Household water use and greywater management in Khulna city, Bangladesh

While substantial progress has been made in improving water and sanitation services in low- and middle-income countries, aligned basic services such as greywater, stormwater, and solid waste management have progressed little in recent decades. Data was collected in Khulna city, Bangladesh via a household survey (n = 192) of low-income areas exploring domestic water use and greywater volumes, characteristics, and disposal practices. Most households (71%) use a piped water supply for domestic purposes, supplemented by seasonal rainwater harvesting (26%) and greywater use (13%). Of the total water used by households (mean: 594 L/household/day and equivalent to 116 L/person/day), approximately 58% becomes greywater through bathing, dishwashing, religious practices, handwashing, laundry, and mopping. Greywater produced ranges from 61-1274 L/household/day, with a mean of 345 L/household/day and equivalent to 78.4 L/person/day. Greywater characteristics vary depending on the activity, individual behaviours and any products used during cooking, bathing, or cleaning. After generation, households dispose greywater to open drains (67%), nearby waterbodies (17%) directly to the ground (9%), or decentralised wastewater treatment system (7%). Without services for greywater management, greywater disposal may have considerable public and environmental health implications, necessitating careful attention and oversight from service-providers and stakeholders beyond the household-level.

Awareness of Tetanus Toxoid Vaccination among Women of Reproductive Age Attending Outpatient Department in a Tertiary Level Hospital

Maternal and neonatal tetanus is still a major but preventable cause of mortality in many developing countries like Bangladesh. Women of reproductive age are very prone to tetanus infection. This descriptive cross-sectional study was carried out at outpatient department (OPD) of Sir Salimullah Medical College and Mitford Hospital, Bangladesh from October 2019 to April 2020 to determine the level of awareness about Tetanus Toxoid (TT) vaccination in women of reproductive age 15-49 years. Data were collected from 342 women by face to face interview with a semi-structured questionnaire. A large number of the respondents (43.27%) were belonged to 15-24 years age group, majority (92.98%) were Muslim and most of them (41.28%) were SSC passed. A very large number of them (78.36%) were married and (64.55%) had 1-2 children. More than three quarter (78.36%) of women heard about tetanus and 83.96% women thought that tetanus is preventable by TT vaccination. Among the respondents who had heard about tetanus, majority (68.67%) of them had taken TT vaccine, 92.58% of them had taken the first dose before 25 years of age and 71.05% had completed the full course. Regarding awareness of the respondents, 65.79% were aware of risk of neonatal tetanus of an unimmunized mother & 61.19% distinguished that agent of tetanus can be transmitted through wounds. It is considered that the findings of the study will provide a useful basis for further research and planning.

Do patients with prediabetes managed with metformin achieve better glycaemic control? A national study using primary care medical records

AIMS

To estimate the effectiveness of metformin on glycaemic parameters among participants with incident prediabetes attending Australian general practices.

METHODS

This retrospective cohort study used electronic health records of regular participants (3+ visits in two consecutive years) attending 383 Australian general practices (MedicineInsight). Participants with 'incident' prediabetes (newly recorded diagnosis between 2012 and 2017) and their glycaemic parameters (haemoglobin A1c [HbA1c] or fasting blood glucose [FBG]) at 6-, 12-, and 18-24 months post diagnosis (unexposed) or post-management with metformin (treatment) were identified from the database. We estimated the average treatment effect (ATE) of metformin management on glycaemic parameters using both linear regression and augmented inverse probability weighting.

RESULTS

Of the 4770 investigated participants with 'incident' prediabetes, 10.2% were managed with metformin. Participants on metformin had higher HbA1c levels at the baseline than those unexposed (mean 45 mmol/mol [6.2%] and 41 mmol/mol [5.9%], respectively), but no differences were observed at 6-12 months (mmol/mol ATE 0.0, 95% CI -0.4; 0.7) or 12-18 months (ATE -0.3, 95% CI -1.2; 0.3). However, participants on metformin had lower mean HbA1c mmol/mol at 18-24 months (ATE -1.1, 95% CI -2.0; 0.1) than those unexposed. Consistent results were observed for FBG (ATE at 6-12 months -0.14 [95% CI -0.25; -0.04], 12-18 months 0.02 [95% CI -0.08; 0.13] and 18-24 months -0.07 [95% CI -0.25; 0.12]).

CONCLUSION

The higher HbA1c and FBG baseline levels among participants with 'incident' prediabetes managed with metformin improved after 6-12 months of starting pharmacological management, and the effect persisted for up to 24 months. Management with metformin could prevent further deterioration of glycaemic levels.

Efficacy of Fexofenadine in the Treatment of Chronic Idiopathic Urticaria

Urticaria is a common clinical condition that gives a major concern for physicians and patients alike. Urticaria is referred to as chronic when wheals occur daily or almost daily for a period of at least six weeks. The primary purpose of this study is to find out the efficacy of fexofenadine in the treatment of chronic idiopathic urticaria patients among the Bangladeshi population. This quasi-experimental study was performed in the Department of Dermatology & Venereology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh from July 2013 to December 2013. Total 100 patients of chronic idiopathic urticaria aged 18 years and above with exclusion and inclusion criteria were selected. Then they were given fexofenadine 120mg twice daily for the treatment of chronic idiopathic urticaria for four weeks. A semi quantitative rating scales were used for the assessment of therapeutic efficacy before and after treatment. Data were collected in a pre-designed questionnaire by face-to-face interview and analyzed by the help of SPSS. Among the 100 respondents after one week of treatment, 8.0% had complete disappearance of symptoms, 10.0% had marked improvement, 40.0% had moderate improvement and 42.0% had slight improvement. After two weeks of treatment 35.0% had complete disappearance of symptoms, 13.0% had marked improvement, 12.0% had moderate improvement and 40.0% had slight improvement. After three weeks of treatment 40.0% had complete disappearance of symptoms, 13.0% had marked improvement, 35.0% had moderate improvement and 12.0% had slight improvement. After four weeks of treatment 42.0% had complete disappearance of symptoms, 24.0% had marked improvement, 26.0% had moderate improvement and 8.0% had slight improvement. The study concluded that fexofenadine is very effective in the treatment of chronic idiopathic urtecaria.

Endothelin-1 and angiotensin II act as progression but not competence growth factors in vascular smooth muscle cells

The direct effects of endothelin-1 and angiotensin II on cell cycle progression were investigated in rat aorta smooth muscle cells in primary culture. The phase of the cell cycle was determined by an immunocytochemical analysis of cell cycle-specific nuclear antigens. The primary cultured cells were synchronized in the G0 phase (100%) by serum deprivation for 24 h. Endothelin-1 (0.1 microM) or angiotensin II (1 microM) had no effect on the cell cycle of G0 cells, whereas platelet-derived growth factor (PDGF) stimulated the entry of the G0 cells into the G1 phase (100%) without a further progression to the S and M phases. Endothelin-1 or angiotensin II stimulated the progression of the PDGF-pretreated G1 cells to the S and M phases. Fura-2 microfluorometry revealed that, between the G0 and G1 cells, there were no differences in the extent and time course of cytosolic Ca2+ elevations induced by endothelin-1 or angiotensin II, which suggested that endothelin-1 and angiotensin II receptors and their signaling pathways regulating cytosolic Ca2+ remained intact in these cell phases. We thus conclude that endothelin-1 and angiotensin II require the prior G0/G1 transition induced by a competence growth factor such as PDGF to exert their mitogenic effects. These results suggest the important role of endothelin-1 and angiotensin II in atherosclerosis as promoters (progression growth factors), but not as initiators.

cAMP induces up-regulation of ETA receptor mRNA and increases responsiveness to endothelin-1 of rat aortic smooth muscle cells in primary culture

The effects of cAMP on the expression of ETA (ET-1 selective type) receptor mRNA and on the response to endothelin-1 (ET-1) were investigated in rat aortic smooth muscle cells in primary culture, using reverse transcription polymerase chain reaction (RT-PCR) and fura-2 microfluorometry of cytosolic Ca2+ concentrations ([Ca2+]i). Incubation of the smooth muscle cells with 10 microM forskolin and 10 microM 3-isobutyl-1-methyl-xanthine (IBMX) induced an increase in ETA receptor mRNA by 420% of control after 24 hours. ET-1 induced a biphasic increase in [Ca2+]i, first transient and second sustained phases. Incubation of the smooth muscle cells with forskolin and IBMX for 24 hours increased the [Ca2+]i response by 849% in the first phase and 286% in the second phase, compared with time-matched controls. From these results, we conclude that cAMP induces an up-regulation of the ETA receptor mRNA and increases responsiveness to ET-1 of rat aortic smooth muscle cells in primary culture.