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1.
Cureus ; 15(12): e51254, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38283425

ABSTRACT

Background and aim Antenatal care (ANC) is universally acknowledged as an essential intervention for enhancing the well-being of both mothers and children. The World Health Organization advises a minimum of four ANC visits. The objective of this study is to assess the effectiveness of adequate ANC in mitigating adverse perinatal outcomes. Methods This cross-sectional study was done at the Department of Obstetrics and Gynecology, Delta Medical College & Hospital, Bangladesh, from March 2023 to August 2023. A total of 226 mothers who gave birth at the hospital during this period were enrolled in the study. Results More than 87% of the participants received adequate (≥4 visits) antenatal care from a registered physician. More than 84% of the mothers gave birth via cesarean section. Among the mothers who received inadequate ANC, the proportion of adverse perinatal outcomes was higher (69.0%) than that of those who received adequate ANC (32.0%). A significant association (p<0.05) was noted between inadequate antenatal care and adverse perinatal outcomes. Pregnant women receiving adequate antenatal checkups were 79% less likely to experience adverse perinatal outcomes compared to those receiving inadequate ANC. Conclusion Adequate ANC is a very efficient and economical strategy for mitigating adverse perinatal outcomes.

2.
Int. j. morphol ; 39(1): 138-142, feb. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1385305

ABSTRACT

SUMMARY: Urethral process, sigmoid flexure, urethra at the pelvic arch and neck of urinary bladder in goats are very much prone to form obstructive urolithiasis. The present study was carried out to establish baseline work on the normal measurement of the urethral passage and different segments of penis of uncastrated and castrated Black Bengal (BB) goat which will be supportive for obstructive urolithiasis management. Different segment of penis along with urethra of 25 uncastrated and 25 castrated male Black Bengal goats were collected from different slaughter house of Chattogram City Corporation. The length and diameter of male urethra and different segment of penis in uncastrated buck were significantly higher (p<.001) than castrated buck. The length of the pelvic urethra was 5.88 ± 0.111 cm and 4.58 ± 0.15 cm in uncastrated and castrated buck respectively. The length of the neck of urinary bladder; root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 0.688 ± 0.156 cm and 0.38 ± 0.048 cm, 5.02 ± 0.09 cm and 4.24±0.10 cm, 23.48 ± 0.37 cm and 22.74 ± 0.43 cm, 9.2 ± 0.107 cm and 8.18 ± 0.29 cm, 1.92 ± 0.032 cm and 1.44 ± 0.10 cm, 2.32 ± 0.029 cm and 1.78 ± 0.07 cm respectively. The diameter of the neck of urinary bladder, root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 1.94 ± 0.041 cm and 1.44 ± 0.05 cm, 3.7 ± 0.049 cm and 3.3 ± 0.144 cm, 2.63 ± 0.066 cm and 1.86 ± 0.08 cm, 2.77 ± 0.90 cm and 2.18 ± 0.07 cm , 1.81 ± 0.034 cm and 1.4 ± 0.06 cm, 0.66 ± 0.014 cm and 0.56 ± 0.05 cm respectively. Finally, total lengths of penis in uncastrated and castrated buck were 30.42±0.459 cm and 28.42±0.553 cm respectively. The length and diameter of the neck of the urinary bladder, root, sigmoid flexure, urethral process of the penis are clinically more important for obstructive urolithiasis.


RESUMEN: El proceso uretral, el ángulo sigmoideo, la uretra en el arco pélvico y el cuello de la vejiga urinaria en las cabras son muy propensos a formar urolitiasis obstructiva. El presente estudio se llevó a cabo para establecer un trabajo de referencia sobre la medición normal del pasaje uretral y diferentes segmentos de pene de cabra de Bengala Negra (BB) no castrada y castrada, que serán de apoyo para el manejo de la urolitiasis obstructiva. Se recolectaron diferentes segmentos de pene junto con la uretra de 25 machos de cabras de Bengala negras sin castrar y 25 castrados de diferentes mataderos de Chattogram City Corporation. La longitud y el diámetro de la uretra y los diferentes segmentos del pene en el macho no castrado fueron significativamente más altos (p <0,001) que en el macho castrado. La longitud de la uretra pélvica fue de 5,88 ± 0,111 cm y 4,58 ± 0,15 cm en animales sin castrar y castrados, respectivamente. La longitud del cuello de la vejiga urinaria; raíz, cuerpo, flexión sigmoidea, glande del pene y proceso uretral del pene en el macho sin castrar y castrado fueron 0,688 ± 0,156 cm y 0,38 ± 0,048 cm, 5,02 ± 0,09 cm y 4,24 ± 0,10 cm, 23,48 ± 0,37 cm y 22,74 ± 0,43 cm , 9,2 ± 0,107 cm y 8,18 ± 0,29 cm, 1,92 ± 0,032 cm y 1,44 ± 0,10 cm, 2,32 ± 0,029 cm y 1,78 ± 0,07 cm, respectivamente. El diámetro del cuello de la vejiga urinaria, la raíz, el cuerpo, el ángulo sigmoide, el glande del pene y el proceso uretral del pene en el macho no castrado y castrado fueron 1,94 ± 0,041 cm y 1,44 ± 0,05 cm, 3,7 ± 0,049 cm y 3,3 ± 0,144 cm. 2,63 ± 0,066 cm y 1,86 ± 0,08 cm, 2,77 ± 0,90 cm y 2,18 ± 0,07 cm, 1,81 ± 0,034 cm y 1,4 ± 0,06 cm, 0,66 ± 0,014 cm y 0,56 ± 0,05 cm respectivamente. Finalmente, las longitudes totales de pene en machos castrados y no castrados fueron de 30,42 ± 0,459 cm y 28,42 ± 0,553 cm respectivamente. La longitud y el diámetro del cuello de la vejiga urinaria, la raíz, el ángulo sigmoideo y el proceso uretral del pene son clínicamente más importantes para la urolitiasis obstructiva.


Subject(s)
Animals , Female , Penis/anatomy & histology , Urethra/anatomy & histology , Goats/anatomy & histology , Urolithiasis
3.
Ann Anat ; 228: 151452, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31778790

ABSTRACT

BACKGROUND: The excellence in the field of stem cell therapy demands alternative and more convenient stem cells for potential applications. Researchers have opted for least invasive and broadly multipotent cells with minimum ethical concerns. Bovine amniotic fluid derived mesenchymal stem cells (BAF-MSCs) due to their ease of collection and owing similar gestational length to that of human could be presumed as an attractive large animal model for biomedical and biotechnology research. METHODS: Bovine amniotic fluid derived stem cells were isolated from abattoir based samples and characterized for epithelial, neuronal, mesenchymal and pluripotent markers by qPCR and immunofluorescence studies at P1, P3, P5 and P7 alongside population doubling time, growth curve and multilineage differentiation studies. RESULTS: The cells were explored for unique expression of Sox2, which was observed to be up regulated with increase in passage number and Nestin was found to be downregulated during further passaging of mesenchymal cells in this study. The cells also co-expressed Oct ¾ at initial passages which diminished within further passages. Evidence regarding diversity and heterogeneity in different cell population in amniotic fluid was recorded by positive expression of epithelial cell markers like pan Cytokeratin and p63 during early passages. The study suggested that cells with higher expression of Sox2 generated comparatively larger neurospheres with comparative strong expression of Sox2 and Nestin by immunofluorescence staining and qPCR analysis. Besides BAF-MSCs derived neurospheres were also shown to express pro-neuronal markers like ß-III Tubulin, GAP43 and ASCL-1. CONCLUSIONS: This study explores and characterizes BAF-MSCs for their multipotent and neurogenic potentials and their use for clinical applications, though more detailed studies are needed to determine the exact pathways linked with neurogenic capacities of these cells and their morphological assessments at different gestational ages in bovines. The knowledge from the bovine model after detailed studies, proven safety and efficacy could also be used to understand substitutive strategies to investigate MSCs physiology at different trimesters and potential application of these cells for human and veterinary regenerative medicine provided the animal ethics are carefully monitored.


Subject(s)
Amniotic Fluid/cytology , Stem Cells/cytology , Adipogenesis , Animals , Cattle , Cell Differentiation/physiology , DNA, Complementary/genetics , Down-Regulation , Epithelial Cells/cytology , Epithelial Cells/metabolism , Fluorescent Antibody Technique , Mesenchymal Stem Cells/cytology , Mesenchymal Stem Cells/metabolism , Nestin/metabolism , Neurons/cytology , Neurons/metabolism , Pluripotent Stem Cells/cytology , Pluripotent Stem Cells/metabolism , Real-Time Polymerase Chain Reaction , SOXB1 Transcription Factors/genetics , SOXB1 Transcription Factors/metabolism , Serial Passage , Stem Cells/metabolism , Up-Regulation
4.
Rev Sci Tech ; 38(1): 51-60, 2019 May.
Article in English | MEDLINE | ID: mdl-31564741

ABSTRACT

Zoonotic diseases require a One Health approach for successful control and elimination due to the nature of their transmission between animals and humans. One Health recognises that the health of humans, animals, and the environment are all interconnected. Ethiopia has committed itself to controlling five prioritised zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis and echinococcosis), using a One Health approach. The National One Health Steering Committee (NOHSC) provides a framework for national stakeholders to address gaps in multisectoral communication, coordination and collaboration. In addition, the NOHSC oversees the formation of several specialised disease-focused groups, referred to as 'Technical Working Groups' (TWGs). These TWGs are responsible for developing disease prevention and control strategies, as well as implementing disease-focused public health activities and providing recommendations to the NOHSC. Ethiopia's success using the One Health approach and its efficient control of zoonotic diseases will depend on the commitment of all member Ministries to support the NOHSC and TWGs, as well as to build capacity in Ethiopia's workforce and laboratories, a task supported by its many international partners.


Les zoonoses étant par nature des maladies transmissibles entre les animaux et l'homme, l'approche Une seule santé est la seule qui permette de les contrôler efficacement en vue de les éliminer. Le concept Une seule santé repose sur la prise en compte de l'interconnexion entre la santé humaine, celle des animaux et celle de l'environnement. L'Éthiopie s'est fixé pour objectif de lutter contre cinq maladies zoonotiques classées comme prioritaires (rage, fièvre charbonneuse, brucellose, leptospirose et échinococcose) en suivant une approche Une seule santé. Le comité de pilotage national Une seule santé (NOHSC) apporte un cadre permettant aux parties prenantes du pays de résoudre les problèmes de communication, de coordination et de collaboration intersectorielles. En outre, le NOHSC supervise la création de plusieurs groupes de travail techniques dédiés à des maladies spécifiques. Ces groupes de travail sont chargés d'élaborer des stratégies de prévention et de contrôle, de mettre en oeuvre des activités de santé publique axées sur ces maladies et de formuler des recommandations à l'intention du NOHSC. La réussite des efforts déployés par l'Éthiopie pour appliquer les principes Une seule santé et l'efficacité de la lutte contre les maladies zoonotiques dépendront de l'engagement des ministères concernés à soutenir le NOHSC et les groupes de travail techniques et à renforcer les capacités des ressources humaines et des laboratoires éthiopiens, tâche qui bénéficie de l'appui de nombreux partenaires internationaux.


Toda labor eficaz de control y eliminación de las enfermedades zoonóticas, por la propia naturaleza de su transmisión entre animales y personas, pasa por abordar estas patologías desde los planteamientos de Una sola salud, noción esta que parte del reconocimiento de que salud humana, animal y ambiental están siempre interconectadas. Etiopía está embarcada en el innegociable empeño de combatir cinco enfermedades zoonóticas consideradas prioritarias (rabia, carbunco bacteridiano, brucelosis, leptospirosis y equinococosis) trabajando desde la óptica de Una sola salud. El Comité Directivo Nacional de Una sola salud proporciona a los interlocutores del país un marco de referencia que sirve para subsanar las lagunas existentes en cuanto a comunicación, coordinación y colaboración entre los diversos sectores. Ese órgano, además, supervisa la formación de varios grupos especializados y centrados en una u otra enfermedad, denominados grupos de trabajo técnicos, que tienen por cometido elaborar estrategias de prevención y control de una enfermedad concreta, llevar adelante acciones de salud pública dirigidas contra ella y formular recomendaciones para el Comité Directivo. El éxito de Etiopía a la hora de aplicar los postulados de Una sola salud y de combatir eficazmente las enfermedades zoonóticas dependerá del nivel de compromiso con que todos los ministerios copartícipes presten apoyo al Comité Directivo y los grupos de trabajo técnicos y ayuden a instaurar en el país un tejido lo bastante solvente de laboratorios y recursos humanos, empresa esta en la que Etiopía cuenta con el respaldo de sus numerosos asociados internacionales.


Subject(s)
One Health , Public Health , Animals , Ethiopia , Humans , One Health/trends , Public Health/trends , Zoonoses/prevention & control
5.
RSC Adv ; 9(23): 13254-13262, 2019 Apr 25.
Article in English | MEDLINE | ID: mdl-35520756

ABSTRACT

The enormous numbers of applications of TiO2 nanoparticles (NPs) cause concern about their risk to the environment and human health. Consequently, motivated by the necessity of searching for new sources of TiO2 NPs of low cytotoxicity with antibacterial activity, we synthesized TiO2 NPs by a green route using a solution of titanium(iv) isopropoxide as a precursor and an aqueous extract of Artocarpus heterophyllus leaf as a reducing and surface modifying agent. We investigated their structure, shape, size, and magnetic properties, and evaluated their antibiotic application and cytotoxicity. The synthesized TiO2 NPs were applied against two Gram-negative bacteria (E. coli and S. typhimurium) and two Gram-positive bacteria (S. aureus and B. subtilis) to observe their antibacterial activity; and eventually clear zones of inhibition formed by the TiO2 NPs were obtained. Moreover, after exposing the synthesized TiO2 NPs to HeLa cells (carcinoma cells) and Vero cells (normal cells), no toxic effect was found up to a dose of 1000 mg L-1, indicating the safe use of the samples up to at least 1000 mg L-1. However, toxic effects on HeLa cells and Vero cells were observed at doses of 2000 mg L-1 and 3000 mg L-1, respectively. These results indicate the safe use of Artocarpus heterophyllus leaf extract mediated synthesized TiO2 NPs in their potential applications.

6.
RSC Adv ; 8(65): 37176-37183, 2018 Nov 01.
Article in English | MEDLINE | ID: mdl-35557822

ABSTRACT

Persuaded by the necessity of finding new sources of antibiotics, silver nanoparticles (Ag NPs) were synthesized by adopting a newly developed green synthesis technique and subsequently, their antibacterial activity against different pathogenic bacteria was evaluated. We have successfully synthesized bio-molecule capped ferromagnetic Ag NPs with an average crystallite size of 13 nm using AgNO3 solution as a precursor and Artocarpus heterophyllus leaf extract as a reducing and capping agent. The characterization of the synthesized Ag NPs was carried out using various techniques such as UV-visible (UV-Vis) spectroscopy, energy dispersive X-ray (EDX) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), thermogravimetry (TG), and vibrating sample magnetometer (VSM) analyses. After exposing the synthesized Ag NPs to two Gram-positive bacteria - Staphylococcus aureus and Bacillus cereus and two Gram-negative bacteria - Escherichia coli and Salmonella typhimurium, the zones of inhibition were found to be 15, 16, 19, and 18 mm, respectively. These results imply that the Artocarpus heterophyllus leaf extract mediated green synthesized bio-molecules encapsulated Ag NPs can be considered as a potential antibiotic against human pathogens which is very encouraging.

7.
Int. j. morphol ; 34(3): 909-917, Sept. 2016. ilus
Article in English | LILACS | ID: biblio-828962

ABSTRACT

Bones of forelimb were studied from a prepared skeleton of an adult female Asian elephant (Elephas maximus) in Anatomy Museum of Chittagong Veterinary and Animal Sciences University to understand the morphological form and structure of Asian elephant forelimb. The angle was approximately 123 between caudal border of scapula and caudal border of humerus. The scapula, humerus and bones of the antebrachium (particularly the ulna) were massive bones. The bones of manus were the short and relatively small. The dorsal border of scapula extended from the level of proximal extremity of first rib to the middle of the 6th rib. Ventral angle of scapula articulated with humerus by elongated shaped glenoid cavity (cavitas glenoidalis) of scapula and head of humerus (caput humeri). The major tubercle (tuberculum majus) of humerus was situated laterally to the head, which had smaller cranial part with large caudal part and extended cranially to the head. The crest of minor tubercle (tuberculum minus) was present as the rough line on the mediocaudal surface of humerus that ends in a slight depressed or elevated area, known as teres major tuberosity (tuberositas teres major). The lateral supracondyler crest (crista supra condylaris lateralis) at the caudal surface of the shaft limit the musculo-spiral groove in body of humerus. The radius and ulna are twin bones of forearm and the attachment between ulna and radius occurs in such a way, the radius articulates craniomedially with the ulna in the proximal part. But the shaft spirals laterally over the cranial surface of the ulna to articulate distally with the medial aspect of the ulna. There were 8 carpal bones, 5 metacarpal bones and 5 digits. The comparative size of the proximal and distal raw of carpal bones were ulnar carpal > radial > intermediate > accessory carpal and IV > III > II > I respectively. The gradual lengths of the metacarpal bones were III > IV > II > V > I. Digits I and V were vertical and digit II, III and IV were horizontal.


En el Museo de Anatomía de la Universidad de Veterinaria y Ciencias de Animales de Chittagong fueron estudiados los huesos del miembro torácico de un esqueleto preparado de un elefante asiático (Elephas maximus), hembra adulta, para analizar su morfología y estructura. El ángulo entre el margen caudal de la escápula y el margen caudal del húmero era de aproximadamente 123°. La escápula, húmero y los huesos del antebrazo (en particular la ulna) eran huesos macizos. Los huesos de las manos eran cortos y relativamente pequeños. El margen dorsal de la escápula se extendía desde el nivel de la porción proximal de la primera costilla para la parte media de la sexta costilla. El ángulo ventral de la escápula está articulado con el húmero por la cavidad glenoidea (cavitas glenoidalis), de forma alargada, de la escápula y la cabeza del húmero (caput humeri). El principal tubérculo (tuberculum majus) del húmero estaba situado lateralmente a la cabeza, que tenía una parte craneal pequeña y una mayor parte caudal, extendiéndose cranealmente en la cabeza. La cresta del tubérculo menor (tuberculum minus) estaba presente como la línea áspera sobre la superficie mediocaudal del húmero que termina en una pequeña zona deprimida o elevada, conocida como tuberosidad redonda mayor (tuberositas teres major). La cresta supracondilar lateral (crista supra condylaris lateralis) en la superficie caudal del eje limita la ranura músculo-espiral en el húmero. El radio y la ulna son huesos gemelos del antebrazo y la unión entre la ulna y el radio se produce de tal manera, que el radio articula, craneal y medialmente, con la ulna en la porción proximal. Pero el eje en espiral está ubicado lateralmente sobre la superficie craneal de la ulna para articular distalmente con la cara medial de la ulna. Se identificaron 8 huesos del carpo, 5 metacarpianos y 5 dígitos. El tamaño comparativo de las porciones proximal y distal de los huesos del carpo fue ulna > radial > Intermedio> carpiano accesorio y IV > III > II > I, respectivamente. Las longitudes graduales de los huesos metacarpianos eran III > IV > II > V > I. Dígitos I y V eran verticales y dígitos II, III y IV fueron horizontales.


Subject(s)
Animals , Female , Elephants/anatomy & histology , Humerus/anatomy & histology , Scapula/anatomy & histology , Ulna/anatomy & histology , Asia , Radius/anatomy & histology
8.
Int. j. morphol ; 31(4): 1473-1478, Dec. 2013. ilus
Article in English | LILACS | ID: lil-702336

ABSTRACT

Recent excavated skeleton of an adult female Asian Elephant (Elephas maximus), died in dystokia in Bangladesh was used for macro anatomical study. Some unique morphological features of bones of hind limb were observed. Pelvic canal was more oval and the wings of ilium were wider. Rump slope was about 36°. Angle between femur and tibia was close to 180°. In Femur, the major trochanter was located at the lower level of head. Minor trochanter, fovea capitis and trochanteric ridge were absent. Supracondyloid fossa was shallow but the intercondyloid fossa was deep. Posterior surface of patella possessed a blunt vertical ridge. The articular surfaces of both tibial condyles were clearly concave. The tibia and the fibula were articulated proximally and distally with keeping a wide interosseous space. Instead of tibial tuberosity, there was an elongated triangular depression in proximal part. There were six tarsal bones arranged in three rows. The comparative size of the distal tarsal bones were III+IV > I > II. The comparative lengths of the metatarsal bones were III > II > IV > V> I. Digits I and V were the most vertical and digit III was the most horizontal. The proximal phalanx was the biggest of all.


Fue utilizado para su estudio anatómico macrocroscópico, el esqueleto de un elefante asiático (Elephas maximus) hembra adulta, excavado recientemente y con muerte por distocia en Bangladesh. Se observaron algunas características morfológicas únicas de los huesos de los miembros posteriores. El canal pélvico era más ovalado y las alas del ilion eran más amplias. La pendiente de la rabadilla era de unos 36° aproximadamente; el ángulo entre el fémur y la tibia era próximo a los 180°. En el fémur, el trocánter mayor se encontraba en el nivel inferior de la cabeza. El trocánter menor, la fovea capitis y cresta del trocánter estuvieron ausentes. La fosa supracondílea era superficial, mientras que la fosa intercondílea era profunda. La superficie posterior de la patela poseía una cresta vertical sobresaliente. Las superficies articulares de ambos cóndilos tibiales eran claramente cóncavas. La tibia y la fíbula se articulan proximal y distalmente, manteniendo un amplio espacio interóseo. En lugar de la tuberosidad tibial, había una depresión triangular alargada en parte proximal. Se observaron seis huesos del tarso dispuestos en tres filas. El tamaño relativo de los huesos del tarso distal eran III + IV > I > II. Las longitudes comparativas de los huesos metatarsianos fueron III > II > IV > V > I. Los dígitos I y V fueron los más verticales y el dígito III fue el más horizontal. La falange proximal fue la de mayor tamaño.


Subject(s)
Animals , Elephants/anatomy & histology , Pelvic Bones/anatomy & histology , Hindlimb/anatomy & histology
9.
Vet Rec ; 167(11): 415-9, 2010 Sep 11.
Article in English | MEDLINE | ID: mdl-20834002

ABSTRACT

Skin injuries were assessed in 560 imported and local cattle and water buffaloes at two livestock markets in Bangladesh. The body of each animal was divided into 11 anatomical regions, and abrasions, lacerations, penetrations, ulcerations, bleeding, swelling, hyperkeratosis and scars were recorded for each region. Among the 560 animals studied, 501 were found to have at least one injury. The prevalence of skin injuries was 89 per cent, with 84 per cent of the cattle and 99 per cent of the water buffaloes having obvious skin injuries. The most common types of injury were abrasions that were found in 73 per cent of the animals, followed by scars (50 per cent), and lacerations (41 per cent). Buffaloes had more abrasions (95 per cent), lacerations (57 per cent), swelling (15 per cent) and hyperkeratosis (32 per cent) compared with cattle, whereas scars (60 per cent) were more common in cattle (P<0.001). Within the 11 different anatomical regions, all types of injuries were present but in different proportions. The buttock region had a higher proportion of abrasions (36 per cent) followed by the hip, hindlimb and back regions. Penetration, ulceration, bleeding and swelling were present at lower frequencies in all regions. Causes for these injuries included rubbing against the inside wall of vehicles used for transportation and stock-handler abuse (59 per cent and 13 per cent, respectively). Buffaloes sustained more transport injuries than cattle, and the number of injuries was higher in imported than local animals.


Subject(s)
Buffaloes/injuries , Cattle/injuries , Skin/injuries , Animal Welfare , Animals , Bangladesh , Commerce , Female , Male , Transportation
10.
World J Microbiol Biotechnol ; 8(5): 544-5, 1992 Sep.
Article in English | MEDLINE | ID: mdl-24425576

ABSTRACT

Four different brands of bottled water had counts of aerobic bacteria ranging from 10(3) to 10(6) colony forming units/100 ml. Pathogens isolated includedPseudomonas (in all brands),Alcaligenes andEscherichia coli (each in three brands), andKlebsiella, Enterobacter andShigella (each in two brands). All four brands were judged to be unsatisfactory by accepted health standards.

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