McNemar Chi Research Articles

Abstract 18268: Angina and Functional Capacity Among Women Presenting With Angina and Non-Obstructive Coronary Disease

Introduction: Approximately 75% of women that undergo coronary angiography for angina do not have obstructive disease. However, a significant number have persistent angina, which can reduce their functional capacity and performance, impacting patients’ quality of life. There is a need for further studies that accurately compare angina and functional capacity among women angina with non-obstructive coronary disease (ANOCA). Objective: We examined the association between perceived anginal symptoms and functional capacity in patients with ANOCA Methods: A the Women’s Heart Center at the Christ Hospital, all women completed the Duke Activity Status Index (DASI) and Seattle Angina Questionnaire-7 (SAQ7) at the initial visit. DASI score range from 0 to 58.2 and assess functional capacity using self-assessment and VO2 peak formula with higher scores indicating better functional capacity. SAQ7 assesses angina symptoms, physical limitation, and quality of life; the score is from 0-100, where a lower score indicates a higher frequency of angina, increased physical limitation, and poor quality of life. DASI and SAQ7 scores were correlated. Sperman correlation and Mcnemar chi-square were used to compare DASI and SAQ7 score results. Results: Among 225 women with ANOCA, the mean DASI score was 16.73, and the mean SAQ7 score was 43.79. 63.1% reported a low score of SAQ7, and 79.6% reported a low DASI score. SAQ7 and DASI were moderately correlated (Spearman correlation of +0.42). Further analysis with McNemar chi- square showed that women with lower SAQ7 (score 0-49.4) tends to corresponds with low DASI (score 0-24.5) (Specificity 86.6%), compared to women with higher SAQ7 (score 49.5-100) and high DASI (score 24.6-58.2) (Sensitivity 32.5%) (p<0.001). Discussion: Anginal symptoms are correlated with reduced functional capacity among women with ANOCA. Further prospective studies are needed to evaluate the correlation between angina improvement and functional capacity.

Comparison of standard T2-weighted turbo spin echo and volumetric interpolated breath-hold examination magnetic resonance imaging sequences in the assessment of articular process dysplasia in Pug dogs with thoracolumbar myelopathy.

A retrospective study to compare the classification, as normal, hypoplastic or aplastic, of thoracic (T10-T13) caudal articular process (CAP) morphology in Pug dogs with a thoracolumbar myelopathy as normal, hypoplastic or aplastic, between T2 weighted Turbo Spin Echo (T2W-TSE), in sagittal and transverse planes, and Volumetric Interpolated Breath-hold Examination (VIBE) Magnetic Resonance Imaging (MRI) sequences, in comparison to Computed Tomography (CT). We hypothesized a stronger agreement for VIBE in comparison to T2W-TSE. Diagnostic accuracy of T2W-TSE was inferior to VIBE for aplastic (60%, 95% CI 0.561-0.639 vs. 78%, 95%CI 0.744-0.815) hypoplastic (44%, 95%CI 0.427-0.452 vs. 62.5%, 95%CI 0.595-0.655) and normal CAP (70%, 95%CI 0.655-0.744 vs. 87%, 95%CI 0.848-0.892). Superior accuracy of classification using VIBE vs. T2W-TSE sequences using the McNemar Chi squared test was significant for aplastic (p = 0.0002) and normal CAP (p = 0.004). VIBE sequences had a sensitivity of 96% and specificity of 75% to detect CAP abnormality and with T2W-TSE imaging sensitivity 81% and specificity of 75%. Three-dimensionally reconstructable VIBE sequences were significantly more accurate than traditional T2W-TSE MRI sequences in classifying CAP morphology, which should reduce the need for CT for pre-operative assessment.

CHEMOTHERAPY INDUCED HISTOPATHOLOGICAL CHANGES IN MASTECTOMY SPECIMENS - STUDY AT A TERTIARY CARE CENTRE

Background: Pathological complete response (pCR) to Neo adjuvant chemotherapy (NACT) is a signicant prognostic marker in breast cancer, so accurate diagnosis and grading of pathological chemo response of tumour is needed for an effective planning of treatment regimen. To study the various histopathological Aims: changes in Mastectomy specimens following NACT and to evaluate the pathological response of tumour to NACT, also to compare the expression of ER, PR, and HER2 in biopsies and post NACT mastectomy specimens by Immunohistochemistry (IHC). Methods And Materials: 50 breast carcinoma cases, who was diagnosed on trucut biopsies and treated with preoperative NACT followed by mastectomy was included. In post NACT mastectomy specimens, the chemoresponse was classied according to Union for International Cancer Control (UICC) guidelines. ER, PR, and HER2/ neu receptor expression was compared between trucut biopsy specimens (pre- NACT) and resection specimens (post- NACT). Results were analysed by Chi square test and McNemar chi square test. Among 50 cases, patients presented with lump, Results: involved more on the right and in upper outer quadrant. Most common stage at presentation is stage III A. Histologically all belong to IDCC -NST histological subtype. Signicant reduction in mean tumour size by 52.7% after NACT was observed. pCR, pPR and pNR was observed in 20 %, 58 % and 22 %of the cases respectively. Most common histological change seen in post NACT is necrosis, desmoplasia, brosis, lymphocytic inammatory response. Discordance in ER expression (17.5 %), PR expression (20%) and HER2 /neu (12.5 %) before and after NACT. But these were statistically insignicant. CONCLUSIONS: Pathological evaluation of chemo response of tumour is the gold standard. The discordance rate of ER, PR and HER-2/neu expression following NACT was statistically insignicant, larger studies needed to analyse their impact in patient management.

ODP414 Incidence of Suicidal Events in Transgender Patients with Initiation of Gender Affirming Hormone Therapy

Abstract Objectives Our study aims to evaluate objective markers of suicidal events to further evaluate the relationship between incidence of suicidal events and initiation of gender affirming hormone therapy (HT). Introduction Transgender individuals are at higher risk for suicide compared with non-transgender individuals. Previous studies have revealed that a much higher percentage (18–45%) of transgender persons have attempted suicide in their lifetime, compared with the general population (4.6%). Methods We performed a retrospective chart review of adults at the local Veterans Administration (VA) from January 1, 2008 to December 31, 2020 of patient charts that include ICD-9 and ICD-10 code of F64. X, transgender, male-to-female transgender, female-to-male transgender, gender dysphoria, gender identity disorder, non-binary. Charts were reviewed for incidences of suicidal events defined as requiring hospitalizations, mental health crisis interventions, suicide attempts, and suicide completion. Charts were also reviewed for HT initiation, and mental health medication prescriptions. Data was compared using McNemar's Test or Chi Squared as appropriate. Results 106 patients were found with the ICD codes with an average age of 50 years (standard deviation (SD) 15). Of those, 93 (88%) have previously been prescribed or are currently prescribed HT with an average age of initiation of 41 years (SD 14). Among all patients studied 98 (92%) were diagnosed with a mental health disorder, 57 (54%) had a history of suicidal event, and 50 (47%) had history of mental health medication prescription. Of persons on HT 49 (53%) had a suicidal event prior to the initiation of hormone therapy compared with 31 (33%) who had suicidal events after initiation of HT which was statistically significant (p<0. 001). The most common suicidal event was hospitalization (41), followed by crisis interventions (27), suicide attempt (3), and suicide completion (1). Of all patients on HT: 39 (42%) had no suicidal events pre or post-HT, 5 (5%) had no suicidal events pre-HT but did have suicidal events post-HT, 23 (25%) had suicidal events pre-HT and no suicidal events post-HT, and 26 (28%) had suicidal events pre and post-HT (p<0. 001). Conclusions Among transgender patients at our local VA on HT the incidence of suicidal event prior to initiation of HT was higher than that after initiation of HT. History of suicidal event prior to initiation of HT predicted future incidence of suicidal event after initiation of HT. Potential confounders include mental health evaluation and treatment prior to initiation of HT, limited duration of follow up, age at HT initiation, and initiation of new mental health medication prescriptions.

Life in lockdown: a longitudinal study investigating the impact of the UK COVID-19 lockdown measures on lifestyle behaviours and mental health

BackgroundThe COVID-19 pandemic led to the UK government enforcing lockdown restrictions to control virus transmission. Such restrictions present opportunities and barriers for physical activity and healthy eating. Emerging research suggests that in the early stages of the pandemic, physical activity levels decreased, consumption of unhealthy foods increased, while levels of mental distress increased. Our aims were to understand patterns of diet, physical activity, and mental health during the first lockdown, how these had changed twelve-months later, and the factors associated with change.MethodsAn online survey was conducted with UK adults (N = 636; 78% female) during the first national lockdown (May–June 2020). The survey collected information on demographics, physical activity, diet, mental health, and how participants perceived lifestyle behaviours had changed from before the pandemic. Participants who provided contact details were invited to complete a twelve-month follow-up survey (May–June 2021), 160 adults completed the survey at both time-points. Descriptive statistics, T-tests and McNemar Chi Square statistics were used to assess patterns of diet, physical activity, and mental health at baseline and change in behaviours between baseline and follow-up. Linear regression models were conducted to explore prospective associations between demographic and psycho-social variables at baseline with change in healthy eating habit, anxiety, and wellbeing respectively.ResultsBetween baseline and follow-up, healthy eating habit strength, and the importance of and confidence in eating healthily reduced. Self-rated health (positively) and confidence in eating healthily (negatively) were associated with change in healthy eating habit. There were no differences between baseline and follow-up for depression or physical activity. Mean anxiety score reduced, and wellbeing increased, from baseline to follow-up. Living with children aged 12–17 (compared to living alone) was associated with an increase in anxiety, while perceiving mental health to have worsened during the first lockdown (compared to staying the same) was associated with reduced anxiety and an increase in mental wellbeing.ConclusionsWhile healthy eating habits worsened in the 12 months since the onset of the pandemic, anxiety and mental wellbeing improved. However, anxiety may have increased for parents of secondary school aged children.

Predisposing factors involved in the aetiology of Molar Incisor Hypomineralization: a case-control study.

The aetiology of Molar Incisor Hypomineralisation (MIH) is currently unclear. Over time, several aetiological hypotheses have come forward, including pre- and perinatal medical problems and postnatal illness. The aim of this case-control study is the identification of possible predisposing factors involved in MIH aetiology. Methods Study Design: By hypothesising the probability of at least one predisposing factor present 2.5 times more in MIH cases than in controls, with an estimated prevalence of MIH patients requiring therapy equal to 30%, at a unilateral alpha level of 5% and a power of 80%, 63 couples of subjects are needed with an allocation ratio of 1:1; individual matching for age and gender was carried out. After clinical examination, 78 children with MIH (EAPD criteria) were recruited (mean age 9.36 years). An anamnestic form filled-in by a parent was used to collect data on possible predisposing factors including demographic characteristics, pregnancy, birth, childhood medical illness and medications' intake. One-tail McNemar chi square test was used to evaluate the significance of the association between predisposing factor and MIH; odds ratio and 95% confidence intervals were computed. A multifactorial aetiology may be advocated for MIH development; in particular, further investigations are required to confirm and clarify the role of genetic factors.

Performance of loop-mediated isothermal amplification assay for diagnosis of extrapulmonary tuberculosis and antituberculosis treatment initiation.

Extra-pulmonary TB(EPTB) accounts for 15-20% of total TB cases in India. Many cases remain undiagnosed due to poor sensitivity/long turn-around-time of conventional diagnostic tests. Molecular tests offer rapidity, improved sensitivity and exquisite specificity, but are expensive, require skilled manpower and enhanced laboratory infrastructure. Loop-mediated isothermal amplification (LAMP) assay is a unique, temperature-independent DNA amplification test facilitated by visual optic-readout. WHO has recommended use of LAMP for pulmonary TB diagnosis in 2016. For END-TB strategy to succeed, its necessary to capture all forms of TB. The aim of the study was to determine the sensitivity and specificity of LAMP assay against culture, Xpert MTB/RIF assay and Composite Reference Standard(CRS) for diagnosis of EPTB. In a cross-sectional study hundred consecutive EPTB specimens were processed for microscopy, culture, Xpert and LAMP assay. Standard formulae of sensitivity and specificity and McNemar chi square test of significance was applied. Hundred specimens included in the study were fluids(65), pus(19) and tissue(16). TB was detected in 38 specimens by any of the four methods. Positivity of microscopy-5%, culture-28%, Xpert-25% and LAMP-32%. Sensitivity and specificity of LAMP against culture was 85.71% and 88.89%; against Xpert was 88% and 86.67%; against CRS was 80% and 88.6% respectively. LAMP detected TB in 32 patients of which 28 were put on anti-TB treatment (ATT). Of the 62 patients with negative results in all the tests, 22 were put on ATT. LAMP has good sensitivity for EPTB diagnosis. Further studies are required to establish utility of LAMP as EPTB diagnostic tool.

Role of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Clinically Suspected Cholesteatoma Cases.

To analyze the apparent diffusion coefficient (ADC) values of middle ear and mastoid lesions in Diffusion weighted Magnetic Resonance Imaging (DW-MRI) to arrive at a probable demarcating value to differentiate cholesteatoma from non-cholesteatomatous lesions. Accurate anatomic localization of the lesion was also done using High Resolution Computed Tomography (HRCT) temporal bone. The study cohort consisted of 30 patients who had undergone HRCT, DW-MRI and surgical intervention in clinically suspected cholesteatomatous lesions during the period August 2018 to August 2020.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy values of HRCT and MRI in relation to intraoperative findings and histopathological findings (gold standard) were calculated and compared using the 2-sided McNemar's Chi Square test. Receiver operating characteristic (ROC) curve was used to predict the cut off value of ADC to differentiate between cholesteatoma and non cholesteatomatous lesions. Total patients were 30 out of which 15 were histopathologically proven cholesteatoma. MR DWI showed 100% sensitivity, 80% specificity, and 90% accuracy in diagnosing cholesteatoma compared to HPE. The probable cut off value of ADC in differentiating cholesteatoma from non-cholesteatomatous lesions was found to be < 1.226 × 10-3 mm2/s, statistically using ROC curve. HRCT showed 96.6% accuracy in identifying the location of the lesion. MR-DWI is a useful tool both individually and in combination with HRCT in the diagnosis of cholesteatomas with high accuracy. An ADC cut-off value could also significantly help increase the accuracy of diagnosis.

Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study.

BackgroundMobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn’s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh.ObjectiveThe aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up.MethodsWe conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test.ResultsOverall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of participants with correct knowledge significantly increased for all but one MNCH measure at follow up.ConclusionsThis assessment indicates that the pilot MAMA program is feasible and acceptable in the Afghan context. Further research should be conducted to determine whether program participation leads to improved MNCH knowledge, health practices, and health service utilization in this fragile setting prior to larger scale up.

Evaluation of a Crib Distribution and Safe Sleep Educational Program to Reduce Risk of Sleep-Related Infant Death.

To increase access to safe infant sleep surfaces and reduce risk of sleep-related infant deaths, the Georgia Department of Public Health implemented a portable crib distribution and safe sleep educational program. The aim of this evaluation was to compare parental knowledge and practices related to infant sleep before and after receipt of the safe sleep educational program and crib. A prospective, matched pre- and post-test cohort design with a follow-up survey was utilized to evaluate changes in knowledge and practices. Female participants were recruited through the county health department and met the following criteria: (1) between 32 and 40 weeks pregnant or within 3 months postpartum, and (2) demonstrated financial need. Participants completed a survey prior to the start of a group educational program and upon program completion. For those who agreed, a follow-up phone survey was conducted approximately 10 weeks after program completion or after the infant's birth. McNemar's Chi square tests were conducted to detect significant differences between specific items on pre-test, post-test, and follow-up surveys, and paired sample t tests were conducted to compare differences in knowledge and practice scores. A total of 132 participants completed matched pre- and post-test surveys and 76 completed follow-up surveys. Knowledge of recommendations regarding position, surface, environment, smoking, breastfeeding, and pacifier use increased significantly between pre- and post-test, with most participants maintaining knowledge at follow-up. The proportion of recommended practices also increased significantly. A group-based safe sleep educational program can be effective in reducing risky infant sleep practices.

Pengaruh Pemberian Pendidikan Kesehatan dengan Media Kalender “PINTARE” (Pintar Atasi Diare) dalam Meningkatkan Pengetahuan dan Keterampilan Ibu Tentang Tatalaksana Diare Balita Usia 1-4 Tahun (Studi Kasus di Wilayah Posyandu Desa Growong Lor Kecamatan

Central Java is one of the provinces with a toddler diarrhea outbreaks in 2014 with 35 cases, one of them died. Central Java province each year, an average is above 40%. Scope discovery and treatment of diarrhea in Central Java province in 2015 amounted to 57.9%. Pati Regency found the incidence of diarrhea in children under five is high enough. According to the data of Central Java province in 2014 ranked Pati regency had diarrhea for 18 of the 35 counties and cities in Central Java. This study aims to provide health education and increasing knowledge and skills of mothers and children against diarrheal diseases with the media calendar. This research is a Quasi Experiment design with non-equivalent control group design. Samples in this study of 40 people, with 20 as the experimental samples and 20 as a control sample. The analysis is the analysis of univariate and bivariate analysis which using mc-Nemar test and Chi square test. The results showed that; 1) there is a significant difference in the mother's knowledge regarding the treatment of diarrhea among children aged 1-4 years were given health education with the calendar media and without media calendar (p = 0.011, α = 0.05), 2) there is a difference meaningful skills of mothers about the treatment of diarrhea among children aged 1-4 years were given health education with the calendar media and without media calendar (p = 0.010, α = 0.05). Based on these results it can be concluded that health education is effective in increasing knowledge and skills about the treatment of diarrhea mothers of children aged 1-4 years. Keywords : Health Education, Knowledge, Skills, Diarrhea

Canine Monocytic Ehrlichiosis among working dogs of organised kennels in India: A comprehensive analyses of clinico-pathology, serological and molecular epidemiological approach

Canine Monocytic Ehrlichiosis (CME) is a serious tick-borne rickettsial disease affecting canine populations globally. Besides few reports from stray and pet dogs from localised geographical regions (cities/towns/small states), a comprehensive study on prevalence of Ehrlichia canis (E. canis) among working dogs from different geo-climatic zones of India was pertinently lacking. Study of CME among these dog populations was thus carried out, encompassing clinical aspects and different diagnostic methodologies viz., microscopy, serology and molecular biology. During the two-year study period, clinical specimens from 225 cases suspected of canine ehrlichiosis were examined for clinical pathology and presence of the haemoparasites. Overall prevalence of ehrlichiosis by microscopic examination, commercial dot-ELISA kit and nested PCR assay was estimated to be 1.3%, 19.1% and 5.8%, respectively, which were found to be statistically significant by McNemar Chi squared test (p<0.05). It was also observed that possibly due to widespread use of doxycycline therapy in field, CME presently does not remain a potential threat which it uses to pose earlier. However, concurrent infections of E. canis and Babesia gibsoni were found to be mostly fatal. Keeping in view of high number of apparently healthy dogs (24) out of total positive cases (46) observed during the study, it is recommended that prevalence studies on CME should also involve screening of apparently healthy dogs. Phylogenetic analysis carried on partial sequencing of 16S rRNA of E. canis strains revealed that all of the Indian strains clustered in a single clade with other E. canis species from India and rest of the world. Molecular divergence was observed among the sequences of Brazilian and American isolates which were also included in the present study. These findings have thus opened a new paradigm for planning of pragmatic control strategies against CME.

Dynamic Video Endoscopyin Eustachian tube dysfunction: is it better than impedance audiometry

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

Dynamic Video Endoscopyin Eustachian tube dysfunction: is it better than impedance audiometry

Objectives: 1. To find out which among dynamic slow motion video endoscopy (DSVE) and impedance audiometry is a better investigation for diagnosis of Eustachian tube dysfunction in the cases of middle ear disorders. 2. To correlate the Eustachian dysfunction with nasal pathology.Material and methods:  A case control study done on a total of 84 patients (168 ears) where ear complaints either unilateral or bilateral (total 95 ears) having middle ear disease were taken as cases. Patients without any ear and nasal complaints and normal ears of the case group were taken as controls (total 73 ears). DSVE was performed in cases and controls to compare the incidence of Eustachian dysfunction in the two groups. Impedance audiometry was performed in all cases by William’s or Toynbee’s test, depending on the presence of perforation. Nasal pathologies were identified by endoscopy or CT-scan.Results: On comparing DSVE findings with impedance audiometry, a strong association was found by applying Mc Nemar Chi square test. However, no significant correlation was found between results obtained on impedance audiometry with middle ear disease. In the mechanical type of dysfunction, we found nasal, paranasal or nasopharyngeal pathology in all the cases. In unilateral otitis media, the contralateral healthy ear was also associated with Eustachian dysfunction.Conclusion: DSVE is a better investigation than impedance audiometry for diagnosing Eustachian dysfunction in cases of chronic otitis media, especially the functional type. Nasal, paranasal or nasopharyngeal pathologies should be looked for in all cases of mechanical type of dysfunction and adequately addressed.

Factors associated with neonatal deaths in Chitwan district of Nepal.

BackgroundNeonatal mortality has remained unchanged since 2006 in Nepal. Reducing neonatal mortality is indispensable to reduce child mortality. The objective of this study was to investigate the factors associated with neonatal mortality. This study assesses socio-demographic factors, maternal health care and newborn care practices contributing to neonatal deaths in Chitwan district of Central Nepal.MethodsA case–control study was conducted during April–July 2012. The study used a mixed-method approach, in which records of neonatal deaths were obtained from the District Public Health Office and a comparison group, survivors, was obtained from the same community. A total of 198 mothers (of 99 neonatal deaths and 99 survivor neonates) were included in the survey. Focus group discussions, in-depth interviews and case studies were also conducted. Maternal characteristics were analyzed using descriptive statistics, Mc Nemar’s Chi square test and multivariable backward conditional logistic regression analysis. Qualitative data were analyzed by narrative analysis method.ResultsMore than four-fifth of mothers (86 %) had antenatal check-up (ANC) and the proportion of four or more ANC was 64 %. Similarly, the percentage of mothers having institutional delivery was 62 %, and postnatal check-up was received by 65 % of mothers. In multivariable analysis, low birth weight [adjusted odds ratio: 8.49, 95 % CI (3.21–22.47)], applying nothing on cord [adjusted odds ratio: 5.72, 95 % CI (1.01-32.30)], not wrapping of newborn [adjusted odds ratio: 9.54, 95 % CI (2.03–44.73)], and no schooling of mother [adjusted odds ratio: 2.09, 95 % CI (1.07–4.11)] were significantly associated with an increased likelihood of neonatal mortality after adjusting for other confounding variables. Qualitative findings suggested that bathing newborns after 24 h and wrapping in clean clothes were common newborn care practices. The mothers only attended postnatal care services if health problems appeared either in the mother or in the child.ConclusionResults of this study suggest that the current community based newborn survival intervention should provide an even greater focus to essential newborn care practices, low birth weight newborns, and female education.

Black Chocolate Consumption Reduces Subjective Symptoms in 18-22 Years Old Females with Premenstrual Syndrome

Menstruation is the release of the endometrium with bleeding every month, except during pregnancy. Before or during menstruation, a woman may experience stiffness or abdominal cramps, mood fluctuations and other physical and psychological disorders, which is termed as premenstrual syndrome (PMS). The aim of this research is to observe and value the effect of dark chocolate on clinical symptoms of PMS. This research is an experimental prospective, using experimental design with one group pre and post test. Subjects were 30 women aged 18-22 years. Every day for 2 weeks before menstruation period, subjects took 20 gram of dark chocolate, then were asked to answer questionaire. The data measured is the score as well as individual PMS symptoms before and after eating dark chocolate, was analyzed using a nonparametric Wilcoxon test, followed by McNemar chi square with α=0.05. A highly significant decrease was found in anxiety symptoms, whereas statistically significant reduction was found in fatigue or feeling tired, cramps abdominal, bloating, diarrhea, headache, back pain, change in appetite, muscle or joint pain, and problems in concentration. But the symptom of acne complaint was increased from 73.3% to 76.7%. Consumption of dark chocolate reduces premenstrual syndrome scores on women aged 18-22 years. Keywords: dark chocolate, premenstrual syndrome

Assessment of the Contribution of Crowd Sourced Data to Post-Earthquake Building Damage Detection

This paper compares the results of building damage detection based on Crowd Sourced (CS) data, image processing of remotely sensed (RS) data and predictive modelling with institutional spatial data (Spatial Data Infrastructure - SDI). In particular, it focuses on the contribution of Crowd Sourcing to detecting post-earthquake building damages, while also considering the integration of Crowd Sourced with two other data sources (RS and modelling). To simulate CS data submission following the 2003 earthquake in Bam City (Iran) a survey was administered to the population which experienced the earthquake. The results obtained from this and two other sources are compared with the Actual Earthquake (AE) data by cross-tabulation analysis and McNemar's Chi Square Test. When assessed against AE data, the average accuracy levels of assessments based on the use of RS data and CS data integrated with each RS data and predictive modelling and with both, show a statistically significant increase relative to the predictive modelling. While this research does not provide for a full assessment of the value of CS data alone and in fact finds it slightly inferior to predictive modelling, it suggests that Crowd Sourcing could be a useful source of information, especially if combined with other sources.

Nasal Smear Eosinophil CountVs AEC of Patients diagnosed with Allergic Rhinitis Attending a Tertiary Care Hospital &amp;the Effect of Treatment with a TopicalSteroid Nasal Spray on theSame

Allergic rhinitis being a heterogeneous disorderis often under-diagnosed despite its high prevalence. The age, sex, race or socioeconomic status has no bearing on those who get affected.It is one of the most common chronic conditions in the developed world with a significant impact on the quality of life.Methodology: All the patients who were diagnosed with allergic rhinitis satisfying the inclusion criteria were included in the study by universal sampling, after obtaining informed consent. A total of 42 patients were thus included. Statistical Analysis:The baseline data was expressed as percentages & proportions. Mcnemar Chi square test & Paired t-test were applied for comparison between the two tests & for analyzing the pre-treatment & post- treatment values ofnasal smear eosinophil counts & AEC. Results: Sensitivities of the tests were calculated as 40% & 54% for nasal smear eosinophil count & AEC respectively. The difference in sensitivities were found to be significant (p<0.05). The difference in the pre-treatment & post-treatment values of both nasal smear& AEC were found to be significant (p<0.05). AEC reduction was observed in 85.7% of the patients from the pre- treatment values & reduction in the nasal smear eosinophil counts were found in 28.6% of the patients.

Effectiveness of Workshop on Basic Research Skill Development among First Year Postgraduate Medical Students of a Private University in South Karnataka, India

Objective : To assess the effectiveness of the workshop on “Basic Research Skill Development”, conducted for newly admitted post graduate medical students of a private university from Mangalore, South Karnataka, India. Method : With a participatory approach, 2 days workshop (in July 2011) was organized for basic research skills development among 57 freshly admitted medical postgraduates. Based on the sessions, predesigned, structured tool (with 39 questions -MCQ or True / false type) was prepared. Initially, participants were exposed to Pretest to record prior knowledge. At the end of workshop Post-test was done with same tool. Data was analysed using McNemar chi square & paired-t tests by SPSS version17. P<0.05 was considered to be significant. Result : Forty four postgraduates willing to participate in this study were involved. Paired t test showed increased research knowledge & skills significantly (p < 0.0005, Mean diff SD= 6.227). Post-test showed higher number of correct responses for all questions except one. Significantly higher level of correct answers (p < 0.0005) were observed in questions -- Boolean operators in Literature search, Hierarchy of study designs, Nested Case control study, Examples of epidemiological studies, Cross-sectional study, Full form of SPSS. Conclusion : A positive findings of summative evaluation of “Basic Research Skill Development” workshop held at the beginning of postgraduate medical courses, justifies the need for such workshop for every medical school.

Leishman Giemsa cocktail as a new, potentially useful cytological technique comparable to Papanicolaou staining for oral cancer diagnosis

Background:Papanicolaou staining is commonly used for staining exfoliative cytology smears with Romanowsky stains being used sparingly. Leishman Giemsa (LG) cocktail, being a relatively new staining technique, has not been used in exfoliative cytology. This easy, cost-effective and one-step technique warrants further study because of its potential application in screening of oral cancer.Aim:To study and evaluate the diagnostic efficiency and reliability of Leishman Giemsa (LG) cocktail in comparison with Papanicolaou (Pap) and May-Grünwald Giemsa (MGG) stains in exfoliated cells for the detection of oral squamous cell carcinoma.Materials and Methods:Three smears were prepared from each 100 controls (buccal mucosa) and 100 patients, clinically diagnosed with oral squamous cell carcinoma and stained with Pap, MGG and LG cocktail stains. The slides were evaluated for the staining characteristics of nucleus and cytoplasm. The diagnostic efficiency of each stain was evaluated by comparing the cytologic diagnosis of each stain with the histopathological diagnosis. Finally, the diagnostic reliability was evaluated by comparing the three stains with each other and the histologic diagnosis.Statistical Analysis:The data were statistically evaluated with Friedman test, Wilcoxon sign rank test and McNemar chi square test using SPSS15 software.Results:The results from the histologically confirmed cases of squamous cell carcinoma and the number of cases diagnosed by Pap and LG cocktail were almost identical and both were superior to MGG. The P value obtained for the confirmed cases of squamous cell carcinoma in comparison for Pap vs MGG was 0.001, MGG vs LG cocktail was 0.001 and LG cocktail vs Pap was 0.157. Hence, no statistical significant difference was observed between the diagnostic ability of Pap and LG cocktail stains.Conclusion:LG cocktail is an easy, cost-effective and one-step technique comparable to Pap staining; however, it warrants further study in its potential application in screening of oral cancer.