A thermo-mechanically loaded rotating FGM cylindrical pressure vessels under parabolic changing properties: An analytical and numerical analysis

This study aims to develop an exact analytical solution for steady-state thermo-mechanical stress in a functionally graded (FG) thick-walled cylindrical vessel. The cylinder is subjected to combined rotational speed and internal pressures while the thermal load is with convective and radiative boundary conditions. The dimensionless governing equations and boundary conditions, represented as a quartic equation, are derived and solved using Ferrari's method. The temperature, displacement, and stress fields across the thick-walled cylindrical vessel are calculated by finding the roots of the quartic equation. In order to investigate the accuracy of the exact analytical solution, a numerical model is constructed based on a standard Galerkin discretization approach of the finite element method (FEM). The analytical solutions and the results obtained through FEM show a high level of agreement. Furthermore, the study analyzes the effects of material parameters on temperature, displacement, and stress fields. Displacement, temperature, and stress fields are presented in the form of dimensionless graphs along the radial direction. For the considered parametric studies, results revealed that parabolic grading is beneficial than conventional grading. This study reveals that for the thermal loading, the maximum temperature, displacement, and tangential stress decrease for the parabolic grading. A similar but lower value of temperature, displacement, and tangential stress is also observed in the case of thermomechanical loading. This study is expected to assist in the assessment of the reliability of load calculations and contribute to the overall durability of pressure vessels. The results obtained from this study can provide valuable insights into thermo-elasticity and the thermo-mechanical behavior of thick-walled cylindrical vessels and can aid in the design and optimization of such systems.

Identification of novel inhibitors against Med15a KIX domain of Candida glabrata

Candida glabrata, the second most common cause of invasive fungal infections, exhibits multi-drug resistance to commonly used antifungal drugs. To counter this resistance, there is a critical need for novel antifungals. This study identifies small molecule inhibitors that target a three-helix bundle KIX domain in the Med15a Mediator subunit of Candida glabrata (CgMed15a KIX). This domain plays a crucial role by interacting with the Pleiotropic Drug Resistance transcription factor Pdr1, a key regulator of the multidrug resistance pathway in Candida glabrata. We performed high throughput computational screening of large chemical datasets against the binding sites of the CgMed15a KIX domain to identify novel inhibitors. We selected six potential candidates with high affinity and confirmed their binding with the CgMed15a KIX domain. A phytochemical compound, Chebulinic acid binds to the CgMed15a KIX domain with a KD value of 0.339 μM and shows significant inhibitory effects on the growth of Candida glabrata. Molecular dynamics simulation studies further revealed the structural stability of the CgMed15a KIX-Chebulinic acid complex. Thus, in conclusion, this study highlights Chebulinic acid as a novel potential antifungal compound against Candida glabrata.

N-acetylglucosamine: a behavioral fate switch in Candida albicans

Candida albicans, a significant commensal fungus in the human gut, causes a wide spectrum of opportunistic infections. In a recent study, Yang et al. revealed the importance of a host-associated gut signal, GlcNAc, in C. albicans and described its significant role towards achieving a successful commensal-virulence trade-off program in the human body.

Etiology of Chronic Abnormal Uterine Bleeding According to the FIGO's PALM-COEIN Classification in Bangladeshi Women of Reproductive Age: A Cross-Sectional Study

Chronic abnormal uterine bleeding (AUB) is common, but there is a lack of standardized methods for investigating and etiological categorization of AUB. The PALM-COEIN classification system of AUB is getting important to overcome this issue. This cross-sectional study was conducted from January 2019 to December 2019 at Mymensingh Medical College Hospital, Mymensingh, Bangladesh, to determine the causes of AUB in women of the reproductive age group and categorize the causes of AUB as per the PALM-COEIN classification. A total of 380 women with chronic AUB were evaluated. The distribution of PALM-COEIN causes of AUB were AUB-P (1.8%), AUB-A (9.2%), AUB-L (13.2%), AUB-M (5.8%), AUB-C (1.1%), AUB-O (24.7%), AUB-E (1.6%), AUB-I (6.6%), and AUB-N (36.1%). The participants' mean age was 29.6 (±10.5) years, the majority (78.2%) of them was married, only a few (9.5%) had comorbid diseases, including hypertension (HTN) (1.1%), diabetes mellitus (DM) (5.3%), and hypothyroidism (8.7%). Women in the AUB-M classification had higher age than others; anemia was more prevalent in the AUB-P group, the AUB-O group had the highest TSH levels and hypothyroidism frequency. The PALM-COEIN classification helps ascertain the cause of AUB practically and should be used in routine clinical practices to manage these patients better.

Efficacy of Nebulized Hypertonic Saline (3%) Versus Normal Saline and Salbutamol in Treating Acute Bronchiolitis in A Tertiary Hospital: A Randomized Controlled Trial

Acute bronchiolitis is a viral respiratory illness of infants and young children that occurs in the first two years of life. It is a major cause of hospital admissions in Bangladesh. Management of bronchiolitis is a great challenge for the pediatrician both in the outpatient and inpatient department. Because mainstay of treatment options are usually supportive like cool humidified oxygen, fluids, bronchodilators, epinephrine and corticosteroids. A number of agents have been proposed as adjunctive therapies, but their effects are controversial. Nebulized hypertonic saline (3%) has been reported to have some benefit in recent studies. So the objective of this study was to compare the efficacy of nebulized 3% hypertonic saline (HS) with salbutamol and normal saline (0.9%) nebulization in children with acute bronchiolitis. A double-blind randomized controlled trial was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from November 2015 to October 2016. A total of 100 children aged one month to two years with acute bronchiolitis admitted in the Pediatric wards of MMCH were included in the study and were randomly assigned to either 3% nebulized hypertonic saline (n=50) or to 0.9% nebulized isotonic saline with salbutamol solution (n=50). The main outcome variables were clinical severity score, length of hospital stay, duration of oxygen therapy and oxygen saturation (SpO2). The therapy was repeated three times on every hospitalization day and the outcome was evaluated two times daily (12 hourly) for 60 hours. Mean duration of oxygen therapy in study group was 33.6±21.7 hours and in control group was 36.8±22.5 hours. But their difference was not statistically significant (p>0.05). The mean clinical severity score and mean oxygen saturation of the entire study patients in both groups decreased and increased respectively during hospital stay. There was significant difference of mean clinical severity score and oxygen saturation between admission and follow up-5 in each group (p<0.001). But their difference between two groups was not statistically significant (p>0.05). Mean duration of hospital stay was 2.91±1.54 days in study group and 3.09±1.85 days in control group. But their difference between two groups was not statistically significant (p>0.05). So in acute bronchiolitis nebulized hypertonic saline (3%) is as effective as normal saline (0.9%) and salbutamol nebulization.

Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh

A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.

VLBI measurement of the vector baseline between geodetic antennas at Kokee Park Geophysical Observatory, Hawaii

We measured the components of the 31-m-long vector between the two very-long-baseline interferometry (VLBI) antennas at the Kokee Park Geophysical Observatory (KPGO), Hawaii, with approximately 1 mm precision using phase delay observables from dedicated VLBI observations in 2016 and 2018. The two KPGO antennas are the 20 m legacy VLBI antenna and the 12 m VLBI Global Observing System (VGOS) antenna. Independent estimates of the vector between the two antennas were obtained by the National Geodetic Survey (NGS) using standard optical surveys in 2015 and 2018. The uncertainties of the latter survey were 0.3 and 0.7 mm in the horizontal and vertical components of the baseline, respectively. We applied corrections to the measured positions for the varying thermal deformation of the antennas on the different days of the VLBI and survey measurements, which can amount to 1 mm, bringing all results to a common reference temperature. The difference between the VLBI and survey results are 0.2 ± 0.4 mm, -1.3 ± 0.4 mm, and 0.8 ± 0.8 mm in the East, North, and Up topocentric components, respectively. We also estimate that the Up component of the baseline may suffer from systematic errors due to gravitational deformation and uncalibrated instrumental delay variations at the 20 m antenna that may reach ± 10 and -2 mm, respectively, resulting in an accuracy uncertainty on the order of 10 mm for the relative heights of the antennas. Furthermore, possible tilting of the 12 m antenna increases the uncertainties in the differences in the horizontal components to 1.0 mm. These results bring into focus the importance of (1) correcting to a common reference temperature the measurements of the reference points of all geodetic instruments within a site, (2) obtaining measurements of the gravitational deformation of all antennas, and (3) monitoring local motions of the geodetic instruments. These results have significant implications for the accuracy of global reference frames that require accurate local ties between geodetic instruments, such as the International Terrestrial Reference Frame (ITRF).

407 Incidental Focal Intrahepatic Duct Dilatation (FIDD) – A Finding That Mandates Further Investigation That May Include Liver Resection

Background

The increasing use of imaging has led to incidental findings in the liver. The Western experience of managing focal intrahepatic duct dilatation (FIDD) is not well recorded. We present our experience based on a large prospectively maintained database at a tertiary hepatobiliary surgical unit.

Method

Patients with liver resection for FIDD between January 2003-December 2019 were retrospectively identified from the liver unit database. The demographics, symptomatology, blood test results, imaging, type of liver resection, morbidity, mortality, and histology of resected specimens were recorded.

Results

9 patients had FIDD among 994 liver resections performed (0.9%). 6 patients were asymptomatic, 2 upper abdominal pain and 1 recurrent gram-negative sepsis. Liver function tests were normal in all patients. Two patients had cholangiocarcinoma (CCA), 4 intrahepatic stones, 1 intraductal papillary neoplasm of bile duct (IPN –B) and 2 benign strictures.

Conclusions

FIDD is rare in the Western population. Most patients are asymptomatic with an incidental finding of FIDD on cross-sectional imaging. Differentiating benign and malignant pathology is difficult warranting liver resection in fit patients to resolve the diagnosis. Liver resection is safe and can be potentially curative in patients with a neoplasm, which can occur in 30% of patients with FIDD.

Starch-lipid interaction alters the molecular structure and ultimate starch bioavailability: A comprehensive review

Starch bioavailability which results in eliciting postprandial glycaemic response, is a trait of great significance and is majorly influenced by the physical interaction among the matrix components governed by their molecular structure as well as dynamics. Among physical interactions limiting starch bioavailability, starch and any guest molecules like lipid interact together to alter the molecular structure into a compact V-type arrangement endorsing the processed crystallinity, thus limiting carbolytic enzymatic digestion and further bioavailability. Considering the importance of starch-lipid dynamics affecting bioavailability, intensive research based on endogenous (internal lipids which are embedded into the food matrix) as well as exogenous (those are added from outside into the food matrix during processing like cooking) lipids have been carried out, endorsing physical interactions at colloidal and microstructural levels. The shared insights on such binary (starch-lipid) interactions revealed the evolution of characterization techniques as well as their role on altering the functional and nutritional value. It is very much vital to have a thorough understanding about the mechanisms on the molecular level to make use of these matrix interactions in the most efficient way, while certain basic questions are still remaining unaddressed. Do starch - lipid complexation affects the ultimate starch bioavailability? If so, then whether such complexation ability depends on amylose - fatty acid/lipid content? Whether the complexation is influenced further by fatty acid type/concentration/chain length or saturation? Further comprehending this, whether the altered bioavailability by binary (starch-lipid) could further be affected by ternary (starch-lipid-protein) and quaternary (starch-lipid-protein-phenolics) interactions are also discussed in this comprehensive review.

Diversity of Vibrio parahaemolyticus in marine fishes of Bangladesh

AIMS

To determine the occurrence, diversity, antibiotic resistance and biofilm formation of Vibrio parahaemolyticus isolated from marine fishes in Bangladesh.

METHODS AND RESULTS

A total of 80 marine fishes were obtained from the local markets and examined for the presence of V. parahaemolyticus. All the isolated V. parahaemolyticus were characterized for the presence of virulence markers, thermostable direct hemolysin (TDH) or thermostable direct hemolysin related hemolysin (TRH). Isolates were serotyped and further characterized by enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) typing to analyse the genetic diversity. Moreover, biofilm formation and antibiotic resistance patterns were also determined. About 63·75% (51/80) of the tested marine fishes were contaminated with V. parahaemolyticus. From the contaminated fishes, 71 representatives V. parahaemolyticus were isolated and none of them harboured tdh and trh virulence genes. Nine different O-groups and seven different K-types were found by serological analysis and the dominant serotype was O5:KUT. In ERIC-PCR analysis, eight clusters (A-H) were found and the most common pattern was A (46·5%). All of the isolates were resistant to ampicillin and 78·9% of isolates were resistant to streptomycin. The highest biofilm formation was found at 37°C compared to 25°C and 4°C.

CONCLUSION

Diverse V. parahaemolyticus are present in marine fishes in the local market of Bangladesh with antibiotic-resistant properties and biofilm formation capacity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The widespread prevalence of diverse V. parahaemolyticus in marine fishes is an issue of serious concern, and it entails careful monitoring to ascertain the safety of seafood consumers.

Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations

High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.

Cytokines and chemokines measured in dried SLA-stimulated whole blood spots for asymptomatic Leishmania infantum and Leishmania donovani infection

Whole blood stimulation with soluble Leishmania antigen (SLA), followed by plasma cytokine and chemokine determination, provides means of detecting subjects with asymptomatic Leishmania infection. This work examines the potential of Protein Saver 903 cards for the storage and transport of SLA-stimulated dried plasma spot samples. Blood was collected from asymptomatic and negative control subjects living in a Leishmania infantum- (Spain) and Leishmania donovani-endemic area (Bangladesh). After SLA-stimulation, three types of sample were prepared: frozen liquid plasma (-20 °C), and plasma dropped onto Protein Saver cards kept at -20 °C (DPS-FZ), and at ambient temperature (DPS-AT). The concentrations of IFN-γ, IL-2, CXCL10, CXCL9, CCL2 and CXCL8 in the thawed liquid plasma (TLP), DPS-FZ and DPS-AT samples were then determined. Strong correlations were seen between the TLP and DPS-FZ/AT samples for all the studied cytokines/chemokines in both the L. infantum and L. donovani areas. Protein Saver 903 cards would therefore appear to allow for the transport of SLA-stimulated plasma samples by courier at ambient temperature. The CXCL10 and CXCL9 detectable in these plasma spots provided robust markers for identifying asymptomatic subjects from both endemic areas. This easy procedure opens up new possibilities for field studies in resource-limited settings, which could help in Leishmania control.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Current Trends of Using Antimicrobials at Obstetrics and Gynaecology Department in a Tertiary Care Hospital

This cross-sectional descriptive study was done to analyse the current trends of using antimicrobials in various surgical procedures at Obstetrics and Gynaecology department in Mymensingh Medical College Hospital, Mymensingh from July 2014 to June 2015. Among 300 postoperative obstetrics and gynaecological surgery cases, samples were selected as non-random purposive selection method where pattern of using antimicrobials were analysed by SPSS method 20.1 versions. The incidence of antimicrobial resistance is on continued rise with a threat to return to the pre-antibiotic era. This has led to emergence of such bacterial infections which are essentially untreatable by the current armamentarium of available treatment options. Now-a-days variation of choosing antibiotic are quietly accepted in Obstetrics and Gynaecology department as prophylaxis purpose to control life threatening conditions such as postoperative wound infection, septicaemia, urinary tract infection etc. The data analysis revealed that among 300 obstetrical and gynaecological surgeries, Nitroimidazoles (93.33%), Cephalosporins (91%) and Aminoglycosides (59%) group were most commonly used antimicrobials in both obstetrics and gynaecological surgeries. Metronidazole (93.33%), Ceftriaxone (68.66%), Gentamicin (60.33%), Cefuroxime (48%), Flucloxacillin (42%), Cefixime (27%) were the most commonly used antimicrobials at obstetrics and gynaecology department. Combination of Ceftriaxone, Metronidazole and Gentamicin (37.66%), Ceftriaxone and Metronidazole (25.33%), Cefuroxime, Metronidazole and Gentamicin (16%), Ciprofloxacin, Metronidazole and Gentamicin (5.33%) were most commonly used antimicrobials postoperatively. Total mean duration of antimicrobial therapy was 10.45 days. Antibiotics are useful in prevention of infection. But indiscriminately use of antibiotics without any guideline may lead to antimicrobial resistance. So, antimicrobial surveillance committee should be formed by hospital authority to know the local using pattern of antibiotics.

Fluoride enrichment in an alluvial aquifer with its subsequent effect on human health in Birbhum district, West Bengal, India

This research work primarily deals with the geochemistry and genesis of fluoride (F^-) in an alluvial aquifer with an emphasis on prevalence of dental and skeletal fluorosis among the endemic population. Hydrogeochemical outcomes reveal that chemical weathering and ion-exchange phenomena are the two dominant processes that make study area groundwater into NaHCO₃ water type. Presence of intercalated zeolite rich sediments (F_Total 412-446 mg/kg) having higher ion-exchange capacity (120-125 meq/100 g) within the aquifer is the source and mobilizing factors of F^- in groundwater respectively. Laboratory experiment further justifies higher desorption potential of aquifer sediments at the groundwater pH of 6.5-7.5. Health survey reveals that out of 235 studied population 60% suffer from dental fluorosis while females >30 years of age became exposed early to osteoporosis disease.

Impact of post-operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India

BACKGROUND

The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast-conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx).

MATERIALS AND METHODS

Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student's t-test was used for comparative analysis of the means.

RESULTS

The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14-3.48). The mean Dmean of LAD for L-EBC and R-EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77-1.60). The mean-Dmax of LCx for patients with L-EBC (2.9 Gy; range: 1.2-4.35 Gy) was statistically higher than that for R-EBC (1.3 Gy; range: 0.7-3.2 Gy) (P = 0.045). The mean-Dmean of LCx for L-EBC (2.1 Gy; range: 0.6-3.6 Gy) was also significantly higher than that of L-EBC (0.9 Gy; range: 0.7-2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m-Dmax and m-Dmean of LCx).

CONCLUSION

This pilot dosimetric study confirms the assumption that patients with left-sided EBC are at higher risk of developing long-term cardiac morbidity when treated with PORT due to increased dose to LAD.

Association of vitamin D status with incidence of enterotoxigenic, enteropathogenic and enteroaggregative Escherichia coli diarrhoea in children of urban Bangladesh

OBJECTIVE

To evaluate the association between vitamin D status and diarrhoeal episodes by enterotoxigenic (ETEC), enteropathogenic (EPEC) and enteroaggregative (EAEC) E. coli in underweight and normal-weight children aged 6-24 months in urban Bangladesh.

METHODS

Cohorts of 446 normal-weight and 466 underweight children were tested separately for ETEC, EPEC and EAEC from diarrhoeal stool samples collected during 5 months of follow-up while considering vitamin D status at enrolment as the exposure. Cox proportional hazards models with unordered failure events of the same type were used to determine diarrhoeal risk factors after adjusting for sociodemographic and concurrent micronutrient status.

RESULTS

Vitamin D status was not independently associated with the risk of incidence of ETEC, EPEC and EAEC diarrhoea in underweight children, but moderate-to-severe retinol deficiency was associated with reduced risk for EPEC diarrhoea upon adjustment. Among normal-weight children, insufficient vitamin D status and moderate-to-severe retinol deficiency were independently associated with 44% and 38% reduced risk of incidence of EAEC diarrhoea, respectively. These children were at higher risk of ETEC diarrhoea with vitamin D deficiency status when adjusted for micronutrient status only.

CONCLUSION

This study demonstrates for the first time that normal-weight children with insufficient vitamin D status have a reduced risk of EAEC diarrhoea than children with sufficient status. Moderate-to-severe deficiency of serum retinol is associated with reduced risk of EPEC and EAEC diarrhoea in underweight and normal-weight children.

Study on the safety and efficacy of miltefosine for the treatment of children and adolescents with post-kala-azar dermal leishmaniasis in Bangladesh, and an association of serum vitamin E and exposure to arsenic with post-kala-azar dermal leishmaniasis: an open clinical trial and case-control study protocol

INTRODUCTION

Post-kala-azar dermal leishmaniasis (PKDL) is a dermatological complication that occurs primarily among treated visceral leishmaniasis (VL) patients, and sporadically in a few without a history of VL. It mostly affects children and adolescents but is also common in adults. The conventional treatment with 120 intramuscular injections of sodium stibogluconate (SSG) is phasing out. Miltefosine (MF) is the only eventual alternative to SSG; however, its efficacy and safety profiles for treatment of children and adolescents with PKDL are lacking. In addition, risk factors for PKDL are poorly investigated. Host genetic, nutritional and environmental factors could be potential risk factors. As such, here we propose to evaluate the efficacy and safety of MF for 12 weeks at an allometric dose for children and adolescents with PKDL, and also to explore potential risk factors for PKDL.

METHODS AND ANALYSIS

A cross-sectional survey will look for suspected participants with PKDL among treated VL children and adolescents, a subsequent open clinical trial with MF at allometric dose, with a follow-up at 12 months. A case-control study will be carried out for PKDL risk factors. Assuming 95% cure rate, 95% CI and α=0.05, a sample size of 73 children with PKDL is needed. Considering an attrition rate of 10%, the final sample size is 80 children in each group. Descriptive and analytical analyses will be performed. Primary outcome is safety and cure rate of 12 weeks of treatment with MF.

ETHICS AND DISSEMINATION

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) Ethical Review Committee (ERC) approved the protocol (PR#013045). Written informed consent will be taken from all participants and their guardians (in case of minor). A Data and Safety Monitoring Board (DSMB) of ICDDR,B ERC will monitor all study activities to ensure the safety of the participants.

TRIAL REGISTRATION NUMBER

NCT02193022; Pre-results.

Inferring the fluoride hydrogeochemistry and effect of consuming fluoride-contaminated drinking water on human health in some endemic areas of Birbhum district, West Bengal

This research work is carried out to evaluate fluoride (F) hydrogeochemistry and its effect on the population of two endemic villages of Birbhum district, West Bengal. Fluoride concentration in drinking water varies from 0.33 to 18.08 mg/L. Hydrogeochemical evolution suggests that ion-exchange mechanism is the major controlling factor for releasing F in the groundwater. Most of the groundwater samples are undersaturated with respect to calcite and fluorite. Health survey shows that out of 235 people, 142 people suffer from dental fluorosis. According to fluoride impact severity, almost 80 and 94 % people in an age group of 11-20 and 41-50 suffer from dental and skeletal fluorosis, respectively. Statistically drinking water F has a positive correlation with dental and skeletal fluorosis. Bone mineral density test reveals that 33 and 45 % of the studied population suffer from osteopenic and osteoporosis disease. IQ test also signifies that F has a bearing on the intelligence development of the study area school children. The existence of significant linear relationship (R (2) = 0.77) between drinking water F and urinary F suggests that consumption of F-contaminated drinking water has a major control over urinary F (0.39-20.1 mg/L) excretion.

Leishmania vaccine development: exploiting the host-vector-parasite interface

Visceral leishmaniasis (VL) is a disease transmitted by phlebotomine sand flies, fatal if untreated, and with no available human vaccine. In rodents, cellular immunity to Leishmania parasite proteins as well as salivary proteins of the sand fly is associated with protection, making them worthy targets for further exploration as vaccines. This review discusses the notion that a combination vaccine including Leishmania and vector salivary antigens may improve vaccine efficacy by targeting the parasite at its most vulnerable stage just after transmission. Furthermore, we put forward the notion that better modeling of natural transmission is needed to test efficacy of vaccines. For example, the fact that individuals living in endemic areas are exposed to sand fly bites and will mount an immune response to salivary proteins should be considered in pre-clinical and clinical evaluation of leishmaniasis vaccines. Nevertheless, despite remaining obstacles there is good reason to be optimistic that safe and effective vaccines against leishmaniasis can be developed.

Nanofiltration based water reclamation from tannery effluent following coagulation pretreatment

Coagulation-nanofiltration based integrated treatment scheme was employed in the present study to maximize the removal of toxic Cr(VI) species from tannery effluents. The coagulation pretreatment step using aluminium sulphate hexadecahydrate (alum) was optimized by response surface methodology (RSM). A nanofiltration unit was integrated with this coagulation pre-treatment unit and the resulting flux decline and permeate quality were investigated. Herein, the coagulation was conducted under response surface-optimized operating conditions. The hybrid process demonstrated high chromium(VI) removal efficiency over 98%. Besides, fouling of two of the tested nanofiltration membranes (NF1 and NF3) was relatively mitigated after feed pretreatment. Nanofiltration permeation fluxes as high as 80-100L/m(2)h were thereby obtained. The resulting permeate stream quality post nanofiltration (NF3) was found to be suitable for effective reuse in tanneries, keeping the Cr(VI) concentration (0.13mg/L), Biochemical Oxygen Demand (BOD) (65mg/L), Chemical Oxygen Demand (COD) (142mg/L), Total Dissolved Solids (TDS) (108mg/L), Total Solids (TS) (86mg/L) and conductivity levels (14mho/cm) in perspective. The process water reclaiming ability of nanofiltration was thereby substantiated and the effectiveness of the proposed hybrid system was thus affirmed.

Specific antibody responses as indicators of treatment efficacy for visceral leishmaniasis

Acute visceral leishmaniasis (VL) is caused by infection with parasites of the Leishmania donovani complex and may be fatal if not treated. Early diagnosis and efficacious treatment are the keys to effective VL management and control. Novel regimens are being developed to overcome limitations in VL treatment options, which are currently restricted by high costs, severe systemic side effects, and unresponsiveness. Although simple and accurate serological tests are available to help confirm VL, none are suitable to monitor treatment efficacy and cure. Here, we confirm that serum antibody responses to the diagnostic antigens rK39 and rK28 are unaltered by treatment, but demonstrate that antibodies produced against two antigens, rK26 and rK18, can be used as an indirect measure of parasite clearance. The levels of anti-rK18 and -rK26 antibodies were high in patients at initial diagnosis but declined in patients treated with either SSG (Ethiopia) or AmBisome (Bangladesh). Taken together, we propose that serological tests which measure antibodies to rK26 and rK18 merit consideration as potential markers of treatment success and cure.

How useful is endorectal ultrasound in the management of early rectal carcinoma?

INTRODUCTION

Endorectal ultrasonography (EUS) is used to T stage early rectal tumours and select patients to whom transanal endoscopic microsurgery (TEM) could be offered. Published papers have shown that EUS can have good accuracy, but there is little literature on how EUS influences patient management. The study aim is to ascertain the value of EUS in the management of early rectal tumours.

METHODS

Patients with adenomas/early rectal carcinoma being considered for TEM were prospectively studied. Each patient underwent EUS. The surgeon recorded the expected T stage, confidence level of the T stage and management plan for each patient on a proforma before and after the ultrasound result was revealed. Comparison was made between the ultrasound stage and final pathological stage where available.

RESULTS

Ninety-six patients were referred over 2 years. Nine were out of reach of the rigid probe and were excluded. Proformas were completed on 53/87 patients (age range 28-87 years, mean age 66 years, 30 males/23 females). Forty-eight patients had a pathological report to compare with the EUS T stage. Ultrasound agreed with the pathological T staging in 43 patients (90%). Patient management was changed in five patients. In 30% of (16/53) patients, EUS increased the confidence level for T staging.

CONCLUSION

Although EUS has a high accuracy in predicting the T stage of early rectal cancers, it never changes the management plan for lesions thought to be benign. It seldom changes the pre-operative selection process when clinical examination is considered with other imaging modalities (MRI/CT). EUS should be reserved for answering specific questions in difficult cases rather than for all patients.

Biomarkers for intracellular pathogens: establishing tools as vaccine and therapeutic endpoints for visceral leishmaniasis

Visceral leishmaniasis in South Asia is a serious disease affecting children and adults. Acute visceral leishmaniasis develops in only a fraction of those infected individuals, the majority being asymptomatic with the potential to transmit infection and develop disease. We followed 56 individuals characterized as being asymptomatic by seropositivity with rk39 rapid diagnostic test in a hyperendemic district of Bangladesh to define the utility of Leishmania-specific antibodies and DNA in identifying infection. At baseline, 54 of the individuals were seropositive with one or more quantitative antibody assays and antibody levels persisted at follow up. Most seropositive individuals (47/54) tested positive by quantitative PCR at baseline, but only 16 tested positive at follow up. The discrepancies among the different tests may shed light on the dynamics of asymptomatic infections of Leishmania donovani, as well as underscore the need for standard diagnostic tools for active surveillance as well as assessing the effectiveness of prophylactic and therapeutic interventions.

Alteration of the serum biomarker profiles of visceral leishmaniasis during treatment

Until recently, chemotherapy for visceral leishmaniasis (VL; also known as kala-azar) was severely limited by factors such as high cost, route of administration, generation of side effects and potential for resistance. Although largely effective, chemotherapies have become available with the introduction of new drugs and multi-drug regimens for VL. These could be further improved by the identification of biomarkers that are altered during effective treatment. The identification of such biomarkers in the circulation would also simplify efficacy trials. In this study, we determined immunological signatures within the serum of ethnically and geographically distinct VL patients (from Bangladesh and Brazil). Our results indicate that inflammatory and regulatory cytokines (IFNγ, TNFα, IL-10, IL-17), as well as levels of growth factors (FGF, VEGF), are elevated within the serum of VL patients from these sites. The examination of samples from Brazilian VL patients during and beyond standard treatment with meglumine antimoniate identified multiple parameters that revert to levels comparable to those of healthy endemic control individuals. The consolidation of these results provides a 'response to treatment' signature that could be used within efficacy trials to rapidly and simply determine successful interruption of VL.

Exact goodness-of-fit tests for Markov chains

Goodness-of-fit tests are useful in assessing whether a statistical model is consistent with available data. However, the usual χ² asymptotics often fail, either because of the paucity of the data or because a nonstandard test statistic is of interest. In this article, we describe exact goodness-of-fit tests for first- and higher order Markov chains, with particular attention given to time-reversible ones. The tests are obtained by conditioning on the sufficient statistics for the transition probabilities and are implemented by simple Monte Carlo sampling or by Markov chain Monte Carlo. They apply both to single and to multiple sequences and allow a free choice of test statistic. Three examples are given. The first concerns multiple sequences of dry and wet January days for the years 1948-1983 at Snoqualmie Falls, Washington State, and suggests that standard analysis may be misleading. The second one is for a four-state DNA sequence and lends support to the original conclusion that a second-order Markov chain provides an adequate fit to the data. The last one is six-state atomistic data arising in molecular conformational dynamics simulation of solvated alanine dipeptide and points to strong evidence against a first-order reversible Markov chain at 6 picosecond time steps.

Microtrap electrode devices for single cell trapping and impedance measurement

This paper reports the design and fabrication of electrode microtraps for single cell trapping and impedance measurement. In this work, the microtrap electrodes of parallel and elliptical geometry have been fabricated by electroplating of gold electrodes of optimum thickness. This has enabled the formation of electrode traps without requiring any precision alignment between separate insulating traps like PDMS and the bottom gold electrodes. Further the improved uniformity of the electric field between the trapping electrodes as observed from COVENTORWARE simulation significantly reduces the effect of cell position inside the microwell on the electrical measurement unlike previous reports. This makes it possible to directly extract the equivalent cell parameters from the electrical measurement without introducing any correction factor corresponding to cell position. We have performed impedance spectroscopy with both the microwell electrode structures with single HeLa cell at two different positions of trapping. It has been observed that there is almost no change in the extracted values of cell resistance and capacitance for different positions within parallel electrodes and there is only 0.7 % and 0.85 % change in cell resistance and capacitance for the two positions within elliptical electrodes. Thus these microwell electrode structures can be used as an improved and a more convenient platform for single cell electrical characterization.

Synthesis, characterization and antimicrobial activity of dextran stabilized silver nanoparticles in aqueous medium

A simple one-step rapid synthetic route is described for the preparation of silver nanoparticles by reduction of silver nitrate (AgNO3) using aqueous dextran solution which acts as both reducing and capping agent. The formation of silver nanoparticles is assured by characterization with UV-vis spectroscopy, atomic force microscopy (AFM), transmission electron microscopy (TEM) and X-ray diffraction (XRD). The absorbance of the silver nanoparticles is observed at 423 nm. The AFM image clearly shows the surface morphology of the well-dispersed silver nanoparticles with size range of 10-60 nm. TEM images show that the nanoparticles are spherical in shape with ∼5-10 nm dimensions. The crystallinity of Ag nanoparticles is assured by XRD analysis. The antimicrobial activity of as synthesized silver nanoparticles is tested against the bacteria, Bacillus subtilis, Bacillus cereus, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The bacterial growth is inhibited by gradual reduction of the concentration of the silver nanoparticles.