Prevalence of epilepsy in Bangladesh: Results from a national household survey

OBJECTIVE

To determine the prevalence and types of epilepsy in Bangladesh.

METHODS

We conducted a nationwide population-based cross-sectional survey among Bangladeshi population of all ages, except children under one month. We surveyed 9839 participants (urban, 4918; rural, 4920) recruited at their households using multistage cluster sampling. Trained physicians with neurology background confirmed the diagnosis of suspected epilepsy cases identified by interviewer-administered questionnaires. We reported the overall and sex, residence, and age groups-specific prevalence of epilepsy per 1000 populations with 95% confidence interval.

RESULTS

The national prevalence of epilepsy per 1000 was 8.4 (95% CI 5.6-11.1), urban 8.0 (4.6-11.4), and rural 8.5 (5.60-11.5). The prevalence in adult males and females was 9.2 (5.7-12.6) and 7.7 (3.6-11.7), respectively. The prevalence in children aged <18 years (8.2, 3.4-13.0 was similar to adults (8.5 (5.4-11.4). Among all epilepsy cases, 65.1% had active epilepsy. Their (active epilepsy) prevalence was 5.8 (3.5-8.1). Of them, 63.4% were not receiving treatment. Moreover, those who received allopathy treatment, 72.5% had low adherence leading to a high treatment gap.

SIGNIFICANCE

Our findings out of this first-ever national survey were similar to other Asian countries. However, the prevalence of active epilepsy and treatment gap were considerably higher. This study serves useful evidence for tailoring interventions aimed to reduce the burden of epilepsy-primarily through targeted community awareness program-and access to antiepileptic treatment in health facilities in Bangladesh.

Antidiabetic and antiulcerative potential of Garcinia lanceifolia Roxb. bark

Background

Garcinia lanceifoliaRoxb. has been used by many ethnic communities of Northeast India to mitigate various disorders like dyspepsia, ulcers, diabetes, etc. However, a robust scientific study on its antidiabetic and antiulcer potential is unavailable till date. The aim of this present study is to scientifically validate if the antidiabetic and antiulcer effects reported by the ethnic tribes of Assam has any scientific value or not. The effects were tested in adult Wistar albino rats using approved animal models for preclinical testing of pharmacological activities.

Results

The hydroalcoholic extract of the bark ofGarcinia lanceifoliaRoxb. was prepared and its LD50was calculated. The LD50was determined to be greater than 5000 mg/kg body weight. The extract at doses of 250 mg/kg body weight and 500 mg/kg body weight was found to exhibit a very potent dose-dependent antidiabetic activity. The results were backed by a battery of test including analysis of serum levels of blood glucose, lipid profiles, in vivo antioxidant enzymes, and histopathological studies. Evidence of dose-dependent antiulcer activity of the extract was backed by robust scientific data. It was found that HAEGL induced a significant dose-dependent increase in the ulcer index in both alcohol-induced and acetic acid-induced ulcer models, which was evident from the macroscopic observation of the inner lining of the gastric mucosa and the histological evaluation of the extracted stomach.

Conclusion

The results suggested that the bark ofGarcinia lanceifolia(Roxb.) has significant antidiabetic and antiulcer potential. Further studies with respect to the development herbal dosage forms and its safety evaluation are required.

Risk assessment and evaluation of heavy metals concentrations in blood samples of plastic industry workers in Dhaka, Bangladesh

To assess the potential health risk caused by heavy metals twenty-six blood samples were collected from plastic industry workers based on ages and smoking status in Dhaka, Bangladesh. Heavy metals were analyzed with an atomic absorption spectrometer. The mean concentrations of Lead (Pb), Cadmium (Cd), Nickel (Ni), and Zinc (Zn) found in blood samples of the exposed workers were 32.78 ± 9.47, 1.08 ± 0.47, 1.42 ± 1.01, and 9.08 ± 1.95 μgL-1, respectively. The average heavy metal concentrations in blood samples of smoking workers show a narrow range of fluctuation than that of non-smoking workers. A review of different age groups of industry workers shows the workers between the ages of 26 and 40 are more likely to contaminated with Pb (35.90 ± 8.06 μgL-1) and Ni (1.61 ± 1.31 μgL-1). The higher level of Cd (1.26 ± 0.46 μgL-1) and Zn (9.91 ± 2.80 μgL-1) was found in >40 years old workers. The mean concentration in indoor dust samples of different industrial subsections reported as 40.27 ± 10.33, 3.24 ± 0.83, 18.08 ± 3.61, and 103.64 ± 8.16 mg kg-1 for Pb, Cd, Ni, and Zn, respectively. Exposed workers have relatively less critical health implications concluded from the average daily intake (ADI), hazard quotient (HQs), and hazard index (HI) values. The HI values of Pb, Cd, Ni, and Zn were reported as 2.0 × 10-2, 4.64 × 10-4, 1.62 × 10-3, and 5.49 × 10-4, respectively, which have imparted minimal risks (as HI < 1) to the health of the workers. The cancer risks of Pb, Cd, and Ni were reported as 1.46 × 10-10, 1.77 × 10-9, and 1.31 × 10-9, respectively lower than the threshold values. Therefore, the result divulged a potentially lower cancer risk compared to EPA limit value of 1 × 10-6 to 1 × 10-4 for exposed industrial workers.

Source Quantification of South Asian Black Carbon Aerosols with Isotopes and Modeling

Black carbon (BC) aerosols perturb climate and impoverish air quality/human health-affecting ∼1.5 billion people in South Asia. However, the lack of source-diagnostic observations of BC is hindering the evaluation of uncertain bottom-up emission inventories (EIs) and thereby also models/policies. Here, we present dual-isotope-based (Δ¹⁴C/δ¹³C) fingerprinting of wintertime BC at two receptor sites of the continental outflow. Our results show a remarkable similarity in contributions of biomass and fossil combustion, both from the site capturing the highly populated highly polluted Indo-Gangetic Plain footprint (IGP; Δ¹⁴C-f_biomass = 50 ± 3%) and the second site in the N. Indian Ocean representing a wider South Asian footprint (52 ± 6%). Yet, both sites reflect distinct δ¹³C-fingerprints, indicating a distinguishable contribution of C₄-biomass burning from peninsular India (PI). Tailored-model-predicted season-averaged BC concentrations (700 ± 440 ng m^-3) match observations (740 ± 250 ng m^-3), however, unveiling a systematically increasing model-observation bias (+19% to -53%) through winter. Inclusion of BC from open burning alone does not reconcile predictions (f_biomass = 44 ± 8%) with observations. Direct source-segregated comparison reveals regional offsets in anthropogenic emission fluxes in EIs, overestimated fossil-BC in the IGP, and underestimated biomass-BC in PI, which contributes to the model-observation bias. This ground-truthing pinpoints uncertainties in BC emission sources, which benefit both climate/air-quality modeling and mitigation policies in South Asia.

Polariton mediated resonance energy transfer in a fluid

The focus of this work is on a microscopic quantum electrodynamical understanding of cumulative quantum effects in resonance energy transfer occurring in an isotropic and disordered medium. In particular, we consider quantum coherence, defined in terms of interferences between Feynman pathways, and analyze pure-amplitude and phase cross terms that appear in the Fermi golden rule rate equation that results from squaring the matrix element for mediated energy transfer. It is shown that pure-amplitude terms dominate in the near-zone when chromophores are close in proximity to one another (within a few nanometers), and phase cross terms dominate toward the far-zone when phase differences between different Feynman pathways begin to emerge. This can be understood in terms of physical attributes of the mediating photon, whose character becomes more real at long distances, coinciding with vanishing longitudinal components of the field, as transverse components begin to dominate.

A survey on automatically constructed universal knowledge bases

A universal knowledge base can be defined as a domain-independent ontology containing instances. Ontologies define the concepts and relations among these concepts and are used to represent a domain of interest. These universal knowledge bases are the elementary units for automated reasoning on the Semantic Web. The Semantic Web is an extension of the World Wide Web which facilitates software agents to share content beyond the limitations of applications and websites. This survey focuses on the most prominent automatically constructed universal knowledge bases including KnowItAll, DBpedia, YAGO, NELL, Probase, BabelNet and Knowledge Vault. We take a closer look at how these knowledge bases are built, in particular at the information extraction and taxonomy generation process and investigate how they are used in practical applications. Due to quality concerns, the most successful and widely employed knowledge bases are manually constructed to maintain high quality, but they suffer from low coverage, high assembly and quality assurance cost. On the contrary, automatic approaches for building knowledge bases try to overcome these drawbacks. Although it is strenuous to achieve the same level of quality as for manual knowledge bases, we found that the surveyed automatically constructed knowledge bases have shown promising results and are useful for many real-world applications.

Total syntheses of several iridolactones and the putative structure of noriridoid scholarein A: an intramolecular Pauson-Khand reaction based one-stop synthetic solution

A simple and general approach towards the total syntheses of several iridolactones such as (±)-boschnialactone, (±)-7-epi-boschnialactone, (±)-teucriumlactone, (±)-iridomyrmecin, (±)-isoboonein, (±)-7-epi-argyol, (±)-scabrol A, (±)-7-epi-scabrol A, and (±)-patriscabrol as well as the putative structure of scholarein A is delineated. The synthetic strategy features a diastereoselective intramolecular Pauson-Khand reaction (IPKR) to construct the iridoid framework followed by some strategic synthetic manipulations to access the targeted monoterpenes including those having diverse oxy-functionalization patterns and with 3-5 contiguous stereogenic centres in a highly stereocontrolled manner. Also, the present endeavour includes the first total synthesis of scabrol A.

Multiple Choice Questions in Medical Education: How to Construct High Quality Questions

Multiple choice questions (MCQ) are the most widely used objective test items. Students often learn what we assess, and not what we teach, although teaching and assessment are the two sides of the same coin. So, assessment in medical education is very important to ensure that qualified competent doctors are being produced.A good test is the test that assesses higher level of thinking skills. Many inhouse MCQs are found faulty which assess lower level of thinking skills. The main problems in constructing good MCQs are that (i) very few faculty members have formal training in questions construction, (ii) most of the questions are prepared in the last minutes where little time exist for vetting to review the quality of questions and (iii) lack of promise on the standard of the question format and underestimation of the use of blueprint in medical schools. Constructing good MCQs, emphasis should be given that, the stem is meaningful and present a definite problem, it contains only relevant material and avoid negativity. It should be ensuring that, all options present as plausible, clear and concise, mutually exclusive, logical in order, free from clues and avoid ‘all of the above’ and ‘none of the above’. The MCQs can tests well any higher level of the cognitive domain, if it is constructed well. Efforts must be made to prepare and use of test blueprint as a guide to construct good MCQs. This paper describes and offers medical teachers a window to a comprehensive understanding of different types and aspects of MCQs and how to construct test blueprint and good MCQs that tests higher order thinking skills in the future medical graduates, thereby ensures competent doctors are being produced.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 79-88

Mediation of resonance energy transfer by two polarisable particles

The molecular quantum electrodynamics theory is employed to calculate the matrix element and Fermi golden rule rate for resonant transfer of electronic excitation energy between a donor and an acceptor in the vicinity of two neutral electric dipole polarizable particles, which play the role of bridging species. The emitter and absorber couple linearly to the electric displacement field via their electric dipole moments, while each mediator interacts quadratically with this field through its dynamic polarizability. This form of interaction Hamiltonian enables fourth-order perturbation theory to be used to compute the probability amplitude together with summation over 24 time-ordered diagrams representing a single virtual photon exchange between each pair of coupled particles. Expressions for the migration rate mediated by two inert molecules are obtained for an arbitrary arrangement of the four species that are in fixed mutual orientation or are freely tumbling. These formulae are valid for all interparticle separation distances outside the orbital overlap region. From the general result, rate equations applicable to an equidistant collinear configuration of the four bodies are evaluated. Near- and far-zone limiting forms of the transfer rate for the relay pathway are also calculated and exhibit inverse sixth and inverse square dependences on relative separation distances between pairs of particles, confirming the short-range (radiationless) and long-range (radiative) energy transfer mechanisms associated with two-body theory. The distance behavior of interference terms between two-, three-, and four-body terms is also examined, and the relative importance of each contribution to the total transfer rate is discussed.

Comparison of Upper Limb Translocated Femoral Vein and Prosthetic Arteriovenous Bridge Grafts

Introduction

Native veins are an ideal option for dialysis in a patient with chronic kidney disease (CKD) as compared to a prosthetic graft. Femoral vein (FV) translocation to the upper arm is also an alternative to a prosthetic graft as reported in the literature when all options of using the native veins of the arms are exhausted. Thus, we aimed to compare the patency of the upper limb translocated FV arteriovenous fistula (AVF) with a prosthetic arteriovenous bridge graft (AVBG).

Methods

It is a retrospective cohort study that was conducted in the Department of Vascular Surgery, Aga Khan University Hospital. It included adult patients who underwent either upper arm translocation of FV or prosthetic AVBG using the consecutive purposive sampling technique. There were a total of 10 patients who underwent FV translocation AVF and 20 patients who had AVBG in the upper arms.

Results

A total of 30 patients were included in the study. Of these 30 patients, 10 underwent FV translocation AVF and the remaining 20 had AVBG. There was a significant difference in the mean operating time of the two surgeries. The mean operating time in FV translocation was 223 (± 41.5) minutes and in those with AVBG, the mean operating time was 100 (±26.5) (p= <0.001). There was no significant difference in the total length of hospital stay in both procedures performed. The primary patency rate for FV translocation was 90% and 95% in AVBG (p=1.00). Ten percent of FV translocation had a primary failure rate compared with that of AVBG, which was 5% (p=1.00). The mean follow-up period was 61 weeks in the FV translocation group and 64 weeks in the AVG group.

Conclusion

There was no significant difference in both groups in terms of patency, length of hospital stay, and fewer complications were observed in the FV translocation group as compared with the AVBG group.

Management of CBD Stone in Situs lnversus Total is: A Case Report

Situs inversustotalis is a rare congenital condition present in approximately 0.01% of thepopulation in which the major visceral organs are reversed from their normal position and canpose difficulties in the diagnosis and management of abdominal pathology. Symptomaticcholelithiasis is very common and laparoscopic cholecystectomy is the gold standard treatmentat present. Laparoscopic surgery in a situation of situs inversus is challenging due tothe mirror-image anatomy. Diagnostic pitfalls and technical details of the laparoscopic cholecystectomyare discussed. Journal of Surgical Sciences (2017) Vol. 21 (1) :48-50

Choroidal detachment with exudative retinal detachment following Ahmed valve implantation in Sturge-Weber syndrome

Ahmed glaucoma valve implant appears to be a relatively useful drainage device in eyes with glaucoma secondary to Sturge-Weber syndrome (SWS). However, early postoperative choroidal and exudative retinal detachment may occur from a rapid expansion of the choroidal hemangioma with effusion of fluid into the suprachoroidal and subretinal spaces. We report the case of a ten-year-old boy who had SWS with choroidal haemangioma and secondary glaucoma. He had Ahmed glaucoma valve implantation on account of the secondary glaucoma which had been refractory to both conventional medical and surgical managements. He developed choroidal and exudative retinal detachment postoperatively. However, he responded to conservative treatment and further surgical management was not required. Ahmed glaucoma valve in the treatment of glaucoma secondary to SWS is useful, but the risk of choroidal effusion with exudative retinal detachment is still present. Surgeons should be alert to this likely complication and be prepared for prompt management.

A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic

BACKGROUND

Over 28 000 individuals were infected with Ebola virus during the West Africa (2013-2016) epidemic, yet there has been criticism of the lack of robust clinical descriptions of Ebola virus disease (EVD) illness from that outbreak.

OBJECTIVES

To perform a meta-analysis of published data from the epidemic to describe the clinical presentation, evolution of disease, and predictors of mortality in individuals with EVD. To assess the quality and utility of published data for clinical and public health decision-making.

DATA SOURCES

Primary articles available in PubMed and published between January 2014 and May 2017.

ELIGIBILITY

Studies that sequentially enrolled individuals hospitalized for EVD and that reported acute clinical outcomes.

METHODS

We performed meta-analyses using random-effect models and assessed heterogeneity using the I2 method. We assessed data representativeness by comparing meta-analysis estimates with WHO aggregate data. We examined data utility by examining the availability and compatibility of data sets.

RESULTS

In all, 3653 articles were screened and 34 articles were included, representing 16 independent cohorts of patients (18 overlapping cohorts) and at least 6168 individuals. The pooled estimate for case fatality rate was 51% (95% CI 46%-56%). However, pooling of estimates for clinical presentation, progression, and predictors of mortality in individuals with EVD were hampered by significant heterogeneity, and inadequate data on clinical progression. Our assessment of data quality found that heterogeneity was largely unexplained, and data availability and compatibility were poor.

CONCLUSIONS

We have quantified a missed opportunity to generate reliable estimates of the clinical manifestations of EVD during the West Africa epidemic. Clinical data standards and data capture platforms are urgently needed.

P1943Ambient temperature and seasonal effects on blood pressure in 2.6 million Australians

Background

There is evidence that blood pressure (BP) levels vary considerably from season to season, due principally to variation in ambient temperature. This gives the potential for both under- and over-treatment if BP lowering medications are not varied seasonally, but is not acknowledged in clinical guidelines. We will describe the seasonal variation in BP and assess the association between systolic blood pressure (SBP) and outdoor maximum ambient temperature in Australia.

Methods

The primary care data is an extract from MedicineInsight, a national general practice data program developed and managed by NPS MedicineWise, which extracts deidentified data from almost 10% of all Australian general practices. We included patients aged 30–90 years with at least one BP measure recorded from 1 Jan 2010 to 1 Aug 2017. Australian Bureau of Meteorology daily max temperature is linked by matching observation dates and location to nearest weather station. Decomposition of the mean will determine seasonal variation. Multiple linear regression was used to estimate the associations between max temperature and SBP with adjustment for age, sex, socioeconomic index, current smoking, comorbidities, BP lowering medication use, lipid lowering medication use and year of BP measurement.

Results

The study population includes 2.6 million people, mean age 55 years (standard deviation [SD] 16.3). Fifty-five percent are female, over a third of the cohort reside in New South Wales, and 62.4% reside in major Australian cities. The mean (SD) temperature was 23°C (6.6).

There was a mean (SD) of 7 (11.4) BP measurements per person over the study period, median 3 measures (interquartile range 1–8). A quarter had a history of hypertension, 8% had a history of cardiovascular disease, and 8% had a history of diabetes. Twenty-six percent had at least one prescription for BP lowering therapy.

The average monthly SBP for the cohort demonstrated strong seasonal variation with higher values in winter. The population mean varies by 3mmHg SBP between seasons across Australia, ranging from 1.7mmHg in the Northern Territory to 3.5mmHg in South Australia (range of mean maximum temperature 3°C [30–33] and 14°C [15–29] for the capital cities respectively). Each 10°C increase in max outdoor temperature was associated with a 1.8mmHg [95% CI 1.80–1.83] lower mean SBP. The proportion of people with SBP>140mmHg varied by season, irrespective of age, sex and use of BP lowering treatment. For example, among those treated control rates varied between 70 and 81%, and among those not treated between 78 and 85% (Figure).

Blood pressure seasonality in Australia

Conclusions

BP control rates vary considerably by season. These findings have implications for the reliable diagnosis of hypertension, and suggest seasonal adjustments in treatment should be considered for some patients. The clinical and public health relevance of this phenomenon is expected to increase with increasing climate variability.

Acknowledgement/Funding

National Health and Medical Research Council Australia, National Heart Foundation Australia

P5732Effects of blood pressure lowering drugs in heart failure: a systematic review and meta-analysis of randomised controlled trials

Background

Observational studies have reported a J-shaped relationship between blood pressure (BP) and all-cause and cardiovascular mortality in patients with heart failure (HF). Although decreasing BP significantly reduces the risk of fatal and non-fatal cardiovascular outcomes in the general population across a range of baseline BP categories, the extent to which those findings are applicable to HF patients and whether the relationship holds true when baseline BP is very low remain unclear. Therefore, it is yet to be established whether the observed J-shaped relationship between BP and clinical outcomes in patients with HF is causal and/or modified by antihypertensive treatment.

Purpose

We aimed to combine evidence from all HF trials that have investigated the effects of drugs with BP-lowering properties to assess (1) the extent to which such drugs reduce BP in HF, (2) the association between the net change in BP between treatment arms and cause-specific outcomes, and (3) whether treatment effects (including benefits and potential harms) vary according to baseline BP.

Methods

We conducted a systematic review and meta-analysis including randomised clinical trials of drugs with BP-lowering properties conducted in patients with chronic HF with at least 300 patient-years follow-up.

Results

We included a total of 37 trials (91,950 patients) and showed that treatment with drugs with BP-lowering properties significantly reduced SBP by 2.0 mmHg in all trials and by 2.4 mmHg in placebo-controlled trials (Figure 1). There was no evidence that BP reduction in placebo-controlled trials varied across strata of baseline BP, but there was suggestive evidence for differential effects by drug class, with renin-angiotensin-aldosterone system inhibitors reducing SBP by 3.2 mmHg (95% CI [−4.0, −2.4]), whilst BB appeared to have a neutral effect on BP. There was no evidence that the relative risk reduction afforded by treatment with BP-lowering drugs on all-cause mortality, cardiovascular mortality and HF hospitalisation was significantly different across categories of baseline BP. There was also no strong evidence for heterogeneity of treatment effect on adverse events leading to treatment discontinuation by baseline BP. Meta-regression did not show significant associations between the magnitude of BP reduction achieved in each trial and risk of those clinical outcomes.

Figure 1

Conclusions

Treatment with drugs with BP-lowering properties resulted in a small but significant decrease in SBP in patients with HF irrespective of baseline BP. There was no evidence that the effects of those drugs differed across the range of baseline SBP, thus supporting the efficacy and safety of those drugs in patients with low baseline BP. Data from published reports was insufficient to adequately investigate whether BP-dependent mechanisms contribute to the effect of BP-lowering drugs on clinical outcomes in patients with HF.

Acknowledgement/Funding

None

A Quantum Electrodynamics Description of Quantum Coherence and Damping in Condensed-Phase Energy Transfer

Quantum coherence in condensed-phase electronic resonance energy transfer (RET) is described within the context of quantum electrodynamics (QED) theory. Mediating dressed virtual photons (polaritons) are explicitly incorporated into the treatment, and coherence is understood within the context of interfering Feynman pathways connecting the initial and final states for the RET process. The model investigated is that of an oriented three-body donor, acceptor, and mediator RET system embedded within a dispersive and absorbing polarizable medium. We show how quantum coherence can significantly enhance the rate of RET and give a rigorous picture for subsequent decoherence that is driven by both phase and amplitude damping. Energy-conserving phase damping occurs as a result of geometric and dispersive effects and is associated with destructive interference between Feynman pathways. Dissipative amplitude damping, on the other hand, is attributed to vibronic relaxation and absorptivity of the medium and can be understood as virtual photons (polaritons) leaking into the environment. This model offers insights into the emergence of coherence and subsequent decoherence for energy transfer in photosynthetic systems.

Scalable Total Syntheses of Some Natural and Unnatural Lamellarins: Application of a One-Pot Domino Process for Regioselective Access to the Central 1,2,4-Trisubstituted Pyrrole Core

Short and scalable total syntheses of lamellarin G trimethyl ether, lamellarin D trimethyl ether, lamellarin H, lamellarin η, dihydrolamellarin η, and lamellarin U have been realized in four to six linear steps with an overall yield of ≤22%. Highlights of the synthesis include single-step access to the central 1,2,4-trisubstituted pyrrole core in a highly regioselective manner via a one-pot [3+2] cycloaddition/elimination/aromatization sequence-based domino process. Subsequent, palladium-mediated double C-H oxidative coupling in a single-pot operation provides access to the pentacyclic coumarin-fused pyrrolo-dihydroisoquinoline core present in lamellarins.

Air pollution tolerance index of Mangifera indica plant species growing in the greater Dhaka region, Bangladesh

Air pollution tolerance index (APTI) of the mango (Mangifera indica) leaves growing in the greater Dhaka region, Bangladesh was studied. Leaf samples were collected in winter season from both roadsides and residential locations of different parts of greater Dhaka region. The APTI values of the leaves were calculated from the total chlorophyll content (TCC), ascorbic acid concentration, relative water content (RWC), and pH of the leaf extract. Determined APTI values were compared with Particulate Matter (PM2.5) values in each sampling location. TCC and ascorbic acid concentration were determined with a UV-Visible spectrophotometer. TCC values varied between 0.25 and 1.10 mg/g with an average of 0.66 mg/g. The average concentration of ascorbic acid was 2.21 mg/g (values ranging from 0.33 to 3.24 mg/g) and the RWC varied from 81.5% to 97.4%. Moreover, pH values of the leaf extracts were found acidic (4.48-5.78). The average APTI values varied depending on the locations with a total average of 10.1. However, the average APTI value in the residential area (10.5) was slightly higher compared to roadsides (9.70) indicating the existence of high-level pollutions at the roadsides. The highest APTI value was observed in Dhaka city sampling location (10.6) where the lowest value was found in Narayangonj (9.70). APTI values showed a strong correlation with particulate matter concentrations (PM2.5). These results suggest that Mangifera indica is very sensitive to the air pollutants. J. Biodivers. Conserv. Bioresour. Manag. 2019, 5(1): 1-12

Comparative efficiency of wheat straw and sugarcane bagasse biochar reduces the cadmium bioavailability to spinach and enhances the microbial activity in contaminated soil

Biochar is considered a novel soil amendment for cadmium (Cd) stabilization in contaminated soils. A pot experiment was conducted to examine the efficiency of wheat straw and sugarcane bagasse induced biochar on Cd mobility in soil and its bioavailability to spinach in contaminated soil. Soil pH, Cd contents in plant tissues and microbial biomass were examined. Results showed that Cd was significantly decreased by 30.95% and 20.83% with wheat straw and sugarcane bagasse biochar at 2% application rate respectively, relative to the control. Similarly, Cd contents were decreased in plants shoots by 15.41 and 14.33%, while in roots by 48.3 and 35.54%, when wheat straw and sugarcane biochar were added at 2% application rate respectively. Moreover, soil microbial biomass was significantly increased with the application of all biochar types and their applications rates. Finally, wheat straw biochar at 2% application rate can be considered as an effective approach for Cd stabilization in contaminated soils.

Evaluation of Training Session Applying Gagne’s Events of Instructions

Background: This study explores the effectiveness of educator's training programs regarding the presentation, materials, facilities, relevance and usefulness of the training to the current employment and facilitator’s knowledge using Gagne’s event of instructions. Method: A half day long training was conducted on September 2017 at reach of the two health care teaching institutes. At the end of training, evaluation was done and rated in 5 point Likert scale with 5 as the highest score. Participants agreed that the training was useful and relevant to their work. Result: This study showed a positive perception of the learners which will help their job performance as well as the outcome of their dental teaching school and Gagne’s Events of Instructions can be used when conducting this type of training sessions. Conclusion: Regular training program for staff development need to be carried out following a system approach with right mix of input and contents which process with right sequences of instructions to fill the gap between desired performance and actual staff performance. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.552-556

Rice straw- and rapeseed residue-derived biochars affect the geochemical fractions and phytoavailability of Cu and Pb to maize in a contaminated soil under different moisture content

Management of toxic elements contaminated upland and wetland soils using biochar is of great concern from both agricultural and environmental points of view. The impact of rice straw- and rapeseed residue-derived biochars produced under 300 °C and 550 °C (added to the soil at 2% and 5%; w/w) on the geochemical fractions, phytoavailability, and uptake of Cu and Pb in a contaminated mining soil under different moisture contents (80%, 60%, and 40% of soil field capacity) was investigated in a greenhouse pot experiment using maize. The higher rate of rice straw-derived biochar pyrolyzed at 550 °C caused a significant reduction in the mobile (soluble + exchangeable) fraction of Cu (59.42%) and Pb (75.4%) and increased the residual fractions of Cu (37.8%) and Pb (54.7%) in the treated soil under the highest moisture content (80%) as compared to the untreated soil. Therefore, this biochar significantly decreased the phytoavailability (CaCl₂-extractable form) of Cu by 59.5% and Pb by 67.6% under the highest moisture content. Also, at the same moisture level (80%), the higher rate of rapeseed residue-derived biochar pyrolyzed at 550 °C decreased significantly the phytoavailability of Cu by 46.5% and Pb by 60.52% as compared to the untreated soil. The 5% rate of the higher temperature pyrolyzed rice straw and rapeseed biochars decreased the uptake of Cu and Pb by the roots and shoots of maize up to 51% for Cu and 45% for Pb. Immobilization of Cu and Pb in the biochar-treated soil at 80% moisture content may possibly due to the associated increase of soil pH and poorly-crystalline Fe oxides content, and/or the metals precipitation with sulfides. These results indicated that application of high temperature pyrolyzed rice straw- and rapeseed residue-derived biochars at 5% could immobilize Cu and Pb and decrease their uptake by maize under high levels of moisture content; consequently, they can be used for phyto-management of Cu and Pb contaminated wetland soils.

Assessing risk to human health for heavy metal contamination through street dust in the Southeast Asian Megacity: Dhaka, Bangladesh

Contaminants in road dusts can directly pose significant human health risks through oral ingestion, particle inhalation, and dermal contact. Therefore, this study has been designed to analyze heavy metal contaminations in 88 street dusts collected from the 22 high traffic sites and industrial areas of the Southeast Asian Megacity: Dhaka (capital of Bangladesh) using energy dispersive X-ray fluorescence (EDXRF) spectroscopy. This study revealed that the maximum Pb, Cd, Zn, Cr, Ni, As, Mn and Cu contents in the street dust samples were 18.9, 11.6, 239.2, 144.3, 37.1, 8.1, 261.5 and 49.6 mg/ kg respectively in which Ni and Pb concentration were 2 times, and Cd concentration was 200 times higher than the background level in soil; and As concentration was slightly higher than soil background level. The spatial distribution of heavy metal concentrations in street dust samples in Dhaka City was revealed that the hot spot areas of Pb, Ni, Cd and As were mainly associated with heavy traffic and industrial activities. The risk assessment strategies were used for this study for identifying the routes of exposure through oral ingestion, inhalation, and dermal contact by the fine particles (~75 μm) of street dust, especially for children based on the US EPA health risk models. Both non-carcinogenic and carcinogenic risks of heavy metals were characterized in street dust samples. Results based on the hazard index (HI), in the case of non-cancer effect, the ingestion of dust particles of children and adults in Dhaka City appeared to be the route of exposure to street dust that results in a higher risk for heavy metals, followed by dermal contact. This study revealed that the inhalation of re-suspended particles through mouth and nose were almost negligible. It was also noticed that children were experiencing the potential health risk due to HI for Cr (1.04), which was slightly higher than the safe level 1, and Cd (0.69) was close to the safe level 1. Reversely, cancer risk for Cr (i.e. 4.27 × 10^-6) was fallen within the range of threshold values (10^-4 to 10^-6) and As (i.e. 9.59 × 10^-7) was close to the upper limit of threshold values (10^-4 to 10^-6).

Near-Zone Mediation of RET by One and Two Proximal Particles

The effect of two inert, electric dipole polarizable molecules in relaying electronic excitation energy resonantly between a donor-acceptor pair is studied within the framework of molecular QED theory. Since transfer is efficacious when the coupled particles are close to one another, the matrix element is calculated in the near-zone approximation by employing static dipolar interaction potentials and third-order diagrammatic perturbation theory. For isotropic species, the Fermi golden rule exchange rate exhibits a Förster-like inverse sixth power dependence on each pair separation distance, is proportional to the modulus squares of the transition electric dipole moments of donor and acceptor, and depends on the polarizabilities of the two mediators. Comparison is made with direct (2-body) and third-body mediated near-zone transfer. Matrix elements for these last two processes are used to evaluate contributions to the rate due to 2-body-3-body, 2-body-4-body, and 3-body-4-body interference terms. In each of these cases, an inverse cubic dependence on each of the relative particle displacements is found.

Effective Role of Biochar, Zeolite and Steel Slag on Leaching Behavior of Cd and Its Fractionations in Soil Column Study

Remediation of cadmium (Cd) from contaminated soils is considered a complicated task of environmental safety. A column leaching experiment was planned to estimate the influence of biochar (BC), zeolite (ZE) and steel slag (SL) at 1.5% and 3% application rate on Cd leaching behavior and chemical fractionation in contaminated soil. A sequential extraction procedure, the European Community Bureau of Reference (BCR), Toxicity Characteristic Leaching Procedure (TCLP) and NH₄NO₃ were performed after leaching was completed. The soluble portion of Cd was decreased by 36.3%, 18.4% and 28.7% and Cd contents in leachate were decreased by 44.8%, 30% and 31.3% after BC, ZE and SL addition at 3% rate, respectively over control soil. The greater reduction in TCLP extractable Cd was observed by 29.6% with BC and 22.4% with ZE and 25.7% with SL at 3% application rate. Overall, biochar can be considered an efficient soil amendment to reduce Cd leaching as well as increased its stabilization within soil profile.

Particulate matters and gaseous pollutants in indoor environment and Association of ultra-fine particulate matters (PM1) with lung function

Real-time particulate matters (PM₁, PM_2.5, PM₄, PM₇, PM₁₀, and TSP) with AEROCET 531S (USA), gaseous pollutants (NO₂ and TVOC) with Aeroquel 500 gas sampler (NZ) were measured from the indoor air of houses at four residential locations in Dhaka, Bangladesh. PM₁₀ samples were collected on quartz filters with a dual channel dust sampler (IPM-FDS 2510, India) for selected trace metal determination from five houses of Dhaka. Respiratory function of the occupants was assessed by using a peak expiratory flow meter (Rossmax PF 120). Mean PM₁, PM_2.5, and PM₁₀ concentrations were 46.1 ± 13.4, 76.0 ± 16.2, and 203.9 ± 44.8 μg m^-3, respectively. Higher enrichment factors of Pb, Zn, and Ni were found for traffic, industrial, and constructional activities. The correlation between indoor and outdoor PM_2.5 (R² = 0.42) and ratios (I/O < 1) suggesting indoor air was effected by outdoor air. The concentration of NO₂ (0.076 ± 0.007 ppm) and TVOC (90.0 ± 46.0 ppm) was found above than other studies. The average total hazard ratio (THR) in Dhaka was 9.06 and has the highest exposure to air pollutants (PM_2.5, PM₁₀, NO₂) in Khilkhet (THR 10.1) residents. A negative association between ultra-fine particles (PM₁) and peak flow rate measurements of the residents living in these houses indicates that inhalations of ultra-fine particles has great influence on the reduced lung efficiency.

Technical Varieties of Ross Procedure: A Case Series

Replacement of aortic valve with the pulmonary autograft is carried out through the Ross procedure due to its potential for growth, durability in pediatric population, and absence of anticoagulation. This case series reports the postoperative outcome of two technical variations of Ross procedure in eight patients who underwent surgery from January 2007 to December 2016. The dominant valvular hemodynamic indication was aortic regurgitation. The techniques employed for Ross procedure included free standing root replacement in six patients and modified root replacement with autograft stabilisation using Dacron interposition graft in two patients. Right ventricular outflow tract (RVOT) conduit reconstruction was achieved by utilisation of Contegra bio prosthesis in four patients; and use of manually constructed valved conduit comprising of PTFE (polytetrafluoroethelene) membrane and bovine pericardial tube in remaining four patients. There was no mortality and no re-intervention. The technical varieties of Ross procedure offer freedom from need of anti-coagulation, mortality, and RVOT conduit failure in younger adults.

Photochemical degradation affects the light absorption of water-soluble brown carbon in the South Asian outflow

Light-absorbing organic aerosols, known as brown carbon (BrC), counteract the overall cooling effect of aerosols on Earth's climate. The spatial and temporal dynamics of their light-absorbing properties are poorly constrained and unaccounted for in climate models, because of limited ambient observations. We combine carbon isotope forensics (δ¹³C) with measurements of light absorption in a conceptual aging model to constrain the loss of light absorptivity (i.e., bleaching) of water-soluble BrC (WS-BrC) aerosols in one of the world's largest BrC emission regions-South Asia. On this regional scale, we find that atmospheric photochemical oxidation reduces the light absorption of WS-BrC by ~84% during transport over 6000 km in the Indo-Gangetic Plain, with an ambient first-order bleaching rate of 0.20 ± 0.05 day^-1 during over-ocean transit across Bay of Bengal to an Indian Ocean receptor site. This study facilitates dynamic parameterization of WS-BrC absorption properties, thereby constraining BrC climate impact over South Asia.

Coping Strategies among First and Third Year Medical Students in a Malaysian Public University

Background: Medical students lead a stressful life and therefore the coping strategy is very important for them to alleviate the stress. The objective of this study was to explore the coping strategy among the first year and third year medical students and also to identify any significant difference between genders and study-years. Materials & methods: This cross-sectional study involved first and third year medical students of University Kebangsaan Malaysia of session 2013/2014. Coping strategy was explored using the ‘Coping Inventory for Stressful Situations’ (CISS) which consist of 48-items where 16 under task-oriented, 16 under emotional-oriented and 16 under avoidance-oriented coping. A five-point Likert’ scale ranging from ‘1=not at all’ to ‘5=very much’ was used to rate the items. Results: Task oriented coping was found the most common strategy among all students while emotion oriented was the least. First year students scored significantly higher than third year showing their best effort to adapt a new environment with insignificant difference between genders. Conclusions: Task-oriented coping strategy of the students is a good sign of problem solving skills. Though majority of the students adapt this method of coping, still there are other methods in practice. Medical school should focus for growing awareness about the positive coping methods in response to stress. This is necessary for the long term benefit of the students as well for better service to the nation. J MEDICINE JUL 2019; 20 (1) : 5-11 

Global Sources of Fine Particulate Matter: Interpretation of PM2.5 Chemical Composition Observed by SPARTAN using a Global Chemical Transport Model

Exposure to ambient fine particulate matter (PM_2.5) is a leading risk factor for the global burden of disease. However, uncertainty remains about PM_2.5 sources. We use a global chemical transport model (GEOS-Chem) simulation for 2014, constrained by satellite-based estimates of PM_2.5 to interpret globally dispersed PM_2.5 mass and composition measurements from the ground-based surface particulate matter network (SPARTAN). Measured site mean PM_2.5 composition varies substantially for secondary inorganic aerosols (2.4-19.7 μg/m³), mineral dust (1.9-14.7 μg/m³), residual/organic matter (2.1-40.2 μg/m³), and black carbon (1.0-7.3 μg/m³). Interpretation of these measurements with the GEOS-Chem model yields insight into sources affecting each site. Globally, combustion sectors such as residential energy use (7.9 μg/m³), industry (6.5 μg/m³), and power generation (5.6 μg/m³) are leading sources of outdoor global population-weighted PM_2.5 concentrations. Global population-weighted organic mass is driven by the residential energy sector (64%) whereas population-weighted secondary inorganic concentrations arise primarily from industry (33%) and power generation (32%). Simulation-measurement biases for ammonium nitrate and dust identify uncertainty in agricultural and crustal sources. Interpretation of initial PM_2.5 mass and composition measurements from SPARTAN with the GEOS-Chem model constrained by satellite-based PM_2.5 provides insight into sources and processes that influence the global spatial variation in PM_2.5 composition.

Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school

Background

Empathy is one of the cardinal components for physician-patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia.

Methods

This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80.

Results

Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic.

Conclusions

To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Analysis of Problems Posed in Problem Based Learning Cases: Nature, Sequence of Discloser and Connectivity with Learning Issues

Background: Problems posed in problem based learning (PBL) cases used during pre-clinical teaching-framework are typically a set of descriptions of events in need of explanations and resolution. The objectives of this study were to analyze the problems in PBL cases aimed to suggest areas for improvement.Methods: It was a review of cases used in PBL in undergraduate medical curriculum at UKM Medical Centre. Problems in PBL cases were labeled as ‘Triggers’ and ‘Patient Information Sheets’ which were disclosed as prescribed in structured facilitators’ guide. Six of the 10 PBL cases used in semester-1, session 2013-2014 were selected randomly for analysis.Results: Problems in 50% cases were overloaded and in 50% cases sequences of problem-disclosure were disorderly-labeled, though the flow of descriptions were alright. Averagely, 82% faculty-intended learning issues prescribed in facilitators’ guide were connected with problems. Unconnected learning issues were the result of faculty directed teacher-centered approach of guidance, while important learning issues that could have been derived against problems were un-identified.Conclusion: Connectivity of average 82% faculty-intended learning issues with problems reflect as good quality of PBL problems in UKM Medical Centre. However, problem disclosers in disorderly-labeled fashion, unconnected and unidentified issues against some problems in spite of conducting a good numbers of faculty development workshops, raised the issue of needs of further research on standard of training workshops. Educational leaders should give due importance on professionalism and needs of high-quality training for faculty to enhance PBL skills either by utilizing and mobilizing existing properly trained faculty or by hiring appropriate trained faculty.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.417-423

Perspective: Quantum Hamiltonians for optical interactions

The multipolar Hamiltonian of quantum electrodynamics is extensively employed in chemical and optical physics to treat rigorously the interaction of electromagnetic fields with matter. It is also widely used to evaluate intermolecular interactions. The multipolar version of the Hamiltonian is commonly obtained by carrying out a unitary transformation of the Coulomb gauge Hamiltonian that goes by the name of Power-Zienau-Woolley (PZW). Not only does the formulation provide excellent agreement with experiment, and versatility in its predictive ability, but also superior physical insight. Recently, the foundations and validity of the PZW Hamiltonian have been questioned, raising a concern over issues of gauge transformation and invariance, and whether observable quantities obtained from unitarily equivalent Hamiltonians are identical. Here, an in-depth analysis of theoretical foundations clarifies the issues and enables misconceptions to be identified. Claims of non-physicality are refuted: the PZW transformation and ensuing Hamiltonian are shown to rest on solid physical principles and secure theoretical ground.

Molecular characterization and multidisciplinary management of Gerbich hemolytic disease of the newborn

Gerbich (Ge) antigens are high frequency red cell antigens expressed on glycophorin C (GYPC) and glycophorin D. Hemolytic disease of the fetus and newborn (HDFN) due to Gerbich antibody is rare and presents a clinical challenge, as Gerbich negative blood is scarce. We report a case of HDFN due to maternal Ge3 negative phenotype and anti-Ge3 alloimmunization, successfully managed by transfusion of maternal blood. Molecular testing revealed that the mother has homozygous deletion of exon 3 of GYPC, the father is homozygous wildtype for GYPC, and the infant is obligate heterozygote expressing Ge3.

Starch Derivatives that Contribute Significantly to the Bonding and Antibacterial Character of Recycled Fibers

The objective of the current research was to fabricate and explore the ability of a renewable resource-based paper strength agent to enhance fiber-fiber bonding and introduce antibacterial properties to recycled fiber paper sheets. The agent corn starch, was modified with diethylenetriamine pentaacetic acid (DTPA), complexed with chitosan, and added to recycled furnishes to provide a plethora of hydrogen bonding sites predicated by acid groups, hydroxyls, and amines. The goal was two-fold: (1) to not only increase interfiber bonding, but (2) afford antibacterial character. The modified corn starch was characterized in previous work by thermal gravimetric analysis, differential scanning calorimeter, and Fourier transform infrared spectroscopy. The recycled pulp slurry was mixed with a ∼1.5% modified starch/chitosan agent before manufacturing a two-dimensional paper substrate that was subjected to mechanical testing. The burst, STFI compressive strength, tensile, and interfiber bonding strength increased 48.8, 49.5, 49.9, and 176%, respectively, while significantly increased gloss was obtained despite slightly diminished tear and roughness. The antibacterial character of these substrates was confirmed by the substrates displaying a 97% bacteria kill rate.

Cadmium Immobilization Potential of Rice Straw-Derived Biochar, Zeolite and Rock Phosphate: Extraction Techniques and Adsorption Mechanism

Heavy metal contamination in agricultural soils has become a serious environmental concern due to their generally high mobility and toxic effects on plants and food security. An incubation study was conducted to assess the effectiveness of biochar (BC), zeolite (ZE) and rock phosphate (RP) stabilizers on the immobilization of cadmium (Cd) in contaminated soils. Various extraction techniques were carried out: a sequential extraction procedure, the European Community Bureau of Reference (BCR), the toxicity characteristics leaching procedure (TCLP) and extraction with ammonium nitrate. In addition, Cd adsorption by these materials was observed using Langmuir and Freundlich isotherms. The results showed that with an increase in soil pH the exchangeable fraction of Cd in soil was significantly reduced by 28%-29.4%, 9%-13% and 4%-14% for BC, ZE, and RP, respectively. According to the Langmuir adsorption isotherm, BC-amended soil showed a higher adsorption capacity (Q_m) of Cd from 8.38 to 19.85 mg g^-1. Overall, BC offered better results when compared to other amendments.

Chemical characterization of PM2.5 collected from a rural coastal island of the Bay of Bengal (Bhola, Bangladesh)

This work focuses on the chemical characterization of fine aerosol particles (PM_2.5) collected from a rural remote island of the Bay of Bengal (Bhola, Bangladesh) from April to August, 2013. PM_2.5 particle-loaded filters were analyzed for organic carbon (OC), elemental carbon (EC), water-soluble ions, and selected saccharides (levoglucosan, mannosan, galactosan, arabitol, and mannitol). The average PM_2.5 mass was 15.0 ± 6.9 μg m^-3. Organic carbon and elemental carbon comprised roughly half of the analyzed components. Organic carbon was the predominant contributor to total carbon (TC) and accounting for about 28% of PM_2.5 mass. Secondary organic carbon (SOC) was inferred to be ~ 26% of OC. The sum of ions comprised ~ 27% of PM_2.5 mass. The contribution of sea salt aerosol was smaller than expected for a sea-near site (17%), and very high chloride depletion was observed (78%). NssSO₄^2- was a dominant ionic component with an average concentration of 2.0 μg m^-3 followed by Na⁺, NH₄⁺, and nssCa²⁺. The average concentration of arabitol and mannitol was 0.11 and 0.14 μg m^-3, respectively, while levoglucosan and its stereoisomers (mannosan and galactosan) were bellow detection limit. NH₄⁺/SO₄^2- equivalent ratio was 0.30 ± 0.13 indicating that secondary inorganic aerosol is not the main source of SO₄^2-. Enrichment factor (EF) analysis showed that SO₄^2- and NO₃^- were enriched in atmospheric particles compared to sea aerosol and soil indicating their anthropogenic origin. Higher OC/EC ratio (3.70 ± 0.88) was a good indicator of the secondary organic compounds formation. Other ratios (OC/EC, K⁺/EC, nssSO₄^2-/EC) and correlation analysis suggested mixed sources for carbonaceous components. Arabitol and mannitol both showed strong correlation with EC having R ² value 0.89 and 0.95, respectively. Air mass trajectories analysis showed that concentrations of soil and anthropogenic species were lower for air masses originating from the sea (May-August) and were higher when air came from land (April).

Expulsion of a Lacrimal Dacryolith by Sneezing: A Rare Event

Purpose

To describe the case of a man presenting with intermittent epiphora of the right eye and a low grade dacryocystitis due to a dacryolith.

Methods/Results

He was treated conservatively and was offered a Dacryocystorhinostomy. A few weeks before surgery, he developed swelling and pain over the right medial canthus followed by violent sneezing with spontaneous extrusion of the dacryolith.

Discussion

The authors propose that the dacryolith fragmented spontaneously and once it reached the nasal cavity, was expelled by violent sneezing to the nostril, a mechanism not previously reported.

Conclusions

Reformation of dacryolith is a likely possibility, and recurrence of symptoms in such cases may ultimately require a Dacryocystorhinostomy.