POS1083 INCREASED INTESTINAL PERMEABILITY IN PATIENTS WITH PSORIATIC ARTHRITIS CLASSIFIED AS TREATMENT FAILURES DURING THE 26-WEEK FLORA TRIAL

Background

Changes in the integrity of the intestinal wall may be implicated in the gut-joint axis of inflammatory arthritis.1 Yet, the gut barrier is only poorly evaluated in psoriatic arthritis (PsA).2

Objectives

In this exploratory study, we evaluated intestinal permeability before and 26 weeks after one faecal microbiota transplantation (FMT) or sham intervention in adults with PsA.

Methods

We have previously reported the clinical results of a 26-week, double-blind, parallel-group, 1:1 randomised, sham-controlled, superiority trial of gastroscopic-guided FMT as an add-on treatment to methotrexate in 31 adults with active peripheral PsA (FLORA trial, NCT03058900).3 The primary efficacy endpoint was the proportion of participants who experienced treatment failure through 26 weeks, defined as need for more than one intra-articular glucocorticoid injection and/or anti-TNFα inhibition. We encouraged patients not to take nonsteroidal anti-inflammatory drugs during the trial. The FMT material was obtained from one of four healthy blood donors. As part of the trial, we performed a lactulose and mannitol test (L:M test) at baseline (n=31) and at the final 26-week visit (n=26) to assess the permeability of the intestinal wall (higher L:M ratios indicate higher permeability). After an overnight fasting, patients provided a urine sample before ingesting 10 g of lactulose and 5 g of D-mannitol. Samples were collected after 3 hours and stored at −80°C until analysis. No food or drinking (except for water) was allowed during the test. We measured the lactulose-to-mannitol ratio in the urine samples using a Waters Acquity UPLC system coupled to a high-resolution mass spectrometer Waters Xevo G2 QToF (Waters Corp., Milford, MA, USA). MassLynx software (Waters Corporation) was used for data acquisition and visual inspection. We used StataSE-64 to perform the Wilcoxon rank sum and the matched-pairs signed-rank test. Data is presented as median and range. The level of significance was set to 0.05.

Results

At baseline, no significant difference was observed in the L:M ratio between donors (n=4) and patients (n=31) (0.0065 [0–0.063] vs 0.014 [0–0.28]; p=0.50). The L:M ratio increased from baseline to week 26 in both the FMT (0.0020 [-0.27 – 0.32] and the sham group (0.0046 [-0.012 – 0.088]), but only in the sham group differed the baseline L:M ratio significantly from the one measured at week 26 (p=0.92 [FMT] and p=0.032 [sham]). The patients who were classified as treatment failures during the trial (n=7) had a significantly higher L:M ratio at week 26 compared to the patients who were non-failures (n=19) (0.027 [0.017 – 0.33]) vs 0.012 [0 – 0.064], p=0.01), please see Figure 1.

Figure 1.

L:M ratios at week 26 in treatment failures (n=7) and non-failures (n=19), respectively. Higher L:M ratios indicate higher intestinal permeability.

Conclusion

In the FLORA trial, intestinal permeability evaluated by the L:M test did not differ significantly between donors and patients at baseline. Whether the higher intestinal permeability observed in patients classified as treatment failures compared to non-failures at week 26 can be attributed to differences in disease activity and/or the instigation of additional immunosuppression in the failure group during the trial needs further investigation.

References

[1]Gracey E, Vereecke L, McGovern D, et al. Revisiting the gut-joint axis: links between gut inflammation and spondyloarthritis. Nat Rev Rheumatol. 2020;16(8):415-433.

[2]Hecquet S, Totoson P, Martin H, et al. Intestinal permeability in spondyloarthritis and rheumatoid arthritis: A systematic review of the literature. Semin Arthritis Rheum. 2021;51(4):712-718.

[3]Kragsnaes MS, Kjeldsen J, Horn HC, et al. Safety and efficacy of faecal microbiota transplantation for active peripheral psoriatic arthritis: an exploratory randomised placebo-controlled trial. Ann Rheum Dis. 2021;80(9):1158-1167.

Disclosure of Interests

None declared

In-kitchen aerosol exposure in twelve cities across the globe

Poor ventilation and polluting cooking fuels in low-income homes cause high exposure, yet relevant global studies are limited. We assessed exposure to in-kitchen particulate matter (PM_2.5 and PM₁₀) employing similar instrumentation in 60 low-income homes across 12 cities: Dhaka (Bangladesh); Chennai (India); Nanjing (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Akure (Nigeria); Blantyre (Malawi); Dar-es-Salaam (Tanzania) and Nairobi (Kenya). Exposure profiles of kitchen occupants showed that fuel, kitchen volume, cooking type and ventilation were the most prominent factors affecting in-kitchen exposure. Different cuisines resulted in varying cooking durations and disproportional exposures. Occupants in Dhaka, Nanjing, Dar-es-Salaam and Nairobi spent > 40% of their cooking time frying (the highest particle emitting cooking activity) compared with ∼ 68% of time spent boiling/stewing in Cairo, Sulaymaniyah and Akure. The highest average PM_2.5 (PM₁₀) concentrations were in Dhaka 185 ± 48 (220 ± 58) μg m^-3 owing to small kitchen volume, extensive frying and prolonged cooking compared with the lowest in Medellín 10 ± 3 (14 ± 2) μg m^-3. Dual ventilation (mechanical and natural) in Chennai, Cairo and Sulaymaniyah reduced average in-kitchen PM_2.5 and PM₁₀ by 2.3- and 1.8-times compared with natural ventilation (open doors) in Addis Ababa, Dar-es-Salam and Nairobi. Using charcoal during cooking (Addis Ababa, Blantyre and Nairobi) increased PM_2.5 levels by 1.3- and 3.1-times compared with using natural gas (Nanjing, Medellin and Cairo) and LPG (Chennai, Sao Paulo and Sulaymaniyah), respectively. Smaller-volume kitchens (<15 m³; Dhaka and Nanjing) increased cooking exposure compared with their larger-volume counterparts (Medellin, Cairo and Sulaymaniyah). Potential exposure doses were highest for Asian, followed by African, Middle-eastern and South American homes. We recommend increased cooking exhaust extraction, cleaner fuels, awareness on improved cooking practices and minimising passive occupancy in kitchens to mitigate harmful cooking emissions.

Light absorption properties of brown carbon from biomass burning emissions

A laboratory-scale experiment was conducted to determine the light absorption properties of brown carbon (BrC) produced from the incomplete combustion of 14 different biomasses. Particulate matters (PM) emitted from biomass burning were collected on the quartz fiber filters with a low volume sampler. BrC from filter samples was extracted with two different solvents (methanol and water), and absorption characteristics of BrC were determined using a UV-Vis spectrophotometer. The absorption coefficient (b_abs-BrC), mass absorption efficiency (MAE_BrC), absorption angstrom exponent (AAE_BrC), and absorbing portion of refractive index (k_abs-BrC) were calculated for each biomass from the absorbance of the extracted solution. Methanol-soluble BrC (MeS-BrC) showed higher absorbance than water-soluble BrC (WS-BrC) in all biomasses. MeS-BrC has higher b_abs-BrC than WS-BrC, suggesting that the rate of light absorption on BrC extracted in methanol was higher. The absorption coefficients (b_abs-BrC) were varied among biomasses-rain tree had the highest value of b_abs-BrC, whereas jute stick had the lowest. The mass absorption efficiency of BrC (MAE_BrC) was evaluated in both water and methanol extracts, and it was found that the MAE_BrC for MeS-BrC in the biomasses was greater than that of WS-BrC. The highest MAE_BrC value (13.02 m²g^-1) was identified in the jackfruit tree, whereas the lowest MAE_BrC value (0.1 m²g^-1) was observed in the jute stick. The absorption angstrom exponent (AAE) of both WS-BrC and MeS-BrC was determined which represents the light absorption capacity of the aerosol particles. The highest AAE value was found in cow dung, and the lowest was found in rain tree. The increasing pH of the WS-BrC solution increased its optical absorption. However, this study revealed that the light absorption properties of brown carbon emitted from commonly used biomasses were varied significantly.

Communication Skills of Fresh Medical Graduates in a Malaysian Private University

Objective: Effective communication is an integral part of good medical practice. Skills in communication is an art, and comprises of a set of fundamental elements: skills in introducing, questioning, listening, facilitating and closing. The objective of this study was to determine the perceptions of fresh medicalgraduates’ communication skills at Widad University College (WUC). Materials and Methods: It was a cross-sectional study conducted in 2019 among 50 fresh medical graduates of WUC. A standardized questionnaire that asked about skills in fundamental elements of communication with diverse people on diverse issues, was used to collect the data. The data was collated and analyzed utilising a measuring scale ranged from very well to very poor and presented using descriptive statistics. Results and Discussion: Total 46 participants responded giving a response rate 92%. The highest number of participants (79%) responded as very well in introductory skills while the lowest 59% in listening skills. In a diverse group, 70%-74% respondents communicated as very well with patients, patients’ families, superiors, support staffs and colleagues. Only 57%-67% responded as very well in breaking bad news, counselling, and taking informed-consent. Nevertheless, 2%-13% participants’ skills were very poor to uncertain, where 13% uncertain in breaking bad news and 9% in counselling and informed-consenting. Conclusion: Communication skills of most of the WUC fresh medical-graduates were very well and reasonably well. However, the art of communication does not come naturally, 2-13% of the graduates’ skills need to be consciously promoted by faculty during undergraduate training. Medical schools should give more emphasis on the development of more effective communication in all aspects of future doctors. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 404-412

Research Priorities of Applying Low-Cost PM2.5 Sensors in Southeast Asian Countries

The low-cost and easy-to-use nature of rapidly developed PM_2.5 sensors provide an opportunity to bring breakthroughs in PM_2.5 research to resource-limited countries in Southeast Asia (SEA). This review provides an evaluation of the currently available literature and identifies research priorities in applying low-cost sensors (LCS) in PM_2.5 environmental and health research in SEA. The research priority is an outcome of a series of participatory workshops under the umbrella of the International Global Atmospheric Chemistry Project–Monsoon Asia and Oceania Networking Group (IGAC–MANGO). A literature review and research prioritization are conducted with a transdisciplinary perspective of providing useful scientific evidence in assisting authorities in formulating targeted strategies to reduce severe PM_2.5 pollution and health risks in this region. The PM_2.5 research gaps that could be filled by LCS application are identified in five categories: source evaluation, especially for the distinctive sources in the SEA countries; hot spot investigation; peak exposure assessment; exposure–health evaluation on acute health impacts; and short-term standards. The affordability of LCS, methodology transferability, international collaboration, and stakeholder engagement are keys to success in such transdisciplinary PM_2.5 research. Unique contributions to the international science community and challenges with LCS application in PM_2.5 research in SEA are also discussed.

DDQ-Catalyzed Oxidative C(sp3)-H Functionalization of Aryltetralins and Subsequent Chemoselective Oxidative Demethylation to Access Dihydronaphthalenes and Dihydronaphthoquinones

A highly controlled DDQ-catalyzed oxidative C(sp³)-H functionalization of three contiguous carbon atoms in aryltetralins is reported for efficient access to diverse oxygenated dihydronaphthalene scaffolds. The first total synthesis of pachypostaudin B is realized. Further, a CAN-mediated chemoselective oxidative demethylation on the dihydronaphthalene scaffolds is demonstrated to arrive at the rarely observed dihydronaphthoquinone core in moderate to good yields. The present methodology enables quick access to a library of magnoshinin and merrilliaquinone analogs.

Potential health risks due to in-car aerosol exposure across ten global cities

Car microenvironments significantly contribute to the daily pollution exposure of commuters, yet health and socioeconomic studies focused on in-car exposure are rare. This study aims to assess the relationship between air pollution levels and socioeconomic indicators (fuel prices, city-specific GDP, road density, the value of statistical life (VSL), health burden and economic losses resulting from exposure to fine particulate matter ≤2.5 µm; PM_2.5) during car journeys in ten cities: Dhaka (Bangladesh); Chennai (India); Guangzhou (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Blantyre (Malawi); and Dar-es-Salaam (Tanzania). Data collected by portable laser particle counters were used to develop a proxy of car-user exposure profiles. Hotspots on all city routes displayed higher PM_2.5 concentrations and disproportionately high inhaled doses. For instance, the time spent at the hotspots in Guangzhou and Addis Ababa was 26% and 28% of total trip time, but corresponded to 54% and 56%, respectively, of the total PM_2.5 inhaled dose. With the exception of Guangzhou, all the cities showed a decrease in per cent length of hotspots with an increase in GDP and VSL. Exposure levels were independent of fuel prices in most cities. The largest health burden related to in-car PM_2.5 exposure was estimated for Dar-es-Salam (81.6 ± 39.3 μg m^-3), Blantyre (82.9 ± 44.0) and Dhaka (62.3 ± 32.0) with deaths per 100,000 of the car commuting population per year of 2.46 (2.28-2.63), 1.11 (0.97-1.26) and 1.10 (1.05-1.15), respectively. However, the modest health burden of 0.07 (0.06-0.08), 0.10 (0.09-0.12) and 0.02 (0.02-0.03) deaths per 100,000 of the car commuting population per year were estimated for Medellin (23 ± 13.7 μg m^-3), São Paulo (25.6 ± 11.7) and Sulaymaniyah (22.4 ± 15.0), respectively. Lower GDP was found to be associated with higher economic losses due to health burdens caused by air pollution in most cities, indicating a socioeconomic discrepancy. This assessment of health and socioeconomic parameters associated with in-car PM_2.5 exposure highlights the importance of implementing plausible solutions to make a positive impact on peoples' lives in these cities.

Wintertime Air Quality in Megacity Dhaka, Bangladesh Strongly Affected by Influx of Black Carbon Aerosols from Regional Biomass Burning

Clean air is a key parameter for a sustainable society, and currently, megacity Dhaka has among the worst air qualities in the world. This results from poorly constrained contributions of a variety of sources from both local emissions and regional influx from the highly polluted Indo-Gangetic Plain, impacting the respiratory health of the 21 million inhabitants in the Greater Dhaka region. An important component of the fine particulate matter (PM_2.5) is black carbon (BC) aerosols. In this study, we investigated the combustion sources of BC using a dual carbon isotope (δ¹³C and Δ¹⁴C) in Dhaka during the high-loading winter period of 2013/14 (regular and lockdown/hartal period) in order to guide mitigation policies. On average, BC (13 ± 6 μg m^-3) contributed about 9% of the PM_2.5 (145 ± 79 μg m^-3) loadings. The relative contribution from biomass combustion under regular conditions was 44 ± 1% (with the rest from fossil combustion), while during periods of politically motivated large-scale lockdown of business and traffic, the biomass burning contribution increased to 63 ± 1%. To reduce the severe health impact of BC and other aerosol pollution in Dhaka, mitigation should therefore target regional-scale biomass/agricultural burning in addition to local traffic.

Teaching medical education during the era of COVID-19 pandemic: challenges and probable solutions

Abstract not available Bangladesh Journal of Medical Science Vol.20(5) 2021 p.3-6

Indoor air quality indicators and toxicity potential at the hospitals' environment in Dhaka, Bangladesh

Indoor air quality (IAQ) is a leading apprehension currently especially in the perilous atmosphere, like hospitals. Clean and fresh air is very crucial for the patients and healthcare professionals in the hospitals. Therefore, we examined IAQ indicators (PM_1.0, PM_2.5, PM₁₀, NO₂, CO₂, and TVOC) at sixteen locations of three hospitals with an emphasis on seasonal variations, indoor/outdoor correlation, and concomitant toxicity potential (TP) of human exposure between October 2019 and January 2020. For the measurement of trace gases (NO₂, CO₂, and TVOC), Aeroqual 500 series (New Zealand) sampler was used; particulate matter (PM_1.0, PM_2.5, and PM₁₀) concentrations and relative humidity (RH) were measured using the IGERESS air quality monitoring device (WP6930S, China). The total average concentration of IAQ indicators were 104.1 ± 67.6 (PM_1.0), 137.4 ± 89.2 (PM_2.5), and 159.0 ± 103.3 (PM₁₀) μgm^-3; 0.11 ± 0.02 (NO₂), 1047.1 ± 234.2 (CO₂), and 176.5 ± 117.7 (TVOC) ppm. Significant variations of IAQ indicators were observed between different locations of the hospitals. Winter IAQ indicators were much higher than post-monsoon season. Indoor particulate matter (PM) levels were lower than outdoor, but gaseous pollutants were higher in indoor than outdoor except NO₂. Indoor TVOC was about two times higher than outdoor and also higher in post-monsoon than winter. A good positive correlation was observed between indoor and outdoor particulate matter during winter. A strong positive correlation was obtained between NO₂ and RH with PM in winter. Very high (> 10) indoor toxicity potential (TP) values of PM_2.5 and PM₁₀ were determined during winter. Extremely high TP values indicated potential severe health consequences of the healthcare professionals and patients in indoor hospitals' environment.

Role of trans-radial band protocols in radial artery occlusion: Randomized trial

BACKGROUND

Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital's radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications.

METHODS

This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The secondary outcomes included hematoma and bleeding after radial band removal.

RESULTS

The mean age of the participants in the trial was 58.3 ± 11.5 years, while 63% of them were men. Participants in both the groups had similar baseline characteristics. Radial artery occlusion was not significantly different between protocol A and protocol B (10% vs. 14%, p = 0.49, respectively). Similarly, hematoma and bleeding after trans-radial band removal showed no statistical difference between the groups.

CONCLUSION

Trans-radial band deflation practice at our institution was non-inferior to Cohen and Alfonso's protocol in the incidence of radial artery occlusion after coronary angiography.

TRIAL REGISTRATION NUMBER

This trial is registered at clinicaltrials.gov (https://clinicaltrials.gov) with registration number NCT03298126.

An Audit on Mentor-Mentee Program: Mentees Perceptions on Mentors

Introduction: Mentor-mentee program is essential for mentees’ development. The objective of this paper was to investigate mentees’ perceptions on their mentors. Methods: A questionnairesurvey among all-50 clinical-medical students who mentored by 16 faculty members at Widad University College(WUC)Malaysia, was conducted in 2019.A standardized-questionnaire that examined the mentorship-roles, communication-frequencies, mentor-mentee-relationships and mentoring-effectiveness was used. Relationship was measured by a 4-point scale against each of satisfaction, importance, support, and impact while effectiveness was measured using 0-5 scale on 11-behavioral-skills. Results: Response rate was 92%; only 17% mentees perceived, their mentors played all five mentorship-roles while 30% played only one role. Though 41% mentees had ≥6 communications per-semester with mentors, one year-5 mentee had no-communication at all. Over 16 mentor-mentee relationship and 55 mentoring-effectiveness scores, the mean relationship and effectiveness score was 12.03(75%) and 37.45(72%) respectively. Mentees expected more communication-sessions and their contributions to be acknowledged. Conclusion: Mentor-mentee program at WUC revealed 75% and 72% respectively in mentormentee- relationship and mentoring-effectiveness, which is good. However, faculty needs to play more mentorship-roles and acknowledged mentees’ contributions. Addition of portfolio and reflective-writing in the curriculum will benefits in monitoring mentees’ development. Educational managers should pay attention to this and adequate training of mentors to fulfil the mentees’ needs. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.840-847

Discriminatory Resonance Energy Transfer Mediated by a Third Molecule

Relay of resonant excitation energy between two chiral molecules by an inert third particle is studied using molecular quantum electrodynamics theory. A single virtual photon propagates between each interacting pair. Fourth-order diagrammatic time-dependent perturbation theory is employed to compute the matrix element. Rate terms dependent upon the chirality of the donor and acceptor species are extracted using the Fermi golden rule. Interestingly, the mediated rate is discriminatory. For freely tumbling particles it exhibits an inverse-square dependence on each interparticle separation distance, indicating a purely radiative exchange mechanism. Furthermore, the isotropic rate is found to be a maximum for a collinear geometry and vanishes when the angle between the donor, mediator, and acceptor is 90°. The indirect rate is compared with direct transfer between two chiral molecules. Insight is gained into discriminatory migration of energy in a dielectric medium.

Resonance energy transfer mediated by a chiral molecule

The problem of resonant energy transfer (RET) between an electric dipole donor, D, and an electric dipole acceptor, A, mediated by a passive, chiral third-body, T, is considered within the framework of molecular quantum electrodynamics theory. To account for the optical activity of the mediator, magnetic dipole and electric quadrupole coupling terms are included in addition to the leading electric dipole interaction term. Fourth-order diagrammatic time-dependent perturbation theory is used to obtain the matrix element. It is found that the Fermi golden rule rate depends on pure multipole moment polarizabilities and susceptibilities of T, as well as on various mixed electric and magnetic multipole moment response functions. The handedness of T manifests through mixed electric-magnetic dipole and mixed electric dipole-quadrupole polarizabilities, which affect the rate and, respectively, require the use of fourth-rank and sixth-rank Cartesian tensor averages over T, yielding non-vanishing isotropic rate formulae applicable to a chiral fluid medium. Terms of a similar order of magnitude proportional to the product of electric dipole polarizability and either magnetic dipole susceptibility or electric quadrupole polarizability of T are also computed for oriented and freely tumbling molecules. Migration rates dependent upon the product of the pure electric dipole or magnetic dipole polarizability with the mixed electric-magnetic or electric dipole-quadrupole analogs, which require fourth- and fifth-rank Cartesian tensor averaging, vanish for randomly oriented systems. Asymptotically limiting rate expressions are also evaluated. Insight is gained into RET occurring in complex media.

Assessment of heavy metal pollution in the agricultural soils, plants, and in the atmospheric particulate matter of a suburban industrial region in Dhaka, Bangladesh

Unplanned industrialization and improper management of wastes and gases into open surfaces are affecting the agricultural lands causing heavy metal pollution. This study monitored a suburban industrial zone located beside the Dhaka Export Processing Zone (DEPZ) at the Dhaka district in Bangladesh. We studied the heavy metal (Fe, Mn, Cr, Cu, Ni, Co, Zn, Pb, and Cd) concentration in the agricultural soils, plants, and in the atmospheric particulate matter (PM). The soils were found moderately contaminated with Fe, Cu, Ni, Co, and Zn and less contamination with Mn, Cr, Pb, and Cd. The enrichment factor (EF) and pollution load index (PLI) concluded a moderate level of soil pollution in this region. Besides, the plant samples showed an excess level of Cr and a similar level of Cu, Ni, Co, Zn, Pb, and Cd compared with the levels of industrial polluted sites of Bangladesh. The atmospheric PM analysis showed the presence of Fe, Mn, Cu, Ni, Zn, and Pb metals. The EF showed the anthropogenic origin of Mn and Ni in the atmospheric PM. The statistical correlation (r < 0.0001) of soil and plant heavy metals showed the possibility of transfer of metals from soil to plant which will cause the increase of pollution intensity. Overall, this agricultural region became an intermediate pollution zone. This study will help the decision-maker become conscious of heavy metal pollution in the suburban regions to monitor agricultural lands from anthropogenic pollution.

The British Association of Dermatologists' Undergraduate Curriculum Update 2021

The General Medical Council (GMC) plans to introduce a national Medical Licensing Assessment (MLA) in 2024 for all UK medical students as part of their primary medical qualification, with dermatology specified in its assessment blueprint. We present an Update to the British Association of Dermatologists' Undergraduate Curriculum, aligned both to the MLA Content Map and the GMC Outcomes for Graduates 2018.

A descriptive study of Forcefully Displaced Myanmar Nationals (FDMN) presenting for care at public health sector hospitals in Bangladesh

BACKGROUND

In 2017 hundreds of thousands of 'Rohingya' fled to camps for Forcefully Displaced Myanmar Nationals (FDMN) in Cox's Bazar, Bangladesh.

OBJECTIVE

To describe the FDMNs presenting for care at public health facilities in Bangladesh so as to understand the health problems faced by the FDMNs and the burden on these public health facilities.

METHODS

This study combined a retrospective review of existing hospital and clinic data with prospective surveillance in government health care centres.

FINDINGS

The retrospective data showed a 26% increase in the number of consultations at the Kutupalong community clinic, the primary health facility closest to the camps, from 19,567 in 2015 to 26,309 in 2019. There was a corresponding 11% increase in admissions to health facilities in the area, from 80,991 in 2017 to 91,424 in 2019. Prospective surveillance of 9,421 FDMNs seeking health care from July 2018 to December 2019 showed that 29% had an infectious disease, 20% nutritional problems, 12% pregnancy-related conditions and 7% trauma or injury.

CONCLUSIONS

Great uncertainty remains regarding the return of FDMN to their home country of Myanmar. The current on-going protests following the military coup adds further insecurity to the status of the Rohingya. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector. Continued support by the international public health community and civil society organizations is needed.

In-car particulate matter exposure across ten global cities

Cars are a commuting lifeline worldwide, despite contributing significantly to air pollution. This is the first global assessment on air pollution exposure in cars across ten cities: Dhaka (Bangladesh); Chennai (India); Guangzhou (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Blantyre (Malawi); and Dar-es-Salaam (Tanzania). Portable laser particle counters were used to develop a proxy of car-user exposure profiles and analyse the factors affecting particulate matter ≤2.5 μm (PM_2.5; fine fraction) and ≤10 μm (PM_2.5-10; coarse fraction). Measurements were carried out during morning, off- and evening-peak hours under windows-open and windows-closed (fan-on and recirculation) conditions on predefined routes. For all cities, PM_2.5 and PM₁₀ concentrations were highest during windows-open, followed by fan-on and recirculation. Compared with recirculation, PM_2.5 and PM₁₀ were higher by up to 589% (Blantyre) and 1020% (São Paulo), during windows-open and higher by up to 385% (São Paulo) and 390% (São Paulo) during fan-on, respectively. Coarse particles dominated the PM fraction during windows-open while fine particles dominated during fan-on and recirculation, indicating filter effectiveness in removing coarse particles and a need for filters that limit the ingress of fine particles. Spatial variation analysis during windows-open showed that pollution hotspots make up to a third of the total route-length. PM_2.5 exposure for windows-open during off-peak hours was 91% and 40% less than morning and evening peak hours, respectively. Across cities, determinants of relatively high personal exposure doses included lower car speeds, temporally longer journeys, and higher in-car concentrations. It was also concluded that car-users in the least affluent cities experienced disproportionately higher in-car PM_2.5 exposures. Cities were classified into three groups according to low, intermediate and high levels of PM exposure to car commuters, allowing to draw similarities and highlight best practices.

Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital

An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.