns on the image, depending upon the line density of the grid and the sampling frequency of the x-ray detector. Such artifacts degrade the image quality and may mask small but important details such as small vessels and interventional device features. Appearance of these artifacts becomes increasingly severe as the detector spatial resolution is improved. We have previously demonstrated that, to remove these artifacts by dividing out a reference grid image, one must first subtract the residual scatter that penetrates the grid; however, for objects with anatomic structure, scatter varies throughout the FOV and a spatially differing amount of scatter must be subtracted. In this study, a standard stationary Smit-Rontgen X-ray grid (line density - 70 lines/cm, grid ratio - 13:1) was used with a high-resolution CMOS detector, the Dexela 1207 (pixel size - 75 micron) to image anthropomorphic head phantoms. For a 15 × 15cm FOV, scatter profiles of the anthropomorphic head phantoms were estimated then iteratively modified to minimize the structured noise due to the varying grid-line artifacts across the FOV. Images of the anthropomorphic head phantoms taken with the grid, before and after the corrections, were compared demonstrating almost total elimination of the artifact over the full FOV. Hence, with proper computational tools, anti-scatter grid artifacts can be corrected, even during dynamic sequences.

Focal Spot Deblurring for High Resolution Direct Conversion X-ray Detectors

Small pixel high resolution direct x-ray detectors have the advantage of higher spatial sampling and decreased blurring characteristic. The limiting factors for such systems becomes the degradation due to the focal spot size. One solution is a smaller focal spot; however, this can limit the output of the x-ray tube. Here a software solution of deconvolving with an estimated focal spot blur is presented. To simulate images from a direct detector affected with focal-spot blur, first a set of high-resolution stent images (FRED from Microvention, Inc., Tustin, CA) were acquired using a 75μm pixel size Dexela-Perkin-Elmer detector and frame averaged to reduce quantum noise. Then the averaged image was blurred with a known Gaussian blur. To add noise to the blurred image a flat-field image was multiplied with the blurred image. Both the ideal and the noisy-blurred images were then deconvolved with the known Gaussian function using either threshold-based inverse filtering or Weiner deconvolution. The blur in the ideal image was removed and the details were recovered successfully. However, the inverse filtering deconvolution process is extremely susceptible to noise. The Weiner deconvolution process was able to recover more of the details of the stent from the noisy-blurred image, but for noisier images, stent details are still lost in the recovery process.

Abstract 2089: Role of Cdx2 in maintainining differentiated chromatin structure during tumor progression

Tumor progression often coincides with the appearance of tumor cells with dedifferentiated or stem-like properties; the ontogeny of these cells is unclear, but they are thought to carry a more malignant capacity than their differentiated counterparts. Cdx2 is a transcriptional factor that specifies cell fate of the intestinal epithelium. Epigenetic studies have demonstrated that Cdx2 loss alters chromatin structure in the intestinal epithelium. Cdx2 loss is often observed during colon tumor progression and is correlated with de-differentiation. Our current study is aimed to test the hypothesis that the Cdx2 prevents tumor progression by maintaining the tumor epigenome. To this end, we have generated two mouse models to determine the effect of Cdx2 loss on chromatin structure in a tumorigenic environment and in primary tumors. Our current studies are aimed at comparing Cdx2 binding sites on the genome in a normal and tumorigenic environment, and in defining how Cdx2 loss affects chromatin structure in primary tumors. These studies will shed light on how alterations in chromatin structure can contribute to the epigenomic mechanisms of colon tumor progression.

Note: This abstract was not presented at the meeting.

Citation Format: Ansu O. Perekatt, Ritu Rana, Namit Kumar, Michael Valdez, Michael Verzi. Role of Cdx2 in maintainining differentiated chromatin structure during tumor progression. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2089. doi:10.1158/1538-7445.AM2015-2089

Recurrent pyogenic granuloma with a satellite lesion

Pyogenic granuloma (PG) is a tumorlike growth of the oral mucosa or skin that is considered to be an exaggerated conditioned response to minor trauma. It usually is painless, bleeds easily, and is considered to be nonneoplastic in nature. Pyogenic granuloma predominantly occurs in the second decade of life, mostly among young adult females. Clinically, it is a smooth or lobulated exophytic lesion manifesting as small, red, erythematous papules on a pedunculated or sometimes sessile base that usually is hemorrhagic. We report the case of 30-year-old woman who presented with a PG in the anterior palatal region during pregnancy that recurred with a satellite lesion 1 year following surgical excision.

Development and characterization of Haemophilus influenzae type b conjugate vaccine prepared using different polysaccharide chain lengths

Capsular polysaccharide conjugates of Haemophilus influenzae type b (Hib) are important components of several mono- or multi-valent childhood vaccines. However, their access to the most needy people is limited due to their high cost. As a step towards developing a cost effective and more immunogenic Hib conjugate vaccine, we present a method for the preparation of Hib capsular polysaccharide (PRP)-tetanus toxoid (TT) conjugates using optimized PRP chain length and conjugation conditions. Reactive aldehyde groups were introduced into the polysaccharides by controlled periodate oxidation of the native polysaccharide, which were subsequently covalently linked to hydrazide derivatized tetanus toxoid by means of reductive amination. Native polysaccharides were reduced to average 100 or 50kDa polysaccharide and 10kDa oligosaccharides in a controlled manner. Various conjugates were prepared using Hib polysaccharide and oligosaccharide yielding conjugates with polysaccharide to protein ratios in the range of 0.25-0.5 (w/w) and free saccharide levels of less than 10%. Immunization of Sprague Dawley rats with the conjugates elicited specific antibodies to PRP. The low molecular weight PRP-TT conjugates were found to be more immunogenic as compared to their high molecular weight counterparts and the PRP-TT reference vaccine.

The value of the urinary protein:creatinine ratio for the detection of significant proteinuria in women with suspected preeclampsia

To explore the correlation between urinary protein:creatinine ratio and 24-h excretion of protein, we studied 149 women referred to a day assessment unit for investigations for suspected preeclampsia. Paired samples were obtained for measurement of urinary protein:creatinine ratio and 24-h protein excretion. Collection of a 24-h urine sample was validated by the daily creatinine excretion. The outcome measure was proteinuria of 300 mg/day or more. Inaccurate 24-h collection was observed in 17% of women. All women (n = 56) with a protein:creatinine ratio >60 mg/mM had significant proteinuria. No woman with protein:creatinine ratio <18 mg/mM (n = 20) had significant proteinuria. We recommend that a dual cut-off should be used for excluding and "ruling in" the diagnosis of significant proteinuria. A 24-h urine collection should be used only for urinary protein:creatinine ratio values between 18 and 60 mg/mM in the detection of significant proteinuria.

Anti-scatter grid artifact elimination for high resolution x-ray imaging CMOS detectors

Higher resolution in dynamic radiological imaging such as angiography is increasingly being demanded by clinicians; however, when standard anti-scatter grids are used with such new high resolution detectors, grid-line artifacts become more apparent resulting in increased structured noise that may overcome the contrast signal improvement benefits of the scatter-reducing grid. Although grid-lines may in theory be eliminated by dividing the image of a patient taken with the grid by a flat-field image taken with the grid obtained prior to the clinical image, unless the remaining additive scatter contribution is subtracted in real-time from the dynamic clinical image sequence before the division by the reference image, severe grid-line artifacts may remain. To investigate grid-line elimination, a stationary Smit Röntgen X-ray grid (line density: 70 lines/cm, grid ratio 13:1) was used with both a 75 micron-pixel CMOS detector and a standard 194 micron-pixel flat panel detector (FPD) to image an artery block insert placed in a modified uniform frontal head phantom for a 20 × 20cm FOV (approximately). Contrast and contrast-to-noise ratio (CNR) were measured with and without scatter subtraction prior to grid-line correction. The fixed pattern noise caused by the grid was substantially higher for the CMOS detector compared to the FPD and caused a severe reduction of CNR. However, when the scatter subtraction corrective method was used, the removal of the fixed pattern noise (grid artifacts) became evident resulting in images with improved CNR.

Isolation and molecular identification of Mycoplasma equigenitalium from equine genital tracts in northern India

Although Mycoplasma equigenitalium has been implicated in equine reproductive problems, its prevalence is largely unexplored due to the lack of specific diagnostic tests. To address this limitation, the authors developed and optimized species-specific primer pairs that target M. eguigenitalium rpoB (RNA polymerase B subunit) gene sequences. The specificity of the PCR assay developed in this study was determined using 12 field isolates including the type strain of M. equigenitalium and other Mycoplasma species. In the field study, a total of 122 mare and stallion samples comprising of 50 clinical and 72 random samples were subjected to species-specific PCR assay to detect M. equigenitalium in equine genital tracts. Mycoplasma equigenitalium (MEG) species-specific PCR detected 22.13% positive samples; however, only 9.01% of the samples were found to be positive using the conventional culture technique. The PCR established in this study could be used for rapid, specific and accurate diagnosis of M. equigenitalium strains. To the authors' knowledge, this is the first report addressing the development and evaluation of species-specific PCR to detect M. equigenitalium.

Workflow for the use of a high-resolution image detector in endovascular interventional procedures

Endovascular image-guided intervention (EIGI) has become the primary interventional therapy for the most widespread vascular diseases. These procedures involve the insertion of a catheter into the femoral artery, which is then threaded under fluoroscopic guidance to the site of the pathology to be treated. Flat Panel Detectors (FPDs) are normally used for EIGIs; however, once the catheter is guided to the pathological site, high-resolution imaging capabilities can be used for accurately guiding a successful endovascular treatment. The Micro-Angiographic Fluoroscope (MAF) detector provides needed high-resolution, high-sensitivity, and real-time imaging capabilities. An experimental MAF enabled with a Control, Acquisition, Processing, Image Display and Storage (CAPIDS) system was installed and aligned on a detector changer attached to the C-arm of a clinical angiographic unit. The CAPIDS system was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmap, radiography, and digital-subtraction-angiography (DSA). Using the automatic controls, the MAF detector can be moved to the deployed position, in front of a standard FPD, whenever higher resolution is needed during angiographic or interventional vascular imaging procedures. To minimize any possible negative impact to image guidance with the two detector systems, it is essential to have a well-designed workflow that enables smooth deployment of the MAF at critical stages of clinical procedures. For the ultimate success of this new imaging capability, a clear understanding of the workflow design is essential. This presentation provides a detailed description and demonstration of such a workflow design.

Combined soft and hard tissue augmentation for a localized alveolar ridge defect

Ideal alveolar ridge width and height allows placement of a natural appearing pontic, which provides maintenance of a plaque-free environment. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. Localized alveolar ridge defect refers to a volumetric deficit of the limited extent of bone and soft-tissue within the alveolar process. These ridge defects can be corrected by hard tissue and/or soft-tissue augmentation. A 30-year-old male patient was referred to the Department of Periodontology for correction of Seibert's Class III ridge defect in the lower anterior region. Granulation tissue/connective tissue present at the base of the defect was removed after elevation of full thickness flap. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap and bone graft was placed into the defect. If a soft-tissue graft material could be used to replace the palatal grafts, then all the possible complications associated with donor site would be eliminated and above all periodontal plastic surgery and ridge augmentation would be better accepted by patients.