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.