Understanding the dynamics of chemsex among men who have sex with men, male sex workers and transgender women in Dhaka, Bangladesh: a multiphase sequential mixed-method research protocol

INTRODUCTION

Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (hijra) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and hijra in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions.

METHODS AND ANALYSIS

This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and hijra to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops.

ETHICS AND DISSEMINATION

Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.

Teknologi Pengolahan Air Bersih sebagai Upaya Peningkatan Kesehatan Masyarakat di Desa Bunga Raya, Kabupaten Siak

Salah satu sumber air bersih yang digunakan masyarakat Desa Bunga Raya, Kec. Bunga Raya Kab. Siak untuk mandi, mencuci, masak, dan minum adalah air tanah. Air tanah digunakan bersumber dari sumur gali maupun sumur bor. Dari hasil wawancara dan pengamatan langsung di lapangan warna air sumur masyarakat kuning seperti sirup lemon, baunya seperti bau karat dan bau telur busuk jika baru di pompa, rasanya jika untuk kumur-kumur seperti agak asam dan ngilu di gigi, sehingga jika ini dikonsumsi dan berlangsung dalam jangka waktu yang panjang tanpa tindak lanjut dapat membahayakan masyarakat desa setempat. Melihat kondisi ini tim pengabdian dengan berkoordinasi dengan pejabat setempat (Ketua RT) menyusun jadwal pelaksanaan kegiatan Sosialisasi & Pelatihan Teknologi Pengolahan Air Bersih sebagai Upaya Peningkatan Kesehatan Masyarakat di Desa Bunga Raya, Kec. Bunga Raya Kabupaten Siak. Kegiatan sosialisasi dan pelatihan dilakukan dengan metode penyuluhan dan demonstrasi pembuatan teknologi pengolahan air bersih oleh tim PKM, Mahasiswa Kukerta UNRI, dan warga masyarakat sekitar. Manfaat yang diperoleh peserta dari kegiatan PKM ini antara lain warga masyarakat dapat menjernihkan air secara mandiri dengan teknologi pengolahan air, tercukupi kebutuhan akan air bersih yang sehat, tidak berwarna, tidak berbau dan tidak berasa sebagai bagian dari kebutuhan dasar setiap manusia. Kegiatan pengabdian secara keseluruhan dapat dikatakan baik dan berhasil, dilihat dari ketercapaian tujuan pelatihan (95%), ketercapaian target materi yang telah direncanakan (100%), dan kemampuan peserta dalam penguasaan materi (85%). Teknologi filter pengolahan air yang dirancang menjadi solusi dalam membantu memperbaiki kualitas air sumur gali dan sumur bor sehingga sesuai dengan standar air bersih yang dipersyaratkan.

Pelatihan Pemanfaatan Maggot Black Soldier Fly (BSF) untuk Pengolahan Sampah Organik sebagai Alternatif Pakan Ternak pada Santri Pondok Pesantren Syekh Burhanuddin Kuntu, Kab. Kampar, Prov. Riau

Pondok Pesantren Syekh Burhanuddin berada di Desa Kuntu Kabupaten Kampar. Dengan bertambah jumlah santri setiap tahunnya menyebabkan semakin banyak sampah di lingkungan pesantren. Pengelolaan sampah dipesantren belum baik, sampah hanya dikumpulkan di satu tempat lalu dibakar. Pembakaran dapat menyebabkan pencemaran udara dan akan berdampak pada lingkungan sekitar pesantren. Sesuai Motto yang telah digariskan oleh pendiri Pesantren adalah Tafaqquh Fiddin (mendalami ilmu agama) disamping penguasaan ilmu pengetahuan, juga diperlukan keterampilan. Pondok pesantren mengadakan inovasi/terobosan baru dalam mengembangkan ilmu dan keterampilan yang Tafaqquh Fiddin dengan beberapa program keterampilan life skill. Salah satu keterampilan life skill yang bisa dilakukan yaitu inovasi pengolahan sampah organik sebagai media budidaya Maggot Black Soldier Fly (BSF). Hal tersebut dimulai dari identifikasi masalah bersama dengan para santri, diskusi dan pemberian solusi serta pelatihan budidaya maggot dengan secara interaktif dengan melibatkan teori dan praktek bersamaan agar lebih mudah difahami. Kegiatan pengabdian secara keseluruhan dapat dikatakan baik dan berhasil, dilihat dari ketercapaian tujuan pelatihan (85%), ketercapaian target materi yang telah direncanakan (100%), dan kemampuan peserta dalam penguasaan materi (75%). Tujuan utama dari kegiatan ini sudah tercapai yaitu pengolahan sampah organik untuk mengurangi jumlah sampah di sekitar lingkungan sebagai pakan larva lalat BSF. Selain itu dapat juga memberikan tambahan pendapatan para santri.

EBV-positive mucocutaneous ulceration

Ulceration of the oral cavity is common and a frequent reason for referral to secondary and tertiary centres. Epstein-Barr virus (EBV)-related mucocutaneous ulceration, however, is a rare cause of oral ulceration that has been described only recently. Histologically these lesions resemble lymphomas; however, their management and prognosis differ significantly. We present a case of EBV-induced oral ulceration and discuss the diagnosis and management of and available literature for the condition, which was treated successfully through conservative measures alone.

Assessment of MRI technologists in acceptance and willingness to integrate artificial intelligence into practice

INTRODUCTION

The integration of AI in medical imaging has tremendous exponential growth, especially in image production, image processing and image interpretation. It is expected that radiographers working across all imaging modalities have adequate knowledge as they are part of the end-user team. The current study aimed to investigate the knowledge, willingness and challenges facing the Magnetic Resonance Imaging (MRI) technologists in the integration of Artificial Intelligence (AI) into MRI practice.

METHODS

Total of 120 participants were recruited using a snowball sampling technique. A two-phase study was undertaken using survey and focus group discussion (FGD) to capture participants' knowledge, interpretations, needs and obstacles toward AI integrations in MRI practice. The survey and FGD provided the base to understand the participant's' knowledge, acceptance and needs for AI.

RESULTS

Results showed medium to high knowledge, excitement about AI integration without disturbance of MRI practice. Participants thought that AI can improve MRI protocol selection (91.8%), reduce the scan time (65.3%), and improve image post-processing (79.5%). Education and learning resources concerning AI were the main obstacles facing MRI technologists.

CONCLUSION

MRI technologists have the knowledge and possess basic technical information. The application of AI in MRI practice might greatly influence and improve MRI technologist's work. A structured and professional program should be integrated in both undergraduate and continuous education to prepare for effective AI implementation.

IMPLICATIONS FOR PRACTICE

Application of AI in MRI can be used in many aspects, such as optimize image quality and avoidance of image artifacts. Moreover, AI can play an important role in patient's safety at the MRI unit to reduce incidents. Education, infrastructure, and knowledge of end-users are keys for the incorporation of AI use, development and optimisation.

Classification of Alzheimer's disease using ensemble of deep neural networks trained through transfer learning

Deep learning; transfer learning; ensemble learning; Alzheimer's disease.

Developing and testing community-based tuberculosis (TB) screening intervention to increase TB referral, case detection and knowledge among sexual minority people in urban Bangladesh: a mixed-method study protocol

INTRODUCTION

Although Bangladesh is a country of generalised tuberculosis (TB) epidemic, the HIV prevalence is low among general populations, and 3.9% among key populations. Despite the high possibility of HIV-TB coinfection, scientifically tested approaches for increasing TB case detection among sexual minority people are yet to be developed and implemented in Bangladesh. Such approaches could foster service delivery linkages between communities and the government health system. Findings of this experimental research are likely to provide new insights for programme managers and policy planners for adopting a similar approach in order to enhance TB referral, thus ultimately increasing TB case detections and reducing the likelihood of TB-related mortalities and morbidities, irrespective of HIV status.

METHODS AND ANALYSIS

This operational research will follow a quasi-experimental design, applying both qualitative and quantitative methods, in two drop-in centres in three phases. Phase 1 will encompass baseline data collection and development of a community-based TB screening approach. In phase 2, the newly developed intervention will be implemented, followed by end-line data collection in phase 3. Qualitative data collection will be continued throughout the first and second phases. The baseline and end-line data will be compared both in the intervention and comparison areas to measure the impact of the intervention.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Institutional Review Board of International Centre for Diarrhoeal Disease Research, Bangladesh. The findings will be disseminated through diverse scientific forums including peer-reviewed journals, presentation at conferences and among the policy-makers for policy implication. The study started in January 2019 and will continue until June 2020.

Hepatitis C virus treatment in people who inject drugs (PWID) in Bangladesh

BACKGROUND

Given the considerable social marginalization experienced by people who inject drugs (PWID), treatment of hepatitis C virus (HCV) in this population presents unique challenges. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) medications among PWID receiving harm reduction services from a Drop-in-Center in Dhaka, Bangladesh.

METHODS

In this prospective study conducted between December 2016 and May 2018, 200 PWID with either recent injecting drug use (i.e., within the previous two months) or a history of injecting drug use and are currently receiving opioid substitution therapy were recruited. Blood was collected to conduct relevant laboratory tests. Eligible PWID who tested positive for HCV RNA (n = 55), were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, sustained virologic response (SVR), and reinfection were assessed.

RESULTS

At baseline, 40% (n = 79) of the 200 participants recruited to the study tested positive for antibodies to HCV and 34% (n = 68) had detectable HCV RNA in their blood. Of 55 eligible PWID who initiated treatment, 93% (n = 51) completed treatment while 87% (n = 48) were available for follow-up SVR assessment, all of whom achieved SVR. Thus, intent-to-treat SVR was 87% and the modified intent-to-treat SVR was 100% with one reinfection (4•2 cases per 100 person-years). Further, 75% (i.e., 41 out of the 55 participants) were at least 90% adherent to therapy.

CONCLUSION

Our findings strongly suggest that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programs in Bangladesh is feasible but may require additional interventions such as Opioid Substitution Therapy, intense follow up by outreach workers, and services and counselling provided by full time clinicians.

Chiral organocatalysts based on lipopeptide micelles for aldol reactions in water

A comprehensive study of the self-assembly in water of a lipopeptide consisting of a sequence of l-proline, l-arginine and l-tryptophan with a hydrocarbon chain has been performed. Fluorescence assays were used to determine the critical aggregation concentration. In situ small-angle X-ray scattering (SAXS) and molecular dynamics simulations showed the presence of spherical micelles with diameters around 6 nm. In agreement with these results, cryo-TEM images showed globular aggregates with diameters ranging from ≈4 nm up to ≈9 nm. Furthermore, the lipopeptide catalytic activity has been tested for the direct aldol reaction between cyclohexanone and p-nitrobenzaldehyde, and we have observed that the self-association of the organocatalyst played a critical role in the enhanced activity. Water affects the selectivity, and poor results are obtained under neat reaction conditions. The location of the catalytic groups at the lipopetide/water solvent interface also endowed unusual selectivity in the catalyzed aldol reactions. Under optimized reaction conditions, high yields (up to >99%), good enantioselectivity (ee up to 85%) and high diastereoselectivity (ds up to 92 : 8) were obtained.

A Study on Performance and Safety Tests of Defibrillator Equipment

INTRODUCTION

Nowadays, more than 10,000 different types of medical devices can be found in hospitals. This way, medical electrical equipment is being employed in a wide variety of fields in medical sciences with different physiological effects and measurements. Hospitals and medical centers must ensure that their critical medical devices are safe, accurate, reliable and operational at the required level of performance. Defibrillators are critical resuscitation devices. The use of reliable defibirillators has led to more effective treatments and improved patient safety through better control and management of complications during Cardiopulmonary Resuscitation (CPR).

MATERIALS AND METHODS

The metrological reliability of twenty frequent use, manual defibrillators in use ten hospitals (4 private and 6 public) in one of the provinces of Iran according to international and national standards was evaluated.

RESULTS

Quantitative analysis of control and instrument accuracy showed the amount of the obtained results in many units are critical which had less value over the standard limitations especially in devices with poor battery. For the accuracy of delivered energy analysis, only twelve units delivered acceptable output values and the precision in the output energy measurements especialy in weak battry condition, after activation of discharge alarm, were low.

CONCLUSION

Obtained results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially for high risk instruments. It is also necessary to provide training courses on the fundumentals of operation and performane parameters for medical staff in the field of meterology in medicine and how one can get good accuracy results especially in high risk medical devices.

Self-Assembly and Anti-Amyloid Cytotoxicity Activity of Amyloid beta Peptide Derivatives

The self-assembly of two derivatives of KLVFF, a fragment Aβ(16-20) of the amyloid beta (Aβ) peptide, is investigated and recovery of viability of neuroblastoma cells exposed to Aβ (1-42) is observed at sub-stoichiometric peptide concentrations. Fluorescence assays show that NH2-KLVFF-CONH2 undergoes hydrophobic collapse and amyloid formation at the same critical aggregation concentration (cac). In contrast, NH2-K(Boc)LVFF-CONH2 undergoes hydrophobic collapse at a low concentration, followed by amyloid formation at a higher cac. These findings are supported by the β-sheet features observed by FTIR. Electrospray ionization mass spectrometry indicates that NH2-K(Boc)LVFF-CONH2 forms a significant population of oligomeric species above the cac. Cryo-TEM, used together with SAXS to determine fibril dimensions, shows that the length and degree of twisting of peptide fibrils seem to be influenced by the net peptide charge. Grazing incidence X-ray scattering from thin peptide films shows features of β-sheet ordering for both peptides, along with evidence for lamellar ordering of NH2-KLVFF-CONH2. This work provides a comprehensive picture of the aggregation properties of these two KLVFF derivatives and shows their utility, in unaggregated form, in restoring the viability of neuroblastoma cells against Aβ-induced toxicity.

Hybrid membrane biomaterials from self-assembly in polysaccharide and peptide amphiphile mixtures: controllable structural and mechanical properties and antimicrobial activity

Macroscopic capsules, with tunable properties based on hierarchical self-assembly on multiple lengthscales, are prepared from the co-operative self-assembly of polysaccharide and peptide amphiphiles.

A Study on Performance and Safety Tests of Electrosurgical Equipment

INTRODUCTION

Modern medicine employs a wide variety of instruments with different physiological effects and measurements. Periodic verifications are routinely used in legal metrology for industrial measuring instruments. The correct operation of electrosurgical generators is essential to ensure patient's safety and management of the risks associated with the use of high and low frequency electrical currents on human body.

MATERIAL AND METHODS

The metrological reliability of 20 electrosurgical equipment in six hospitals (3 private and 3 public) was evaluated in one of the provinces of Iran according to international and national standards.

RESULTS

The achieved results show that HF leakage current of ground-referenced generators are more than isolated generators and the power analysis of only eight units delivered acceptable output values and the precision in the output power measurements was low.

CONCLUSION

Results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially in high risk instruments. It is also necessary to provide training courses for operating staff in the field of meterology in medicine to be acquianted with critical parameters to get accuracy results with operation room equipment.

Congenital dermoid inclusion cyst over the anterior fontanelle: report of two cases

Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is an uncommon cystic lesion. It is a benign and curative lesion. In these two cases a soft, cystic mass located over the anterior fontanelle. The cyst had no intracranial extension and was easily excised intact. The clinical and image findings of the cysts were described and compared with the usual dermoids. Many different types of lesions over the children's skull exist and some are commonly diagnosed in daily practice. Congenital dermoid inclusion cyst over the anterior fontanelle (CDIC) is a rare and benign lesion.Pulse Vol.7 January-December 2014 p.42-45

Interactions between lipid-free apolipoprotein-AI and a lipopeptide incorporating the RGDS cell adhesion motif

The interaction of a designed bioactive lipopeptide C16-GGGRGDS, comprising a hexadecyl lipid chain attached to a functional heptapeptide, with the lipid-free apoliprotein, Apo-AI, is examined. This apolipoprotein is a major component of high density lipoprotein and it is involved in lipid metabolism and may serve as a biomarker for cardiovascular disease and Alzheimers' disease. We find via isothermal titration calorimetry that binding between the lipopeptide and Apo-AI occurs up to a saturation condition, just above equimolar for a 10.7 μM concentration of Apo-AI. A similar value is obtained from circular dichroism spectroscopy, which probes the reduction in α-helical secondary structure of Apo-AI upon addition of C16-GGGRGDS. Electron microscopy images show a persistence of fibrillar structures due to self-assembly of C16-GGGRGDS in mixtures with Apo-AI above the saturation binding condition. A small fraction of spheroidal or possibly "nanodisc" structures was observed. Small-angle X-ray scattering (SAXS) data for Apo-AI can be fitted using a published crystal structure of the Apo-AI dimer. The SAXS data for the lipopeptide/Apo-AI mixtures above the saturation binding conditions can be fitted to the contribution from fibrillar structures coexisting with flat discs corresponding to Apo-AI/lipopeptide aggregates.

Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification-rehabilitation programme in Dhaka, Bangladesh: a prospective cohort study

BACKGROUND

To determine relapse rates and associated factors among people who use drugs (PWUDs) attending abstinence-oriented drug treatment clinics in Dhaka, Bangladesh.

METHODS

A cohort of male and female PWUDs admitted to the 3-month drug detoxification-rehabilitation treatment programmes of three non-governmental organisation-run drug treatment clinics in Dhaka, Bangladesh were interviewed on admission and over the following 5 months, which included the first 2 months after discharge. The study subjects comprised 150 male and 110 female PWUDs who had been taking opiates/opioids, cannabis or other drugs (including sedatives) before admission, had provided informed consent and were aged ≥16 years. Interviews were conducted using semi-structured questionnaires at four time points; on admission, at discharge and at 1 and 2 months after discharge. Relapse rates were assessed by the Kaplan-Meier method. Factors associated with relapse on enrolment and after discharge were determined using the Cox proportional hazards regression model.

RESULTS

A greater proportion of female than male subjects relapsed over the study period (71.9% versus 54.5%, p < 0.01). For men, baseline factors associated with relapse were living with other PWUDs (relative hazard ratio [RHR] = 2.27), living alone (RHR = 2.35) and not having sex with non-commercial partners (RHR = 2.27); whereas for women these were previous history of drug treatment (RHR = 1.94), unstable housing (RHR = 2.44), higher earnings (RHR = 1.89), preferring to smoke heroin (RHR = 3.62) and injecting buprenorphine/pethidine (RHR = 3.00). After discharge, relapse for men was associated with unstable housing (RHR = 2.78), living alone (RHR = 3.69), higher earnings (RHR = 2.48) and buying sex from sex workers (RHR = 2.29). Women' relapses were associated with not having children to support (RHR = 3.24) and selling sex (RHR = 2.56).

CONCLUSIONS

The relapse rate was higher for female PWUDs. For both male and female subjects the findings highlight the importance of stable living conditions. Additionally, female PWUDs need gender-sensitive services and active efforts to refer them for opioid substitution therapy, which should not be restricted only to people who inject drugs.

Effectiveness, safety, and cost-effectiveness of photodynamic therapy in Barrett's esophagus: a systematic review

Barrett's esophagus, the management of which remains controversial, is the precursor condition to esophageal adenocarcinoma. A number of endoscopic treatments have been designed as an alternative to surgical resection for patients with high-grade dysplasia. One of these, photodynamic therapy, involves the light activation of a photosensitizer that causes local tissue destruction via oxidation reactions. The present work reviews the effectiveness, safety, and cost-effectiveness of this treatment. A systematic review of the literature recorded in the Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database, and the National Health Service Economic Evaluation Database was undertaken. Articles reporting randomized clinical trials of photodynamic therapy for the treatment of Barrett's esophagus, and economic assessments of the procedure, were selected. The quality of the articles was checked. Twelve articles were included in this review: eight randomized, controlled clinical trials and four economic assessments. The clinical trials suffered from methodological limitations, but the economic assessments were considered to be good quality. Photodynamic therapy is effective for the ablation of dysplasia in Barrett's esophagus, although the frequency of adverse events is quite high. The procedure is presented as a cost-effective alternative to intense endoscopic monitoring and esophagectomy. However, the evidence regarding its effectiveness in reducing the number of patients who go on to develop cancer is only incipient. Rigorous, controlled studies with longer follow-up times, in which photodynamic therapy is compared with surgical resection and other endoscopic techniques, are needed.

Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery

Background

The safety and effectiveness of robotic, open and conventional laparoscopic surgery in gynaecological surgery was assessed in a systematic review of the literature. This will enable the general surgical community to understand where robotic surgery stands in gynaecology.

Methods

A search was made for previous systematic reviews in the Abstracts of Reviews of Effects, Health Technology Assessment, Cochrane Collaboration and Hayes Inc. databases. In addition, the MEDLINE, Embase and CINAHL databases were searched for primary studies. The quality of studies was assessed and meta-analyses were performed.

Results

Twenty-two studies were included in the review. All were controlled but none was randomized. The majority were retrospective with historical controls. The settings in which robotic surgery was used included hysterectomy for malignant and benign disease, myomectomy, sacrocolpopexy, fallopian tube reanastomosis and adnexectomy. Robotic surgery achieved a shorter hospital stay and less blood loss than open surgery. Compared with conventional laparoscopic surgery, robotic surgery achieved reduced blood loss and fewer conversions during the staging of endometrial cancer. No clinically significant differences were recorded for the other indications tested.

Conclusion

The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.

Prevalence of infections, HIV risk behaviors and factors associated with HIV infection among male injecting drug users attending a needle/syringe exchange program in Dhaka, Bangladesh

Injecting drug users (IDU) in Bangladesh are at the early stages of an HIV epidemic. To understand the dynamics of the HIV epidemic, male IDU (n = 561) were recruited from the needle/syringe exchange program in Dhaka in 2002, who underwent a risk-behavior survey and were tested for HIV, syphilis, hepatitis C, and hepatitis B. Correlates of HIV infection were determined by conducting bivariate and multiple regression analyses. The median age of the IDU was 35 years, 39.6% had no formal education, approximately half were married and/or living with their regular sex partner and 26% were currently homeless. The median age at first injection was 29 years. HIV was detected in 5.9% of the IDU and homelessness was the only factor independently associated with HIV (OR = 5.5). Urgent measures must be undertaken to prevent escalation of the HIV epidemic. The study's limitations are noted.

Bangladesh moves from being a low-prevalence nation for HIV to one with a concentrated epidemic in injecting drug users

Bangladesh has been conducting annual serological surveillance for HIV and syphilis since 1998 among most at-risk populations including sex workers, males having sex with males, injecting drug users (IDUs) and heroin smokers. During the seventh round conducted between January and June 2006, 10,368 people were sampled and the overall HIV prevalence was 0.9%. The highest HIV rate was recorded in male IDUs from the capital city Dhaka (7%), and the rates have risen significantly over the rounds (P < 0.001). In Dhaka, most of the HIV-positive IDUs (10.5%) were localized in one neighbourhood, while in the remaining neighbourhoods 1% were positive (P < 0.001). In all other groups, HIV prevalence was <1%. Active syphilis rates were highest in female IDUs (9.9%) followed by female street-based sex workers (8.6%). However, rates in female sex workers in Dhaka declined significantly over the years (P < 0.001). Bangladesh has to act urgently to prevent escalation of the epidemic.

The effectiveness of respondent driven sampling for recruiting males who have sex with males in Dhaka, Bangladesh

This paper evaluates the effectiveness of respondent driven sampling (RDS) to sample males who have sex with males (MSM) in Dhaka, Bangladesh. A major objective for conducting this survey was to determine whether RDS can be a viable sampling method for future routine serologic and behavioral surveillance of MSM as well as other socially networked, hard to reach populations in Bangladesh. We assessed the feasibility of RDS (survey duration; MSM social network properties; number and types of initial recruits) to recruit a diverse group of MSM, the efficacy of an innovative technique (systematic coupon reduction) to manage the implementation and completion of the RDS recruitment process and reasons why MSM participated or did not participate. The findings provide useful information for improving RDS field techniques and demonstrate that RDS is an effective sampling method for recruiting diverse groups of MSM to participate in HIV related serologic and behavioral surveys in Dhaka.

Implication of human epidermal growth factor receptor-2 (HER-2) over expression in treatment of breast cancer in developing countries—report on 250 cases from Bangladesh

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Background: Carcinoma breast is the second most common malignancy in Bangladeshi women. Though HER-2 over expression has profound effect on prognosis of breast cancer, no published data is available about this among Bangladeshi patients. Our aim in this study was to see HER-2 status in Bangladeshi patients, and their relation with other prognostic parameters. Implication of this molecular marker in management of breast cancer in poor country like ours remains controversial, keeping in mind the exorbitantly high cost of Trastuzumab. Methods: This prospective study was conducted in the department of Oncology at Bangladesh Medical College Hospital, National Institute of Cancer Research and Hospital and Ahsania Mission Cancer Hospital Bangladesh, from January 2003 to December 2006. Total 250 women with breast carcinoma were enrolled; biopsy specimens were tested by immunohistochemistry to detect HER-2 status. For recommending treatment with Trastuzumab, patients with 3+ immunohistochemistry results were considered HER-2 positive. Fluorescent In Situ Hybridization (FISH) testing facility was not available. These findings were correlated with age, ER/PR and nodal status. The practical application of marker in terms of use of Trastuzumab was analyzed. Results: Age of patients ranged from 19.75 years to 72 years, mean age was 49.75 years. HER-2 was over expressed in 38.4 % (96) cases and their mean age was 42.92 years compared to 47.61 years in HER-2 negative cases. HER-2 positive cases tended to have higher rates of lymph node metastases (44 out of 96) compared to HER-2 negative (46 out of 154) cases (45.8 % vs 29.87 %). ER/PR was positive in 64 % cases. HER-2 over expression was inversely related to ER / PR expression. Of the HER-2 positive cases, 11.45 % (11 out of 96) afforded treatment with Trastuzumab. Conclusions: HER-2 is over expressed in almost 38 % of breast carcinoma patients in Bangladesh. This expression is associated with relatively young age, lymph node metastasis and lack of ER / PR expression. Only 11.45 % of patients with HER-2 over expression afforded Trastuzumab though 38 % of cases over expressed HER-2.

No significant financial relationships to disclose.

[Integrated PET/CT scanner in oncology applications: a radiologic perspective]

OBJECTIVE

To describe our experience with an integrated PET/CT system in the clinical applications in Oncology.

MATERIAL AND METHODS

An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist.

RESULTS

Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%.

CONCLUSION

In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique.

Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study

BACKGROUND

Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined.

METHODS

All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression.

RESULTS

Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers.

CONCLUSION

Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU.

Use of Family Planning Services in the Transition To a Static Clinic System in Bangladesh: 1998–2002

CONTEXT

In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system.

METHODS

Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics.

RESULTS

In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time.

CONCLUSIONS

Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives.

Insulin improves well-being for selected elderly type 2 diabetic subjects

The effects of insulin therapy on patient well-being, treatment satisfaction and mood, and on carer strain were studied in 30 elderly Type 2 diabetic patients (age 73 +/- 7 (SD) yr) in poor glycaemic control on tablet therapy. A comparison group of ten poorly controlled patients who remained on oral agents was also studied. After 4 weeks of insulin treatment, there were significant improvements in mental health, role-emotional, role-physical (all P<0.05) and vitality (P<0.01) domains of the short form health survey (SF-36), and also in the diabetes treatment and satisfaction questionnaire (DTSQ) and geriatric depression scale (both P<0.01) compared to baseline. After 12 weeks, the improvements in mental health, social functioning and vitality (P<0.01 for all domains), and in the DTSQ were sustained. Carer strain was lower at 4 weeks. No changes in outcomes were seen in the comparison group. In selected elderly Type 2 diabetic patients, insulin treatment is associated with significant improvements in well-being, treatment satisfaction and mood, even without significant improvements in glycaemic control and without increase in carer strain. The SF-36 and DTSQ are sensitive to the benefits of the changes in the treatment for these patients.

Transient Campylobacter bacteremia in a healthy child

A 7-month-old immunocompetent child was brought to the emergency department with fever and diarrhea. Blood and stool cultures grew Campylobacter species. Campylobacter bacteremia resolved without treatment.

Importance of insulin in subjective, cognitive, and hormonal responses to hypoglycemia in patients with IDDM

Not all episodes of hypoglycemia are recognized as such by diabetic patients, suggesting that it is possible for them to adapt to a low blood glucose level, although the mechanism involved is not known. The aim of this study was to examine whether insulin has an effect, independent of blood glucose, on the subjective, cognitive, and hormonal responses to hypoglycemia. Nine patients with insulin-dependent diabetes mellitus (IDDM) participated in three hyperinsulinemic glucose-clamp studies. After 60 min at 4.5 mM, blood glucose was randomized to be 1) maintained at 4.5 mM for 240 min, 2) lowered to 2.8 mM for 180 min followed by 60 min at 2 mM with an insulin infusion rate of 40 mU.m-2.m-1, and 3) fitted to the same protocol as 2 but with an infusion rate of 120 mU.m-2.min-1. Symptoms and awareness of hypoglycemia (100-mm visual analogue scales), cognitive function, and counterregulatory hormone levels were assessed every 30 min. There were no subjective or cognitive changes during the euglycemic study. Awareness and hypoglycemic symptoms (hunger, facial flushing, trembling, and sweating) were attenuated by the higher insulin infusion rate (P less than 0.05 and P less than 0.01, respectively). Cognition was significantly impaired after 60 min at 2.8 mM (P less than 0.001) and deteriorated further when the blood glucose level was lowered to 2 mM (P less than 0.01). Levels of cortisol (P less than 0.01) and growth hormone (P less than 0.05) but not epinephrine were suppressed by the higher insulin infusion rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies on trematodes of the family Heterophyidae (Odhner, 1914) in Iran: 1. Preliminary epidemiological surveys in man and carnivores in Khuzestan

Trematodes of the family Heterophyidae in man and carnivores were studied in Khuzestan, south-west Iran. Eight hundred and eleven stool samples from a population of 3400 in 13 villages in a swampy area located in central Khuzestan were examined by the formalin-ether concentration technique. The following helminths were found: Ascaris lumbricoides 7%, Trichostrongylus spp. 53%, hookworms 4+, Trichuris trichiura 5%, Hymenolepis nana 12% and heterophyid spp. 8%. Post-mortem examination of carnivores revealed that 14.2% of jackals, 33.3% of foxes and 2.5% of dogs were infected with heterophyids, namely Metagonimus yokogawai, Heterophyes heterophyes and H. katsuradai. The freshwater snails Melanoides and Melanopsis spp. and brackish water fishes Barbus spp. and Mugil spp. were thought to be the intermediate hosts of these flukes in this area. This is the first report of heterophyid infection in man and carnivores in Iran.

Steroids and apparent cerebral atrophy on computed tomography scans

Computed tomography scans of 15 long-term steroid users showed varying degrees of apparent cerebral atrophy, not expected at their ages (8 to 40 years). Most were suffering from autoimmune diseases. There appeared to be some correlation between dosage and degree of apparent atrophy. There was surprisingly little clinical evidence of cerebral dysfunction associated with this apparent atrophy. In two of the cases, the appearance of the brain improved following decrease or cessation of steroid use. Speculations are made on possible causes.

Comparative studies on the evaluation of the effect of new anthelminthics on various intestinal helminthiasis in Iran. Effects of anthelminthics on intestinal helminthiasis

The effect of pyrantel pamoate, levamisole, mebendazole, thiabendazole and bephenium hydroxynaphthoate on various intestinal helminths were evaluated among the inhabitants of four villages in the Dezful area southwest of Iran. A total number of 328 persons, all infected simultaneously with Ascaris and hookworm (Ancylostoma duodenale) and 49.2% with Trichostrongylus spp., were randomly divided into six groups. One group was kept as the control and the other five were each treated with one compound. Follow-up examinations showed that all of the drugs used were highly effective on Ascaris, and the differences in the cure rate were not statistically significant except for bephenium hydroxynaphthoate which showed a lower cure rate. For hookworm, cure rates of 100, 90, and 85% were observed with levamisole, pyrantel pamoate and bephenium hydroxynaphthoate, respectively. Cure rates observed with mebendazole and thiabendazole were 35 and 51%, respectively. For Trichostrongylus, the highest cure rate was achieved with levamisole, followed by thiabendazole and mebendazole. While the percentage of people showing side-effects was rather low for all drugs, thiabendazole and bephenium hydroxynaphthoate produced a higher, and levamisole a lower, percentage of side effects.

Reciprocal changes in serum concentrations of 3,3',5-triiodothyronine (T3) in systemic illnesses

Serum concentrations of 3,3',5'-triiodothyronine (reverse T3, rT3) were measured in adult patients with several systemic illnesses whose serum total and/or free T3 were low, serum total T4 was low or normal, and free T4 was either normal or elevated. The mean serum rT3 was 76, 46, and 77 ng per 100 ml in patients with hepatic cirrhosis, chronic renal failure, and acute febrile illnesses, respectively; the values in patients with hepatic cirrhosis and acute febrile illness were significantly higher than, and values in patients with renal failure did not differ significantly from, the mean serum rT3 (41 ng per 100 ml) in normal subjects. The mean serum rT3 in another group of patients from Calcutta, India, who had severe protein calorie malnutrition (PCM), was 53 ng per 100 ml; it was significantly higher than the corresponding value, 22 ng per 100 ml, in the same patients after feeding treatment. Mean serum rT3 in patients with systemic illnesses was not so high as that (151 ng per 100 ml) in the normal newborn, who also has low serum T3 and normal or high T4. High serum rT3 in patients with systemic illness could not be attributed to increased serum protein binding of rT3; whenever studied, the dialyzable fraction of rT3 was not decreased but actually increased. The mean serum-free rT3 was 450,207, and 366 pg per 100 per 100 ml in patients with hepatic cirrhosis, chronic renal failure, and acute febrile illnesses, respectively; each of these values was significantly higher than the corresponding value, 98 pg per 100 ml, in normal subjects. The mean serum free rT3, 516 pg per 100 ml, in newborn cord sera was similar to that in patients with hepatic cirrhosis but was higher than that observed in patients with chronic renal failure and acute febrile illnesses. High serum rT3 and low serum T3 in patients with PCM improved to normal or towards normal after feeding treatment. Since the peripheral metabolism of T4 is normally the predominant source of T3 as well as rT3 in man, our data, demonstrating reciprocal changes in serum rT3 and T3 and no consistent change in serum T4, suggest that body metabolism of T4 may be so altered in systemic illness that the conversion of T4 to rT3 may be increased while that to T3 is decreased. The mechanism or the biological significance of such a diversion of T4, from the normally occurring conversion to highly potent T3, to the generation of poorly calorigenic rT3 in systemic illness, is not clear at this time. The data in patients with PCM demonstrate, however, that such a change in the metabolism of T4 can be reversible.