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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2021: 3886-3889, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34892081

RESUMO

Malnutrition is a global health crisis and is a leading cause of death among children under 5 years. Detecting malnutrition requires anthropometric measurements of weight, height, and middle-upper arm circumference. However, measuring them accurately is a challenge, especially in the global south, due to limited resources. In this work, we propose a CNN-based approach to estimate the height of standing children under 5 years from depth images collected using a smartphone. According to the SMART Methodology Manual, the acceptable accuracy for height is less than 1.4 cm. On training our deep learning model on 87131 depth images, our model achieved a mean absolute error of 1.64% on 57064 test images. For 70.3% test images, we estimated height accurately within the acceptable 1.4 cm range. Thus, our proposed solution can accurately detect stunting (low height-for-age) in standing children below 5 years of age.

3.
J Clin Exp Hepatol ; 11(5): 565-572, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34511817

RESUMO

Background: The occurrence of acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) negatively impacts the survival of patients. There are scant data on the impact of serum urea on outcomes in these patients. We performed this study to evaluate the relationship between admission serum urea and the survival in patients with ACLF and AKI. Methods: A prospective study was conducted on patients with ACLF (as per Asian Pacific Association for the Study of the Liver criteria) and AKI (as per Acute Kidney Injury Network criteria) hospitalized in the gastroenterology ward between October 2016 and May 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared in patients with respect to the admission serum urea level. Results: A total of 103 of 143 hospitalized patients with ACLF had AKI and were included as study subjects. The discrimination ability between survivors and the deceased was similar for serum urea levels (area under the receiver operating characteristic curve [AUROC] [95% confidence interval {CI}]: 28 days survival, 0.76 [0.67-0.85]; 90 days survival, 0.81 [0.72-0.91]) and serum creatinine levels (AUROC [95% CI]: 28 days survival, 0.75 [0.66-0.84]; 90 days survival: 0.77 [0.67-0.88]) in patients with ACLF and AKI. However, on multivariate analysis, admission serum urea (not serum creatinine) was an independent predictor of mortality in these patients both at 28 days (p = 0.001, adjusted hazard ratio [AHR]: 1.013 [1.005-1.021]) and 90 days (p = 0.001, AHR: 1.014 [1.006-1.022]). Conclusion: Over two-thirds of patients with ACLF had AKI. The discrimination ability between survivors and the deceased was similar for both serum urea and serum creatinine levels. However admission serum urea was found to be a better predictor of mortality than serum creatinine in patients with ACLF and AKI.

5.
J Family Med Prim Care ; 10(4): 1515-1519, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34123884

RESUMO

The concept of Herd immunity is a key factor for epidemic control. According to it only a proportion of entire population needs to be immune either via natural infection or vaccination. The idea of herd immunity via natural infection rather than vaccination is a bit controversial, as it is not clear how long will the antibodies last, and whether re-infection or re-activation of the virus can occur after the antibodies starts weaning from the body. It has been suggested that coronavirus will likely become similar to a seasonal flu once the herd immunity is attained. Till then, it will continue causing outbreaks year-round and there could be multiple waves of virus transmission before achieving herd immunity. Therefore, the public needs to learn to live with it, and continue practising the best prevention measures, including wearing of masks, physical distancing, hand hygiene, and avoidance of gathering.

7.
J Family Med Prim Care ; 9(4): 1792-1794, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32670918

RESUMO

With declaration of 2019 novel coronavirus disease (COVID-19) as a pandemic on 11 March 2020 by World Health Organization, India came to alert for its being at next potential risk. It reached alert Level 2, i.e. local transmission for virus spread in early March 2020 and soon thereafter alert Level 3, i.e. community transmission. With on-going rise in COVID-19 cases in country, Government of India (GoI) has been taking multiple intense measures in coordination with the state governments, such as urban lockdown, active airport screening, quarantining, aggressive calls for 'work from home', public awareness, and active case detection with contact tracing in most places. Feedback from other countries exhibits COVID-19 transmission levels to have shown within country variations. With two-third of Indian population living in rural areas, present editorial hypothesizes that if India enters Level 3, rural hinterland would also be at risk importation (at least Level 1). Hence, we have to call for stringent containment on rural-urban and inter-state fringes. This along with other on-going measures can result in flattening curve and also in staggering 'lockdowns', and thus, helping sustain national economy.

9.
Ther Apher Dial ; 24(6): 725-730, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31951077

RESUMO

Therapeutic plasma exchange (TPE) disturbs the pH and electrolyte status. This study aimed to analyze the changes in pH, ionized calcium (iCa), sodium (Na), potassium (K), and bicarbonate (HCO3 ) of patients undergoing TPE and factors affecting these changes. The study included patients (age > 16 years) undergoing TPE from July 2016 to August 2017. Data on patient demographics, TPE procedures, pre-, and immediate post-TPE blood gas analysis values and adverse events during TPE were collected. A statistical analysis of the data was done to determine changes in pH and electrolytes and the factors affecting them. The changes in iCa, Na, and K due to the procedure were found to be statistically significant (P < .001). The changes in systolic (P = .010) and diastolic (P = .001) blood pressure during the procedure were significant. The predictors for the change in iCa were pre-procedure iCa (P < .001), age of the patient (P < .001), and the pre-procedure pH (P = .002). Complications related to hypocalcemia occurred in 12% of the TPE procedures. Hypocalcemic manifestations did not show any significant association with pre-procedure iCa levels, change in iCa levels during the procedure and age or gender of the patient. TPE induces marked changes in electrolytes but these changes are transient and do not warrant any intervention. The correction of iCa levels pre-TPE and continuous infusion of calcium during the procedure helps prevent marked fluctuations in iCa levels. This does not eliminate risks of hypocalcemia. Vigilance and preparedness to deal with complications related to hypocalcemia is the best strategy.


Assuntos
Concentração de Íons de Hidrogênio , Hipocalcemia , Hepatopatias , Troca Plasmática , Desequilíbrio Hidroeletrolítico , Adulto , Gasometria/métodos , Gasometria/estatística & dados numéricos , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Índia/epidemiologia , Hepatopatias/sangue , Hepatopatias/epidemiologia , Hepatopatias/terapia , Masculino , Troca Plasmática/efeitos adversos , Troca Plasmática/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia
10.
J Glob Health ; 9(2): 020701, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673343

RESUMO

Background: Millennium Development Goal 4 (MDGs) mobilised countries to reduce child mortality by two thirds the 1990 rate in 2015. While India did not reach MDG 4, it considerably reduced child mortality in the MDG-era. Efficient and targeted interventions and adequate monitoring are necessary to further progress in improvements to child health. Looking forward to the Sustainable Development Goal (SDG)-era, the Indian Council of Medical Research and The INCLEN Trust International conducted a national research priority setting exercise for maternal, child, newborn health, and maternal and child nutrition. Here, results are reported for child health. Methods: The Child Health and Nutrition Research Initiative (CHNRI) method for research priority setting was employed. Research ideas were crowd-sourced from a network of child health experts from across India; these were refined and consolidated into research options (ROs) which were scored against five weighted criteria to arrive weighted Research Priority Scores (wRPS). National and regional priority lists were prepared. Results: 90 experts contributed 596 ideas that were consolidated into 101 research options (ROs). These were scored by 233 experts nationwide. National wRPS for ROs ranged between 0.92 and 0.51. The majority of the top research priorities related to development of cost-effective interventions and their implementation, and impact evaluations, improving data quality; and monitoring of existing programs, or improving the management of morbidities. The research priorities varied between regions, the Economic Action Group and North-Eastern states prioritised questions relating to delivering interventions at community- or household-level, whereas the North-Eastern states and Union Territories prioritised research questions involving managing and measuring malaria, and the Southern and Western states prioritised research questions involving pharmacovigilance of vaccines, impact of newly introduced vaccines, and delivery of vaccines to hard-to-reach populations. Conclusions: Research priorities varied geographically, according the stage of development of the area and mostly pertained to implementation sciences, which was expected given diversity in epidemiological profiles. Priority setting should help guide investment decisions by national and international agencies, therefore encouraging researchers to focus on priority areas. The ICMR has launched a grants programme for implementation research on maternal and child health to pursue research priorities identified by this exercise.


Assuntos
Pesquisa Biomédica/organização & administração , Saúde da Criança , Pesquisa/organização & administração , Criança , Humanos , Índia
11.
Ther Apher Dial ; 23(1): 86-91, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30125463

RESUMO

The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t-test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti-A (128) and anti-B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti-A and anti-B titers. Average agreements between the DTT-applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti-A (κ = 0.473) and anti-B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.


Assuntos
Sistema ABO de Grupos Sanguíneos , Rejeição de Enxerto , Testes Imunológicos/métodos , Transplante de Rim/efeitos adversos , Reação Transfusional , Sistema ABO de Grupos Sanguíneos/análise , Sistema ABO de Grupos Sanguíneos/imunologia , Adulto , Anticorpos/sangue , Incompatibilidade de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos/prevenção & controle , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Transplante de Rim/métodos , Masculino , Reprodutibilidade dos Testes , Reação Transfusional/imunologia , Reação Transfusional/prevenção & controle
12.
PLoS Med ; 15(7): e1002615, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30040859

RESUMO

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Distribuição por Idade , Criança , Comportamento Infantil , Desenvolvimento Infantil , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/fisiopatologia , Transtornos do Neurodesenvolvimento/psicologia , Prevalência , Medição de Risco , Fatores de Risco
13.
Indian J Med Res ; 145(5): 611-622, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28948951

RESUMO

In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes.


Assuntos
Pesquisa Biomédica/tendências , Saúde da Criança/tendências , Saúde Materna/tendências , Estado Nutricional/fisiologia , Criança , Feminino , Prioridades em Saúde/tendências , Humanos , Índia/epidemiologia , Recém-Nascido , Gravidez
14.
J Glob Health ; 7(1): 011003, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28686749

RESUMO

BACKGROUND: Health research in low- and middle- income countries (LMICs) is often driven by donor priorities rather than by the needs of the countries where the research takes place. This lack of alignment of donor's priorities with local research need may be one of the reasons why countries fail to achieve set goals for population health and nutrition. India has a high burden of morbidity and mortality in women, children and infants. In order to look forward toward the Sustainable Development Goals, the Indian Council of Medical Research (ICMR) and the INCLEN Trust International (INCLEN) employed the Child Health and Nutrition Research Initiative's (CHNRI) research priority setting method for maternal, neonatal, child health and nutrition with the timeline of 2016-2025. The exercise was the largest to-date use of the CHNRI methodology, both in terms of participants and ideas generated and also expanded on the methodology. METHODS: CHNRI is a crowdsourcing-based exercise that involves using the collective intelligence of a group of stakeholders, usually researchers, to generate and score research options against a set of criteria. This paper reports on a large umbrella CHNRI that was divided into four theme-specific CHNRIs (maternal, newborn, child health and nutrition). A National Steering Group oversaw the exercise and four theme-specific Research Sub-Committees technically supported finalizing the scoring criteria and refinement of research ideas for the respective thematic areas. The exercise engaged participants from 256 institutions across India - 4003 research ideas were generated from 498 experts which were consolidated into 373 research options (maternal health: 122; newborn health: 56; child health: 101; nutrition: 94); 893 experts scored these against five criteria (answerability, relevance, equity, innovation and out-of-box thinking, investment on research). Relative weights to the criteria were assigned by 79 members from the Larger Reference Group. Given India's diversity, priorities were identified at national and three regional levels: (i) the Empowered Action Group (EAG) and North-Eastern States; (ii) States and Union territories in Northern India (including West Bengal); and (iii) States and Union territories in Southern and Western parts of India. CONCLUSIONS: The exercise leveraged the inherent flexibility of the CHNRI method in multiple ways. It expanded on the CHNRI methodology enabling analyses for identification of research priorities at national and regional levels. However, prioritization of research options are only valuable if they are put to use, and we hope that donors will take advantage of this prioritized list of research options.


Assuntos
Saúde da Criança , Saúde do Lactente , Saúde Materna , Ciências da Nutrição , Pesquisa/organização & administração , Criança , Feminino , Humanos , Índia , Recém-Nascido , Gravidez
15.
Ann N Y Acad Sci ; 1331: 119-141, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25294668

RESUMO

This paper introduces convergent innovation (CI) as a form of meta-innovation-an innovation in the way we innovate. CI integrates human and economic development outcomes, through behavioral and ecosystem transformation at scale, for sustainable prosperity and affordable universal health care within a whole-of-society paradigm. To this end, CI combines technological and social innovation (including organizational, social process, financial, and institutional), with a special focus on the most underserved populations. CI takes a modular approach that convenes around roadmaps for real world change-a portfolio of loosely coupled complementary partners from the business community, civil society, and the public sector. Roadmaps serve as collaborative platforms for focused, achievable, and time-bound projects to provide scalable, sustainable, and resilient solutions to complex challenges, with benefits both to participating partners and to society. In this paper, we first briefly review the literature on technological innovation that sets the foundations of CI and motivates its feasibility. We then describe CI, its building blocks, and enabling conditions for deployment and scaling up, illustrating its operational forms through examples of existing CI-sensitive innovation.


Assuntos
Agricultura/métodos , Atenção à Saúde/tendências , Desenvolvimento Econômico , Comércio , Comportamento Cooperativo , Técnicas de Apoio para a Decisão , Economia Médica , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde , Modelos Econômicos , Modelos Organizacionais , Inovação Organizacional , Setor Público
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