An egg intervention improves ponderal but not linear growth among infants 6-12 months of age in rural Bangladesh

BACKGROUND

Animal source foods are rich in multiple nutrients. Regular egg consumption may improve infant growth in low- and middle-income countries.

OBJECTIVE

To assess the impact of daily egg consumption on linear growth among 6- to 12-month-olds in rural Bangladesh.

METHODS

We conducted a 2x4 factorial cluster-randomized controlled trial allocating clusters (n=566) to treatment for enteric pathogens or placebo, and a daily egg, protein supplement, isocaloric supplement, or control. All arms received nutrition education. Here we compare the effect of the egg intervention versus control on linear growth, a pre-specified aim of the trial. Infants were enrolled at 3 months. We measured length and weight at 6 and 12 months and visited households weekly to distribute eggs and monitor compliance. We used linear regression models to compare 12-month mean length, weight, and z-scores for length-for-age (LAZ), weight-for-length, and weight-for-age (WAZ), and log-binomial or robust Poisson regression to compare prevalence of stunting, wasting, and underweight between arms. We used generalized estimating equations to account for clustering and adjusted models for baseline measures of outcomes.

RESULTS

We enrolled 3051 infants (n=283 clusters) across arms, with complete 6- and 12-month anthropometry data from 1228 infants (n=142 clusters) in the egg arm and 1109 infants (n=141 clusters) in the control. At baseline, 18.5%, 6.0%, and 16.4% were stunted, wasted, and underweight, respectively. The intervention did not have a statistically significant effect on mean LAZ (β = 0.05, 95% CI: -0.01, 0.10) or stunting prevalence (β = 0.98, 95% CI: 0.89, 1.13) at 12 months. Mean weight (β = 0.07 kg, 95% CI: 0.02, 0.11) and WAZ (β = 0.06, 95% CI: 0.02, 0.11) were significantly higher in the egg versus control arms.

CONCLUSIONS

Provision of a daily egg for 6 months to infants in rural Bangladesh improved ponderal but not linear growth.

CLINICAL TRIAL REGISTRY

NCT03683667, https://clinicaltrials.gov/ct2/show/NCT03683667.

Correction: Development of electrochemical sensors for quick detection of environmental (soil and water) NPK ions

[This corrects the article DOI: 10.1039/D4RA00034J.].

Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort

Background

Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries.

Methods

We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates.

Findings

We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36, -0.19]) and MW (-0.23 [-0.34, -0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions.

Interpretation

Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support.

Funding

Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813.

Multidimensional evaluation of the early emergence of executive function and development in Bangladeshi children using nutritional and psychosocial intervention: A randomized controlled trial protocol

INTRODUCTION

Reversing malnutrition-induced impairment of cognition and emotional regulation is a critical global gap. We hypothesize that brain-targeted micronutrient supplemented nutritional rehabilitation in children with moderate acute malnutrition, followed by 2 years micronutrient supplementation will impact on the cognition and emotion regulation of these children.

METHODS

The primary outcome of this prospective, randomized controlled trial is to study the development of executive functions (EFs) and emotion regulation (ER) in this cohort. Moderate acute malnourished (MAM; WLZ/WHZ <-2 and ≥-3 z-score, and/or 11.5 cm ≤ MUAC < 12.5cm; n = 140)children aged around one year (11m-13m) in Mirpur, Dhaka, Bangladesh will be randomized (1:1) to receive either locally produced Ready to Use Supplementary Food (RUSF) or Enhanced Ready to Use Supplementary Food (E-RUSF) until anthropometric recovery (WLZ/WHZ > -1SD), or for 3 months after enrollment (whichever is earlier). The randomized MAMs groups will be given either Small Quantity Lipid Based Nutrient Supplement (SQLNS) or Enhanced Small Quantity Lipid Based Nutrient Supplement (E-SQLNS), respectively until the end of the 2-year follow up period. Standard psychosocial stimulation will be provided to the MAMs intervention groups. Biological samples will be collected, anthropometric and neurocognitive assessments will be performed at 2 (22m-26m) and 3 (34m-38m) years of age. Two control groups will be recruited: 1), non-malnourished one-year (11m-13m) old children (WLZ/WHZ score>-1SD; n = 70); and 2) three-year (34m-38m) old children (n = 70) with untreated MAM (WHZ <-2 and ≥-3 z-score, and/or 11.5≤MUAC<12.5 cm). The 3-year-old MAM reference group will be assessed once and provided with 2 months of nutritional rehabilitation support (RUSF Nutriset's Plumpy'Sup™).

Development of electrochemical sensors for quick detection of environmental (soil and water) NPK ions

All over the world, technology is becoming more and more prevalent in agriculture. Different types of instruments are already being used in this sector. For the time being, every farmer is trying to produce more crops on a piece of land. Eventually, soil loses its nutrients; however, to grow more crops, farmers use more fertilizers without knowing the proper conditions of the soil in real time. To overcome this issue, many scientists have recently focused on developing electrochemical sensors to detect macronutrients, i.e., nitrogen (N), phosphorus (P), and potassium (K), in soil or water rapidly. In this review, we focus mainly on the recent developments in electrochemical sensors used for the detection of nutrients (NPK) in different types of samples. As it is outlined, the use of smart and portable electrochemical sensors can be helpful for the reduction of excess fertilizer and can play a vital role in maintaining suitable conditions in soils and water. We are optimistic that this review can guide researchers in the development of a portable and suitable NPK detection system for soil nutrients.

Prelacteal feeding is not associated with infant size at 3 months in rural Bangladesh: a prospective cohort study

BACKGROUND

Early and exclusive breastfeeding may reduce neonatal and post-neonatal mortality in low-resource settings. However, prelacteal feeding (PLF), the practice of giving food or liquid before breastfeeding is established, is still a barrier to optimal breastfeeding practices in many South Asian countries. We used a prospective cohort study to assess the association between feeding non-breastmilk food or liquid in the first three days of life and infant size at 3-5 months of age.

METHODS

The analysis used data from 3,332 mother-infant pairs enrolled in a randomized controlled trial in northwestern rural Bangladesh conducted from 2018 to 2019. Trained interviewers visited women in their households during pregnancy to collect sociodemographic data. Project staff were notified of a birth by telephone and interviewers visited the home within approximately three days and three months post-partum. At each visit, interviewers collected data on breastfeeding practices and anthropometric measures. Infant length and weight measurements were used to produce length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores. We used multiple linear regression to assess the association between anthropometric indices and PLF practices, controlling for household wealth, maternal age, weight, education, occupation, and infant age, sex, and neonatal sizes.

RESULTS

The prevalence of PLF was 23%. Compared to infants who did not receive PLF, infants who received PLF may have a higher LAZ (Mean difference (MD) = 0.02 [95% CI: -0.04, 0.08]) score, a lower WLZ (MD=-0.06 [95% CI: -0.15, 0.03]) score, and a lower WAZ (MD=-0.02 [95% CI: -0.08, 0.05]) score at 3-5 months of age, but none of the differences were statistically significant. In the adjusted model, female sex, larger size during the neonatal period, higher maternal education, and wealthier households were associated with larger infant size.

CONCLUSION

PLF was a common practice in this setting. Although no association between PLF and infant growth was identified, we cannot ignore the potential harm posed by PLF. Future studies could assess infant size at an earlier time point, such as 1-month postpartum, or use longitudinal data to assess more subtle differences in growth trajectories with PLF.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03683667 and NCT02909179.

Membrane aerated biofilm reactor system driven by pure oxygen for wastewater treatment

Pure oxygen is proposed for wastewater treatment due to its advantages over conventional air aeration. This study investigates a Pure Oxygen-based Membrane Aerated Biofilm Reactor (PO-MABR) for the first time under various operating conditions. The PO-MABR employs a gas-permeable membrane for direct diffusion of low-pressurized pure oxygen to the biofilm, ensuring exceptional carbon and nitrogen removal. The effectiveness of PO-MABR was investigated by varying operational conditions, including temperature, carbon-to-nitrogen ratio, gas pressure, and flow rate. Results indicate superior performance, with a 97% chemical oxygen demand removal and 19% higher total nitrogen removal than Air-Ventilated MABR (A-MABR) due to thicker biofilm and unique microbial structures in PO-MABR. Also, PO-MABR demonstrated resilience to low temperatures and effectively treated both high and low-strength wastewater. The findings emphasize the efficiency of PO-MABR in wastewater treatment, advocating for its adoption due to superior carbon and nitrogen removal across diverse operational conditions.

Association of Serum Magnesium Level with Severity of Neurological Disability in Patients with Acute Ischemic Stroke

Magnesium (Mg) has important effects on vascular system and deficiency of this cation is thought to be a risk factor for cerebrovascular atherosclerosis and complications. The study was planned to find out the association of serum magnesium level with severity of neurological disability in patient with acute ischemic stroke. This cross-sectional descriptive study was conducted in the department of Neurology and Medicine at Mymensingh Medical College & Hospital, Mymensingh from June, 2018 to October, 2019. Patients with acute ischemic stroke were evaluated following informed written consent. Diagnosis was confirmed by neuroimaging of brain. Moreover, serum magnesium assay was done for each patient. Data were collected by interview, clinical examination and laboratory investigations of patients using a case record form and analysis was carried out by using the SPSS 22.0 (IBM Inc., Armonk, NY, USA). Mean age of acute ischemic stroke patients was 63.94±13.93 years with male predominance (58.30%). Majority of the respondents (70.2%) had NIH Stroke Scale (NIHSS) score 5-15 (moderate stroke), 13.1% had score 1-5 (minor stroke), 13.1% had score15-20 (Moderate to severe stroke) and 3.6% had score 21-42 (severe stroke). Mean serum magnesium level was 1.83±0.283mg/dl. Hypomagnesaemia was present in 28(33.3%) patients and it was related with higher NIHSS scoring (p<0.05). Multiple regression showed that among the risk factors, serum magnesium level was independently associated with severity of neurological disability of the acute ischemic stroke (p<0.001). In this study, the correlation coefficient between serum magnesium level and NIHSS score was found as r= - 0.667 which showed negative relationship between serum magnesium and NIHSS score. Lower serum magnesium level is associated with the severity of neurological disability of acute ischemic stroke patient. Further case-control studies are required to validate this finding.

Frequency of Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis in an Academic Hospital of Bangladesh

Post-ERCP acute pancreatitis (PEP) is a common and serious complication with high morbidity and mortality rates. There is a paucity of data on the frequency of PEP in a resource constraint setting like Bangladesh. Hence we have conducted a prospective study to determine the frequency of PEP and the factors associated with its occurrence. This prospective, observational study was carried out in Gastroenterology Department of Dhaka Medical College & Hospital, Dhaka, Bangladesh from April 2018 to December 2018 on the consecutive patients who underwent ERCP. PEP and its severity were diagnosed according to consensus definition. Serum lipase was done in all patients before procedure and 24 hours after procedure or if patient develops abdominal pain after the procedure which became earlier. Total 168 patients were included (mean age 46.97±14.35 years; male 72(43.0%). The most common indication of ERCP was choledocholithiasis 97(58.0%) followed by malignant biliary obstruction 45(27.0%), recurrent pyogenic cholangitis 8(5.0%), chronic pancreatitis 4(2.3%), biliary ascariasis 4(2.3%) and others 10(6.0%). Overall post ERCP complication rate was 46(27.3%) including cholangitis 29(17.3%), pancreatitis 16(9.5%), bleeding 12(7.1%), aspiration pneumonia 4(2.4%) and death 3(1.8%). Regarding the severity of PEP, 50.0%, 43.7% and 6.3% patients developed mild, moderate and severe pancreatitis respectively. Number of cannulation attempts >5 times [22(48%) vs. 17(14%); p=0.001], cannulation attempts duration more than 10 minutes [25(55%) vs. 27(22%); p=0.001], unintentional passage of guide wire into the pancreatic duct [8(17%) vs. 18(15%); p=0.001], pancreatic duct contrast injection [12(26%) vs. 2(1.6%); p=0.001] and pre-cut sphincterotomy [16(35%) vs. 6(4.9%); p=0.001] were significantly different between the patients who developed PEP compared to those who did not. In multiple logistic regressions analysis, pancreatic duct contrast injection was significantly associated with PEP [OR 25.523 with 95% CI (4.049- 100.0%)]. Around ten percent patients had developed PEP. Regarding the severity half of them were mild, 44.0% patients had moderate and 6.0% patient had severe type of pancreatitis. Difficult cannulation, unintentional passage of guide wire into the pancreas, pancreatic duct contrast injection and pre-cut sphincterotomy were associated with PEP. Among them pancreatic duct contrast injection had independent significance in the causation of PEP.

Disinfection efficiency of chlorine dioxide and peracetic acid against MNV-1 and HAV in simulated soil-rich wash water

Wash water from fresh vegetables and root vegetables is an important vehicle for foodborne virus transmission. However, there is lack of assessing rapid viral inactivation strategies in wash water characterized by a high soil content at the post-harvest stage. Considering the significance of food safety during the washing stage for fresh and root vegetable produce prior to marketing, we assessed the inactivation efficacy by using chlorine dioxide (ClO2) and peracetic acid (PAA) against a surrogate of human norovirus (murine norovirus 1, MNV-1) and hepatitis A virus (HAV), in wash water containing black soil and clay loam. The results indicated that MNV-1 and HAV were reduced to the process limit of detection (PLOD), with reductions ranging from 4.89 to 6.35 log10 PFU, and 4.63 to 4.96 log10 PFU when treated with ClO2 at 2.5 ppm for 10 mins. Comparatively, when treated with 500 ppm of PAA for 10 mins, MNV-1 and HAV were maximum reduced to 1.75 ± 0.23 log10 PFU (4.50 log10 PFU reduction) and 2.13 ± 0.12 log10 PFU (2.72 log10 PFU reduction). This demonstrated the efficacy of ClO2 in eliminating foodborne viruses in soil-rich wash water. When we validated the recovery of the virus from two types of wash water, the pH (9.24 ± 0.33 and 5.95 ± 0.05) had no impact on the recovery of MNV-1, while the recovery of HAV was less than 1 %. By adjusting the pH to a neutral level, recovery of HAV and its RNA levels was increased to 15.94 and 3.89 %. Thus, this study emphasized the critical role of pH in the recovery of HAV from the complex soil-rich aqueous environment, and the efficacy of ClO2 serving as a pivotal reference for the development of control strategies against foodborne viruses in the supply chain of fresh and root vegetables.

The Potential Role of Ionic Liquid as a Multifunctional Dental Biomaterial

In craniofacial research and routine dental clinical procedures, multifunctional materials with antimicrobial properties are in constant demand. Ionic liquids (ILs) are one such multifunctional intelligent material. Over the last three decades, ILs have been explored for different biomedical applications due to their unique physical and chemical properties, high task specificity, and sustainability. Their stable physical and chemical characteristics and extremely low vapor pressure make them suitable for various applications. Their unique properties, such as density, viscosity, and hydrophilicity/hydrophobicity, may provide higher performance as a potential dental material. ILs have functionalities for optimizing dental implants, infiltrate materials, oral hygiene maintenance products, and restorative materials. They also serve as sensors for dental chairside usage to detect oral cancer, periodontal lesions, breath-based sobriety, and dental hard tissue defects. With further optimization, ILs might also make vital contributions to craniofacial regeneration, oral hygiene maintenance, oral disease prevention, and antimicrobial materials. This review explores the different advantages and properties of ILs as possible dental material.

Comparison of the virucidal efficacy of essential oils (cinnamon, clove, and thyme) against hepatitis A virus in suspension and on food-contact surfaces

Essential oils (EOs) have been used for centuries as flavor enhancers in foods, and owing to their antimicrobial properties, they have potential as natural food preservatives. However, their effect on food-borne viruses is unknown. Therefore, in this study, the virucidal effects of three EOs (cinnamon, clove, and thyme) on the infectivity of the hepatitis A virus (HAV) were investigated. Different concentrations of each EO (0.05, 0.1, 0.5, and 1%) were mixed with viral suspensions in accordance with ASTM E1052-11:2011 and incubated for 1 h at room temperature. The EOs exhibited a concentration-dependent effect in the suspension tests, and HAV titers decreased by approximately 1.60 log PFU/mL when treated with EOs at the highest concentration of 1%. The antiviral effect of EOs treated at 1% for 1 h was also evidenced in surface disinfection tests according to the OECD:2013, as approximately 2 log PFU/mL reduction on hard food-contact surfaces (stainless steel and polypropylene) and approximately 2 and 1.4 log PFU/mL reduction on low-density polyethylene and kraft (soft food-contact surfaces), respectively. Moreover, RT-qPCR results revealed that HAV genome copies were negligibly reduced until treated with a high concentration (1%) in suspension and carrier tests. Overall, our findings highlighted the potential of cinnamon, clove, and thyme EOs as natural disinfectants capable of limiting HAV (cross-) contamination conveyed by food-contact surfaces. These findings advance our knowledge of EOs as antimicrobials and their potential in the food sector as alternative natural components to reduce viral contamination and improve food safety.

Nanostructured wearable electrochemical and biosensor towards healthcare management: a review

In recent years, there has been a rapid increase in demand for wearable sensors, particularly these tracking the surroundings, fitness, and health of people. Thus, selective detection in human body fluid is a demand for a smart lifestyle by quick monitoring of electrolytes, drugs, toxins, metabolites and biomolecules, proteins, and the immune system. In this review, these parameters along with the main features of the latest and mostly cited research work on nanostructured wearable electrochemical and biosensors are surveyed. This study aims to help researchers and engineers choose the most suitable selective and sensitive sensor. Wearable sensors have broad and effective sensing platforms, such as contact lenses, Google Glass, skin-patch, mouth gourds, smartwatches, underwear, wristbands, and others. For increasing sensor reliability, additional advancements in electrochemical and biosensor precision, stability in uncontrolled environments, and reproducible sample conveyance are necessary. In addition, the optimistic future of wearable electrochemical sensors in fields, such as remote and customized healthcare and well-being is discussed. Overall, wearable electrochemical and biosensing technologies hold great promise for improving personal healthcare and monitoring performance with the potential to have a significant impact on daily lives. These technologies enable real-time body sensing and the communication of comprehensive physiological information.

Ocular Involvement in Transfusion Dependent Thalassemia Children

Thalassemia is one of the most common haemoglobinopathies in the world. Transfusion dependent thalassemia patients need regular blood transfusion. Repeated blood transfusions lead to iron overloads which can affect various organs in the body including eyes. The present study aims to evaluate the ocular involvements in transfusion dependent thalassemia children and their relationship with duration of the disease and serum ferritin level. This cross-sectional observational study included 46 multi-transfused thalassemia children aged 3-18 years. Detailed ophthalmological examination including visual acuity, slit lamp bio microscopy, direct and indirect ophthalmoscopy was done. Statistical analysis was done using SPSS version (IBM) 23.0. Student's t-test and chi-square (χ²) test was done and p value of <0.05 was considered significant. Out of 46 thalassemia children male were 25(54.3%) and female were 21(45.7%). Mean age of the children was 8.94±5.04 years, mean duration of disease was 7.02±3.5 years and mean serum ferritin level 1543.68±914.43ng/dl. Ocular involvements were detected in 19(41.3%) children. Among them 8(17.39%) children had more than one ocular involvements. The ocular manifestations were decreased visual acuity in 17(36.95%), corneal dryness in 7(15.21%), lens opacity in 6(13.04%), optic disc atrophy in 7(15.21%), peripheral retinal pigmentation in 5(10.86%) and retinal vessels tortuosity in 3(6.52%) children. Higher serum ferritin level and increased duration of the disease were significantly (p<0.001) related with ocular involvement. Various ocular involvements were found in transfusion dependent thalassemia children. Therefore, transfusion dependent thalassemia children should be screened periodically for early detection and proper management of ocular changes.

Relation of Neutrophil-Lymphocyte Ratio with Clinical Severity in Patients with Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) is an acute autoimmune polyradiculoneuropathy. Neutrophil-lymphocyte ratio (NLR) is a novel prognostic and inflammatory marker in patients with neurological diseases. The study was designed to observe the relation between neutrophil lymphocyte ratio and the clinical severity in patients with Guillain-Barre Syndrome (GBS). This cross-sectional descriptive study was conducted at the department of Neurology and Medicine, Mymensingh Medical College and Hospital from April 2019 to September 2020. Total 58 patients with GBS were enrolled according to the inclusion and exclusion criteria within 7 days of development of symptoms. The clinical diagnosis of GBS was done according to Ausbury and Cornblath's diagnostic criteria; moreover clinical severity was done according to Hughes and Rees scale, Medical Research Council (MRC) grade, cranial nerve involvement and autonomic involvement. After measuring complete blood count, NLR was calculated by dividing neutrophil count to lymphocyte count. Data analysis was done on SPSS 23.0. Mean age of the GBS patients was 36.21±11.55 years. Among 58 respondents 70.69% (41) were male and 29.31% (17) were female. Most of the patients had a GBS severity score of 4(62.07%) followed by 3(27.59%) and 5(10.34%). The mean NLR of the respondents was 3.22±2.25. Acute motor axonal neuropathy (AMAN) was in 48.28% respondents and their mean NLR was 3.89±0.31, 31.03% had AIDP and mean NLR was 3.28±0.46 and 20.69% had Acute motor sensory axonal neuropathy (AMSAN) and mean NLR was 4.5±0.52. The mean NLR of the MRC grade 0, 1, 2, 3 patients was 6.61±1.78, 3.39±0.92, 2.71±1.39 and 1.45±0.40 respectively. Hughes score had a positive correlation (r=0.5333 and p<0.01) and MRC grade had a negative correlation (r= - 0.76805 and p<0.01) with NLR. Severity of GBS was significantly associated with raised NLR. Increase Hughes and Rees scale and decrease MRC grade also related to increased NLR.

Symptomatic and Asymptomatic Campylobacter Infections and Child Growth in South Asia: Analyzing Data from the Global Enteric Multicenter Study

Campylobacter is a major cause of food-borne gastrointestinal illnesses worldwide, predominantly affecting children under 5 years of age. This study examined potential associations of symptomatic (with diarrhea) and asymptomatic (without diarrhea) Campylobacter infections with child growth among children under 5 years of age in South Asia. The Global Enteric Multicenter Study was conducted from 2007 to 2011 with a case-control design. Children were followed for 60 days after enrollment. Stool culture was performed to isolate Campylobacter spp. Among the 22,567 enrolled children, 9,439 were symptomatic, with 786 (8.28%) testing positive for Campylobacter. Conversely, 13,128 asymptomatic healthy controls were included, with 1,057 (8.05%) testing positive for Campylobacter. Growth faltering was observed in the symptomatic group, particularly among children aged 0-11 months (-0.19 height-for-age z score [HAZ]; 95% CI: -0.36, -0.03; P = 0.018) and 24-59 months (-0.16 HAZ; 95% CI: -0.28, -0.04; P = 0.010). However, in the asymptomatic group, growth faltering was observed only in the 24- to 59-month age group, in terms of HAZ (-0.15 HAZ; 95% CI: -0.24, -0.05; P = 0.002) and weight-for-height z score (-0.16; 95% CI: -0.26, -0.06; P = 0.001). These findings underscore the importance of immediate and enhanced introduction of preventive modalities to reduce the burden of Campylobacter infections and reduce their long-term sequelae.

Open-label, randomised controlled trial found that a green banana mixed rice suji diet was most effective for persistent diarrhoea in children in Bangladesh

AIM

Persistent diarrhoea continues for at least 14 days and kills more children than acute diarrhoea. We assessed whether rice suji, green banana mixed rice suji or 75% rice suji improved persistent diarrhoea compared in young children.

METHODS

This open-labelled randomised controlled trial was carried out between December 2017 and August 2019 at the Dhaka Hospital of icddr,b, Bangladesh, with 135 children aged 6-35 months with persistent diarrhoea. The children were randomly assigned to green banana mixed rice suji, rice suji, or 75% rice suji, with 45 in each group. The primary outcome was the percentage who recovered from diarrhoea by day five using an intention to treat analysis.

RESULTS

The children's median age was eight months (interquartile range 7-10 months). By day five the recovery rate was 58%, 31% and 58% children in the green banana mixed rice suji, rice suji and 75% rice suji groups, respectively. The green banana mixed rice suji group had fewer relapses (7%) than the 75% rice suji group (24%). Enteroaggregative Escherichia coli, rotavirus, norovirus, Enteropathogenic Escherichia coli, astrovirus and Campylobacter were the major pathogens for persistent diarrhoea.

CONCLUSION

Green banana mixed rice suji was the most effective option for managing persistent diarrhoea in young children.

Inhibitory effects of vorinostat (SAHA) against food-borne pathogen Salmonella enterica serotype Kentucky mixed culture biofilm with virulence and quorum-sensing relative expression

Salmonella is a food-borne microorganism that is also a zoonotic bacterial hazard in the food sector. This study determined how well a mixed culture of Salmonella Kentucky formed biofilms on plastic (PLA), silicon rubber (SR), rubber gloves (RG), chicken skin and eggshell surfaces. In vitro interactions between the histone deacetylase inhibitor-vorinostat (SAHA)-and S. enterica serotype Kentucky were examined utilizing biofilms. The minimum inhibitory concentration (MIC) of SAHA was 120 µg mL-1. The addition of sub-MIC (60 µg mL-1) of SAHA decreased biofilm formation for 24 h on PLA, SR, RG, Chicken skin, and eggshell by 3.98, 3.84, 4.11, 2.86 and 3.01 log (p < 0.05), respectively. In addition, the initial rate of bacterial biofilm formation was higher on chicken skin than on other surfaces, but the inhibitory effect was reduced. Consistent with this conclusion, virulence genes expression (avrA, rpoS and hilA) and quorum-sensing (QS) gene (luxS) was considerably downregulated at sub-MIC of SAHA. SAHA has potential as an anti-biofilm agent against S. enterica serotype Kentucky biofilm, mostly by inhibiting virulence and quorum-sensing gene expression, proving the histone deacetylase inhibitor could be used to control food-borne biofilms in the food industry.

Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

INTRODUCTION

Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation.

METHODS AND ANALYSIS

In this randomised, three-arm, controlled, non-masked clinical trial in children 1-59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023.

ETHICS AND DISSEMINATION

This study has been approved by the icddr,b Institutional Review Board. We adhere to the 'Declaration of Helsinki' (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar.

TRIAL REGISTRATION NUMBER

NCT04750070.

Viability of SARS-CoV-2 on lettuce, chicken, and salmon and its inactivation by peracetic acid, ethanol, and chlorine dioxide

Since the first SARS-CoV-2 outbreak in Wuhan, China, there has been continued concern over the link between SARS-CoV-2 transmission and food. However, there are few studies on the viability and removal of SARS-CoV-2 contaminating food. This study aimed to evaluate the viability of SARS-CoV-2 on food matrices, depending on storage temperature, and inactivate the virus contaminating food using disinfectants. Two SARS-CoV-2 strains (L and S types) were used to contaminate lettuce, chicken, and salmon, which were then stored at 20,4 and -40 °C. The half-life of SARS-CoV-2 at 20 °C was 3-7 h but increased to 24-46 h at 4 °C and exceeded 100 h at -40 °C. SARS-CoV-2 persisted longer on chicken or salmon than on lettuce. Treatment with 70% ethanol for 1 min inactivated 3.25 log reduction of SARS-CoV-2 inoculated on lettuce but not on chicken and salmon. ClO2 inactivated up to 2 log reduction of SARS-CoV-2 on foods. Peracetic acid was able to eliminate SARS-CoV-2 from all foods. The virucidal effect of all disinfectants used in this study did not differ between the two SARS-CoV-2 strains; therefore, they could also be effective against other SARS-CoV-2 variants. This study demonstrated that the viability of SARS-CoV-2 can be extended at 4 and -40 °C and peracetic acid can inactivate SARS-CoV-2 on food matrices.

Clinicopathological Characteristics of Mucinous and Non-mucinous Adenocarcinoma of the Colon and Rectum

Colorectal carcinoma is the most common cancer of the gastrointestinal tract. More than 95.0% of the cancer is adenocarcinoma. Mucinous adenocarcinomas account for about 10.0% of all colorectal cancers. The expression of mucin themselves may play a role in the ability of tumors cells to escape the effect of systemic therapy and the process of tumor progression, invasion, survival and protection against the host immune response. The mucin lakes may also be a physiological barrier for the delivery of targeted therapy to the tumors cells. The aim of this study was to evaluate and compare the morphologic and histologic prognostic factors of mucinous and non-mucinous adenocarcinoma of the colon and rectum. In this descriptive cross-sectional type of observational study a total of 98 samples with colorectal adenocarcinoma were evaluated on the basis of presence or absence of the mucin from 2017 and 2018. The study was conducted in paraffin-embedded tumor tissue whose slides were stained using the hematoxylin-eosin technique. Mucin was evaluated by Periodic acid schiff and Diastase periodic acid schiff stain. Totally, 27 of 98 patients with colorectal adenocarcinoma (27.6%) had mucinous histologic subtype. Statistical significant results found in this research are as follows: Mucinous subtype tended to have present with moderate anaemia, history of low vegetable diet and larger tumor size, proximal colon involvement, infiltrative morphology and higher stage II compared to non-mucinous histologic subtype. Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer.

Ionic Liquids Exhibit the Piezoelectric Effect

The piezoelectric effect was discovered over a century ago, and it has found wide application since that time. The direct piezoelectric effect is the production of charge upon application of force to a material, and the converse piezoelectric effect is a change in the material dimension(s) upon the application of a potential. To date, piezoelectric effects have been observed only in solid-phase materials. We report here the observation of the direct piezoelectric effect in room-temperature ionic liquids (RTILs). The RTILs 1-butyl-3-methyl imidazolium bis(trifluoromethyl-sulfonyl)imide (BMIM⁺TFSI^-) and 1-hexyl-3-methyl imidazolium bis(trifluoromethylsulfonyl) imide (HMIM⁺TFSI^-) produce a potential upon the application of force when confined in a cell, with the magnitude of the potential being directly proportional to the force applied. The effect is one order of magnitude smaller than that seen in quartz. This is the first report to our knowledge of the direct piezoelectric effect in a neat liquid. Its discovery has fundamental implications about the organization and dynamics in ionic liquids and invites theoretical treatment.

Clinical prediction rule to guide diagnostic testing for Shigellosis and improve antibiotic stewardship for pediatric diarrhea

Background

Diarrheal diseases are a leading cause of death for children under-5. Identification of etiology helps guide pathogen-specific therapy, but availability of diagnostic testing is often limited in low resource settings. Our goal is to develop a clinical prediction rule (CPR) to guide clinicians in identifying when to use a point-of-care diagnostic for Shigella in children presenting with acute diarrhea.

Methods

We used clinical and demographic data from the Global Enteric Multicenter Study (GEMS) study to build predictive models for diarrhea of Shigella etiology in children ≤59 months presenting with moderate-to-severe diarrhea in Africa and Asia. We screened variables using random forests, and assessed predictive performance with random forest regression and logistic regression using cross-validation. We used the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study to externally validate our GEMS-derived CPR.

Results

Of the 5011 cases analyzed, 1332 (27%) had diarrhea of Shigella etiology. Our CPR had high predictive ability (AUC=0.80 (95% CI: 0.79, 0.81) using the top two predictive variables, age and caregiver reported bloody diarrhea. We show that by using our CPR to triage who receives diagnostic testing, 3 times more Shigella diarrhea cases would have been identified compared to current symptom-based guidelines, with only 27% of cases receiving a point-of-care diagnostic test.

Conclusions

We demonstrate how a clinical prediction rule can be used to guide use of a point-of-care diagnostic test for diarrhea management. Using our CPR, available diagnostic capacity can be optimized to improve appropriate antibiotic use.

Relating the Induced Free Charge Density Gradient in a Room-Temperature Ionic Liquid to Molecular-Scale Organization

We report on dilution-dependent changes in the local environments of chromophores incorporated into room-temperature ionic liquid (RTIL)-molecular solvent binary systems where the ionic liquid cation and molecular solvent possess the same alkyl chain length. We have used the RTIL 1-decyl-1-methylpyrrolidinium bis(trifluoromethanesulfonyl)imide (DMPyrr⁺TFSI^-) and the molecular solvent 1-decanol. Perylene was used as a non-polar probe, and cresyl violet (CV⁺) was used as a polar probe chromophore. We observe that in both regions there is a change in the chromophore local environments with increasing 1-decanol content. The changes in the nonpolar regions of the binary RTIL-molecular solvent system occur at a lower 1-decanol concentration than changes in the polar regions. Both chromophores reorient as oblate rotors in this binary system, allowing detailed information on the relative values of the Cartesian components of the rotational diffusion constants to be extracted from the experimental data. The induced free charge density gradient, ρ_f, known to exist in RTILs, persists to high 1-decanol content (1-decanol mole fraction of 0.75), with the structural details of the gradient being reflected in depth-dependent changes in the Cartesian components of the rotational diffusion constants of CV⁺. This is the first time that changes in molecular organization have been correlated with ρ_f.

Prophylactic efficacy of Lactobacillus curvatus B67-derived postbiotic and quercetin, separately and combined, against Listeria monocytogenes and Salmonella enterica ser. Typhimurium on processed meat sausage

This study investigated the antimicrobial and antibiofilm efficacy of separate and combined treatments of Lactobacillus curvatus B67-produced postbiotic and the polyphenolic flavanol quercetin against Listeria monocytogenes and Salmonella enterica ser. Typhimurium. The antimicrobial potentiality of the postbiotic was chiefly associated with organic acids (e.g., lactic and acetic acids). At sub-minimum inhibitory concentration (1/2 MIC), the postbiotic and quercetin effectively reduced the pathogenic biofilm cells on processed pork sausage and meat-processing surfaces (e.g., stainless-steel and rubber). Moreover, the postbiotic exhibited strong residual antimicrobial efficacy over diverse pH and temperature ranges. In addition, the combination of postbiotic with quercetin increased the leakage of pathogenic intracellular metabolites (e.g., nucleic acids and protein) and inhibited pathogenic biofilm formation on both biotic and abiotic surfaces. Therefore, this study confirmed that lactic acid bacteria-derived postbiotic and plant-derived quercetin could be used as potential alternative bioprotective agents in the meat processing industry.

Assessing the Removal Efficiency of Murine Norovirus 1, Hepatitis A Virus, and Human Coronavirus 229E on Dish Surfaces Through General Wash Program of Household Dishwasher

The performance of dishwashers in removing live viruses is an important informative value in practical applications. Since foodborne viruses are present in contaminated food surfaces and water environments. Insufficient washing of dishes typically makes a carrier of foodborne viruses. Dishwashers have shown excellent performance in removing bacterial pathogens, but very limited reports related to eliminate foodborne viruses on contaminated dish surfaces. Here, murine norovirus 1 (MNV-1), hepatitis A virus (HAV), and human coronavirus 229E (HCoV-229E) were experimentally inoculated on the dish surfaces (plate, rice bowl, and soup bowl). Plaque assay, 50% tissue culture infectious dose (TCID₅₀), and real-time quantitative polymerase chain reaction (RT-qPCR) were conducted to determine their removal efficiency of them through the general wash program of household dishwashers. Using titration assay, MNV-1 and HAV were reduced by 7.44 and 6.57 log10 PFU/dish, and HCoV-229E was reduced by 6.43 log10 TCID₅₀/dish through the general wash program, achieving a ≥ 99.999% reduction, respectively. Additionally, RT-qPCR results revealed that viral RNA of MNV-1 and HCoV-229E reduced 5.02 and 4.54 log10 genome copies/dish; in contrast, HAV was not detected on any dish surfaces. This study confirmed the performance of household dishwashers in removing pathogenic live viruses through the general wash program. However, residual viral RNA was not sufficiently removed. Further studies are needed to determine whether the viral RNA can be sufficiently removed using combination programs in household dishwashers.

An Egg Intervention Improves Dietary Intakes but Does Not Fill Intake Gaps for Multiple Micronutrients among Infants in Rural Bangladesh

BACKGROUND

Eggs are nutrient-rich. Strengthening evidence of the impact of egg consumption on dietary quality can inform complementary feeding guidance.

OBJECTIVES

We aimed to assess the effect of an egg intervention on dietary intakes among infants aged 6-12 mo in rural Bangladesh.

METHODS

We conducted a cluster-randomized controlled trial allocating clusters (n = 566) to enteric pathogen control or placebo treatment, with daily provision of a protein-rich meal, isocaloric meal, egg, or control. Nutrition education was provided to all arms. Our focus here is on the egg and control arms. Infants were enrolled at 3 mo. From 6 mo, we visited households weekly to distribute eggs and measure compliance. A semistructured feeding questionnaire assessed 24-h intake at 6, 9, and 12 mo. Assessments were repeated in ∼10% of subjects 2-29 d later. Using NCI SAS macros, we estimated usual intake distributions for energy, protein, fat, and 18 micronutrients and the proportion meeting intake recommendations. We compared the outcomes between the arms using clustered bootstrapping.

RESULTS

Data were available from 757 infants (137 clusters) and 943 infants (141 clusters) in the egg and control arms, respectively. In the egg arm compared with the control arm, the mean usual intakes were higher for energy (610 compared with 602 kcal/d, 9 mo; 669 compared with 658 kcal/d, 12 mo), crude protein (2.2 compared with 1.7 g/(kg·d), 9 mo; 2.4 compared with 1.9 g/(kg·d), 12 mo), available protein (2.0 compared with 1.6 g/(kg·d), 9 mo; 2.1 compared with 1.8 g/(kg·d), 12 mo), and for 13 and 14 micronutrients at 9 and 12 mo, respectively. The proportion meeting intake recommendations for most micronutrients was higher in the egg arm but remained <50% for 15 and 13 micronutrients at 9 and 12 mo, respectively.

CONCLUSIONS

Daily egg consumption improved dietary intakes among Bangladeshi infants, but was insufficient to meet multiple micronutrient intake recommendations, demonstrating the need to be coupled with other strategies.

Improvement of nested reverse transcription-polymerase chain reaction (RT-PCR) with high specificity and sensitivity detection of sapovirus in food matrix

Sapovirus (SaV) is a causative agent of human gastroenteritis in both community outbreaks and sporadic cases worldwide. Shellfish accumulate a variety of pathogens during filter feeding. In particular, the contamination of shellfish by SaV has caused several outbreaks. As reported previously, nested RT-PCR (nRT-PCR) has been widely used in clinical samples, but has not proven suitable for food samples, such as oysters. This study aimed to identify a primer set for the detection of SaV with high specificity and sensitivity in food samples. To accomplish this, primers were improved in RNA-dependent RNA polymerase (RdRp) regions of SaV whole genome sequences. The sensitivity of the improved nRT-PCR was 100-1000 times higher than that of previous nRT-PCR and > 10 times higher than that of the previous real-time RT-PCR assay. Notably, cross-reaction with other viruses or food matrices was not observed by the specificity test. This study improved the reliable primer set to detect SaV in various food matrices with high sensitivity.

A Case of Bilateral Middle Cerebral Artery Stenosis with Unilateral M1 Stenting

Stroke is not only the third leading cause of death in Bangladesh but it also causes a high number of disability adjusted life years loss (485 per 10,000 people). Appropriate treatment of recurrent stroke has to be established. Here we present A 60 year's old male patient with history of recurrent stroke who came in our out patient department. He had progressing bilateral middle cerebral artery atherosclerotic stenosis (100.0% on right side and 52.0% on left side) which was less severs but symptomatic at dominant hemisphere (left). Percutaneous transluminal angioplasty with stenting was done to prevent further ischemia and to increase the blood supply of remaining brain parenchyma. On post stenting follow-up patient did not suffered from any new event of stroke for about 22 months. Percutaneous transluminal angioplasty with stenting is an effective procedure to prevent recurrent stroke for intracranial atherosclerotic disease.

Histopathological Evaluation of Endoscopic Duodenal Biopsies in Children with Coeliac Disease and its Correlation with Tissue Transglutaminase Level

This cross sectional, descriptive study was conducted at Paediatrics department of BSMMU from July 2016 to June 2018 to find out histopathological pattern of Coeliac disease according to Modified Marsh criteria and to correlate it with tissue transglutaminase IgA level. A total of 62 children (age <18 years) attending the Paediatrics department of BSMMU with clinical suspicion of celiac disease were enrolled for the study. Mean age of studied children was 7.87±4.67 years. Ratio of the male and female was 2.27:1. Maximum (66.1%) children came from middle income class family. Out of 62 children, 35.5% (22) were positive for IgA anti-tTG of who female were 11.3% and male 24.2%. Mean duration of symptoms was 44.07±21.77 months in serology positive patients and 34.49±30.52 months in serology negative patients. The age group, 10-14 year showed the highest (50.0%) prevalence of positive anti-tTG. In the tTG positive group mean Hb was 9.6±1.14gm/dl and which is lower than that in tTG negative group (11.7±1.47gm/dl). Among 22 sero-positive patients, histological changes compatible with CD were found in 19 (86.3%) cases and normal in 3 cases. Histological changes were of 3a category of Marsh was found in 12(63.2%) cases, 3b in 4(21.1%) cases and 3c in 3(15.8%) cases. Strong correlation was observed between the serological level of tTGA and histological types of CD by Modified Marsh criteria. In conclusion, screening for celiac disease may be included in diagnostic tests to investigate clinically suspected children and serum tTGA level can be used to predict histopathological severity of coeliac disease.

New formulation zinc sulphate acceptability and adherence in children with acute diarrhoea: A prospective, open-label, interventional study in Bangladesh

AIM

Zinc is an adjunct to oral rehydration salts for management of diarrhoea in children. Due to zinc's unpleasant taste, children often develop nausea and/or vomiting. We aimed to assess acceptability (tolerability) and adherence of improvised formulation of zinc tablet among under-five children with acute diarrhoea.

METHODS

This was an open-label intervention trial among 3-59 months old diarrhoeal children attending the outpatient department of Dhaka Hospital, who were enrolled in two age strata, 3 to <18 months and 18-59 months. Zinc tablets 10 or 20 mg per day were prescribed for a total of 10 days for <6 months and ≥6 months age children respectively, with follow-up. Diary-cards were used to record events.

RESULTS

In stratum 1, 158 (90.8%) children and in stratum 2, 144 (95.4%) children completed the study as per protocol out of 325 enrolled children. Sociodemographic, clinical and anthropometric measurements were comparable in the two strata except admission diarrhoeal duration (median 3 days vs. 2 days, P = 0.001). Adherence to 10 days treatment was 123 (77.8%) in stratum 1 and 127 (88.2%) in stratum 2. Zinc tablets were tolerated very well/well in 280 (92.7%) children. Vomiting, regurgitation and nausea were observed in 99 (32.8%), 59 (19.5%) and 22 (7.4%) children respectively. Caregivers' willingness to use the same drug in future was 300 (99.3%) among all children.

CONCLUSION

Our study findings demonstrate that modified taste and formulation zinc tablets were well tolerated, and caregivers' willingness to use this formulation in future supports its acceptability, adherence and palatability.

Assessment of Nutritional Status of Children with Chronic Kidney Disease in a Tertiary Care Level Hospital, Dhaka, Bangladesh

Malnutrition is recognized to be a serious and common complication of chronic kidney disease (CKD) and is associated with increased morbidity and mortality in children. Early identification and swift intervention is the key in the management of malnutrition in CKD. The objective of the study was to determine the prevalence of malnutrition in children with CKD, to see the prevalence of malnutrition according to different anthropometric indices, to see the prevalence of malnutrition in different stages of CKD, to compare the nutritional status of children with CKD according to chronological age and height age. This analytical cross sectional study was done in the Department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2014 to May 2015. Thirty children were enrolled in the study by purposive sampling. Nutritional assessment was done from dietary assessment by 72 hours recall and anthropometric measurements. Anthropometric indices were expressed in Z-scores and percentiles according to both chronological age and height age. Numeric data was analyzed by ANOVA and categorical data was tested by chi-square test. Difference between proportions was tested by Z-test of proportion. P value (<0.05) was considered significant. Data shows that the mean age of the studied population was 10.99±3.5 years with a male predominance. Eighteen (60.0%) children were on hemodialysis and rests on conservative management. Average calorie intake was 74.31±9.34% of estimated energy requirement (EER). The prevalence of malnutrition was 70.0% (95% CI: 53.6-86.4) according to height Z-score (HAZ), 66.7% (95% CI: 45.8-80.2) for weight Z-score (WAZ) and mid upper arm circumference (MUAC) Z-score, according to BMI percentile it was 56.7% (95% CI: 39-74.4), for mid arm muscle circumference (MAMC) the prevalence was 53.3% (95% CI: 35.5-71.1), according to arm muscle area (AMA) and arm fat area (AFA) the prevalence was 50.0% (95% CI: 38.1-67.9) and for triceps skin fold thickness (TST) it was 43.3% (95% CI: 25.5-61). Height was the most affected parameter and triceps skin fold thickness was the least affected parameter. When anthropometric indices were adjusted for height age, the prevalence was 36.7% according to BMI and TST, 30.0% according to AFA, 13.3% according to MUAC, 10.0% each for MAMC and AMA and 3.3% for WAZ. The difference in the prevalence of malnutrition according to this two approach was statistically significant in all parameters accept BMI, TST and AFA. Malnutrition was more associated with advanced stage of CKD. Low calorie intake was associated with low BMI and low serum albumin level. Serum albumin level was low in the present study population. In conclusion, prevalence of malnutrition is very high in children with CKD.

Impact Evaluation of a Community Nutrition and Livelihood Program on Child Nutrition in Rural Bangladesh

Objectives

Child undernutrition remains high in Bangladesh. Multi-sectoral approaches involving livelihood programs are needed to address the burden of undernutrition. This study examined the impact of an economic development (ED) program receiving poultry assets with/without gardening training added to the Positive Deviant (PD)/Hearth program in rural Bangladesh, compared to the PD/Hearth only (PDH), on child nutrition and health.

Methods

A total of 1,125 children aged 6–13 months with weight-for-age (WAZ) z-score<−1.0 who attended PD/Hearth sessions in September – November 2018 were enrolled in a cohort group in July – August 2019 for the program evaluation. Out of them, 532 were from ED households (PDH/ED). The cohort group was re-assessed in November 2020. A year of program impact between 2019 and 2020 on food security, dietary quality, and health behaviors, accounting for the socio-economic differences between two groups, was estimated using a difference-in-differences approach.

Results

The prevalence of underweight in the PDH and PDH/ED group decreased to 18.6% and 24.7% (p = 0.02) in 2019, but increased to 47.7% vs. 56.2% (p = 0.003) in 2020 without significant difference in program impact by adding the ED. Compared to the PDH group, the PDH/ED group increased a child dietary diversity score by 0.32 score and minimum dietary diversity (defined as four out of seven food groups) by 13.7 percentage points (pp), and a maternal dietary score by 0.28 score. The PDH/ED increased the proportion of food secured households by 12.6 pp, diversified crop production for banana (9.7 pp), papaya (11.7 pp), carrot (3.8 pp), and lemon (5.9 pp) (all p < 0.05), compared to the PD group. The proportion of households having income ≥ 84,000 Taka during the last year increased by 12.4 pp among PDH/ED group, compared to the PDH group (p = 0.003). There was no significant impact on child morbidity, maternal hand-washing practices.

Conclusions

Adding an ED program to the PD/Hearth program improved food security and dietary diversity among children and mothers in rural Bangladesh.

Funding Sources

World Vision Bangladesh.

Adaptive Implementation of a Community Nutrition and Asset Transfer Program during the COVID-19 Pandemic in Rural Bangladesh

Background

Reduced health and nutrition services as a result of coronavirus disease 2019 (COVID-19) measures endanger children's well-being. The Bangladesh Rajshahi Division of Maternal and Child Nutrition (BRDMCN; 2018-2020) involving social behavior change communication (SBCC) and an economic development (ED) of asset transfer was implemented.

Objectives

This study describes how the implementation modality of the BRDMCN was adapted, and changes in the program's short/intermediate-term outcomes during the COVID-19 pandemic compared with pre-pandemic.

Methods

The following evaluation components were assessed: 1) program fidelity, 2) program reach, 3) program acceptance, 4) perceived influence of COVID-19, and 5) short-term outcomes over the 3 y. We compared the first 2 y ("pre-COVID-19," from April 2018 through December 2019) and the final year ("during COVID-19," from January to December 2020) for all components except for (3) and (4). Data were collected through multiple sources: reviews of program annual progress reports, monitoring records of SBCC and ED programs, and cohort surveys (n = 1094).

Results

The percentage dose delivery of activities decreased from 66.7-118% at pre-COVID-19 to 0-90% during COVID-19. The SBCC programs were altered to reduce the frequency of activities as well as the number of participants per session. The ED program involving large group meetings was modified to include within-member meetings, individual visits of community facilitators, or virtual discussions. Production activity using received assets continued during the pandemic, with no significant reduction compared with pre-COVID-19. The percentage of children recovering from underweight after 30 d of a Positive deviance/Hearth (PD/Hearth) session, a component of the SBCC program, remained constant at 16.5-20.3 percentage points before and during the COVID-19 pandemic.

Conclusions

Program activities were scaled back and changed due to the pandemic. The BRDMCN maintained asset management and the degree of short-term outcomes over the course of a 3-y project. Further study is required to determine whether adaptive program management would achieve the long-term expected impact at a population level.

Psychological Assessment of Health-Care Workers Working during COVID-19 Pandemic Condition in Bangladesh

The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.

Sustained and enhanced anaerobic removal of COD and nitrogen in a zeolite amended glycogen accumulating organism dominated biofilm process

Activated sludge, the most widely used biological wastewater treatment process is known to be expensive to operate, largely due to energy expense for oxygen transfer into the bulk wastewater solution. The alternative of using passive aeration facilitates oxygen supply directly from the air resulting in aeration energy savings. The current study demonstrated sustained and improved removal of chemical oxygen demand (COD) and nitrogen in a zeolite modified glycogen accumulating organisms (GAOs) dominated biofilm reactor, which achieved anaerobic removal of COD and ammonium by the activity of GAOs and zeolite, respectively. Draining of the batch-operated reactor enabled the biofilm to directly uptake oxygen from air (passive aeration) to carry out simultaneous nitrification and denitrification due to the activity of GAO (Candidatus competibacter) and nitrifying bacteria (Nitrosomonas and Nitrospira). Under stable long-term (4-months) operation, the process achieved COD and nitrogen removal at rates of 1354 and 79.1 g m^-3 d^-1, respectively. The biofilm process demonstrated >90% nitrogen removal efficiency in multi-cycle (4/8 cycles) strategy with a short treatment time of 8 h. Due to the passive aeration scheme, the energy consumption of the proposed wastewater treatment process is calculated to be about 13-times less than that of traditional activated sludge process. Therefore, the Passive Aeration Simultaneous Nitrification and Denitrification (PASND) biofilm process is a promising low-energy treatment step for efficient removal of COD and nitrogen from wastewater.

The effect of dilution on induced free charge density gradients in room temperature ionic liquids

We report on changes in the magnitude and length scale of the induced free charge density gradient, ρ_f, in three imidazolium room temperature ionic liquids (RTILs) with dilution by methanol and acetonitrile. Using depth- and time-resolved fluorescence measurements of cresyl violet rotational diffusion, we find that ρ_f persists in RTILs to varying degrees depending on RTIL and diluent identity, and in all cases the functional form of ρ_f is not a smooth monotonic diminution in either magnitude or persistence length with increasing diluent, but a stepwise collapse. This finding is consistent with changes in the bulk RTIL as a function of dilution seen using rotational diffusion measurements that show the rotating entity in bulk RTILs exhibits a larger effective hydrodynamic volume than would be expected based on bulk viscosity data for the diluted RTILs. This excess hydrodynamic volume can be understood in the context of aggregation of RTIL ion pairs in the diluted RTIL system. The size of the aggregates is seen to depend on RTIL identity and diluent, and in all cases aggregate size increases with increasing dilution. This finding is consistent with the ρ_f dependence on dilution data. The collapse of ρ_f is seen to correlate with the onset of RTIL ion pair dimer formation, a condition that may facilitate dissociated RTIL ion mobility in the binary system.

Different Features of Cholera in Malnourished and Non-Malnourished Children: Analysis of 20 Years of Surveillance Data from a Large Diarrheal Disease Hospital in Urban Bangladesh

Malnourished children are more prone to infectious diseases including severe diarrhea compared to non-malnourished children. However, data are scarce on differences in the presentation in such children. We aimed to identify clinical differentials among children with cholera with or without malnutrition. Data were extracted from the diarrheal disease surveillance system (DDSS) of Dhaka Hospital of International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) from January 2001 to December 2020. Among children under five in DDSS, cholera positive (culture confirmed) malnourished children (WAZ, WL/HZ or L/HAZ ˂ −2) were considered as cases (n = 920) and children with cholera but non-malnourished (WAZ, WL/HZ or L/HAZ ≥−2.00 to ≤+2.00) were controls (n = 586). After adjusting for potential confounders such as maternal illiteracy, day labor fathers, maternal employment, slum dwelling, non-sanitary latrine use, use of untreated water, and history of cough, it was revealed that malnourished cholera children significantly more often presented in hospital during evening hours (6 p.m. to 12 mid-night) (p < 0.05), had illiterate fathers (p < 0.05), >24 h history of diarrheal duration (p < 0.05), dehydrating diarrhea (p < 0.05), and had longer hospitalization (p < 0.05). The study results underscore the importance of understanding of basic differences in the presentation of severity of cholera in malnourished children for prompt identification and subsequent management of these vulnerable children.

Visual Impairment and Risk of Self-Reported Road Traffic Crashes Among Bus Drivers in Bangladesh

PURPOSE

This study assesses the prevalence and the causes of visual impairment among bus drivers undergoing screening in Bangladesh and associations with self-reported crashes.

METHODS

Eye health screenings including refraction and questionnaires were conducted at 10 bus terminals in 7 districts of Bangladesh from June through August 2019. Presenting near and distance visual impairment and self-reported road traffic crashes were recorded.

RESULTS

Among 700 participants, nearly 1 in 5 (n = 126, 18.0%) had presented visual acuity (VA) in the better-seeing eye ≤6/9, not meeting the vision standard of Bangladesh for bus drivers. A majority of drivers (n = 492, 70.3%) had near or distance refractive error, and most who failed to reach the driving standard (88.1%, n = 111) could be improved with readily available treatment, either glasses or cataract surgery. A history of 1 or more road traffic crashes while driving a bus or minibus was reported by 62 (8.97%) participants. In multivariable models, factors significantly associated with near or distance visual impairment included older age [odds ratio (OR) per year 1.15, 95% confidence interval (CI): 1.12-1.18, P < 0.0001] and having no driver's license (OR 1.80, 95% CI: 1.04-3.13, P = 0.037). Self-reported history of a motor vehicle crash was associated with near or distance visual impairment (OR 2.45, 95% CI: 1.09-5.49, P = 0.030), even when adjusting for other factors such as age and weekly miles are driven.

CONCLUSIONS

Ensuring that bus drivers are screened to meet the required visual standards for driving while referring those who do not for treatment, can contribute to safer roads in this high-risk setting.

Comparison of virucidal efficacy of sodium hypochlorite, chlorine dioxide, peracetic acid, and ethanol against hepatitis A virus by carrier and suspension tests

A carrier (stainless steel disc as a default carrier) testing method is very needed for use in the actual food-processing fields by following the standard guideline. Here, we aimed to compare the virucidal efficacy of four commercial liquid disinfectants, including sodium hypochlorite (NaOCl), chlorine dioxide (ClO₂), and peracetic acid (PAA) against hepatitis A virus (HAV) following the OECD guideline protocol based on the quantitative carrier testing method and compared carrier testing results with the suspension testing results. The OECD method specifies a test for establishing whether a chemical disinfectant or a microbicide has a virucidal activity on hard non-porous surfaces. The antiviral efficacy was evaluated by plaque assays, and disinfectants were considered effective if the virus reduction was greater than or equal to 3 log₁₀ (99.9% decrease) for carrier or 4 log₁₀ (99.99% decrease) for suspension tests. Results indicated that ClO₂ above 500 ppm and 50% ethanol were effective in the carrier test method. In contrast, more than 200 ppm NaOCl and 50 ppm ClO₂ for all exposure times and 70% ethanol with contact for more than 5 min were effective in suspension tests. Treatment with PAA (80-2500 ppm) were not effective in carrier or suspension tests. Therefore, we recommend the use of more than 500 ppm ClO₂ or 50% ethanol with exposure for 10 min to disinfect surfaces that may be contaminated with HAV. Thus, these results could be effective in establishing official antiviral efficacy testing methods and basic data.

Molecular and pathogenic characterization of Vibrio parahaemolyticus isolated from seafood

Gastroenteritis infections in humans are mainly associated with consumption of Vibrio parahaemolyticus contaminated shellfish, which causes health and economic loss. Virulence factor production, antibiotic resistance profile, and biofilm-forming capacity of Vibrio parahaemolyticus isolates on food and food contact surfaces at 30 °C were investigated to evaluate the antibiotic sensitivity and pathogenic level. Strains of V. parahaemolyticus were isolated from shellfish (e.g., Crassostrea gigas, Venerupis philippinarum, Mytilus coruscus, Anadara kagoshimensis) in Korea. When examined for 17 virulence factor-encoding genes, 53.3, 73.1, 87.1, 87.9, and 90.9% of the isolates were positive for genes encoding TDH, T6SS, T3SS1, T3SS2, and Type I pilus, respectively. All isolates showed resistance to vancomycin, tetracyclines, penicillin, nalidixic acid, and doxycycline, among 26 antibiotics tested, with most isolates resistant to kanamycin (93.5%), ampicillin (96.8%), clindamycin (96.8%), tobramycin (88.7%), amikacin (83.97%), and minocycline (80.7%). Biofilm formation, cell-cell attachment, and motility were high in most isolates. These findings may assist in monitoring the epidemics of the pathogen. Continuous monitoring could help to decrease V. parahaemolyticus infections and improve seafood safety.

Listeria monocytogenes biofilm inhibition on food contact surfaces by application of postbiotics from Lactobacillus curvatus B.67 and Lactobacillus plantarum M.2

Owing to their preservative and antimicrobial effects, postbiotics (metabolic byproducts of probiotics) are promising natural components for the food industry. Therefore, the present study aimed to investigate the efficacy of postbiotics collected from isolated Lactobacillus curvatus B.67 and Lactobacillus plantarum M.2 against Listeria monocytogenes pathogens in planktonic cells, motility, and biofilm states. The analysis of the metabolite composition of the postbiotics revealed various organic acids, along with a few well-known bacteriocin-encoding genes with potential antimicrobial effects. Postbiotics maintained their residual antimicrobial activity over the pH range 1-6 but lost all activity at neutral pH (pH 7). Full antimicrobial activity (100%) was observed during heat treatment, even under the autoclaving condition.Minimum inhibitory concentration (MICs) of L. curvatus B.67 and L. plantarum M.2 against L. monocytogenes were 80 and 70 mg/mL, respectively. However, four sub-MICs of the postbiotics (1/2, 1/4, 1/8, and 1/16 MIC) were tested for inhibition efficacy against L. monocytogenes during different experiment in this study. Swimming motility, biofilm formation, and expression levels of target genes related to biofilm formation, virulence, and quorum-sensing were significantly inhibited with increasing postbiotics concentration. Postbiotics from L. plantarum M.2 exhibited a higher inhibitory effect than the postbiotics from L. curvatus B.67. Nonetheless, both these postbiotics from Lactobacillus spp. could be used as effective bio-interventions for controlling L. monocytogenes biofilm in the food industry.

Prenatal nutrition supplementation and growth biomarkers in preadolescent Bangladeshi children: A birth cohort study

Little is known about the usefulness of biomarkers to study the influence of prenatal nutrition supplementation in improving child growth. Anthropometry is not always straightforward to understand how nutrition might impact growth, especially in settings with high rates of malnutrition and infections. We examined the effects of prenatal supplementation on growth and growth biomarkers and the relationship between anthropometric measures and growth biomarkers of children at 4.5 and 9 years of age. Children were enrolled from a longitudinal cohort, where mothers were randomized into daily supplementation with either early‐food (≤9 gestation week [GW]) or usual‐food (~20 GW) (608 kcal 6 days/week); they were further randomized to receive 30‐mg or 60‐mg iron with 400‐μg folic acid, or multiple micronutrients (MM) in rural Bangladesh. Anthropometric data were collected from mothers at GW8 and children at 4.5 (n = 640) and 9 years (n = 536). Fasting blood was collected from children at each age. Early‐food supplementation showed reduced stunting and underweight at 4.5 and 9 years age respectively compared to usual‐food. Prenatal supplementations did not have any effect on growth biomarkers except for STAT5b expression which was lower in the early‐food compared to the usual‐food group (β = −0.21; 95 CI% = −0.36, −0.07). Plasma concentrations of 25‐hydroxy vitamin D and calcium were both inversely associated with weight‐for‐age and body mass index‐for‐age Z‐scores at 9 years, particularly in early‐food and MM groups. Although there was minimal effect on child growth by prenatal supplementations, the associations of biomarkers with anthropometric indices were predominantly driven by timing of food or MM supplementations.

Changes in Nutritional Status and Morbidities Among Children Having Severe Acute Malnutrition Attending a Nutrition Follow-Up Unit in Bangladesh Who Did Not Receive Any Food Supplementation

BACKGROUND

The problem of severe acute malnutrition (SAM) among <5 years old (U-5) children in Bangladesh is awful with higher risk of death or morbidities. However, there is no nationwide program where these children are managed with take-home therapeutic/supplementary food as recommended by World Health Organization.

OBJECTIVE

This study aimed to identify the changes in nutritional status and morbidities over 3 months of U-5 children having severe wasting (ie, SAM) whose parents refused to admit their children in the residential nutrition rehabilitation unit of the Dhaka Hospital of icddr, b, instead attended the nutrition follow-up unit (NFU), and thus did not receive any food supplementation during nutritional rehabilitation.

METHODS

At the NFU, these SAM children on every visit (fortnightly to monthly) received health and nutrition education, multivitamins, zinc and iron supplements, and treatment of illnesses if any.

RESULTS

During the study period, a total 180 U-5 SAM children came regularly for NFU visit for at least 3 months, and they comprised our study sample. Their age at first NFU visit (baseline) was 13.4 ± 7.8 months and 46% were female. Over these 3 month follow-up period, the rate of weight gain was 2.2 ± 1.9 g/kg/d, change in mid upper arm circumference was from 105 to 115 mm, and change in weight-for-length or weight-for-height z-score was from -2.70 ± 0.94 to -1.95 ± 1.00. During the prior 14 days to the 4 NFU follow-up visit, 13.6% to 22.8% had common cold and/or cough, and 12.2% to 15.1% had pneumonia.

CONCLUSION

Because the rate of weight gain was far below the expected ∼5 g/kg/d, the NFU visits without food supplementation are insufficient in terms of catchup growth. Thus, additional efforts are required to improve the management of these SAM children for their catchup growth.

Effects of environmental conditions (temperature, pH, and glucose) on biofilm formation of Salmonella enterica serotype Kentucky and virulence gene expression

Salmonella is a foodborne pathogen and an emerging zoonotic bacterial threat in the food industry. The aim of this study was to evaluate the biofilm formation by a cocktail culture of 3 wild isolates of Salmonella enterica serotype Kentucky on plastic (PLA), silicon rubber (SR), and chicken skin surfaces under various temperatures (4, 10, 25, 37, and 42°C) and pH values (4.0, 5.0, 6.0, 7.0, and 8.0). Then, at the optimum temperature and pH, the effects of supplementation with glucose (0, 0.025, 0.05, and 0.4% w/v) on biofilm formation were assessed on each of the surfaces. The results indicated that higher temperatures (25 to 42°C) and pH values (7.0 and 8.0) led to more robust biofilm formation than lower temperatures (4 and 10°C) and lower pH levels (4.0 to 6.0). Moreover, biofilm formation was induced by 0.025% glucose during incubation at the optimum temperature (37°C) and pH (7.0) but inhibited by 0.4% glucose. Consistent with this finding, virulence related gene (rpoS, rpoH, hilA, and avrA) expression was increased at 0.025% glucose and significantly reduced at 0.4% glucose. This results also confirmed by field emission scanning electron microscope, confocal laser scanning microscopy, and autoinducer-2 determination. This study concluded that optimum environmental conditions (temperature 37°C, pH 7.0, and 0.25% glucose) exhibited strong biofilm formation on food and food contract surfaces as well as increased the virulence gene expression levels, indicating that these environmental conditions might be threating conditions for food safety.