Overactive bladder symptom score - translation and linguistic validation in Bengali.

Aims: Overactive bladder symptom score (OABSS) in English consists of four questionnaires. We proposed to make Bengali version and linguistic validation. Settings: Online survey. Materials and Methods: The translation and linguistic validation was done in the following manner: forward Bengali translation, backward English translation, preparation of online version, online survey, cognitive debriefing and preparation of final version. Backward translation was done by a person proficient in Bengali and English who had never seen the English version. Results: Forward Bengali translation from the English version of OABSS was made. Next backward translation was done. Question number 1 and 2 backward translation was in congruent at the first attempt. But question number 3 and 4 backward translation needed multiple time correction to come to congruence. After agreement of corrected version an online version was created. In the online version along with particulars of the participants, exclusion criteria, OAB diagnostic criteria, category of OAB depending on OABSS score were added. Then this online version was sent for online survey to Bengali-speaking persons (https://forms.gle/qEo8GuXSgxyULoaX9). Fifty-nine persons (43 male, 16 female) participated. Participants were from all-over India, covering many types of occupation. Overall prevalence of OAB was 15.5% and among male 6.9% and female 8.6%. No participants had any difficulty in understanding the questionnaires in congruence; only two persons were unable to understand the category of OAB as per OABSS. Conclusion: OABSS Bengali version is well understood in congruence and linguistically validated. Further studies would assess the reproducibility and accuracy of the questionnaire in Bengali populations.

Urge suppression and modified fluid consumption in the management of female overactive bladder symptoms.

BACKGROUND: At the initial management of overactive bladder (OAB) syndrome urge suppression technique along with other behavioural modification could be a good option. METHODS: Prospective experimental study conducted between 2015 and 2019. Women complaining of OAB were enrolled. Three-day bladder diary and patient global impression of severity (PGI-S) scale were evaluated at baseline. Then, the women were asked to perform the urge suppression technique whenever urgency occurred. She stopped moving, sat down and started squeezing the pelvic floor muscle quickly and tightly about ten times without full relaxation in between squeezes. After that, she did something to distract her mind. Once urgency disappeared, she proceeded to the toilet. If urgency reappeared, she stopped moving and repeated the same thing. Only on relax mood she entered toilet. Modified fluid consumption was - total daily requirement divided into three parts and two-third of that was taken from morning to lunch. The remaining one-third was divided again in three parts and two-third of that was taken before evening. Rest few amount was taken from the evening till waking up the next morning. After 3 months, 3-day bladder diary and patient global impression of improvement (PGI-I) scale assessed the improvement. RESULTS: Ninety-one women ultimately completed the study. Frequency and nocturia were reduced. Seventy-six women had improvement of their urgency sensation (P < 0.001), whereas urgency urinary incontinence reduction was statistically not significant (P > 0.05). PGI-I scale showed that 51.6% felt that either they were very much better or much better. CONCLUSION: Urge suppression and modified fluid consumption is good adjunct in female OAB management.

Single-dose nonavalent HPV vaccine: Need of the hour.

Human Papilloma Virus (HPV) vaccination of the preadolescent (9-14 years) females is the potential solution to eradicate carcinoma cervix. Nonavalent vaccine provides wider coverage than the quadrivalent vaccine. On long-term follow-up, even after single-dose HPV vaccination, the antibody titer remains good. Herd immunity can also be achieved by HPV vaccination. Hence, mass single-dose nonavalent HPV vaccination for sexually naive preadolescent girls can provide almost 100% protections and a cost-effective approach for the developing countries.

Extraperitoneal uterosacral ligament suspension by using the cervix as a traction device.

The present video demonstrates extraperitoneal uterosacral ligament suspension (ULS) while performing vaginal hysterectomy for POP-Q stage 3 prolapse. The ULS bites were taken before severing the uterosacral ligament using the cervix as a traction device. Two ULS sutures were applied on each side to the distal half of the intermediate part. Superior 1st ULS suture with permanent material (polypropylene) was applied to the uppermost exposed area. Inferior 2nd ULS suture with delayed absorbable material (polyglactin) was 0.5-1 cm distal to the superior suture. Next, the usual first clamp of the vaginal hysterectomy (VH) on a cardinal-uterosacral ligament was applied about 1 cm below the second ULS suture. The VH was completed. The ULS sutures were anchored to the vault via either the vesico-vaginal septum or the recto-vaginal septum. Permanent sutures were not brought outside the vaginal epithelium. In 51 cases there was no urological injury. On follow-up (average 2.3 years), 8.3% cases had stage 1 POP, 91.6% had no POP.

Approach to a woman with urinary incontinence.

Urinary incontinence is a bothersome situation to the ailing woman. Many times, the woman does not come to medicos due to shyness, and if she comes also she does not reveal all the information. Hence, a sympathetic and structured approach will help to provide judicious management to these women. When a woman with the complaint of urinary incontinence approaches us, we should collect maximum information with the help of structured questionnaire and protocol. Structured questionnaire provides most of the information pertinent to the urinary incontinence. Associated medical disorders are also looked for. Past obstetrical performance can have implication on this ailment. Pelvic organ prolapse, mass lower abdominal, etc., also can lead to urinary incontinence. Adverse effect of some medicines causes urinary incontinence. During general physical examination, attention has to be paid toward body mass index, joint hypermobility, spine, etc. During local examination, stress test, Bonney test, Q-tip test, etc., may help to some extent. The levator ani muscle is assessed of its strength. Neurological evaluation is to be done for all the patients with urinary incontinence. Urinary culture and sensitivity are routinely done. Once urinary infection is ruled out, then the woman is subjected to frequency/volume diary, ultrasonography, urodynamic study, cystoscopy, etc., depending on the necessity. A systematic approach to urinary incontinence will provide the best comfort to these ailing women.

Detection of atrial fibrillation and other abnormal rhythms from ECG using a multi-layer classifier architecture.

OBJECTIVE: Atrial fibrillation (AF) and other types of abnormal heart rhythm are related to multiple fatal cardiovascular diseases that affect the quality of human life. Hence the development of an automated robust method that can reliably detect AF, in addition to other non-sinus and sinus rhythms, would be a valuable addition to medicine. The present study focuses on developing an algorithm for the classification of short, single-lead electrocardiogram (ECG) recordings into normal, AF, other abnormal rhythms and noisy classes. APPROACH: The proposed classification framework presents a two-layer, three-node architecture comprising binary classifiers. PQRST markers are detected on each ECG recording, followed by noise removal using a spectrogram power based novel adaptive thresholding scheme. Next, a feature pool comprising time, frequency, morphological and statistical domain ECG features is extracted for the classification task. At each node of the classification framework, suitable feature subsets, identified through feature ranking and dimension reduction, are selected for use. Adaptive boosting is selected as the classifier for the present case. The training data comprises 8528 ECG recordings provided under the PhysioNet 2017 Challenge. F1 scores averaged across the three non-noisy classes are taken as the performance metric. MAIN RESULT: The final five-fold cross-validation score achieved by the proposed framework on the training data has high accuracy with low variance (0.8254 [Formula: see text] 0.0043). SIGNIFICANCE: Further, the proposed algorithm has achieved joint first place in the PhysioNet/Computing in Cardiology Challenge 2017 with a score of 0.83 computed on a hidden test dataset.

Modified extraperitoneal uterosacral ligament suspension for prevention of vault prolapse after vaginal hysterectomy.

INTRODUCTION AND HYPOTHESIS: During vaginal hysterectomy, extraperitoneal uterosacral ligament suspension (ULS) bites can be taken before removing the uterus. We evaluated this modified extraperitoneal ULS for vault prolapse prevention. METHODS: Study period was 3.5 years. Fifty-one women with third- and fourth-degree prolapse were enrolled. An inverted V incision was made on the anterior vaginal wall and continued as a semicircular incision on the posterior vaginal wall. Lateral vaginal mucosa was pushed up to expose the cardinal-uterosacral ligament complex. The first ULS suture, using polypropylene no. 1, was taken in the upper-most exposed area of the uterosacral ligament. The second suture, using polyglactin no. 1 or 0, was taken 0.5-1 cm below the first suture. During placement of both sutures, traction on the cervix was maintained. The cardinal-uterosacral ligament complex was clamped, dissected, and ligated 1 cm below the second suture. Vaginal hysterectomy was completed. Ends of the ULS suture were fastened to the vault via vesicovaginal and rectovaginal septum using polypropylene within and polyglactin outside vaginal mucosa. RESULTS: Prolapse stage was 3 in 42 cases and 4 in nine. Duration of operation ranged from 60 to 120 min. Blood loss was 100-300 ml. During follow-up (average 2.3 years) four (8.3%), cases had stage 1 pelvic organ prolapse (POP), three were lost to follow-up, and 44 (91.6%) had no POP. CONCLUSIONS: Using the cervix as a traction device is a good option when performing extraperitoneal ULS during vaginal hysterectomy to prevent vault prolapse.

Pattern Analysis in Physiological Pulsatile Signals: An Aid to Personalized Healthcare.

We present a system to analyze patterns inside pulsatile signals and discover repetitions inside signals. We measure dominance of the repetitions using morphology and discrete nature of the signals by exploiting machine learning and information theoretic concepts. Patterns are represented as combinations of the basic features and derived features. Consistency of discovered patterns identifies state of physiological stability which varies from one individual to another. Hence it has immense impact on deriving the accurate physiological parameters for personalized health analytics. Proposed mechanism discovers the regular and irregular patterns by performing extensive analysis on several real life cardiac data sets. We have achieved more than 90% accuracy in identifying irregular patterns using our proposed method.

Analysis of phonocardiogram signals through proactive denoising using novel self-discriminant learner.

Phonocardiogram (PCG) records heart sound and murmurs, which contains significant information of cardiac health. Analysis of PCG signal has the potential to detect abnormal cardiac condition. However, the presence of noise and motion artifacts in PCG hinders the accuracy of clinical event detection. Thus, noise detection and elimination are crucial to ensure accurate clinical analysis. In this paper, we present a robust denoising technique, Proclean that precisely detects the noisy PCG signal through pattern recognition, and statistical learning. We propose a novel self-discriminant learner that ensures to obtain distinct feature set to distinguish clean and noisy PCG signals without human-in-loop. We demonstrate that our proposed denoising leads to higher accuracy in subsequent clinical analytics for medical investigation. Our extensive experimentations with publicly available MIT-Physionet datasets show that we achieve more than 85% accuracy for noisy PCG signal detection. Further, we establish that physiological abnormality detection improves by more than 20%, when our proposed denoising mechanism is applied.

An unsupervised learning for robust cardiac feature derivation from PPG signals.

We propose here derivation algorithms for physiological parameters like beat start point, systolic peak, pulse duration, peak-to-peak distance related to heart rate, dicrotic minima, diastolic peak from Photoplethysmogram (PPG) signals robustly. Our methods are based on unsupervised learning mainly following morphology as well as discrete nature of the signal. Statistical learning has been used as a special aid to infer most probable feature values mainly to cope up with presence of noise, which is assumed to be insignificant compared to signal values at each investigation window. Performance of the proposed method is found to be better than other standard methods, yielding precision and sensitivity more than 97% obtained from three real life data sets.

Female reproductive aging is master-planned at the level of ovary.

The ovary receives a finite pool of follicles during fetal life. Atresia remains the major form of follicular expenditure at all stages since development of ovary. The follicular reserve, however, declines at an exponential rate leading to accelerated rate of decay during the years preceding menopause. We examined if diminished follicle reserve that characterizes ovarian aging impacts the attrition rate. Premature ovarian aging was induced in rats by intra-embryonic injection of galactosyltransferase-antibody on embryonic day 10. On post-natal day 35 of the female litters, either a wedge of fat (sham control) or a wild type ovary collected from 25-day old control rats, was transplanted under the ovarian bursa in both sides. Follicular growth and atresia, and ovarian microenvironment were evaluated in the follicle-deficient host ovary and transplanted ovary by real time RT-PCR analysis of growth differentiation factor-9, bone morphogenetic protein 15, and kit ligand, biochemical evaluation of ovarian lipid peroxidation, superoxide dismutase (SOD) and catalase activity, and western blot analysis of ovarian pro- and anti-apoptotic factors including p53, bax, bcl2, and caspase 3. Results demonstrated that the rate of follicular atresia, which was highly preponderant in the follicle-deficient ovary of the sham-operated group, was significantly prevented in the presence of the transplanted ovary. As against the follicle-deficient ovary of the sham-operated group, the follicle-deficient host ovary as well as the transplanted ovary in the ovary-transplanted group exhibited stimulated follicle growth with increased expression of anti-apoptotic factors and down regulation of pro-apoptotic factors. Both the host and transplanted ovaries also had significantly lower rate of lipid peroxidation with increased SOD and catalase activity. We conclude that the declining follicular reserve is perhaps the immediate thrust that increases the rate of follicle depletion during the final phase of ovarian life when the follicle reserve wanes below certain threshold size.

Ovotoxic effects of galactose involve attenuation of follicle-stimulating hormone bioactivity and up-regulation of granulosa cell p53 expression.

Clinical evidence suggests an association between galactosaemia and premature ovarian insufficiency (POI); however, the mechanism still remains unresolved. Experimental galactose toxicity in rats produces an array of ovarian dysfunction including ovarian development with deficient follicular reserve and follicular resistance to gonadotrophins that characterize the basic tenets of human POI. The present investigation explores if galactose toxicity in rats attenuates the bioactivity of gonadotrophins or interferes with their receptor competency, and accelerates the rate of follicular atresia. Pregnant rats were fed isocaloric food-pellets supplemented with or without 35% D-galactose from day-3 of gestation and continuing through weaning of the litters. The 35-day old female litters were autopsied. Serum galactose-binding capacity, galactosyltransferase (GalTase) activity, and bioactivity of FSH and LH together with their receptor competency were assessed. Ovarian follicular atresia was evaluated in situ by TUNEL. The in vitro effects of galactose were studied in isolated whole follicles in respect of generation of reactive oxygen species (ROS) and expression of caspase 3, and in isolated granulosa cells in respect of mitochondrial membrane potential, expression of p53, and apoptosis. The rats prenatally exposed to galactose exhibited significantly decreased serum GalTase activity and greater degree of galactose-incorporation capacity of sera proteins. LH biopotency and LH-FSH receptor competency were comparable between the control and study population, but the latter group showed significantly attenuated FSH bioactivity and increased rate of follicular atresia. In culture, galactose increased follicular generation of ROS and expression of caspase 3. In isolated granulosa cells, galactose disrupted mitochondrial membrane potential, stimulated p53 expression, and induced apoptosis in vitro; however co-treatment with either FSH or estradiol significantly prevented galactose-induced granulosa cell p53 expression. We conclude that the ovotoxic effects of galactose involves attenuation of FSH bioactivity that renders the ovary resistant to gonadotrophins leading to increased granulosa cell expression of p53 and follicular atresia.

Primordial germ cell migration in the rat: preliminary evidence for a role of galactosyltransferase.

The precise cellular mechanism of primordial germ cell (PGC) migration remains unknown. Cell surface galactosyltransferase (GalTase) is known to play unique roles in the process of locomotion of many migratory cells. With an objective to seek evidence for possible involvement of GalTase in the migratory process of PGC, we evaluated germ cell migration in the rat following experimental modulation of embryonic GalTase activity. Pregnant rats were laparotomized under anesthesia on Day 10 of pregnancy. While embryos of one uterine horn received lysozyme (100 microg/fetus), those of the other received alpha-lactalbumin (LA; 100 microg/fetus), N-acetylglucosamine (GlcNAc; 250 nmole/fetus), uridine 5'-monophosphate (UMP; 2.5 micromole/fetus), uridine diphosphate-galactose (UDP-gal; 250 nmole/fetus), or a combination of 250 nmole of UDP-gal and 2.5 micromole of UMP/fetus. Between gestation Days 12 and 14, embryos were dissected out and processed for histochemical localization of PGC on the basis of binding of Dolichos biflorus agglutinin on the surface glycoconjugate of the germ cells. The number of PGC in each embryo was counted. There was a daywise increase in the number of PGC in all groups. As compared with lysozyme-exposed controls, the numbers of PGCs at the day-specific sites on all days of examination were significantly lower in the LA- as well as GlcNAc-exposed groups. UMP or UDP-gal individually exerted little or no influence, while the total PGC count rose significantly over the respective control values under simultaneous exposure to UMP and UDP-gal. The present findings suggest a likely catalytic role of GalTase in the process of germ cell migration.

Entomophthoromycosis in South Bengal (Eastern India): a 9 years study.

Subcutaneous mycoses caused by the family Entomophthoraceae is very rare type of disease and is being reported sporadically from various Tropical countries including India. Here we report 8 cases of rhinoentomophthoromycosis caused by Conidiobolous coronatus and 7 cases of chronic subcutaneous phycomycosis caused by Basidiobolus ranarum. Cases were detected during a span of 9 years between 1991 to 1999, from 9 districts in and around Kolkata (Eastern India). Former type of lesions were detected among 20 to 65 age group of healthy individuals, predominantly males (7:1). In the latter type, male-female ratio was 2:5, and except for one all cases belonged to below 20 years age group of healthy individuals. Several cases were detected only after examination of repeat biopsy samples. With high degree of clinical suspicion, right approach is needed for laboratory confirmation of diagnosis.