Association between short birth spacing and child malnutrition in Bangladesh: a propensity score matching approach

OBJECTIVES

This study aimed to explore the effects of short birth spacing (SBS), which is defined as a period of less than 33 months between two successive births, on multiple concurrent forms of child malnutrition (MCFCM) and at least one form of child malnutrition (ALOFCM) using propensity score matching (PSM).

METHODS

This study used data extracted from the 2017-18 Bangladesh Demographic and Health Survey. PSM with four different distance functions, including logistic regression, classification and regression tree, single hidden layer neural network and random forest, were performed to evaluate the effects of SBS on MCFCM and ALOFCM. We also explored how the effects were modified in different subsamples, including women's empowerment, education and economic status (women's 3E index)-constructed based on women's decision-making autonomy, education level, and wealth index, and age at marriage, and place of residence.

RESULTS

The prevalence of SBS was 22.16% among the 4652 complete cases. The matched samples of size 2062 generated by PSM showed higher odds of MCFCM (adjusted OR (AOR)=1.25, 95% CI=1.02 to 1.56, p=0.038) and ALOFCM (AOR=1.20, 95% CI=1.01 to 1.42, p=0.045) for the SBS children compared with their counterparts. In the subsample of women with 3E index≥50% coverage, the SBS children showed higher odds of MCFCM (AOR: 1.43, 95% CI=1.03 to 2.00, p=0.041] and ALOFCM (AOR: 1.33, 95% CI=1.02 to 1.74, p=0.036). Higher odds of MCFCM (AOR=1.27, 95% CI=1.02 to 1.58, p=0.036) and ALOFCM (AOR=1.23, 95% CI=1.02 to 1.51, p=0.032) for SBS children than normal children were also evident for the subsample of mothers married at age≤18 years.

CONCLUSION

SBS was significantly associated with child malnutrition, and the effect was modified by factors such as women's autonomy and age at marriage.

Two rare flavonoid glycosides from Litsea glutinosa (Lour.) C. B. Rob.: experimental and computational approaches endorse antidiabetic potentiality

BACKGROUND

Litsea glutinosa (Lour.) C. B. Rob. belongs to the Litsea genus and is categorized under the family of Lauraceae. The study aimed to investigate the phytoconstituents and pharmacological properties of methanol extract of leaves of Litsea glutinosa, focusing on antidiabetic activity via in vivo and in silico techniques.

METHODS

Extensive chromatographic and spectroscopic techniques were applied to isolate and characterize the constituents from the L. glutinosa plant species. The antidiabetic activity was studied in streptozotocin-induced diabetes mice, and the computational study of the isolated compounds was carried out by utilizing AutoDock Vina programs. In addition, the pharmacokinetic properties in terms of absorption, distribution, metabolism and excretion (ADME) and toxicological profiles of the isolated compounds were examined via in silico techniques.

RESULTS

In the present study, two flavonoid glycosides 4΄-O-methyl (2 ̋,4 ̋-di-E-p-coumaroyl) afzelin (1) and quercetin 3-O-(2 ̋,4 ̋-di-E-p-coumaroyl)-α-L-rhamnopyranoside (2) were isolated from the leaves of L. glutinosa and characterized by 1H and 13C NMR, COSY, HSQC, HMBC, and mass spectral data. Although compounds 1 and 2 have been reported twice from Machilis litseifolia and Lindera akoensis, and Machilis litseifolia and Mammea longifolia, respectively, this is the first report of this isolation from a Litsea species. Administering the methanolic extract of L. glutinosa at doses of 300 and 500 mg/kg/day to mice with diabetes induced by streptozotocin led to a significant decrease in fasting blood glucose levels (p < 0.05) starting from the 7th day of treatment. Besides, the computational study and PASS analysis endorsed the current in vivo findings that the both isolated compounds exerted higher binding affinities to human pancreatic α-amylase and aldose reductase than the conventional drugs. The in silico ADMET analysis revealed that the both isolated compounds have a favorable pharmacokinetic and safety profile suitable for human consumption.

CONCLUSION

According to the current outcomes obtained from in vivo and in silico techniques, the leaf extract of L. glutinosa could be a natural remedy for treating diabetes, and the isolated phytoconstituents could be applied against various illnesses, mainly hyperglycemia. However, more investigations are required for extensive phytochemical isolation and pharmacological activities of these phytoconstituents against broader targets with exact mechanisms of action.

Antimicrobial, antioxidant, and cytotoxic properties of endophytic fungi isolated from Thysanolaena maxima Roxb., Dracaena spicata Roxb. and Aglaonema hookerianum Schott

BACKGROUND

Endophytic fungi have recently been recognized as an impressive source of natural biomolecules. The primary objective of the research was to isolate fungal endophytes from Thysanolaena maxima Roxb., Dracaena spicata Roxb. and Aglaonema hookerianum Schott. of Bangladesh and assess their pharmacological potentialities focusing on antimicrobial, antioxidant, and cytotoxic properties.

METHODS

The fungal isolates were identified up to the genus level by analyzing their macroscopic and microscopic characteristics. Ethyl acetate extracts of all the fungal isolates were screened for different bioactivities, including antimicrobial (disc diffusion method), antioxidant (DPPH scavenging assay), and cytotoxic (brine shrimp lethality bioassay) activities.

RESULTS

Among the thirteen isolates, Fusarium sp. was the most recognized genus, while the others belonged to Colletotrichum sp. and Pestalotia sp. Comparing the bioactivity of all the extracts, Fusarium sp. was shown to be the most effective endophyte, followed by Colletotrichum sp. and Pestalotia sp. In the antimicrobial study, two isolates of Fusarium sp. (internal strain nos. DSLE-1 and AHPE-4) showed inhibitory activity against all the tested bacteria and the highest zone of inhibition (15.5 ± 0.4 mm) was exerted by AHPE-4 against Bacillus subtillis. All the fungal isolates produced mild to moderate free radical scavenging activity, where the highest antioxidant activity was revealed by one isolate of Fusarium sp. (internal strain no. AHPE-3) with an IC50 value of 84.94 ± 0.41 µg/mL. The majority of Fusarium sp. isolates exhibited notable cytotoxic activity, where AHPE-4 exhibited the highest cytotoxicity, having the LC50 value of 14.33 ± 4.5 µg/mL.

CONCLUSION

The findings of the study endorsed that the fungal endophytes isolated from T. maxima, D. spicata, and A. hookerianum hold potential as valuable origins of bioactive substances. Nevertheless, more comprehensive research is warranted, which could develop novel natural compounds from these endophytes to treat various infectious and cancerous diseases.

Chemico-pharmacological and computational studies of Ophiorrhiza fasciculata D. Don and Psychotria silhetensis Hook. f. focusing cytotoxic, thrombolytic, anti-inflammatory, antioxidant, and antibacterial properties

The current study sought to examine the pharmacological potentials of crude methanolic extracts of Ophiorrhiza fasciculata and Psychotria silhetensis, as well as their various solvent fractionates, with a focus on cytotoxic, thrombolytic, membrane stabilizing, antioxidant, and antibacterial activities via in vitro and in silico approaches. The extensive chromatographic and spectroscopic analyses confirmed and characterized two compounds as (±)-licarin B (1) and stigmasterol (2) from O. fasciculata and P. silhetensis, respectively. Petroleum ether soluble fraction of O. fasciculata and the aqueous soluble fraction of P. silhetensis showed the lowest 50% lethal concentrations (1.41 and 1.94 μg/mL, respectively) in brine shrimp bioassay. Likewise, petroleum ether soluble fraction of O. fasciculata and aqueous soluble fraction of P. silhetensis showed the highest thrombolytic activity with 46.66% and 50.10% lyses of the clot, respectively. The methanol and dichloromethane soluble fractions of O. fasciculata reduced erythrocyte hemolysis by 64.03% and 37.08%, respectively, under hypotonic and heat-induced conditions, compared to 81.97% and 42.12% for standard acetylsalicylic acid. In antioxidant activity test, aqueous soluble fraction O. fasciculata (IC50 = 7.22 μg/mL) revealed promising antioxidant potentialities in comparison to standard butylated hydroxytoluene (IC50 = 21.20 μg/mL). In antibacterial screening, chloroform, and dichloromethane soluble fractions of P. silhetensis showed a mild antibacterial activity compared with the standard drug ciprofloxacin. Additionally, the molecular docking study corroborated the current in vitro findings, and the isolated two constituents had higher binding affinities toward epidermal growth factor receptor, tissue plasminogen activator, vFLIP-IKK gamma stapled peptide dimer, glutathione reductase, and dihydrofolate reductase enzyme than their corresponding standard drugs. In addition, the both isolated compounds exerted favorable pharmacokinetics (absorption, distribution, metabolism, excretion) and toxicological profiles with drug-like qualities in computational-based ADMET and drug likeliness analyses. The current research suggests that both plants have potential as a natural treatment for treating thrombosis, inflammation, and oxidative stress. However, more thorough research is required to thoroughly screen for phytochemicals and pinpoint the precise mechanisms of action of the bioactive metabolites derived from these plants against a broad range of molecular targets.

Exploring the multifunctional roles of quantum dots for unlocking the future of biology and medicine

With recent advancements in nanomedicines and their associated research with biological fields, their translation into clinically-applicable products is still below promises. Quantum dots (QDs) have received immense research attention and investment in the four decades since their discovery. We explored the extensive biomedical applications of QDs, viz. Bio-imaging, drug research, drug delivery, immune assays, biosensors, gene therapy, diagnostics, their toxic effects, and bio-compatibility. We unravelled the possibility of using emerging data-driven methodologies (bigdata, artificial intelligence, machine learning, high-throughput experimentation, computational automation) as excellent sources for time, space, and complexity optimization. We also discussed ongoing clinical trials, related challenges, and the technical aspects that should be considered to improve the clinical fate of QDs and promising future research directions.

A Modified Approach for Harvesting Non Vascularized Fibular Graft for Pediatric Age Group

The conventional technique of harvesting free non-vascularized fibular grafting is associated with different scale of morbidity and usually a long scar. We follow a technique that causes minimum interference to the surrounding soft tissues to harvest the desired length of fibula. This prospective study was performed at Department of Orthopaedics, Dhaka Medical College Hospital from January 2018 to December 2018. Thirty patients of average age 10.5 years (range 8 to 14 years) were taken up for the study. The fibula was harvested by two separate incisions, 1 cm each at proximal and distal extent of proposed length of graft after elevating the periosteum circumferentially using a periosteum elevator. Compression bandage and above knee plaster immobilization was applied that help to reduce hematoma formation. The mean follow up is 12 months. The patients were evaluated clinically and by radiology. Twenty nine patients showed good results. One patient had delayed wound healing resulting in fair result. This modified approach of harvesting fibula reduces donor site morbidity and is safer and easier than conventional approach.

Corrigendum to “Prevalence and associated risk factors for mental health problems among female university students during COVID-19 pandemic: A cross-sectional study findings from Dhaka, Bangladesh” [Heliyon 8 (10) (October 2022) Article e10890]

[This corrects the article DOI: 10.1016/j.heliyon.2022.e10890.].

Potential candidates from marine and terrestrial resources targeting mitochondrial inhibition: Insights from the molecular approach

Mitochondria are the target sites for multiple disease manifestations, for which it is appealing to researchers' attention for advanced pharmacological interventions. Mitochondrial inhibitors from natural sources are of therapeutic interest due to their promising benefits on physiological complications. Mitochondrial complexes I, II, III, IV, and V are the most common sites for the induction of inhibition by drug candidates, henceforth alleviating the manifestations, prevalence, as well as severity of diseases. Though there are few therapeutic options currently available on the market. However, it is crucial to develop new candidates from natural resources, as mitochondria-targeting abnormalities are rising to a greater extent. Marine and terrestrial sources possess plenty of bioactive compounds that are appeared to be effective in this regard. Ample research investigations have been performed to appraise the potentiality of these compounds in terms of mitochondrial disorders. So, this review outlines the role of terrestrial and marine-derived compounds in mitochondrial inhibition as well as their clinical status too. Additionally, mitochondrial regulation and, therefore, the significance of mitochondrial inhibition by terrestrial and marine-derived compounds in drug discovery are also discussed.

Comparative Performance Evaluation of Personal Protective Measures and Antiviral Agents Against SARS-CoV-2 Variants: A Narrative Review

Scientists identified SARS-CoV-2 in December 2019 in Wuhan city of China. Soon after its identification, Covid-19 spreads almost everywhere. The World Health Organization (WHO) declared the Covid-19 outbreak as a pandemic on March 11, 2020. Countries are facing multiple waves due to the different variants of the coronavirus. Personal preventive measures, vaccines, and antiviral drugs are the approaches to control Covid-19. However, these approaches are being implemented in different countries at different levels because of the availability of personal protective measures and antiviral agents. The objective of this study was to evaluate the effectiveness of practicing measures to fight the Covid-19 pandemic. Here we searched relevant literature from PubMed and Scopus using the keywords such as personal protective measures, antiviral agents, and vaccine effectiveness. According to the present findings, protective measures were found comparatively less effective. Nevertheless, these measures can be used to limit the spreading of Covid-19. Antiviral agents can reduce the hospitalization rate and are more effective than personal protective measures. The most effective strategy against Covid-19 is early vaccination or multiple vaccination dose. The respective authorities should ensure equal distribution of vaccines, free availability of antiviral drugs, and personal protective measure in poor and developing countries. We recommend more studies to describe the effectiveness of practicing preventive measures and antiviral agents against recent variants of the coronavirus.

Strategies to tackle SARS-CoV-2 Mu, a newly classified variant of interest likely to resist currently available COVID-19 vaccines

Several severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have recently been reported in many countries. These have exacerbated the coronavirus disease 2019 (COVID-19)-induced global health threats and hindered COVID-19 vaccine development and therapeutic progress. This commentary discusses the potential risk of the newly classified Mu variant of interest, seeming a highly vaccine-resistant variant, and the approaches that can be adopted to tackle this variant based on the available evidence. The SARS-CoV-2 B.1.621 (Mu variant) lineage has shown approximately ten times higher resistance to neutralizing sera obtained from COVID-19 survivors or BNT161b2-vaccinated people than the parenteral B.1 lineage. Several urgent and long-term strategic plans, including quick genomic surveillance for uncovering the genetic characteristics of the variants, equitable global mass vaccination, booster dose administration if required, and strict implementation of public health measures or non-pharmaceutical interventions, must be undertaken concertedly to restrict further infections, mutations, or recombination of the SARS-CoV-2 virus and its deadly strains.

Attitudes of mental healthcare professionals and media professionals towards each other in reducing social stigma due to mental illness in Bangladesh

Mental illness is a neglected issue all over the world. The development of negligence towards mental illness could be due to the stigmatized attitudes. Also, social stigma due to mental illness is prevalent in many south Asian countries. In Bangladesh, the condition is even worse than regional data in Asia. The general people consider media as a primary source of information about mental health. However, mental health professionals (MHP) have direct contact with psychiatric patients and their family members. Therefore, both MHP and media professionals (MP) have a role in reducing social stigma due to mental illness. The present study aimed to identify attitudes of MHP and MP towards each other in reducing social stigma due to mental illness. We conducted a cross-sectional online survey among 174 participants (80 MHP and 94 MP). We used two sets of self-reporting questionnaires to assess the attitudes of MHP and MP towards one another. Also, we collected and analyzed sociodemographic profiles of study participants. We observed significant differences in terms of their profession-related statements between MHP and MP. Also, we have seen significant gaps between MHP and MP in terms of their complete agreement on attitude-related aspects. However, most respondents agreed that stigma due to mental illness is a vital problem in Bangladesh. Moreover, maximum participants accepted that the current public images about psychiatry and media role in reducing social stigma need to be improved. We observed gap between MHP and MP in their roles and beliefs in reducing social stigma due to mental illness in Bangladesh. Reciprocal training and awareness programs would help them in reducing social stigma due to mental illness. The findings of the present study would help to sort out the possible areas for interventions. However, the present study has few limitations; therefore, we recommend further studies with more homogeneous and large samples to make better conclusion.

A renewed concept on the MAPK signaling pathway in cancers: Polyphenols as a choice of therapeutics

Abnormalities in the mitogen-activated protein kinase (MAPK) signaling pathway are a key contributor to the carcinogenesis process and have therefore been implicated in several aspects of tumorigenesis, including cell differentiation, proliferation, invasion, angiogenesis, apoptosis, and metastasis. This pathway offers multiple molecular targets that may be modulated for anticancer activity and is of great interest for several malignancies. Polyphenols from various dietary sources have been observed to interfere with certain aspects of this pathway and consequently play a substantial role in the development and progression of cancer by suppressing cell growth, inactivating carcinogens, blocking angiogenesis, causing cell death, and changing immunity. A good number of polyphenolic compounds have shown promising outcomes in numerous pieces of research and are currently being investigated clinically to treat cancer patients. The current study concentrates on the role of the MAPK pathway in the development and metastasis of cancer, with particular emphasis on dietary polyphenolic compounds that influence the different MAPK sub-pathways to obtain an anticancer effect. This study aims to convey an overview of the various aspects of the MAPK pathway in cancer development and invasion, as well as a review of the advances achieved in the development of polyphenols to modulate the MAPK signaling pathway for better treatment of cancer.

Therapeutic potential of marine macrolides: An overview from 1990 to 2022

The sea is a vast ecosystem that has remained primarily unexploited and untapped, resulting in numerous organisms. Consequently, marine organisms have piqued the interest of scientists as an abundant source of natural resources with unique structural features and fascinating biological activities. Marine macrolide is a top-class natural product with a heavily oxygenated polyene backbone containing macrocyclic lactone. In the last few decades, significant efforts have been made to isolate and characterize macrolides' chemical and biological properties. Numerous macrolides are extracted from different marine organisms such as marine microorganisms, sponges, zooplankton, molluscs, cnidarians, red algae, tunicates, and bryozoans. Notably, the prominent macrolide sources are fungi, dinoflagellates, and sponges. Marine macrolides have several bioactive characteristics such as antimicrobial (antibacterial, antifungal, antimalarial, antiviral), anti-inflammatory, antidiabetic, cytotoxic, and neuroprotective activities. In brief, marine organisms are plentiful in naturally occurring macrolides, which can become the source of efficient and effective therapeutics for many diseases. This current review summarizes these exciting and promising novel marine macrolides in biological activities and possible therapeutic applications.

Child drownings in Bangladesh: need for action

Drowning is one of the major public health concerns, and children are the most vulnerable victims of drowning death in Bangladesh, which has been a paramount threat to child survival. Based on available data, we intend to underline the prevalence and associated risk factors for child drowning deaths in Bangladesh. According to the Center for Injury Prevention and Research, Bangladesh, about 19 000 people of all ages drown per year across the country, where approximately 77% are children (<18 years), which means that over 40 Bangladeshi children drown per day. A recent survey reported that as of data collected from January 2020 to June 2021, 83% of drowning victims were children. Insufficient parental supervision, mother's illiteracy, lack of swimming ability, male gender, children under 5 years, geographical and environmental conditions, seasonality, and disasters significantly contribute to child drowning deaths in Bangladesh. We urge the governments and local administrations to address the current crisis by coordinating and integrating several effective efforts to prevent child drowning deaths.

Prospective multifunctional roles and pharmacological potential of dietary flavonoid narirutin

Plant-based phytochemicals are now being used to treat plenty of physiological diseases. Herbal drugs have gained popularity in recent years because of their strength, purity, and cheap cost-effectiveness. Citrus fruits contain significant amounts of flavanones, which falls to the category of polyphenols. Flavanones occupy a major fraction of the total polyphenols present in the plasma when orange juice is taken highly or in moderate states. Narirutin is a disaccharide derivative available in citrus fruits, primarily dihydroxy flavanone. From a pharmacological viewpoint, narirutin is a bioactive phytochemical with therapeutic efficacy. Many experimental researches were published on the use of narirutin. Anticancer activity, neuroprotection, stress relief, hepatoprotection, anti-allergic activity, antidiabetic activity, anti-adipogenic activity, anti-obesity action, and immunomodulation are a couple of the primary pharmacological properties. Narirutin also has antioxidant, and anti-inflammatory activities. The ultimate goal of this review is to provide the current scenario of pharmacological research with narirutin; to make a better understanding for therapeutic potential of narirutin, as well as its biosynthesis strategies and side effects. Extensive literature searches and studies were undertaken to determine the pharmacological properties of narirutin.

Medicinal plants used against hepatic disorders in Bangladesh: A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Liver disease is a major cause of illness and death worldwide which accounts for approximately 2 million deaths per year worldwide, 1 million due to complications of cirrhosis and 1 million due to viral hepatitis and hepatocellular carcinoma. That's why it is seeking the researchers' attention to find out the effective treatment strategies. Phytochemicals from natural resources are the main leads for the development of noble hepatoprotective drugs. The majority of the natural sources whose active compounds are currently employed actually have an ethnomedical use. Ethnopharmacological research is essential for the development of these bioactive compounds. These studies not only provide scientific evidence on medicinal plants utilized for particular therapeutic purposes, but they also ensure cultural heritage preservation. Plenty of experimental studies have been well-documented that the ethnomedicinal plants are of therapeutics' interest for the advanced pharmacological intervention in terms of hepatic disorders.

AIM OF THE STUDY

This study summarizes the processes of hepatotoxicity induced by various toxins and explores identified hepatoprotective plants and their phytoconstituents, which can guide the extraction of novel phytochemical constituents from plants to treat liver injury. This review aimed to summarize the hepatoprotective activity of Bangladeshi medicinal plants where the bioactive compounds may be leads for the drug discovery in future.

MATERIALS AND METHODS

Literature searches in electronic databases, such as Web of Science, Science Direct, SpringerLink, PubMed, Google Scholar, Semantic Scholar, Scopus, BanglaJOL, and so on, were performed using the keywords 'Bangladesh', 'ethnomedicinal plants', 'Hepatoprotective agents' as for primary searches, and secondary search terms were used as follows, either alone or in combination: traditional medicine, medicinal plants, folk medicine, liver, hepatitis, therapeutic uses, and anti-inflammatory. Besides, several books, including the book entitled "Medicinal plants of Bangladesh: chemical constituents and uses" authored by Abdul Ghani, were carefully considered, which contained pharmacological properties and phytoconstituents of many medicinal plants growing and traditionally available in Bangladesh. Among them, the most promising plant species with their latest therapeutic effects against hepatic disorders were deeply considered in this review.

RESULTS

The results of this study revealed that in most cases, therapy using plant extracts stabilized altered hepatic biochemical markers induced by hepatotoxins. Initially, we investigated 32 plant species for hepatoprotective activity, however after extensive literature searching; we observed that 20 plants offer good pharmacological evidence of hepatoprotective function. Consequently, most bioactive compounds derived from the herbs including berberine, thymoquinone, andrographolide, ursolic acid, luteolin, naringenin, genistein, quercetin, troxerutin, morin, epigallocatechin-3-gallate, chlorogenic acid, emodin, curcumin, resveratrol, capsaicin, ellagic acid, etc. are appeared to be effective against hepatic disorders.

CONCLUSIONS

Flavonoids, phenolic acids, monoterpenoids, diterpenoids, triterpenoids, alkaloids, chromenes, capsaicinoids, curcuminoids, and anthraquinones are among the phytoconstituents were appraised to have hepatoprotective activities. All the actions displayed by these ethnomedicinal plants could make them serve as leads in the formulation of drugs with higher efficacy to treat hepatic disorders.

Status of psychological health of students following the extended university closure in Bangladesh: Results from a web-based cross-sectional study

Students' severe affective mental distress has emerged as significant public health attention globally because of the disastrous effects of coronavirus disease 2019 (COVID-19). The current study aimed at exploring the prevalence of two alarming psychological distresses, depression and anxiety, among university students following a prolonged shutdown of educational institutions in Bangladesh. A cross-sectional online-based study was conducted by deploying two standard scales to assess the depression and anxiety among Bangladeshi students from various universities amid the 2nd stream of the COVID-19 pandemic. A total of 568 Bangladeshi university students participated in this questionnaire-based survey through various social media platforms. Frequency and percentage distribution as univariate, chi-square (χ2) test as bivariate, and logistic regression as multivariate analyses were applied to investigate the prevalence of depression and anxiety and their associated various sociodemographic factors. After cleaning and eliminating the partial data, we analyzed 465 responses, where 42% were female and 64.3% were from public universities. Both mental disorders were prevalent in more than 50% of Bangladeshi university students. The students from the private universities were two times and 2.7 times more depressed and anxious, respectively than the students from the public universities. In addition, the students who became incomeless had significantly more anxiety (adjusted odds ratio [AOR] = 1.711; p = 0.018) than those who did not lose income source during the COVID-19 lockdown. The present study revealed that more than 50% of Bangladeshi university students were suffering from depression and anxiety. Several effective measures must be assured by the concerted efforts of university authorities, educationalists, and the Government to alleviate these distressing mental health burdens.

The Upsurge of Diarrhea Amid COVID-19 Pandemic Makes Matter Worse in Bangladesh: A Call to Action

We have seen an alarming increase in diarrhea prevalence amid Coronavirus Disease-2019 (COVID-19) in Bangladesh. Healthcare professionals might face difficulty in diagnosis as these two infectious diseases have some common symptoms. Though there are confirmatory diagnostic tests for individual cases, there are chances of misdiagnosis as co-infections occur. Here we presented distinct clinical features of diarrhea and COVID-19 for differential diagnosis. We demonstrated the common overlapping symptoms of these two infectious diseases to facilitate fast diagnosis of patients. Also, we have discussed possible reasons for this upsurge of diarrheal infections in Bangladesh. Finally, we have made some recommendations based on our findings for managing this upsurge of diarrheal disease during the COVID-19 pandemic in Bangladesh. The healthcare authorities should take immediate measures before the tremendous twin effects of these two infectious diseases.

Delta variant and black fungal invasion: A bidirectional assault might worsen the massive second/third stream of COVID-19 outbreak in South-Asia

BACKGROUND

Here, we have shortly reported the recent updates on the disastrous progressions of the deadly delta variant and a virulent coinfection or post-COVID-19 infection of black fungus in India and its neighbouring countries.

METHODOLOGY

We searched by utilizing appropriate keywords in Google Scholar, PubMed and other scholarly databases alongside several national and international newspapers to collect the latest data regarding the targeted topic.

RESULTS

Recently, the delta variant is wreaking havoc in India, UK, and other countries around the globe and has also exhibited successful infections in around 20 to 55% of the people who have already recovered from COVID-19 originating from the different strains. Besides, a significant catch is the prevalence of 85.5% and 64.11% of Mucormycosis infections being co-morbid with COVID-19 and diabetes, respectively in South-Asian regions.

CONCLUSIONS

To avert the emergence of an epidemic amid the pandemic, prompt actions from concerned authorities are warranted. Proper education on black fungus infection and associated risks from the COVID-19 and diabetes, adequate public awareness, and sufficient healthcare assistance to battle such fungal infections effectively should be ensured as quickly as possible.

Recommendation and Roadmap of Mass Vaccination against Coronavirus Disease 2019 Pandemic in Bangladesh as a Lower-Middle-Income Country

Low-income countries (LICs) and lower-middle-income countries (LMICs) are still deprived of the optimum doses of coronavirus disease 2019 (COVID-19) vaccines for their population, equal access and distribution, as well as mass immunization roadmaps to be implemented for achieving herd immunity and protection from the ongoing pandemic. In this short report, we are interacting with the world public health experts, as well as national and global leaders for warranting the mass vaccination drive to be more progressive against COVID-19 with equitable access of vaccines to LICs or LMICs to save the lives of the poorest country people and refugees. From several scientific databases, such as Google Scholar, PubMed, as well as national and international news websites, the data were collected data by utilizing appropriate keywords regarding the topic. Bangladesh might be exemplified in this brief communication as the representative of LMIC. As of October 14, 2021, 48% of the world's people have received at least one dose of the COVID-19 vaccine. In contrast, only 2.5% of people from LICs have come in under COVID-19 vaccination for at least a single shot. Both LICs and LMICs need far more vision and ambition, including political, administrative, and diplomatic progress along with enhancing the vaccination drive for their population to be immunized through simultaneous mass vaccination progress of other countries with implementing public health safety measures against the COVID-19 pandemic.

Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects

Antibiotics have been used to cure bacterial infections for more than 70 years, and these low-molecular-weight bioactive agents have also been used for a variety of other medicinal applications. In the battle against microbes, antibiotics have certainly been a blessing to human civilization by saving millions of lives. Globally, infections caused by multidrug-resistant (MDR) bacteria are on the rise. Antibiotics are being used to combat diversified bacterial infections. Synthetic biology techniques, in combination with molecular, functional genomic, and metagenomic studies of bacteria, plants, and even marine invertebrates are aimed at unlocking the world's natural products faster than previous methods of antibiotic discovery. There are currently only few viable remedies, potential preventive techniques, and a limited number of antibiotics, thereby necessitating the discovery of innovative medicinal approaches and antimicrobial therapies. MDR is also facilitated by biofilms, which makes infection control more complex. In this review, we have spotlighted comprehensively various aspects of antibiotics viz. overview of antibiotics era, mode of actions of antibiotics, development and mechanisms of antibiotic resistance in bacteria, and future strategies to fight the emerging antimicrobial resistant threat.

Exploring public awareness and spreading pattern analysis of COVID-19 outbreak in Bangladesh

Background: The highly transmissible coronavirus disease 2019 (COVID-19) has plagued the worldwide population with a continuous upward thrust of the death toll, which might be related to insufficient knowledge, attitudes, and behavioral (KAB) score, and public awareness. Objective: The current research sought to explore public awareness in terms of knowledge, attitudes, and behavioral responses toward COVID-19 and analyze its spreading pattern during the embryonic phase in Bangladesh. Methods: From March 19 to April 15 of 2020, seventeen planned questions were answered by the Bangladeshi respondents recruited through a simple snowball sampling technique. Informed consent from each participant was taken in the survey. Results: Out of the total participants (n = 1861), 34.65% were female, and 40.83% had an education level up to Junior School Certificate (JSC). Among all the demographic variables, the highest average knowledge, attitudes and behaviors scores (mean ± SD) were reported for 18- 30 years age group (4.07 ± 1.01 out of 5; 95% confidence interval, [CI] = 4.01-4.13; p< 0.001), above 50 years age group (1.70 ± 0.64 out of 3; 95% CI = 1.59-1.80; p< 0.001), and bachelor or higher degree group (2.64 ± 0.83 out of 4; 95% CI = 2.57-2.70, p< 0.001), respectively. It was clearly depicted that the obtained knowledge score was associated with poor attitudes and behaviors. Conclusion: Education on basic health sciences as well as overwhelming campaign and publicity must be pointed at enhancing KAB scores towards COVID-19 in Bangladesh. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.108-117

Association between the use of social networking sites and mental health of young generation in Bangladesh: A cross-sectional study

The social networking sites (SNS) are popular among people of all levels. Here we aimed to evaluate the relationship between the use of SNS and the mental health of the young generation in Bangladesh. We conducted this cross-sectional study among 791 subjects aged between 15 and 40 years. Self-reported questionnaires were used to collect demographics and SNS usage patterns of the respondents. We have measured the levels of loneliness, depression, generalized anxiety, and sleep disturbance using the recommended mental health assessment scales. The estimations of loneliness, depression, generalized anxiety, and sleep disturbance among the respondents were 64%, 38%, 63%, and 75%, respectively. Young adults, female sex, unmarried individuals, students, and urban residents reported higher psychological issues regarding the SNS use. Reported mental health issues were associated with time spent in SNS, the number of friends and groups connected with, personal beliefs, and feeling about SNS. A notable association between the use of SNS and the mental health issues of users has been ascertained. The present study findings might have significant implications in the field of clinical psychology and psychotherapy. Therefore, we recommend more comprehensive clinical interventions to find the tangible impact of SNS on the mental health of users.

Vaccination against COVID-19 in Bangladesh: Perception and Attitude of Healthcare Workers in COVID-dedicated Hospitals

Healthcare professionals are the crucial and influencing source of information for vaccines and their communication among patients and communities that can accelerate successful vaccination in a country. This cross-sectional study was one of the first and foremost ones in Bangladesh to observe the basic perception and attitudes towards vaccination against COVID-19 among the healthcare workers (HCWs) - doctors, interns, nurses, ward boys, cleaners, and medical technologists of major COVID-dedicated hospitals. The cross-sectional questionnaire-based study was conducted in February 2021 among 550 HCWs to assess the perception and attitude towards vaccination against COVID-19. The study participants were targeted as the priority group for COVID-19 vaccination, working in two major COVID-dedicated hospitals, Holy Family Red Crescent Medical College Hospital (HF-center), and Sheikh Russel National Gastro-liver Institute and Hospital (SR-center) in Dhaka, Bangladesh during the pandemic. The questionnaire was structured with a three-point scale of responses from 'true', 'false', and 'do not know'. The responses were calculated on point-score as +1 for the correct response, -1 for the wrong response, and 0 for 'do not know' with an overall highest and the lowest possible score of +5 to -5. Absolute (n) and relative frequencies (%) were presented for qualitative variables, while quantitative variables were presented as mean (± standard deviation). Chi-square test was done for univariate analysis of qualitative variables and Student's t-test for quantitative variables. With the 95.27% response rate, including 204 males and 320 were female and the male: female ratio was 1: 1.56. The majority of the participants were doctors (45.8%) followed by nurses (27.9%), and MLSS (26.3%) respectively. The respondents were between 18 to 64 years of age with a mean of 36.17±10.94 years. Most of the respondents (95.99%) responded correctly about the cost-free availability of a vaccine against COVID-19 in the country, 87.40% preferred vaccination as safe and effective. Again 29.77% HCWs think the vaccine might not be safe or effective due to emergency authorization. Only 38.93% of respondents could respond correctly about the necessity of vaccines for children, 31.10% think the vaccination was not required instead of natural immunity. The positive perception and attitude of the frontline HCWs in COVID-dedicated hospitals in Bangladesh are crucial which will positively influence motivation and wide acceptance among the general population for the attainment of the nationwide vaccination program, and adopt effective strategic modification to minimize the gaps for a low-middle income country like Bangladesh with its resource constrain.

Understanding and Dealing the SARS-CoV-2 Infection: An Updated Concise Review

Viral infection has made the world to pass through the most critical time of the current century. In December 2019, the Wuhan city of China faced a novel etiological viral agent with atypical secondary pneumonia. The unique virus was severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that caused coronavirus disease 2019 (COVID-19) pandemic. According to the worldometer data, as of December 24, 2020, the world lost more than 1.74 million lives and infected more than 79.3 million people with the novel coronavirus-2. As there is no approved drug to combat the disease or vaccine against the virus, the infection continuously triumphed over the current medical system. The epidemiological analysis showed that geriatric patients are generally the most susceptible to the viral infection, and pediatric patients exhibited milder complications. The clinical characteristics of COVID-19 displayed that the most frequent symptoms are dry cough, fever, dyspnea, and sputum production. Herd immunity is a tested strategy that could moderate viral transmission in developing countries. In this study, authors abridged the epidemiological outcomes, clinical features, and pathophysiology of SARS-CoV-2 infection. The article also focused on vaccine development, herd immunity, and the most promising repurposed therapeutics for the treatment of COVID-19 with their clinical trial updates. Bangladesh Pharmaceutical Journal 24(1): 61-75, 2021

COVID-19 and child marriage in Bangladesh: emergency call to action

The social burden of Bangladesh's already prevalent child marriage problem has further flared up amid the ongoing COVID-19 pandemic. We aim to briefly report on the current scenario of underage marriage in Bangladesh from available sources and highlight concerns. The prevalence of child marriage has increased by at least 13% due to pandemic-enforced long-term school closure throughout the country, while many cases remain unreported. Exacerbated financial crisis, the prolonged shutdown of educational institutions and social insecurities are the principal triggering factors for such a high pace of child marriages. We urge the government and local administrations to address the current situation through concerted and integrated efforts to combat the early marriage crisis in Bangladesh.

Repurposing therapeutic agents against SARS-CoV-2 infection: most promising and neoteric progress

INTRODUCTION

The pathogenic and highly transmissible etiological agent, SARS-CoV-2, has caused a serious threat COVID-19 pandemic. WHO has declared the epidemic a public health emergency of international concern owing to its high contagiosity, mortality rate, and morbidity. Till now, there is no approved vaccine or drug to combat the COVID-19 and avert this global crisis.

AREAS COVERED

In this narrative review, we summarized the updated results (January to August 2020) of the most promising repurposing therapeutic candidates to treat the SARS-CoV-2 viral infection. The repurposed drugs classified under four headlines like antivirals, anti-parasitic, immune-modulating, and miscellaneous drugs were discussed with their in vitro efficacy to recent clinical advancements against COVID-19.

EXPERT OPINION

Currently, palliative care, ranging from outpatient management to intensive care, including oxygen administration, ventilator support, intravenous fluids therapy, with some repurposed drugs, are the primary weapons to fight against COVID-19. Until a safe and effective vaccine is developed, an evidence-based drug repurposing strategy might be the wisest option to save people from this catastrophe. Several existing drugs are now under clinical trials, and some of them are approved in different places of the world for emergency use or as adjuvant therapy in COVID-19 with standard of care.

Is Bangladesh Moving toward Herd Immunity? Current COVID-19 Perspective

Globally, a spectrum of infectious disease outbreaks like SARS in 2013, Ebola in 2014, MERS in 2015, and currently COVID-19, have affected us in the early phase of this century and coerced the people across the world to search the adamant control measures to avert the pandemic by any means. Unfortunately, high economic costs and resource-limitations, especially in low-and middle-income countries, restrict the adoption of the epidemic control measures in most cases. Since late December of 2019, the SARS-CoV-2 virus has been creating a breakneck public health concern worldwide. Currently, there is no effective drug to tackle the COVID-19 infection or vaccine yet to be approved. An old-age concept, herd immunity might be a prospective option in this uncertain situation to fight the COVID-19 pandemic. A minimum fraction of people need to be immunized through vaccination or previous infection to attain the herd immunity base that may build an obstacle to free the community from the disease. The insusceptible or indirectly immunized people can act as an invisible shield to impede the epidemic's dispersion anymore. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S63-S66

Impact of COVID-19 Pandemic among Health Care Providers in Bangladesh: A Systematic Review

Background: The world has been passing the most critical time of the century with the COVID-19 pandemic since late December 2019, and numerous people, including a significant portion of health care providers, got the infection and are still sacrificing their lives. Objective: The study was aimed systematically to assess the severity of the SARS-CoV-2 infection, especially in health care sectors, and to appraise the physical, psychological, and social effects of the COVID-19 epidemic among frontline fighters in Bangladesh. Methodology: The keywords: “COVID-19”, “SARS-CoV-2”, “health care system in Bangladesh”, “health care providers”, etc. were searched to collect the desired articles by utilizing various search engines like google, google scholar, pub med, and science direct journals. Data were extracted and finally, were summarized, discussed, analysed, and reported the study results. Result: Numerous specialist doctors, nurses, and all other healthcare workers are immolating their lives to save human entities amid the current coronavirus pandemic, 2019 (COVID-19). In Bangladesh, till August 9, 2020, 73 doctors, including some senior specialists, died of COVID-19 infection reported by various national newspapers. At the early phase of this epidemic in Bangladesh, around 10% of the total infection was found among health workers, alarmingly reported by the Bangladesh Medical Association (BMA). These frontline fighters are additionally confronting numerous challenges, including psychological sufferings, and furthermore, they are assaulted by the society. Conclusion: Since these fighters are relinquishing their beloved lives to protect us from this brutal virus, we are trying to show our profound gratitude, appreciation, thousands of salutes, and undying tribute to these health care fighters with this publication. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S8-S15

Transition Metal Chelation Augments the Half-life of Secnidazole: Molecular Docking and Fluorescence Spectroscopic Approaches

This current research aimed to establish the most required pharmacodynamics parameters of two transition metal complexes of an antimicrobial drug secnidazole. The spectroscopic fluorescence quenching strategy was outlined to evaluate the binding mechanism and binding affinity of nickel (II) and chromium (III) complexes of secnidazole with bovine serum albumin (BSA). The conformational modifications and the interacting patterns of the protein due to the interaction of the parent compound of the metal complexes have been investigated by molecular docking approach. The ligand-protein interactions were confirmed by the spectral quelling of the serum protein's intensity in the presence of metal chelate of secnidazole. The quenching mechanism was an endothermic dynamic process. The calculated thermodynamic factors delineated van der Waals interactions mainly influenced the spontaneous process. The UV-fluorescence curves were studied to establish the energy transformation profile according to the Förster resonance energy transfer (FRET) theory. The double-logarithm plot exhibited the binding number that ensured the drug-protein interaction was at a 1:1 ratio. The compared binding constants dictated that both metal chelates gained higher binding affinity, longer half-life, and achieved the capacity to show the pharmacological effects by a lower dose than the parent molecule.

Does Rabeprazole Sodium Alleviate the Anti-diabetic Activity of Linagliptin? Drug-Drug Interaction Analysis by In vitro and In vivo Methods

Drug interaction has turned into the preeminent regarding issues for a prescriber during polypharmacy. The foremost objective of this research was to form a complex between linagliptin and rabeprazole sodium by in vitro interactions. The interactions between the drugs have been examined by monitoring some chromatographic and spectroscopic analyses viz. TLC, HPLC, FT-IR, UV, Job's plot, conductometric titrations, and Ardon's spectrophotometric strategy. Rabeprazole sodium formed a stable complex with linagliptin, which was ensured from the insight of these analytical data. The developed complex's bright spot was clearly watched in the TLC plate. The retention time (R_t) of the formed complex was 5.303 min, where the R_t were 3.364 and 3.103 min for linagliptin and rabeprazole sodium, respectively, in HPLC chromatograms. In FT-IR and UV spectra of the formed complex revealed some disappearance of characteristic peaks that affirmed the complexation. All of the variations of the spectrophotometric and chromatographic properties from the antecedent drugs indicated the drug-drug interaction. Another crucial fact for the experimental aim was to affirm the assumed drug interaction by in vivo model examination. The assessment of anti-diabetic property on alloxan-induced Swiss albino mice proved significant in vivo interaction between the drugs. It was outlined from the animal study that the hypoglycemic activity of linagliptin might be significantly affected due to the complex formation of the drug with a proton pump inhibitor (PPI). Nonetheless, it is the primary outcome of the interaction, which recommends the bigger in vivo study or clinical monitoring on the human model.

Effect of Intravenous Paracetamol with Bupivacaine Scalp Nerve Block on Haemodynamics Response as Well as Anaesthetic Requirements during Supratentorial Craniotomies

Noxious stimuli during craniotomy may encourage hypertension and tachycardia, which may rise to morbidity in patients with intracranial hypertension. After craniotomy a moderate level of postoperative pain observed. The objective of this study was to observe the effect of intravenous paracetamol with bupivacaine scalp nerve block (SNB) on haemodynamics response as well as anaesthetic & analgesic requirements during supratentorial craniotomies. This is a single-blind, placebo-controlled, randomized clinical trial carried out in the Neurosurgery operation theatre from August 2015 to July 2017 under supervision of Department of Anaesthesia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 40 patients aged 18-60 years with supratentorial space occupying lesion undergoing craniotomy under general anaesthesia who were attended in the department of Neurosurgery, BSMMU were enrolled in this study and they were divided randomly into two groups, 20 patients in each. The Group A received 100ml normal saline infusion and 0.25% bupivacaine (20ml) in scalp block, while the Group B received intravenous injection paracetamol (1gm) and 0.25% bupivacaine (total 20ml) in scalp block. Statistical analyses were obtained Statistical Packages for Social Sciences (SPSS-22). The mean systolic blood pressure varied within the normal range in both groups. The mean DBP of Group B remained significantly lower than that of Group A in different follow up except at 30 minutes and 60 minutes after dura incision. However, mean MAP of Group B remained significantly lower than that of Group A in different time interval. The mean heart rate of Group B remained significantly lower than that of Group A. The mean intraoperative propofol as well as fentanyl requirements were significantly decreased in Group B in comparison to Group A. The combination of intravenous paracetamol with bupivacaine scalp nerve block provides better intra-operative haemodynamic stability and neurosurgical compliances for the patients undergoing supratentorial craniotomies under general anaesthesia.

Patient features and survival of pediatric aplastic anemia in the USA: a large institution experience

BACKGROUND

We performed the first epidemiologic investigation to examine association of demographics and clinical characteristics at diagnosis, as well as health care expense coverage, with survival of US children with aplastic anemia (AA).

METHODS

We obtained electronic medical record data of 1140 children aged 0-19 years diagnosed with AA followed at a pediatric health system between 2004 and 2014. Kaplan-Meier curve and Cox proportional hazards regressions were used.

RESULTS

Self-pay patients had a mortality risk five times higher than that of those insured by publicly funded insurance (hazards ratio, 95% CI: 6.0, 3.7-9.8). Other features associated with higher mortality risk include pancytopenia (hazards ratio, referent: 4.2, constitutional AA); underweight (2.0, normal-weight); platelet count <50 × 109/l (1.3, ≥50 × 109/l); male sex (1.3, female); and ages at diagnosis 6-11, 11-16 and 16-19 years (1.6, 1.9, 2.3, 1-3 years), respectively.

CONCLUSIONS

Self-pay was the strongest prognostic factor for pediatric AA mortality. Older age, pancytopenia, underweight, male sex and lower platelet count were also associated with increased risk of mortality. These findings may be useful for providers, researchers and policymakers to ensure effective health care delivery to this population and to motivate future etiologic research and establishment of a surveillance registry.

Bt Eggplant Project in Bangladesh: History, Present Status, and Future Direction

The purpose of this article is to provide information on the history, accomplishments, and future direction of the Bt brinjal (eggplant) program in Bangladesh, formerly under the Agricultural Biotechnology Support Project II, now the South Asia Eggplant Improvement Partnership (SAEIP). The India-based Maharashtra Hybrid Seed Company (Mahyco) developed an eggplant expressing Cry1Ac (EE-1) for control of the eggplant fruit and shoot borer (EFSB). In a partnership among Mahyco, USAID, Sathguru Management Consultants and Cornell University EE-1 was provided to the Bangladesh Agricultural Research Institute (BARI) who bred it into local varieties. After regulatory approval, four varieties were distributed to 20 farmers who harvested Bt brinjal in 2014. Adoption in subsequent years has increased rapidly so that, in 2018, 27,012 farmers used this technology. This article provides background information on the process leading up to current adoption levels, the level of control of EFSB achieved and the economic benefits of Bt brinjal. Efforts on stewardship, farmer training and communication are discussed. In order to ensure the long-term future of the partnership, we discuss the need to enhance involvement of the private sector in the production and stewardship of Bt eggplant. Bt brinjal is the first genetically engineered crop to be commercially released in Bangladesh, and other GE crops are in the pipeline. Hence, success of the Bt brinjal partnership is likely to affect the future of other GE crops in Bangladesh, as well as other parts of the world where biotechnology is needed for food security and environmental safety.

Distal Common Bile Duct Tuberculosis with Obstructive Jaundice: A Case Report

Tuberculosis (TB) isolated in Common Bile Duct (CBD) is very rare and its treatment is somewhat controversial. We report a case of distal CBD tuberculosis diagnosed as cholangiocarcinoma. A 40 year old man presented with obstructive jaundice without abdominal pain, fever or weight loss. Ultrasonography and Magnetic Resonance Cholangio-Pancreatography (MRCP) indicated a mass lesion in the Distal CBD, which caused structure of the distal common bile duct. As Cholangiocarcinoma was suspected, he underwent Whipple procedure (pancreaticoduodenectomy). Histological examination of resected specimen revealed typical features of tuberculosis in the distal CBD, pancreatic head and lymph nodes. The rest of the abdominal cavity was unremarkable. Anti-microbial therapy for tuberculosis is started for 12 month course and he is well.

'Aeromonas intestinalis' and 'Aeromonas enterica' isolated from human faeces, 'Aeromonas crassostreae' from oyster and 'Aeromonas aquatilis' isolated from lake water represent novel species

Four Aeromonas strains from clinical and environmental samples differed from known species on the basis of rpoD gene sequence. Multilocus phylogenetic analysis and in silico DNA-DNA hybridization confirmed them as four new species even though their 16S rRNA gene sequence similarity with their closest relatives was >98.7%, as occurred for other Aeromonas spp.

Bat Hunting and Bat-Human Interactions in Bangladeshi Villages: Implications for Zoonotic Disease Transmission and Bat Conservation

Bats are an important reservoir for emerging zoonotic pathogens. Close human–bat interactions, including the sharing of living spaces and hunting and butchering of bats for food and medicines, may lead to spillover of zoonotic disease into human populations. We used bat exposure and environmental data gathered from 207 Bangladeshi villages to characterize bat exposures and hunting in Bangladesh. Eleven percent of households reported having a bat roost near their homes, 65% reported seeing bats flying over their households at dusk, and 31% reported seeing bats inside their compounds or courtyard areas. Twenty percent of households reported that members had at least daily exposure to bats. Bat hunting occurred in 49% of the villages surveyed and was more likely to occur in households that reported nearby bat roosts (adjusted prevalence ratio [aPR] 2.3, 95% CI 1.1–4.9) and villages located in north‐west (aPR 7.5, 95% CI 2.5–23.0) and south‐west (aPR 6.8, 95% CI 2.1–21.6) regions. Our results suggest high exposure to bats and widespread hunting throughout Bangladesh. This has implications for both zoonotic disease spillover and bat conservation.

Pigtail Catheter in the Management of Liver Abscess

Amoebic liver abscess is a common condition in Bangladesh. Though conservative treatment plays a major role, refractory patients can be successfully treated with minimally invasive approach. This prospective study was carried out to evaluate the prospect of sono-guided percutaneous catheter drainage for liver abscess patients not responding to conservative treatment. This study was done at Dhaka Medical College Hospital from January 2005 to June 2006 among patients with liver abscess that were treated conservatively outside and got admitted in different surgery and medicine units. Included 35 patients were evaluated clinically and through relevant investigations. Sono-guided percutaneous pigtail catheter was introduced for drainage and patients were followed up for two weeks on average at hospital indoor by amount of drainage, clinical improvement and serial follow up USG. After discharge from the hospital, all patients were followed up monthly and assessed clinically and ultrasonographically up to two months on outdoor basis. Thirty five patients underwent pigtail catheter drainage that was refractory to conservative treatment or needle aspiration. Following insertion of catheter patients who were pyrexic, fever subsided in two to three days and never back during the postoperative period and follow up. Antimicrobials were changed according to the report of the culture and sensitivity of the aspirate that was done routinely. Maximum total (4300 ml) amount of pus was drained in a patient. Average duration of catheter drainage in this study was 8 days. With a very low morbidity and zero mortality rates, minimum treatment costs and early return to regular life style proved this minimally invasive procedure to be a rational treatment option for amoebic liver abscess in selective cases.

Primary malignant melanoma of the penis with secondary to adrenal

Primary malignant melanoma of penis with secondaries to the adrenal gland is rare. Here we report a case of malignant melanoma of penis in a 60 years old man who presented with intermittent gross, episodic haematuria of 11 months duration and a hard indurated pigmented fungating lesion over the glans penis. Following an initial tissue biopsy from the penile growth which revealed malignant melanoma the patient underwent partial Panectomy. Few days after recovery the patient underwent laparotomy and incisional biopsy from adrenal mass revealed metastatic malignant melanoma histopathologically.

Epidemiology of electrical injury: findings from a community based national survey in Bangladesh

OBJECTIVES

The objective of this study is to explore the magnitude and pattern of electrical injury in Bangladesh.

METHOD

A national survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising a 819,429 population. The survey was conducted at a household level with a structured questionnaire.

RESULTS

The incidence of fatal and non-fatal injury was found to be 1.6 and 73.7 per 100,000 population year respectively. Compared to females, males were found at a higher risk (RR 1.62; 95% CI 1.37-1.91) and rural people found more vulnerable compared to urban people (RR 5.97; 95% CI 4.71-7.57). The home was found as the most common place for electrical injury, with more than 50% of injury taking place at home. The household source of electricity was found as the most common source of electrical injury. Lightning was also found as major source for electrical injury which constituted more than 25% of the injuries cause by electrical current. More than 80% of electrical injuries occurred between 6a.m. and 6p.m.

CONCLUSION

Electrical injury is an emerging cause of mortality and morbidity in both urban and rural areas of Bangladesh. Males and rural people were the more vulnerable group for electrical injury compared to women and the urban population. The home is the most common place for injury occurrence.

Impaired microglial activation in the brain of IL-18-gene-disrupted mice after neurovirulent influenza A virus infection

Knockout of the interleukin-18 (IL-18) gene predisposed mice to impaired clearance of neurovirulent influenza A virus-infected neurons from the brain. In wild-type mice, IL-18 molecule-producing microglia/macrophages emerged in virally attacked regions as early as day 3 after infection. Microglial transformation into macrophages culminated at day 7 to 9, with upregulated expression of Iba1, a novel calcium-binding protein that controls phagocytic functions of microglia/macrophages. In IL-18-/- mice, microglial transformation was interrupted with reduced Iba1 expression. Interferon-gamma (IFN-gamma)-immunopositive neurons appeared in and around virally invaded regions in wild-type mice, peaking in number at day 7, whereas such cells were barely detected in IL-18-/- mice. Stereotaxic microinjection of recombinant IFN-gamma triggered microglial transformation in IL-18-/- mice and upregulated Iba1 expression, leading to effective eradication of virally infected neurons. Collectively, these results suggest that IL-18 plays a key role in activating microglial functions directed against the influenza virus infection by inducing neuronal IFN-gamma in the brain parenchyma.