Pathogens identified in the internal tissues and placentas of stillbirths: results from the prospective, observational PURPOSe study

OBJECTIVE

To examine internal organ tissues and placentas of stillbirths for various pathogens.

DESIGN

Prospective, observational study.

SETTINGS

Three study hospitals in India and a large maternity hospital in Pakistan.

POPULATION

Stillborn infants delivered in a study hospital.

METHODS

A prospective observational study.

MAIN OUTCOME MEASURES

Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths.

RESULTS

Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%).

CONCLUSIONS

In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.

Heat transport in inclined flow towards a rotating disk under MHD

Flow towards a rotating disk is of highly practical significance in numerous engineering applications such as Turbine disks, rotary type machine systems and many more. In light of this, the current work is an attempt to explore MHD oblique flow towards a rotating disk. Hydromagnetic effects in addition to heat transfer is taken into consideration. The flow governing Partial Differential Equations are altered to a system to coupled non-linear Ordinary Differential Equations through scaling group of transformations which afterwards are tackled using Shooting Algorithm. The impact of obliqueness parameter γ, rotation ratio parameter [Formula: see text] and magnetic field parameter M on 2-dimensional and 3-dimensional stream contours are presented. Location of the shear center varies with magnetic field parameter. Heat flow at the disk surface boosts with magnet field parameter M and rotation ratio parameter [Formula: see text].

Leukemia segmentation and classification: A comprehensive survey

Blood is made up of leukocytes (WBCs), erythrocytes (RBCs), and thrombocytes. The ratio of blood cancer diseases is increasing rapidly, among which leukemia is one of the famous cancer which may lead to death. Leukemia cancer is initiated by the unnecessary growth of immature WBCs present in the sponge tissues of bone marrow. It is generally analyzed by etiologists by perceiving slides of blood smear images under a microscope. The morphological features and blood cells count facilitated the etiologists to detect leukemia. Due to the late detection and expensive instruments used for leukemia analysis, the death rate has risen significantly. The fluorescence-based cell sorting technique and manual recounts using a hemocytometer are error-prone and imprecise. Leukemia detection methods consist of pre-processing, segmentation, features extraction, and classification. In this article, recent deep learning methodologies and challenges for leukemia detection are discussed. These methods are helpful to examine the microscopic blood smears images and for the detection of leukemia more accurately.

Prolotherapy Improves Anatomical and Clinical Outcomes in Monosodium Iodoacetate Induced Model of Osteoarthritis

Objective: To assess the ameliorative effects of Prolotherapy on the pain score of the gait cycle in Monosodium Iodoacetate (MIA) induced osteoarthritis in the rat knee joint. Study Design: Laboratory-based experimental study. Place and Duration of Study: Department of Anatomy, Army Medical College, Rawalpindi in collaboration with the National Institute of Health (NIH), Islamabad and Pathology Lab Pak Emirates Rawalpindi, Pakistan, from Aug to Nov 2021. Methodology: Thirty male Sprague Dawley rats were randomly divided into three groups (n=10 in each group). The control group was Group-A. To induce osteoarthritic changes in Group-B, a single dose of 1mg Monosodium Iodoacetate was injected intra-articularly into the right knee. Group-C received a single dose of 1mg Monosodium Iodoacetate injection in the right knee intra articularly to induce osteoarthritic changes, and was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% Xylocaine, 1ml of injection thiamine, and 1ml of injection Methylcobalamin) at 2, 6 and 10 weeks intra articularly into the right knee joint.  Before euthanasia, Pain scoring schemes for gait in rats of all groups were done at 0, 2 and 14 weeks. Results: The present study concluded that prolotherapy improved the gait cycle pain score in experimental group C (p-value 0.001 on the intergroup comparison at two weeks and 14 weeks while p-value 0.001 when compared pain score within the Group C at 0, 2 and 14 weeks). Conclusion: Prolotherapy had ameliorative effects on the pain score of the gait cycle in experimental Group C on Monosodium Iodoacetate......

Evaluation of offshore oil spill response waste management strategies: A lifecycle assessment-based framework

This study presents a novel life cycle assessment-based framework for low-impact offshore oil spill response waste (OSRW) management. The framework consists of design of experiment, life cycle assessment (LCA), multi-criteria decision analysis (MCDA), operational cost analysis, and generation of regression models for impact prediction. The framework is applied to four OSRW management strategies as different combinations of solid and liquid oily waste collection, segregation, transportation, and treatment/disposal technologies. Hypothetical scenarios based on oily waste compositions are developed, and the associated environmental impacts and operational costs are evaluated. The LCA results show that oily waste composition accounts for < 5% of the total environmental impacts. Chemical demulsification has the highest total impacts due to high marine ecotoxicity and human toxicity, followed by incineration and transportation. The cost analysis reveals that the strategy comprised of centrifugation and landfilling is most preferable while the combination of chemical demulsification and incineration is least favorable. The strategy of combined use of centrifugation and landfilling is ranked as the most suitable in the MCDA. Regression models are developed to predict environmental impacts based on important factors. The framework can help waste management practitioners select low-impact strategies for handling offshore OSRW.

Exploration of bioconvection flow of MHD thixotropic nanofluid past a vertical surface coexisting with both nanoparticles and gyrotactic microorganisms

This communication presents analysis of gravity-driven flow of a thixotropic fluid containing both nanoparticles and gyrotactic microorganisms along a vertical surface. To further describe the transport phenomenon, special cases of active and passive controls of nanoparticles are investigated. The governing partial differential equations of momentum, energy, nanoparticles concentration, and density of gyrotactic microorganisms equations are converted and parameterized into system of ordinary differential equations and the series solutions are obtained through Optimal Homotopy Analysis Method (OHAM). The related important parameters are tested and shown on the velocity, temperature, concentration and density of motile microorganisms profiles. It is observed that for both cases of active and passive control of nanoparticles, incremental values of thermophoretic parameters corresponds to decrease in the velocity distributions and augment the temperature distributions.

A deep network designed for segmentation and classification of leukemia using fusion of the transfer learning models

White blood cells (WBCs) are a portion of the immune system which fights against germs. Leukemia is the most common blood cancer which may lead to death. It occurs due to the production of a large number of immature WBCs in the bone marrow that destroy healthy cells. To overcome the severity of this disease, it is necessary to diagnose the shapes of immature cells at an early stage that ultimately reduces the modality rate of the patients. Recently different types of segmentation and classification methods are presented based upon deep-learning (DL) models but still have some limitations. This research aims to propose a modified DL approach for the accurate segmentation of leukocytes and their classification. The proposed technique includes two core steps: preprocessing-based classification and segmentation. In preprocessing, synthetic images are generated using a generative adversarial network (GAN) and normalized by color transformation. The optimal deep features are extracted from each blood smear image using pretrained deep models i.e., DarkNet-53 and ShuffleNet. More informative features are selected by principal component analysis (PCA) and fused serially for classification. The morphological operations based on color thresholding with the deep semantic method are utilized for leukemia segmentation of classified cells. The classification accuracy achieved with ALL-IDB and LISC dataset is 100% and 99.70% for the classification of leukocytes i.e., blast, no blast, basophils, neutrophils, eosinophils, lymphocytes, and monocytes, respectively. Whereas semantic segmentation achieved 99.10% and 98.60% for average and global accuracy, respectively. The proposed method achieved outstanding outcomes as compared to the latest existing research works.

Preventable stillbirths in India and Pakistan: a prospective, observational study

OBJECTIVE

Stillbirths occur 10-20 times more frequently in low-income settings compared with high-income settings. We created a methodology to define the proportion of stillbirths that are potentially preventable in low-income settings and applied it to stillbirths in sites in India and Pakistan.

DESIGN

Prospective observational study.

SETTING

Three maternity hospitals in Davangere, India and a large public hospital in Karachi, Pakistan.

POPULATION

All cases of stillbirth at ≥20 weeks of gestation occurring from July 2018 to February 2020 were screened for participation; 872 stillbirths were included in this analysis.

METHODS

We prospectively defined the conditions and gestational ages that defined the stillbirth cases considered potentially preventable. Informed consent was sought from the parent(s) once the stillbirth was identified, either before or soon after delivery. All information available, including obstetric and medical history, clinical course, fetal heart sounds on admission, the presence of maceration as well as examination of the stillbirth after delivery, histology, and polymerase chain reaction for infectious pathogens of the placenta and various fetal tissues, was used to assess whether a stillbirth was potentially preventable.

MAIN OUTCOME MEASURES

Whether a stillbirth was determined to be potentially preventable and the criteria for assignment to those categories.

RESULTS

Of 984 enrolled, 872 stillbirths at ≥20 weeks of gestation met the inclusion criteria and were included; of these, 55.5% were deemed to be potentially preventable. Of the 649 stillbirths at ≥28 weeks of gestation and ≥1000 g birthweight, 73.5% were considered potentially preventable. The most common conditions associated with a potentially preventable stillbirth at ≥28 weeks of gestation and ≥1000 g birthweight were small for gestational age (SGA) (52.8%), maternal hypertension (50.2%), antepartum haemorrhage (31.4%) and death that occurred after hospital admission (15.7%).

CONCLUSIONS

Most stillbirths in these sites were deemed preventable and were often associated with maternal hypertension, antepartum haemorrhage, SGA and intrapartum demise.

TWEETABLE ABSTRACT

Most stillbirths are preventable by better care for women with hypertension, growth restriction and antepartum haemorrhage.

Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries

BACKGROUND

Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.

METHODS

We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses.

RESULTS

Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD).

CONCLUSIONS

Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers).

TRIAL REGISTRATION

Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).

481 Improving the Quality of Pelvic Radiographs - Making A Difference One Picture at A Time

Inadequate pelvic radiographs can lead to missed pathology, necessitate repeat imaging, and subsequently compromise patient safety. The audit conducted aimed to assess and improve the quality of pelvic radiographs at our Trust against local and international guidelines.

Retrospective analysis of pelvic radiographs over a one-month period using PACS at Colchester General Hospital was conducted. All pelvic radiographs were assessed according to International Guidelines (EUR 16250EN). Postoperative radiographs were measured against local guidelines. The results were then presented in the departmental meeting and a re-audit was performed in June 2020.

A total of 190 pelvic radiographs were collected in September 2019. From the 23 postoperative radiographs, 9 did not include distal end of prosthesis. During the re-audit in June 2020 the same number of pelvic images were collected. Data showed that only 2 out of 29 postoperative images did not include the distal end of the prosthesis.

The audit demonstrated need for improvement at our Trust. This was carried out through a presentation in the departmental meeting, highlighting areas that needed improvement. The re-audited results from June 2020 have shown an improvement in the quality of pelvic radiographs and have had direct implications in clinical outcomes.

480 Preoperative Templating in Hip Hemiarthroplasty Improves Femoral Offset and Function

The use of preoperative templating for hip hemiarthroplasty increases the likelihood of successfully restoring offset. This study sought to identify whether templating improves radiographic and clinical outcomes in this group.

Data belonging to all patients that underwent hip hemiarthroplasty between March 2018 and March 2019 were collected. The patients were grouped based on whether or not their preoperative images were templated. Radiographs were studied retrospectively to calculate preoperative and postoperative offset and LLD for each patient. The clinical outcomes that were measured included the rate of periprosthetic fracture, dislocation and contra-lateral neck of femur fracture for each group. Data was analysed by SPSS.

There were 208 patients of which 72 were templated and 136 not templated. The percentage difference between the preoperative and postoperative offset was lower in the templated group (p &lt; 0.05). There was no significant difference in radiographic LLD between the two groups. There was no significant difference in the clinical outcomes between the two groups.

A significantly closer restoration to the original offset was achieved with preoperative templating, which is likely to improve function in this group. There were no significant differences in the other clinical outcomes between the two groups.

Analysis of non-Newtonian magnetic Casson blood flow in an inclined stenosed artery using Caputo-Fabrizio fractional derivatives

BACKGROUND AND OBJECTIVE

Arterial diseases would lead to several serious disorders in the cardiovascular system such as atherosclerosis. These disorders are mainly caused by the presence of fatty deposits, cholesterol and lipoproteins inside blood vessel. This paper deals with the analysis of non-Newtonian magnetic blood flow in an inclined stenosed artery.

METHODS

The Casson fluid was used to model the blood that flows under the influences of uniformly distributed magnetic field and oscillating pressure gradient. The governing fractional differential equations were expressed using the Caputo Fabrizio fractional derivative without singular kernel.

RESULTS

The analytical solutions of velocities for non-Newtonian model were then calculated by means of Laplace and finite Hankel transforms. These velocities were then presented graphically. The result shows that the velocity increases with respect to Reynolds number and Casson parameter, while decreases when Hartmann number increases.

CONCLUSIONS

Casson blood was treated as the non-Newtonian fluid. The MHD blood flow was accelerated by pressure gradient. These findings are beneficial for studying atherosclerosis therapy, the diagnosis and therapeutic treatment of some medical problems.

Association of haemoglobin levels in the first trimester and at 26-30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial

OBJECTIVE

Limited data are available from low- and middle-income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes.

DESIGN

ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6⁺⁰ -13⁺⁶  weeks and 26⁺⁰ -30⁺⁰  weeks of gestation with fetal and neonatal outcomes.

SETTING

Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala.

POPULATION

A total of 11 976 pregnant women.

METHODS

Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes.

MAIN OUTCOME MEASURES

Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g.

RESULTS

The mean haemoglobin levels at 6⁺⁰ -13⁺⁶  weeks and at 26-30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6⁺⁰ -13⁺⁶  weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70-89 g/l compared with haemoglobin of 110-129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26-30 weeks of gestation.

CONCLUSIONS

Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6⁺⁰ -13⁺⁶  weeks and at 26-30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger.

TWEETABLE ABSTRACT

Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6-13 weeks and 26-30 weeks of gestation.

A Revolution toward Gene-Editing Technology and Its Application to Crop Improvement

Genome editing is a relevant, versatile, and preferred tool for crop improvement, as well as for functional genomics. In this review, we summarize the advances in gene-editing techniques, such as zinc-finger nucleases (ZFNs), transcription activator-like (TAL) effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR) associated with the Cas9 and Cpf1 proteins. These tools support great opportunities for the future development of plant science and rapid remodeling of crops. Furthermore, we discuss the brief history of each tool and provide their comparison and different applications. Among the various genome-editing tools, CRISPR has become the most popular; hence, it is discussed in the greatest detail. CRISPR has helped clarify the genomic structure and its role in plants: For example, the transcriptional control of Cas9 and Cpf1, genetic locus monitoring, the mechanism and control of promoter activity, and the alteration and detection of epigenetic behavior between single-nucleotide polymorphisms (SNPs) investigated based on genetic traits and related genome-wide studies. The present review describes how CRISPR/Cas9 systems can play a valuable role in the characterization of the genomic rearrangement and plant gene functions, as well as the improvement of the important traits of field crops with the greatest precision. In addition, the speed editing strategy of gene-family members was introduced to accelerate the applications of gene-editing systems to crop improvement. For this, the CRISPR technology has a valuable advantage that particularly holds the scientist's mind, as it allows genome editing in multiple biological systems.

Bacterial mediated silver nanoparticles and their efficacy against MRSA

Bacterial mediated Silver nanoparticles is considered as an emerging Ecofriendly approach to eradicate human pathogens. This paper aims to provide the biological approach for the synthesis of silver nanoparticles from indigenously isolated bacteria. This study will be beneficial to control the nosocomial infections triggered by MRSA (Methicillin-resistant Staphylococcus aureus). The current study is the extracellular synthesis of silver nanoparticles by using the cell free filtrate of bacterial strains isolated from the soil. The optimization study was also carried out to obtain the maximum production of silver nanoparticles. Nanoparticles were confirmed and characterized by UV-Vis spectroscopy and Transmission Electron Microscopy (TEM) having the plasmon resonance peak between 420-450nm with 10-60nm in size range and most were spherical in shape. Synthesized silver nanoparticles showed a potential antibacterial activity against MRSA (Methicillin Resistant Staphylococcus aureus) in-vitro study. This is the green approach for the production of AgNPs, as there was no previous work done on the synthesis of silver nanoparticles by bacteria in this region of Southern Punjab, Pakistan and these nanoparticles can be used to treat nosocomial infection. These silver nanoparticles can be used in effective disease management as antimicrobial agent.

Identification of Candidate Biomarkers for HCV Leading to Hepatocellular Carcinoma Differential Stages From Serum Samples

Background:

Hepatocellular carcinoma (HCC) is one of the most deadly liver malignancy found and Hepatitis C virus (HCV) is a prominent risk factor for this disease. Prognosis of HCC is poor; initiate the need of markers to discover therapeutic targets in HCC.

Introduction:

Clinical staging systems of HCC composed of tumor characteristics along with liver function test are important in prognosis but they are not precise. Molecular profiling can lead to a better understanding of the physiopathology of HCC and can help in the development of novel therapeutic approaches.

Methods:

64 HCC serum samples (shifted from HCV) were graded into stage I- IV; along with +ive (3 Hepatitis C) and -ive control (2 healthy persons). Proteins were separated by sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE) and differential mRNA expression from serum samples of different HCC stages was confirmed by Real Time Polymerase Chain Reaction (qPCR).

Results:

HCC serum proteins displayed differential expression of glutathione s-transferase (GST), glypican-3 (GPC3), vitronectin (VTN), and clusterin (CLU) by SDS-PAGE. GST was expressed in -ive control, while GPC3 was found in both -ive and +ive control. The qPCR analysis, display more than 0.07 fold decrease in GST in I-IV HCC stages. The highest increase in HCC stages was observed by GPC3; about 4 fold increase in I-IV stages. VTN show 1.7-3.4 fold; while CLU show 2-3.5 fold increase in four stages of HCC.

Conclusion:

GPC3, VTN and CLU in combination can be good potential markers for differentiating stages (I-IV) of HCC.

Utilization of Cu-nanoparticles as medication agent to reduce atherosclerotic lesions of a bifurcated artery having compliant walls

OBJECTIVE

A theoretical analysis is presented to study the bio-nanofluid with copper as medication agent for atherosclerotic bifurcated artery with flexible walls.

DESIGN/APPROACH

The circulatory framework in human body is comprised of a system of veins that incorporate the bifurcation in this way the impact of copper nanoparticles on parent, at apex and on daughter artery regions (in the wake of being bifurcated) is watched. Streaming of blood along vessel segment is recognized to be newtonian. The consistent idea of the atherosclerotic arterial wall is additionally considered to make relationship with permeability aspects with arterial wall thickness. Copper nanoparticles are utilized to reduce the atherosclertic lesions for bifurcated stenotic artery.

FINDINGS

The designed equations along with the experimental values of copper nanoparticles and blood are utilized for theoretical investigation. Moreover, hemodynamics impacts are also figure out to examine the flow of blood for atherosclertic artery. Comparison between parent and daughter artery is plotted through velocity profile. To see the theoretical assistance of this copper mediated model in biomedical field, graphical illustration is presented. At the end, noticed that the inclusion of copper nanoparticles enhances the velocity significantly both for parent as well as daughter artery.

CONCLUSIONS

The circulation of blood is considered to be different from pressure between portions of atherosclerotic and non-atherosclerotic artery. Shear stress is reduces by changing the bifurcation angle for daughter artery while trend is reversed for parent artery. The size of inner circularting bolus decreases by changing compliant parameter for parent artery while shape is changed for daughter artery.

Efficacy of Prednisolone in bronchiolitis with and without family history of atopy

OBJECTIVE

To determine decrease in respiratory distress and hospital stay in bronchiolitis patients with and without family history of atopy when treated with prednisolone.

METHODS

The multi-centre quasi-experimental study was conducted in three hospitals of Sialkot, Pakistan, from October 2017 to March 2018, and comprised patients of bronchiolitis who were divided into 2 groups on the basis of presence or absence of family history of atopy. Half of the patients in each group received oral prednisolone 2mg/kg/day for three consecutive days along with supportive care, and the remaining half received only supportive care. Patients were monitored at 12 and 24 hours for clinical response using Modified Respiratory distress Assessment Instrument score. Length of hospital stay was monitored upto 72 hours. SPSS 20 was used for data analysis.

RESULTS

Of the 212 patients, 72(34%) were in the atopic group and 140(66%) in the non-atopic group. In atopic group, there was a significant respiratory distress difference observed between steroid and non-steroid subgroups at 24 hours (p=0.001) and all (100%) patients in the steroid subgroup got discharged at 24 hours, while only 8(22%) were discharged in the non-steroid subgroup. In non-atopic group, no significant improvement in corresponding terms was observed (p>0.05).

CONCLUSIONS

Oral prednisolone in bronchiolitis was found to be only effective in patients with family history of atopy.

Improving childhood tuberculosis detection and treatment through facility-based screening in rural Pakistan

SETTING

Many children with tuberculosis (TB) remain undiagnosed due to the absence of services, lack of child-friendly diagnostics and underappreciation of TB as a common cause of childhood illness.

OBJECTIVE

To show the impact of systematic verbal screening and contact tracing with appropriate management services on TB case finding in pediatric populations.

DESIGN

Between October 2014 and March 2016, children were verbally screened at the pediatric out-patient departments of four public hospitals in Jamshoro District, Pakistan. Children with symptoms or risk of TB were referred for clinical evaluation and free chest X-ray and bacteriological tests. Children with TB were started on treatment and their care givers asked to bring household members to the hospital for screening.

RESULTS

Over 105 000 children were verbally screened and 5880 presumptive childhood TB patients were identified; 1417 children (prevalence 1.3%) were diagnosed with TB; 43% were female. The median age was 5 years; 82% had pulmonary TB. An additional 390 children with TB were diagnosed through contact tracing. These activities resulted in a three-fold increase in pediatric TB case notifications.

CONCLUSION

Systematic verbal screening with clinical evaluation and free diagnostics can identify children with TB who may otherwise be missed in rural health settings.

Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan

OBJECTIVE

To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes.

DESIGN

Prospective cohort study.

SETTING

Rural India and Pakistan.

POPULATION

Pregnant women residing in the study catchment area.

METHODS

We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10-10.9 g/dl), moderate (7-9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days.

RESULTS

A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)-normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)-normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage.

CONCLUSION

Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered.

TWEETABLE ABSTRACT

Severe maternal anaemia is associated with adverse fetal and neonatal outcomes in low/middle-income countries.

Numerical simulation of oscillatory oblique stagnation point flow of a magneto micropolar nanofluid

The particular inquiry is made to envision the characteristics of magneto-hydrodynamic oscillatory oblique stagnation point flow of micropolar nanofluid. The applied magnetic field is assumed parallel towards isolating streamline. A relative investigation is executed for copper and alumina nanoparticles while seeing water type base fluid. To be more specific, in the presence of both weak and strong concentration, the physical situation of micropolar fluid is mathematically modeled in terms of differential equations. The transformed mixed system is finally elucidated by midpoint method with the Richardson extrapolation development and shooting mechanism with fifth order R–K Fehlberg technique. The impact of governing parameters are shown and explored graphically. The obtained results are compared with existing published literature. Moreover, it is found that the magnetic susceptibility of nanofluids shows provoking nature towards copper as compared to Alumina. Also it is perceived that Cu–water shows higher wall shear stress and heat transfer rate than Al₂O₃–water. Additional, the thickness of momentum boundary layer is thin for weak concentration as related to strong concentration.

The particular inquiry is made to envision the characteristics of magneto-hydrodynamic oscillatory oblique stagnation point flow of micropolar nanofluid.

A comparative analysis for the solution of nonlinear Burgers' equation

In this work, a comparative study of seven well-known mathematical techniques for the coupled Burgers' equations is reported. The techniques involve in this comparison are as follows: Laplace transform Adomian decomposition method, Laplace transform homotopy perturbation method, Variational iteration method, Variational iteration decomposition method, Variational iteration homotopy perturbation method, the optimal homotopy asymptotic method, and OHAM with Daftardar-Jafari polynomial. Here we considered a practical example which consists of coupled Burgers' equations with the kinematic viscosity ε=1. Convergence and stability analysis is a major part of this analysis. After a careful observation, it is found that the variational iteration method has faster convergence than all the remaining methods. Adomian decomposition method and Homotopy perturbation method show weaker stability in comparison with other involved techniques.

Both Ultrasound Features and Nuclear Atypia are Associated with Malignancy in Thyroid Nodules with Atypia of Undetermined Significance

BACKGROUND

The optimal management of thyroid nodules that undergo fine-needle aspiration (FNA) with findings of atypia of undetermined significance (AUS) is unclear. Categorizing nodules by AUS subtype and ultrasound characteristics may improve risk stratification. Therefore, the purpose of this study is to evaluate the association between AUS subtype and ultrasound features on risk of malignancy (ROM).

METHODS

We performed a review of all patients with a thyroid nodule who underwent an FNA at our institution between January 2010 and November 2015. Patients with AUS were divided into groups with (1) nuclear atypia, (2) architectural atypia, or (3) Hurthle cell atypia. Their ultrasound features were assessed using the American Thyroid Association (ATA) thyroid nodule sonographic patterns. We conducted a univariate and multivariable analysis to determine the association between AUS subtype and other variables of interest with ROM.

RESULTS

Of the 3428 thyroid nodules that underwent FNA, 237 (6.9%) had AUS. Of the 97 surgically resected nodules, 67 (69%) were benign and 30 (31%) were malignant. On univariate analysis nuclear atypia (p < 0.01) was associated with a thyroid malignancy. On multivariable analysis, both ATA high-risk ultrasound features (p = 0.04, odds ratio [OR] 3.68) and nuclear atypia (p < 0.01, OR 11.8) were independently associated with a final diagnosis of thyroid carcinoma.

CONCLUSIONS

Nuclear atypia and ATA high-risk ultrasound features are useful in identifying patients with AUS that are at a higher risk of thyroid malignancy. Surgeons should take these factors into consideration when evaluating patients with AUS.

Small molecule targeting the Rac1-NOX2 interaction prevents collagen-related peptide and thrombin-induced reactive oxygen species generation and platelet activation

Essentials Reactive oxygen species (ROS) generation by NOX2 plays a critical role in platelet activation. Rac1 regulation of NOX2 is important for ROS generation. Small molecule inhibitor of the Rac1-p67phox interaction prevents platelet activation. Pharmacologic targeting of Rac1-NOX2 axis can be a viable approach for antithrombotic therapy.

SUMMARY

Background Platelets from patients with X-linked chronic granulomatous disease or mice deficient in nicotinamide adenine dinucleotide (phosphate) (NAD(P)H) oxidase isoform NOX2 exhibit diminished reactive oxygen species (ROS) generation and platelet activation. Binding of Rac1 GTPase to p67phox plays a critical role in NOX2 activation by facilitating the assembly of the NOX2 enzyme complex. Objective We tested the hypothesis that Phox-I, a rationally designed small molecule inhibitor of Rac-p67phox interaction, may serve as an antithrombosis agent by suppressing ROS production and platelet activation. Results Collagen-related peptide (CRP) induced ROS generation in a time-dependent manner. Platelets from Rac1-/- mice or human platelets treated with NSC23766, a specific Rac inhibitor, produced significantly less ROS in response to CRP. Treatment of platelets with Phox-I inhibited diverse CRP-induced responses, including: (i) ROS generation; (ii) release of P-selectin; (iii) secretion of ATP; (iv) platelet aggregation; and (v) phosphorylation of Akt. Similarly, incubation of platelets with Phox-I inhibited thrombin-induced: (i) secretion of ATP; (ii) platelet aggregation; (iii) rise in cytosolic calcium; and (iv) phosphorylation of Akt. In mouse models, intraperitoneal administration of Phox-I inhibited: (i) collagen-induced platelet aggregation without affecting the tail bleeding time and (ii) in vivo platelet adhesion/accumulation at the laser injury sites on the saphenous vein without affecting the time for complete cessation of blood loss. Conclusions Small molecule targeting of the Rac1-p67phox interaction may present an antithrombosis regimen by preventing GPVI- and non-GPVI-mediated NOX2 activation, ROS generation and platelet function without affecting the bleeding time.

Molecular epidemiology, associated risk factors, and phylogenetic analysis of anaplasmosis in camel

Camel Anaplasmosis is caused by members of family Anaplasmatacae, a tick transmitted, obligate intracellular bacteria. The etiological bacteria are transmitted by ixodid tick species. The species have multi host range distribution that is why it is crucial to diagnose it timely. The aim of present study was to investigate the molecular epidemiology i.e. prevalence and risk factors analysis of camel anaplasmosis. Furthermore, variations in hematological standards were also evaluated. The study found an overall 13.33% prevalence in camels. The confirmation of PCR positive samples for Anaplasma spp. was made through sequencing, the study isolatesshowed high homology with Iranian, Chinese, Philippines and South African isolates of Anaplasmatacae (Accession numbers'; KX765882, KP062964, KY242456, LC007100 and U54806) on BLAST queries. The phylogenetic analysis revealedthree study isolates of present study clustered with each other and the cluster was found closer to Chinese isolate of A. phagocytophilum (KY242456), A. marginale (KU586048), and Mongolian isolates of A. ovis (LC194134). Two of the isolates resembled Iranian isolate of Candidatus Anaplasmacamelii (KX765882), while one isolate resembled with Chinese isolates of A. Platys (KX987336) and Croatian isolates of A. Platys (KY114935). The key risk factors odds ratio (OR>1) identified for occurrence of camel anaplasmosis using regression model found sex and age of animal, previous tick history, tick infestation and tick control status, housing type, cracks in walls, rearing system and other species in surrounding as the key risk factors. The hematological parameters like lymphocytes, monocytes, granulocytes and platelets count were significantly decreased (p < 0.05) in diseased camels than healthy. This is the first ever molecular data on camel anaplasmosis in Pakistan. The disease should be monitored unceasingly as the etiologies have multi host distribution. Prompt attention should be offered to animals because neutropenia, lymphopenia and thrombocytopenia can exacerbate the disease by making the animal predisposed to otherdiseases.

Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial

OBJECTIVE

Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries.

DESIGN

Cluster randomised trial.

SETTING

Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.

MAIN OUTCOME MEASURES

The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality.

RESULTS

During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components.

CONCLUSIONS

Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced.

TWEETABLE ABSTRACT

Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.

A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry

OBJECTIVE

To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology.

DESIGN

A population-based, prospective observational study.

SETTING

Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia.

POPULATION

All deaths among pregnant women resident in the study sites from 2014 to December 2016.

METHODS

For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD.

MAIN OUTCOME MEASURES

Assigned causes of maternal mortality.

RESULTS

Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy.

CONCLUSIONS

The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions.

TWEETABLE ABSTRACT

An algorithmic system for determining maternal cause of death in low-resource settings is described.

Gyrotactic microorganisms and thermoelectric effects on the dynamics of 29 nm CuO-water nanofluid over an upper horizontal surface of paraboloid of revolution

Purpose

The purpose of this paper is to provide an insight into the influence of gyrotactic microorganisms and Hall effect on the boundary layer flow of 29 nm CuO-water mixture on the upper pointed surface of a rocket, over the bonnet of a car and upper pointed surface of an aircraft. This is true since all these objects are examples of an object with variable thickness.

Design/methodology/approach

The simplification of Rosseland approximation (Taylor series expansion of T4 about T∞) is avoided; thus, two different parameters relating to the study of nonlinear thermal radiation are obtained. The governing equation is non-dimensionalized, parameterized and solved numerically.

Findings

Maximum vertical and horizontal velocities of the 29 nm CuO-water nanofluid flow is guaranteed at a small value of Peclet number and large value of buoyancy parameter depending on the temperature difference. When the magnitude of thickness parameter χ is small, cross-flow velocity decreases with the velocity index and the opposite effect is observed when the magnitude of χ is large.

Originality/value

Directly or indirectly, the importance of the fluid flow which contains 29 nm CuO nanoparticle, water, and gyrotactic microorganisms in the presence of Hall current has been pointed out as an open question in the literature due to its relevance in imaging, ophthalmological and translational medicine informatics.

On the formation of fold-type oscillation marks in the continuous casting of steel

Asymptotic methods are employed to revisit an earlier model for oscillation-mark formation in the continuous casting of steel. A systematic non-dimensionalization of the governing equations, which was not carried out previously, leads to a model with 12 dimensionless parameters. Analysis is provided in the same parameter regime as for the earlier model, and surprisingly simple analytical solutions are found for the oscillation-mark profiles; these are found to agree reasonably well with the numerical solution in the earlier model and very well with fold-type oscillation marks that have been obtained in more recent experimental work. The benefits of this approach, when compared with time-consuming numerical simulations, are discussed in the context of auxiliary models for macrosegregation and thermomechanical stresses and strains.

Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system

OBJECTIVE

We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm.

DESIGN

Prospective, observational study.

SETTING

Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya.

POPULATION

Pregnant women residing in defined study regions.

METHODS

Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions.

MAIN OUTCOME MEASURES

Primary cause of stillbirth.

RESULTS

Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration.

CONCLUSIONS

Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system.

TWEETABLE ABSTRACT

Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.

Morphological changes in the Heart in unrelated deaths

Background: Cardiovascular diseases are the major cause of morbidity and mortality worldwide. In the Indian subcontinent, they account for more than 25% of deaths. Numerous studies have been conducted on the cardiovascular system in cases of sudden death; but there has been a major neglect to study the heart in cases of people who died of unrelated causes.In the present study, we have attempted to study the CVS in detail in those individuals who died of unrelated causes and have tried to assess the prevelance of atherosclerosis, conduction system lesions, inflammatory and valvular pathologies in them.Materials and Methods: The present study was a prospective one conducted from June 2007 to June 2009 in the department of Pathology, Kasturba Medical College, Mangalore. The hearts of persons who died of unrelated causes were studied.Results: Various lesions encountered in the heart were coronary artery disease (70.58%), medial hyperplasia of SAnode (38.23%) and AV node (55.88%), chronic inflammation of the conduction system (55.88%) and calcification (11.76%). Malarial myocarditis was seen in 5.88% and pulmonary stenosis was seen in 2.94% of the cases. No cardiac pathology was detected in 5.88% cases.Conclusion: Our study highlights the prevelace of atherosclerotic changes and conduction system abnormalities in the general population. Hence, we conclude that examination of the CVS is extremely important in cases of sudden death; but it should also be made mandatory in unrelated deaths too, as it can diagnose a lot of hidden pathology.