Recent Outcomes and Challenges of Artificial Intelligence, Machine Learning, and Deep Learning in Neurosurgery

Neurosurgeons receive extensive technical training, which equips them with the knowledge and skills to specialise in various fields and manage the massive amounts of information and decision-making required throughout the various stages of neurosurgery, including preoperative, intraoperative, and postoperative care and recovery. Over the past few years, artificial intelligence (AI) has become more useful in neurosurgery. AI has the potential to improve patient outcomes by augmenting the capabilities of neurosurgeons and ultimately improving diagnostic and prognostic outcomes as well as decision-making during surgical procedures. By incorporating AI into both interventional and non-interventional therapies, neurosurgeons may provide the best care for their patients. AI, machine learning (ML), and deep learning (DL) have made significant progress in the field of neurosurgery. These cutting-edge methods have enhanced patient outcomes, reduced complications, and improved surgical planning.

Elemental Characterization of Ambient Particulate Matter for a Globally Distributed Monitoring Network: Methodology and Implications

Global ground-level measurements of elements in ambient particulate matter (PM) can provide valuable information to understand the distribution of dust and trace elements, assess health impacts, and investigate emission sources. We use X-ray fluorescence spectroscopy to characterize the elemental composition of PM samples collected from 27 globally distributed sites in the Surface PARTiculate mAtter Network (SPARTAN) over 2019-2023. Consistent protocols are applied to collect all samples and analyze them at one central laboratory, which facilitates comparison across different sites. Multiple quality assurance measures are performed, including applying reference materials that resemble typical PM samples, acceptance testing, and routine quality control. Method detection limits and uncertainties are estimated. Concentrations of dust and trace element oxides (TEO) are determined from the elemental dataset. In addition to sites in arid regions, a moderately high mean dust concentration (6 μg/m3) in PM2.5 is also found in Dhaka (Bangladesh) along with a high average TEO level (6 μg/m3). High carcinogenic risk (>1 cancer case per 100000 adults) from airborne arsenic is observed in Dhaka (Bangladesh), Kanpur (India), and Hanoi (Vietnam). Industries of informal lead-acid battery and e-waste recycling as well as coal-fired brick kilns likely contribute to the elevated trace element concentrations found in Dhaka.

Diversification of the VH3-53 immunoglobulin gene segment by somatic hypermutation results in neutralization of SARS-CoV-2 virus variants

COVID-19 induces re-circulating long-lived memory B cells (MBC) that, upon re-encounter with the pathogen, are induced to mount immunoglobulin responses. During convalescence, antibodies are subjected to affinity maturation, which enhances the antibody binding strength and generates new specificities that neutralize virus variants. Here, we performed a single-cell RNA sequencing analysis of spike-specific B cells from a SARS-CoV-2 convalescent subject. After COVID-19 vaccination, matured infection-induced MBC underwent recall and differentiated into plasmablasts. Furthermore, the transcriptomic profiles of newly activated B cells transiently shifted toward the ones of atypical and CXCR3+ B cells and several B-cell clonotypes massively expanded. We expressed monoclonal antibodies (mAbs) from all B-cell clones from the largest clonotype that used the VH3-53 gene segment. The in vitro analysis revealed that some somatic hypermutations enhanced the neutralization breadth of mAbs in a putatively stochastic manner. Thus, somatic hypermutation of B-cell clonotypes generates an anticipatory memory that can neutralize new virus variants.

Linking green supply chain management practices and environmental performance in the manufacturing industry: a hybrid SEM-ANN approach

This research determines the influence of green supply chain management practices (GSCM) on environmental performance. It also investigates the moderating role of supply chain environmental cooperation on GSCM practices and environmental performance relationships. A total of 370 employees of several Bangladeshi manufacturing companies were conveniently chosen as respondents. To verify the data validity and reliability and to test the hypotheses, we used SmartPLS. Finally, we employed an artificial neural network (ANN) to examine the relationship. Green design and green manufacturing have significant positive impacts on environmental performance, while green procurement and green distribution do not. Moreover, environmental cooperation moderates the relationships of green design and green distribution with environmental performance. The moderating effect of supply chain environmental cooperation in the relationship between GSCM practices and environmental performance in the manufacturing industry adds knowledge to the existing literature by incorporating a hybrid model combining PLS-SEM and ANN. Our study adds to the current body of knowledge by delving into the literature on GSCM from the perspective of Bangladesh's industrial sector. This study fills a knowledge gap by shedding light on the interactions of GSCM and environmental performance. Indeed, this study represents a step forward from classic linear regression-based models to an ANN-based nonlinear model. It also demonstrates new contributions to the literature on green supply chain management and environmental performance.

Disaster after disaster: the outbreak of infectious diseases in Pakistan in the wake of 2022 floods

In June 2022, Pakistan witnessed catastrophic floods, affecting millions of people. The ensuing epidemics of cholera, cryptosporidiosis, rotavirus infections, generalized diarrhoea, typhoid and paratyphoid fevers, as well as the frequency of vector-borne diseases including malaria and dengue fever, are studied in this investigation. It also explores the latest outbreak of poliomyelitis and the frequency of respiratory diseases such COVID-19, diphtheria, and tuberculosis, as well as how floods have contributed to skin and eye problems. The report also describes the obstacles governments must overcome in order to manage these health emergencies and offers possible solutions for reducing the effects of ongoing and anticipated epidemics. This flood emphasizes the pressing need for international action and acts as an alarming indicator of the significant impact of climate change. It emphasizes how crucial it is to have effective flood response and preparation strategies in developing nations that are vulnerable to natural disasters.

Sonographic Characteristics and Pathology Correlation of Breast Imaging Reporting and Data System (BI-RADS) Category 4 Lesions

INTRODUCTION

The Breast Imaging-Reporting and Database System (BI-RADS) category 4 is designated for breast lumps that do not display the typical features of malignancy but still raise enough suspicion to warrant a recommendation for a biopsy, as malignancy cannot be ruled out through imaging alone. The main objective of this study was to investigate the sonographic characteristics and pathology correlation of BI-RADS 4 breast lesions and determine the positive predictive rate of BI-RADS 4 lesions in diagnosing breast cancer, using histopathology as the gold standard.

METHODS

This was a cross-sectional study conducted at the Department of Radiology, Aga Khan University Hospital in Karachi, spanning from May 2021 to August 2022, with a duration of 15 months. The study focused on female patients over the age of 18 who presented with suspicious breast lesions on ultrasound. Both mammography and ultrasound-guided core needle biopsy were performed on these patients, followed by a detailed histopathological evaluation of the biopsy specimens. To calculate the positive predictive value (PPV), true positive cases were identified through both histopathology and ultrasonography.

RESULTS

A total of 227 cases were categorized as BI-RADS 4 lesions, with the patients' mean age being 47.8 ± 14.3 years (range: 17 - 88). Among the biopsied lesions, 101 cases were confirmed to be true positive for breast malignancies, resulting in a PPV for malignancy of 44.9%. Conversely, there were 124 false positive cases out of the 227 BI-RADS 4 category lesions (54.63%). The primary indication for presentation was a breast lump, and out of the 101 confirmed malignant cases, 70 (69.3%) were associated with malignancy.

CONCLUSION

BI-RADS 4 can be utilized to assess suspicious breast lumps; however, for more reliable results and to avoid false negatives, histopathological confirmation should complement the imaging findings.

Explainable deep learning model for automatic mulberry leaf disease classification

Mulberry leaves feed Bombyx mori silkworms to generate silk thread. Diseases that affect mulberry leaves have reduced crop and silk yields in sericulture, which produces 90% of the world's raw silk. Manual leaf disease identification is tedious and error-prone. Computer vision can categorize leaf diseases early and overcome the challenges of manual identification. No mulberry leaf deep learning (DL) models have been reported. Therefore, in this study, two types of leaf diseases: leaf rust and leaf spot, with disease-free leaves, were collected from two regions of Bangladesh. Sericulture experts annotated the leaf images. The images were pre-processed, and 6,000 synthetic images were generated using typical image augmentation methods from the original 764 training images. Additional 218 and 109 images were employed for testing and validation respectively. In addition, a unique lightweight parallel depth-wise separable CNN model, PDS-CNN was developed by applying depth-wise separable convolutional layers to reduce parameters, layers, and size while boosting classification performance. Finally, the explainable capability of PDS-CNN is obtained through the use of SHapley Additive exPlanations (SHAP) evaluated by a sericulture specialist. The proposed PDS-CNN outperforms well-known deep transfer learning models, achieving an optimistic accuracy of 95.05 ± 2.86% for three-class classifications and 96.06 ± 3.01% for binary classifications with only 0.53 million parameters, 8 layers, and a size of 6.3 megabytes. Furthermore, when compared with other well-known transfer models, the proposed model identified mulberry leaf diseases with higher accuracy, fewer factors, fewer layers, and lower overall size. The visually expressive SHAP explanation images validate the models' findings aligning with the predictions made the sericulture specialist. Based on these findings, it is possible to conclude that the explainable AI (XAI)-based PDS-CNN can provide sericulture specialists with an effective tool for accurately categorizing mulberry leaves.

A reflection of Africa's cardiac surgery capacity to manage congenital heart defects: a perspective

Congenital heart defects (CHDs) are birth abnormalities that may drastically alter the structure and functionality of the heart. For 70% of infants with congenital disorders to survive or maintain a better quality of life, surgery is necessary. Over 500 000 of the 1.5 million CHD cases reported annually, or 1% of all live births, occur in Africa, according to the WHO. A surmounted 90% of these patients are from Africa, and as a consequence, 300 000 infants die annually as a result of poor care or difficulty accessing adequate healthcare. However, the high prevalence of CHDs, precipitated by a plethora of aetiologies worldwide, is particularly pronounced in Africa due to maternal infectious diseases like syphilis and rubella amongst the pregnant populace. In low- and middle-income countries, especially in Africa, where foreign missions and organizations care for the majority of complicated cardiac surgical patients, access to secure and affordable cardiac surgical therapy is a substantial issue. Interventions for CHDs are very expensive in Africa as many of the continent's domiciles possess low expenditures and funding, thereby cannot afford the costs indicated by associated surgical treatments. Access to management and healthcare for CHDs is further hampered by a lack of trained surgical personnel, specialized tools, infrastructure, and diagnostic facilities in Africa.

A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis

A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022. Laboratory tests, including complete blood count and electrolyte levels, were within normal ranges. A previous MRI performed during the investigation for alcoholic neuropathy a few months before she quit drinking showed no abnormalities. However, a subsequent MRI during work-up for the current acute symptoms revealed significant signal abnormalities involving the central pons, bilateral cerebral peduncles, and medullary pyramids, consistent with chronic central pontine myelinolysis (CPM) with extrapontine myelinolysis (EPM) extending into the peduncles. The patient received treatment with folate and multivitamins and was scheduled for outpatient follow-up with physical therapy for rehabilitation. This case highlights CPM as a consequence of alcohol withdrawal and emphasizes the importance of timely diagnosis and appropriate management in such patients.

Recent Advancements in Epidural Etanercept for Pain Management in Radiculopathy: A Literature Review

The most common etiology of low back and neck pain is associated with spinal cord pathologies. Regardless of origin, low back and neck pain are some of the most common causes of disability worldwide. Mechanical compression due to spinal cord diseases, such as degenerative disc disorders, can lead to radiculopathy, which manifests as numbness or tingling and can progress to loss of muscle function. Conservative management, such as physical therapy, has not been proven effective in treating radiculopathy, and surgical treatments have more risks than benefits for most patients. Epidural disease-modifying medications, such as Etanercept, have been recently explored due to their minimal invasiveness and direct effects on inhibiting tumor necrosis factor-α (TNF-α). Therefore, this literature review aims to evaluate epidural Etanercept's effect on radiculopathy caused by degenerative disc diseases. Epidural Etanercept has been shown to improve radiculopathy in patients with lumbar disc degeneration, spinal stenosis, and sciatica. Further research is needed to compare the effectiveness of Etanercept with commonly used treatments such as steroids and analgesia.

The Potential Role of Etanercept in the Management of Post-stroke Pain: A Literature Review

Strokes are the second leading cause of death and disability worldwide. The brain injury resulting from stroke produces a persistent neuroinflammatory response in the brain, resulting in a spectrum of neurologic dysfunction affecting stroke survivors chronically, also known as post-stroke pain. Excess production of tumor necrosis factor alpha (TNF alpha) in the cerebrospinal fluid (CSF) of stroke survivors has been implicated in post-stroke pain. Therefore, this literature review aims to assess and review the role of perispinal etanercept in the management of post-stroke pain. Several studies have shown statistically significant evidence that etanercept, a TNF alpha inhibitor, can reduce symptoms present in post-stroke syndrome by targeting the excess TNF alpha produced in the CSF. Studies have also shown improvements in not only post-stroke pain but also in traumatic brain injury and dementia. Further research is needed to explore the effects of TNF alpha on stroke prognosis and determine the optimal frequency and duration of etanercept treatment for post-stroke pain.

A Case of Acute Liver Failure Due to Artemisinin-Derived Herbal Supplements

A 49-year-old female presented with malaise, nausea, vomiting, and discolored urine. She was found to have an acute liver failure with labs significant for aspartate aminotransferase (AST) of 2164, alanine aminotransferase (ALT) of 2425, alkaline phosphatase (ALP) of 106, total bilirubin of 3.6, and lactate dehydrogenase (LDH) of 2269. The international normalized ratio (INR) was also elevated at 1.9. All workup for acute liver failure was negative and it was found that she had started taking a new supplement called "Gut Health", which contained artemisinin, for weight loss and menopausal symptoms. After discontinuing the supplements and symptomatically treating her for acute liver failure, her transaminitis resolved.

Knowledge, Vaccine Preference and Fear of COVID-19 among Malaysians during the Heightened Phase of COVID-19 Pandemic

Objective: The objective of this study was to investigate the knowledge, vaccine preference and fear of COVID-19 among Malaysians. Materials and Methods: This online questionnaire survey was carried out from 6th September 2021 to 12th November 2021 through Google form on adult Malaysians. To collect the data, a pilot-tested validated questionnaire was administered to 387 samples. The questionnaire comprised of participants’ socio-demographic characteristics, knowledge on COVID-19 vaccine with source of information, participants’ specific vaccine preferences with reasons, vaccination status and fear on COVID-19. Results and Discussions: Participants has good knowledge on COVID-19 vaccina. Total 275(71%) participants showed preference for specific vaccine; Pfizer-BioNTech was the most preferred (61.5%) vaccine. The major reason for preference was effectiveness (56.4%). Participants with vaccinepreferred group obtained higher knowledge-score(7.38/8) than non-preferred (7.28/8) with insignificant difference. A total of 376(97%) respondents were vaccinated, among them 250 (66.5%) received preferred vaccine and 22(5.85%) received non-preferred, while rest had no preference. Among 11 non-vaccinated participants, three denied vaccinations as they were offered non-preferred vaccines. Fear of COVID-19 score was found higher (21.34/35) in the vaccinated group compared to non-vaccinated group (19.09/35), although no significant difference was observed. Conclusion: Most of the Malaysians are knowledgeable about COVID-19 vaccination, have vaccine-preference and vaccinated. Vaccine-preferred participants are more knowledgeable than non-preferred with insignificant difference. Among the non-vaccinated participants, 27% (3/11) denied vaccination as offered non-preferred vaccine. Vaccinated group showed more fear of COVID-19 than non-vaccinated, with an insignificant difference. Increased awareness is necessary for the people, unwilling or hesitant to vaccinate. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 135-144

A biobased synthesized N-hydroxymethyl starch-amide for enhancing the wet and dry strength of paper products

The aim of this research was to develop a bio-based paper strength agent for the replacement of petroleum-based paper strength agents. Cationic starch was modified with 2-chloroacetamide in aqueous media. The modification reaction conditions were optimized based on the acetamide functional group incorporated into cationic starch. Further, modified cationic starch was dissolved in water and then reacted with formaldehyde to produce N-hydroxymethyl starch-amide. 1 % N-hydroxymethyl starch-amide was mixed with OCC pulp slurry before preparing the paper sheet for testing the physical properties. The wet tensile index, dry tensile index, and dry burst index of the N-hydroxymethyl starch-amide-treated paper increased 243 %, 36 %, and 38 %, respectively, compared to the control sample. In addition, comparative studies were done between N-hydroxymethyl starch-amide and commercial paper wet strength agent GPAM and PAE. The wet tensile index of 1 % N-hydroxymethyl starch-amide-treated tissue paper was similar to GPAM and PAE, and 2.5 times higher than the control sample.

Plastic Burning Impacts on Atmospheric Fine Particulate Matter at Urban and Rural Sites in the USA and Bangladesh

To better understand the impact of plastic burning on atmospheric fine particulate matter (PM_2.5), we evaluated two methods for the quantification of 1,3,5-triphenylbenzene (TPB), a molecular tracer of plastic burning. Compared to traditional solvent-extraction gas chromatography mass spectrometry (GCMS) techniques, thermal-desorption (TD) GCMS provided higher throughput, lower limits of detection, more precise spike recoveries, a wider linear quantification range, and reduced solvent use. This method enabled quantification of TPB in fine particulate matter (PM_2.5) samples collected at rural and urban sites in the USA and Bangladesh. These analyses demonstrated a measurable impact of plastic burning at 5 of the 6 study locations, with the largest absolute and relative TPB concentrations occurring in Dhaka, Bangladesh, where plastic burning is expected to be a significant source of PM_2.5. Background-level contributions of plastic burning in the USA were estimated to be 0.004-0.03 μg m^-3 of PM_2.5 mass. Across the four sites in the USA, the lower estimate of plastic burning contributions to PM_2.5 ranged 0.04-0.8%, while the median estimate ranged 0.3-3% (save for Atlanta, Georgia, in the wintertime at 2-7%). The results demonstrate a consistent presence of plastic burning emissions in ambient PM_2.5 across urban and rural sites in the USA, with a relatively small impact in comparison to other anthropogenic combustion sources in most cases. Much higher TPB concentrations were observed in Dhaka, with estimated plastic burning impacts on PM_2.5 ranging from a lower estimate of 0.3-1.8 μg m^-3 (0.6-2% of PM_2.5) and the median estimate ranging 2-35 μg m^-3 (5-15% of PM_2.5). The methodological advances and new measurements presented herein help to assess the air quality impacts of burning plastic more broadly.

Early Intervention and Parent Counseling Give Positive Impact in Cerebral Palsy Child: A Case Report

Cerebral palsy is a neuro-development disorder, management of which requires awareness of risk factors and regular developmental assessments. Committed routine follow up is necessary for cerebral palsy patient along with parental adequate knowledge.Effective timely intervention with professional guidance along with medication could significantly improve the overall condition of cerebral palsy patient and therefore would make their living relatively meaningful.Early intervention starts withinfirst 6 months after term age. Intervention should be performed daily in home consideringthe importance of parent child relationship, training and counseling by professionalguidance. In fact, Parental knowledge of their child’s cerebral palsy is inadequate. If professionals give early intervention to the child and improve parental knowledge about cerebral palsy will empower them to help their children to overcome this chronic lifelong disorder. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 926-930

Sources identification of ammonium in PM2.5 during monsoon season in Dhaka, Bangladesh

Ammonia (NH₃) is taken up by fine particulate matter (PM_2.5), and there are concerns about its impact on the environment and health. The source of NH₃, which was thought to be of agricultural sources, has recently been suspected to be non-agricultural sources in urban areas. Here, we collected PM_2.5 during the monsoon season in Dhaka, Bangladesh, the most polluted city in the world, and analyzed the δ¹⁵N-NH₄⁺ in PM_2.5. As the result, the δ¹⁵N-NH₄⁺ ranged from 9.2 ‰ to 34.4 ‰ (average: 20.7 ± 4.8 ‰), the highest of any of the averaged values annual reported in previous researches. In order to perform source analysis, the NH₃ concentrations were estimated using the thermodynamic model ISORROPIA-II. The estimated concentration of NH₃ gas averaged 40.8 μg/m³ (3.0-154.6 μg/m³). The contributions calculated with the mixing model to the δ¹⁵N-NH₄⁺ values in PM_2.5 in Dhaka, Bangladesh averaged 25.3 ± 14 %, 22.8 ± 10 %, 26.5 ± 15 %, and 25.4 ± 10 % for waste, fertilizer, NH₃ slip, and fossil fuel combustion, respectively. Non-agricultural sources (NH₃ slip, and fossil fuel combustion) accounted for almost half (51.9 %) of the contributions. In addition, the several validation tests of the isotope mixing model were also performed. For validating the uncorrected and corrected source data for δ¹⁵N-NH₃, the contribution of non-agricultural sources with uncorrected source data would have been very high (>80 %), much higher than the corrected source data.

Role of Primary Caregivers Regarding Unintentional Injury Prevention Among Preschool Children: A Cross-Sectional Survey in Low- and Middle-Income Country

Importance

Unintentional childhood injuries significantly strain healthcare resources, and their preventable measures can significantly reduce morbidity and mortality.

Objectives

To investigate the role of primary caregivers in preventing unintentional injuries and to identify the groups that require special health intervention programs to reduce the burden of this public health concern.

Methodology

A cross-sectional survey was conducted at three hospitals in Karachi, Pakistan. Parents of preschool children who visited pediatric clinics were invited to participate in the study by completing a self-administered questionnaire comprising questions about knowledge, attitudes, and practices towards preventing unintentional injuries among children.

Results

With an 80% response rate, the overall mean knowledge, attitude, and practices (KAP) score was 27.40 ± 3.48. Only 14.3% of the participants had a high KAP score, while 83.6% and 2.1% of the respondents had moderate and low KAP scores, respectively. People of lower socioeconomic status, unemployed, less educated, and families with more than one preschool child were less knowledgeable and non-adherent to unintentional preventive injury. It was found that 21% of the children had suffered from an unintentional severe injury in the past, and the internet was the most frequent source of gaining knowledge among parents.

Conclusion

Parental knowledge, attitude, practices, and adherence to child safety measures are sub-optimal in our cohort of studied participants. Raising awareness and providing the counseling are essential in reducing the burden of unintentional injuries.

Two bridge-particle-mediated RET between chiral molecules

The problem of resonance energy transfer between a pair of chiral molecules mediated by two electrically polarizable bridging particles is solved using molecular QED theory. In this framework a single virtual photon propagates between any two-coupled entities and is responsible for the conveyance of excitation energy from emitter to absorber. Electric dipole and quadrupole, and magnetic dipole couplings linear in the Maxwell fields are employed for donor and acceptor, while each mediator scatters two virtual photons and responds quadratically to the electric displacement field via its electric dipole polarizability. This enables fourth-order diagrammatic perturbation theory to be used to compute the probability amplitude for the process. Individual multipole moment contributions to the Fermi golden rule rate are then extracted for oriented and isotropic systems. Discriminatory transfer rates arise when either the donor or the acceptor are electric-magnetic dipole and the other has a pure multipole moment, or when both are chiral, with mixed electric dipole-quadrupole contributions vanishing in the fluid phase. The bridge-mediated transfer rate is found to be a maximum for a collinear geometry. Moreover, a multi-level model of the mediator is necessary for energy migration. Asymptotically limiting rates for arbitrary and collinear geometries are also obtained for one centre purely electric dipolar and the other purely quadrupolar, or both donor and absorber purely quadrupolar. Understanding is gained of radiationless and radiative transfer mechanisms between chiral moieties in a dielectric medium.

Abstract 1485: Identification and in vitro validation of miRNA biomarker candidates in head and neck squamous cell carcinoma using a network biology approach

Micro-RNAs are small non-coding RNAs that are able to modulate the gene expression. Aberrant expression of micro-RNAs leads to different diseased conditions such as cancer. Head and Neck Squamous Cell Carcinoma (HNSCC) is the second most prevalent cancer in Pakistan and contributes to 9.1% of mortality annually due to late stage diagnosis and ineffective treatment. This research attempts to identify novel miRNAs candidates for their potential role as diagnostic, prognostics or therapeutic biomarkers in HNSCC patient-derived primary cells in the Pakistani population. miRNA species and their gene targets reported in HNSCC were identified using the miRbase, miRNet, and miRCancer databases, and a total of 69 miRNAs with differential expression levels in HNSCC were selected to seed a miRNA-Gene interaction network that was created using BioGrid and STRING data. Hub genes that were targeted by over-expressed miRNAs were predicted using miRTarbase. GO and KEGG analysis was carried out for the 181 interacting genes including TP53, SMAD4, PTEN, NOTCH2, and STAT3. Enrichment analysis demonstrated the increased involvement of these miRNAs in Cancer Pathways such as Hippo signaling Pathways and FoxO signaling pathways. We prioritized hub genes that were targeted by the highest number of tumor suppressor genes, and identified five miRNA species, including miR-21-5p, miR-16-5p, miR30a-5p, miR-93-5p, and miR106b-5p, as the best biomarker candidates for experimental validation. To validate the in silico findings, the top five microRNA candidates are being screened for expression in a library of local patient-derived primary cell lines from Pakistani HNSCC patients.

Citation Format: Laiba Shah, Maryam Shah, Abdus Salam, Khudeja Salim, Faisal F. Khan. Identification and in vitro validation of miRNA biomarker candidates in head and neck squamous cell carcinoma using a network biology approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1485.

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.