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Background: Respectful maternity care (RMC) refers to the humane and dignified treatment of a childbearing woman throughout her pregnancy, childbirth and immediate postpartum period. Disrespect and abuse of women during labour, childbirth and immediate postpartum period in health facilities is one of the reasons which deter them from further utilizing maternal healthcare services. The present study was thus undertaken to determine to what extent RMC practices are being followed in a health facility in Manipur. Materials and Methods: A cross-sectional study was conducted from May 2022 to August 2022 in a Health facility among women coming for institutional delivery along with direct observations of the labour room. The study tool comprises a semistructured questionnaire related to respectful maternity care which was adapted from the Person-Centered Maternity Care Scale, a validated instrument. The direct observation method was carried out using a checklist adapted from a standardized tool developed by the United States Agency for International Development (USAID). Descriptive statistics were generated and approval of the study was obtained from the Institutional Ethics Committee. Results: A total of 336 (99.1%) women reported at least one form of disrespect or abuse during childbirth. Maximum abuse (91.4%) was reported in the facility and environment domain. Direct observation done on 22 deliveries in the labour room found that 72.7% of the women experienced at least one form of disrespect and abuse. Two (9.1%) women were observed to face physical force or abusive behaviour. Conclusion: Almost all the women reported at least one form of disrespect or abuse during childbirth. There is a need to improve the health facilities and women need to be treated with dignity and respect as it is being violated according to the findings in many studies as with ours.

Introduction: For optimal maternal outcomes during Caesarean Section (CS) under spinal anaesthesia, proper counselling regarding the intraoperative and postoperative effects of spinal anaesthesia is required to enhance postoperative patient satisfaction. Aim: The present study aimed to assess the effects of preoperative counselling on intraoperative and postoperative anxiety, fear, and other physiological responses associated with spinal anaesthesia. Additionally, it aimed to determine the level of perioperative satisfaction among patients during anaesthesia and surgery. Materials and Methods: In this quasi-experimental study, a total of 214 American Society of Anaesthesiologists (ASA) physical status II patients scheduled for elective Lower Segment Caesarean Section (LSCS) were randomly assigned to either group A or group B. Group A received preoperative counselling about intraoperative events and postoperative care, along with routine pre-anaesthetic clinic assessment. Group B only underwent routine pre-anaesthetic clinic assessment. Intraoperative and postoperative satisfaction were assessed using the Visual Analogue Score (VAS), and physiological responses such as heart rate, blood pressure, and oxygen saturation were monitored. Statistical analysis was performed using SPSS version 16.0, and descriptive statistics, Chi-square test, and t-test were used. A p-value 0.05. The majority of patients in both groups were homemakers, with 99.1% in group A and 86.9% in group B. The distribution of VAS scores indicated that no pain and mild pain were more prevalent in the study group, while moderate pain was more common in the control group, which was statistically significant. Therefore, pain was reduced in the preoperative counselling group, and overall patient satisfaction was higher in the counselling group due to guidance throughout the anaesthetic and surgical procedures, leading to better anxiety and haemodynamic control. The distribution of patient satisfaction indicated that all patients reported reduced fear and anxiety due to preoperative guidance. A total of 69.2% of patients were very satisfied with preoperative counselling, and 30.8% were satisfied with preoperative counselling. Conclusion: This quasi-experimental study concludes that preoperative counselling regarding the anaesthetic procedure, intraoperative and postoperative events, and guidance throughout the procedure improves patients’ pain tolerance, cooperation, and behaviour during the perioperative period.

Nareerut Pudpong,1 Sataporn Julchoo,1 Pigunkaew Sinam,1 Sonvanee Uansri,1 Watinee Kunpeuk,1 Rapeepong Suphanchaimat1,2 1International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand; 2Division of Epidemiology, Department of Disease Control, Nonthaburi, ThailandCorrespondence: Rapeepong Suphanchaimat, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand, Tel +66815446966, Email rapeepong@ihpp.thaigov.netBackground: During the COVID-19 pandemic, primary school children are particularly vulnerable as restriction measures have caused a huge impact on their health and well-being. This study aims to assess the prevalence of mental health among primary school children in Thailand during the COVID-19 pandemic and identify factors associated with psychosocial problems.Methods: A survey was conducted among 701 Thai parents of primary school children from January to March 2022 – when teaching modalities between onsite and online learning were alternated. Parents were requested to assess the mental health of their youngest child at primary school age level. Psychosocial problems were measured by the Strengths and Difficulties Questionnaire (SDQ) with a total score of 40, based on 4 domains (emotion, behavior, hyperactivity, and relationship). Independent variables included (1) parental/household factors, (2) children characteristics, and (3) online learning-related issues. The dependent variable was the prevalence of children with a total score of 14– 40, which indicates at risk and/or having mental health problems. The analysis was performed using logistic regression model.Results: Thai parents reported that 41.1% of children had psychosocial problems. Children in a single-parent family (adjusted odds ratio [AOR] = 1.7; 95% confidence interval (CI) = 1.1– 2.8), male children (AOR = 1.7, 95% CI = 1.2– 2.4), and children who did not receive adequate assistance for online learning from their parents (AOR = 2.1, 95% CI = 1.1– 4.0) significantly faced greater odds of mental health problems.Conclusion: The prevalence of Thai primary school children confronting psychosocial difficulties during the COVID-19 pandemic increased, with significant concern. Public health interventions that aim to protect the mental health of primary school children during the pandemic should be introduced and targeted male children and those living with a single parent. Social support that facilitates online learning for children whose parents have limited capacity in supporting them should be implemented.Keywords: mental, health, primary school, children, COVID-19, Thailand

Sarcopenia, defined as a progressive loss of muscle mass and function, is typified by mitochondrial dysfunction and loss of mitochondrial resilience. Sarcopenia is associated not only with aging, but also with various metabolic diseases characterized by mitochondrial dyshomeostasis. Pyruvate dehydrogenase kinases (PDKs) are mitochondrial enzymes that inhibit the pyruvate dehydrogenase complex, which controls pyruvate entry into the tricarboxylic acid cycle and the subsequent adenosine triphosphate production required for normal cellular activities. PDK4 is upregulated in mitochondrial dysfunction-related metabolic diseases, especially pathologic muscle conditions associated with enhanced muscle proteolysis and aberrant myogenesis. Increases in PDK4 are associated with perturbation of mitochondria-associated membranes and mitochondrial quality control, which are emerging as a central mechanism in the pathogenesis of metabolic disease-associated muscle atrophy. Here, we review how mitochondrial dysfunction affects sarcopenia, focusing on the role of PDK4 in mitochondrial homeostasis. We discuss the molecular mechanisms underlying the effects of PDK4 on mitochondrial dysfunction in sarcopenia and show that targeting mitochondria could be a therapeutic target for treating sarcopenia.

Background: The vestibular depth (VD) varies to a great extent among individuals and at different points of reference. The normal range of depth of the vestibule at different areas in the mouth remains to be established. Aim: The primary objective of this study is to assess the average VD around different teeth in the maxilla and the mandible. Furthermore, an attempt has been made to identify the various ranges of VD and understand what could be suggestive of a normal VD. Materials and Methods: The participants included were divided into four age groups, i.e., 6–14 years (Group 1), 15–30 years (Group 2), 31–50 years (Group 3), and >50 years (Group 4). Further, the subjects were grouped into subgroup A, periodontally healthy and subgroup B, gingival recession (GR). Group 1, 2, and 3 included 30 subjects each in subgroup A, while Group 4 subgroup B had 18 subjects. In case of subgroup B, Group 2 included 9 subjects, Group 3–31 subjects, and Group 4–30 subjects. Measurements included the depth of vestibule from 2 reference point, i.e., gingival margin (GM) and incisal edge (IE). Results: In subgroup A, the average VD from GM was found to be the least in the Group 1 i.e., 6–14 years (9.2 mm ± 4.26 in maxilla and 7.01 mm ± 3.14 in the mandible) and the highest in the Group 4 i.e., >50 years (12.06 mm ± 2.73 in maxilla and 10.08 mm ± 2.58 in the mandible). In the case of subgroup B, the least depth from GM was found in the Group 3 i.e., >30–50 years (9.44 mm ± 2.73 in the maxilla and 8.32 mm ± 1.7 in the mandible) and the maximum depth in the Group 4 (>50 years) (11.28 ± 2.31 in maxilla and 9.42 ± 2.87 in the mandible). Conclusion: The study provides a range of VD s in different areas of the mouth in periodontally healthy and individuals with GR, which will contribute to constitute a normal range of VD.

Abstract Background Muscle atrophy, leading to muscular dysfunction and weakness, is an adverse outcome of sustained period of glucocorticoids usage. However, the molecular mechanism underlying this detrimental condition is currently unclear. Pyruvate dehydrogenase kinase 4 (PDK4), a central regulator of cellular energy metabolism, is highly expressed in skeletal muscle and has been implicated in the pathogenesis of several diseases. The current study was designed to investigated and delineate the role of PDK4 in the context of muscle atrophy, which could be identified as a potential therapeutic avenue to protect against dexamethasone‐induced muscle wasting. Methods The dexamethasone‐induced muscle atrophy in C2C12 myotubes was evaluated at the molecular level by expression of key genes and proteins involved in myogenesis, using immunoblotting and qPCR analyses. Muscle dysfunction was studied in vivo in wild‐type and PDK4 knockout mice treated with dexamethasone (25 mg/kg body weight, i.p., 10 days). Body weight, grip strength, muscle weight and muscle histology were assessed. The expression of myogenesis markers were analysed using qPCR, immunoblotting and immunoprecipitation. The study was extended to in vitro human skeletal muscle atrophy analysis. Results Knockdown of PDK4 was found to prevent glucocorticoid‐induced muscle atrophy and dysfunction in C2C12 myotubes, which was indicated by induction of myogenin (0.3271 ± 0.102 vs 2.163 ± 0.192, ****P

The COVID-19 pandemic containment measures such as school closures remarkably disrupt the educational system, from in-person learning to remote or distance education with different interventions. This study aimed to identify the characteristics of interventions in remote or distance education during the COVID-19 pandemic and evaluate the outcomes of each intervention. A systematic review was conducted between October 2021 and May 2022 using four databases. Finally, 22 studies met the eligibility criteria and were included for data analysis. Most of the interventions were synchronous student-centered approaches followed by asynchronous student-centered approaches and mixed-learning through online channels such as desktop- and web-based modality. Remote or distance education is effective in academic development in any learning approach while having mixed effects in student attitudes and perceptions. Academic-related behaviors were most engaged by students in synchronous student-centered approaches. Finally, difficulties or burdens, and mental health or social interaction were similar for all learning approaches in technological problems and support systems from families and teachers. Synchronous student-centered approaches should be the main method of education, but other approaches can be used to complement based on the students' needs. Finally, educational infrastructure and support from teachers and parents are also necessary in remote or distance education. Further studies are needed to focus on primary school students, especially in low-income regions, and apply a randomized study design.

The analysis of heart sound signals constitutes a pivotal domain in healthcare, with the prediction of imbalanced heart sounds offering critical diagnostic insights. However, the inherent diversity in cardiac sound patterns presents a substantial challenge in predicting imbalanced signals. Many scientific disciplines have focused a great deal of emphasis on the problem of class inequality. We introduce an ensemble learning approach employing a convolutional neural network model-based deep learning algorithm to effectively tackle the challenges associated with predicting imbalanced heart sound signals. We use a gammatone filter bank to extract relevant features from the heard sound signal. Our approach leverages a pretrained convolutional neural network architecture, fine-tuning it with gammatonegram images to improve the classification performance. To overcome the challenges posed by imbalanced datasets, we integrate data augmentation into the image processing pipeline. The images are subsequently subjected to classification through deep convolutional neural network employing a transfer learning technique. This involves the utilization of convolutional neural network models such as AlexNet, SqueezeNet, GoogLeNet, and VGG19 to address concerns related to model overfitting. Our experimental results are rigorously validated using the publicly accessible PhysioNet 2016 dataset. The proposed ensemble methodology, incorporating AlexNet, SqueezeNet, and VGG19 models, demonstrated superior performance, attaining an accuracy of 99.51%, a sensitivity rate of 99.34%, and a specificity rate of 99.67%. These results emphasize the substantial clinical promise inherent in our methodology, particularly in the realm of identifying imbalanced and noisy heart sound signals. This, in turn, serves to advance the diagnosis of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Mathudara Phaiyarom,1 Hathairat Kosiyaporn,1 Nareerut Pudpong,1,2 Pigunkaew Sinam,1 Rapeepong Suphanchaimat,1,3 Sataporn Julchoo,1 Watinee Kunpeuk1 1International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand; 2Sirindron College of Public Health, Chonburi, Thailand; 3Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, 11000, ThailandCorrespondence: Mathudara PhaiyaromInternational Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, ThailandTel +66 2 590 2382Fax +66 2 590 2385Email mathudara@ihpp.thaigov.netBackground: The health of urban refugees and asylum seekers (URAS) in Thailand has been under-researched compared with other groups of non-Thai populations, especially in the area of chronic non-communicable diseases (NCD). The objectives of this study were to i) examine NCD prevalence; ii) access to NCD services; and iii) factors associated with access to NCD services among urban refugees and asylum seekers (URAS) in comparison with the Thai population.Methods: A cross-sectional study, using a self-administrative questionnaire adapted from the Thai Health and Welfare Survey (HWS), was conducted in 2019. URAS were randomly selected from the register of the Bangkok Refugee Center. One hundred and eighty-one URAS participated in the survey. The data were combined with 2941 Thai records from the HWS. The population scope was confined to Bangkok. Bivariate analysis by Chi-square, Fisher’s exact, and Mann–Whitney U-tests was conducted to examine difference in demographic and access to NCD services between URAS and Thais. Multivariable logistic regression was performed to identify factors associated with access to NCD services.Results: Overall, URAS were young, less educated, and poorer than Thais. The trend of NCDs was similar to the Thai population, except mental health disorders appeared to be more prevalent in URAS. Almost half of the URAS did not receive any formal treatment. Being insured, abiding with Buddhism, and living in more affluent households were factors associated with better access to NCD services. URAS from Asian countries had greater access to NCD care than those from non-Asian countries.Conclusion: Policymakers should consider expanding the insurance coverage to URAS, similar to coverage for Thai populations. Additional studies on refugees’ health status and service utilization in other settings outside Bangkok are strongly recommended.Keywords: urban refugee, asylum seeker, NCD, healthcare, Thailand

Kalmegh (Andrographis paniculata) is an important medicinal plant belonging to the Acanthaceae family and used for the treatment of many diseases. This study is focused on determining the critical limit for the cultivation of A. paniculata in sodic soil. A pot experiment was conducted with different exchangeable sodium percentages (ESPs) to determine the critical limit for the cultivation of A. paniculata in sodic soil. The critical limit, 16 ESP, was found for A. paniculata grown in sodic soil. Overall, increasing trends in N, P, K, Ca, Mg, Na, Zn, Fe, Cu, Mn, Cr, and Mo and a decreasing trend in Ni and Se were observed in all part of the plant due to increasing sodicity levels. The determination of the critical limit for the cultivation of A. paniculata in sodic soil is an important aspect of this paper. The nutrients and heavy metal profiling with the extreme levels of sodicity will be useful to study the nutrient utilization pattern for the nutrient management strategy of A. paniculata. [ABSTRACT FROM AUTHOR]

Introduction: For the best maternal and foetal outcome during caesarean section under spinal anaesthesia, maintaining Systolic Blood Pressure (SBP) at 100% of the baseline is necessary. Mephentermine and Phenylephrine are both sympathomimetic drugs used for timely correction of maternal hypotension. Aim: To compare the effect of intravenous bolus administration of mephentermine and phenylephrine for prevention and management of maternal hypotension and to evaluate the foetal outcome. Materials and Methods: In this randomised double-blinded controlled trial, a total of 150 American Society of Anaesthesiologist (ASA) II scheduled for elective Lower Segment Caeserean Section (LSCS) were randomly allocated into three groups to receive the study drugs: group A received mephentermine 6 mg in 2 mL Normal Saline (NS), group B received phenylephrine 100 mcg in 2 mL NS, and group C received 2 mL NS immediately following sub-arachnoid block. Whenever hypotension occurred (Systolic Blood Pressure (SBP) 0.05). The time of first rescue vasopressor and the total volume of requirement was earlier and higher in group C with the mean timing of 5.87±4.37 min and mean volume of 2.68±1.58 mL, respectively. Conclusion: There was a significant improvement of arterial blood pressures and better neonatal outcome observed when phenylephrine (100 mcg) and mephentermine (6 mg) are given as a prophylactic intravenous (i.v.) bolus dose immediately after subarachnoid block; especially in the initial time period between skin incision and delivery of the baby. When given as a prophylactic i.v. bolus, it had the advantage of lesser total dose requirement of the vasopressor used and better haemodynamic maintenance till the delivery of the baby.

Aim: The present study explores the effects of high population density (PD), climatic and environmental factors on transmission of coronavirus disease 2019 (COVID-19) in selected metropolitan cities of India. Materials and Methods: A data extraction sheet has been prepared to summarize the data of confirmed severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) cases and number of deaths in ten metropolitan cities, which was taken from Government of India website. The data on environmental factors of each selected metropolitan city were compiled from the official website and climatic conditions from Meteorological Department Government of India. Results: In India, maximum positive COVID-19 cases (>32%) has been found in tropical wet and dry climate zone. While the incidence of COVID-19 cases has been found less in the arid zone of India. Poor correlation has been found between level of Vitamin D, total COVID-19 cases, and mortalities in the studied metropolitan cities. No significant correlation was found between the health care index and COVID-19 cases and mortality. Conclusions: Correspondence and principal component analysis statistics showed high PD, poverty, climatic and environmental factors influenced the SARS-CoV-2 transmission in metropolitan cities of India.

Abstract Background In addition to healthcare entitlements, ‘migrant-friendly health services’ in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand. Methods In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHWs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems. Results The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes. Conclusion Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

Abstract Background Although the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population. Methods A cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n = 2941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past 12 months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need. Results Overall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1 and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations. Conclusion The prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.

Introduction: Propofol contributes largely in the rapid evolution of day care surgery due to its superior recovery characteristics. However, it is associated with dose-dependent systemic arterial hypotension which increases morbidity and mortality. Bispectral index (BIS) is an Electroencephalographic (EEG) derived parameter used to assess the depth of anaesthesia. Titrating drugs to a specific BIS value during general anaesthesia allows to adjust the dose of anaesthetic needed by the patient thereby, reducing the dose related side-effects. Aim: To determine whether the dose of propofol guided BIS values causes less arterial hypotension than the commonly used sleep dose method. Materials and Methods: The present study was a randomised control trial conducted on 92 patients of American Society of Anesthesiologists (ASA) I and II physical status, aged 18-60 years, of both genders, scheduled for elective surgeries under general anaesthesia and were randomly divided into group A and B (46 in each). For induction of anaesthesia, group A received propofol till the BIS values reached 50±1 for 30 seconds, while group B received sleep dose of propofol without BIS monitoring. Haemodynamic effects Heart Rate (HR), Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and Mean Arterial Pressure (MAP) were recorded at baseline, during induction and at 1,5, 10 and 15 minutes after intubation. Total propofol consumption and secondarily, level of sedation after extubation using Ramsay Sedation Scale were also measured in both the groups. Results: The total dose requirement of propofol was reduced significantly in group A compared to group B (p0.005). On arrival to Post Anaesthesia Care Unit (PACU), group A were more co-operative, oriented patients compared to group B (67.4% vs 32.6, respectively. Conclusion: The BIS monitoring significantly reduces the consumption of propofol for induction of anaesthesia while the incidence of hypotension was similar in both the groups. Lower sedation level with comparatively better extubation score with the use of BIS helps in fast tracking.