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Throughout the history of power systems, power cables have been used to securely and efficiently distribute electrical energy to the destined locations. Cross-linked polyethylene (XLPE), a commonly used insulator in high-voltage cables, have several desirable properties, such as low dielectric loss, high dielectric constant, high thermal conductivity, enhanced thermal stability, and superior resistance against electrical stress. However, further improvements of XLPE's performance are needed. The incorporation of large specific surface area nanoparticles, such as boron nitride nanosheets and graphene oxide, exhibited a great potential in enhancing XLPE's properties. These nanoparticles create numerous trapping sites, even at small loading levels, due to their large interfacial regions. In addition, voltage stabilisers with polar groups can scavenge high-energy electrons generated by local electric fields, thereby inhibiting the electrical tree growth. Another important aspect of enhancing XLPE's dielectric performance is the inclusion of antioxidants with phenolic groups. These antioxidants react with peroxyl radicals, mitigating their harmful effects. This review summarises the effects of nanoparticles, voltage stabilisers, antioxidants, and polymer amalgamation on dielectric performance of XLPE as an insulation material. The major challenges in dielectric insulation such as breakdown voltage strength, electrical tree growth, structural defect, space charge accumulation, and thermal aging are addressed.
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INTRODUCTION: Oral health problems are frequently overlooked in patients with epilepsy. We evaluate the oral health status of epilepsy patients from a tertiary teaching hospital. MATERIALS AND METHODS: We conducted a cross-sectional study of epilepsy patients from the neurology clinic, Hospital Canselor Tuanku Muhriz, Kuala Lumpur. The dental assessment included the decayed, missing and filled teeth (DMFT) criteria, as well as the plaque and periodontal status by dentists. RESULTS: A total of 151 patients were recruited. The median age of onset of epilepsy was 16 (IQR 7-30) years, with generalised seizures at 59.6% and focal seizures in 40.4% of patients. Fair or poor oral health was present in 59 (39.1%) and gingivitis was seen in 65 (43%). The median DMFT decayed (D), missing (M) and filled teeth (FT) was 3 (IQR 1- 7). The median age of patients with fair or poor oral health was older (40 years, IQR 31-51) than the patients with excellent or good oral health (33 years, IQR 26-45), (p=0.014). Multivariate logistic regression analysis showed that carbamazepine (Odds Ratios, OR: 3.694; 95% Confidence Intervals, 95%CI: 1.314, 10.384) and hypertension (OR 6.484; 95%CI: 1.011, 41.594) are the risk factors for fair or poor oral health. Phenytoin use is 4.271 times more likely to develop gingivitis (OR 4.271; 95% CI: 1.252, 14.573). CONCLUSION: Factors that contribute to fair or poor oral health include age, antiseizure medications like phenytoin and carbamazepine, and hypertension. Effective preventive strategies should be implemented to maintain oral health in epilepsy patients.
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Epilepsia , Salud Bucal , Centros de Atención Terciaria , Humanos , Adulto , Masculino , Femenino , Epilepsia/epidemiología , Epilepsia/tratamiento farmacológico , Estudios Transversales , Centros de Atención Terciaria/estadística & datos numéricos , Persona de Mediana Edad , Malasia/epidemiología , Adulto Joven , Anticonvulsivantes/uso terapéutico , AdolescenteRESUMEN
BACKGROUND: Exposure to ambient air pollution is associated with a significant number of deaths. Much of the evidence associating air pollution with adverse effects is from North American and Europe, partially due to incomplete data in other regions limiting location specific examinations. The aim of the current paper is to leverage satellite derived air quality data to examine the relationship between ambient particulate matter and all-cause and cause-specific mortality in Asia. METHODS: Six cohorts from the Asia Cohort Consortium provided residential information for participants, recruited between 1991 and 2008, across six countries (Bangladesh, India, Iran, Japan, South Korea, and Taiwan). Ambient particulate material (PM2·5) levels for the year of enrolment (or 1998 if enrolled earlier) were assigned utilizing satellite and sensor-based maps. Cox proportional models were used to examine the association between ambient air pollution and all-cause and cause-specific mortality (all cancer, lung cancer, cardiovascular and lung disease). Models were additionally adjusted for urbanicity (representing urban and built characteristics) and stratified by smoking status in secondary analyses. Country-specific findings were pooled via random-effects meta-analysis. FINDINGS: More than 300,000 participants across six cohorts were included, representing more than 4-million-person years. A positive relationship was observed between a 5 µg/m (Dockery et al., 1993) increase in PM2·5 and cardiovascular mortality (HR: 1·06, 95 % CI: 0.99, 1·13). The additional adjustment for urbanicity resulted in increased associations between PM2.5 and mortality outcomes, including all-cause mortality (1·04, 95 % CI: 0·97, 1·11). Results were generally similar regardless of whether one was a current, never, or ex-smoker. INTERPRETATION: Using satellite and remote sensing technology we showed that associations between PM2.5 and all-cause and cause-specific Hazard Ratios estimated are similar to those reported for U.S. and European cohorts. FUNDING: This project was supported by the Health Effects Institute. Grant number #4963-RFA/18-5. Specific funding support for individual cohorts is described in the Acknowledgements.
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Contaminantes Atmosféricos , Contaminación del Aire , Exposición a Riesgos Ambientales , Material Particulado , Humanos , Material Particulado/análisis , Asia , Exposición a Riesgos Ambientales/estadística & datos numéricos , Exposición a Riesgos Ambientales/efectos adversos , Masculino , Estudios de Cohortes , Femenino , Contaminación del Aire/estadística & datos numéricos , Contaminación del Aire/efectos adversos , Contaminantes Atmosféricos/análisis , Persona de Mediana Edad , Adulto , Enfermedades Cardiovasculares/mortalidad , Anciano , Neoplasias/mortalidad , Neoplasias Pulmonares/mortalidad , Enfermedades Pulmonares/mortalidad , Modelos de Riesgos Proporcionales , Causas de MuerteRESUMEN
Barium calcium titanate (BCT) ceramics with varying yttrium doping concentrations were fabricated using the solid-state compaction process to explore the attributes of dopants. (Ba0.75Ca0.25) TiO3 and (Ba0.75Ca0.25) (YyTi(1-y)) O3 where, y = 0.00, 0.10, 0.15, and 0.20 ceramics were synthesized by pressing isostatically in pellet press apparatus, then sintered at 1250 °C with consequent cooling in furnace ambient. The structural, morphological, and dielectric properties were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), and impedance spectroscopy interpretations, respectively. The XRD analysis revealed that the cubic BCT lattice was transformed into a tetragonal structure with Yttrium doping. Scanning electron microscopy (SEM) disclosed that yttrium doping countered the liquid phase formation of BCT as well as influenced grain development and microstructure, leading to the formation of distinct grain boundaries and improved densification. The average grain size (18-29 nm) of the Y-BCT increases as the doping level rises. At 60 Hz, it was reported that the dielectric constant obtained a maximum value of 70000 with a resistivity of 5 × 108 Î-cm for y = 0.15. The manifestation of the secondary phase confirmed from XRD, allocating an easy path for oxygen migration, might be responsible for the rise in oxygen vacancy, higher leakage current, and dielectric loss for y = 0.01. Co-doping of calcium and yttrium in BCT ceramics has modified the basic structure and ameliorated composites' structural stability and dielectric characteristics. The optimized sample, upon demonstrating outstanding efficiency, ought to be employed for specific uses such as energy storage devices and capacitors.
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Abstract Combining ability analysis provides useful information for the selection of parents, also information regarding the nature and magnitude of involved gene actions. Crops improvement involves strategies for enhancing yield potentiality and quality components. Targeting the improvement of respective characters in bitter gourd, combining ability and genetic parameters for 19 characters were estimated from a 6×6 full diallel analysis technique. The results revealed that the variances due to general combining ability (GCA) and specific combining ability (SCA) were highly significant for most of the important characters. It indicated the importance of both additive and non-additive gene actions. GCA variances were higher in magnitude than SCA variances for all the characters studied indicating the predominance of the additive gene effects in their inheritance. The parent P2 (BG 009) appeared as the best general combiner for earliness; P1 (BG 006) for number of fruits, average single fruit weight and fruit yield; P4 (BG 027) for node number of first female flower and days to seed fruit maturity; P3 (BG 011) for fruit length and thickness of the fruit flesh; P5 (BG 033) for 100-seed weight; and P6 for number of nodes per main vine. The SCA effect as well as reciprocal effect was also significant for most of the important characters in different crosses.
Resumo A análise da capacidade de combinação fornece informações úteis para a seleção dos pais, também informações sobre a natureza e a magnitude das ações dos genes envolvidos. A melhoria das safras envolve estratégias para aumentar a potencialidade da produção e os componentes de qualidade. Visando ao aprimoramento dos respectivos caracteres em cabaça-amarga, capacidade de combinação e parâmetros genéticos para 19 caracteres, foram estimados a partir de uma técnica de análise dialélica completa 6 × 6. Os resultados revelaram que as variâncias, devido à capacidade geral de combinação (GCA) e capacidade específica de combinação (SCA), foram altamente significativas para a maioria dos caracteres importantes. Indicou a importância das ações gênicas aditivas e não aditivas. As variâncias GCA foram maiores em magnitude do que as variâncias SCA para todos os caracteres estudados, indicando a predominância dos efeitos do gene aditivo em sua herança. O pai P2 (BG 009) apareceu como o melhor combinador geral para o início; P1 (BG 006) para número de frutos, peso médio de um único fruto e produção de frutos; P4 (BG 027) para número de nó da primeira flor fêmea e dias para a maturidade do fruto da semente; P3 (BG 011) para comprimento do fruto e espessura da polpa do fruto; P5 (BG 033) para peso de 100 sementes; e P6 para o número de nós por videira principal. O efeito SCA, bem como o efeito recíproco, também foi significativo para a maioria dos personagens importantes em cruzamentos diferentes.
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Momordica charantia , Productos Agrícolas , Flores , Mejoramiento de la Calidad , Frutas/genéticaRESUMEN
Abstract Combining ability analysis provides useful information for the selection of parents, also information regarding the nature and magnitude of involved gene actions. Crops improvement involves strategies for enhancing yield potentiality and quality components. Targeting the improvement of respective characters in bitter gourd, combining ability and genetic parameters for 19 characters were estimated from a 6×6 full diallel analysis technique. The results revealed that the variances due to general combining ability (GCA) and specific combining ability (SCA) were highly significant for most of the important characters. It indicated the importance of both additive and non-additive gene actions. GCA variances were higher in magnitude than SCA variances for all the characters studied indicating the predominance of the additive gene effects in their inheritance. The parent P2 (BG 009) appeared as the best general combiner for earliness; P1 (BG 006) for number of fruits, average single fruit weight and fruit yield; P4 (BG 027) for node number of first female flower and days to seed fruit maturity; P3 (BG 011) for fruit length and thickness of the fruit flesh; P5 (BG 033) for 100-seed weight; and P6 for number of nodes per main vine. The SCA effect as well as reciprocal effect was also significant for most of the important characters in different crosses.
Resumo A análise da capacidade de combinação fornece informações úteis para a seleção dos pais, também informações sobre a natureza e a magnitude das ações dos genes envolvidos. A melhoria das safras envolve estratégias para aumentar a potencialidade da produção e os componentes de qualidade. Visando ao aprimoramento dos respectivos caracteres em cabaça-amarga, capacidade de combinação e parâmetros genéticos para 19 caracteres, foram estimados a partir de uma técnica de análise dialélica completa 6 × 6. Os resultados revelaram que as variâncias, devido à capacidade geral de combinação (GCA) e capacidade específica de combinação (SCA), foram altamente significativas para a maioria dos caracteres importantes. Indicou a importância das ações gênicas aditivas e não aditivas. As variâncias GCA foram maiores em magnitude do que as variâncias SCA para todos os caracteres estudados, indicando a predominância dos efeitos do gene aditivo em sua herança. O pai P2 (BG 009) apareceu como o melhor combinador geral para o início; P1 (BG 006) para número de frutos, peso médio de um único fruto e produção de frutos; P4 (BG 027) para número de nó da primeira flor fêmea e dias para a maturidade do fruto da semente; P3 (BG 011) para comprimento do fruto e espessura da polpa do fruto; P5 (BG 033) para peso de 100 sementes; e P6 para o número de nós por videira principal. O efeito SCA, bem como o efeito recíproco, também foi significativo para a maioria dos personagens importantes em cruzamentos diferentes.
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Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.
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Estenosis de la Válvula Aórtica , Asma , Enfermedad de la Válvula Aórtica Bicúspide , Diabetes Mellitus Tipo 2 , Reemplazo de la Válvula Aórtica Transcatéter , Femenino , Humanos , Anciano , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugíaRESUMEN
The study identifies potential carcinogenic health risk-zone of Chattogram city for the occurrence of trihalomethanes (THMs) at its water distribution network. The EPANET-THMs simulation model along with an empirical model have been adopted in the study to predict THMs content of supply water of the distribution network of the city's Karnaphuli service area. The empirical model has estimated THMs level of supply water based on influential water quality parameters, and few of these have been used as pre-set values for subsequent EPANET simulation. The simulation (R2= 0.7) shows that THMs' concentrations throughout the network vary from 33 to 486 µg/L. Around 60% of total junctions showed THMs concentrations above 150 µg/L, while that is above 50 µg/L for most (99%) of the junctions. Residual Free chlorine, one of the precursors for the THMs formation in distribution line, has also been simulated by EPANET considering varying applied chlorine dose at the water purification unit and wall (Kw) and bulk (Kb) decay constants. The simulated free residual chlorine peaks are found to be closer to the actual values with chlorine dose of 2 mg/L, and decay constants, Kw = 1 d-1 and Kb = 1 d-1. A mean lifetime total risk of cancer due to the presence of THMs has been found to be very high. Spatial distribution of carcinogenic risk shows that the central zone of the service area is the most vulnerable zone, followed by the western and northern zone. The first ever zone wise risk identification could be used as baseline data for operational and regulatory purposes and may raise awareness among the city's inhabitants. Furthermore, the application of EPANET in combination with an empirical model could be an effective tool for predicting THMs' concentration in water distribution networks in developing countries like Bangladesh to minimize the expenses of measuring THMs.
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Separation or monotone-likelihood can be observed in fitting process of a multinomial logistic model using maximum likelihood estimation (MLE) when sample size is small and/or one of the outcome categories is rare and/or there is one or more influential covariates, resulting in infinite or biased estimate of at least one regression coefficient of the model. This study investigated empirically to identify the optimal data condition to define both 'separation' and 'near-to-separation' (partial separation) and explored their consequences in MLE and provided a solution by applying a penalized likelihood approach, which has been proposed in the literature, by adding a Jeffreys prior-based penalty term to the original likelihood function to remove the first-order bias in the MLEs of the multinomial logit model via equivalent Poisson regression. Furthermore, the penalized estimating equation (PMLE) is extended to a weighted estimating equation allowing for survey-weight for analyzing data from a complex survey. The simulation study suggests that the PMLE outperforms the MLE by providing smaller amount of bias and mean squared of error and better coverage. The methods are applied to analyze data on choice of health facility for treatment of childhood diseases.
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The presence of conduction defects complicating acute myocardial infarction (MI) is relatively frequent and is associated with increased short and long term mortality. Thrombolytic therapy has been established to reduce the mortality in acute MI, however its role in reducing the incidence of conduction defects is less clearly defined. Morbidity and mortality associated with conduction defects also remain unchanged. This study was aimed to assess the correlation between conduction defects and adverse in-hospital outcome of patients with acute ST segment elevation MI. This cross sectional descriptive type of observational study was conducted among 100 purposively selected patients with acute ST segment elevation MI in the coronary care unit (CCU) of Mymensingh Medical College Hospital, Bangladesh from June 2012 to March 2013. The patients were divided into two groups depending on the presence or absence of conduction defects namely Group A- 40 patients with conduction defects and Group B- 60 patients without conduction defects. Highest number of the patients (36.0%) was in the age group of 45-55 years. In case of inferior MI, age groups 45-55 years and 55-65 years had equal number of patients (30.4%). Only 2.0% patients were in age group of 75-85 years and this group had only inferior MI. Total number of female patients were 16(16.0%). Female patients had more inferior MI (17.4%) than anterior MI (15.9%). Number of MI patients was slightly more in inferior MI (46.0%) than anterior MI (44.0%). Group B had equal number of patients in both anterior and inferior MI. Conduction defects were more common in inferior MI (43.5%) than anterior MI (40.9%). Atrio-ventricular conduction defects were more common in inferior MI whereas intra-ventricular conduction defects were more common in anterior MI. Complete heart block (CHB) was more prevalent in inferior MI. Complications were more common in Group A (65.0%) than Group B (18.3%). In terms of complications the difference between two groups were significant (p<0.001). Group A showed higher rate of mortality (20.0%) than Group B (3.3%). In cases of anterior MI difference in mortality between Group A and Group B was highly significant (p<0.001). Conduction defects in the setting of acute MI are a common finding. Atrio-ventricular conduction defects occur more frequently in inferior MI whereas intra-ventricular conduction defects were more frequently encountered in anterior MI. Patients with conduction defects had more complications than those without conduction defects. Presence of conduction defects significantly increases the mortality of patients with anterior MI.
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Infarto del Miocardio , Infarto del Miocardio con Elevación del ST , Anciano , Anciano de 80 o más Años , Estudios Transversales , Electrocardiografía , Femenino , Bloqueo Cardíaco , Hospitales , Humanos , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , PronósticoRESUMEN
To compare the outcome of the laparoscopic totally extra peritoneal (Lap TEP) and open Lichtenstein tension free mesh repair (OLMR) of inguinal hernia. This study was conducted as a prospective comparative (Quasi experimental) study from January 2010 to December 2010 at Combined Military Hospital (CMH), Dhaka, Bangladesh. A total of 100 male patients aged 24 to 70 years who underwent laparoscopic totally extra-peritoneal (Lap TEP) and open Lichtenstein tension free mesh repair (OLMR) of inguinal hernia were included in this study. Data of operating time, intraoperative and short-term postoperative complications, postoperative pain, postoperative hospital stay and return to normal activity were recorded and analyzed with SPSS program. Mean age of the patients was 51.39±15.099 years in OLMR group (Group A) and 47.10±9.338 years in Lap TEP group (Group B). Mean operating time was longer in Laparoscopic TEP group (Group B, 57.67±6.915 minutes) then open Lichtenstein mesh repair group (Group A, 50.56±6.292 minutes). Patient in the Lap TEP group (Group B) experienced less post operative pain, less post operative complications, shorter hospital stay and early return to normal activity then OLMR group (Group A). One patient (3.33%) in group B needed conversion to open Lichtenstein method. Two (6.66%) patients developed pneumoperitoneum in Group B (Lap TEP repair). Superficial wound infection developed in five (7.14%) patients in OLMR group (Group A) and two (6.66%) patients in Lap TEP group (Group B). In Laparoscopic TEP group (Group B) and Lichtenstein group (Group A), patients return to normal activity within on an average 07 and 11 days respectively. Laparoscopic totally extra peritoneal (TEP) mesh repair technique was associated with less post operative pain, less post operative complications, shorter hospital stay, faster recovery with early return to normal activity compared with Lichtenstein tension free mesh repair of inguinal hernia.
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Hernia Inguinal , Laparoscopía , Adulto , Anciano , Bangladesh , Hernia Inguinal/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/cirugía , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Recurrencia , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
A study was undertaken to determine the contents of trace metals in 60 topsoils and 80 brinjal fruits samples from a famous brinjal-producing area of Bangladesh using atomic absorption spectrophotometer. The study also looked at soil pollution levels, dietary intake of nutritionally important trace elements, and human health risks from toxic metals induced by dermal soil exposure and consumption of brinjal. The content of Pb, Ni, Cd, Cu, Fe, Mn, and Zn in brinjal fruits harvested from farmer's fields ranged from 0.204-0.729, 0.031-0.212, < 0.010-0.061, 1.819-2.668, 3.267-5.910, < 0.010-0.866 and 2.160-3.846 µg g-1, respectively, while the amount of Cr was negligible. The calculated enrichment factors showed that 70, 50, and 25% of soil sampling sites had values in the 2.00-5.00 range for Pb, Zn, and Cd, respectively, while 30% of sites had values > 5.00 for Cd, indicating moderate to significant enrichment of these metals in the soil. The study also revealed that brinjal consumption provides a tiny amount of nutritionally important trace elements required for an adult human. Regarding the computed incremental lifetime cancer risks (ILCR), the study revealed that the values for Pb and Ni in all samples and Cd in 40% of samples were several hundred times higher for males and females than the USEPA threshold level due to oral ingestion of brinjal fruits. In contrast, dermal exposures to soil trace elements were within an acceptable range. The PCA results revealed that the contents of Cd, Pb, Ni, and Cu in soils showed strong positive correlations with those elements present in brinjal. The current study suggests future traceability research, focusing on pinpointing potential entry routes for toxic elements into the vegetable food chain.
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Metales Pesados , Contaminantes del Suelo , Solanum melongena , Oligoelementos , Adulto , Bangladesh , Cadmio , Monitoreo del Ambiente , Frutas/química , Humanos , Plomo , Metales Pesados/análisis , Metales Pesados/toxicidad , Medición de Riesgo , Suelo , Contaminantes del Suelo/análisis , Contaminantes del Suelo/toxicidad , Oligoelementos/análisisRESUMEN
Different studies worldwide showed that dyslipidaemia is involved in the pathogenesis of ischemic heart diseases (IHD). This cross sectional descriptive type of observational study was carried out at Mymensingh Medical College Hospital during the period of six months from January 2021 to September 2021 to estimate the lipid profile among patients admitted in the coronary care unit (CCU) with myocardial infarction (MI). Data were collected from purposively selected 343 patients with MI by face to face interview and laboratory investigations using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 21.0. The study results revealed that mean age of the patients with myocardial infarction was 53.16 years with a standard deviation of 11.68 years. Majority of them (284, 82.8%) were male and the remaining (59, 17.2%) were female. Proportion of risk factors for ischaemic heart disease (IHD) were estimated and found that 244(71.1%) patients were smoker; 150(43.7%) had hypertension and 110(32.2%) had family history of IHD. Ninety nine (28.9%) patents were obese with BMI ≥25kg/m². Eighty three (24.2%) patients had diabetes mellitus; 66(19.2%) lead sedentary life and 61(17.8%) patients with myocardial infarction had dyslipidaemia. Mean LDL of patients with myocardial infarction was 103.65±39.73mg/dl; mean total cholesterol (TC) was 189.44±45.41mg/dl; mean TG was 243.11±205.19mg/dl and mean HDL was 39.29±8.98mg/dl. LDL was increased in 10(2.9%) patients; total cholesterol was raised in 121 (35.3%) patients and TG was raised in 195(56.9%) patients. HDL was raised in 26(7.6%) patients and it was lowered in 57(16.6%) patients. Mean LDL, TC, TG and HDL of younger (≤45 years) and older (>45 years) patients were compared and t-test showed no significant difference (p>0.05). Similarly mean LDL, TC, TG and HDL of male and female were compared and again t-test showed no significant difference (p>0.05). Though the pattern of lipid profile was found similar in younger and older patients and in males and females, a significant number of patients (61, 17.8%) with MI had dyslipidaemia which should be address by dietary and lifestyle modification.
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Dislipidemias , Infarto del Miocardio , Bangladesh/epidemiología , LDL-Colesterol , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Centros de Atención TerciariaRESUMEN
Coronary artery disease (CAD) is the leading cause of death in developed and developing countries. Associated co-morbidities like diabetes, hypertension and obesity are making the situation worse. WHO enlisted obesity as an epidemic which also affects a great number of young population. Some recent studies showed the presence of an apparent paradoxical relationship between obesity and cardiovascular prognosis in certain subsets of patents. As BMI is an established marker of obesity; an attempt has been made to assess relationship between BMI and angiographic severity of coronary artery disease in Acute Coronary Syndrome (ACS) patients of Bangladeshi origin. To assess the association between body mass index and angiographic severity of coronary artery disease in patients with acute coronary syndrome; this cross sectional analytical study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital (MMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU) from December 2016 to February 2018 among purposively selected 65 patients. Relevant ethical issues were taken into consideration. Coronary angiogram was done in the same index hospitalization period. After coronary angiogram performed patients were grouped into two groups according to their BMI. Patients with BMI <25kg/m² as Group I and those ≥25kg/m² as Group II. Angiographic severity of coronary artery disease was assessed by vessel score and Syntax score. Mean age of Group I was 54.45±10.42 years, while in Group II it was 50.76±8.89 years reflecting the early presentation of higher BMI patients. Male to female ratio was 12:1. Mean BMI of Group I and Group II was 22.56±1.59 and 28.67±2.64 respectively. In Group I, 10(25.0%) had single vessel lesion, 15(37.5%) had double vessel lesion and 14(35.0%) had triple vessel lesion, while in Group II, 6(24.0%) had single vessel lesion, 12(48.0%) had double vessel lesion and 5(20.0%) had triple vessel lesion. Mean Syntax score of Group I and Group II was 13.18±8.45 and 10.42±7.14 respectively. Patients in the increasing BMI class had a higher prevalence of diabetes, hypertension and dyslipidaemia. A negative correlation was observed between BMI and angiographic severity (Vessel score, Syntax score and HRCA e.g. LM disease) of CAD indicating that patients with higher BMI had a lower coronary artery disease (CAD) severity than their normal BMI counterparts. Patients with high BMI have a lower CAD severity than usually expected. After adjustment for co-morbidities, BMI was not found as an independent predictor of severity of coronary artery disease.
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Síndrome Coronario Agudo , Enfermedad de la Arteria Coronaria , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/epidemiología , Adulto , Índice de Masa Corporal , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.
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COVID-19 , Bangladesh/epidemiología , COVID-19/epidemiología , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Masculino , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: TB was the leading cause of death from a single infectious pathogen globally between 2014 and 2019. Fine-scale estimates of TB prevalence and case notifications can be combined to guide priority-setting for strengthening routine surveillance activities in high-burden countries. We produce policy-relevant estimates of the TB epidemic at the second administrative unit in Bangladesh.METHODS: We used a Bayesian spatial framework and the cross-sectional National TB Prevalence Survey from 2015-2016 in Bangladesh to estimate prevalence by district. We used case notifications to calculate prevalence-to-notification ratio, a key metric of under-diagnosis and under-reporting.RESULTS: TB prevalence rates were highest in the north-eastern districts and ranged from 160 cases per 100,000 (95% uncertainty interval [UI] 80-310) in Jashore to 840 (UI 690-1020) in Sunamganj. Despite moderate prevalence rates, the Rajshahi and Dhaka Divisions presented the highest prevalence-to-notification ratios due to low case notifications. Resolving subnational disparities in case detection could lead to 26,500 additional TB cases (UI 8,500-79,400) notified every year.CONCLUSION: This study is the first to produce and map subnational estimates of TB prevalence and prevalence-to-notification ratios, which are essential to target prevention and treatment efforts in high-burden settings. Reaching TB cases currently missing from care will be key to ending the TB epidemic.
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Tuberculosis , Bangladesh/epidemiología , Teorema de Bayes , Estudios Transversales , Humanos , Prevalencia , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/prevención & controlRESUMEN
Combining ability analysis provides useful information for the selection of parents, also information regarding the nature and magnitude of involved gene actions. Crops improvement involves strategies for enhancing yield potentiality and quality components. Targeting the improvement of respective characters in bitter gourd, combining ability and genetic parameters for 19 characters were estimated from a 6×6 full diallel analysis technique. The results revealed that the variances due to general combining ability (GCA) and specific combining ability (SCA) were highly significant for most of the important characters. It indicated the importance of both additive and non-additive gene actions. GCA variances were higher in magnitude than SCA variances for all the characters studied indicating the predominance of the additive gene effects in their inheritance. The parent P2 (BG 009) appeared as the best general combiner for earliness; P1 (BG 006) for number of fruits, average single fruit weight and fruit yield; P4 (BG 027) for node number of first female flower and days to seed fruit maturity; P3 (BG 011) for fruit length and thickness of the fruit flesh; P5 (BG 033) for 100-seed weight; and P6 for number of nodes per main vine. The SCA effect as well as reciprocal effect was also significant for most of the important characters in different crosses.
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Momordica charantia , Productos Agrícolas , Flores , Frutas/genética , Mejoramiento de la CalidadRESUMEN
BACKGROUND: Mapping the spatial distribution of the dengue vector Aedes (Ae.) aegypti and accurately predicting its abundance are crucial for designing effective vector control strategies and early warning tools for dengue epidemic prevention. Socio-ecological and landscape factors influence Ae. aegypti abundance. Therefore, we aimed to map the spatial distribution of female adult Ae. aegypti and predict its abundance in northeastern Thailand based on socioeconomic, climate change, and dengue knowledge, attitude and practices (KAP) and/or landscape factors using machine learning (ML)-based system. METHOD: A total of 1066 females adult Ae. aegypti were collected from four villages in northeastern Thailand during January-December 2019. Information on household socioeconomics, KAP regarding climate change and dengue, and satellite-based landscape data were also acquired. Geographic information systems (GIS) were used to map the household-based spatial distribution of female adult Ae. aegypti abundance (high/low). Five popular supervised learning models, logistic regression (LR), support vector machine (SVM), k-nearest neighbor (kNN), artificial neural network (ANN), and random forest (RF), were used to predict females adult Ae. aegypti abundance (high/low). The predictive accuracy of each modeling technique was calculated and evaluated. Important variables for predicting female adult Ae. aegypti abundance were also identified using the best-fitted model. RESULTS: Urban areas had higher abundance of female adult Ae. aegypti compared to rural areas. Overall, study respondents in both urban and rural areas had inadequate KAP regarding climate change and dengue. The average landscape factors per household in urban areas were rice crop (47.4%), natural tree cover (17.8%), built-up area (13.2%), permanent wetlands (21.2%), and rubber plantation (0%), and the corresponding figures for rural areas were 12.1, 2.0, 38.7, 40.1 and 0.1% respectively. Among all assessed models, RF showed the best prediction performance (socioeconomics: area under curve, AUC = 0.93, classification accuracy, CA = 0.86, F1 score = 0.85; KAP: AUC = 0.95, CA = 0.92, F1 = 0.90; landscape: AUC = 0.96, CA = 0.89, F1 = 0.87) for female adult Ae. aegypti abundance. The combined influences of all factors further improved the predictive accuracy in RF model (socioeconomics + KAP + landscape: AUC = 0.99, CA = 0.96 and F1 = 0.95). Dengue prevention practices were shown to be the most important predictor in the RF model for female adult Ae. aegypti abundance in northeastern Thailand. CONCLUSION: The RF model is more suitable for the prediction of Ae. aegypti abundance in northeastern Thailand. Our study exemplifies that the application of GIS and machine learning systems has significant potential for understanding the spatial distribution of dengue vectors and predicting its abundance. The study findings might help optimize vector control strategies, future mosquito suppression, prediction and control strategies of epidemic arboviral diseases (dengue, chikungunya, and Zika). Such strategies can be incorporated into One Health approaches applying transdisciplinary approaches considering human-vector and agro-environmental interrelationships.
RESUMEN
Atherosclerosis is the pathognomic sign of ischaemic heart disease. Inflammation of the coronary artery contributes to the development of atherosclerosis. Neutrophil-to-lymphocyte ratio (NLR) has been reported to predict the risk of CAD and associated events in patients with ST-Segment elevation myocardial infarction (STEMI). This study was done to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital adverse cardiac events in patients with STEMI thrombolysed with streptokinase (STK). This cross sectional descriptive type of study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from August, 2017 to October, 2018. The STEMI patients, thrombolysed with STK had blood samples at admission, analyzed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off value. Chi square test was used to compare rate of adverse events and death in hospital stay. Logistic regression analysis was used to estimate predictive ability of NLR for in-hospital cardiac events. A total of 87 (39.90%) patients had complications. Patients in high NLR group had higher rate of complications (48.3% vs. 22.5%, p<0.001) in hospital than those in low NLR group. Arrhythmias (21.1% vs. 9.9%, p<0.041), heart failure (27.9% vs. 14.1%, p=0.024), cardiogenic shock (16.3% vs. 4.2%, p<0.011), death (6.8% vs. 2.8%, p=0.227), re-infarction /post MI angina (4.1% vs. 0.0% p=0.084) occurred more in high NLR group. Mean NLR was significantly different between Group I and Group II (3.11±0.84 vs. 10.20±6.08, p<0.0001). Multivariate regression analysis showed NLR an independent predictor of in-hospital adverse cardiac events (p<0.0001). High on admission NLR is an independent predictor for in-hospital adverse cardiac events in patients with STEMI thrombolysed with streptokinase.
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Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Estudios Transversales , Hospitales , Humanos , Linfocitos , Neutrófilos , Valor Predictivo de las Pruebas , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Estreptoquinasa/uso terapéuticoRESUMEN
Complete assessment of obstructive jaundice requires the use of various imaging modalities that are required to detect the cause and level of obstruction thus helping in treatment planning. Magnetic Resonance Cholangio Pancreatography (MRCP) is a current available technology which is a non-invasive technique that visualizes the gallbladder, biliary tree and pancreatic duct and also provides information about surrounding structures. This study was done to correlate the MRCP findings with post-operative result and thereby demonstrate the specificity, sensitivity and efficacy of MRCP as an accurate investigatory tool for biliary obstruction. Total of fifty (50) patients of clinically diagnosed obstructive jaundice were studied from March 2017 to August 2017 in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka, Bangladesh. In all these cases, USG was the initial screening investigation followed by MRCP. Cause and level of obstruction were evaluated using MRCP findings. MRCP results were correlated with surgical findings and few cases also with direct ERCP findings. Statistical analysis was done to see the sensitivity, specificity, accuracy, positive and negative predictive values of MRCP in diagnosis of biliary obstruction. In this study, USG detected level of obstruction in 56% (28 out of 50) cases. USG could detect causes of obstruction in 100% (02 out of 02) cases of choledocal cyst and 66.67% (02 out of 03) benign stricture, 60% (03 out of 05) cases of periampullary carcinoma, 57.70% (06 out of 14) cases of choledocholithiasis, and 42.86% (15 out of 26) cases of cholangiocarcinoma. On the other hand, MRCP detected level of obstruction in 98% (49 out of 50) cases. MRCP could detect causes of obstruction in 100% cases of cholangiocarcinoma, choledocholithiasis, benign stricture and choledocal cyst and 80% (04 out of 05) cases of periampullary carcinoma. In this study, ERCP could detect causes of obstruction in 32 cases of choledocholithiasis and benign stricture, but in case of cholangiocarcinoma ERCP was failed in 3 cases. In this study, for detection of cause of obstruction, ERCP had the highest sensitivity (97.79%); followed by MRCP (96.65%) and USG (60.25%). The overall diagnostic accuracy for detection of cause of obstruction was the highest for ERCP (95.50%); followed by MRCP (94.50%) and USG (64.50%). MRCP can be done in a short duration and is a noninvasive diagnostic modality compared to ERCP. MRCP needs to be advocated as a viable and non-invasive alternative with compararable sensitivity and specificity to ERCP.