Evaluation of environmental impacts of cotton polo shirt production in Bangladesh using life cycle assessment

The textile industry is widely considered as one of the most pollutant-releasing sectors globally. As the world is moving toward sustainability, it is essential to thoroughly assess how a textile product affects the environment. The aim of this study is to investigate the environmental impact of textile manufacturing in Bangladesh using life cycle assessment (LCA) method. A cradle-to-gate LCA was conducted to produce 1000 units of cotton polo shirts following ISO 14040 standards. LCA was also conducted for each final product at every manufacturing stage of cotton polo shirt, including the production of 1000 kg of cotton fibers, 1000 kg of yarn, 1000 kg of grey fabrics, 1000 kg of dyed-finished fabrics, and finally, assembling of 1000 pieces of polo shirts. Inventory analysis revealed that for producing 1000 pieces of polo shirts, 0.12 hector of land, 363.89 kg of cotton fiber, 324.84 kg of yarn, 320.45 kg of knitted fabric, and 299.5 kg of dyed-finished fabrics were required. The study also found that 1550.9 kWh of electricity, 15.47 L of diesel, and 72.54 m3 of natural gas were needed to produce 1000 pieces of polo shirts. The potential environmental impacts were categorized into 12 different types based on the CML 2001 method and calculated using openLCA 2.0 software. The outcomes of LCA revealed considerable environmental impacts in different categories during manufacturing of cotton polo shirts in Bangladesh. For example, the global warming potential (GWP) associated with the manufacturing of 1000 pieces of polo shirts was 1345.97 kg CO2-eq. Among several production stages of polo shirts, the highest contributor of GWP was dyeing section (38.36 %), followed by cotton fiber production (29.32 %) and yarn manufacturing (18.92 %). The obtained data also revealed that for cultivating cotton fibers, manufacturing of yarn and grey fabrics, and finally dyeing-finishing of same quantity fabric (1000 kg), the GWP were 1084.41 kg CO2-eq, 783.67 kg CO2-eq, 145.88 kg CO2-eq, 1723.88 kg CO2-eq, 314.94 kg CO2-eq, respectively. The outcome of the impact assessment will be crucial for decision-making when it comes to taking remedial actions to lessen negative environmental consequences for the sustainable development of textile industry in Bangladesh.

A data-driven global flood forecasting system for medium to large rivers

Losses from catastrophic floods are driving intense efforts to increase preparedness and improve response to disastrous flood events by providing early warnings. Yet accurate flood forecasting remains a challenge due to uncertainty in modeling, calibrating, and validating a useful early warning system. This paper presents the Requisitely Simple (ReqSim) flood forecasting system that includes key variables and processes of basin hydrology and atmospheric forcing in a data-driven modeling framework. The simplicity of the modeling structure and data requirements of the system allows for customization and implementation in any medium to large rain-fed river basin globally, provided there are water level or discharge measurements at the forecast locations. The proposed system's efficacy is demonstrated in this paper through providing useful forecasts for various river basins around the world. This include 3-10-day forecasts for the Ganges and Brahmaputra rivers in South Asia, 2-3-day forecast for the Amur and Yangtze rivers in East Asia, 5-10-day forecasts for the Niger, Congo and Zambezi rivers in West and Central Africa, 6-8-day forecasts for the Danube River in Europe, 2-5-day forecasts for the Parana River in South America, and 2-7-day forecasts for the Mississippi, Missouri, Ohio, and Arkansas rivers in the USA. The study also quantifies the effect of basin size, topography, hydrometeorology, and river flow controls on forecast accuracy and lead times. Results indicate that ReqSim's forecasts perform better in river systems with moderate slopes, high flow persistence, and less flow controls. The simple structure, minimal data requirements, ease of operation, and useful operational accuracy make ReqSim an attractive option for effective real-time flood forecasting in medium and large river basins worldwide.

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.

A Morphometric Study of Olecranon Fossa of Adult Human Humerus of Bangladeshi Population

Olecranon fossa is the largest fossa among the three fossae of the humerus. It is present in the lower end of the posterior surface just above the trochlea. Osteometry of olecranon fossa is important since their fractures occur in 10.0% of upper limb fractures. The aim of this study was to measure different parameters of olecranon fossa. This study was taken from 100 (right=43 and left=57) samples were selected through the purposive sampling technique for this cross-sectional descriptive study which was carried out in the Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. Data were tabulated and statistically analyzed using Microsoft Excel and SPSS software. The mean ±SD vertical diameter of the olecranon fossa of the right humeri was 16.858±2.623mm and the left humeri were 17.071±2.905mm. The mean ±SD width of the olecranon fossa of the right humeri was 24.239±2.520mm and the left humeri were 24.509±2.692mm. The mean ±SD maximum depth of the olecranon fossa of the right humeri was 13.442±1.688mm and the left humeri were 13.124±1.733mm. The anatomical knowledge of the olecranon fossa is beneficial for anthropologists, orthopedic surgeons and radiologists in cases of olecranon fractures of the humerus.

Association of low serum 25-Hydroxy vitamin D [25(OH) d] with hepatic encephalopathy in patients with decompensated liver cirrhosis

BACKGROUND AND STUDY AIMS

The mechanism of hepatic encephalopathy is complex and has not been conclusively established. Recent studies support lower serum 25-Hydroxy Vitamin D [25(OH) D] levels in patients with hepatic encephalopathy. This study aimed to evaluate the association between serum 25(OH) D and hepatic encephalopathy in patients with decompensated cirrhosis of liver.

PATIENTS AND METHODS

A total of 70 cirrhosis patients (35 cases of hepatic encephalopathy and 35 patients without encephalopathy as control, mean age 53.07 ± 12.99 years, 67 % male) were recruited for this study. Assessment of the severity of cirrhosis was done by using a model for end-stage liver disease(MELD) and Child Turcotte Pugh (CTP) scores, and assessment of the severity of hepatic encephalopathy was done according to West Haven criteria. Serum 25 (OH) D level was measured by Chemiluminescent Microparticle Immuno Assay(CMIA).

RESULTS

The mean serum 25(OH) D level among hepatic encephalopathy patients was significantly lower in comparison to the control group without encephalopathy (18.76 ± 8.84 nmol/L vs 31.19 ± 13.9 nmol/L, P<0.0001). 91.4 % of hepatic encephalopathy patients had moderate to severe 25(OH)D deficiency as compared to 51.4 % in the control group. There was a significant correlation observed between the severity of the 25 (OH) D deficiency and the severity of liver disease (r =  - 0.35, P = 0.002). No statistically significant difference in serum 25(OH) D levels was found among patients with different hepatic encephalopathy grades (P = 0.416).

CONCLUSION

A significant association was found between a low serum 25(OH) D leveland hepatic encephalopathy. It requires further large-scale multicenter studies to establish it as a risk factor and predictor of hepatic encephalopathy.

CTC together with Shh and Nrf2 are prospective diagnostic markers for HNSCC

BACKGROUND

The lack of appropriate prognostic biomarkers remains a significant obstacle in the early detection of Head and Neck Squamous Cell Carcinoma (HNSCC), a cancer type with a high mortality rate. Despite considerable advancements in treatment, the success in diagnosing HNSCC at an early stage still needs to be improved. Nuclear factor erythroid 2-related factor 2 (Nrf2) and Sonic Hedgehog (Shh) are overexpressed in various cancers, including HNSCC, and have recently been proposed as possible therapeutic targets for HNSCC. Circulating Tumor Cell (CTC) is a novel concept used for the early detection of cancers, and studies have suggested that a higher CTC count is associated with the aggressiveness of HNSCC and poor survival rates. Therefore, we aimed to establish molecular markers for the early diagnosis of HNSCC considering Shh/Nrf2 overexpression in the background. In addition, the relation between Shh/Nrf2 and CTCs is still unexplored in HNSCC patients.

METHODS

In the present study, we selected a cohort of 151 HNSCC patients and categorized them as CTC positive or negative based on the presence or absence of CTCs in their peripheral blood. Data on demographic and clinicopathological features with the survival of the patients were analyzed to select the patient cohort to study Shh/Nrf2 expression. Shh and Nrf2 expression was measured by qRT-PCR.

RESULTS

Considering significant demographic [smoking, betel leaf (p-value < 0.0001)] and clinicopathological risk factors [RBC count (p < 0.05), Platelet count (p < 0.05), Neutrophil count (p < 0.005), MCV (p < 0.0001), NLR (p < 0.05), MLR (p < 0.05)], patients who tested positive for CTC also exhibited significant overexpression of Shh/Nrf2 in both blood and tissue compared to CTC-negative patients. A strong association exists between CTCs and tumor grade. Following chemotherapy (a combination of Cisplatin, 5FU, and Paclitaxel), the frequency of CTCs was significantly decreased in patients with HNSCC who had tested positive for CTCs. The Kaplan-Meier plot illustrated that a higher number of CTCs is associated with poorer overall survival (OS) in patients with HNSCC.

CONCLUSIONS

Detecting CTCs, and higher expression of Shh and Nrf2 in HNSCC patients' blood, can be a promising tool for diagnosing and prognosticating HNSCC.

Variation of Acromiocoracoid and Acromioglenoid Distance in Bangladeshi People

This cross-sectional descriptive purposive study was done on 150 (70 right and 80 left) fully ossified dry human scapulae of Bangladeshi people to find out the variation in length of acromiocoracoid and acromioglenoid distance. Sample collection was carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh from January to December 2019. Any kind of damaged or broken scapulae were excluded to maintain standard measurement. Length of these distances was measured with the help of digital Vernier slide calipers. The mean±SD acromiocoracoid distance were 35.8±4.64 mm and 36.32±5.55 mm on right and left sided scapulae respectively and the mean±SD acromioglenoid distance were 27.69±3.43 mm on right sided scapulae and 28.18±3.26 mm on left sided scapulae. These data are important to compare Bangladeshi scapulae to those from various other races that could contribute to demographic studies of shoulder disease probability and management in Bangladeshi population.

Study of Nutrient Foramina of Dry Adult Human Clavicle

As a modified long bone, the clavicle is most important bone for transmission of body weight from upper limb to the axial skeleton, for attachment of muscles and is a significant source of bone grafting. This descriptive cross-sectional study was conducted among 150 (65 right and 85 left) fully ossified dry human clavicle in Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. Sample was collected by the help of nonrandom purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. In this study, nutrient foramen was present in 86.67% (130) cases. On the right side, 87.69% (57) cases and on the left side, 85.88% (73) cases were found present. Out of 130 clavicles where nutrient foramen were present, 52.31% (68) nutrient foramina were on inferior surface, 46.92% (61) on posterior surface and 0.77% (1) on superior surface. On the right side, 49.12% (28) cases were found on inferior surface and 49.12% (28) were on posterior surface and remaining 1.75% (1) was on superior surface. On the left side, 54.79% (40) cases were found on inferior surface and 45.21% were on posterior surface whereas none was found on superior surface. Among the present 130 cases, 1 nutrient foramen was found in total 80% (104) cases and 2 in 20% (26) cases. In right side, the numbers of cases were 75.44% (43) for 1 and 24.56% (14) for 2 nutrient foramina. In left side, the number of cases of 1 was 83.56% (61) and 16.44% (12) for 2 foramina. The nutrient foraminal direction was 98.46% (128) towards acromial end and 1.54% (2) to sternal end. In the right side, the direction was 100% (57) towards acromial end. In the left side, the direction was 97.26% (71) towards acromial end and 2.74% (2) to sternal end. In the current study, the mean ±SD nutrient foramina of 65 clavicles of right side were 71.04±13.91 and 67.13±16.30 in 85 left sided clavicles. The purpose for undertaking this study was to obtain baseline data on nutrient foramen to help to predict the success rate and different surgical interventions regarding fractures and grafting.

Anatomical Study of Number, Location and Position of Nutrient Foramina of Fully Ossified Dry Human Humerus

The nutrient foramen is the natural opening present in the shaft of the humerus. It passes the nutrient artery to the medullary cavity. The nutrient artery is the chief artery that enters the bone through a nutrient foramen to provide nutrition for its growth. It plays an important role in healing during fracture and trauma and is also important for bone grafting. This study aimed to determine the common location, position and number of nutrient foramina of fully ossified dry human humerus. One hundred samples (right- 43 and left- 57) were selected through the purposive sampling technique for this cross-sectional descriptive study carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. Data were tabulated and statistically analyzed using Microsoft Excel and SPSS software. Among 43 right humeri, 37(75.51%) have single-nutrient foramen and 06(24.49%) have double-nutrient foramina. Among 57 left humeri, 53(92.98%) have single nutrient foramen, 03(5.27%) have double nutrient foramina and 01(1.75%) has triple nutrient foramina. In case of location of nutrient foramina, among 49 right nutrient foramina, 45(91.84%) were found on the anteromedial surface, 02(4.08%) were found on the anterolateral surface and 02(4.08%) were on the posterior surface of the shaft of the humerus. In case of 62 left nutrient foramina, 57(91.94%) were found on the anteromedial surface and 05(8.06%) were found on the posterior surface of the shaft of the humerus. Among 49 right nutrient foramina, 01(2.04%) was found on the upper third, 46(93.88%) on the middle third and 02(4.08%) on the lower third of the shaft of the humerus. In case of 62 left nutrient foramina, 01(1.60%) was on the upper third, 57(91.95%) were on the middle third and 04(6.45%) were on the lower third of the shaft of the humerus.

Radiation Therapy Sensitizes Head-and-Neck Cancer Cells to Killing by Chimeric Antigen Receptor (CAR)-NK Cells Targeting CD70

PURPOSE/OBJECTIVE(S)

CAR-T cell therapy is limited by toxicity, high cost, logistical manufacturing issues in the autologous setting and risk of GVHD in the allogeneic setting. Substitution of T cells with NK cells opens the possibility for an allogeneic off-the-shelf product with a better safety profile. However, the inadequate efficacy of CAR-NK cells against solid tumors can be extrapolated from experience with CAR-T cells. There is limited but promising preclinical evidence that radiation therapy (RT) enhances CAR-T cell tumoricidal activity against solid tumors. However, there is no data examining the potential synergy between RT and CAR-NK cell therapy.

MATERIALS/METHODS

We engineered CAR-NK cells with CD27 receptor as extracellular domain to target its natural ligand CD70, which is overexpressed in head-and-neck cancers (HNSCC). CAR-NK cell killing was assessed real-time through xCELLigence cytotoxicity assays. CD70+ OQ01 human HNSCCs were used for most experiments. FaDu is a CD70- HNSCC (negative ctrl). UMRC3 is a CD70+ kidney cancer cell line (positive ctrl). CD70 expression pre- and post-RT was assessed by flow cytometry and Western blot. Ionizing RT was compared at 5 doses: 0, 1.75, 3.5, 7, and 14 Gy. A single dose of 3.5 Gy was used for most experiments. Post-radiation effects were generally assessed at 3 days or 9 days post-RT. Intracellular staining was used to assess NK cell expression of IFN-γ, CD107a, and TNF-α by flow cytometry. CD27/CD70 interaction blockade was through α-CD27 pre-treatment of CAR-NK cells.

RESULTS

OQ01 HNSCCs heterogeneously express CD70 and are killed by CD70 CAR-NK cells in vitro. Pre-conditioning low-dose RT of 3.5 Gy applied to OQ01 HNSCCs 3 days prior to coculture with NK cells enhances CD70 CAR-NK cell killing, with ∼30% increased cytotoxicity against the tumor cells. Low-dose RT by itself did not induce acute cytolysis. As a possible mechanism for the increased sensitivity of irradiated OQ01 cells to CD70 CAR-NK cells, we found that RT enhances CD70 expression among HNSCCs in a dose-dependent manner. There was no increase in NK cell expression of IFN-γ, CD107a, and TNF-α with exposure to irradiated target cells. CD27/CD70 blockade does not solely abrogate RT-induced sensitization toward CAR-NK cell killing. Despite RT induction of transient increased expression of CD70, which normalizes by 9 days post-RT, there is persistent increase in RT-synergized target cell killing even at this later timepoint. Thus, altogether, RT sensitizes CD70-expressing HNSCC cells to CAR-NK cell killing in vitro.

CONCLUSION

This work represents the first preclinical study to identify the synergy of RT and CAR-NK cell therapy in solid tumors and is the first demonstration of CAR-NK cell activity against human HNSCCs. We show significantly enhanced potency of CAR-NK cells against irradiated tumor cells in vitro. Collectively, this research will be vital to guide efforts expanding into other target antigens and tumor types.

Unraveling the impact of ORF3a Q57H mutation on SARS-CoV-2: insights from molecular dynamics

ORF3a is a conserved accessory protein of SARS-CoV-2, linked to viral infection and pathogenesis, with acquired mutations at various locations. Previous studies have shown that the occurrence of the Q57H mutation is higher in comparison to other positions in ORF3a. This mutation is known to induce conformational changes, yet the extent of structural alteration and its role in the viral adaptation process remain unknown. Here we performed molecular dynamics (MD) simulations of wt-ORF3a, Q57H, and Q57A mutants to analyze structural changes caused by mutations compared to the native protein. The MD analysis revealed that Q57H and Q57A mutants show significant structural changes in the dimer conformation than the wt-ORF3a. This dimer conformer narrows down the ion channel cavity, which reduces Na + or K + permeability leading to decrease the antigenic response that can help the virus to escape the host immune system. Non-bonding interaction analysis shows the Q57H mutant has more interacting residues, resulting in more stability within dimer conformation than the wt-ORF3a and Q57A. Moreover, both mutant dimers (Q57H and Q57A) form a novel salt-bridge interaction at the same position between A:Asp142 and B:Lys61, whereas such an interaction is absent in the wt-ORF3a dimer. We have also noticed that the TM3 domain's flexibility in Q57H is increased because of strong inter-domain interactions of TM1 and TM2 within the dimer conformation. These unusual interactions and flexibility of Q57H mutant can have significant impacts on the SARS-CoV-2 adaptations, virulence, transmission, and immune system evasion. Our findings are consistent with the previous experimental data and provided details information on the structural perturbation in ORF3a caused by mutations, which can help better understand the structural change at the molecular level as well as the reason for the high virulence properties of this variant.Communicated by Ramaswamy H. Sarma.

Structural and functional effects of the L84S mutant in the SARS-COV-2 ORF8 dimer based on microsecond molecular dynamics study

The L84S mutation has been observed frequently in the ORF8 protein of SARS-CoV-2, which is an accessory protein involved in various important functions such as virus propagation, pathogenesis, and evading the immune response. However, the specific effects of this mutation on the dimeric structure of ORF8 and its impacts on interactions with host components and immune responses are not well understood. In this study, we performed one microsecond molecular dynamics (MD) simulation and analyzed the dimeric behavior of the L84S and L84A mutants in comparison to the native protein. The MD simulations revealed that both mutations caused changes in the conformation of the ORF8 dimer, influenced protein folding mechanisms, and affected the overall structural stability. In particular, the ⁷³YIDI⁷⁶ motif has found to be significantly affected by the L84S mutation, leading to structural flexibility in the region connecting the C-terminal β4 and β5 strands. This flexibility might be responsible for virus immune modulation.  The free energy landscape (FEL) and principle component analysis (PCA) have also supported our investigation. Overall, the L84S and L84A mutations affect the ORF8 dimeric interfaces by reducing the frequency of protein-protein interacting residues (Arg52, Lys53, Arg98, Ile104, Arg115, Val117, Asp119, Phe120, and Ile121) in the ORF8 dimer.  Our findings provide detail insights for further research in designing structure-based therapeutics against the SARS-CoV-2.Communicated by Ramaswamy H. Sarma.

Correlation between Depth of Medial and Lateral Curvatures of Clavicle

Having the first bone to ossify clavicle is a bone of pectoral girdle. It is the only bony attachment between the trunk and upper limb. To obtain the precise data that is required to investigate the range in size and morphological features of the human clavicle, a study was undertaken on dry human clavicles which had been sourced from the Department of Anatomy. The purpose for undertaking this study was to obtain baseline data on the clavicular bow in the transverse plane. This cross-sectional descriptive study having some analytical components was done among 150 (65 right and 85 left) fully ossified dry clavicles in Mymensingh Medical College, Bangladesh from January 2020 to December 2020. Sample which met the inclusion criteria was collected through non random sampling technique, from Anatomy department of Mymensingh Medical College and Community Based Medical College Bangladesh. The parameters (the depth of medial and lateral curvatures) were measured with the help of rigid osteometry board and were expressed in millimeter. In the current study, the mean±SD depth of medial curvature of 65 clavicles of right side was 15.54±3.54mm and 15.45±3.24mm of 85 left clavicles. The mean±SD depth of lateral curvature of right side was 11.71±2.54mm and of left side was 9.21±2.31mm. Correlation was done in between depth of medial and lateral curvatures on both sides and the regression line showed positive correlation but these differences were statistically non-significant on both sides.

Haematohidrosis: A Case Series of Five Patients

Haematohidrosisis manifested by sweating mixed with blood. It is a rare disease and there are scarce literature regarding case report. We are describing five cases of haematohidrosis in different age group here in this case series. In case 1- a 20 year old woman was admitted with history of recurrent haemorrhage from various sites without any trauma or anticoagulant or antipletlet medication. There was no evidence of local trauma. Physical examination was unremarkable. Her blood workup came out insignificant. In case 2- a 10 year old boy was admitted with epistaxis, conjunctival bleeding, haematuria and per rectal bleeding without any history of injury. He had no history of medicine which would cause bleeding. Physical examination and laboratory profile were insignificant. In case 3- a 15 year old boy presented with recurrent haematuria and conjunctival haemorrhage without any trauma. No history of medication that would cause the bleeding. His systemic examination and laboratory profile was unremarkable. In case 4- a 25 year old woman presented with bleeding from ear, nose and eyes without any local trauma. She was not on any medication that would cause bleeding. Her systemic inquiry and laboratory profile was unremarkable. In case 5- a 20 year old woman presented with bleeding from eyes, ears and umbilicus. There was no evidence of self-inflicted injury. She had features of anxiety disorder. Other systemic examination and laboratory profile was unremarkable. All the cases were labelled as haematohidrosis and treated with propranolol with successful outcome. We report this case series to build up awareness and disseminate clinical knowledge.

Clinical Profile of Pediatric Cases of Dengue during the 2019 Epidemic in Bangladesh: A Multicenter Cross-Sectional Study

Bangladesh experienced the largest dengue epidemic during 2019, with more than 100,000 confirmed cases and 164 deaths. Almost one-third of these cases were children. The present study aimed to investigate the clinical and hematological manifestations of pediatric dengue cases during the epidemic. This was a multicenter cross-sectional study conducted in Dhaka Medical College Hospital, Dhaka, Dr. Sirajul Islam Medical College Hospital and Tangail Sadar Hospital, Tangail, Bangladesh between the period of June 2019 and September 2019. The study included 208 pediatric patients (age <18 years) with confirmed dengue fever. Patient's demographics, clinical and laboratory features of dengue were collected through patients' interview, clinical examination and laboratory investigations. Descriptive statistics were used to represent the patients' socio-demographic information, clinical presentations and hematological parameters. The majority of the patients were aged between 6 and 17 years with male predominance. The most commonly presented clinical manifestations were fever (100.0%), headache (59.0%), myalgia (42.0%), rash (36.0%), retro-orbital pain (28.0%) and diarrhea (24.0%). Warning signs abdominal pain (40.0%) and persistent vomiting (29.0%), bleeding manifestations such as melena (17.0%), gum bleeding (7.0%) and epistaxis (6.0%) and evidence of plasma leakage such as oliguria (3.4%), ascites (2.4%), pleural effusion (1.4%), and shock (1.0%) were also present in the patients. Raised HCT levels, leucopenia and thrombocytopenia were present in almost 23.0%, 43.0% and 28.0% of children, respectively. Warning signs and plasma leakage were present in a substantial number of patients indicating potential risk of severe dengue. Prompt diagnosis and management based on best clinical judgment might prevent severe dengue at an early stage.

A176 ASSOCIATIONS OF ANTIBIOTICS, HORMONAL THERAPIES, ORAL CONTRACEPTIVES, AND LONG-TERM NSAIDS WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE PROSPECTIVE URBAN RURAL EPIDEMIOLOGY (PURE) STUDY

Background

The pathogenesis of inflammatory bowel disease (IBD) which includes Crohn’s disease (CD) and ulcerative colitis (UC), is believed to involve activation of the intestinal immune system in response to the gut microbiome among genetically susceptible hosts. IBD has been historically regarded as a disease of developed nations, though in the past two decades there has been a reported shift in the epidemiological pattern of disease. High-income nations with known high prevalence of disease are seeing a stabilization of incident cases, while a rapid rise of incident IBD is being observed in developing nations. This suggests that environmental exposures may play a role in mediating the risk of developing IBD. The potential environmental determinants of IBD across various regions is vast, though medications have been increasingly recognized as one broad category of risk factors.

Purpose

Several medications have been considered to contribute to the etiology of IBD. This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.

Method

This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including CD and UC. Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Result(s)

During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p<0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.

Conclusion(s)

Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.

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Salim Yusuf is supported by the Heart & Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease. The PURE Study is an investigator-initiated study funded by the Population Health Research Institute, the Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR’s Strategy for Patient Oriented Research (SPOR) through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies, with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithkline, and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries; these include: Argentina: Fundacion ECLA; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases; Colombia: Colciencias, grant number 6566-04-18062; India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia, grant numbers 100 -IRDC/BIOTEK 16/6/21 (13/2007) and 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600 -RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; International Development Research Centre, Canada; Philippines: Philippine Council for Health Research & Development; Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University; Saudi Arabia: the Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number RG -1436-013); South Africa: the North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC); Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors; the Swedish Heart and Lung Foundation; the Swedish Research Council; the Swedish Council for Health, Working Life and Welfare, King Gustaf V’s and Queen Victoria Freemasons Foundation, AFA Insurance, Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, grant from the Swedish State under the Läkar Utbildnings Avtalet agreement, and grant from the Västra Götaland Region; Turkey: Metabolic Syndrome Society, AstraZeneca, Turkey, Sanofi Aventis, Turkey; United Arab Emirates (UAE): Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai UAE.

Disclosure of Interest

C. Pray: None Declared, N. Narula Grant / Research support from: Neeraj Narula holds a McMaster University Department of Medicine Internal Career Award. Neeraj Narula has received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, and Ferring, E. C. Wong: None Declared, J. K. Marshall Grant / Research support from: John K. Marshall has received honoraria from Janssen, AbbVie, Allergan, Bristol-Meyer-Squibb, Ferring, Janssen, Lilly, Lupin, Merck, Pfizer, Pharmascience, Roche, Shire, Takeda and Teva., S. Rangarajan: None Declared, S. Islam: None Declared, A. Bahonar: None Declared, K. F. Alhabib: None Declared, A. Kontsevaya: None Declared, F. Ariffin: None Declared, H. U. Co: None Declared, W. Al Sharief: None Declared, A. Szuba: None Declared, A. Wielgosz: None Declared, M. L. Diaz: None Declared, R. Yusuf: None Declared, L. Kruger: None Declared, B. Soman: None Declared, Y. Li: None Declared, C. Wang: None Declared, L. Yin: None Declared, M. Erkin: None Declared, F. Lanas: None Declared, K. Davletov: None Declared, A. Rosengren: None Declared, P. Lopez-Jaramillo: None Declared, R. Khatib: None Declared, A. Oguz: None Declared, R. Iqbal: None Declared, K. Yeates: None Declared, Á. Avezum: None Declared, W. Reinisch Consultant of: Speaker for Abbott Laboratories, Abbvie, Aesca, Aptalis, Astellas, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, PLS Education, Schering-Plough, Shire, Takeda, Therakos, Vifor, Yakult, Consultant for Abbott Laboratories, Abbvie, Aesca, Algernon, Amgen, AM Pharma, AMT, AOP Orphan, Arena Pharmaceuticals, Astellas, Astra Zeneca, Avaxia, Roland Berger GmBH, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, DSM, Elan, Eli Lilly, Ernest & Young, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, LivaNova, Mallinckrodt, Medahead, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nash Pharmaceuticals, Nestle, Nippon Kayaku, Novartis, Ocera, Omass, Otsuka, Parexel, PDL, Periconsulting, Pharmacosmos, Philip Morris Institute, Pfizer, Procter & Gamble, Prometheus, Protagonist, Provention, Robarts Clinical Trial, Sandoz, Schering-Plough, Second Genome, Seres Therapeutics, Setpointmedical, Sigmoid, Sublimity, Takeda, Therakos, Theravance, Tigenix, UCB, Vifor, Zealand, Zyngenia, and 4SC, Advisory board member for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, DSM, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Sandoz, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zealand, Zyngenia, and 4SC, P. Moayyedi: None Declared, S. Yusuf: None Declared

A comprehensive photovoltaic study on tungsten disulfide (WS2) buffer layer based CdTe solar cell

Transition metal di-chalcogenides (TMCDs)-Tungsten disulfide (WS₂) exhibit excellent optoelectronic properties such as suitable bandgap, high absorption coefficient, good conductivity, high carrier mobility, etc. to be used as a photovoltaic material for thin-film solar cells. In the present work, we have replaced the traditional buffer CdS and ITO/ZnO window layer in CdTe solar cells with the non-toxic, earth-abundant WS₂ buffer and SnO₂ window layer, respectively. The SCAPS-1D solar simulator is used to investigate the potentiality of WS₂ as buffer material in CdTe solar cells. This numerical study provides a comparison of the performances between the proposed structure: SnO₂/WS₂/CdTe/Au and the baseline structure: ITO/ZnO/CdS/CdTe/Au. The impacts of the charge carrier generation rate, spectral response, current-voltage characteristics, bulk defect density, defect density at buffer/absorber interface, operating temperature, and capacitance-voltage characteristics on the solar cell performance parameters have also been analyzed. The tolerance level of defect density in WS₂ bulk and WS₂/CdTe interface are found to be 10¹⁷ cm^-3 and 10¹² cm^-3, respectively. The temperature study reveals the poor structural robustness and thermal stability of the proposed cell. The conversion efficiency of the proposed cell has found to be 20.55% at the optimized device structure. Nevertheles, these findings may provide an insight to fabricate viable, environment friendly, and inexpensive CdTe thin-film solar cells.

Reduced IFN-γ levels along with changes in hematologic and immunologic parameters are key to COVID-19 severity in Bangladeshi patients

The manifestation of coronavirus disease 2019 (COVID-19) severity and mortality has been associated with dysregulation of the immune response, often influenced by racial disparities and conferred by changes in hematologic and immunologic parameters. These biological and hematologic parameters as well as cytokine profiles were investigated in a cohort of 61 COVID-19-positive patients (categorized into mild, moderate, and severe groups) from Bangladesh using standard analytical methods. The data reported that the interleukin (IL)-4 and IL-6 levels were significantly increased, whereas the levels of interferon (IFN)-γ were significantly reduced in patients with severe COVID-19 (p < 0.05) compared with those in patients with mild and/or moderate COVID-19. The extent of erythrocyte sedimentation rate (ESR); neutrophil count; and levels of ferritin, C-reactive protein (CRP), and D-dimer (p < 0.05) were found to be significantly increased, whereas the white blood cell (WBC), lymphocyte, eosinophil, and platelet counts (p < 0.05) were observed to be significantly reduced in patients with severe COVID-19 compared with those in the patients in other 2 groups. Our study exhibited a significantly higher IL-6-to-lymphocyte ratio in patients with severe COVID-19 than in those with mild and moderate COVID-19. The calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and ferritin-to-ESR ratio were significantly increased in patients with severe COVID-19. The increase in the IL-4 and IL-6 levels along with CRP and D-dimer levels may envisage a hyperinflammatory environment and immune dysregulation, which contribute to prolonged viral persistence, leading to severe disease. However, the reduced level of IFN-γ can be attributed to a less fatality toll in Bangladesh compared with that in the rest of the world.

Association between body mass index (BMI) and severity of coronary artery disease in young onset acute coronary syndrome (ACS)

Funding Acknowledgements

Type of funding sources: None.

Background

A high body mass index (BMI) is seems to be associated with an increased incidence of coronary artery disease. If the affected person is young, the consequences are more tragic. There are variable information on the relation of incidence and severity of coronary artery disease in high BMI populations. We have examined the association between BMI and severity of coronary artery disease in young onset Acute Coronary Syndrome (ACS).

Methods

In this prospective observational study a total number of 150 patients, aged ≤45 years presented with acute coronary syndrome were enrolled to analyze association between Body Mass Index (BMI) and severity of coronary artery disease.

Results

The mean BMI in male was 24.6±3.6 and the mean BMI in female was 25.4±3.3. Among the 150 patients, 2(1.3%) was underweight, 78(52%) was normal, 60(40%) was overweight & 10(6.7%) was obese. All underweighted patients were diagnosed as STEMI. Among the normal BMI patients, 18(23.1%) had UA, 12(15.4%) had NSTEMI & 48 (61.5%) had STEMI. Among the overweight patients, 23(38.3%) had UA, 9(15%) had NSTEMI & 28(46.7%) had STEMI. And among the obese patients, 4(40%) had UA, 1 (10%) had NSTEMI & 5(50%) had STEMI. Considering involving coronary artery, left main coronary artery involvement was 0(0%), 6 (7.7%), 5 (8.3%) & 0(0%) in underweight, normal, overweight & obese patients respectively. Left anterior descending coronary artery involvement was 2(100%), 54 (69%), 45 (75%) & 7 (70%) in underweight, normal, overweight & obese patients respectively. Left circumflex coronary artery involvement was 1(50%), 33 (42%), 25 (41.7%) & 1 (9%) in underweight, normal, overweight & obese patients respectively. And right coronary artery involvement was 1(50%), 35 (44.9%), 31 (51.7%) & 5 (50%) in underweight, normal, overweight & obese patients respectively. In underweight patients 1(50%) had SVD and 1 (50%) had TVD. In normal BMI patients 40 (51.3%) had SVD, 11(14.1%) had DVD and 19 (24.4%) had TVD. In overweight patients 27 (45%) had SVD, 15 (25%) had DVD and 13 (21.7%) had TVD. And in obese patients 5 (50%) had SVD, 3(30%) had DVD and 0 (0%) had TVD. In all BMI group SVD was more common.

Conclusion

There is no statistically significant differences in severity of coronary artery in respect to body mass index (BMI), in patients presented with acute coronary syndrome.

Assessment of maternal dietary patterns and their relationship with c-reactive protein in pregnancy

Background

Inflammation during pregnancy including elevated C-reactive protein (CRP) is associated with adverse pregnancy outcomes. Understanding relationships between CRP and modifiable factors such as dietary patterns is key to identifying opportunities for pregnancy intervention. This study assessed change in adherence to the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diet (MED-diet) from early to late-pregnancy and the relationship between adherence to both dietary patterns at early-pregnancy with plasma CRP at early and late-pregnancy.

Methods

Women (n = 215) attending antenatal clinics at Monash Health, Melbourne were recruited at 10-20 weeks gestation. Medical history and blood samples were collected at 5 antenatal visits. Adapted DASH and MED-diet scores were calculated from Food Frequency Questionnaires completed at early ([mean±SD] 15±3 weeks) and late (36±1 week) pregnancy. CRP was measured in maternal plasma samples collected at early and late-pregnancy. Adjusted linear regression assessed associations of early-pregnancy DASH and MED-diet scores with early and late-pregnancy plasma CRP.

Results

DASH score at early (23.5±4.8) and late (23.5±5.2) pregnancy was not significantly different (p = 0.971). There was no statistically significant change in MED-diet score from early (3.99±1.6) to late-pregnancy (4.08±1.8) (p = 0.408), however, MED-diet adherence and plasma CRP at early pregnancy were significantly and inversely associated (β= -0.14 [95%CI= -0.27, -0.01], p = 0.039).

Conclusions

Adherence to the MED-diet in early pregnancy may be beneficial in reducing inflammatory markers and assisting optimal pregnancy outcomes. Assessment of dietary patterns is important to assist identifying modifiable factors which impact maternal and child health.

Key messages

Barriers for using amoxycillin dispersible tablet in pediatric pneumonia treatment in Bangladesh

 

World Health Organization recommends guideline for integrated management of childhood illnesses (IMCI) where Amoxicillin Dispersible Tablet (DT) appears as the first drug of choice for treating childhood pneumonia. The Government of Bangladesh adopted the IMCI strategy in 1998, and scaled it up nationwide by 2014. But, even today, the use of Amoxicillin DT, either in public or private sector, for managing childhood pneumonia is a rare event in Bangladesh. We conducted this exploratory study to understand the existing barriers, both in public and private sector, those have influences on reduced availability of Amoxicillin DT and non-compliance of health service providers to follow IMCI guideline by using Amoxicillin DT for treating a child with pneumonia, in Bangladesh. We conducted desk review of relevant strategy and policy documents, key informant interviews with 19 key individuals from Ministry of Health and national / international NGOs. Collected information were analyzed and interpreted using thematic analysis method. Identified barriers through this study pointed to inadequate policy level focus on IMCI implementation, non-inclusion of Amoxicillin DT in the national essential drug list, single source of Amoxicillin DT producing pharmaceutical in the country coupled with bureaucracy and procurement procedural complexity, lack of training of health service providers and abundant availability of antibiotic over the counter. Study respondents recommended for policy level strengthening of IMCI program, increasing coverage of training for health care provider, including practicing pediatricians both at public and private sectors, facilitating production and procurement procedures and prohibiting antibiotic sell over the counter.

Key messages

• Facilitation of production and procurement procedure coupled with enforcement of law prohibiting antibiotics availability over the counter are urgent needs.

• Policy level support emphasizing full compliance of service providers for quality of implementation of IMCI program in Bangladesh (and similar other settings) is also important.

Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary revascularization following acute coronary syndrome

Background

Many patients require arterial revascularization after an index ACS. Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a).

Objectives

We determined whether the risk of first coronary or any (coronary, peripheral artery or carotid) revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo.

Methods

The ODYSSEY OUTCOMES trial (NCT01663402) compared alirocumab with placebo in 18,924 patients with ACS and elevated atherogenic lipoproteins despite optimized statin treatment. Treatment effects were summarized by competing-risks proportional hazard models.

Results

A total of 1559 (8.2%) patients had coronary, 204 (1.1%) peripheral artery, and 40 (0.2%) carotid revascularization after randomization. Alirocumab reduced first coronary revascularization (9.6% vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR 0.85, 95% CI 0.78–0.94; p=0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm (ptrend &lt;0.0001) and inversely related to treatment HRs (ptrend &lt;0.001). The greatest benefits of alirocumab on coronary or any revascularization were observed in patients with baseline lipoprotein(a) in the top quartile (≥59.6 mg/dL) (figures).

Conclusions

Alirocumab reduced revascularization after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): SanofiRegeneron Pharmaceuticals

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children

Meningitis literally means inflammation of the meninges. It is mostly caused by bacteria, virus, fungus and protozoa and pyogenic meningitis constitutes a serious neurological disorder associated with significant morbidity and mortality in developing countries. This study was carried out to evaluate the clinical presentation and immediate outcome of pyogenic meningitis in children. This was a prospective observational study and conducted at department of Paeditrics in Cumilla Medical College Hospital, Cumilla, Bangladesh from July 2014 to June 2015. Total 50 children were diagnosed as pyogenic meningitis fulfilling the inclusion criteria was included in this study. Cases were enrolled purposively. Immediately after admission through history and clinical examination, complete blood count, random blood sugar, Cerebrospinal fluid (CSF) examination and blood culture was done in all patients. For statistical analysis chi-square test was done and significance of analysis was made when p value <0.05. This study includes patients aged between 2 months to 12 years and male female ratio was 1.5:1. Several risk factors like male sex (60.0%), age below one year (42.0%), Protein energy malnutrition (PEM) (30.0%), not exclusively breastfed (44.0%) were identified. Common presenting complaints were fever (100.0%), convulsion (96.0%), altered consciousness (42.0%) and vomiting (38.0%). Common physical signs were neck rigidity (56.0%), Kernig's sign (26.0%) and bulged fontanelle (34.0%). CSF was hazy in 54.0%, clear in 38.0% and turbid in 08.0% cases, CSF protein was more than 100mg/dl in 90.0% of the cases and glucose was less than 40mg/dl in most of the cases (94.0%). Streptococcus Pneumoniae (49.0%) followed by Neisseria Meningitidis (38.0%) were the two most commonly isolated organism responsible for pyogenic meningitis. Mortality rate during hospital stay was 18.0% and complications developed in 18.0% of cases. To avoid maltreatment in our resource limited setting due to failure of identifying organism, this study might help to administer appropriate antibiotics against organism and to reduce morbidity and mortality in meningitis. This study revealed less mortality rate in our country than neighbors and severe malnutrition important risk factors for the burden of pyogenic meningitis. It requires large scale multicentre studies to establish the whole scenario of Bangladesh.

Correlation between Antero-posterior Diameter and Vertical Diameter of Both Ends of Fully Ossified Dry Human Clavicle

Clavicle is an upper limb locomotory bone which helps in formation of pectoral girdle and connected the upper limb with axial skeleton. There is no baseline data of clavicle in contrast to demographic variation in our country, so the study was designed to obtain baseline data on clavicle for anthropological, forensic and clinical use. This descriptive cross-sectional study was done among 150 (65 right and 85 left) fully ossified dry human clavicle in Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. Sample was collected by the help of nonrandom purposive sampling technique from Department of Anatomy of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. The parameters were the antero-posterior diameter and vertical diameter of sternal and acromial ends of clavicle, measured with the help of digital vernier slide caliper and expressed in millimeter. In the current study the mean±SD antero-posterior diameter of sternal end of 65 clavicles of right side was 21.97±2.889mm and 85 clavicles of left side were 20.30±3.459mm. The mean±SD antero-posterior diameter of acromial end of 65 right sided clavicles was 21.96±5.161mm and 85 clavicles of left side were 21.00±4.002mm. Correlation was done in between antero-posterior diameter and vertical diameter of sternal end of clavicle and the differences were highly significant on both sides. Similarly, when correlation was done for the acromial end of clavicle the difference was found non-significant on right side and highly significant on left side.

Comparative Study between Acacia Nilotica versus Povidone Iodine in Topical Treatment of Omphalocele Major

Well established and common practice in conservative management of omphalocele major is escharotics therapy with different topical agents. Among them mercurochrome, alcohol, silver salts, povidone iodine, acacia nilotca paste are commonly used. It is a comparative study between application of acacia nilotica paste and povidone iodine solution as a primary non surgical treatment of omphalocele major regarding efficacy and safety of these two topical agents. A double blind randomized controlled study was conducted at the department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2019. In this study 20 cases of omphalocele major and randomly divided into two equal groups. Group A and Group B treated with acacia nilotica paste and povidone iodine solution respectively. Gastroschisis, ruptured-omphalocele major or omphalocele minor excluded in this study. The size of the fascial defect in cm, time required for full oral feeding tolerance and duration of hospital stay were evaluating parameters. Patients with Group A tolerated full oral feeding earlier, shorter total hospital stay duration and low mortality rate than those from Group B. Application of acacia nilotica is a safe and effective treatment of omphalocele major regarding rapid full oral feeding tolerance, shorter hospital stay and low mortality rate.

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Heavy metal pollution through hand loom-dyeing effluents and its effect on the community health

Kumarkhali upazila in Kushtia district of western Bangladesh has become especially vulnerable to dye-effluent pollution over the last two decades. Twenty dyeing effluent samples were obtained at random from various dyeing units and used to determine the heavy metal concentration. The effluent pH, electrical conductivity and total dissolved solids ranged from 3.69 to 13.68, 627 to 7160 mS cm^-1 and 4140 to 19800 mg L^-1, respectively. In dyeing effluents, the average concentrations of Zn, Cu, Pb, Mn, Fe and Cr ions were 5.50, 82.75, 6.80, 14.27, 66.03 and 65.28 μg mL^-1, respectively, while the amount of Cd was barely detectable. Total annual discharges of Cu, Zn, Pb, Mn, Fe and Cr were found to be 21.52, 1.43, 1.77, 3.71, 17.12 and 16.98 kg year^-1, respectively, which were high enough to pollute the local environment. According to the survey report, only a minority were aware of public safety measures and proper disposal procedures, though many respondents were conscious of the dangers associated with dyes and chemical substances. Most interviewees (58.33%) used synthetic dyes and other dangerous chemicals throughout the dyeing process, despite the fact that 43.33% did not use hand gloves. A remarkable 80% of respondents were improperly disposing of unused dyes and chemicals. Overall, there was a lack of awareness, right attitude and appropriate behavioural patterns about using dyeing chemicals. To prevent the negative effects of dyeing effluents on the community in the research area, environmental conservation rules should be appropriately implemented.

Sero-prevalence and risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 infection in women and children in a rural district of Bangladesh: A cohort study

Background

Bangladesh reported its first COVID-19 case on March 8, 2020. Despite lockdowns and promoting behavioural interventions, as of December 31, 2021, Bangladesh reported 1.5 million confirmed cases and 27 904 COVID-19-related deaths. To understand the course of the pandemic and identify risk factors for SARs-Cov-2 infection, we conducted a cohort study from November 2020 to December 2021 in rural Bangladesh.

Methods

After obtaining informed consent and collecting baseline data on COVID-19 knowledge, comorbidities, socioeconomic status, and lifestyle, we collected data on COVID-like illness and care-seeking weekly for 54 weeks for women (n = 2683) and their children (n = 2433). Between March and July 2021, we tested all participants for SARS-CoV-2 antibodies using ROCHE's Elecsys® test kit. We calculated seropositivity rates and 95% confidence intervals (95% CI) separately for women and children. In addition, we calculated unadjusted and adjusted relative risk (RR) and 95% CI of seropositivity for different age and risk groups using log-binomial regression models.

Results

Overall, about one-third of women (35.8%, 95% CI = 33.7-37.9) and one-fifth of children (21.3%, 95% CI = 19.2-23.6) were seropositive for SARS-CoV-2 antibodies. The seroprevalence rate doubled for women and tripled for children between March 2021 and July 2021. Compared to women and children with the highest household wealth (HHW) tertile, both women and children from poorer households had a lower risk of infection (RR, 95% CI for lowest HHW tertile women (0.83 (0.71-0.97)) and children (0.75 (0.57-0.98)). Most infections were asymptomatic or mild. In addition, the risk of infection among women was higher if she reported chewing tobacco (RR = 1.19,95% CI = 1.03-1.38) and if her husband had an occupation requiring him to work indoors (RR = 1.16,  95% CI = 1.02-1.32). The risk of infection was higher among children if paternal education was >5 years (RR = 1.37, 95% CI = 1.10-1.71) than in children with a paternal education of ≤5 years.

Conclusions

We provided prospectively collected population-based data, which could contribute to designing feasible strategies against COVID-19 tailored to high-risk groups. The most feasible strategy may be promoting preventive care practices; however, collecting data on reported practices is inadequate. More in-depth understanding of the factors related to adoption and adherence to the practices is essential.

First Cardiac Magnetic Resonance Experience in Bangladesh: A Case of Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive degeneration and replacement of the right ventricular (RV) myocardial tissue by fat and fibrosis and produce clinical condition. Desmosome gene mutations are only the causative state for ARVD hereditary disorder. The arrhythmogenic right ventricular cardiomyopathy incidence is about 1/1000-5000. Mostly young people and athletes are bearing the clinical presentations include presyncope, syncope, ventricular tachycardias or ventricular fibrillation leading to cardiac arrest. We report about the first case of Cardiac magnetic resonance (CMR) imaging to diagnose a case Arrhythmogenic right ventricular dysplasia (ARVD) of a 34-year-old male from Savar, Dhaka, Bangladesh who was referred to cardiac emergency for the evaluation recurrent dizzy spells.

Structure and dynamics of membrane protein in SARS-CoV-2

SARS-CoV-2 membrane (M) protein performs a variety of critical functions in virus infection cycle. However, the expression and purification of membrane protein structure is difficult despite tremendous progress. In this study, the 3 D structure is modeled followed by intensive validation and molecular dynamics simulation. The lack of suitable homologous templates (>30% sequence identities) leads us to construct the membrane protein models using template-free modeling (de novo or ab initio) approach with Robetta and trRosetta servers. Comparing with other model structures, it is evident that trRosetta (TM-score: 0.64; TM region RMSD: 2 Å) can provide the best model than Robetta (TM-score: 0.61; TM region RMSD: 3.3 Å) and I-TASSER (TM-score: 0.45; TM region RMSD: 6.5 Å). 100 ns molecular dynamics simulations are performed on the model structures by incorporating membrane environment. Moreover, secondary structure elements and principal component analysis (PCA) have also been performed on MD simulation data. Finally, trRosetta model is utilized for interpretation and visualization of interacting residues during protein-protein interactions. The common interacting residues including Phe103, Arg107, Met109, Trp110, Arg131, and Glu135 in the C-terminal domain of M protein are identified in membrane-spike and membrane-nucleocapsid protein complexes. The active site residues are also predicted for potential drug and peptide binding. Overall, this study might be helpful to design drugs and peptides against the modeled membrane protein of SARS-CoV-2 to accelerate further investigation. Communicated by Ramaswamy H. Sarma.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Patient factors associated with the offering of telehealth appointments from primary care physicians among Medicare Beneficiaries: Results from a national survey

INTRODUCTION

This study assessed patient factors associated with self-reported telehealth offerings from their primary care physicians (PCPs) among Medicare beneficiaries during the COVID-19 pandemic, and compared potential telehealth accessibility of telehealth appointments from PCP by US census region before and during the COVID-19 pandemic.

METHODS

Data were from the Medicare Current Beneficiary Survey (MCBS) 2021 Winter COVID-19 Supplement. We conducted a multivariable logistic regression to examine patient-level factors associated with telehealth offerings.

RESULTS

Overall, 78% Medicare beneficiaries reported that they had access to telehealth appointments from their PCPs during the COVID-19 pandemic. Majority beneficiary respondents reported to have Internet access (82.1%) and own at least one type of computer device (81.5%). Respondents with Internet access (Adjusted Odds Ratio (AOR) = 1.66, 95% Confidence Interval (CI): 1.38, 2.00; p < 0.0001) and owning a device (AOR = 1.43, 95 %CI: 1.19, 1.72; p < 0.0001) were more likely to report PCP telehealth offerings controlling for patient characteristic variables in the model. Respondents who were female (AOR = 1.16, 95 %CI: 1.02, 1.31; p = 0.020), age group of 65-74 years (AOR = 1.29, 95 %CI: 1.07, 1.56; p = 0.008), income ≥$25,000 (AOR = 1.36, 95 %CI: 1.18 1.56; p < 0.0001), metropolitan residence (AOR = 1.96, 95 %CI: 1.72, 2.24; p < 0.0001), and with a history of weakened immune system (AOR = 1.46, 95 %CI: 1.18, 1.80; p < 0.0001) or diabetes (AOR = 1.20, 95 %CI: 1.06, 1.37; p = 0.005) were more likely to report PCP telehealth offerings compared to their counterparts. Non-Hispanic Black (AOR = 0.70, 95 %CI: 0.58, 0.85; p < 0.0001) (compared to Non-Hispanic-White) and beneficiaries living in the South (compared to those living in the Northwest, Midwest, and West) were less likely to report PCP telehealth offerings.

DISCUSSION

Key findings suggested health disparities existed in telehealth offerings from PCPs in terms of Internet access, device owning, age, race/ethnicity, income, residential locations, and census regions. Policy makers should consider these health disparities and provide targeted incentives and/or interventions when expanding and encouraging utilization of telehealth among Medicare beneficiaries.

Detection of SARS-CoV-2 RNA by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) on Self-Collected Nasal Swab Compared With Professionally Collected Nasopharyngeal Swab

Background: Self-collection of nasal swabs for the detection of SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) would considerably increase the testing capability and decrease the risk of transmission among healthcare workers (HCW) and the use of personal protective equipment (PPE).

Objectives: This study aimed to evaluate the performance of self-collected nasal swabs compared with professionally collected nasopharyngeal (NP) swabs for detection of SARS-CoV-2 RNA by RT-PCR.

Materials and methods: We performed a cross-sectional study where the suspected cases of coronavirus disease 2019 (COVID-19) were instructed about the self-collection of nasal swabs from their mid-turbinate. The results were compared to a nasopharyngeal swab collected by a trained healthcare worker in the same patient at the same sitting.

Results: We enrolled 100 participants, of which, 69 (69%) were male and 31 (31%) were female. The median age of the study participant was 36 years. Of the participants, 58 (58%) were symptomatic, and the commonest clinical presentation was cough, which was present in 42 (42%) participants. Out of 100 samples, 31 (31%) professionally collected nasopharyngeal swabs and 28 (28%) self-collected nasal swabs were positive for SARS-CoV-2 by RT-PCR. Out of 31 professionally collected positive samples, three samples were negative in self-collection. Out of 28 self-collected positive samples, no sample was negative in the professional collection. The sensitivity and specificity of self-collected nasal swabs compared to professionally collected nasopharyngeal swabs were 90.32% and 100.00%, respectively. The sensitivity of self-collected nasal was 100% when the cycle threshold (Ct) value of the professionally collected NP swab was less than 30.

Conclusion: Our study showed that self-collected nasal swabs' sensitivities were similar to professionally collected NP swabs with a high viral load (low Ct value). Hence, this method could be used when the patient is symptomatic and come to the health providers in the early stage of COVID-19 illness.

Perinatal and long-term outcome of fetal intracranial hemorrhage: systematic review and meta-analysis

OBJECTIVE

Fetal intracranial hemorrhage (ICH) is associated with an increased risk of perinatal mortality and morbidity. Healthcare professionals often find it challenging to counsel parents due to its rarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcome of fetuses with ICH.

METHODS

MEDLINE, EMBASE, ClinicalTrials.gov and The Cochrane Library databases were searched. Inclusion criteria were studies reporting the outcome of fetuses, newborns and infants diagnosed with ICH. The primary outcome was perinatal death (PND), defined as the sum of intrauterine (IUD) and neonatal death (NND). The secondary outcomes were stillbirth, NND, IUD, termination of pregnancy, need for surgery/shunting at birth, cerebral palsy (defined according to the European Cerebral Palsy Network and classified as diplegia, hemiplegia, quadriplegia, dyskinetic or mixed), neurodevelopmental delay and intact survival. All outcomes were explored in the included fetuses with ICH. A subgroup analysis according to the location of the hemorrhage (intra-axial and extra-axial) was also planned. Meta-analysis of proportions was used to combine data, and pooled proportions and their 95% CI were reported.

RESULTS

Sixteen studies (193 fetuses) were included in the meta-analysis. PND occurred in 14.6% (95% CI, 7.3-24.0%) of fetuses with ICH. Among liveborn cases, 27.6% (95% CI, 12.5-45.9%) required shunt placement or surgery after birth and 32.0% (95% CI, 22.2-42.6%) had cerebral palsy. Furthermore, 16.7% (95% CI, 8.4-27.2%) of cases had mild neurodevelopmental delay, while 31.1% (95% CI, 19.0-44.7%) experienced severe adverse neurodevelopmental outcome. Normal neurodevelopmental outcome was reported in 53.6% of fetuses. Subgroup analysis according to the location of ICH showed that PND occurred in 13.3% (95% CI, 5.7-23.4%) of fetuses with intra-axial bleeding and 26.7% (95% CI, 5.3-56.8%) of those with extra-axial bleeding. In fetuses with intra-axial hemorrhage, 25.2% (95% CI, 11.0-42.9%) required shunt placement or surgery after birth and 25.5% (95% CI, 15.3-37.2%) experienced cerebral palsy. In fetuses with intra-axial hemorrhage, mild and severe neurodevelopmental delay was observed in 14.9% (95% CI, 12.0-27.0%) and 32.8% (95% CI, 19.8-47.4%) of cases, respectively, while 53.2% (95% CI, 37.0-69.1%) experienced normal neurodevelopmental outcome. The incidence of mortality and postnatal neurodevelopmental outcome in fetuses with extra-axial hemorrhage could not be estimated reliably due to the small number of cases.

CONCLUSIONS

Fetuses with a prenatal diagnosis of ICH are at high risk of perinatal mortality and adverse neurodevelopmental outcome. Postnatal shunt placement or surgery was required in 28% of cases and cerebral palsy was diagnosed in approximately one-third of infants. Due to the rarity of ICH, multicenter prospective registries are warranted to collect high-quality data. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Assessment of hygienic and sanitation practices among poultry butchers in selected Municipality areas of Assam (India)

A study was conducted in Dhubri and Biswanath Chariali Municipality areas to assess the adoption of hygienic and sanitation practices being followed by poultry butchers. A total of 60 poultry butchers were selected randomly, 30 from each Municipality area so that the final sample consisted of 60 poultry butchers. Data were collected using a pre-tested structured interview schedule by personal interviews. The schedule was designed to collect information on the socioeconomic profile of the butchers, personal and meat shop hygiene, maintenance of meat shop and its equipment. The data revealed that all the poultry butchers were male among which (75%) of them had an education level only up to eight standard. The overall mean age of the poultry butchers was found to be 39.95±8.64 years of which majority (75%) of them belong to middle age group. The present study indicated that none of the poultry butchers underwent any formal training for hygienic meat handling. It was also pointed out that most (85%) of the butcheries were located at market area, while only a few (15%) were found in the residential area. Only 18.33 per cent of the poultry butchers wore clean clothes while 81.67 per cent of them did not adopt this practice during working. Majority (88.33%) of them did not wash their hands after smoking/ chewing tobacco.It was also revealed that majority (88.33%) of the butchers did not clean knives before and after cutting of meat. Majority of the butchers agreed that cleanliness of equipment (71.67%), the meat shop and its surrounding (68.33%) and personal hygiene (68.33%) were some of the important factors that were essential to ensure wholesome meat production. From the above study, it may be concluded that appropriate interventional measures by the concerned agencies such as awareness trainings for poultry butchers on crucial areas of food safety, hygienic practices relating to meat handling and personal safety are imperative. The results of the study also shed light on the need for measures to improve the infrastructural facilities in poultry meat butcheries and for appropriate interventions to strengthen the food quality control system by the government regulatory authorities.

Efficacy and Safety of the Awake Prone Positioning in Patients with COVID-19 Related Respiratory Distress: A Scoping Review

Prone positioning (PP) is becoming an important treatment modality for the management of COVID-19 related respiratory distress syndrome. The aim of this scoping review was to evaluate effectiveness and safety of awake PP in non-intubated patients with COVID-19 related acute respiratory distress at different care settings. The study was conducted during December 1, 2019 to August 30, 2020 using health science electronic databases and grey literature. A PRISMA flow diagram was used and finally 06 studies with 187 patients were included for review. Male patients were predominating with the mean age of approximately 55 years. Oxygenation was improved in 79.14% patients. One hundred fifty seven (83.95%) patients with COVID-19-related hypoxemic respiratory distress tolerated the procedure. Intubations required 25.41% of the patients or mechanical ventilation and 6(3.2%) patients expired. Number of patients in the reported studies could tolerate more than 3 hours of PP without a major side effect. Awake proning improved oxygenation of the patients suffering from COVID-19 related respiratory hypoxia in different care settings. Early instituted prone positioning may be an effective alternative method of treating COVID-19 related respiratory distress. Patient compliance and small size cohort studies are the limitations of this review. Multicenter controlled studies are warranted before conclusions are made about safety and the settings.

Totally Implantable Oxygen Generator (TIOG) for Hypoxia and Hypoxemia

Hypoxia and hypoxemia are the conditions when oxygen is depleted from the cell due to, for example, respiratory failure, cancer, etc. While the current therapy brought reasonable clinical outcomes, its systematic nature of oxygen delivery can be compromised by a significant dropout and side effects. This paper presents a totally implantable oxygen generator (TIOG) for localized, highly controllable, real-time, and targeted oxygen delivery.

METHODS

The TIOG system, an ultra-low power implantable wireless platform, is built using off-the-shelf components. The TIOG can be remotely operated to enable a tailored oxygen delivery based on electrolysis with a precisely controlled electrical signal (i.e., current level, frequency, and duty cycle).

RESULTS

The in vitro experiments demonstrate that the TIOG could deliver oxygen with a rate of 9.27 ± 1.9 µmol/L/min with the pulsed electrical current (800 µA, 600 µs pulse or 6% duty cycle with 10 ms period). The system could also suppress chlorine generation under the safety guideline (5 mg/L). Operating at 433 MHz ISM band, the TIOG could be wirelessly controlled from up to 600 cm distance with a 0%-bit error rate (BER) and 0%-packet error rate (PER). A single charge of the battery could operate the system for up to 3.3 hr, which can be wirelessly recharged for long-term operation.

CONCLUSION

The longevity of the TIOG system enables ambulatory oxygen therapy in a much longer-term than current practice.

Repurposing fusion inhibitor peptide against SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving. Although several vaccines were approved, this pandemic is still a major threat to public life. Till date, no established therapies are available against SARS-CoV-2. Peptide inhibitors hold great promise for this viral pathogen due to their efficacy, safety, and specificity. In this study, seventeen antiviral peptides which were known to inhibit SARS-CoV-1 are collected and computationally screened against heptad repeat 1 (HR1) of the SARS-CoV-2 spike protein (S2). Out of 17 peptides, Fp13 and Fp14 showed better binding affinity toward HR1 compared to a control peptide EK1 (a modified pan-coronavirus fusion inhibitor) in molecular docking. To explore the time-dependent interactions of the fusion peptide with HR1, molecular dynamics simulation was performed incorporating lipid membrane. During 100 ns MD simulation, structural and energy parameters of Fp13-HR1 and Fp14-HR1 complexes demonstrated lower fluctuations compared to the control EK1-HR1 complex. Furthermore, principal component analysis and free energy landscape study revealed that these two peptides (Fp13 and Fp14) strongly bind to the HR1 with higher affinity than that of control EK1. Tyr917, Asn919, Gln926, lys933, and Gln949 residues in HR1 protein were found to be crucial residues for peptide interaction. Notably, Fp13, Fp14 showed reasonably better binding free energy and hydrogen bond contribution than that of EK1. Taken together, Fp13 and Fp14 peptides may be highly specific for HR1 which can potentially prevent the formation of the fusion core and could be further developed as therapeutics for treatment or prophylaxis of SARS-CoV-2 infection.

The Association Between Socioeconomic Status, Sex, Race / Ethnicity and In-Hospital Mortality Among Patients Hospitalized for Heart Failure

BACKGROUND

The association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated.

METHODS AND RESULTS

We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00-1.05) and male sex (RR 1.09, 95% CI 1.07-1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76-0.81) and Hispanic (RR 0.90, 95% CI 0.86-0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization.

CONCLUSIONS

SES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.