Antimicrobial Susceptibility Patterns of Bacterial Isolates from Blood Culture of Pediatric Patients with Suspected Sepsis at a Tertiary Care Hospital in Mymensingh, Bangladesh

Sepsis is a serious, life-threatening condition, occurring when an infectious agent invades the body, resulting in systemic inflammatory response syndrome (SIRS). Neonates and children are among the most vulnerable population groups of developing sepsis because of their weak immune barrier. Despite major advances in prevention, diagnosis and treatment of bacterial infections, invasive infections followed by sepsis remain one of the leading causes of childhood mortality. The aim of this study was to identify bacterial agents and antimicrobial resistance patterns of aerobic bacteria among children suspected of having sepsis. This cross-sectional descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Blood samples were collected from pediatric patients, suspected of having sepsis referred from inpatient facility of department of Neonatology and Pediatrics, Mymensingh Medical College Hospital (MMCH). Blood samples were inoculated into BacT/ALERT PF Plus bottles followed by sub-culture of positive samples in blood agar, MacConkey agar and chocolate agar plates. Isolated bacteria were identified by routine biochemical tests. Antimicrobial resistance pattern of all isolated bacteria was seen by disk diffusion method. MIC of vancomycin by agar dilution method was determined for isolated S. aureus and Coagulase negative Staphylococci (CoNS). The prevalence of pediatric sepsis was 31.82% with highest isolation rate 35.55% among neonates. The isolation rate of gram-positive bacteria was 62.50% where S. aureus was the most common isolate 32.15% followed by CoNS 30.36%. Out of 21 gram-negative bacteria, Pseudomonas spp. was the most frequent isolate 7(33.33%), all of which were resistant to cefuroxime, ceftriaxone and ceftazidime along with all klebsiella and Acinetobacter isolates. Out of 18 S. aureus isolates, 94.44%, 88.89% and 66.67% were resistant to Azithromycin, Penicillin-G and Ciprofloxacin respectively. The MIC of Vancomycin by agar dilution method was observed <2μg/ml against all isolated S. aureus and CoNS. All the Gram-positive isolates were sensitive to Linezolid and Vancomycin. Early detection of bacteria followed by antimicrobial susceptibility test can help by selection of appropriate antibiotic and prevent spread of infection.

Species Identification and Antifungal Susceptibility Pattern of Candida Isolates in Patients with Vulvovaginitis from Mymensingh, Bangladesh

Vulvovaginal Candidiasis (VVC), a frequent and cumbersome reproductive tract infection affects women's physical and mental health. Although Candida albicans was reported as the most common agent of VVC yet, recently there are significant changes in the pattern of Candida species causing VVC with varying antifungal susceptibility pattern. Therefore this cross-sectional, descriptive type of observational study conducted to identify the spectrum of Candida species associated with VVC and assesses their antifungal susceptibility pattern from March 2021 to February 2022. High vaginal swabs from 175 patients clinically suspected of VVC were collected and cultured on Sabouraud dextrose agar with Chloramphenicol. Species were identified by phenotypic methods like- germ tube test, sub-culture in chromogenic agar media and genotypic methods like- Polymerase chain reaction (PCR), Restriction fragment length polymorphism (RFLP). Antifungal susceptibility was done by disk diffusion method. Out of 175 patients, 52(29.7%) were positive for Candida species. Of the isolates- C. albicans 34(65.0%), Non albicans Candida (NAC) 18(35.0%). Among NAC, C. glabrata 5(9.6%), C. tropicalis 5(9.6%), C. parapsilosis 4(7.7%) and each of C. krusei, C. kefyr, C. ciferrii, C. dubliniensis were 1(1.9%). On susceptibility testing highest resistance was to Clotrimazole 31.0% followed by Nystatin 13.0%, Itraconazole 12.0% and Fluconazole 10.0%. Resistance to azole was higher in NAC than in albicans. Of these patients, 16(31.0%) had history of recurrent VVC (RVVC) of which 12(75.0%) were by NAC, predominantly C. glabrata 5(32.0%). The results showed the increasing incidence of NAC associated vaginitis with higher resistance and recurrence that should be considered in gynecology clinics.

Factors affecting the micronutrient status of adolescent girls living in complex agro-aquatic ecological zones of Bangladesh

Inadequate intake of both macro and micronutrients is the major determinant of micronutrient deficiencies in adolescent girls. This study assessed multiple micronutrient status including vitamin D, iron, vitamin A, and urinary iodine concentration among adolescent girls through two seasonal cross-sectional surveys conducted during dry and wet seasons. Mixed-effects linear and logistic regression analysis were conducted to assess associations between micronutrient status, salinity and seasonality. The mean age of the girls was 14 years. Vitamin (OH)D insufficiency was significantly higher in freshwater areas in wet season compared to dry season (wet season: 58% and dry season: 30%, P < 0.001). In wet season, risk of vitamin (OH)D insufficiency was three times higher compared to dry season (AOR: 3.03, 95% CI 1.71, 5.37, P < 0.001). The odds of vitamin (OH)D insufficiency was 11 times higher in fresh water areas compared to high saline areas (AOR: 11.51, 95% CI 3.40, 38.93, P < 0.001). The girls had higher risk of iron deficiency in wet season. Despite the environment being enriched with micronutrient-contained aquatic food, adolescent girls in coastal areas experience different micronutrient deficiencies. The high prevalence of vitamin (OH)D insufficiency in freshwater locations and seasonal iron deficiency in high saline areas needs attention.

Clinical Profiles and Outcomes of Cytomegalovirus Positive Renal Transplant Patients in Early Post-Transplant Period

Cytomegalovirus infection can cause increased mortality and morbidity in renal transplant recipient. The purpose of the present study was to observe the clinical profiles and outcomes of Cytomegalovirus positive renal transplant patients in early post-transplant period. This prospective cohort study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2016 to August 2017. Adult patients who had undergone renal transplantation were selected as study population. CMV serology (CMV IgM and CMV IgG) of both donor and recipient were detected before renal transplantation. Cytomegalovirus viral DNA was extracted from both serum by using a commercially available DNA extraction kit and PCR was done by the StepOne™ PCR machine using real time PCR kit in all patient during the early post-transplant period. During this period, sign symptoms of patients with cytomegalovirus infection as well as clinical outcomes were also noted. Total number of 32 patients was included in this study with the mean age of 31.15±11.56 years. Cytomegalovirus was found positive in 11(34.4%) patients and negative in 21(65.6%) patients. Anorexia was the most common presentation which was found in 81.8% cases followed by renal impairment, fever, diarrhea, cough and weight loss which were present in 6(54.5%), 3(27.3%), 2(18.2%), 2(18.2%) and 2(18.2%) cases respectively. The outcomes of cytomegalovirus positive patients in first 6 months after renal transplantation revealed 25.0% patients had cytomegalovirus infection; 6.2% patients had cytomegalovirus disease and 6.2% patients were died. However, 9.4% patients had co-infection in the form of UTI and 6.2% patients had re activation of hepatitis C infection associated with cytomegalovirus infection. Cytomegalovirus was found positive in approximately one third of renal transplant recipients in early post-transplant period. Careful clinical evaluation and appropriate laboratory parameters should be looked over for timely diagnosis and management of these cases.

Salinity extrusion and resilience of coastal aquaculture to the climatic changes in the southwest region of Bangladesh

The southwest coastal belt of Bangladesh is characterized by a fresh and saline water interaction which gives rise to a discrete inter-saline freshwater convergence zone (ICZ). Hydrology and farming along this transition zone is influenced by upstream and downstream abiotic factors including salinity intrusion and water flow. To better understand the changing geography of the transitional ICZ line and the relative influence of these hydrological events on farming therein, the recent study compared relative changes from 2010 to 2014 based on qualitative and quantitative survey work with 80 households of 4 villages (Shobna, Faltita, Badukhali and Rudaghora) from Khulna and Bagerhat district. Contrary to the conventional hotcake climate change induced salinity intrusion the study found a significant decrease in saltwater influx and increased freshwater volume in the ICZ villages, reflecting a seaward movement trend. Farmer perception shifted to low saline and freshwater in many areas where it was high saline and medium saline in 2010. The factual and perceived salinity were varied from 1 ± 0.44 to 2 ± 0.77 ppt in the studied villages. To confront the condition farmer diversified their farming pattern from single crop like either only shrimp or prawn culture to concurrent culture of shrimp-prawn, shrimp, prawn and rice with an increased production of (68-204 kg/ha), finfish (217-553 kg/ha) and dyke crop (92-800 kg/ha). Thus, affecting the socioeconomic condition of the farmer with an increase in average monthly income, reported for the better-off classes in 2014, ranged from 14,300 to 51,667 BDT and for the worse-off ranged from 5000 to 9900 BDT. In contrast, this average monthly income was 9500- 27,000 for better-off and 3875 - 8600 for worse-off classes, reported in 2010. Besides, farming areas (average 17% for better-off and -0.5% for worse-off) and land leasing (average increment rate per ha 50%) also increased among the surveyed farmers, reported in 2014 compared to 2010. In addition, several adaptation strategies like unrefined salt use, change of water use, diversification through prawn, finfish and dyke crops along with traditional shrimp and overall land use change have a positive impact on farmer's economic and nutritional security as well as farming intensity. The study showed a unique attributes of salinity extrusion in micro-level of ICZ line where farmers intensified farming system with indigenous knowledge to secured their livelihoods.

Adolescent girls in aquaculture ecozones at risk of nutrient deficiency in Bangladesh development and validation of an integrated metric

BACKGROUND

This study developed and validated an integrated metric that enhances understanding of linkages between agro-ecological and socio-economic factors that are important for explaining nutritional wellbeing in relation to fish consumption; especially among adolescent girls who are at risk of nutritional deficiency in Bangladesh. Currently, there is no metric that takes account of environmental, cultural and economic contexts when considering fish consumption and dietary health from a policy perspective.

METHODS

The study was designed as a bi-seasonal survey, repeated in the same population of adolescent girls recruited during the dry and wet seasons. Sampling was stratified by five settings (four aqua-agroecological zones and one processing plant community), with 60 girls recruited in each. Associations between candidate predictors (salinity, diet diversity, religion, socio-economic status and women's autonomy score) and dependent variables representing nutritional outcomes (anthropometry, omega-3 index and micronutrient levels) were explored in multivariable regressions. The fitted model with its predictors was validated, and a risk score derived from responses to a few short questions on religion, salinity zone, female autonomy, diet diversity and tilapia consumption.

RESULTS

The omega-3 index showed the clearest distinction between seasons, by salinity and religion. Higher female autonomy, religion (being Hindu rather than Muslim), geographical location (living in a high or mid-saline area), and a higher dietary diversity were the strongest predictors of whole blood omega-3 index. The c-index for the prognostic model was 0.83 and 0.76 in the wet and dry season respectively, indicating good predictive accuracy. There appeared to be a clear trend in risk scores differentiating between those 'chronically at risk' and those 'never at risk'.

CONCLUSIONS

Observational data on different aquaculture-ecozones defined by salinity enabled us to establish linkages between seasonal fish intake, religion, diet diversity, female autonomy and nutritional wellbeing. The purpose of the metric is to reveal these specific linkages in practice. This tool should improve targeting of timely, preventative and cost-effective nutritional interventions to adolescent girls most at-risk from low omega-3 levels in communities where seafood is produced.

Nutritional value of the marine fish in Bangladesh and their potential to address malnutrition: A review

Marine fish are good source of essential macro- and micronutrients and major food items in coastal areas in Bangladesh. However, there is no review that details the nutritional value of marine fish in Bangladesh. Therefore, this review focuses on the nutrient composition of marine fish in Bangladesh and how the marine fish can address common nutrient deficiencies among women and children. Nutrient composition data was collected through literature searching in databases and source, including PubMed, Web of Science, Google Scholar, ScienceDirect, WorldFish, and Bangladesh-based database Banglajol. Calculation was carried out to present how one serving marine fish could potentially meet the daily requirement of protein, iron, zinc, calcium, vitamin A, and docosahexaenoic acid (DHA) for pregnant and lactating women and children aged 6-23 months. A total of 97 entries covering nutrient composition analysis of 67 individual fish species were extracted from 12 articles published between 1993 and 2020. Included articles contained analysis of proximate composition, vitamins, minerals, fatty acids, and amino acid. Twelve minerals and nine vitamins were analyzed and reported. The average energy, protein, fat, and ash content per 100 g edible raw marine fish was 343.58 kJ, 16.76 g, 4.16 g, and 2.22 g, respectively. According to available data, marine fish are good sources of protein, zinc, calcium, and DHA. Pelagic small fish, which are mainly captured by artisanal small-scale fishers, had more nutritional value than other categories of fish. Furthermore, marine small fish were found more nutritious than commonly consumed freshwater fish types in Bangladesh, including major carps, introduced carps, and tilapia. Therefore, the study concludes that marine fish have high potential to address malnutrition in Bangladesh. There was scarcity of literature regarding the nutrient composition of marine fish in Bangladesh and in South Asia as a whole, so more comprehensive quality research in this area is recommended.

Seafood in Food Security: A Call for Bridging the Terrestrial-Aquatic Divide

The contribution of seafood to global food security is being increasingly highlighted in policy. However, the extent to which such claims are supported in the current food security literature is unclear. This review assesses the extent to which seafood is represented in the recent food security literature, both individually and from a food systems perspective, in combination with terrestrially-based production systems. The results demonstrate that seafood remains under-researched compared to the role of terrestrial animal and plant production in food security. Furthermore, seafood and terrestrial production remain siloed, with very few papers addressing the combined contribution or relations between terrestrial and aquatic systems. We conclude that far more attention is needed to the specific and relative role of seafood in global food security and call for the integration of seafood in a wider interdisciplinary approach to global food system research.

Export-Driven, Extensive Coastal Aquaculture Can Benefit Nutritionally Vulnerable People

Export-orientated shrimp and prawn farming in coastal ghers has been associated with negative environmental, social, and nutritional impacts. This study challenges these perceptions based on field observations from four communities in South West Bangladesh. Most households observed (&gt;60%) were either directly involved in seafood farming or engaged elsewhere in the seafood value chain. Our study set out to establish how the type and location of aquaculture impacted on access to and consumption of aquatic animals. Additionally, we assessed the effects of both household socioeconomic status and intra-household food allocation on individual diet and nutritional outcomes. We used a blended approach, including a 24-h consumption recall on two occasions, analysis of the proximate composition of aquatic animals and biomarkers from whole blood from a sample of the target population. The diverse polyculture systems generated broad social benefits, where “export-oriented” production actually supplied more food locally than to global markets. Key findings: (1) worse-off households achieved higher productivity of farmed aquatic animals on smaller landholding than better-off households with larger landholdings; (2) vegetable production on gher dikes was a significant source of nutrition and income in lower saline gradients; (3) more fish was eaten in lower saline gradients although fish consumption was highly variable within and between households; (4) intra-household allocation of specific foods within diets were similar across communities; (5) recommended nutrient intakes of protein and zinc exceeded daily requirements for adolescent females, but energy, calcium, and iron were below recommended intake levels; (6) n-3 LC-PUFA, expressed as percentage of total fatty acids, in whole blood samples of adolescent females declined with ambient salinity level regardless of household socioeconomic status; (7) analysis of aquatic animals consumed found that mangrove species and tilapia harvested from higher saline ghers contained high levels of desirable PUFAs. These findings suggest that export-driven, extensive coastal aquaculture can be nutrition sensitive when co-products are retained for local consumption.

COVID-19 impacts and adaptations in Asia and Africa's aquatic food value chains

The COVID-19 pandemic is a shock affecting all areas of the global food system. We tracked the impacts of COVID-19 and associated policy responses on the availability and price of aquatic foods and production inputs during 2020, using a high frequency longitudinal survey of 768 respondents in Bangladesh, Egypt, India, Myanmar, Nigeria. We found the following: (1) Aquatic food value chains were severely disrupted but most effects on the availability and accessibility of aquatic foods and production inputs were short-lived. (2) Impacts on demand for aquatic foods, production inputs, and labor have been longer lasting than impacts on their supply. (3) Retail prices of aquatic foods spiked briefly during March-May 2020 but trended down thereafter, whereas prices of production inputs rose. These trends suggest a deepening 'squeeze' on the financial viability of producers and other value chain actors. (4) Survey respondents adapted to the challenges of COVID-19 by reducing production costs, sourcing alternative inputs, diversifying business activities, leveraging social capital, borrowing, seeking alternative employment, and reducing food consumption. Many of these coping strategies are likely to undermine well-being and longer-term resilience, but we also find some evidence of proactive strategies with potential to strengthen business performance. Global production of aquatic food likely contracted significantly in 2020. The importance of aquatic food value chains in supporting livelihoods and food and nutrition security in Asia and Africa makes their revitalization essential in the context of COVID-19 recovery efforts. We outline immediate and longer-term policies and interventions to support this goal.

The impact of the COVID-19 pandemic on fish consumption and household food security in Dhaka city, Bangladesh

The effects of COVID-19 are continuing to increase around the world as the pandemic claims thousands of lives. Bangladesh is no exception and has been greatly affected by SARS-CoV-2. Apart from the number of people who are or have been directly getting infected with this disease, millions of people are directly or indirectly facing many challenges to their livelihoods and the security of their food and nutritional supply, along with other societal issues created by the pandemic. In this study, a hybrid approach of online and telephone questionnaire surveys was used to investigate the food security of Dhaka city's inhabitants at household level. Approximately 80% of the respondents reported reduced income, and a quarter of respondents lost their jobs between March and June 2020. The frequency of fish consumption, an essential component of Bangladeshi diets, significantly reduced during the pandemic. This was especially apparent in affluent segments of the community. Out of the respondents, 75% reported an increase in the price of fish in Dhaka city. A range of coping strategies were observed: including decreasing the frequency of grocery shopping, shifting to online shopping, reducing consumption of high price commodities, reducing junk food consumption, cleaning fish and meat with hot water and vinegar, and increasing the consumption of protein and vitamin C rich food items. Prior to COVID-19, 80% of the households surveyed bought fish from wet markets. This number dropped to 45% during the pandemic. Many households substituted fish and meat with poultry, eggs and dried fish. About half of the households stockpiled rice, lentils and potatoes during the peak of the pandemic. However, if the pandemic lasts for a prolonged period, those living on low incomes in urban areas will experience some level of food insecurity from a reduced income or loss of work. Because of this, a large-scale sustainability policy should be undertaken to secure the food and nutritional security of low-income and middle-class household.

Temporal trends in between and within-country inequalities in caesarean delivery in low- and middle-income countries: a Bayesian analysis

OBJECTIVE

To provide updated information about between-country variations, temporal trends and changes in inequalities within countries in caesarean delivery (CD) rates.

DESIGN

Cross-sectional study of Demographic and Health Survey (DHS) during 1990-2018.

SETTING

74 low- and middle-income countries (LMICs).

POPULATION

Women 15-49 years of age who had live births in the last 3 years.

METHODS

Bayesian linear regression analysis was performed and absolute differences were calculated.

MAIN OUTCOME MEASURE

Population-level CD by countries and sociodemographic characteristics of mothers over time.

RESULTS

CD rates, based on the latest DHS rounds, varied substantially between the study countries, from 1.5% (95% CI 1.1-1.9%) in Madagascar to 58.9% (95% CI 56.0-61.6%) in the Dominican Republic. Of 62 LMICs with at least two surveys, 57 countries showed a rise in CD during 1990-2018, with the greatest increase in Sierra Leone (19.3%). Large variations in CD rates were observed across mother's wealth, residence, education and age, with a higher rate of CD by the richest and urban mothers. These inequalities have widened in many countries. Stratified analyses suggest greater provisioning of CD by the richest mothers in private facilities and poorest mothers in public facilities.

CONCLUSIONS

CD rates varied substantially across geographical locations and over time, irrespective of public or private health facilities. Changes in CD rates continue across wealth, place of residence, education, and age of mother, and are widening in most study countries.

TWEETABLE ABSTRACT

Increasing caesarean delivery rates were greater among the richest and urban mothers than their counterparts, with widened gaps in LMICs.

Depression among Patients Presenting with Gastrointestinal Symptoms: Prevalence and Associated Factors

Gastrointestinal diseases frequently affect patients' physical and emotional wellbeing as being heavily affected by stress. This study was conducted to find out prevalence and severity of depressive symptoms among patients presenting with gastrointestinal symptoms. This cross sectional study was conducted at Outpatients Department jointly by Department of Gastroenterology and Department of Psychiatry of a tertiary care hospital in north east part of Bangladesh from November 2011 to June 2012. Consecutive patients with gastrointestinal symptoms underwent psychiatric evaluation using HDRS and analyzed. 442 patients, 38(8.6%) were found normal. Among the rest 128(28.96%), 138(31.22%), 72(16.29%) and 66(14.93%) had mild, moderate, severe and very severe depressive symptoms respectively. Female sex (95.03% vs. 89.32%), married people (93.77 vs. 86.13%), older age (98.24%), rural people (94.26% vs. 84.36%), farmers (96.36%) and house wives (96.24%) were more affected. Prevalence of depression was also higher among patients with lower socioeconomic class, less educated people and rural background. Depressive symptoms are very common in patients presenting with gastrointestinal symptoms. Awareness regarding psychiatric assessment and intervention may reduce sufferings and thus improve wellbeing of these patients.

Medicinal Properties Screening of Mallotus paniculatus Extract

Introduction: Traditionally, Mallotus paniculatus (Balik Angin) plant is used in the treatment of various diseases in rural areas such as remedy after childbirth, wound healing and fever. In this present study, four medicinal properties of the plant were investigated which included antibacterial, antifungal, anticancer and antioxidant activities. Materials and Methods: Potential medicinal compounds were extracted from the plant leaves by sonication with 3 different solvents namely ethanol, ethyl acetate and hexane respectively. The antibacterial and antifungal properties were determined using disc diffusion agar and broth dilution assay, the antioxidant activity by DPPH scavenging assay and the anticancer effect by MTT assay. Results: From the screening of the medicinal properties, M. paniculatus leave extracts were shown to possess antibacterial, antioxidant and anticancer properties but not antifungal properties. Ethanolic and ethyl acetate extracts of the leave were active against gram positive bacteria (Staphylococcus aureus and Bacillus subtilis) but not gram negative bacteria (Pseudomonas aeruginosa and Escherichia coli). The antioxidant activity of the ethanolic crude extract was high; with IC50 of 30 μg/ml comparable with the positive controls; ascorbic acid and butylated hydroxytoluene (BHT). Both ethanolic and ethyl acetate extracts were cytotoxic against breast cancer (MCF7), colon cancer (HT-29), cervix cancer (Hela) cell lines. Conclusion: M. paniculatus leave extract has many potential medicinal values for further studies.

Assessment of food safety knowledge, attitudes and practices of fish farmers and restaurants food handlers in Bangladesh

The study was conducted to assess the present status of knowledge, attitudes and practices (KAP) concerning the food safety and hygiene issues among fish farmers and food handlers in Noakhali, Bangladesh. Data were collected from 100 respondents (50 fish farmers and 50 food handlers) through face to face interviews. All the respondents agreed that training on hygiene practices was necessary and they were interested to attend training in their spare time. Food handlers (88%) agreed that raw foods must be kept separate from prepared foods and 68% of them believed that improper preservation of foods is harmful to health. About 52% of farmers used a face mask when spreading insecticides, fertilizers, and chemicals. Food handlers were wearing protective clothing (32%) and masks (12%) when touching and distributing unwrapped foods, however no handlers used a cap. A significant strong correlation coefficient (rs) was found between knowledge with attitudes, knowledge with practices and attitudes with practices of 0.73-0.99 among the three domains for fish farmers and food handlers. The correlation among the three levels was satisfactory, however, some food safety concepts and practices regarding hygiene were still insufficient. Therefore, an effective and appropriate training program on food safety and hygiene should be launched in a holistic approach for all fish farmers and food handlers to increase awareness and ensure safe food for consumers with a view to reducing the possibility of disease outbreak.

Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression

BACKGROUND

Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates.

OBJECTIVES

To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR.

SEARCH STRATEGY

PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019.

SELECTION CRITERIA

Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors.

DATA COLLECTION AND ANALYSIS

Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants.

MAIN RESULTS

We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation.

CONCLUSIONS

An appropriate reporting of CDMR should be a key priority in maternal health policies and practices.

TWEETABLE ABSTRACT

Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.

Minimotif Miner 4: a million peptide minimotifs and counting

Minimotif Miner (MnM) is a database and web system for analyzing short functional peptide motifs, termed minimotifs. We present an update to MnM growing the database from ∼300 000 to >1 000 000 minimotif consensus sequences and instances. This growth comes largely from updating data from existing databases and annotation of articles with high-throughput approaches analyzing different types of post-translational modifications. Another update is mapping human proteins and their minimotifs to know human variants from the dbSNP, build 150. Now MnM 4 can be used to generate mechanistic hypotheses about how human genetic variation affect minimotifs and outcomes. One example of the utility of the combined minimotif/SNP tool identifies a loss of function missense SNP in a ubiquitylation minimotif encoded in the excision repair cross-complementing 2 (ERCC2) nucleotide excision repair gene. This SNP reaches genome wide significance for many types of cancer and the variant identified with MnM 4 reveals a more detailed mechanistic hypothesis concerning the role of ERCC2 in cancer. Other updates to the web system include a new architecture with migration of the web system and database to Docker containers for better performance and management. Weblinks:minimotifminer.org and mnm.engr.uconn.edu

Electrostatic rogue waves in double pair plasmas

A nonlinear Schrödinger equation is derived to investigate the modulational instability of ion-acoustic (IA) waves (IAWs) in a double pair plasma system containing adiabatic positive and negative ion fluids along with super-thermal electrons and positrons. The analytical analysis predicts two types of modes, viz., fast ( ω f ) and slow ( ω s ) IA modes. The possible stable and unstable parametric regions for the IAWs in the presence of external perturbation can be observed for both ω f and ω s . The number density of the negative ions and positrons plays a vital role in generating the IA rogue waves in the modulationally unstable region. The applications of our present work in astrophysical environments [viz., D-region (H + , O 2 - ) and F-region (H + , H - ) of the Earth's ionosphere] and in laboratory plasmas [viz., pair-ion fullerene (C + , C - )] are pinpointed.

Young adult pregnancy status and the risk of developing overweight and obesity among women and men

Pregnancies can end in miscarriage, birth or termination. Although it is well known that pregnancy results in weight gain across the life course, it is unknown whether pregnancies which end in termination and miscarriage contribute to this. The study used a sub-sample of 3630 adult offspring from the original cohort of the Mater University of Queensland Study of Pregnancy (MUSP) and its outcomes, in Brisbane, Australia. Anthropometric data were measured at 5, 14 and 21 years of age and experience of pregnancy including termination, miscarriage and births were self-reported at 21 years. Multivariable analyses were conducted to determine whether pregnancy status of young people independently associated with overweight or obesity status. The women who had at least one birth were more likely to have overweight (odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.01, 2.27) or obese (OR 2.38; 95% CI: 1.58, 3.59) compared to women who did not experience any pregnancy. Women whose pregnancies were terminated or miscarried were at the same risk of overweight or obesity as women who did not experience any pregnancy. For men, there is no association between the pregnancies in their partners and the mean difference in their body mass index. Young women whose pregnancies result in a birth, but not terminations or miscarriages, are at greater risk of having overweight or obesity following the birth.

Response of Proliferative Lupus Nephritis with Pulse Cyclophosphamide Therapy during Induction Period: A Single Centre Study in Bangladesh

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Efficient Algorithms for Finding the Closest l-mers in Biological Data

With the advances in the next generation sequencing technology, huge amounts of data have been and get generated in biology. A bottleneck in dealing with such datasets lies in developing effective algorithms for extracting useful information from them. Algorithms for finding patterns in biological data pave the way for extracting crucial information from the voluminous datasets. In this paper we focus on a fundamental pattern, namely, the closest l-mers. Given a set of m biological strings S1,S2,…,Sm and an integer l, the problem of interest is that of finding an l-mer from each string such that the distance among them is the least. I.e., we want to find m l-mers X1,X2,…,Xm such that Xi is an l-mer in Si (for 1 ≤ i ≤ m) and the Hamming distance among these m l-mers is the least (from among all such possible l-mers). This problem has many applications including motif search. Algorithms for finding the closest l-mers have been used in solving the (l,d)-motif search problem (see e.g., \cite{PeSz00,DBR07}). In this paper novel algorithms are proposed for this problem for the case of . A comprehensive experimental evaluation is performed for m=3, along with a further empirical study of m=4 and 5.

Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.

Heavy ion-acoustic rogue waves in electron-positron multi-ion plasmas

The nonlinear propagation of heavy-ion-acoustic (HIA) waves (HIAWs) in a four-component multi-ion plasma (containing inertial heavy negative ions and light positive ions, as well as inertialess nonextensive electrons and positrons) has been theoretically investigated. The nonlinear Schrödinger (NLS) equation is derived by employing the reductive perturbation method. It is found that the NLS equation leads to the modulational instability (MI) of HIAWs, and to the formation of HIA rogue waves (HIARWs), which are due to the effects of nonlinearity and dispersion in the propagation of HIAWs. The conditions for the MI of HIAWs and the basic properties of the generated HIARWs are identified. It is observed that the striking features (viz., instability criteria, growth rate of MI, amplitude and width of HIARWs, etc.) of the HIAWs are significantly modified by the effects of nonextensivity of electrons and positrons, the ratio of light positive ion mass to heavy negative ion mass, the ratio of electron number density to light positive ion number density, the ratio of electron temperature to positron temperature, etc. The relevancy of our present investigation to the observations in space (viz., cometary comae and earth's ionosphere) and laboratory (viz., solid-high intense laser plasma interaction experiments) plasmas is pointed out.

Maternal depression and family adversity: Linked pathways to offspring depression?

There is conflicting evidence about the contribution of maternal depression and family adversity to depression experienced by offspring. Because maternal depression and family adversity are related, there is a need to determine how they independently contribute to offspring depression. Data are from a long-running prospective birth cohort study (Mater-University of Queensland Study of Pregnancy and its outcomes - MUSP). For this study some 2200 offspring were followed up at 30 years of age. We first examine the association between maternal depression and family adversity over the period from the pregnancy to the child reaching adulthood. Then we consider the extent to which maternal depression and family adversity trajectories over this period predict CIDI/DSM-IV episodes of depression in the offspring of these mothers at 30 years of age. We find a strong bi-directional association between maternal depression and family experiences of adverse life events over the entire period the child is at home. After adjustment, children reared in a family experiencing high levels of adverse life events are more likely to experience a lifetime ever DSM-IV diagnosis of depression, are more likely to have experienced multiple episodes of lifetime ever depression, and are more likely to report their first episode of depression was at a younger age. The findings suggest the association between maternal depression and offspring depression appears to be partly attributable to the higher levels of family adversity characteristic of depressed mothers.

Sleep quality and obesity in young subjects: a meta-analysis

OBJECTIVES

To assess the effect of poor sleep quality on Overweight/Obesity (Ow/Ob) in young subjects, and explore if this association is independent of sleep duration.

METHODS

Pubmed, EMBASE, and MEDLINE databases were searched for papers on sleep quality and overweight/obesity, focusing on children, adolescents, and young adults. Studies based on subjects with medical/psychological problems or published in languages other than English were excluded. Quality effects model was used to pool studies for meta-analysis.

RESULTS

Findings from the systematic review suggest a link between poor sleep quality and Ow/Ob in young subjects. Pooled estimate (from 26,553 subjects) suggest a role of inadequate sleep (including both short duration and poor quality) in Ow/Ob (OR: 1.27 95% CI: 1.05-1.53). Sub-group-analyses suggest considerably higher odds of Ow/Ob (OR = 1.46, 95% CI: 1.24-1.72) in young subjects with poor sleep quality (independent of duration).

CONCLUSIONS

Poor sleep quality seems to be associated with Ow/Ob, and some studies indicate this association to be independent of duration. Therefore, considering only sleep duration might not help in disentangling sleep-obesity association. However, this review is mostly composed of cross-sectional studies. Therefore, a causal link or the stability of the sleep quality and Ow/Ob association could not be established.

Association of vitamin D status with incidence of enterotoxigenic, enteropathogenic and enteroaggregative Escherichia coli diarrhoea in children of urban Bangladesh

OBJECTIVE

To evaluate the association between vitamin D status and diarrhoeal episodes by enterotoxigenic (ETEC), enteropathogenic (EPEC) and enteroaggregative (EAEC) E. coli in underweight and normal-weight children aged 6-24 months in urban Bangladesh.

METHODS

Cohorts of 446 normal-weight and 466 underweight children were tested separately for ETEC, EPEC and EAEC from diarrhoeal stool samples collected during 5 months of follow-up while considering vitamin D status at enrolment as the exposure. Cox proportional hazards models with unordered failure events of the same type were used to determine diarrhoeal risk factors after adjusting for sociodemographic and concurrent micronutrient status.

RESULTS

Vitamin D status was not independently associated with the risk of incidence of ETEC, EPEC and EAEC diarrhoea in underweight children, but moderate-to-severe retinol deficiency was associated with reduced risk for EPEC diarrhoea upon adjustment. Among normal-weight children, insufficient vitamin D status and moderate-to-severe retinol deficiency were independently associated with 44% and 38% reduced risk of incidence of EAEC diarrhoea, respectively. These children were at higher risk of ETEC diarrhoea with vitamin D deficiency status when adjusted for micronutrient status only.

CONCLUSION

This study demonstrates for the first time that normal-weight children with insufficient vitamin D status have a reduced risk of EAEC diarrhoea than children with sufficient status. Moderate-to-severe deficiency of serum retinol is associated with reduced risk of EPEC and EAEC diarrhoea in underweight and normal-weight children.

KCMBT: a k-mer Counter based on Multiple Burst Trees

MOTIVATION

A massive number of bioinformatics applications require counting of k-length substrings in genetically important long strings. A k-mer counter generates the frequencies of each k-length substring in genome sequences. Genome assembly, repeat detection, multiple sequence alignment, error detection and many other related applications use a k-mer counter as a building block. Very fast and efficient algorithms are necessary to count k-mers in large data sets to be useful in such applications.

RESULTS

We propose a novel trie-based algorithm for this k-mer counting problem. We compare our devised algorithm k-mer Counter based on Multiple Burst Trees (KCMBT) with available all well-known algorithms. Our experimental results show that KCMBT is around 30% faster than the previous best-performing algorithm KMC2 for human genome dataset. As another example, our algorithm is around six times faster than Jellyfish2. Overall, KCMBT is 20-30% faster than KMC2 on five benchmark data sets when both the algorithms were run using multiple threads.

AVAILABILITY AND IMPLEMENTATION

KCMBT is freely available on GitHub: (https://github.com/abdullah009/kcmbt_mt).

CONTACT

rajasek@engr.uconn.edu

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Vitamin-D status is not a confounder of the relationship between zinc and diarrhoea: a study in 6-24-month-old underweight and normal-weight children of urban Bangladesh

BACKGROUND/OBJECTIVE

The role of micronutrients particularly zinc in childhood diarrhoea is well established. Immunomodulatory functions of vitamin-D in diarrhoea and its role in the effect of other micronutrients are not well understood. This study aimed to investigate whether vitamin-D directly associated or confounded the association between other micronutrient status and diarrhoeal incidence and severity in 6-24-month underweight and normal-weight children in urban Bangladesh.

SUBJECTS/METHODS

Multivariable generalised estimating equations were used to estimate incidence rate ratios for incidence (Poisson) and severity (binomial) of diarrhoea on cohorts of 446 normal-weight and 466 underweight children. Outcomes of interest included incidence and severity of diarrhoea, measured daily during a follow-up period of 5 months. The exposure of interest was vitamin-D status at enrolment.

RESULTS

Normal-weight and underweight children contributed 62 117 and 62 967 day observation, with 14.2 and 12.8 days/child/year of diarrhoea, respectively. None of the models showed significant associations of vitamin-D status with diarrhoeal morbidity. In the final model, zinc-insufficient normal-weight children had 1.3 times more days of diarrhoea than sufficient children (P<0.05). Again zinc insufficiency and mother's education (1-5 and >5 years) had 1.8 and 2.3 times more risk of severe diarrhoea. In underweight children, older age and female had 24-63 and 17% fewer days of diarrhoea and 52-54 and 31% fewer chances of severe diarrhoea.

CONCLUSION

Vitamin-D status was not associated with incidence and severity of diarrhoea in study children. Role of zinc in diarrhoea was only evident in normal-weight children. Our findings demonstrate that vitamin-D is not a confounder of the relationship between zinc and diarrhoea.

Caesarean delivery and the risk of offspring overweight and obesity over the life course: a systematic review and bias-adjusted meta-analysis

A causal role of Caesarean delivery (CD) on developing overweight and obesity in the life course of offspring has been postulated. However, the true strength of this association is not clear and the potential for confounding has not been adequately addressed. A systematic review and meta-analysis were conducted to evaluate the strength of this association, this time using a bias-adjusted model in addition to conventional methods. Our search yielded 32 estimates from 14 publications (n = 261,000) for meta-analysis. The pooled analysis of seven estimates (n = 194,463) demonstrated a trend only towards a risk increase (RR = 1.15; 95% CI:0.94, 1.40) in overweight and obesity combined (ow+ob) due to CD in early childhood (0-5 years) and a similar trend was observed for mid-childhood and adolescence (5-18 years). In adulthood, a moderate increase in risk for ow+ob due to CD was observed (n = 30,200) (RR = 1.28; 95% CI 1.02, 1.34). Results for obesity and overweight separately were stronger for obesity and demonstrated a decreasing effect across the three life stages. Conventional methods of analysis suggested less uncertainty than we report and publication bias assessment was strongly suggestive of a bias in favour of positive studies. The current analysis therefore suggests that the small effects seen with CD in this and previous meta-analyses are probably a cumulative consequence of several biases we have outlined, including confounding effect and publication bias.

Anxiety symptoms and the risk of diabetes mellitus in Australian women: evidence from 21-year follow-up

OBJECTIVES

This study aimed to explore the association between transitions in anxiety symptoms and the risk of diabetes in women, using longitudinal data.

STUDY DESIGN

This longitudinal study measured diabetes, and transitions in anxiety symptoms, using validated instruments.

METHODS

Data obtained by the Mater-University of Queensland Study of Pregnancy were analysed. Anxiety was measured using the Delusion Symptoms States Inventory (DSSI). To examine possible transitions over different time periods, anxiety was grouped into four categories and assessed at different phases over a 21-year period.

RESULTS

Three hundred and one women reported diabetes 21 years after the index pregnancy. Almost half of the women who reported anxiety symptoms continued to report these at a subsequent follow-up (FU) phase. About 1 in 10 women who had not reported anxiety symptoms at 5-year FU did so at the subsequent 14-year FU. In prospective analyses, we did not find significant association of diabetes with negative transition (no anxiety to anxiety at subsequent phase) or with positive history of anxiety symptom, but an increasing risk was evident. Women with persistent symptoms had a 1.85-fold greater risk of diabetes (95% CI: 1.18-2.90). The cross-sectional analysis did not produce significant results.

CONCLUSIONS

Despite some limitations, this study provides insight into the long-term association between events of anxiety and the risk of diabetes across the reproductive life of women. However, the evidence is not strong enough to support a direct effect of anxiety in causing diabetes.

RLT-S: A Web System for Record Linkage

Background

Record linkage integrates records across multiple related data sources identifying duplicates and accounting for possible errors. Real life applications require efficient algorithms to merge these voluminous data sources to find out all records belonging to same individuals. Our recently devised highly efficient record linkage algorithms provide best-known solutions to this challenging problem.

Method

We have developed RLT-S, a freely available web tool, which implements our single linkage clustering algorithm for record linkage. This tool requires input data sets and a small set of configuration settings about these files to work efficiently. RLT-S employs exact match clustering, blocking on a specified attribute and single linkage based hierarchical clustering among these blocks.

Results

RLT-S is an implementation package of our sequential record linkage algorithm. It outperforms previous best-known implementations by a large margin. The tool is at least two times faster for any dataset than the previous best-known tools.

Conclusions

RLT-S tool implements our record linkage algorithm that outperforms previous best-known algorithms in this area. This website also contains necessary information such as instructions, submission history, feedback, publications and some other sections to facilitate the usage of the tool.

Availability

RLT-S is integrated into http://www.rlatools.com, which is currently serving this tool only. The tool is freely available and can be used without login. All data files used in this paper have been stored in https://github.com/abdullah009/DataRLATools. For copies of the relevant programs please see https://github.com/abdullah009/RLATools.

Unusually High Mortality in Waterfowl Caused by Highly Pathogenic Avian Influenza A(H5N1) in Bangladesh

Mortality in ducks and geese caused by highly pathogenic avian influenza A(H5N1) infection had not been previously identified in Bangladesh. In June-July 2011, we investigated mortality in ducks, geese and chickens with suspected H5N1 infection in a north-eastern district of the country to identify the aetiologic agent and extent of the outbreak and identify possible associated human infections. We surveyed households and farms with affected poultry flocks in six villages in Netrokona district and collected cloacal and oropharyngeal swabs from sick birds and tissue samples from dead poultry. We conducted a survey in three of these villages to identify suspected human influenza-like illness cases and collected nasopharyngeal and throat swabs. We tested all swabs by real-time RT-PCR, sequenced cultured viruses, and examined tissue samples by histopathology and immunohistochemistry to detect and characterize influenza virus infection. In the six villages, among the 240 surveyed households and 11 small-scale farms, 61% (1789/2930) of chickens, 47% (4816/10 184) of ducks and 73% (358/493) of geese died within 14 days preceding the investigation. Of 70 sick poultry swabbed, 80% (56/70) had detectable RNA for influenza A/H5, including 89% (49/55) of ducks, 40% (2/5) of geese and 50% (5/10) of chickens. We isolated virus from six of 25 samples; sequence analysis of the hemagglutinin and neuraminidase gene of these six isolates indicated clade 2.3.2.1a of H5N1 virus. Histopathological changes and immunohistochemistry staining of avian influenza viral antigens were recognized in the brain, pancreas and intestines of ducks and chickens. We identified ten human cases showing signs compatible with influenza-like illness; four were positive for influenza A/H3; however, none were positive for influenza A/H5. The recently introduced H5N1 clade 2.3.2.1a virus caused unusually high mortality in ducks and geese. Heightened surveillance in poultry is warranted to guide appropriate diagnostic testing and detect novel influenza strains.

Longitudinal impact of sleep on overweight and obesity in children and adolescents: a systematic review and bias-adjusted meta-analysis

Short sleep duration is considered a potential risk for overweight/obesity in childhood and adolescence. However, most of the evidence on this topic is obtained from cross-sectional studies; therefore, the nature and extent of the longitudinal associations are unclear. This study explores the prospective association between short sleep and overweight/obesity in young subjects. The MEDLINE, EMBASE, Pubmed, and CINAHL databases were searched for English-language articles, published until May 2014, reporting longitudinal association between sleep and body mass index (BMI) in children and adolescents. Recommendations of the Sleep Health Foundation were used to standardize reference sleep duration. Sleep category, with sleep duration less than the reference sleep, was considered as the short sleep category. Meta-analysis was conducted to explore the association between short sleep and overweight/obesity. A review of 22 longitudinal studies, with subjects from diverse backgrounds, suggested an inverse association between sleep duration and BMI. Meta-analysis of 11 longitudinal studies, comprising 24,821 participants, revealed that subjects sleeping for short duration had twice the risk of being overweight/obese, compared with subjects sleeping for long duration (odds ratio 2.15; 95% confidence interval: 1.64-2.81). This study provides evidence that short sleep duration in young subjects is significantly associated with future overweight/obesity.

Roles of superthermal electrons and positrons on positron-acoustic solitary waves and double layers in electron-positron-ion plasmas

Positron-acoustic (PA) solitary waves (SWs) and double layers (DLs) in four-component plasmas consisting of immobile positive ions, mobile cold positrons, and superthermal (kappa distributed) hot positrons and electrons are investigated both numerically and analytically by deriving Korteweg-de Vries (K-dV), modified K-dV (mK-dV), and Gardner equations along with their DLs solutions using the reductive perturbation method. It is examined that depending on the plasma parameters, the K-dV SWs, Gardner SWs, and DLs support either compressive or rarefactive structures, whereas mK-dV SWs support only compressive structure. It is also found that the presence of superthermal (kappa distributed) hot positrons and hot electrons significantly modify the basic features of PA SWs as well as PA DLs. Besides, the critical number density ratio of hot positrons and cold positrons play an important role in the polarity of PA SWs and DLs. The implications of our results in different space as well as laboratory plasma environments are briefly discussed.

Goldenhar syndrome - a case report

Goldenhar syndrome is a developmental abnormality of 1st & 2nd branchial arch involving the craniofacial microsomia with ocular & vertebral abnormality. Though most of the cases are sporadic, some familial association is also found in autosomal dominant or recessive manner. Teratogenic effect of some toxic substances may lead to the condition. Ocular abnormalities are epibulbar dermoid, lipodermoid & coloboma. Otic defects are preauricular tags, microtia, anotia & conductive hearing loss. Cardio-pulmonary & genitourinary abnormalities are common associations. Here we have described the case of a 10 years old girl had ocular, auricular & vertebral changes consistent with Goldenhar syndrome, she was managed with multidisciplinary approach and she was symptomatically improved but corrective surgery was planned as schedule of respective department.

Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis

Gestational weight gain (GWG) is considered one of the risk factors for future obesity in the offspring. However, the direction and strength of this association at different periods of offspring life is relatively unknown. This study investigates whether excess or inadequate maternal GWG during pregnancy influences the risk of offspring obesity at different stages in life. A systematic review of published articles was undertaken after a comprehensive search of different databases, and extracted data were meta-analysed. To quantify offspring obesity estimates in relation to GWG, we stratified obesity estimates within three life stages of the offspring age: <5 years, 5 to <18 years and 18+ years. Our meta-analysis showed that, compared with offspring of women with adequate GWG, offspring of women who gained inadequate gestational weight were at a decreased risk of obesity (relative risk [RR]: 0.86; 95% confidence interval [CI]: 0.78-0.94), and offspring of women who gained excess weight were at an increased risk of obesity (RR: 1.40; 95% CI: 1.23-1.59). These relationships were similar after stratification by life stage. Findings of this study therefore suggest that excess GWG does influence offspring obesity over the short- and long-term, and should therefore be avoided.

Efficient sequential and parallel algorithms for record linkage

Background and objective

Integrating data from multiple sources is a crucial and challenging problem. Even though there exist numerous algorithms for record linkage or deduplication, they suffer from either large time needs or restrictions on the number of datasets that they can integrate. In this paper we report efficient sequential and parallel algorithms for record linkage which handle any number of datasets and outperform previous algorithms.

Methods

Our algorithms employ hierarchical clustering algorithms as the basis. A key idea that we use is radix sorting on certain attributes to eliminate identical records before any further processing. Another novel idea is to form a graph that links similar records and find the connected components.

Results

Our sequential and parallel algorithms have been tested on a real dataset of 1 083 878 records and synthetic datasets ranging in size from 50 000 to 9 000 000 records. Our sequential algorithm runs at least two times faster, for any dataset, than the previous best-known algorithm, the two-phase algorithm using faster computation of the edit distance (TPA (FCED)). The speedups obtained by our parallel algorithm are almost linear. For example, we get a speedup of 7.5 with 8 cores (residing in a single node), 14.1 with 16 cores (residing in two nodes), and 26.4 with 32 cores (residing in four nodes).

Conclusions

We have compared the performance of our sequential algorithm with TPA (FCED) and found that our algorithm outperforms the previous one. The accuracy is the same as that of this previous best-known algorithm.

Acute renal failure following wasp sting

Wasp stings can result in multi system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure cardiac involvement, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. We report here a case of eight year old boy presented with history of wasp sting followed by scanty micturation, generalized swelling and respiratory distress. After admission renal replacement therapy along with oral Prednisolone was started as serum creatinine level was gradually increasing. Kidney biopsy reveled Acute Interstitial Nephritis (AIN). Diagnosis was made of acute renal failure due to AIN following wasp stings.

Dust-acoustic Gardner solitons and double layers in dusty plasmas with nonthermally distributed ions of two distinct temperatures

A rigorous theoretical investigation has been performed on dust-acoustic (DA) solitary structures in an unmagnetized dusty plasma, consisting of negatively charged mobile dust grains, Boltzmann distributed electrons, and nonthermally distributed ions of two distinct temperatures. The Korteweg-de Vries (K-dV), modified K-dV (mK-dV) and Gardner equations, and their solitary waves (SWs) and double layer (DL) (in case of Gardner equation) solutions are derived by using the reductive perturbation technique. The basic features of the DA Gardner solitons (GSs) and DLs are studied analytically as well as numerically. It has been observed that the GSs significantly differ from K-dV and mK-dV solitons, and only positive potential DLs exist in the system. It is also studied that two-temperature nonthermal ions significantly modify the nature and basic properties of the DA SWs. The present investigation can be very effective for understanding and studying the nonlinear characteristics of the DA waves in laboratory and space dusty plasmas.

Post-transfusion increment of platelet count in thrombocytopenic patients treated with platelet concentrates

The Platelet (PLT) Transfusion Therapy plays an important role in the support of surgical, haematological, oncological and transplant patients. The present study was assigned to find out the post transfusion increment of platelet count among the thrombocytopenic patients in Bangladeshi population. This descriptive study was conducted at the Departments of Haematology and Transfusion Medicine, BSMMU, Dhaka. Total 42 thrmbocytopenic patients were randomly assigned to receive a transfusion when their platelet counts below 10000 per cubic millimeter or with active bleeding. Pre transfusion and post transfusion platelet count were measured in all patients. Out of 42 patients, 26(61.90%) were male and 16(38.10%) were female. Leukemia was the most common cause of thrombocytopenia (47.62%). Most of the patients (71.34%) required transfusion of multiple units of platelet and 12(28.57%) patients required double units. Before transfusion of platelet concentrate <30×10⁸/L, 30-80×10⁸/L and >80×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. After transfusion of platelet concentrate <50×10⁸/L, 50-100×10⁸/L and >100×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. In all patients post transfusion platelet count increases but 2 or multiple units of transfusion were needed.

Wandering spleen associated with β-Thalassemia: a case report

The clinical entity 'Wandering spleen' is an uncommon presentation and it is more often diagnosed in children than in adults, mostly women of reproductive age. Here is a case of a young woman who presented with generalized weakness and fever, and a painless mobile lump in her central abdomen. The laboratory evaluation revealed a haemolytic state and Haemoglobin electrophoresis showed β-Thalassemia trait (Hb A2 5.1%). Ultrasonography and Computerized Tomography (CT) scan confirmed that the mass is spleen and spleen is not present in its normal anatomical location. Abdominal CT described a well-defined, homogenous pediculated mass with echo texture comparable to spleen. Radioisotope scanning could be used as an alternative for confirmation of diagnosis of this rare condition, but was not done in our case. Colour Doppler sonography of the splenic circulation revealed no infarction and intact splenic vasculature. Wandering spleen should be considered in the differential diagnosis of idiopathic abdominal or pelvic lumps. The authoritative opinion for the treatment of such a case is splenectomy or splenopexy especially in children and here, in this case splenectomy was done.

Feasibility study on the culture of mud crab Scylla serrata in the mid coast region of Bangladesh

A study was conducted at Hatiya and Nijhum Island, Noakhali in the mid coastal region of Bangladesh to identify feasibility of mud crab culture for a study period of six months from January 2010 to June 2010. Data were collected through questionnaire interviews, focus group discussions and cross check interviews. Average yearly collection of mud crabs in this area was about 890.36 tons where lower grade crabs 45.16% and these can be brought under culture practice. It has observed that saline water intrusion was evident 670 Ha. In Hatiya and vast inundated area with saline water was found in Nijhum Island. Overall waiter salinity range was between 2-10 ppt., pH range of 7.8-8.6 and the soil was silt-loamy. The average temperature of the last three years was approximately 26.10 degrees C and rainfall was almost 10.85 mm. It was observed that natural feeds were available in this study area and there was existed a small potential marketing channel with 3-4 middlemen. Also there was a good transportation system both water and road way. So, present study revealed that the area is suitable for crab culture during April to October.

Effects of nonthermal ions and polarization force on dust-acoustic waves in a density-varying dusty plasma

A rigorous theoretical investigation has been made of the effects of nonthermal ions and polarization force (which arises due to the dust density inhomogeneity) on the propagation of dust-acoustic (DA) waves in a density-varying unmagnetized dusty plasma (consisting of nonthermal ions, Maxwellian electrons, and negatively charged mobile dust) by the normal mode analysis. It has been shown that the dispersion properties of the DA waves are significantly modified by the presence of nonthermal ions and polarization force. It has been also found that the phase speed of the DA waves, as well as the dust density perturbation, increases (decreases) with the increase of nonthermal ions (polarization force), and that the potential associated with the DA waves decreases with the increase of the equilibrium dust number density. The implications of our results in the specific situation of space environments (dust-ion plasma situation) are also briefly discussed.

Nonlinear electromagnetic perturbations in a degenerate ultrarelativistic electron-positron plasma

Nonlinear propagation of fast and slow magnetosonic perturbation modes in an ultrarelativistic, ultracold, degenerate (extremely dense) electron positron (EP) plasma (containing ultrarelativistic, ultracold, degenerate electron and positron fluids) has been investigated by the reductive perturbation method. The Alfvén wave velocity is modified due to the presence of the enthalpy correction in the fluid equations of motion. The degenerate EP plasma system (under consideration) supports the Korteweg-de Vries (KdV) solitons, which are associated with either fast or slow magnetosonic perturbation modes. It is found that the ultrarelativistic model leads to compressive (rarefactive) electromagnetic solitons corresponding to the fast (slow) wave mode. There are certain critical angles, θ(c), at which no soliton solution is found corresponding to the fast wave mode. For the slow mode, the magnetic-field intensity affects both the soliton amplitude and width. It is also illustrated that the basic features of the electromagnetic solitary structures, which are found to exist in such a degenerate EP plasma, are significantly modified by the effects of enthalpy correction, electron and positron degeneracy, magnetic-field strength, and the relativistic effect. The applications of the results in a pair-plasma medium, which occurs in many astrophysical objects (e.g., pulsars, white dwarfs, and neutron stars) are briefly discussed.

Burden and outcome of human influenza in a tertiary care hospital of Bangladesh

OBJECTIVE

To determine the magnitude and outcome of influenza in southern part of Bangladesh and also to identify intrusion of novel influenza virus.

METHODS

This study was conducted for two years (2008-2009) in outpatient and inpatient department of both paediatrics and medicine discipline of Khulna Medical College Hospital. Nasal and throat swab specimens were collected from each influenza like illness (ILI) case and kept together in a virus transport media and transported to international centre for diarrhoeal disease and research, Bangladesh laboratory. Influenza virus was detected by rRT-PCR including types and subtypes.

RESULTS

A total of 526 patients were enrolled during the study period with the mean (SD) age of 19 (17) years. Identification of influenza virus was 14% and positive cases were mostly found in under-five children (24%). The vast majority (88%) of influenza cases were found during April to September. Virus detection rate was higher in inpatient department (IPD) (21%) than in outpatient department (12%). The dominant virus type and subtype was influenza A (87%) and H3 (49%), respectively. Type A was significantly higher than type B in causing severe illness compared to ILI (OR=7.04, 95%CI: 2.76-18.7, P<0.01). Headache and chest indrawing was found in significantly higher proportion (P<0.05) in influenza positive IPD cases. Among 31 hospitalized cases majority (77%) recovered completely except two cases that needed referral for additional support.

CONCLUSIONS

Influenza mostly affected under-five children and young adult. The peak season here was late summer and rainy season.

Family food behaviours and adolescents' overweight status: a mother-offspring link study

BACKGROUND

The role of family food behaviours on weight status of family members is not well understood. The objective of this study was to examine the influence of some aspects of family food behaviours on adolescents overweight.

METHOD

In a cross-sectional mother-child-linked study design, participants were a subsample of 3862 adolescents (51.9% boys) from the Mater hospital-University of Queensland Study of Pregnancy (MUSP), a longitudinal study of a birth cohort of 7,223 women and their offspring. Information on aspects of family food behaviours (family meal patterns and influences, frequency of family food consumption, and influences on family food selection) was collected by self reported questionnaires from mothers in a 14 years follow up (in 1994-1997) and other covariates at different stages of follow-ups. Body Mass Index of the adolescents was calculated using measured height and weight.

RESULTS

Being overweight at 14 years had significant negative associations with mothers' report on the importance of family meals (OR=1.28), frequency of eating cake/biscuits (OR=1.71), and significant positive association with mothers' report on frequency of consumption of cooked vegetables (OR=1.32), soft drinks (OR=1.60) and importance of fattening of foods (OR=1.27).

CONCLUSION

The study confirmed the importance of the family and some family food behaviours in shaping risk of being overweight amongst adolescents. Because of the cross-sectional nature of this study, we could not conclude that they had casual correlations. Comparison with the literature suggests that some of these effects may be specific to particular contexts, potentially affected by cultural and socio-economic differences.

Nonlinear ion modes in a dense plasma with strongly coupled ions and degenerate electron fluids

The properties of solitary and shock structures associated with nonlinear ion modes in a dense plasma with strongly coupled nondegenerate ions and degenerate electron fluids are presented. For this purpose, we have used the viscoelastic fluid model for the ions, the inertialess electron momentum equation with weakly and ultrarelativistic pressure laws for the degenerate electron fluids, and Poisson's equation to derive the Burgers and Kortweg-de Vries equations. Possible stationary solutions of the latter are the shock and solitary structures, respectively. It is found that the speed, amplitude, and width of the shock and solitary waves critically depend on the strong coupling between ions and electron degeneracy effects. The relevance of our investigation to the role of localized excitations in dense astrophysical objects is briefly discussed.