Human cytomegalovirus modulates mTORC1 to redirect mRNA translation within quiescently infected monocytes

Human cytomegalovirus (HCMV) utilizes peripheral blood monocytes as a means to systemically disseminate throughout the host. Following viral entry, HCMV stimulates non-canonical Akt signaling leading to the activation of mTORC1 and the subsequent translation of select antiapoptotic proteins within infected monocytes. However, the full extent to which the HCMV-initiated Akt/mTORC1 signaling axis reshapes the monocyte translatome is unclear. We found HCMV entry alone was able to stimulate widescale changes to mRNA translation levels and that inhibition of mTOR, a component of mTORC1, dramatically attenuated HCMV-induced protein synthesis. Although monocytes treated with normal myeloid growth factors also exhibited increased levels of translation, mTOR inhibition had no effect, suggesting HCMV activation of mTOR stimulates the acquisition of a unique translatome within infected monocytes. Indeed, polyribosomal profiling of HCMV-infected monocytes identified distinct prosurvival transcripts that were preferentially loaded with ribosomes when compared to growth factor-treated cells. Sirtuin 1 (SIRT1), a deacetylase that exerts prosurvival effects through regulation of the PI3K/Akt pathway, was found to be highly enriched following HCMV infection in an mTOR-dependent manner. Importantly, SIRT1 inhibition led to the death of HCMV-infected monocytes while having minimal effect on uninfected cells. SIRT1 also supported a positive feedback loop to sustain Akt/mTORC1 signaling following viral entry. Taken together, HCMV profoundly reshapes mRNA translation in an mTOR-dependent manner to enhance the synthesis of select factors necessary for the survival of infected monocytes.IMPORTANCEHuman cytomegalovirus (HCMV) infection is a significant cause of morbidity and mortality among the immunonaïve and immunocompromised. Peripheral blood monocytes are a major cell type responsible for disseminating the virus from the initial site of infection. In order for monocytes to mediate viral spread within the host, HCMV must subvert the naturally short lifespan of these cells. In this study, we performed polysomal profiling analysis, which demonstrated HCMV to globally redirect mRNA translation toward the synthesis of cellular prosurvival factors within infected monocytes. Specifically, HCMV entry into monocytes induced the translation of cellular SIRT1 to generate an antiapoptotic state. Defining the precise mechanisms through which HCMV stimulates survival will provide insight into novel anti-HCMV drugs able to target infected monocytes.

Penile Color Doppler Ultrasonography in Patients with Type 2 Diabetes Mellitus Presenting with Erectile Dysfunction: A Single-Center Experience from Bangladesh

Erectile dysfunction (ED) is common in type 2 diabetes mellitus (T2DM). ED is considered the earliest marker of widespread endothelial dysfunction. Color Doppler ultrasonography (CDUS) of the penis is a valuable tool in identifying vasculogenic ED and may predict coronary vascular disease. In Bangladesh, no study has evaluated CDUS of the penis in such patients. This study assessed the penile CDUS characteristics of adult patients with T2DM having ED. This cross-sectional study was conducted from January to December 2021 at a specialized diabetes hospital in Cumilla, Bangladesh. The baseline velocities of the right and the left cavernosal arteries were measured at the penile base. Arterial insufficiency was defined as a peak systolic velocity (PSV) value <25 cm/s and venous insufficiency was described as an end-diastolic velocity (EDV) >5 cm/s at the end of the examination. Eighty-seven subjects were evaluated; the mean age was 44.2±9.2 years, mean duration of DM was 7.9±2.8 years; of them, 31.0% were smokers, 75.9% obese, 92.0% central obese, 69.0% hypertensive, 96.6% dyslipidemic and 51.7% with low testosterone. The mean HbA1c was 9.3±1.9%; DM was uncontrolled in 89.7% of the study subjects. Penile vasculopathy was found in 21.8% (17.2% had arterial insufficiency, 2.3% had a venous leak, and 2.3% had arterial insufficiency with a venous leak). There were no statistical differences between the two groups, with and without penile vasculopathy, except for diastolic blood pressure, which was higher in the vasculopathy group. CDUS may be incorporated into the tools for evaluating diabetic ED to direct specific management.

Knowledge and Attitude Regarding Human Monkeypox Virus Infection among Nurses: A Cross-Sectional Study

Introduction

Monkeypox (Mpox) is an infectious illness that can spread to humans through infected humans, animals, or contaminated objects. In 2022, the monkeypox virus spread to over 60 countries, raising significant public health concerns. Nurses play a vital role in patient care and have critical responsibilities in managing infected patients and being aware of the potential impact on the general population.

Objective

This study aimed to investigate the knowledge and attitudes (KAs) of Bangladeshi nurses regarding monkeypox infectious disease.

Methods

A cross-sectional study was conducted between October 2022 and March 2023 to evaluate the KA of nurses. Semi-structured and self-administered questionnaires were used, distributed via Google Form, and a convenient sampling technique was implemented. The dataset was analyzed using the Chi-square test, multivariable logistic regression, and Pearson correlation coefficient.

Results

A total of 1047 datasets were included in the final analysis. Overall, 57.97% of the participants demonstrated good knowledge, and 93.12% of the respondents had a positive attitude towards monkeypox disease. Female nurses exhibited better knowledge (adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 0.88-1.98) and a more positive attitude (AOR 1.64; 95% CI 1.12-3.00) than male nurses. Furthermore, a strong correlation was observed between good knowledge of monkeypox disease and a positive attitude (r = 0.76, p < 0.001), while poor knowledge moderately correlated with a negative attitude (r = 0.53, p < 0.001).

Conclusions

Given the need for further improvement in KA, we recommend implementing additional training programs to enhance the abilities and motivation of nurses in effectively managing patients affected by monkeypox.

Assessing climate-induced agricultural vulnerable coastal communities of Bangladesh using machine learning techniques

The agricultural arena in the coastal regions of South-East Asian countries is experiencing the mounting pressures of the adverse effects of climate change. Controlling and predicting climatic factors are difficult and require expensive solutions. The study focuses on identifying issues other than climatic factors using the Livelihood Vulnerability Index (LVI) to measure agricultural vulnerability. Factors such as monthly savings of the farmers, income opportunities, damage to cultivable lands, and water availability had significant impacts on increasing community vulnerability with regards to agricultural practice. The study also identified the need for assessing vulnerability after certain intervals, specifically owing to the dynamic nature of the coastal region where the factors were found to vary among the different study areas. The development of a climate-resilient livelihood vulnerability assessment tool to detect the most significant factors to assess agricultural vulnerability was done using machine learning (ML) techniques. The ML techniques identified nine significant factors out of 21 based on the minimum level of standard deviation (0.03). A practical application of the outcome of the study was the development of a mobile application. Custom REST APIs (application programming interface) were developed on the backend to seamlessly sync the app to a server, thus ensuring the acquisition of future data without much effort and resources. The paper provides a methodology for a unique vulnerability assessment technique using a mobile application, which can be used for the planning and management of resources by different stakeholders in a sustainable way.

Gastrointestinal Manifestations among COVID-19 Patients in Bangladesh: A Cross Sectional Study

This study was done to find out the frequency of gastrointestinal manifestations among adult COVID-19 patients in Bangladesh. This descriptive cross sectional retrospective study was conducted from 27 May till 20 June 2020. Data were collected retrospectively from three different hospitals of Dhaka, Bangladesh. Patients were interviewed over telephone and verbal consents were taken. Their demographic and clinical profiles were put in the questionnaires by the investigators themselves. Statistical analysis was done thereafter. Out of 226 patients diagnosed with COVID-19, 145(61.4%) patients had gastrointestinal symptoms. Five of them had none other than gastrointestinal symptoms. Twenty six patients were asymptomatic. Mean age of the patients with were 41.6±14.8 years. Males were affected almost equally as the females (51.72% vs. 48.27%) (Ratio 1.1:1). Anorexia (44.7%) followed by diarrhoea (35%) and nausea (22.6%) were the predominant symptoms. Patients with co-morbidities (74.7%) were more prone to develop GI symptoms. Family members (71.6%) of COVID-19 patients with GI symptomatic patients were more affected than the others. Hospitalizations (77.6%) were more among GI symptomatic patients than the others. Thirty Five percent (35%) patients had diarrhoea. Mean duration of diarrhoea was 2.7±1.7 days with a frequency of were 4±1.8 days per day. Gastrointestinal manifestations are common among patients with COVID-19. Clinicians need to be aware of the GI features amongst COVID-19 patients so that they can be addressed and treated effectively and immediately. Further large scale study is needed to predict the disease outcome among COVID 19 patients with GI symptoms.

A Haemophilic Dengue Patient with Pleural Effusion and Earache

About 2.5 billion people are living at a higher risk of dengue fever in hundreds of tropical and sub-tropical countries. Treatment of dengue fever is quite complicated and challenging because of the lack of effective treatment approaches. We herein report a rare case of a 25-year-old female with a past medical history of haemophilia A, suffering from dengue fever, pleural effusion, earache, myalgia, headache, and vomiting. Dengue was confirmed by the non-structural protein 1 (NS1) antigen and immunoglobulin M (IgM) antibody test. She had low blood pressure (80/60 mmHg), frequent vomiting, and low platelet count during hospitalization. Moreover, a genetic disorder like haemophilia with plasma leakage and earache made the patient's condition worse. However, by repeated platelet infusion, the platelet counts elevated and the patient was discharged from the hospital after nine days. Complete recovery was achieved after 27 days. This is a rare case of dengue; physicians should be aware of the severity of the disease and its management tactics. More discussion and research need to be carried out to develop an effective and optimized treatment and management options to reduce the mortality and morbidity due to dengue fever with a co-morbid disease.

Miltefosine Induced Reduced Male Fertility Capacity after Treatment of Post Kala-azar Dermal Leishmaniasis, Bangladesh

Post Kala-azar Dermal Leishmaniasis (PKDL) is the sequel of visceral leishmaniasis in Indian subcontinent and may appear among patients with or without previous history of visceral leishmaniasis (VL). The aim of the study is to understand the male reproductive safety profile of miltefosine used for the treatment of Post Kala-azar Dermal Leishmaniasis (PKDL) in Bangladesh. From January 2017 to March 2017, an exploratory study was carried out on male fertility capacity in Bangladesh among male patients above 14 years old with PKDL treated with miltefosine. Twenty nine male patients were included to observe the effect of miltefosine on reproductive health. All PKDL patients had history of visceral leishmaniasis (VL) in different time periods. Among them three (10.3%) patients were unable to ejaculate semen. In semen analysis, 3 patients (10.3%) were found azoospermia (sperm count & motility- 0, viscosity- good, pH- 7 to 8), microscopically there was presence of RBC (5-15/HPF), WBC (8-15/HPF). Another 3 patients (10.3%) were found oligospermia (sperm count- 4.2 to 15.3 million/ml, motility- 20 to 50%, viscosity- good, pH- 6 to 9, RBC- 4 to 15/HPF, WBC- 4 to 15/HPF). The study documented some important findings in evaluating male infertility and selection of drug regimens in treating PKDL patients with miltefosine for 12 weeks.

Antibiotic use for pneumonia among children under-five at a pediatric hospital in Dhaka city, Bangladesh

BACKGROUND

Pneumonia has been the leading cause of morbidity and mortality among children under 5 for more than 3 decades, particularly in low-income countries like Bangladesh. The World Health Organization (WHO) developed a pneumonia case management strategy which included the use of antibiotics for both primary and hospital-based care. This study aims to describe antibiotic usage for treating pneumonia in children in a private pediatric teaching hospital in Dhaka, Bangladesh.

METHODS

We conducted this cross-sectional study among children <5 years old who were admitted to a private pediatric hospital in Dhaka with a diagnosis of pneumonia in November 2012.

RESULTS

We enrolled 80 children during the study period. Among them, 28 (35.4%) were underweight, 14 (17.7%) were moderately underweight, and 13 (16.5%) were severely under-weight. On the basis of WHO classification (2005), 43 children (54%) had severe pneumonia and 37 (46%) had very severe pneumonia, as diagnosed by the research physician. Among the prescribed antibiotics in the hospital, parenteral ceftriaxone was the most common 40 (50%), followed by cefotaxime plus amikacin 14 (17.5%), cefuroxime 7 (8.8%), ceftazidime plus amikacin 6 (7.5%), ceftriaxone plus amikacin 3 (3.8%), meropenem 2 (2.5%), cefepime 2 (2.5%), and cefotaxime 2 (2.5%).

CONCLUSION

Despite the WHO pneumonia treatment strategy, the inappropriate use of higher-generation cephalosporin and carbapenem was high in the study hospital. The results underscore the noncompliance with the WHO guidelines of antibiotic use and the importance of enforcing regulatory policy of the rational use of antibiotics for treating hospitalized children with pneumonia. Following these guidelines may help prevent increased antimicrobial resistance.

Efficacy and Safety of Carbetocin in Comparison to Oxytocin in the Active Management of Third Stage of Labour Following Vaginal Delivery: An Open Label Randomized Control Trial

Objective(S):This study was conducted to evaluate the efficacy and safety of carbetocin in comparison to oxytocin in the active management of third stage of labour following vaginal delivery.Methods:A randomized-controlled trial was conducted in the Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh over a period of nine months from January to September, 2015. Patients who got admitted in ICMH with labour pain were assessed by general examination, abdominal examination and labour status was confirmed by per vaginal examination. On the basis of selection criteria total 94 pregnant women who had undergone vaginal delivery were randomized for two groups of drugs. According to computer generated randomization sequential number was allocated for cases. One group of patients received intravenous 100 micro gram carbetocin and another group of patients received intramuscular 10 IU oxytocin in third stage of labour. Outcome measures such as amount of blood loss in 24 hours, primary PPH, massive blood loss, need of fundal massage, need for additional uterotonic therapy, blood transfusions as well as other adverse effects were all documented.Results: In this study, massive blood loss did not occur in any of patients in carbetocin group. But massive blood loss occurred in 8.5% women of oxytocin group. Further fundal massage, immediate blood transfusion and additional uterotonics were not needed by any patient in carbetocin group. In oxytocin group, fundal massage required in 10.6% of women, blood transfusion was needed for 6.4% patients and additional uterotonics was needed for 10.6% women. Average amount of blood loss were 64 ml less in carbetocin group and adverse effects of drugs were almost similar in both groups. Primary PPH was developed 6.4% in oxytocin group but none of patients developed PPH in carbetocin group.Conclusion: Carbetocin appears to be an effective new drug in the active management of third stage of labour in vaginal delivery. A single dose of 100 microgram IV carbetocin is more effective than oxytocin for maintaining adequate uterine tone, less blood loss and preventing postpartum bleeding in women undergoing vaginal delivery. So, carbetocin can be considered as a good alternative to oxytocin in the active management of third stage of labour in vaginal deliveryBangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 3-9

To evaluate the extent of awareness about hazards of blood transfusion among the blood recipients

This cross-sectional, observational study was carried out among the blood receiving patients conducted in the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University from April 2008 to August 2009, over 126 purposively selected, to evaluate the extent of awareness about hazards of blood transfusion among the blood recipient. In this study 74.1% of male and 73.3% of female respondents had correct knowledge of blood transfusion (p>0.05). In literate group 85(91.4%) had knowledge about blood donation and transfusion compared to 8(8.6%) in illiterate group with significant statistical difference (p=0.001). Different misconception and lack of awareness about safe blood transfusion is present among people receiving blood and blood products. Illiterate persons have significant less level of knowledge about safe blood transfusion. So the number of educational programs on blood-donation should be expanded and transmitted to encourage possible receivers to take blood from nonprofessional volunteer donor and to carry out relevant screening tests before receiving blood products. Furthermore, they should know that all measures besides screening tests are implemented by blood banks to ensure that blood donation is safe for donors and that transfusion of the donated blood is safe for recipients.