Prevalence of Thyroid Dysfunction in Type 2 Diabetes Mellitus

The level of thyroid hormones is often changed in uncontrolled diabetic patients. Screening for Thyroid dysfunction (TD) among patients with Type 2 Diabetes mellitus (T2DM) should be performed considering the increased prevalence of thyroid disorders. This cross-sectional comparative study was conducted in outpatient department of Endocrinology and Medicine, Mymensingh Medical College Hospital, Mymensingh (MMCH) from 1st March 2020 to 30th August 2021. One hundred (100) patients with type 2 diabetes along with 100 (hundred) non-diabetic controls of same age group were enrolled in the study. After taking clinical data, patients were investigated to estimate Fasting plasma glucose (FPG), serum free tri-iodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) level to see thyroid dysfunction. Patients were selected with purposive sampling. Thyroid dysfunction was found to be more in T2DM (15.0%) in comparison with non-diabetic controls (5.0%) and this difference was statistically significant (p=0.018). In both diabetic and non-diabetic groups, subclinical hypothyroidism and hypothyroidism were the most common thyroid dysfunction. Thyroid dysfunction was found more in 40-60 years that suggests the prevalence of thyroid dysfunction are increasing in diabetic patients with advancing age. Thyroid dysfunction was found more among overweight and obese patient in both groups. Mean BMI was found higher among diabetic patient with thyroid dysfunction. Logistic regression showed significant association of Thyroid dysfunction with age >50 years and high FPG level. We found thyroid dysfunction was more prevalent in patients with T2DM than non-diabetics. So, screening for thyroid dysfunction among type 2 diabetic patients by estimating Serum TSH, FT4 level should be performed.

An overview of systematic reviews on predictors of smoking cessation among young people

Understanding the factors that influence smoking cessation among young people is crucial for planning targeted cessation approaches. The objective of this review was to comprehensively summarize evidence for predictors of different smoking cessation related behaviors among young people from currently available systematic reviews. We searched six databases and reference lists of the included articles for studies published up to October 20, 2023. All systematic reviews summarizing predictors of intention to quit smoking, quit attempts, or smoking abstinence among people aged 10-35 years were included. We excluded reviews on effectiveness of smoking cessation intervention; smoking prevention and other smoking behaviors; cessation of other tobacco products use, dual use, and polysubstance use. We categorized the identified predictors into 5 different categories for 3 overlapping age groups. JBI critical appraisal tool and GRADE-CERqual approach were used for quality and certainty assessment respectively. A total of 11 systematic reviews were included in this study; all summarized predictors of smoking abstinence/quit attempts and two also identified predictors of intention to quit smoking. Seven reviews had satisfactory critical appraisal score and there was minimal overlapping between the reviews. We found 4 'possible' predictors of intention to quit smoking and 119 predictors of smoking abstinence/quit attempts. Most of these 119 predictors were applicable for ~10-29 years age group. We had moderate confidence on the 'probable', 'possible', 'insufficient evidence', and 'inconsistent direction' predictors and low confidence on the 'probably unrelated' factors. The 'probable' predictors include a wide variety of socio-demographic factors, nicotine dependence, mental health, attitudes, behavioral and psychological factors, peer and family related factors, and jurisdictional policies. These predictors can guide improvement of existing smoking cessation interventions or planning of new targeted intervention programs. Other predictors as well as predictors of intention to quit smoking need to be further investigated among adolescents and young adults separately.

Targeting the Cell Cycle, RRM2 and NF-κB for the Treatment of Breast Cancers

A hallmark of cancer is the dysregulation of the cell cycle. The CDK4/6 inhibitor palbociclib is approved for treating advanced estrogen-receptor-positive breast cancer, but its success is limited by the development of acquired resistance owing to long-term therapy despite promising clinical outcomes. This situation necessitates the development of potential combination strategies. Here, we report that didox, an inhibitor of ribonucleotide reductase in combination with palbociclib, can overcome palbociclib resistance in ER-positive and ER-negative breast cancers. This study shows didox downregulates an element of the cell cycle checkpoint, cyclin D1, accompanied by a reduction in NF-κB activity in vitro and tumor growth inhibition of palbociclib-resistant ER positive breast cancer tumor growth in vivo. Furthermore, didox induces cell cycle arrest at G1 as well as reduces ROS generated by on-target effects of palbociclib on the cell cycle. Our current study also reports that the CCND1 and RRM2 upregulation associated with palbociclib-resistant breast cancers decreases upon ribonucleotide reductase inhibition. Our data present a novel and promising biomarker-driven combination therapeutic approach for the treatment of ER-positive and ER-negative breast cancers that involves the inhibition of the CDK4/6-cyclinD1/pRb cell cycle axis that merits further clinical investigation in human models.

Artificial intelligence approaches for early detection of neurocognitive disorders among older adults

Introduction

Dementia is one of the major global health issues among the aging population, characterized clinically by a progressive decline in higher cognitive functions. This paper aims to apply various artificial intelligence (AI) approaches to detect patients with mild cognitive impairment (MCI) or dementia accurately.

Methods

Quantitative research was conducted to address the objective of this study using randomly selected 343 Saudi patients. The Chi-square test was conducted to determine the association of the patient's cognitive function with various features, including demographical and medical history. Two widely used AI algorithms, logistic regression and support vector machine (SVM), were used for detecting cognitive decline. This study also assessed patients' cognitive function based on gender and developed the predicting models for males and females separately.

Results

Fifty four percent of patients have normal cognitive function, 34% have MCI, and 12% have dementia. The prediction accuracies for all the developed models are greater than 71%, indicating good prediction capability. However, the developed SVM models performed the best, with an accuracy of 93.3% for all patients, 94.4% for males only, and 95.5% for females only. The top 10 significant predictors based on the developed SVM model are education, bedtime, taking pills for chronic pain, diabetes, stroke, gender, chronic pains, coronary artery diseases, and wake-up time.

Conclusion

The results of this study emphasize the higher accuracy and reliability of the proposed methods in cognitive decline prediction that health practitioners can use for the early detection of dementia. This research can also stipulate substantial direction and supportive intuitions for scholars to enhance their understanding of crucial research, emerging trends, and new developments in future cognitive decline studies.

Genetic determinants of SARS-CoV-2 and the clinical outcome of COVID-19 in Southern Bangladesh

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on population health. The genetic determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in southern Bangladesh are not well understood.

METHODS

This study aimed to determine the genomic variation in SARS-CoV-2 genomes that have evolved over 2 years of the pandemic in southern Bangladesh and their association with disease outcomes and virulence of this virus. We investigated demographic variables, disease outcomes of COVID-19 patients and genomic features of SARS-CoV-2.

RESULTS

We observed that the disease severity was significantly higher in adults (85.3%) than in children (14.7%), because the expression of angiotensin-converting enzyme-2 (ACE-2) diminishes with ageing that causes differences in innate and adaptive immunity. The clade GK (n = 66) was remarkable between June 2021 and January 2022. Because of the mutation burden, another clade, GRA started a newly separated clustering in December 2021. The burden was significantly higher in GRA (1.5-fold) highlighted in mild symptoms of COVID-19 patients than in other clades (GH, GK, and GR). Mutations were accumulated mainly in S (22.15 mutations per segment) and ORF1ab segments. Missense (67.5%) and synonymous (18.31%) mutations were highly noticed in adult patients with mild cases rather than severe cases, especially in ORF1ab segments. Moreover, we observed many unique mutations in S protein in mild cases compared to severe, and homology modeling revealed that those might cause more folding in the protein's alpha helix and beta sheets.

CONCLUSION

Our study identifies some risk factors such as age comorbidities (diabetes, hypertension, and renal disease) that are associated with severe COVID-19, providing valuable insight regarding prioritizing vaccination for high-risk individuals and allocating health care and resources. The findings of this work outlined the knowledge and mutational basis of SARS-CoV-2 for the next treatment steps. Further studies are needed to confirm the effects of structural and functional proteins of SARS-CoV-2 in detail for monitoring the emergence of new variants in future.

Examining the disparities of anti-malarial drug consumption among children under the age of five: a study of 5 malaria-endemic countries

BACKGROUND

Malaria is one of the most prominent illnesses affecting children, ranking as one of the key development concerns for many low- and middle-income countries (LMICs). There is not much information available on the use of anti-malarial drugs in LMICs in children under five. The study aimed to investigate disparities in anti-malarial drug consumption for malaria among children under the age of five in LMICs.

METHODS

This study used recent available cross-sectional data from the Malaria Indicator Survey (MIS) datasets across five LMICs (Guinea, Kenya, Mali, Nigeria, and Sierra Leone), which covered a portion of sub-Saharan Africa. The study was carried out between January 2, 2023, and April 15, 2023, and included children under the age of five who had taken an anti-malarial drug for malaria 2 weeks before the survey date. The outcome variable was anti-malarial drug consumption, which was classified into two groups: those who had taken anti-malarial drugs and those who had not.

RESULTS

In the study of LMICs, 32,397 children under five were observed, and among them, 44.1% had received anti-malarial drugs. Of the five LMICs, Kenya had the lowest (9.2%) and Mali had the highest (70.5%) percentages of anti-malarial drug consumption. Children under five with malaria are more likely to receive anti-malarial drugs if they are over 1 year old, live in rural areas, have mothers with higher education levels, and come from wealthier families.

CONCLUSION

The study emphasizes the importance of developing universal coverage strategies for anti-malarial drug consumption at both the national and local levels. The study also recommends that improving availability and access to anti-malarial drugs may be necessary, as the consumption of these drugs for treating malaria in children under the age of five is shockingly low in some LMICs.

A two-generational reproductive study to assess the effects of Juglans regia on reproductive developments in the male and female rats

Environmental pollutants and lifestyle severely threaten human and animal health, leading to disturbances of various functions, including infertility. So, exploring a safe treatment that could effectively reverse infertility remains a challenge. The current study was intended to explore the fertility-enhancing effect of Juglans Regia oil in two successive generations of rats; F0 and F1. J. Regia oil was initially tested for in vitro antioxidant assay via ROS and DPPH, followed by in vivo toxicity testing. In the fertility assessment, eighteen pairs of male and female rats (n=36, 1:1, F0 generation) were divided into three groups and dosed with 1 mL/kg and 2 mL/kg daily of J. Regia oil and saline, respectively, up to pre-cohabitation, cohabitation, gestation and lactation periods. The reproductive performance, including body weight, live birth index, fertility index, and litter size, was assessed. Hormonal and antioxidant markers of F1 generations were assessed with the histopathological evaluation of male and female organs. The oil of J. Regia showed great antioxidant potential (P < 0.05) in DPPH (1,1-diphenyl-2-picrylhydrazyl) and ROS (Reactive Oxygen Species) methods (P<0.05). The continued exposure of the F0 and F1 generations to J. Regia oil did not affect body weight, fertility index, litter size, and survival index. We have found pronounced fertility outcomes in both genders of F0 and F1 generations with J. Regia 2 mL/kg/day in comparison to the control. Results showed that J. Regia significantly increased (P < 0.05) luteinizing hormone (LH), plasma testosterone, follicular stimulating hormone (FSH), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in both generations. Histology of both generations reveals improved spermatogenesis and folliculogenesis with enhanced architecture. Altogether, the present results suggest that J. Regia improved fertility in both male and female rats by improving hormonal activities and oxidative stress.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Exploring therapeutic potential of Woodfordia fruticosa (L.) Kurz leaf and bark focusing on antioxidant, antithrombotic, antimicrobial, anti-inflammatory, analgesic, and antidiarrheal properties

Background and Aims

The study aimed to evaluate the pharmacological properties of methanolic extracts of leaves and barks of Woodfordia fruticosa (L.) Kurz (family: Lythraceae) focusing on antioxidant, thrombolytic, anti-inflammatory, antibacterial, analgesic, and antidiarrheal effects.

Methods

1,1-Diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging assay, clot lysis, disc diffusion, and membrane stabilizing methods were employed to assess in vitro antioxidant, thrombolytic, antibacterial, and anti-inflammatory properties of the leaf and bark methanolic extracts (ME) of W. fruticosa and different organic solvents, that is, petroleum ether (PE), dichloromethane (DCM), chloroform (CL), and aqueous (AQ) fractions. In addition, in vivo central and peripheral analgesic and antidiarrheal activities of both crude extracts were evaluated at two doses (200 and 400 mg/kg of body weight [bw]).

Results

All the extracts and fractions showed promising antioxidant properties by scavenging DDPH free radicals with IC50 of 6.11-20.79 μg/mL. AQ fraction (41.24%) of leaves and ME (44.90%) of bark exerted notable in vitro thrombolytic activity. The CL fraction of leaves and AQ fraction of the bark showed 43.16% and 45.37% inhibition of RBC hemolysis, respectively, compared to the inhibition of RBC hemolysis by aspirin in a hypotonic-induced membrane stabilizing assay. Besides, both extracts were observed to provide significant (p < 0.001) central and peripheral analgesic responses at both doses of 200 and 400 mg/kg bw. Furthermore, both doses of bark extract (p < 0.001) and the 400 mg/kg bw of leaf extract (p < 0.05) were observed to possess statistically significant antidiarrheal activity. Additionally, in an in vivo acute toxicity investigation, both extracts had a median lethal dose (LD50) greater than 5000 mg/kg bw, indicating their safety level.

Conclusion

The current study proves the ethnomedicinal uses of W. fruticosa; however, further studies are required for phytochemical screening to isolate the responsible bioactive compounds and discover the lead molecules from the plant species.

Magnetic Resonance Imaging Evaluation of Common Spinal Intramedullary Tumours: Ependymoma and Astrocytoma

This cross-sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2015 to June 2016 in collaboration with Department of Neurosurgery and Department of Pathology of same hospital, to assess MRI findings of common IMSCTs and to find out the validity of MRI in the diagnosis of spinal ependymoma and astrocytoma, thereby differentiating these two common intramedullary entities. For this purpose, 40 patients aged from 15 to 60 years, who were diagnosed or suspected cases of having intramedullary spinal cord tumours were enrolled. These patients underwent preoperative MRI for evaluation of the spinal cord tumours during the study period in department of Radiology and Imaging. Also, patients were diagnosed by MRI as having IMSCTs incidentally was included. All of them were followed by histopathological examination of the same lesions after surgery. Among these 40 patients after exclusion for valid reason 28 cases were included as study population. MR images were obtained on a 1.5 Tesla (Avanto Magnatom, Siemens) unit with a spine surface coil. MRI findings were compared with histopathology after surgery keeping histopathology as gold standard. Out of 28 clinically and MRI diagnosed IMSCTs cases, 19 cases of ependymoma, 8 cases of astrocytoma and one diagnosed as hemangioblastoma by MRI. The mean age was 34.11±9.55 years, ranging from 15 to 56 years for ependymoma, 26.88±8.08 years ranging from 16 to 44 years for astrocytoma. Highest incidence (47.4%) was in between 31 to 40 years for ependymoma, 50.0% were in between 21-30 for Astrocytoma. On MRI majority 12(63.2%) of the cord ependymomas and majority 5(62.5%) of astrocytomas were in cervical region. While considering axial location ependymomas are mostly 17(89.5%) central and astrocytomas 5(62.5%) are eccentric in location. It was observed that out of 19 cases of ependymoma more than half 10(52.6%) had elongated shape, 12(63.1%) had well defined margin. Associated syringohydromyelia was present in 16(84.2%) cases. On T1WI 11(57.9%) and 8(42.1%) cases were iso and hypo respectively. On T2WI 14(73.7%) cases were hyper intense. After Gd-DTPA in most cases, 13(68.4%) cases showed diffuse enhancement. Noticeable and sizeable solid component observed among 13(68.4%) of the cases. Hemorrhage with cap sign was found in more than one third 7(36.8%) cases. Out of 8 cases of astrocytomas 4(50.0%) had lobulated shape, ill-defined margin 5(62.5%). T1WI: Iso 5(62.5%), hypo 3(37.5%), T2WI: hyper 5(62.5%), After Gd-DTPA: focal and heterogenous enhancement 3(37.5%) and rim enhancement 4(50.0%). Component: mixed 4(50.0%), cystic 3(37.5%) and solid 1(12.5%). Hemorrhage without cap sign 2(25.0%), associated syringohydromyelia 1(12.5%). In the case of evaluation of intramedullary ependymoma sensitivity of MRI in the present series is 94.44%, specificity 80.0%, Positive predictive value (PPV) 89.5%, Negative predictive value (NPV) 88.9% and accuracy 89.28%. In case of MRI evaluation of intramedullary astrocytoma sensitivity of MRI in the present study is 85.71%, specificity 90.47%, PPV 75%, NPV 95% and accuracy 89.2%. Thus present study shows MRI is a sensitive and effective noninvasive imaging modality in diagnosing common intramedullary spinal cord tumours.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Occurrence of shigellosis in pediatric diarrheal patients in Chattogram, Bangladesh: A molecular based approach

Shigellaa Gram-negative, non-motile bacillus, is the primary causative agent of the infectious disease shigellosis, which kills 1.1 million people worldwideevery year. The children under the age of five are primarily the victims of this disease. This study has been conducted to assess the prevalence of shigellosis through selective plating, biochemical test and conventional PCR assays, where the samples were collected from suspected diarrheoal patients. Invasive plasmid antigen H (ipaH) and O-antigenic rfc gene were used to identify Shigella spp. and S. flexneri respectively. For validation of these identification, PCR product of ipaH gene of a sample (Shigella flexneri MZS 191) has been sequenced and submitted to NCBI database (GenBank accession no- MW774908.1). Further this strain has been used as positive control. Out of 204, around 14.2% (n = 29)(P> 0.01) pediatric diarrheoal cases were screened as shigellosis. Another interesting finding was that most of shigellosis affected children were 7 months to 1 year (P> 0.01).The significance of this study lies in the analyses of the occurrenceand the molecular identification of Shigellaspp. and S. flexneri that can be utilized in improving the accurate identification and the treatment of the most severe and alarming shigellosis.

Association of Metabolites, Nutrients, and Toxins in Maternal and Cord Serum with Asthma, IgE, SPT, FeNO, and Lung Function in Offspring

The role of metabolites, nutrients, and toxins (MNTs) in sera at the end of pregnancy and of their association with offspring respiratory and allergic disorders is underexplored. Untargeted approaches detecting a variety of compounds, known and unknown, are limited. In this cohort study, we first aimed at discovering associations of MNTs in grandmaternal (F0) serum with asthma, immunoglobulin E, skin prick tests, exhaled nitric oxide, and lung function parameters in their parental (F1) offspring. Second, for replication, we tested the identified associations of MNTs with disorders in their grandchildren (F2-offspring) based on F2 cord serum. The statistical analyses were sex-stratified. Using liquid chromatography/high-resolution mass spectrometry in F0, we detected signals for 2286 negative-ion lipids, 59 positive-ion lipids, and 6331 polar MNTs. Nine MNTs (one unknown MNT) discovered in F0-F1 and replicated in F2 showed higher risks of respiratory/allergic outcomes. Twelve MNTs (four unknowns) constituted a potential protection in F1 and F2. We recognized MNTs not yet considered candidates for respiratory/allergic outcomes: a phthalate plasticizer, an antihistamine, a bile acid metabolite, tryptophan metabolites, a hemiterpenoid glycoside, triacylglycerols, hypoxanthine, and polyphenol syringic acid. The findings suggest that MNTs are aspirants for clinical trials to prevent adverse respiratory/allergic outcomes.

Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis

OBJECTIVES

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality.

STUDY DESIGN

Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used.

METHODS

Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths.

RESULTS

Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days.

CONCLUSIONS

The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.

Microplastics in freshwater wild and farmed fish species of Bangladesh

In today's world, microplastic contamination of aquatic systems is a subject of major concern. In this study, the incidence of microplastics in freshwater fish from both farmed and wild sources was evaluated. Wild catla (Gibelion catla), stinging catfish (Heteropneustes fossilis), rui (Labeo rohita), tengara catfish (Mystus tengara), and pabdah catfish (Ompok pabda) were collected from Padma River, Turag River, and Bhairab River. Farmed fishes of same species were collected from Mymensingh and Chandpur fish markets. A total of 68 (43.6%) microparticles out of 156 were identified as microplastics using ATR-FTIR. About 66.67% (20 out of 30) of farmed fish samples had microplastics in their digestive system, while 88.4% (23 of 26) of wild fish samples presented microplastics. There was a significant difference (p < 0.05) in average microplastic count between wild and farmed fish. Average microplastic count also showed a significant difference among five fish species (p < 0.01). A variety of polymers were observed, with polyethylene being the most abundant, followed by polyester, polypropylene, polyamide-6, and polyurethane. This study suggests that microplastic contamination is ubiquitous and contamination is common in all of the fish species investigated, independent of their origin (wild or farmed). However, wild fish population is at a greater risk of ingesting microplastics. This study, for the first time ever, reports plastic pollution in freshwater fishes of Bangladesh from wild and farmed sources.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh

BACKGROUND

Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions.

METHODS

This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers.

RESULTS

A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity.

CONCLUSIONS

Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.

Abstract 5989: Targeting RRM2 & cell cycle for breast cancer treatment

Endocrine treatment is an effective first-line therapy for targeting ER positive, HER2 negative breast cancer. But success is limited by development of acquired resistance due to long-term therapy. Cyclin D1 and cyclin dependent kinase 4/6 (CDK4/6) complex causes phosphorylation and subsequent inactivation of retinoblastoma (Rb) tumor suppressor protein which promotes progression of the cell cycle from G1 to S phase. This observation led the development of the first CDK4/6 inhibitor palbociclib (Ibrance; Pfizer) which induces cell cycle arrest at G1 phase in cancer cells. Owing to intrinsic and acquired drug resistance development, success is limited despite promising clinical outcomes. This situation necessitates the development of potential combination strategies to overcome drug resistance. Ribonucleotide reductase (RR) is a rate limiting enzyme in DNA synthesis consisting of two subunits RRM1 and RRM2. Didox inhibits ribonucleotide reductase subunit 2 (RRM2) which ultimately blocks DNA synthesis. Combination of didox with palbociclib is a potential strategy to target ER positive and ER negative/triple negative breast cancer. Previously, we have shown that didox (DDX) can significantly halt malignant breast cancer cell division in combination with the anthracycline drug doxorubicin by targeting RRM2, mutant p53 and NFkB regulatory proteins. Recently, we confirmed that didox in combination with palbociclib significantly lowers ER positive and ER negative breast cancer and their palbociclib resistant counterparts’ growth compared to no treatment or palbociclib treatment. We also confirmed that ER positive MCF7 and ER negative MDA-MB-468 parental breast cancer cells IC50 of palbociclib drug is lower than their palbociclib resistant counterparts. Here, we are reporting that didox decreases cell cycle proteins alone or in combination with palbociclib in ER positive MCF7 and ER negative MDA-MB-468 parental and palbociclib resistant breast cancer cells. This finding opens a novel approach for targeting both ER positive as well as ER negative breast cancer treatment. We are also reporting that didox treatment modulates cyclin D1 (CCND1) and RRM2 expression in MCF7 and MDA-MB-468 breast cancer along with their palbociclib resistant counterparts. Additionally, we observed that didox alone or in combination with palbociclib alters the cell cycle of MCF7 and MDA-MB-468 parental and palbociclib resistant breast cancer cells. Our data presents a novel and promising approach for the treatment of ER positive and ER negative breast cancer that involves inhibition of RRM2 and cell cycle that merits further clinical investigation in animal and human models.

Citation Format: Nahid Sultana, Howard L. Elford, Jesika S. Faridi. Targeting RRM2 & cell cycle for breast cancer treatment. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5989.

Investigating the prospect of cleaner production in informal enterprises: A scientific assessment of environmental burdens and economic efficiency

The present study aims to assess the prospects for cleaner production (CP) and sustainable development (SD) of informally operated small manufacturing enterprises, which are frequently blamed for uncontrolled waste disposal and causing pollution to the environment. The economic efficiency level of these firms has been explored to this end, and the metallic pollution loads in the surrounding environment have been scientifically analyzed to investigate the nexus between these two. DEA (Data Envelopment Analysis)-Tobit analysis has been employed, and a pollution load index (PLI) of heavy metal pollution comprising two environmental compartments (soil and water) has been constructed based on the concentration level of metalloid pollutants in the samples collected from the surrounding areas of the studied informal firms in Bangladesh. The study disproves CP practice in majority of the informal firms in Bangladesh by observing a positive relationship between firm-level efficiency and pollution load sourced from their production activities. Afterwards, this study estimates the eco-efficiency level of firms by considering pollution load as an undesirable output and minimizing its impact in an input-oriented DEA model. Applying the eco-efficiency scores in censored Tobit regression analysis, the outcome endorses the prospect of CP for informally operated enterprises in Bangladesh. However, the CP prospect can only materialize if and only if firms are provided with adequate technical, financial, and strategic support for achieving eco-efficiency in their production. The informal and marginal nature of the studied firms restricts them from getting access to the facilities and support services needed for implementing CP and moving towards sustainable manufacturing. Therefore, this study recommends green practices in informal manufacturing and limiting the informal firms by bringing them gradually under the coverage of formalization, which is in line with the achievement of the targets mentioned in Sustainable Development Goal 8.

Combined Effects of Nickel and Arsenic on Growth and Mineral Nutrients Accumulation in Kalmi (Ipomoea Aquatica), Red Amaranth (Amaranthus SP.) And Spinach (Spinacia Oleracea L.) And Nutrient Release Pattern In Soil at Different Days of Incubation

Arsenic (As) is a broadly distributed toxic metalloid that accumulates in the environment through natural and anthropogenic sources. Numerous techniques were evolved for arsenic remediation from water including adsorption, flocculation, ion exchange and reverse osmosis. Due to the excessive affinity between iron and inorganic arsenic species, iron-based adsorption is an emerging technique for the remediation of arsenic-contaminated water and soil. Whereas iron (Fe) and nickel (Ni) belong to the same chemical group (VIIIB) in the periodic table, it is expected to get similar interaction of Ni with As. An in vitro incubation study and pot experiment were conducted to evaluate the effect of Nickel on mineral release patterns in soil and growth yield of kalmi (Ipomoea aquatica), red amaranth (Amaranthus sp.) and Spinach (Spinacia oleracea L.). Nickel was applied as different doses of Nickel of 10, 40 and 160 mg/kg respectively where As was applied with irrigation water at the rates of 1 mg/L and incubated at field moisture condition for 10, 20 and 30 days individually in different pots. Total organic carbon (C), total nitrogen (N), phosphorus (P), sulfur (S), potassium (K) and 0.1N HCl extractable arsenic (As), iron (Fe) contents were determined at 10, 20 and 30 days of incubation. The pot experiment was carried out in triplicates for 45 days till the plants were grown to maturity. The growth performance of plants and the remedial effect of Ni on As toxicity in soil and plant was examined. Nickel showed a significant impact on fresh and dry yield of three plants and an antagonistic relationship between Ni and As was also observed i.e., Ni in soil was found to lessen the availability of As in soil likewise its accumulation in plants. J. Biodivers. Conserv. Bioresour. Manag. 2022, 8(2): 79-88

Diagnostic Accuracy of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Tear

The anterior cruciate ligament (ACL) is the most generally injured one of the major knee ligaments. These injuries plague both athletes and non-athletes. This cross-sectional and comprehensive study was conducted in the Department of Radiology and Imaging collaborating with Department of Orthopedics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, completed from January 2014 to December 2015. The study evaluated the role of MRI in the diagnosis of anterior cruciate ligament injury of knee joint, keeping Arthroscopy as standard, compared the MRI and arthroscopic findings to determine accuracy, sensitivity and predictivity of MRI in the diagnosis of ACL injury in knee joint. For this purpose, a total of 50 patients having clinical suspicion of ACL injury in knee joint were enrolled in this study to perform MRI and Arthroscopy. MRI was done in all these patients. Clinically suspected but MRI diagnosed as no ACL injury, patients who were not willing to undergo arthroscopy examination and patient who were not fit for arthroscopy were excluded from the study. More than half (52.0%) of the patients were in 3rd decade and male to female ratio was 3.5:1. Less than one fourth (24.0%) of the patients were service holder. Forty two percent patients had duration of suffering for 2 weeks. Most 49(98.2%) patients had history of trauma, 45(90.0%) had pain in Knee joint, 24(48.0%) had difficulty in walking, 19(38.0%) had swelling in Knee joint and 13(26.0%) had restricted range of motion. Anterior drawer test was 37(74.0%) and Lachman test 16(32.0%). Loss of normal contour of ACL was found in 50.0%. Signal change of ACL in PD and T2W1 was found 42(84.0%) patients, and thickened ACL in 33(66.0%) patients. In MRI diagnosis tear was present in 80.0% of the patients. ACL tear diagnosed by MRI among the patients, 20(40.0%) had partial tear and 20(40.0%) had complete tear. In arthroscopy diagnosis 38(76.0%) had tear present. ACL tear diagnosed by arthroscopy of the patients 15(30.0%) had partial tear and 23(46.0%) had complete tear. Majority 20(40.0%) patients had medial meniscus injury, 15(30.0%) had lateral meniscus injury, 11(22.0%) had PCL injury, 4(8.0%) had lateral co-lateral ligament injury and 2(4.0%) had medial co-lateral ligament injury. In MRI diagnosis of anterior cruciate ligament tear, 37 cases were true positive, three cases false positive, one case false negative and nine cases was true negative. The validity of MRI diagnosis evaluation for anterior cruciate ligament tear was 97.4% sensitivity, 75.0% specificity, 92.0% accuracy, 92.5% positive predictive values and 90.0% negative predictive values.

Anticancer potential of phytochemicals from Oroxylum indicum targeting Lactate Dehydrogenase A through bioinformatic approach

In recent years, small molecule inhibition of LDHA (Lactate Dehydrogenase A) has evolved as an appealing option for anticancer therapy. LDHA catalyzes the interconversion of pyruvate and lactate in the glycolysis pathway to play a crucial role in aerobic glycolysis. Therefore, in the current investigation LDHA was targeted with bioactive phytochemicals of an ethnomedicinally important plant species Oroxylum indicum (L.) Kurz. A total of 52 phytochemicals were screened against LDHA protein through molecular docking, ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) assay and molecular dynamics simulation to reveal three potential lead compounds such as Chrysin-7-O-glucuronide (-8.2 kcal/mol), Oroxindin (-8.1 kcal/mol) and Oroxin A (-8.0 kcal/mol). ADMET assay unveiled favorable pharmacokinetic, pharmacodynamic and toxicity properties for all the lead compounds. Molecular dynamics simulation exhibited significant conformational stability and compactness. MM/GBSA free binding energy calculations further corroborated the selection of top candidates where Oroxindin (-46.47 kcal/mol) was found to be better than Chrysin-7-O-glucuronide (-45.72 kcal/mol) and Oroxin A (-37.25 kcal/mol). Aldolase reductase and Xanthine dehydrogenase enzymes were found as potential drug targets and Esculin, the FDA approved drug was identified as structurally analogous to Oroxindin. These results could drive in establishing novel medications targeting LDHA to fight cancer.

Clinical Profile and Immediate Outcome of Pyogenic Meningitis in Children

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

Evaluation of Liver Function Tests in β-Thalassemia Major Children

Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However these recurrent blood transfusions result in iron overload which along with chelation therapy causes deterioration of liver function. Aim of the study was to evaluate the liver function tests in β-thalassemia major patients. This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. In this study, 50 diagnosed patients of β Thalassemia major (Group A) and 50 apparently healthy children (Group B) of both sexes were selected from the department of Paediatrics, Dhaka medical college. The study parameters were serum ferritin, bilirubin, AST, ALT, ALP. The results were compared statistically between groups. Serum ferritin level (mean±SD) in thalassemic major patients in Group A (890±446.38 microgram/L) which is significantly higher above normal level. Serum bilirubin in Group A (3.27±2.62 mg/dl) and in Group B (0.48±0.24 mg/dl), Serum ALT in Group A (53.06±34.0 U/L) and in Group B (16.70±4.81 U/L), AST in Group A (84.56±33.54 U/L) and in Group B (11.60±2.72 U/L) and ALP levels in Group A (422.42±226.99 IU/L) and in Group B (221.86±80.54 IU/L). All the values were significantly higher (p<0.001) in β-thalassemia patient than that of normal children. This study concludes that liver function parameters are significantly higher in β thalassemia major patients. So routine evaluation of liver function tests may be advocated for thalassemic patients to predict early onset of hepatic dysfunction.

Age Related Changes in the Purkinje Cells in Human Cerebellar Cortex in Bangladeshi People

This study was done to see the changes in the number of Purkinje cells per square mm in different age groups of Bangladeshi people. This cross-sectional descriptive type of study was done on total 40 postmortem human cerebellums, in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2016 to June 2017. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh Medical College, by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Paraffin blocks of cerebellum were cut at 4-5μm thickness and stained with routine "Haematoxylin and Eosin" (H & E) stain. Estimation of number of Purkinje cell was done by using the counting circle and examined under the light microscope. In the present study, the mean±SD number of Purkinje cell was found 128.67±25.15 per sq mm in Group A, 136.53±34.45 in Group B per sq mm, 135.55±29.44 per sq mm in Group C, 127.69±35.31 per sq mm in Group D.

Number and Diameter of White Pulp of Spleen in Different Age and Sex Groups of Bangladeshi People

Spleen is a haemo-lymph organ and belongs to the reticuloendothelial system of human body, develops from mesodermal proliferation between the two leaves of dorsal mesogastrium. The microscopic structure of spleen is variable depending on the developmental stage of the organ, and the age and immune status of the individual. In our country, we depend on foreign data which came from the subjects of different races and from the individuals under different geographic conditions. So the study was carried out to minimize the dependency on foreign standards and to identify the diameter of white pulp in different age and sex of the Bangladeshi individuals with a view to establish local data bank related to spleen of Bangladeshi people. This cross-sectional descriptive study was performed on 65 postmortem human spleens (34 of male and 31 of female) to find out the number and diameter of white pulp of spleen of Bangladeshi people by purposive sampling technique. And done in Autopsy laboratory of the Department of Forensic Medicine of Mymensingh Medical College, Bangladesh from 16th October 2016 to 15th January 2017. The samples were divided into three age groups including Group A (5-20 years), Group B (21-40 years) and Group C (41-60 years). Dissection was performed according to standard autopsy techniques. For statistical analysis, unpaired student 't' test was done. The mean±SD number of white pulp of male spleen was greater than female spleen in Group A, B and C but mean±SD diameter of white pulp of female spleen was found greater than male spleen in all groups. Comparison of number of white pulp between sexes showed that statistically there was no significant difference within all the age groups at p>0.05 level. No age change was evident in diameter of white pulp but in between sexes, diameter is greater in females than males. Mean difference of diameter of white pulp between sexes showed no significant difference within the age groups at p>0.05.

706 IMPROVING PRESCRIPTION OF PARKINSON’S DISEASE MEDICATIONS FOR PATIENTS ON ELDERLY CARE WARDS AT ROYAL STOKE UNIVERSITY HOSPITAL

Introduction

Patients with Parkinson’s disease (PD) are commonly admitted into hospital with various acute medical conditions. Inaccurate prescription can result in adverse effects, increased hospital stay, and increased morbidity and mortality. We present a QIP conducted to improve PD medication prescription pattern among doctors and medication delivery from the nursing staff.

Method

In PDSA 1, we conducted a survey among doctors and nurses to assess their initial knowledge on PD medications. A baseline review of PD prescriptions on our Frail Elderly Assessment Unit (FEAU) was conducted. Our interventions include Introduction: of PD medication alert sticker attached to drug charts and recorded drug chart when they are taken off the wards. In PDSA 2, repeat survey was carried on Elderly care wards. We also reviewed PD prescriptions over a 2-week period on Elderly care wards.

Results

During the surveys, there were 55 respondents in PDSA 1 and 51 respondents in PDSA 2. The percentage of those who feel PD medications are critical medications remain similar in both cycles (98%). There was an improvement in the awareness of PD stickers from 44% to 83%. Those who feel PD alert stickers are appropriate improved from 93% to 100%. Respondents who chose all included appropriate PD medication sources for improving prescription pattern improved from 38% to 62%. There were 8 prescriptions during PDSA 1 and 21 prescriptions during PDSA 2. The use of PD stickers improved from 0% to 76%. The numbers of PD medications prescribed appropriately improved from 50% to 65%.

Conclusion

An improvement in prescription pattern was demonstrated, as we hope to improve patient safety and increase awareness across the trust. Our recommendations include use of PD medication alert sticker and recorded drug chart. We discussed our plans in Medicine Governance meeting, departmental newsletter, and presented in departmental audit meeting.

Hybrid support vector regression and crow search algorithm for modeling and multiobjective optimization of microalgae-based wastewater treatment

Microalgae-based wastewater treatment (and biomass production) is an environmentally benign and energetically efficient technique as compared to traditional practices. The present study is focused on optimization of the major treatment variables such as temperature, light-dark cycle (LD), and nitrogen (N)-to-phosphate (P) ratio (N/P) for the elimination of N and P from tertiary municipal wastewater utilizing Chlorella kessleri microalgae species. In this regard, a hybrid support vector regression (SVR) technique integrated with the crow search algorithm has been applied as a novel modeling/optimization tool. The SVR models were formulated using the experimental data, which were furnished according to the response surface methodology with Box-Behnken Design. Various statistical indicators, including mean absolute percentage error, Taylor diagram, and fractional bias, confirmed the superior performance of SVR models as compared to the response surface methodology (RSM) and generalized linear model (GLM). Finally, the best SVR model was hybridized with the crow search algorithm for single/multi-objective optimizations to acquire the global optimal treatment conditions for maximum N and P removal efficiencies. The best-operating conditions were found to be 29.3°C, 24/0 h/h of LD, and 6:1 of N/P, with N and P elimination efficiencies of 99.97 and 93.48%, respectively. The optimized values were further confirmed by new experimental data.

Genome Sequences of SARS-CoV-2 Sublineage B.1.617.2 Strains from 12 Children in Chattogram, Bangladesh

We announce the complete genome sequences of 12 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sublineage B.1.617.2 strains (Delta variant) obtained from nasopharyngeal and oropharyngeal swab samples from 12 pediatric patients in Chittagong, Bangladesh, displaying COVID-19 symptoms. Oxford Nanopore MinION sequencing technology was used to generate the genomic sequences.

Abnormal fractional flow reserve and non-hyperaemic pressure ratios in patients with severe aortic stenosis and non-obstructive coronary artery disease

Background

Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) are well-validated tools that assess the physiological significance of coronary artery disease (CAD). Low coronary lumen to myocardial mass (V/M) ratio on CT is associated with lower FFR/NHPRs and predisposes towards ischaemia in CAD. Whilst CAD and aortic stenosis (AS) frequently co-exist, patients report angina despite obstructive disease.

Purpose

We therefore sought to study the interrelationship between V/M and invasive pressure indices in patients with severe AS.

Methods

35 patients with severe AS were prospectively recruited as part of CAST-FFR study. Patients underwent CT coronary angiography and invasive pressure-wire assessment. All pressure-indices were assessed in the left anterior descending artery (LAD). Data was extracted to calculate FFR, iFR, diastolic pressure ratios (DPR and dPR) and Diastolic Hyperaemia-free Ratio (DFR). Patient-specific V/M were extracted off-site by independent core lab.

Results

Mean age was 75±7.5 years, median V/M ratio was 20.7 and mean aortic gradient and DI were 44.3±11.6mmHg and 0.23±0.4 respectively. 79% of patients had CADRADs score of &lt;2. There were moderate positive correlations between FFR/NHPRs and V/M, including FFR (r=0.60), PdPa (r=0.48), iFR (r=0.59), DPR (r=0.59), dPR (r=0.63), DFR (r=0.67), (all p&lt;0.005). In patients with positive pressure assessments, 69% (FFR), 71% (iFR), 70% (DPR) and 65% (DFR) had CADRADs score &lt;2. In severe AS, lower V/M was associated with lower pressure-indices (FFR 0.75 vs 0.86, iFR 0.79 vs 0.92, DFR 0.80 vs 0.91, all p&lt;0.005), leading to high rates of positive physiologic assessment (FFR 88%, PdPa 72%, iFR 67%, DPR 78%, DFR 74%).

Conclusion

Patients with severe AS exhibit high rates of abnormal FFR and NHPR values, despite having no obstructive CAD. Their propensity for having abnormal physiological results is, in part, influenced by coronary volume to mass ratio. These results are important for clinicians considering using invasive physiological tools to guide revascularisation decisions in patients with severe AS.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Monash University, Cardiac Society of Australia and New Zealand Correlation between NHPR/FFR and VMInvasive pressure indices and VM

Prevalence and molecular characterization of antibiotic resistance and associated genes in Klebsiella pneumoniae isolates: A clinical observational study in different hospitals in Chattogram, Bangladesh

Objective

This study was performed to investigate the prevalence of multidrug resistance and molecular characterization of Klebsiella pneumoniae (KPN) from clinical isolates in the southern region of Bangladesh. Additional analysis of the prevalence of bla_NDM-1, bla_SHV-11, uge genes of KPN was also carried out among these clinical isolates.

Method

The study was carried out using 1000 clinical isolates collected from two different hospitals of Chattogram. A drug susceptibility test was performed by the disk diffusion method to detect KPN’s response to 16 antibiotics. The presence of antibiotic-resistant and (or) virulent genes bla_NDM-1, bla_SHV-11, uge were investigated using the PCR technique. Isolates having bla_NDM-1, bla_SHV-11, uge gene were further validated by sequencing followed by phylogenetic analysis. Phylogenetic relationships among these isolates were determined by Clustal omega and MEGA7.

Result

A total of 79%, 77%, 74.9%, 71%, 66% and 65% isolates exhibited resistance against cefuroxime, cefixime, cefotaxime, ceftazidime, cefepime and ceftriaxone respectively. The frequency of resistance to other antibiotics varied from 26.5% to 61.8%. PCR analysis showed that 64% of strains harbored bla_NDM-1 gene, and 38% strains harbored bla_SHV-11 gene. Moreover, 47% of samples were carrying uge gene, and 19% of samples carried bla_NDM-1, bla_SHV-11, uge genes together.

Conclusion

In this study, we’ve analysed the pattern of expression as well as prevalence of bla_NDM-1, bla_SHV-11, and uge genes in Klebsiella isolates. Upon molecular and statistical analysis, we found a high prevalence of multi-drug resistance KPN strains in the isolates. The Klebsiella isolates were confirmed to harbor multiple ESBL genes and 64% of the isolates were found to be producing NDM-1. As multidrug resistance is an alarming issue, continuous surveillance and routine clinical detection of resistant bacteria and plasmids are necessary to prevent catastrophic public health incidents.

Environmental kuznets curve and causal links between environmental degradation and selected socioeconomic indicators in Bangladesh

This study has investigated the Environmental Kuznets Curve (EKC) hypothesis and focuses on the resource stock of the country in relation to the selection of environmental degradation indicators. Acknowledging the critical role of the EKC for policy formulation and development strategies, this study has examined the validity of the EKC hypothesis by exploring the relationship between economic growth, urbanization, energy consumption, trade openness, human capital and ecological footprints for the period 1972-2018 in Bangladesh. The autoregressive distributive lag bounds testing approach is applied for this purpose, taking into account the structural break in the time series. A fully modified OLS estimation has also been applied as the robustness check of the results. Results from the empirical analysis confirm the existence of the EKC in Bangladesh in both the long run and short run. The causal nexus among the variables is examined by applying the Vector Error Correction Granger causality test. The causality test result shows that economic growth and urbanization cause ecological footprints in both the short run and the long run. Based on this result, it can be inferred that economic growth activities in Bangladesh can be continued and extended with minimal ecological cost through structural economic change and proper environmental management.

Correlation between Length of Ala and Transverse Diameter of First Sacral Vertebral Body in both Sexes

Sacrum is a triangular bone formed by the fusion of five sacral vertebrae. It is situated near the lower end of the spinal column, where it joins both hip bones to form the posterio superior wall of the pelvic cavity. It is an important bone for identification of sex in human skeletal system. This cross sectional and descriptive study was done among 150 (59 male and 91 female) fully ossified dry human sacrum in Mymensingh Medical College, Mymensingh, Bangladesh from January 2017 to December 2017. The sex of sacrum was determined by previously measured different parameters. Sample collection was done by purposive sampling technique from anatomy department of Mymensingh Medical College and Community Based Medical College of Bangladesh, Mymensingh. The parameters included the length of ala and transverse diameter of first sacral vertebral body which were measured by digital vernier slide caliper and was expressed in mm. In present study the mean length of ala in male and female were 29.21±6.30mm and 30.77±5.56mm respectively. The mean transverse diameter of first sacral vertebral body in male and female were 48.10±4.83mm and 44.05±6.16mm respectively. Comparison of both length of ala and transverse diameter of first sacral vertebral body was done between male and female by unpaired student 't' test which was statistically significant. There was positive correlation between these two parameters and the differences were statistically highly significant in both sexes.

Abstract 1240: RRM2 and mutant p53 as therapeutic targets in TNBC

Triple negative breast cancer (TNBC) is a highly aggressive type of cancer associated with poor prognosis and characterized by the absence of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor type 2 (HER2). TNBC accounts for 10 - 15% of all new cases of breast cancer. TNBC is heterogenous in nature (70% basal-like) and currently doesn't have effective targeted therapy. As such, dose-dense chemotherapeutic agents used in combination, such as doxorubicin (DOXO) with cyclophosphamide, is the regimen of choice for TNBC. However, DOXO has limited efficacy as a therapeutic agent owing to acquired drug resistance and its cardiotoxic effects. Ribonucleotide reductase (RR) is the rate limiting enzyme required for the conversion of ribonucleotide to deoxyribonucleotide in DNA synthesis during cell proliferation. Didox (3,4 dihydroxybenzohydroxamic acid) is a unique RR inhibitor with iron chelating and free radical scavenging properties. We have previously identified that ribonucleotide reductase M2 (RRM2) is upregulated in TNBC cells and is a key contributor to acquired drug resistance. We found that Didox not only inhibits RRM2, but it also reduces mutant p53 protein levels and inhibits the activation of the NF-κB pathway. Through this inhibition, we found that Didox works synergistically with DOXO to inhibit TNBC tumor growth while also minimizing DOXO-induced cardiac damage in mice. In our present study, we have observed that RRM2 expression is upregulated in TNBC patients from three independent data sets and that high RRM2 levels are associated with lower recurrence free survival (RFS) and overall survival (OS). Interestingly, high levels of RRM2 were only predictive of lower RFS and OS in patients with wild-type p53 but not mutant p53. Additionally, we have found that Didox downregulates mutant p53 protein levels in TNBC cell lines but does not alter total p53 in cells with functioning p53. Our data confirms that Didox induced downregulation of mutant p53 is not a transcriptional effect. Finally, we have identified that RRM2 protein levels increase in TNBC with progression of stage as measured in patient tissue microarray analysis. Our data presents a novel and promising approach for the treatment of TNBC that involves inhibition of RRM2, NF-kB activation, and mutant p53 that merits further clinical investigation in human models.

Citation Format: Nahid Sultana, Elizabeth A. Wilson, Howard L. Elford, Jesika S. Faridi. RRM2 and mutant p53 as therapeutic targets in TNBC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1240.

Predicting sun protection measures against skin diseases using machine learning approaches

BACKGROUND

The substantial growth rate of skin cancer has necessitated adequate protection from solar radiation. Consequently, analyzing sun protection practices is an imperative research area in dermatology and pharmacology.

AIMS

This paper aims to analyze public sun-protection manners in the Arabian Peninsula regions.

METHODS

A simple random survey was conducted to assess public sun protection manners. Artificial neural network (ANN) and support vector machine (SVM) were selected from several machine learning algorithms to create the models for predicting public sun protection measures based on the prediction accuracy. Model performances were evaluated based on several performance indicators depending on the confusion matrices and receiver operating characteristic curves.

RESULTS

51% of the respondents have a low level, and 49% have a high level of sun protection practices. The results showed that the SVM performed considerably amended than the ANN for predicting the response. The relative importance of the predictors for the best predictive SVM model was also analyzed. The predictors are ranked as: the number of times having sunburnt >gender > use seat belt while driving/riding a vehicle >considers the UV index for personal sun exposure >income based on the expenses >sports/exercise activities >consciousness of the chance for having sunburnt on extended exposure to the sun >age > having any skin problem >nationality > skin type.

CONCLUSION

These identified significant predictors might be considered for developing an effective policy to increase public consciousness using proper protection from solar radiation's detrimental effect to rule out skin diseases.

Molecular Targeting of RRM2, NF-κB, and Mutant TP53 for the Treatment of Triple-Negative Breast Cancer

Doxorubicin and other anthracycline derivatives are frequently used as part of the adjuvant chemotherapy regimen for triple-negative breast cancer (TNBC). Although effective, doxorubicin is known for its off-target and toxic side effect profile, particularly with respect to the myocardium, often resulting in left ventricular (LV) dysfunction and congestive heart failure when used at cumulative doses exceeding 400 mg/m² Previously, we have observed that the ribonucleotide reductase subunit M2 (RRM2) is significantly overexpressed in estrogen receptor (ER)-negative cells as compared with ER-positive breast cancer cells. Here, we inhibited RRM2 in ER-negative breast cancer cells as a target for therapy in this difficult-to-treat population. We observed that through the use of didox, a ribonucleotide reductase inhibitor, the reduction in RRM2 was accompanied by reduced NF-κB activity in vitro When didox was used in combination with doxorubicin, we observed significant downregulation of NF-κB proteins accompanied by reduced TNBC cell proliferation. As well, we observed that protein levels of mutant p53 were significantly reduced by didox or combination therapy in vitro Xenograft studies showed that combination therapy was found to be synergistic in vivo, resulting in a significantly reduced tumor volume as compared with doxorubicin monotherapy. In addition, the use of didox was also found to ameliorate the toxic myocardial effects of doxorubicin in vivo as measured by heart mass, LV diameter, and serum troponin T levels. The data present a novel and promising approach for the treatment of TNBC that merits further clinical evaluation in humans.

Sun Awareness and Sun Protection Practices

Background

The incidence of skin cancer has increased over the past few years, owing to excessive exposure to ultraviolet (UV) radiation. Over the past decade, protection against solar radiation has been highly encouraged in numerous public health education campaigns. The adopted sun protection practices include avoiding exposure to the sun, using protective clothing, and applying sunscreen. The aim of this paper was to analyze the awareness and attitudes towards sun protection practices in some regions of the Arabian Peninsula.

Objective

The main objective of this study is to estimate the level of sun protection practices and determine the factors that have a significant impact on the level of adoption of sun protection practices by residents in the Arabian Peninsula.

Methods

A 35-question self-reporting online questionnaire to evaluate the sun protection measures adopted by the residents was distributed in the Kingdom of Saudi Arabia and Kingdom of Bahrain. The survey was conducted from January 2018 to May 2019, and a total 830 responses were collected for analysis. The data were analyzed using the statistical software SPSS. The chi-squared test and Spearman's correlation were performed to determine the association of the sun protection level with factors concerning the socio-demographic characteristics, sun sensitivity, health-conscious lifestyle, adopted sun protection measures, and general awareness about the UV index, skin cancer, and vitamin D. Logistic regression classification was applied in developing the empirical model to predict the sun protection level of the residents.

Results

Based on the analysis, only 34% of the total 830 respondents use sunscreen and most of the sunscreen users are female. The three most popular sun protection practices are: 1) avoiding exposure to the sun during peak hours, 2) using protective clothing, and 3) using sunglasses. The results indicate that 22% of respondents use a low level of sun protection, 53% use a medium level of protection, while 25% of respondents use a high level of sun protection. Many of the respondents understand that exposure to the sun can cause skin cancer and skin aging, while 54% of the respondents still believe that a suntan can be healthy if sunburn is avoided. Thirty percent of the participants of this study are aware of the UV index, and only 20% of all respondents know the correct meaning of the UV index. The overall predictive accuracy of the constructed logistic regression model is 67%. Based on the results of the logistic regression model, the five most significant factors of the sun protection level are: 1) perception that the sun can cause skin aging, or not, 2) age, 3) awareness of the dangerous effects of sun exposure, 4) income with respect to expenses, and 5) taking the UV index into consideration during exposure to the sun.

Conclusion

Most of the respondents are aware about sun protection. However, the sun protection level of the residents is still inadequate. An efficient strategy of increasing the awareness of the effective use of sun protection systems must be established based on the significant factors to prevent skin cancer.

Human Health Risk Assessment with Reference to the Consumption of Shrimp and Marine Fish

BACKGROUND AND OBJECTIVE

Meghna river estuary plays a major role in the national fish production and is being connected to other channels that might accelerate the magnification of heavy metals in human tissue through the food chain after fish consumption. Therefore present study aimed to elucidate possible human health risks should people consume fishes from this river.

MATERIALS AND METHODS

Total 5 heavy metals (Cu, Zn, Pb, Cd and Cr) in 6 being exported and highly consumed fish species (Lates calcarifer, Penaeous monodon, Encrasicholina heteroloba, Polynemus paradiseus, Sillaginopsis panijus and Ilisha megaloptera) from fish landing center during January 2016 to February 2017, near the Meghna river, Noakhali, Bangladesh were measured in the present study by using atomic absorption spectrometry (AAS).

RESULTS

The metal concentration (μg g-1) varied as Cu 4.63- 73.57, Zn 39.54-180.44, Pb 0.011-0.019, Cd .003-.122 and Cr 4.92-15.88 where Zn and Cr surpassed the different food safety guidelines. Estimation of daily dietary intake (EDI) of all the elements was measured from the national fish consumption data. Value <1.0 of estimated Target Hazard Quotients (THQ) for all fish species indicated the absence of public health hazard in the area for continuous consumption for 70 years. Besides, the Target carcinogenic risk (TR) for Pb (1.92 E-08) was also lying below the lifetime carcinogenic risk (E-05).

CONCLUSION

Although, this result pointed out an almost safe level of metal content in fishes for human consumption still continuous monitoring is necessary to ensure the safety of humans who rely heavily on aquatic resources in that area.

Abstract 5212: The benefits of Didox in triple negative breast cancer treatment targeting mutant p53

Triple-negative breast cancer (TNBC) is an aggressive histological subtype of malignancy with limited treatment options. Frequently, doxorubicin (DOXO)- based chemotherapy is utilized in this patient population due to the lack of molecular targets available. While DOXO is an effective chemotherapeutic agent, its efficacy is limited due to acquired drug resistance and cardiotoxicity. Therefore the identification of other treatment options for TNBC is needed. TNBC is a heterogeneous malignancy, with 70% of cases classified as a basal subtype, which further complicates the search for an effective molecular target. However, it has been identified that 80% of TNBC samples carry TP53 (tumor protein p53) mutations, which leads to a mutant p53 protein no longer able to act as a tumor suppressor and thus failing to halt cell growth. Mutant p53, when present in malignant cells, is far less susceptible to degradation than its wild-type counterpart, and thus accumulates within the cell. As such, the TP53 is an attractive therapeutic target for TNBC. We have previously identified that ribonucleotide reductase M2 (RRM2) is upregulated in TNBC cells and is a key contributor to acquired drug resistance. The ribonucleotide reductase inhibitor Didox has been shown to be a powerful free radical scavenger and iron chelator. Through these mechanisms, Didox alleviates the non-selective cytotoxic effects of DOXO on non-cancerous tissue, including cardiotoxicity and potentiates DOXO's efficacy against malignant cells. We have previously reported that Didox in combination with DOXO effectively treats TNBC by enhancing tumor inhibition and minimizing DOXO-induced heart damage. Our current study shows that Didox alone or in combination with DOXO downregulates mutant p53 protein levels in the mutant p53 TNBC cell lines MDA-MB 468, MDA-MB 231 and BT-20. This effect is notably absent in breast cancer cell lines with wild-type p53, including MCF7, A3B5 and ZR751, where p53 successfully acts as a tumor suppressor allowing for cell cycle arrest or apoptosis after DNA damage. We hypothesize that mutant p53 is a valid therapeutic target in TNBC. As shown here, the addition of Didox downregulates mutant p53 levels and thus enhances tumor inhibition while alleviating DOXO-associated cardiotoxicity.

Citation Format: Nahid Sultana, Elizabeth A. Wilson, Khyati N. Shah, Howard L. Elford, Jesika S. Faridi. The benefits of Didox in triple negative breast cancer treatment targeting mutant p53 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5212.

Doppler Evaluation of Carotid Vessels in Type 2 Diabetes

Type 2 diabetes considered as a compound of metabolic syndrome. It can cause both micro and macrovascular complications. Diabetes is a strong risk factor in the development of atherosclerosis and likewise carotid artery disease. Carotid artery stenosis may cause stroke. Doppler ultrasound is the most common imaging technique for the diagnosis of carotid disease. Objective of the study was to assess the percentage of atherosclerotic carotid disease in asymptomatic Type 2 diabetics (T2D) by Doppler sonography and to find out the association of different risk factors of diabetic patient with atherosclerosis. A cross sectional study was done. A total of 43 type 2 diabetic patients (27 male, 16 female) referred from the out patient department and admitted patients in Mymensingh Medical College Hospital (MMCH) during January 2017 to December 2017 for the purpose of evaluation of intima media thickness (IMT) and carotid artery stenosis by Duplex color Doppler ultrasonography examination were enrolled in this study. Patients with previous history of recent stroke or transient ischemic attack (<6 weeks), history of carotid surgery or cervical radiotherapy were excluded. Carotid artery disease was found 65.1% in asymptomatic type 2 diabetics. Among them increased IMT in 48.8% and carotid stenosis was present in 37.2% and >50% stenosis (Peak systolic velocity >125cm/sec) was present in 9.3%. Age >50% years, smoking, duration of DM >10 years, hypertension, history of ischaemic heart disease and history of diabetic retinopathy were found to be associated with carotid atherosclerosis as well as carotid stenosis. High percentage of carotid artery disease (65.1%) was found in asymptomatic type 2 diabetes mellitus. This result suggests the need for carotid Doppler evaluation of all Type 2 diabetics as a first measure of stroke prevention, with the hope that timely intervention might avert stroke and its accompanying disability.

Prevalence of Diabetic Nephropathy in Patients Attending the Endocrine Department of Mymensingh Medical College Hospital

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Due to severe morbidity and mortality of DN and limited effective therapies, research has mainly focused on prevention of this debilitating illness by modification of risk factors. Aims of this study were to find out the prevalence of diabetic nephropathy, its factors and to correlate the functional status of the kidney. This cross-sectional study was conducted in the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 1st January 2013 to 30th June 2013. A total 105 patients having clinical diagnosis of Diabetes mellitus were enrolled in this study. Data were collected by interview of the patients, clinical examination and laboratory investigation. Data was analyzed using the Chi-square test for Categorical variables and unpaired Student's 't' test for differences in means for continuous variables. P value <0.05 was considered significant. With DN (30.5%) patients 21.1% had micro-albuminuria and 9.5% had macro-albuminuria. The mean age for the DN patient was 47.9±14.7 years and male female ratio was 1:1. BMI was found significantly low in patients with DN (p<0.05). Prolonged duration of diabetes (>5 years) and uncontrolled diabetes were found as significant risk factors associated with DN. Other risk factors were hypertension, family history of hypertension, family history of diabetes mellitus and irregular treatment of diabetes mellitus. Mean serum creatinine, mean estimated glomerular filtration rate (GFR) and mean blood sugar level was 1.3±0.6mg/dl, 69.4±26.7ml and 15.6±7.1mmol/L respectively in DN patients. Relation was significant for higher serum creatinine and lower eGFR values (p<0.05). Prevalence of diabetic nephropathy was 30.5%. Long standing diabetes (>5 years) and uncontrolled diabetes were the important risk factors for the development of diabetic nephropathy. Diabetic nephropathy is associated with higher serum creatinine and lower eGFR values.