Prevalence and Risk Factors of Urinary Incontinence among Elderly Women Residing in Kochi Corporation: A Community-based Cross-sectional Study.

Background: A study was done on the prevalence, risk factors, and treatment-seeking behavior of elderly women with urinary incontinence (UI) residing in Kochi Corporation, Kerala, India. The community-based cross-sectional study was done in Kochi on 525 elderly women aged 60 years and above, selected by cluster random sampling, after getting consent, using a questionnaire. The overall prevalence of UI was found to be 64% (95% confidence interval (CI) 59.5-67.6). The most common type of UI was found to be the urge type of incontinence (38.3%, 95% CI, 34.14-42.45). Chronic cough (odds ratio [OR] 1.754, 95% 1.170-2.631), chronic constipation (OR: 1.563, 95% CI: 1.030-2.373), obesity (OR: 1.591, 95% CI: 1.110-2.280), diabetes (OR: 1.517, 95% CI: 1.036-2.222), and taking medications for diabetes and hypertension (OR: 1.476, 95% 1.008-2.163) were found to be risk factors of UI. Multiparity (OR: 1.757, 95% CI: 1.073-2.876), delivery at home (OR: 1.761, 95% CI: 1.205-2.575), undergoing any pelvic surgery (OR: 1.504, 95% CI: 1.052-2.150) were the gynecological and obstetric factors associated with UI. Context: Very few community-based studies are available on UI among elderly women. Aim: The primary objective of the study was to estimate the prevalence of UI among elderly women residing in the Kochi corporation. The secondary objective was to determine the risk factors of UI. Settings and Design: A community-based cross-sectional study was done in the Kochi Corporation of Ernakulam district. Subjects and Methods: A pilot study was conducted and based on this, the sample size was computed to be 72.41. Data from 525 individuals were collected using cluster random sampling. A questionnaire for urinary incontinence diagnosis questionnaire was used for assessing the type of UI. Statistical Analysis Used: Percentage prevalence, Chi-square test. Results: The overall prevalence of UI was found to be 64%. The most common type of UI was found to be the urge type of incontinence. Chronic cough, chronic constipation, obesity, diabetes, taking medications for diabetes, and hypertension were found to be risk factors of UI. Multiparity, delivery at home, and undergoing any pelvic surgery were the gynecological and obstetric factors associated with UI. Conclusions: The prevalence of UI among elderly women in this study was found to be 63.9%. The most common type of UI was found to be urge type of incontinence 38.3%, followed by mixed incontinence 32.3%, and stress incontinence 29.3%. Chronic cough (OR: 1.754), chronic constipation (OR: 1.563), obesity (OR: 1.591), diabetes (OR: 1.517), and taking medications for diabetes and hypertension (OR: 1.476) were found to be risk factors for UI. Multiparity (OR: 1.757), delivery at home (OR: 1.761) and undergoing any pelvic surgery (OR: 1.504) were the gynecological and obstetric factors associated with UI among elderly women in this study. Chronic cough (adjusted odds ratio [aOR] 1.64, 95% CI: 1.08-2.50), obesity (aOR: 1.64, 95% CI: 1.13-2.39), pelvic surgery (aOR: 1.64, 95% CI: 1.13-2.39), and delivery at home (aOR: 1.89, 95% CI: 1.27-2.82) were found to be independent risk factors for UI among elderly women.

Performance evaluation of external compound parabolic concentrator integrated with thermal storage tank for domestic solar refrigeration system.

The aim of this research was to develop a model for a solar refrigeration system (SRS) that utilizes an External Compound Parabolic Collector and a thermal energy storage system (TESS) for solar water heating in Chennai, India. The system parameters were optimized using TRNSYS software by varying factors such as collector area, mass flow rate of heat transfer fluid, and storage system volume and height. The resulting optimized system was found to meet 80% of hot water requirements for the application on an annual basis, with an annual collector energy efficiency of 58% and an annual TESS exergy efficiency of 64% for a discharge period of 6 h per day. In addition, the thermal performance of 3.5 kW SRS was studied by connecting it to an optimized solar water heating system (SWHS). The system was found to generate an average cooling energy of 12.26 MJ/h annually, with a coefficient of performance of 0.59. By demonstrating the ability to efficiently generate both hot water and cooling energy, the results of this study indicate the potential for utilizing a SWHS in combination with STST and SRS. The optimization of system parameters and the use of exergy analysis provide valuable insights into the thermal behavior and performance of the system, which can inform future designs and improve the overall efficiency of similar systems.

Drug-induced sleep endoscopy-continuous positive airway pressure (DISE-CPAP), a newer modality to choose the right candidates for CPAP.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is recommended for moderate-to-severe obstructive sleep apnea (OSA). We aimed to investigate whether or not combining drug-induced sleep endoscopy (DISE) with CPAP titration may inform more appropriate pressure settings. MATERIALS AND METHODS: A sleep CPAP titration study and DISE-CPAP treatment were performed on consecutive subjects with moderate-to-severe OSA under controlled sedation using bispectral monitoring. Video recordings of dynamic changes in UA with CPAP pressure ranges of 5 to 25 cm were assessed in accordance with the VOTE classification. The 95th percentile (95th PC) pressure of the CPAP titration trial was compared to optimal pressure for alleviating UA blockage. RESULTS: We included 30 subjects (mean age 37.5, 17% women). All showed UA collapse at more than one level, with more than 80% of them collapsing completely at the levels of the velum and oropharynx. At the velum, 90% of subjects experienced improvement with CPAP. At the oropharynx, 75% of subjects experienced improvement with CPAP. The mean pressure and standard deviation (SD) of the 95th PC of the CPAP titration was 14.3 (3.5) cmH2O, while the pressure required to partially or fully open the airway (best possible pressure) was 16.1 (3.9) cmH2O; mean (SD) difference, 1.9 (2.2); P ≤ 0.001. The limits of agreement between the CPAP 95th pressure and the ideal pressure were - 6.32 to + 2.52. CONCLUSIONS: The palate and lateral pharynx were more affected by CPAP than the hypopharynx. Most of the time, the mean 95th PC CPAP titration pressure was lower than the mean optimal pressure needed to alleviate the collapse.

Clustering of COVID-19 data for knowledge discovery using c-means and fuzzy c-means.

In this work, the partitioning clustering of COVID-19 data using c-Means (cM) and Fuzy c-Means (Fc-M) algorithms is carried out. Based on the data available from January 2020 with respect to location, i.e., longitude and latitude of the globe, the confirmed daily cases, recoveries, and deaths are clustered. In the analysis, the maximum cluster size is treated as a variable and is varied from 5 to 50 in both algorithms to find out an optimum number. The performance and validity indices of the clusters formed are analyzed to assess the quality of clusters. The validity indices to understand all the COVID-19 clusters' quality are analysed based on the Zahid SC (Separation Compaction) index, Xie-Beni Index, Fukuyama-Sugeno Index, Validity function, PC (performance coefficient), and CE (entropy) indexes. The analysis results pointed out that five clusters were identified as a major centroid where the pandemic looks concentrated. Additionally, the observations revealed that mainly the pandemic is distributed easily at any global location, and there are several centroids of COVID-19, which primarily act as epicentres. However, the three main COVID-19 clusters identified are 1) cases with value <50,000, 2) cases with a value between 0.1 million to 2 million, and 3) cases above 2 million. These centroids are located in the US, Brazil, and India, where the rest of the small clusters of the pandemic look oriented. Furthermore, the Fc-M technique seems to provide a much better cluster than the c-M algorithm.

Can technological advancements help to alleviate COVID-19 pandemic? a review.

The COVID-19 pandemic is continuing, and the innovative and efficient contributions of the emerging modern technologies to the pandemic responses are too early and cannot be completely quantified at this moment. Digital technologies are not a final solution but are the tools that facilitate a quick and effective pandemic response. In accordance, mobile applications, robots and drones, social media platforms (such as search engines, Twitter, and Facebook), television, and associated technologies deployed in tackling the COVID-19 (SARS-CoV-2) outbreak are discussed adequately, emphasizing the current-state-of-art. A collective discussion on reported literature, press releases, and organizational claims are reviewed. This review addresses and highlights how these effective modern technological solutions can aid in healthcare (involving contact tracing, real-time isolation monitoring/screening, disinfection, quarantine enforcement, syndromic surveillance, and mental health), communication (involving remote assistance, information sharing, and communication support), logistics, tourism, and hospitality. The study discusses the benefits of these digital technologies in curtailing the pandemic and 'how' the different sectors adapted to these in a shorter period. Social media and television's role in ensuring global connectivity and serving as a common platform to share authentic information among the general public were summarized. The World Health Organization and Governments' role globally in-line with the prevention of propagation of false news, spreading awareness, and diminishing the severity of the COVID-19 was discussed. Furthermore, this collective review is helpful to investigators, health departments, Government organizations, and policymakers alike to facilitate a quick and effective pandemic response.

Assessment of Health Facilities for Airborne Infection Control Practices and Adherence to National Airborne Infection Control Guidelines: A Study from Kerala, Southern India.

INTRODUCTION: Nosocomial transmission of airborne infections, such as H1N1, drug-resistant tuberculosis, and Nipah virus disease, has been reported recently and has been linked to the limited airborne infection control strategies. The objective of the current study was to assess the health facilities for airborne infection control (AIC) practices and adherence to the National AIC (NAIC) guidelines, 2010. MATERIALS AND METHODS: A cross-sectional study was conducted in 25 public and 25 private hospitals selected from five randomly selected districts in the state of Kerala. A checklist with 62 components was developed based on the NAIC guidelines. Frequencies, percentages, and mean with standard deviation were used to summarize facility risk assessment and compliance to guidelines. RESULTS: Most of the facilities had infection control committees 35 (70%). Annual infection control trainings were held for staff in 21 (42%) facilities. Twenty (40%) facilities were not familiar with NAIC guidelines. Counseling on cough etiquette at registration was practiced in 5 (10%) institutions. Cross ventilation was present in outpatient departments in 27 (54%) institutions. Sputum was disposed properly in 43 (86%) institutions. N95 masks were available in high-risk settings in 7 (14%) health facilities. CONCLUSION: There exist deficiencies in adherence to all components of NAIC guidelines including administrative, environmental, and use of personal protective equipment in both government and private hospitals in the state.

Homozygous variant, p.(Arg643Trp) in VAC14 causes striatonigral degeneration: report of a novel variant and review of VAC14-related disorders.

VAC14-related disorders include two distinct phenotypes, striatonigral degeneration [MIM# 617054] and Yunis-Varon syndrome. Striatonigral degeneration is a recently described childhood onset dystonia caused by pathogenic variants in VAC14. It is characterized by a period of apparent normalcy followed by abrupt onset neuroregression, dystonia, involuntary movements and degenerative brain lesions involving caudate nucleus, putamen and substantia nigra. Yunis-Varon syndrome is a well described severe condition characterised by skeletal findings and dysmorphism along with neuronal degeneration. Pathogenic variants in FIG4 have been previously reported to cause Yunis-Varon syndrome. Recently, loss of function variants in VAC14 were also reported in an individual affected with Yunis-Varon syndrome. Total seven individuals from four families are reported to have VAC14-related disorders till date. Here, we report another individual with clinical and radiological features suggestive of striatonigral degeneration with homozygous missense variant in VAC14. The patient fibroblasts showed extensive vacuolization, characteristic of VAC14-related disorders. We also review the phenotype and genotype associated with these disorders.

Investigating a community wide outbreak of hepatitis A in Kerala, India.

BACKGROUND: There was an outbreak of acute hepatitis in Nellikuzhy panchayat of Kothamangalam taluk, Ernakulam district, Kerala, during November and early December 2016. Objective of this study is to describe the epidemiological features of the outbreak and to identify the probable source. MATERIALS AND METHODS: The outbreak was defined in terms of time, place, and person. A hypothesis was generated and tested using a case-control study. Cases were selected by simple random sampling from the line list and controls were age-matched neighborhood individuals without any history of jaundice. Chi-square test, univariate analysis, and multi-variate logistic regression analyses were done to identify the probable risk factors. RESULTS: Around 223 hepatitis A cases were identified. Attack rate was found to be highest among the age group of 16-30 years at 1.44% and was eight times higher among males. Epidemic curve suggested a point source outbreak possibly from exposure to food or water from a newly opened hotel in the area. The case-control study confirmed the hypothesis with a statistically significant association between cases and history of exposure to food from the hotel [OR 120; 95% CI 14.6-996.2; P value < 0.001]. CONCLUSION: Observations and results of the case-control study revealed that the probable source of the Hepatitis A outbreak at Nellikuzhy panchayat was a hotel. The study findings also add evidences to the changing epidemiological pattern of hepatitis A in Kerala, and warrant the necessity to enforce food safety rules in the State.

Anti-inflammatory Effect of Picrorhiza kurroa in Experimental Models of Inflammation.

Picrorhiza kurroa is an important medicinal plant in the Ayurvedic system of medicine. The root and rhizome of this plant are used for the treatment of various liver and inflammatory conditions. In the present study, we sought to investigate the anti-inflammatory activity of P. kurroa rhizome extract against carrageenan-induced paw edema and cotton pellet implantation-induced granuloma formation in rats. In addition, its immunomodulatory activity was evaluated in Complete Freund's Adjuvant-induced stimulation of a peritoneal macrophage model and lipopolysaccharide-stimulated RAW 264.7 murine macrophages. Pretreatment with P. kurroa rhizome extract inhibited carrageenan-induced paw edema and cotton pellet-induced granuloma formation in a dose-dependent manner. This was associated with reduced levels of inflammatory cytokines (TNF-α, IL-1ß, IL-6) accompanied with increased anti-inflammatory cytokine (IL-10) in the serum and peritoneal macrophages. Additionally, P. kurroa rhizome extract inhibited inflammatory TNF-receptor 1 and cyclooxygenase-2 in Complete Freund's Adjuvant-induced activated peritoneal macrophages. Furthermore, P. kurroa rhizome extract treatment significantly inhibited iNOS and suppressed the activation of NF-κB through inhibition of its phosphorylation and by blocking the activation of IκB kinase alpha in lipopolysaccharide-stimulated RAW264.7 macrophages. Taken together, these results suggest that P. kurroa has anti-inflammatory activity that is mediated through the suppression of macrophage-derived cytokine and mediators via suppression of NF-κB signaling.

Biochemical effects of feeding soft drink and ethanol.

This work was undertaken to study whether consumption of alcoholic beverage mixed with soft drinks could reduce the metabolic effect caused by ethanol. When 24 hr fasted rats were intragastrically fed rum (with 40% ethanol) diluted (1:1) with water, 3.0 ml (0.5 g ethanol) per 100 g body weight and sacrificed 12 hr later in fasting condition, exhibited higher levels of triacyl glycerol, glucose, total cholesterol, high density lipoprotein (HDL), aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALP) in serum, higher levels of total cholesterol, triacyl glycerol and thiobarbituric acid reactive substances (TBARS) in both liver and kidneys, and lower levels of serum albumin. When fasted rats were fed 3.0 ml soft drink (0.31 mg caffeine), they showed increased levels of triacyl glycerol, glucose, ALT and ALP in the serum, TBARS in liver and kidneys, triacyl glycerol and total cholesterol in kidneys and lower levels of serum albumin. Soft drink feeding did not reduce serum total cholesterol but reduced HDL levels. Also soft drink did not alter liver lipids. When a mixture of 1.5 ml diluted rum (0.25 g ethanol) and 1.5 ml soft drink (0.154 mg caffeine) were fed to the fasted rats, the serum parameters increased similar to rats fed rum only except that total cholesterol and HDL cholesterol were unaltered. TBARS in kidneys and liver were also increased but triacyl glycerol levels were not altered. Thus feeding ethanol with soft drink does not reduce the metabolic effects of ethanol but it will prevent ethanol induced serum HDL cholesterol rise.