Machine learning models for prediction of double and triple burdens of non-communicable diseases in Bangladesh.

Increasing prevalence of non-communicable diseases (NCDs) has become the leading cause of death and disability in Bangladesh. Therefore, this study aimed to measure the prevalence of and risk factors for double and triple burden of NCDs (DBNCDs and TBNCDs), considering diabetes, hypertension, and overweight and obesity as well as establish a machine learning approach for predicting DBNCDs and TBNCDs. A total of 12,151 respondents from the 2017 to 2018 Bangladesh Demographic and Health Survey were included in this analysis, where 10%, 27.4%, and 24.3% of respondents had diabetes, hypertension, and overweight and obesity, respectively. Chi-square test and multilevel logistic regression (LR) analysis were applied to select factors associated with DBNCDs and TBNCDs. Furthermore, six classifiers including decision tree (DT), LR, naïve Bayes (NB), k-nearest neighbour (KNN), random forest (RF), and extreme gradient boosting (XGBoost) with three cross-validation protocols (K2, K5, and K10) were adopted to predict the status of DBNCDs and TBNCDs. The classification accuracy (ACC) and area under the curve (AUC) were computed for each protocol and repeated 10 times to make them more robust, and then the average ACC and AUC were computed. The prevalence of DBNCDs and TBNCDs was 14.3% and 2.3%, respectively. The findings of this study revealed that DBNCDs and TBNCDs were significantly influenced by age, sex, marital status, wealth index, education and geographic region. Compared to other classifiers, the RF-based classifier provides the highest ACC and AUC for both DBNCDs (ACC = 81.06% and AUC = 0.93) and TBNCDs (ACC = 88.61% and AUC = 0.97) for the K10 protocol. A combination of considered two-step factor selections and RF-based classifier can better predict the burden of NCDs. The findings of this study suggested that decision-makers might adopt suitable decisions to control and prevent the burden of NCDs using RF classifiers.

Polyembolokoilamania with obsessive compulsive and related disorders: A case series.

Polyembolokoilamania is a condition seen in a medical or surgical emergencies where the person, sometimes repetitively, inserts various foreign bodies through body orifices or skin to obtain gratification often associated with background psychiatric diagnoses. We present three cases where one patient with Obsessive Compulsive Disorder (OCD) presented with urethral polyembolokoilamania, one with Excoriation disorder presented with multiple pin-piercing behavior through the skin and one case of OCD presented with anal polyembolokoilamania. Treatment of the underlying Obsessive-Compulsive and Related Disorders curbed such behaviors successfully in all three cases emphasizing the importance of treating background psychiatric disorders in such conditions.

Benzodiazepine withdrawal catatonia: Two cases from a tertiary care center in Eastern India.

Catatonia is a diagnostic entity of a neuropsychiatric cluster of symptoms that can occur in a number of different psychiatric, neurologic, and metabolic disorders. Benzodiazepines remain the mainstay of the treatment of catatonia through their possible effect on the gamma-aminobutyric acid (GABA) receptor modulation in the central nervous system (CNS). Rarely, patients have been seen to manifest catatonic symptoms when they face sudden withdrawal from long-term benzodiazepine treatment. Here, we have presented two such cases of different clinical profiles where following benzodiazepine withdrawal, sudden catatonic symptoms emerged that responded quickly on re-administration of benzodiazepines.

Double and triple burden of non-communicable diseases and its determinants among adults in Bangladesh: Evidence from a recent demographic and health survey.

BACKGROUND: Globally, non-communicable diseases (NCDs) are a significant public health problem. NCDs are the leading cause of death in Bangladesh. This study aimed to estimate the prevalence of double burden of NCDs (DBNCDs) and triple burden of NCDs (TBNCDs) such as hypertension, diabetes and overweight or obesity and to explore the risk factors of DBNCDs and TBNCDs in Bangladesh. MATERAILS AND METHODS: This study included 12 685 participants (5465 male and 7220 female) from 2017 - 2018 nationally representative Bangladesh Demographic and Health Survey. Descriptive statistics were calculated for the distribution and prevalence of DBNCDs and TBNCDs. Bivariate and multilevel logistic regression analyses were used to assess the individual- and community-level determinants of DBNCDs and TBNCDs. RESULTS: The prevalence of DBNCDs and TBNCDs was 21.4% and 6.1%, respectively. At individual-level, higher age, female, currently and formerly/ever married, richest, higher education were more likely to suffer from the DBNCDs and TBNCDs. Furthermore, at the community level, the division had a significant association with DBNCDs and TBNCDs. In addition, family size had a significant effect on DBNCDs, and caffeinate drinks and poverty significantly affected TBNCDs. CONCLUSION: Overall, there is a low prevalence of TBNCDs compared with DBNCDs in Bangladesh. Age, gender, marital status, wealth index, education level and division are significantly associated with DBNCDs and TBNCDs. The government and non-government health organisations should pay proper attention to handle the burden of NCDs in Bangladesh.

Prevalence of Psychiatric Morbidity Among Undergraduate Students of a Dental College in West Bengal.

BACKGROUND: Stresses of medical course affects the academic performance as well as physical and psychological health of the students negatively. In the present day scenario every one of us has vulnerability to have psychiatric morbidity. Like other young adults, undergraduate dental students are similarly vulnerable to turmoil due to academic and social stresses, which often hamper the educational achievement. Early detection and treatment of psychological morbidities shorten the suffering leading to less social impairment in long term. AIM: The aim of this study was to assess the psychiatric morbidity of dental students and the factors affecting their mental health. SETTINGS AND DESIGN: This cross sectional, descriptive and correlation study was conducted in North Bengal Dental College, a rural dental college of West Bengal, India. MATERIALS AND METHODS: The study sample consisted of a total of 89 dental students. The student enrollment was done by "simple random sampling method". The semi-structured proforma and the General Health Questionnaire (GHQ)-28 were used to collect data and to assess the psychiatric morbidity. STATISTICAL ANALYSIS: Pearson's correlation followed by multivariate linear regression analysis was done to assess the effect of academic achievement, positive and negative event on the GHQ total score. RESULTS: The overall mean GHQ total score in the study population was 5.33, with a SD of 4.85 which was above the cutoff (>4) score. Karl Pearson correlation co-efficient r-values for GHQ total score with 'academic achievement' and 'negative events' score were 0.718 and 0.628 respectively and p-values were 0.001 and 0.001. CONCLUSION: The poor academic performance and negative events had strong impact on psychological morbidity of dental students. The findings of our study can't be generalized for all undergraduate dental student due to small sample size and non inclusion of many other variables.

Prevalence of psychiatric co-morbidity among patients attending dental OPD and the role of consultation-liaison psychiatry in dental practice in a tertiary care general hospital.

BACKGROUND: Psychiatric co-morbidities are frequent among patients attending dental OPD, some of which go unrecognized and hence untreated. AIMS: The present study has been carried out to detect the psychiatric co-morbidities among dental patients and determine the scope of consultation-liaison (C-L) psychiatry in a rural teaching hospital regarding comprehensive management of the patients. SETTINGS AND DESIGN: This cross-sectional, descriptive type study was conducted in a multi-speciality tertiary care teaching hospital in the northern part of West Bengal, India. MATERIALS AND METHODS: One hundred patients attending the dental OPD were randomly included in the study and every patient was consecutively referred to psychiatry department for assessment, during the period from 1(st) November 2013 to 30(th) April 2014. All referred patients were clinically examined and psychiatric co-morbidity was assessed by the help of General Health Questionnaire (GHQ)-28 and Mental Status Examination. STATISTICAL ANALYSIS USED: The data were subjected to statistical package for social sciences (SPSS), version 16, and statistically analyzed using Cross tab and Chi test. P <0.05 was considered to be statistically significant. RESULTS: The commonest dental illness was dental caries (22%). More than two-third of the patients had psychiatric co-morbidity according to GHQ-28 total score. Sixty-eight patients were diagnosed to have mental disorder on mental status examination. Somatoform disorder (25%) was the commonest type of mental disorder, followed by mixed anxiety and depression (14%). CONCLUSIONS: This study has pointed the need for psychological examination of patients visiting dental specialty with unexplained physical symptoms. Such patients can be identified and treated, provided a psychiatric consultation service exists.

Cataract surgery outcomes in bangladeshi children.

PURPOSE: To measure visual acuity (VA) outcomes, complication rates, and the social impact of cataract surgery in a cohort who underwent surgery as children in Bangladesh. DESIGN: Case series. PARTICIPANTS: A total of 471 of 850 children from 6 Bangladeshi districts who had been identified as cataract blind using key informants (KIs) between 2004 and 2009 during the Bangladesh Childhood Cataract Campaign (BCCC) together with all those children not included in the BCCC database but in the Child Sight Foundation (CSF) database who had been identified as cataract blind. METHODS: The subjects and families were contacted again by KIs and transported to local examination centers, where parents and subjects were administered a questionnaire and subjects underwent full ocular examination. Where operative data were available (15%), they were analyzed in conjunction with questionnaire and examination findings. Statistical analysis was performed using SPSS Statistics (IBM, Armonk, NY). MAIN OUTCOME MEASURES: Presenting and best-corrected visual acuities (BCVAs), cause(s) of poor outcome, postoperative refraction, and school attendance. RESULTS: A total of 407 of the participants had undergone bilateral surgery as children, with a mean follow-up of 8.8 years. The mean age at examination was 16 years (range, 5-28 years; standard deviation [SD], 4.6 years); 63% of those examined were male; 22% had a binocular presenting VA of >20/60; and 53% were severely visually impaired or blind (VA <20/200). After refraction, 33% had VA >20/60 in their better eye and 33% had VA <20/200. Factors that predicted poor VA in multivariate logistic regression analysis were nystagmus (P < 0.001), longer delay in presentation (P < 0.001), and magnitude of absolute spherical equivalent refractive error (P<0.001). Some 50% had nystagmus, and 69% of those currently aged ≤16 years were attending school. Better acuity was associated with school attendance (P < 0.001), whereas gender was not. CONCLUSIONS: Approximately one third of all participants had a BCVA of ≥20/60 in their better eye. Amblyopia and nystagmus limited visual outcome, indicating the need for earlier detection and treatment. This is the first study to show the link between pediatric cataract outcome and access to education, a millennium development goal.