In silico and in vivo experiment of soymilk peptide (tetrapeptide - FFYY) for the treatment of hypertension

Enzyme-Treated Soymilk (ETS) was produced from Commercial Soymilk (CSM) with the treatment of proteinase PROTIN SD-NY10 (Bacillus amyloliquefaciens). Previously, we have isolated novel peptides from ETS but data related to isolated-peptides are scant. In this study, bio-informatics and in vivo analysis of isolated-peptides showed strong binding affinity to the active site of the Angiotensin Converting Enzyme (ACE). Among four peptides, tetrapeptide Phe-Phe-Tyr-Tyr (FFYY) showed strong binding affinity and inhibitory activity to the ACE-enzyme (binding affinity -9.5 Kcal/mol and inhibitory concentration of 1.9 µM respectively) as well as showed less toxicity compared to other peptides. The animal experiment revealed that single oral dose of FFYY (80 µg/kg body weight/day) effectively ameliorates the systolic, diastolic and mean blood pressure in the spontaneously hypertensive rat (SHR) model. Chronic oral administration of FFYY (80 µg/kg body weight/day for 3 weeks) reduced the systolic blood pressure elevation and ACE activity without any adverse side effects on the physiological and biological parameters of SHR. In conclusion, both in silico and in vivo experiments of soymilk-isolated FFYY peptide showed a promising option as a potential alternative for hypertension treatment without adverse side effects on SHR.

Evaluation of Antimicrobial Efficacy and Clinical Outcomes of Triphala and 2.5% Sodium Hypochlorite as Intraradicular Irrigants in Pulpectomy of Primary Teeth

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

Prevalence and Associated Factors of Liver Enzyme Abnormalities Among Bangladeshi Women: A Cross-Sectional Study

Background Liver enzyme abnormalities can indicate underlying liver health issues and are influenced by various factors. This study aimed to investigate the prevalence of liver enzyme abnormalities and their associated factors among nonpregnant and nonlactating (NPNL) women in Bangladesh. Methodology A cross-sectional study was conducted among 251 NPNL Bangladeshi women. Data on demographic, socioeconomic, and health-related variables were collected. Logistic regression analysis was used to determine the association between liver enzyme abnormalities and associated factors. Results The prevalence of liver enzyme abnormalities among participants was determined, with associated factors such as age, body mass index (BMI), monthly income, and food security status examined. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were observed in 54 (21.5%) and 47 (18.7%) of participants, respectively, with 116 (46.2%) exhibiting an AST/ALT ratio exceeding 1.00. Food insecurity was significantly associated with a higher prevalence of elevated ALT levels (24.4% vs. 8.7%, P = 0.02), as well as low monthly income (18.8%, 14.7% vs. 36.7%, P < 0.01) and higher BMI (11% vs. 27.7% and 25.6%, P = 0.02). Similar trends were observed for AST levels. Moreover, participants with a higher BMI exhibited significantly higher rates of at least one abnormal liver function enzyme (15.9% vs. 34.9%, P = 0.01). Logistic regression analysis revealed a significant association between abnormal liver enzyme levels and certain demographic and socioeconomic factors, specifically BMI and age. Conclusions This study provides insights into the prevalence of liver enzyme abnormalities and their associated factors among NPNL Bangladeshi women. The findings underscore the importance of addressing factors such as BMI and age in mitigating liver health issues in this population. Further research and targeted interventions are warranted to address these concerns effectively.

Nutrient density of Bangladeshi foods and its application in planning diet for pregnant women

Nutrient profiling is a method that classifies foods based on their nutrient content and identifies foods that are high in micronutrients both across and within food groups. This study aimed to identify foods that are rich sources of the seven micronutrients (iron, zinc, calcium, thiamine, riboflavin, vitamin A, and vitamin B12) of public health concern for the Bangladeshi population.. This study developed a metric termed "naturally nutrient-rich score 7 (NNR7)" specifically for third-trimester pregnant women to identify nutrient-dense foods. Further, it computed the nutrient adequacy score (NAS) of the top NNR7-scored foods for seven micronutrients to assess the extent (percent) to which foods can meet pregnant women's recommended dietary allowances (RDA). A linear programming technique was then used to construct a nutrient-adequate model diet for third-trimester pregnant women using the top ten NNR7-scored foods. According to the NNR7, food groups such as leafy vegetables, fish, meat, poultry and eggs, and vegetables are the richest sources of the problem micronutrients. Mutton liver (916.7%), soybean (39.3%), lamb liver (2160%) and duck liver (50.0%) were found to fulfill the highest percentage of the RDA of vitamin A, zinc, vitamin B12, and iron, respectively. In the formulated nutrient-adequate diets for pregnant women, rice, potato, brown wheat flour, and soya oil were universal to all three diets and Bengal gram, orange, Ganges River sprat, and duck liver were the most common ones. The study findings highlight the need for the consumption of foods such as leafy vegetables, fish, meat, poultry, eggs, pulses and vegetables to increase the intake of problematic micronutrients. Planning a nutrient-adequate diet for pregnant women using linear programming can be an alternative approach to optimize and shape food choices to meet their nutritional requirements.

Mental Health Assessment of Health Care Providers of Bangladesh during Covid-19 Pandemic: A Cross-Sectional Web-Based Study

SARS COV 2 raised immense agony to everyone. As health care workers remains direct contact with patients, they are vulnerable to mental health disorder. The study was done to identify mental health status of health care providers of Bangladesh. It was a cross sectional web based survey among health care providers of bangladesh. A structured web based questionnaire was prepared both in Bangla and English version for better understanding. Total 2594 health care workers responded to online survey. Male were 1303(50.2%) and female were 1291(49.8%). Occupational demography shows 98.5% were physicians. Mean value of patient health questionnaire 9 (PHQ9) and generalized anxiety disorder (GAD) were 8.43±6.082 and 8.27±5.234 respectively among healthcare providers. To overcome anxiety and depression, 93.4% of HCW didn't receive any psychological material and 85.6% HCW didn't find physiological resources even through media. Despite many lacking, healthcare workers were resilient in our study.

Association Among Cystic Volume, Intracystic Pressure, and Histopathological Changes in the Liver in Patients With Choledochal Cyst

Background Choledochal cyst is a congenital cystic dilatation of the biliary tree. Various aspects of pathophysiology are unclear, particularly with reference to intracholedochal cystic pressure (ICCP) and liver histopathology. This study aimed to determine the relationship among cystic volume, ICCP, and histopathological changes in the liver in patients with choledochal cysts. Methods This cross-sectional study was carried out among 21 patients diagnosed with choledochal cysts, who attended the Department of Pediatric Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) from April 2021 to August 2022. Cystic volume was measured pre-operatively using ultrasonography, while ICCP was measured per-operatively with a pressure gauge. Liver histology was assessed through an intraoperative liver biopsy and graded using the meta-analysis of histological data in viral hepatitis (METAVIR) scoring system. The data were analyzed using SPSS version 25.0 (IBM Corporation, Armonk, New York). Frequency and percentages were calculated to present categorical variables, and for quantitative variables, mean, standard deviation (SD), median, and interquartile range (IQR) were calculated. Fisher's exact tests were performed to determine the association between cystic volume, ICCP, and the grading of hepatic fibrosis. A p-value of <0.05 was considered statistically significant. Results The age of the patients ranged from 1 to 12 years, with a mean of 5.0±3.4 years. The male-to-female ratio was 1:4.3. Type I cysts were the most prevalent (71.4%). The median and IQR for cystic volume were 3.4 ml and 1.1-8.2 ml, respectively. The median and IQR for ICCP were 7.46 mmHg and 4.67-9.33 mmHg, respectively. The most frequent grade of fibrosis was F1 (38.1%), followed by F2 (23.8%) and F3 (23.8%). A negative relationship between cystic volume and ICCP was observed, which was statistically significant (p=0.008). A positive relationship was also observed between ICCP and the grading of liver fibrosis, which was statistically significant (p=0.002). Although a negative correlation between cystic volume and grading of liver fibrosis was noted, it was not statistically significant (p=0.198). Conclusions This study reveals significant associations between cystic volume, ICCP, and the grading of liver fibrosis in patients with choledochal cysts. Smaller volume cysts may exhibit higher ICCP, resulting in more pronounced fibrotic changes in the liver.

Beyond the regulatory radar: knowledge and practices of rural medical practitioners in Bangladesh

BACKGROUND

Informal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service.

METHODS

We conducted a cross-sectional study in 2015-16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline.

RESULTS

We invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together.

CONCLUSIONS

Inappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.

Tensor Decomposition-based Feature Extraction and Classification to Detect Natural Selection from Genomic Data

Inferences of adaptive events are important for learning about traits, such as human digestion of lactose after infancy and the rapid spread of viral variants. Early efforts toward identifying footprints of natural selection from genomic data involved development of summary statistic and likelihood methods. However, such techniques are grounded in simple patterns or theoretical models that limit the complexity of settings they can explore. Due to the renaissance in artificial intelligence, machine learning methods have taken center stage in recent efforts to detect natural selection, with strategies such as convolutional neural networks applied to images of haplotypes. Yet, limitations of such techniques include estimation of large numbers of model parameters under nonconvex settings and feature identification without regard to location within an image. An alternative approach is to use tensor decomposition to extract features from multidimensional data although preserving the latent structure of the data, and to feed these features to machine learning models. Here, we adopt this framework and present a novel approach termed T-REx, which extracts features from images of haplotypes across sampled individuals using tensor decomposition, and then makes predictions from these features using classical machine learning methods. As a proof of concept, we explore the performance of T-REx on simulated neutral and selective sweep scenarios and find that it has high power and accuracy to discriminate sweeps from neutrality, robustness to common technical hurdles, and easy visualization of feature importance. Therefore, T-REx is a powerful addition to the toolkit for detecting adaptive processes from genomic data.

Uncovering footprints of natural selection through spectral analysis of genomic summary statistics

Natural selection leaves a spatial pattern along the genome, with a haplotype distribution distortion near the selected locus that fades with distance. Evaluating the spatial signal of a population-genetic summary statistic across the genome allows for patterns of natural selection to be distinguished from neutrality. Considering the genomic spatial distribution of multiple summary statistics is expected to aid in uncovering subtle signatures of selection. In recent years, numerous methods have been devised that consider genomic spatial distributions across summary statistics, utilizing both classical machine learning and deep learning architectures. However, better predictions may be attainable by improving the way in which features are extracted from these summary statistics. We apply wavelet transform, multitaper spectral analysis, and S-transform to summary statistic arrays to achieve this goal. Each analysis method converts one-dimensional summary statistic arrays to two-dimensional images of spectral analysis, allowing simultaneous temporal and spectral assessment. We feed these images into convolutional neural networks and consider combining models using ensemble stacking. Our modeling framework achieves high accuracy and power across a diverse set of evolutionary settings, including population size changes and test sets of varying sweep strength, softness, and timing. A scan of central European whole-genome sequences recapitulated well-established sweep candidates and predicted novel cancer-associated genes as sweeps with high support. Given that this modeling framework is also robust to missing genomic segments, we believe that it will represent a welcome addition to the population-genomic toolkit for learning about adaptive processes from genomic data.

Electrical data of 10W, 40W, 80W, and 250W photovoltaic modules under the aging condition: Tested by a Solar Manufacturer Company in Bangladesh

The health monitoring system of photovoltaic modules throughout their lifespan is an important research topic. The dataset of aged PV modules is required to investigate the performance of the aged PV array for simulation work. Different aging factors are responsible for decreasing the output power of aged PV modules and increasing the degradation rate. In addition, mismatch power losses are increases with the nonuniformity of aged PV modules due to different aging factors. In this work, four datasets of 10W, 40W, 80W, and 250W PV modules are collected under nonuniform aging conditions. Each dataset contains forty modules with a four-year aged average. The average deviation of each electrical parameter of the PV modules can be calculated from this data. Moreover, a correlation can be developed between the average deviation of electrical parameters and mismatch power loss in PV array modules under early aging conditions.

Study of Operative Events and Time Requirement of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst- the Experience at BSMMU Hospital

Of all varieties, Type I Choledochal cyst causing saccular or fusiform dilatation of the extra-hepatic biliary ductal system is the commonest (90.0 - 95.0%). Its presentations vary. To restore the continuity of the extra-hepatic biliary tract after excision of type I Choledochal cyst, surgeons have few alternatives to use, with their advantages and disadvantages. Roux en-Y Hepatico-jejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I Choledochal cyst. But now Hepatico-duodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. For the last five years, we, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, have been using Hepatico-duodenostomy as preferred anastomotic option in treating type I Choledochal cyst. Here, we are presenting our experience at BSMMU Hospital, regarding operative events and time requirement of Hepaticoduodenostomy for the treatment of type I Choledochal cyst and, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document study, from January 2013 to December 2017, at BSMMU Hospital, on forty two, MRCP confirmed type I Choledochal cyst patients of pediatric age. Patients' particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records and documented in duly coded individual data collection sheet maintaining standard privacy protocol. Information regarding presentations, operative findings and procedural events including per-operative mortality, injury to the vital structures during operation, conversion to RYHJ, operative time (minutes), blood loss and transfusion requirements (ml) of Heaticoduodenostomy for type I Choledochal cyst, were specially searched for. There was no operative mortality. None of these patients required per-operative blood transfusion. Nor there was any inadvertent injury to the adjacent structures. The mean operative time required for Hepaticoduodenostomy was 88 minutes with a range of 75 to 125 minutes. Through this study, at BSMMU Hospital, operative events and time requirement of Hepatico-duodenostomy for treating type I Choledochal cyst, was found to be yielding acceptable results, for safe practice.

Tensor decomposition based feature extraction and classification to detect natural selection from genomic data

Inferences of adaptive events are important for learning about traits, such as human digestion of lactose after infancy and the rapid spread of viral variants. Early efforts toward identifying footprints of natural selection from genomic data involved development of summary statistic and likelihood methods. However, such techniques are grounded in simple patterns or theoretical models that limit the complexity of settings they can explore. Due to the renaissance in artificial intelligence, machine learning methods have taken center stage in recent efforts to detect natural selection, with strategies such as convolutional neural networks applied to images of haplotypes. Yet, limitations of such techniques include estimation of large numbers of model parameters under non-convex settings and feature identification without regard to location within an image. An alternative approach is to use tensor decomposition to extract features from multidimensional data while preserving the latent structure of the data, and to feed these features to machine learning models. Here, we adopt this framework and present a novel approach termed T-REx , which extracts features from images of haplotypes across sampled individuals using tensor decomposition, and then makes predictions from these features using classical machine learning methods. As a proof of concept, we explore the performance of T-REx on simulated neutral and selective sweep scenarios and find that it has high power and accuracy to discriminate sweeps from neutrality, robustness to common technical hurdles, and easy visualization of feature importance. Therefore, T-REx is a powerful addition to the toolkit for detecting adaptive processes from genomic data.

Impact of COVID-19 on poultry market in Bangladesh

As a result of COVID-19 spread, Bangladesh implemented a range of measures including general holidays, lockdown, no lockdown, and strict lockdown which resulted in the dramatic ups and downs of the price level of the products. This study aimed to examine the influence of COVID-19 on poultry products (meat and eggs) in Bangladesh using Gazipur-an intensive poultry growing area - as a case study. Monthly market price data of poultry meat and eggs, and primary panel data from the same respondents using a random sampling technique through a structured questionnaire-based interview, Focus Group Discussion (FGD), and Key Informant Interview (KII) were collected. The results reveal that after the incidence of COVID-19, the price of poultry products at farmgate, wholesale and retail levels dropped drastically for the first three months (February to April 2020). Following that, the market price of farm (broiler) chicken and eggs increased by 40% and more than 30%, respectively. On the other hand, the price of local (deshi) chicken increased by 15%, which was already high on the market. However, in the early phase of COVID-19, many smallholder poultry farmers and hatchery owners were forced to shut down due to less demand/no demand of the product along with high feed cost and inadequate support from external sources. The government should provide financial support with low or no-interest rate to the smallholder growers in order to enhance their resilience against shocks like COVID-19 pandemic, natural disasters, etc.

Clinico-epidemiological Characteristics of Asymptomatic and Symptomatic COVID-19-Positive Patients in Bangladesh

As of August 15, 2020, Bangladesh lost 3591 lives since the first Coronavirus disease 2019 (COVID-19) case announced on March 8. The objective of the study was to report the clinical manifestation of both symptomatic and asymptomatic COVID-19-positive patients. An online-based cross-sectional survey was conducted for initial recruitment of participants with subsequent telephone interview by the three trained physicians in 237 adults with confirmed COVID-19 infection in Bangladesh. The study period was 27 April to 26th May 2020. Consent was ensured before commencing the interview. Collected data were entered in a pre-designed case record form and subsequently analyzed by SPSS 20.0. The mean±SD age at presentation was 41.59±13.73 years and most of the cases were male (73.0%). A total of 90.29% of patients reside in urban areas. Among the positive cases, 13.1% (n=31) were asymptomatic. Asymptomatic cases were significantly more common in households with 2 to 4 members (p=0.008). Both symptomatic and asymptomatic patients shared similar ages of presentation (p=0.23), gender differences (p=0.30) and co-morbidities (p=0.11). Only 5.3% of patients received ICU care during their treatment. The most frequent presentation was fever (88.3%), followed by cough (69.9%), chest pain (34.5%), body ache (31.1%), and sore throat (30.1%). Thirty-nine percent (n=92) of the patients had co-morbidities, with diabetes and hypertension being the most frequently observed. There has been an upsurge in COVID-19 cases in Bangladesh. Patients were mostly middle-aged and male. Typical presentations were fever and cough. Maintenance of social distancing and increased testing are required to meet the current public health challenge.

Spatial price transmission in the onion markets of Bangladesh: An application of NARDL approach

As the price of local onions is greatly impacted by the price of imported onions at these two levels of the supply chain, the goal of this study was to ascertain whether onion prices in Bangladesh are transmitted asymmetrically at the wholesale and retail levels. To analyze asymmetry, the study employed the nonlinear autoregressive distributed lag (NARDL) model in the short and long run using monthly time series data from January 2006 to December 2020. The NARDL model captures the effects of both positive and negative shocks in the short as well as in the long run. The empirical results from the NARDL indicate that the wholesale price of local onion shares a short-run relationship with the wholesale price of imported onion while the local retail price of onion shares a long-run relationship with the imported retail price of onion. In addition, the short-run impact of local wholesale and imported wholesale prices is asymmetric. Long-run evidence supports the existence of an asymmetric effect between the local and imported retail onion prices. Using the Pairwise Granger causality test, we examined the causal relationships between wholesale and retail prices. The direction of the casual relationship indicates that the wholesale and retail prices of imported onions lead to the wholesale and retail prices of local onions. A clear understanding of the onion market, how prices move between market actors, and its role in determining market price interaction could be gained by analyzing the asymmetric relationship between the local and imported onion prices. As a result, significant policy recommendations could be made to control the onion price in Bangladesh.

Empirical assessment of onion supply chain constraints in Bangladesh: A pre-covid to covid situation

In Bangladesh, Covid-19 has wrecked devastation on people's livelihoods and economies. It began with supply chain disruptions affecting a variety of agricultural products, particularly perishable ones. Onion, the most consumed species in Bangladesh and Asia is also fallen into that category. The goal of this study was to shed light on the current onion supply chain as well as the constraints faced by the actors in Bangladesh's major onion-producing area markets (i.e., Pabna, Rajshahi, and Chapainawabganj). The extent to which pre-existing constraints on market actors of onion were discovered and distinguished in pre-covid to covid conditions. The backward supply chain analysis revealed that the local market seller supplied the majority of necessary farm inputs (i.e., seed, seedlings, and fertilizer). Wholesalers, commission agents (aratdars), local wholesalers (beparies), and retailers were all involved in forward connecting. Producers received roughly 71% of the retail price (0.76/kg), followed by retailers (BDT 2.07/kg), wholesalers (BDT 1.22/kg), commission agents (aratdars) (BDT 0.85/kg), and independent wholesalers (beparies) (BDT 0.36/kg). Moreover, a constraint factor index and econometric analysis were utilized to determine the most critical constraints and their influencing factors. Obstacles to onion production and commercialization ranged from moderate (66%) to severe (33.5%), with a few being fairly severe (0.5%). The paucity of high-quality seed, the cost and difficulty of timely transportation, and the market's inaccessibility to government intervention were all significant drawbacks to increased onion output. The primary impediments to onion marketing were a lack of or inability to receive marketing expertise, frequent demand fluctuations, and an insufficient storage facility for other market intermediaries. The findings of the study can assist in establishing a dynamic policy framework that includes procedure for expanding market infrastructure, rehabilitating current onion market actors through adequate training, assuring information abundance, and rapidly addressing market mishaps for ensuring sustainability.

National TB Control Program of Bangladesh: System Failure and Loss of Effectiveness

The National Tuberculosis Control Program (NTP) is one of the largest programs run by the state with many successes. However, underreporting is considered a real flaw of the current program. To report the characteristics and outcomes of TB patients registered in an upazila health complex in Kazipur, Sirajganj district, Bangladesh between September 2018 and February 2019 under the control of NTP was the objective of the study. This retrospective cohort study was conducted using routinely collected program data from the aforementioned site. Data retrieved from the hospital record form. Formal permission was obtained from the local authority. Consent statements and ethical aspects were waived due to the retrospective nature of the study. Analysis was performed using SPSS 20.0. A total of 207 tuberculosis cases were included with an average age of presentation of 43 years. Approximately 82.0% had pulmonary tuberculosis (PTB) and the rest had extrapulmonary tuberculosis (EPTB). PTB was more common in males, whereas EPTB was common in females (p=0.01). Of all cases, 84.0% were diagnosed by a positive sputum smear and 16.0% were diagnosed clinically with a negative sputum smear. Attendance at follow-up was 82.12%, 70.04% and 68.59% at months 2, 5 and 6 following index admission respectively. Overall, the cure rate was higher in PTB than EPTB [146 (85.9%) vs. 5 (13.5%), p<0.001). The rate of treatment completion was 25.1% (n=52) and the death count was 1.4% (n=3) [PTB-1.2 (n=2) vs. EPTB-2.7% (n=1)]. A gradual decline in reporting or completion of treatment was observed in this setting. However, a nationwide study is warranted to explore this issue in detail.

Inhibiting the endocannabinoid degrading enzymes FAAH and MAGL during zebrafish embryogenesis alters sensorimotor function

The endocannabinoid system (eCS) plays a critical role in a variety of homeostatic and developmental processes. Although the eCS is known to be involved in motor and sensory function, the role of endocannabinoid (eCB) signaling in sensorimotor development remains to be fully understood. In this study, the catabolic enzymes fatty acid amide hydrolase (FAAH), and monoacylglycerol lipase (MAGL) were inhibited either simultaneously, or individually during the first ∼24 hours of zebrafish embryogenesis, and the properties of contractile events and escape responses were studied in animals ranging in age from 1 day post fertilization (dpf) to 10 weeks. This perturbation of the eCS resulted in alterations to contractile activity at 1 dpf. Inhibition of MAGL using JZL 184 and dual inhibition of FAAH/MAGL using JZL 195 decreased escape swimming activity at 2 dpf. Treatment with JZL 195 also produced alterations in the properties of the 2 dpf short latency C-start escape response. Animals treated with JZL 195 exhibited deficits in escape responses elicited by auditory/vibrational (A/V) stimuli at 5 and 6 dpf. These deficits were also present during the juvenile developmental stage (8-10-week-old fish), demonstrating a prolonged impact to sensory systems. These findings demonstrate that eCS perturbation affects sensorimotor function, and underscores the importance of eCB signaling in the development of motor and sensory processes.

Expression and Development of TARP γ-4 in Embryonic Zebrafish

Fast excitatory synaptic transmission in the CNS is mediated by the neurotransmitter glutamate, binding to and activating AMPA receptors (AMPARs). AMPARs are known to interact with auxiliary proteins that modulate their behavior. One such family of proteins is the transmembrane AMPAR-related proteins, known as TARPs. Little is known about the role of TARPs during development or about their function in nonmammalian organisms. Here, we report on the presence of TARP γ-4 in developing zebrafish. We find that zebrafish express 2 forms of TARP γ-4: γ-4a and γ-4b as early as 12 h post-fertilization. Sequence analysis shows that both γ-4a and γ-4b shows great level of variation particularly in the intracellular C-terminal domain compared to rat, mouse, and human γ-4. RT-qPCR showed a gradual increase in the expression of γ-4a throughout the first 5 days of development, whereas γ-4b levels were constant until day 5 when levels increased significantly. Knockdown of TARP γ-4a and γ-4b via either splice-blocking morpholinos or translation-blocking morpholinos resulted in embryos that exhibited deficits in C-start escape responses, showing reduced C-bend angles. Morphant larvae displayed reduced bouts of swimming. Whole-cell patch-clamp recordings of AMPAR-mediated currents from Mauthner cells showed a reduction in the frequency of mEPCs but no change in amplitude or kinetics. Together, these results suggest that γ-4a and γ-4b are required for proper neuronal development.

Cataract Disease Detection by Using Transfer Learning-Based Intelligent Methods

One of the most common visual disorders is cataracts, which people suffer from as they get older. The creation of a cloud on the lens of our eyes is known as a cataract. Blurred vision, faded colors, and difficulty seeing in strong light are the main symptoms of this condition. These symptoms frequently result in difficulty doing a variety of tasks. As a result, preliminary cataract detection and prevention may help to minimize the rate of blindness. This paper is aimed at classifying cataract disease using convolutional neural networks based on a publicly available image dataset. In this observation, four different convolutional neural network (CNN) meta-architectures, including InceptionV3, InceptionResnetV2, Xception, and DenseNet121, were applied by using the TensorFlow object detection framework. By using InceptionResnetV2, we were able to attain the avant-garde in cataract disease detection. This model predicted cataract disease with a training loss of 1.09%, a training accuracy of 99.54%, a validation loss of 6.22%, and a validation accuracy of 98.17% on the dataset. This model also has a sensitivity of 96.55% and a specificity of 100%. In addition, the model greatly minimizes training loss while boosting accuracy.

Tyrosine phosphorylation of S1PR1 leads to chaperone BiP-mediated import to the endoplasmic reticulum

Cell surface G protein–coupled receptors (GPCRs), upon agonist binding, undergo serine–threonine phosphorylation, leading to either receptor recycling or degradation. Here, we show a new fate of GPCRs, exemplified by ER retention of sphingosine-1-phosphate receptor 1 (S1PR1). We show that S1P phosphorylates S1PR1 on tyrosine residue Y¹⁴³, which is associated with recruitment of activated BiP from the ER into the cytosol. BiP then interacts with endocytosed Y¹⁴³-S1PR1 and delivers it into the ER. In contrast to WT-S1PR1, which is recycled and stabilizes the endothelial barrier, phosphomimicking S1PR1 (Y¹⁴³D-S1PR1) is retained by BiP in the ER and increases cytosolic Ca²⁺ and disrupts barrier function. Intriguingly, a proinflammatory, but non-GPCR agonist, TNF-α, also triggered barrier-disruptive signaling by promoting S1PR1 phosphorylation on Y¹⁴³ and its import into ER via BiP. BiP depletion restored Y¹⁴³D-S1PR1 expression on the endothelial cell surface and rescued canonical receptor functions. Findings identify Y¹⁴³-phosphorylated S1PR1 as a potential target for prevention of endothelial barrier breakdown under inflammatory conditions.

Maternal health status and household food security on determining childhood anemia in Bangladesh -a nationwide cross-sectional study

Background

The aim of this study was to examine the effect of household food security on childhood anemia in Bangladesh while controlling for socioeconomic and demographic factors.

Methods

We used nationally representative Bangladesh Demographic Health Survey (BDHS) 2011 data for this study, the only existing survey including anemia information and household food security. The sample included 2171 children aged 6–59 months and their mothers. Differences between socioeconomic and demographic variables were analyzed using Chi-square test. Univariate and multivariate logistic regression analyses were performed to estimate the effects of different socioeconomic and demographic factors on childhood anemia. We also performed mediation analysis to examine the direct and indirect effect of household food security on childhood anemia.

Results

In Bangladesh, 53% male (95% CI: 50–56) and 51% female (95% CI: 47–54) children aged 6–59 months were anemic in 2011. The food insecure households have 1.20 times odds (95% CI: 0.97–1.48) of having anemic children comparing to food secure households in the unadjusted model. On the other hand, anemic mothers have 2 times odds (95% CI: 1.67–2.44) of having anemic children comparing to non-anemic mothers. However, household food security is no longer significantly associated with childhood anemia in the adjusted model while mothers’ anemia remained a significant factor (OR 1.87: 95% CI: 1.53–2.29). Age of children is the highest associated factor, and the odds are 4.89 (95% CI: 3.21–7.45) for 6–12 months old children comparing to 49–59 months in the adjusted model. Stunting and household wealth are also a significant factor for childhood anemia. Although food security has no significant direct effect on childhood anemia, maternal anemia and childhood stunting mediated that relationship.

Conclusions

Future public health policies need to focus on improving mothers’ health with focusing on household food security to eliminate childhood anemia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11581-3.

Open Label Randomized Controlled Comparison of Three Alternative Regimes of Ciprofloxacin, Azithromycin and Cefixime for Treatment of Uncomplicated Typhoid Fever in Bangladesh

Multi-drug resistant Typhoid fever (resistant to previously used chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole) has been commonly described in the South East Asia region and a recent report suggests that the salmonella typhi have reduced response to fluoroquinolones (nalidixic acid-resistant). The optimum treatment protocol for this type of serovar has not been established. This study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever which was conducted in the medicine ward of Dhaka Medical College Hospital (DMCH) and outdoor setting in private practice in Dhaka metropolitan city, Mymensingh and Sylhet town from January 2017 to December 2017. Bangladeshi adults with uncomplicated typhoid fever were included in this an open-label randomized controlled trial. Ciprofloxacin (20mg/kg of body weight/day for 14 days), azithromycin (20mg/kg/day for 14 days), and Cefixime (16mg/kg/day for 14 days) were compared. Of the 81 enrolled patients, 62 were eligible for analysis (61 S. enterica serovar Typhi, 1 Salmonella enterica serovar paratyphi A). Of the S enterica serovar Typhi isolates, 88.7% (55/62) were MDR and 93.5% (58/62) were nalidixic acid resistant (NAR). The clinical cure rate was 62% (13/21) with ciprofloxacin, 71% (15/21) with Cefixime, and 85% (17/20) with azithromycin (p=0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with cefixime (7.1 days [6.2 to 8.1 days]) and ciprofloxacin (8.2 days [7.2 to 9.2 days]) (p<0.001). All three antibiotics were well tolerated. A 7-day course of azithromycin can be successfully used in uncomplicated typhoid fever due to isolates of MDR S enterica serovar Typhi.

A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh

Introduction

In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention.

Methods

We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers.

Results

In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54).

Conclusion

Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.

Trial registration number

The trial is registered in ISRCTN (ISRCTN16001234).

Novel mutations in NSP-1 and PLPro of SARS-CoV-2 NIB-1 genome mount for effective therapeutics

BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), is rapidly acquiring new mutations. Analysis of these mutations is necessary for gaining knowledge regarding different aspects of therapeutic development. Previously, we have reported a Sanger method-based genome sequence of a viral isolate named SARS-CoV-2 NIB-1, circulating in Bangladesh. The genome has four novel non-synonymous mutations in V121D, V843F, A889V, and G1691C positions.

RESULTS

Using different computational tools, we have found V121D substitution has the potential to destabilize the non-structural protein-1 (NSP-1). NSP-1 inactivates the type-1 interferon-induced antiviral system. Hence, this mutant could be a basis of attenuated vaccines against SARS-CoV-2. V843F, A889V, and G1691C are all located in nonstructural protein-3 (NSP-3). G1691C can decrease the flexibility of the protein. V843F and A889V might change the binding pattern and efficacy of SARS-CoV-2 papain-like protease (PLPro) inhibitor GRL0617. V843F substitution in PLPro was the most prevalent mutation in the clinical samples. This mutation showed a reduced affinity for interferon-stimulated gene-15 protein (ISG-15) and might have an impact on innate immunity and viral spread. However, V843F+A889V double mutant exhibited the same binding affinity as wild type PLPro. A possible reason behind this phenomenon can be that V843F is a conserved residue of PLPro which damaged the protease structure, but A889V, a less conserved residue, presumably neutralized that damage.

CONCLUSIONS

Mutants of NSP-1 could provide attenuated vaccines against coronavirus. Also, these mutations of PLPro might be targeted to develop better anti-SARS therapeutics. We hope our study will help to get better insides during the development of attenuated vaccine and PLPro inhibitors.

Effects of estradiol on in vitro maturation of buffalo and goat oocytes

PURPOSE

The effects of estradiol on oocyte development seem to be varied among species. The present study investigated the effects of 17β-estradiol on in vitro maturation of buffalo and goat oocytes.

METHODS

Cumulus oocyte complexes (COCs) were aspirated from large antral follicles of slaughtered buffalo and goat ovaries. COCs were cultured in TCM-199 medium supplemented with 0, 0.5, 1, and 1.5 µg/mL of 17β-estradiol for in vitro maturation. Then, oocytes were used for the examination of state of nuclear maturation and cumulus expansion.

RESULTS

In both species, oocytes treated with 17β-estradiol showed higher cumulus expansion rate than control (0 µg/mL treated). In buffalo, the percentage of oocytes matured to the metaphase II (MII) stage increased in the concentration-dependent manner of 17β-estradiol. Similarly, estradiol positively influenced nuclear maturation of goat oocytes in vitro.

CONCLUSIONS

Estradiol has promoting effects on normalprogress of in vitro oocyte meiosis in buffalos and goats.

Divergence and agreement on nutrient intake between the two food composition tables of Bangladesh

In Bangladesh, two food composition tables (FCTs) were published over two consecutive years, in 2012 and in 2013. When different databases are used to calculate nutrient intakes, assessment of divergence and agreements is required. This study aimed to compare the differences in nutrient intakes, to assess the similarities in nutrient intakes between the two FCTs, and to explore the factors that cause the difference in nutrient intakes, if any. A total sample of 40 households was taken from the Household Income Expenditure Survey of 2010. Adult male equivalent (AME) units were used to estimate weighted average intake. Weighted k statistics were used to assess agreements between the two FCTs. Although median intake of energy and energy-yielding nutrients (protein, fats, and carbohydrates) were found statistically significant between the two databases, the differences were not large enough to have practical significance. Excellent agreements were found in energy and carbohydrates with good for fats and fair for protein. However, statistically significant median percent differences were seen in beta carotene (441%), vitamin B6 (153%), and folate (129%), vitamin C (106%), zinc (101%), and iron (41%) intakes. For thiamin, iron, calcium, and phosphorous, more than 50% of the subjects were found in the same quintile, whereas nine out of 15 vitamins and minerals were misclassified into the opposite quintiles (≥10%). Fair agreements were found for most of the micronutrients. Variations in analytical methods and sources of nutrient information were the main contributing factors for actual differences. FCT data should be interpreted with caution, especially for micronutrients.

Convalescent plasma transfusion therapy in severe COVID-19 patients- a safety, efficacy and dose response study: A structured summary of a study protocol of a phase II randomized controlled trial

Objectives

General: To assess the safety, efficacy and dose response of convalescent plasma (CP) transfusion in severe COVID-19 patients

Specific:

a. To identify the appropriate effective dose of CP therapy in severe patients

b. To identify the efficacy of the therapy with their end point based on clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality

c. To assess the clinical improvement after CP transfusion in severe COVID-19 patients

d. To assess the laboratory improvement after CP transfusion in severe COVID-19 patients

Trial Design

This is a multicentre, multi-arm phase II Randomised Controlled Trial.

Participants

Age and sex matched COVID-19 positive (by RT-PCR) severe cases will be enrolled in this trial. Severe case is defined by the World Health Organization (W.H.O) clinical case definition. The inclusion criteria are

1. Respiratory rate > 30 breaths/min; PLUS

2. Severe respiratory distress; or SpO2 ≤ 88% on room air or PaO2/FiO2≤ 300 mm of Hg, PLUS

3. Radiological (X-ray or CT scan) evidence of bilateral lung infiltrate, AND OR

4. Systolic BP < 90 mm of Hg or diastolic BP <60 mm of Hg.

AND/OR

5. Criteria 1 to 4 AND or patient in ventilator support

Patients’ below18 years, pregnant and lactating women, previous history of allergic reaction to plasma, patients who have already received plasma from a different source will be excluded. Patients will be enrolled at Bangabandhu Sheikh Mujib Medical University (BSMMU) hospital, Dhaka medical college hospital (DMCH) and Mugda medical college hospital (MuMCH). Apheretic plasma will be collected at the transfusion medicine department of SHNIBPS hospital, ELISA antibody titre will be done at BSMMU and CMBT and neutralizing antibody titre will be checked in collaboration with the University of Oxford.

Patients who have recovered from COVID-19 will be recruited as donors of CP. The recovery criteria are normality of body temperature for more than 3 days, resolution of respiratory symptoms, two consecutively negative results of sputum SARS-CoV-2 by RT-PCR assay (at least 24 hours apart) 22 to 35 days of post onset period, and neutralizing antibody titre ≥ 1:160.

Intervention and comparator

This RCT consists of three arms, a. standard care, b. standard care and 200 ml CP and c. standard care and 400 ml CP. Patients will receive plasma as a single transfusion. Intervention arms will be compared to the standard care arm.

Main outcomes

The primary outcome will be time to clinical improvement within seven days of treatment or until discharge whichever is later and in-hospital mortality. The secondary outcome would be improvement of laboratory parameters after therapy (neutrophil, lymphocyte ratio, CRP, serum ferritin, SGPT, SGOT, serum creatinine and radiology), length of hospital stay, length of ICU stay, reduction in proportion of deaths, requirement of ventilator and duration of oxygen and ventilator support.

Randomisation

Randomization will be done by someone not associated with the care or assessment of the patients by means of a computer generated random number table using an allocation ratio of 1:1:1.

Blinding (masking)

This is an open level study; neither the physician nor the patients will be blinded. However, the primary and secondary outcome (oxygen saturations, PaO2/FiO2, BP, day specific laboratory tests) will be recorded using an objective automated method; the study staff will not be able to influence the recording of these data.

Number to be randomised (sample size)

No similar study has been performed previously. Therefore no data are available that could be used to generate a sample size calculation. This phase II study is required to provide some initial data on efficacy and safety that will allow design of a larger study. The trial will recruit 60 participants (20 in each arm).

Trial Status

Protocol version 1.4 dated May 5, 2020 and amended version 1.5, dated June 16, 2020. First case was recruited on May 27, 2020. By August 10, 2020, the trial had recruited one-third (21 out of 60) of the participants. The recruitment is expected to finish by October 31, 2020.

Trial registration

Clinicaltrials.gov ID: NCT04403477. Registered 26 May, 2020

Full Protocol

The full protocol is attached as an additional file, accessible from the Trial’s website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Autoinhibition of TRPV6 Channel and Regulation by PIP2

Transient receptor potential vanilloid 6 (TRPV6), a calcium-selective channel possessing six transmembrane domains (S1-S6) and intracellular N and C termini, plays crucial roles in calcium absorption in epithelia and bone and is involved in human diseases including vitamin-D deficiency, osteoporosis, and cancer. The TRPV6 function and regulation remain poorly understood. Here we show that the TRPV6 intramolecular S4-S5 linker to C-terminal TRP helix (L/C) and N-terminal pre-S1 helix to TRP helix (N/C) interactions, mediated by Arg470:Trp593 and Trp321:Ile597 bonding, respectively, are autoinhibitory and are required for maintaining TRPV6 at basal states. Disruption of either interaction by mutations or blocking peptides activates TRPV6. The N/C interaction depends on the L/C interaction but not reversely. Three cationic residues in S5 or C terminus are involved in binding PIP2 to suppress both interactions thereby activating TRPV6. This study reveals "PIP2 - intramolecular interactions" regulatory mechanism of TRPV6 activation-autoinhibition, which will help elucidating the corresponding mechanisms in other TRP channels.

Genome-wide identification, characterization and expression profiling of gibberellin metabolism genes in jute

BACKGROUND

Gibberellin (GA) is one of the most essential phytohormones that modulate plant growth and development. Jute (Corchorus sp.) is the second most important source of bast fiber. Our result has shown that exogenous GA can positively regulate jute height and related characteristics which mean increasing endogenous GA production will help to get a jute variety with improved characteristics. However, genes involved in jute GA biosynthesis have not been analyzed precisely.

RESULTS

Genome-wide analysis identified twenty-two candidate genes involved in jute GA biosynthesis pathway. Among them, four genes- CoCPS, CoKS, CoKO and CoKAO work in early steps. Seven CoGA20oxs, three CoGA3oxs, and eight GA2oxs genes work in the later steps. These genes were characterized through phylogenetic, motif, gene structure, and promoter region analysis along with chromosomal localization. Spatial gene expression analysis revealed that 11 GA oxidases were actively related to jute GA production and four of them were marked as key regulators based on their expression level. All the biosynthesis genes both early and later steps showed tissue specificity. GA oxidase genes were under feedback regulation whereas early steps genes were not subject to such regulation.

CONCLUSION

Enriched knowledge about jute GA biosynthesis pathway and genes will help to increase endogenous GA production in jute by changing the expression level of key regulator genes. CoGA20ox7, CoGA3ox2, CoGA2ox3, and CoGA2ox5 may be the most important genes for GA production.

Epidemiology of Typhoid and Paratyphoid: Implications for Vaccine Policy

Background

Typhoid and paratyphoid remain the most common bloodstream infections in many resource-poor settings. The World Health Organization recommends typhoid conjugate vaccines for country-specific introduction, but questions regarding typhoid and paratyphoid epidemiology persist, especially regarding their severity in young children.

Methods

We conducted enteric fever surveillance in Bangladesh from 2004 through 2016 in the inpatient departments of 2 pediatric hospitals and the outpatient departments of 1 pediatric hospital and 1 private consultation clinic. Blood cultures were conducted at the discretion of the treating physicians; cases of culture-confirmed typhoid/paratyphoid were included. Hospitalizations and durations of hospitalizations were used as proxies for severity in children <12 years old.

Results

We identified 7072 typhoid and 1810 paratyphoid culture-confirmed cases. There was no increasing trend in the proportion of paratyphoid over the 13 years. The median age in the typhoid cases was 60 months, and 15% of the cases occurred in children <24 months old. The median age of the paratyphoid cases was significantly higher, at 90 months (P < .001); 9.4% were in children <24 months old. The proportion of children (<12 years old) hospitalized with typhoid and paratyphoid (32% and 21%, respectively) decreased with age; there was no significant difference in durations of hospitalizations between age groups. However, children with typhoid were hospitalized for longer than those with paratyphoid.

Conclusions

Typhoid and paratyphoid fever are common in Dhaka, including among children under 2 years old, who have equivalent disease severity as older children. Early immunization with typhoid conjugate vaccines could avert substantial morbidity, but broader efforts are required to reduce the paratyphoid burden.

Eutectic Synthesis of the P2-Type NaxFe1/2Mn1/2O2 Cathode with Improved Cell Design for Sodium-Ion Batteries

An engaging area of research in sodium-ion batteries (SIBs) has been focusing on discovery, design, and synthesis of high-capacity cathode materials in order to boost energy density to levels close enough to that of state-of-the-art lithium-ion batteries. Of particular interest, P2-type layered oxide, Na_2/3Fe_1/2Mn_1/2O₂, has been researched as a potential cathode in SIBs based on its high theoretical capacity of 260 mA h/g and use of noncritical materials. However, the reported synthesis methods are not only complex and energy-demanding but also often yield inhomogeneous and impure materials with capacities less than 200 mA h/g under impractical test conditions. Here, we report a novel synthesis route using low-temperature eutectic reaction to produce highly homogeneous, crystalline, and impurity-free P2-Na_xFe_1/2Mn_1/2O₂ with enhanced Na-ion diffusivity and kinetics. The overall electrochemical performances of the Na-ion cells have been improved by pairing the P2-cathode with presodiated hard carbon anodes, leading to reversible capacities in the range of 180 mA h/g. This new approach is a contribution toward the simplification of synthesis and scalability of sodium-based cathodes with high crystallinity and fine-tuned morphology and the realization of a sodium-ion battery system with lower cost and improved electrochemical performance.

Study of Immediate Postoperative Outcome of Hepaticoduodenostomy for the Treatment of Type I Choledochal Cyst: The Experience at BSMMU Hospital

Excision of type I choledochal cyst mandates restoration of continuity of extrahepatic biliary drainage system through anastomotic options having their advantages and disadvantages. Roux en-Y Hepaticojejunostomy (RYHJ) has been very popular and long studied standard surgical treatment for type I choledochal cyst. But now Hepaticoduodenostomy (HD) is also being practiced and studied in different centers all over the world for the treatment of the same disease. We have been practicing Hepaticoduodenostomy for treating type I choledochal cyst, at Bangabandhu Sheik Mujib Medical University (BSMMU), for last five years. Here, we are presenting our experience at BSMMU Hospital, regarding immediate post-operative outcome of Hepaticoduodenostomy for the treatment of type I Choledochal cyst, to show whether this procedure can be safely practiced, producing acceptable results. It is a retrospective document review of forty two MRCP confirmed type I Choledochal cyst children, admitted and operated at BSMMU Hospital, from January 2013 to December 2017. Patient's particulars, history, physical examination, investigations (including MRCP confirmation), assessment, surgical plan were collected from relevant medical records under standard privacy protocol. Information regarding early post-operative outcome of Hepaticoduodenostomy in treating uncomplicated type I choledochal cyst were searched for review and evaluation, specifically with respect to- a) mortality (if any); b) morbidities like- i) prolonged post-operative abdominal pain, ii) anastomotic bile leak, iii) features of early Cholangitis, iv) wound dehiscence and c) prolonged Hospital stay. There was no immediate post-operative mortality. But 9(21.42%) patients had prolonged post-operative pain requiring parenteral Pethidine 'on demand' beyond second post-operative day, 2(4.76%) had anastomotic bile leak, 7(16.67%) had early cholangitis and 1(2.38%) had abdominal wound dehiscence; they (21.42%) also stayed in hospital for more than fourteen days. The outcome was acceptably safe when compared with other studies abroad. Through this study, at BSMMU Hospital, immediate post-operative outcome of Hepaticoduodenostomy for treating type I choledochal cyst- in terms of morbidity, mortality and hospital stay- was found to be yielding acceptable results, for safe practice.

Early Exposure to THC Alters M-Cell Development in Zebrafish Embryos

Cannabis is one of the most commonly used illicit recreational drugs that is often taken for medicinal purposes. The psychoactive ingredient in cannabis is Δ⁹-Tetrahydrocannabinol (Δ⁹-THC, hereafter referred to as THC), which is an agonist at the endocannabinoid receptors CB₁R and CB₂R. Here, we exposed zebrafish embryos to THC during the gastrulation phase to determine the long-term effects during development. We specifically focused on reticulospinal neurons known as the Mauthner cells (M-cell) that are involved in escape response movements. The M- cells are born during gastrulation, thus allowing us to examine neuronal morphology of neurons born during the time of exposure. After the exposure, embryos were allowed to develop normally and were examined at two days post-fertilization for M-cell morphology and escape responses. THC treated embryos exhibited subtle alterations in M-cell axon diameter and small changes in escape response dynamics to touch. Because escape responses were altered, we also examined muscle fiber development. The fluorescent labelling of red and white muscle fibers showed that while muscles were largely intact, the fibers were slightly disorganized with subtle but significant changes in the pattern of expression of nicotinic acetylcholine receptors. However, there were no overt changes in the expression of nicotinic receptor subunit mRNA ascertained by qPCR. Embryos were allowed to further develop until 5 dpf, when they were examined for overall levels of movement. Animals exposed to THC during gastrulation exhibited reduced activity compared with vehicle controls. Together, these findings indicate that zebrafish exposed to THC during the gastrula phase exhibit small changes in neuronal and muscle morphology that may impact behavior and locomotion.

Management of a Subgingivally Fractured Maxillary Central Incisor by Reattachment Technique

Reattachment of a fractured fragment to the remaining tooth is challenging but one of the best treatment protocols in regards to aesthetics, function as well as patients acceptance. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability and aesthetics. This case report will discuss a 13 years old boy with a complicated crown-root fracture of maxillary right central incisor tooth. The procedure used to repair the fracture regarding this case including flap surgery with endodontic treatment. The root canal was filled with a root canal sealer and gutta-percha. After root canal obturation, fragment was reattached with an adhesive tooth reattachment technique. After 6 months evaluation, clinical and radiographic examinations showed a stable re-attachment, good aesthetic and healthy periodontium.

Evaluation of Corrosion and Tarnishing of Intra-oral Nickel Chromium and Gold-alloy Cast Crown

Although esthetic factors might limit by the presentation of materials used, all-metal complete cast crown should always be offered to patients requiring restoration of endodontically treated posterior tooth. The complete cast crown has the highest longevity of all fixed restorations. It could be used to rebuild a single tooth or a retainer for a fixed prosthesis. It involves all the axial walls as well as the occlusal surface of the tooth to be restored. All restorations are placed in the oral environment in contact with the gingival tissue. Thus clinicians must choose nontoxic or least toxic metal alloys, since any release of elements that might cause reactions. This study was designed to observe clinical responses of nickel chromium alloy and gold alloy cast crown and provide guidance to ascertain the best alloy for cast metal crown, which serves better functional restoration.

Designing Comprehensive Public Health Surveillance for Enteric Fever in Endemic Countries: Importance of Including Different Healthcare Facilities

Background

Designing comprehensive surveillance to generate credible burden estimates of enteric fever in an endemic country can be challenging because care-seeking behavior is complex and surveillance in different healthcare facilities may lead to documentation of different epidemiological characteristics.

Methods

We conducted retrospective surveillance in 3 healthcare facilities to identify culture-confirmed enteric fever cases in Dhaka, Bangladesh, from January 2012 through December 2016. The study settings included (1) hospital in-patient department (IPD), (2) hospital out-patient department (OPD), and (3) private consultation center OPD. We analyzed the cases to understand their distribution, age ranges, and antibiotic susceptibility patterns across the settings.

Results

Of the 1837 culture-confirmed enteric fever cases, 59% (1079 of 1837) were OPD cases. Children with enteric fever hospitalized in the IPDs were younger than children seeking care at the hospital OPD (median age: 45 vs 60 months) or private OPD (median age: 45 vs 72 months). Multidrug resistance rates were slightly higher in hospital IPD cases than in private OPD cases (26% vs 24%).

Conclusions

In each facility, we identified different epidemiological characteristics, and lack of consideration of any of these may result in misinterpretation of disease burden, identification of different age groups, and/or antibiotic susceptibility patterns.

CB1 and CB2 receptors play differential roles in early zebrafish locomotor development

Endocannabinoids (eCBs) mediate their effects through actions on several receptors, including the cannabinoid receptors CB₁R and CB₂R. The role played by eCBs in the development of locomotor systems is not fully understood. In this study, we investigated the roles of the eCB system in zebrafish development by pharmacologically inhibiting CB₁R and CB₂R (with AM251 and AM630, respectively) in either the first or second day of development. We examined the morphology of motor neurons and we determined neuromuscular outputs by quantifying the amount of swimming in 5 days post-fertilization larvae. Blocking CB₂R during the first day of development resulted in gross morphological deficits and reductions in heart rate that were greater than those following treatment with the CB₁R blocker AM251. Blocking CB₁Rs from 0 to 24 h post-fertilization resulted in an increase in the number of secondary and tertiary branches of primary motor neurons, whereas blocking CB₂Rs had the opposite effect. Both treatments manifested in reduced levels of swimming. Additionally, blocking CB₁Rs resulted in greater instances of non-inflated and partially inflated swim bladders compared with AM630 treatment, suggesting that at least some of the deficits in locomotion may result from an inability to adjust buoyancy. Together, these findings indicate that the eCB system is pivotal to the development of the locomotor system in zebrafish, and that perturbations of the eCB system early in life may have detrimental effects.

Characterization and performance analysis of composite bioplastics synthesized using titanium dioxide nanoparticles with corn starch

Plastic is an amazing material, and wonderful invention, it has changed the world. Plastic is used everywhere and every day across the globe. But despite its varied uses, its disposal has threatened the environment. Biodegradable plastics can meet these needs and can easily be disposed to the environment. This work focuses on the characterization and performance analysis of starch bioplastics and composite bioplastic to reduce the plastic pollution by its various uses. TGA, DSC, SEM, FTIR, and surface roughness analyses were used to characterize, the mechanical properties, thermal properties and the morphology of the starch bioplastics and composite bioplastic. Starch bioplastics were fabricated using starch vinegar and glycerol. Composite bioplastics ware fabricated using starch, vinegar, glycerol and titanium dioxide. The addition of titanium dioxide improved the tensile strength of the bioplastics from 3.55 to 3.95 MPa and decreased elongation from 88% to 62%. According to Differential Scanning Calorimetry (DSC) Test, the melting point (T_m) and Glass Transition Temperature (T_g) significantly affected by the presence of titanium dioxide (TiO₂). The degree of nano-composite crystallinity was formed by the strong interfacial interaction between the titanium dioxide nanoparticles and the amorphous region of the chain. The decomposition temperature of starch bioplastic was increased by mixing with titanium dioxide nanoparticles. The results gained from SEM showed that better compatible morphologies in composite bioplastic compared to starch bioplastic for its fewer voids, holes, and crack. The functional group O-H, C-H, C=O, and C-O indicate the formation of starch bioplastics and composite bioplastics has already occurred which was confirmed by FTIR spectroscopy. The result is also verified with the available results of other researchers. Therefore, composite bioplastic is a modified elevation of a starch bioplastic with a modified upgrade feature. It can be an alternative to existing conventional plastic, especially packaging applications.

Feasibility and Safety of Distal Transradial Access in the Anatomical Snuffbox for Coronary Angiography and Intervention

Distal transradial access in the anatomical snuffbox has advantages over standard proximal access in terms of patient and operator comfort levels and risk of ischemia. Radial artery preservation could be a relevant issue in patients requiring multiple radial artery procedures and coronary bypass with the use of a radial graft or construction of Arterio-Venous fistula in patient of chronic kidney disease. One relevant drawback is the challenging puncture of a small and weak artery, with a steeper learning curve. The study was aimed at proving feasibility and safety of distal transradial access in the anatomical snuffbox. A total of 100 patients were assigned to perform coronary angiogram or intervention through distal transradial access in the anatomical snuffbox from January 2018 to June 2018 in this unit of the University Cardiac Center (UCC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. All of them had normal pulse in their distal radial artery. Both right and left distal radial artery were used and demographic features & complications were recorded during hospital stay. Statistical analysis was done through SPSS version 19. The overall feasibility was 98%, greater than expected in this early clinical experience, with 98 successful accesses out of 100 patients. There was failure to access of distal radial artery in two cases which may be due to hypoplastic/vasospastic distal radial artery. Despite all it can be said that it was very much safe as there was no hand ischemia, hematoma, numbness or proximal radial arterial occlusion. Distal transradial access in the anatomical snuffbox for coronary angiography and intervention is a safe and feasible option for both patients and operators.

Visceral Adiposity Index Score is the Better Predictor of Clinical and Coronary Angiographic Severity Assessment than Other Adiposity Indices in Patients with Acute Coronary Syndrome

Acute coronary syndrome (ACS) is one of the leading causes of death throughout the world and obesity especially visceral adiposity is one of the important concerns globally due to its huge impact on coronary artery disease particularly on ACS. There are several traditional methods like BMI, WC, WHR, WHtR etc. but none of these can measure visceral fat accurately. In this regard visceral adiposity index (VAI) is a novel sex specific index which has significant correlation with visceral adiposity and can express the distribution as well as function of visceral fat precisely. This cross sectional study was done in the Cardiology Department of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from August 2015 to July 2016 to compare the VAI with other adiposity indices for clinical and coronary angiographic severity assessment in patients with acute coronary syndrome. A total of 200 patients (Case 100 patients of ACS and Control 100 patients of non ACS) were included. Afterward clinical, biochemical, echocardiographic and coronary artery angiographic indexes determined by Gensini score were acquired. Adiposity indices like BMI, Waist and Hip circumference, Waist Hip and Waist Height ratio (WHR, WHtR) and finally VAI were calculated using appropriate formula. Patient with ACS had more severe form of clinical features like severe chest pain & shortness of breath (p=0.001), pulse, BP, abnormal precordial findings, BMI, WC, WHR, WHtR, HC, VAI (p=0.001) and angiographic severity (p=0.001) than non ACS group. Multivariate binary logistic regression analysis for clinical and coronary angiographic severity assessment (GS>36) by adiposity indices showed VAI was the better predictor of clinical and coronary angiographic severity assessment with OR's being 5.61 than others. An ROC curve was plotted for each adiposity indices for clinical and coronary angiographic severity assessment showed VAI to have the maximal AUC. A VAI of OR-5.61 was provided as the cutoff value which had a sensitivity of 73.3% and specificity of 76.6% (AUROC=0.839, CI-0.760-0.918, p<0.001) which indicates better than other adiposity indices in patients under study. VAI is an excellent, simple, noninvasive tool to detect the visceral adipose mass & was markedly associated with the clinical and coronary angiographic severity assessment in patients with ACS.

Study on Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is a modern & universally established modality in the evaluation and treatment of suspected biliary and pancreatic disease. In Bangladesh, ERCP services are limited to few tertiary care centers mostly in the capital & large city. ERCP was 1st introduced in Mymensingh on 3rd April 2016 in a private hospital. Since then, Mymensingh Medical College Hospital (MMCH) provides ERCP services to a large volume of patients in collaboration with private center for diagnostic accuracy & therapeutic purpose. The aim of this study was to evaluate our experience in ERCP, to characterize & evaluate the aetiology, findings of ERCP & frequency of complications. This prospective type of study was carried out by the department of hepatology, MMCH from 3rd April 2016 to 10th July 2018 in collaboration with that private center where ERCP has been established. All patients undergoing ERCP during this period were included. Aetiology & findings were assessed at the time of ERCP & complications were assessed during procedure, index hospitalization & within 30 days after the procedure by telephone contact. A total of 301 consecutive ERCP were performed during the study period. Among them, 182(60.5%) were male & 119(39.5%) were female with an age range of 18-78 years. The most common indications for ERCP were: cholangiocarcinoma in 98(32.56%) & choledocholithiasis in 95(31.56%) followed by periampullary growth in 93(30.89%), suspected CBD stricture in 12(4%) & chronic pancreatitis in 2(0.66%). The most common findings were choledocholithiasis (32.56%), cholangiocarcinoma (32.56%), biliary obstruction due to periampullary growth (30.56%). Biliary fistula with distal bile duct stricture was found in (1.66%), bile duct stricture in (1.33%), chronic pancreatitis in (0.66%), and organic papillary stenosis with deformed bulb were discovered in (0.34%) case. All ERCPs were done for therapeutic purpose. Endoscopic sphincterotomy was the most common therapeutic procedure (87.04%) of which biliary stenting was done in (67.44%) & stone extraction in (33.71%). Stone extraction from biliary tree was successfully done in 94 cases (98.67%) but it was unsuccessful from biliary tree in 4 cases (1.33%) & also from pancreatic duct in a separate case. The most frequent complication was Post-ERCP pancreatitis in 9 patients (2.99%) followed by acute confusional state (1.33%). Post-ERCP cholangitis occurred in (0.99%) & death was reported in 2 cases (0.66%) due to anaesthetic hazard.

Transcatheter Closure of Post Infarction Subacute Ventricular Septal Defect: A Case Report

Ventricular septal rupture (VSR) is an uncommon but lethal complication of acute myocardial infarction (MI). Although early surgical closure is the treatment of choice, hospital mortality after emergency surgery remains high. Transcatheter closure of post myocardial infarction ventricular septal defect (PIVSD) has emerged as a potential treatment option in selected cases. Herein, we report a case present in AFC Health FORTIS Heart Institute, Khulna, Bangladesh on 10 February 2017 of sub acute post-MI VSR that was successfully closed using an Amplatzerseptal occlude (ASD) device. The patient had undergone primary percutaneous coronary intervention (PCI) 15 days earlier in the setting of acute MI.

Comparison between Glyceryl Trinitrate and Trimetazidine in Ischaemic Cardiomyopathy Patients

Ischaemic cardiomyopathy (ICM) remains a major health problem, both in developed and developing countries like Bangladesh where it causes a significant number of morbidity and mortality. The treatment and outcome of ICM chiefly depends on the presence and extent of hibernating myocardium. In this regard addressing anginal symptoms is the key to patients' comfort as well to achieving the goal of treatment. Glyceryl trinitrate (GTN) and trimetazidine (TMZ) are two widely used drugs for relieving angina. This pilot study was designed to answer some of the confusions and controversies regarding their use and to bring precision in decision making in the treatment of ICM. Here, comparison of GTN and trimetazidine were done by assessing the symptoms by NYHA and CCS class following their use in ICM patients, admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 15th October, 2015 to 15th April, 2016, who were randomly placed in two groups in a prospective manner. Most of the patients were in age group 51-60 years and were male in both the groups. It was observed that there was no significant difference in NYHA and CCS class at base line and at discharge between two groups (p>0.05). But statistically significant (p<0.05), improvement noted at 6 weeks and 12 weeks in GTN group in comparison to trimetazidine group. GTN stood out to be a better option than TMZ in the treatment of ICM. Moreover GTN is a cheaper option than TMZ.