New record of Philometra species from the marine edible fish Terapon jarbua collected from the Sindh, Arabian Sea, Pakistan

Diseases in fish due to helminth parasites, especially Philometra species, are the primary worry in aquaculture. Philometra are responsible for health problem in fishes they directly affect fish growth and population parameters. A comprehensive survey was conducted involving the examination of the marine fish species Terapon jarbua, gathered from the coastal waters of Sindh, Pakistan In this research different Philometra species from marine fish Terapon jarbua during 2021 and 2022. Philometra nematodes, belonging to the family Philometridae, are common parasitic organisms inhabiting both marine and freshwater environments. Their prevalence, particularly when existing in high numbers within host organisms, can lead to severe and potentially lethal consequences. Employing light microscopy techniques, diverse species of Philometra were identified, including Philometra teraponi, P. jarbuai, P. arabiai, P. karachii, and P. awarii, localized primarily within the ovaries of the host fish. A total of 140 fish samples were examined and 76 were infected. The intensity of infected fish was 54.28%. The identification process encompassed meticulous analysis of crucial parameters, such as body size, esophagus length, positioning of the nerve ring, dimensions of the ventriculus, and ligament size. Intriguingly, the parasites were found in varying contexts; while some were free within the ovaries, others were embedded within tissues, inducing severe muscular dystrophy. This research presents novel findings of Philometra nematodes in the marine waters of Pakistan, extending their host and geographical distribution records. Future studies are needed to better evaluate and describe the dynamics and the epidemiology of Philometra infection in wild and cultured fish species.

The human-wildlife conflict in Musk Deer National Park, Neelum Gureze Valley, Azad Jammu & Kashmir, Pakistan

Abstract Growing human population is a solemn risk to biodiversity at a global level. Massive anthropogenic pressure and invasion in the natural habitats initiated the human-wildlife conflict in rural areas. Present study aimed to assess human-wildlife conflict in Musk Deer National Park (MDNP) from 2013 to 2018. Results revealed an estimated 241784 nomadic and 5589 residential livestock heads grazed in different areas of MDNP during the summer season. A total of 126 heads were depredated by carnivores during the study period. Majority (n=39) of livestock heads were killed in May (n=29). Livestock depredation resulted in economic losses worth 3.115 million PKRs (25744 US$) to the herder community while farmers received 1.629 million PKRs (13466 US$) losses due to crop raiding. Most (64%) of the respondents believed human-wildlife conflict heightened due to scarcity of food or prey in the natural habitats of carnivores. Majority (92%) of the respondents did not like the presence of predators in MDNP. Loss compensation schemes could turn this negative attitude into the positive one and increase tolerance about the presence of carnivores in their vicinity. This study provides an insight into the human-wildlife conflict in MDNP and paves a way for understanding the conflict and conservation of carnivore species in the study area.

Early Inflammatory Response of Dental Pulp in Response to Biodentin and Mineral Trioxide Aggregate as Pulp-capping Agents

This study was carried out to observe immediate inflammatory response of Human Dental Pulp capped with Biodentin and Mineral Trioxide Aggregate (MTA). This prospective clinical study was carried out in the Department of Conservative Dentistry and Endodontics together with the Department of Orthodontia, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from 2016 to 2018. A total number of eighty (80) permanent premolars teeth planned to be extracted for orthodontic alignment of occlusion were used as study sample. Those teeth were divided into two groups; Group A and Group B, having 40 teeth in each (n=40). An occlusal exposure of approximately 1.5mm in diameter was made. Then in -group A, exposed pulp were capped with 2-mm-thick layer of sterile Biodentin (Septodont) and in-group B with ProRoot White MTA (Dentsply). After pulp capping with the experimental material in respective group, cavities in all teeth were restored with glass ionomer cement. After 24 hours the teeth were extracted, fixed in 10% buffered formalin solution, then decalcified by 10.0% nitric acid and embedded in paraffin. Now 2 to 3-micron-thick serial sections were made in the linguo-buccal plane and finally stained with hematoxylin-eosin. Now pulpal inflammation in respect of type, intensity and extension, were determined by using a predetermined evaluation criterion under an optical microscope at 40× magnifications. Statistical differences among the experimental groups were analyzed by Descriptive analysis (Cross Tabulation) (p<0.05). Histologically both the tested materials produced immediate pulpal tissue reaction. 'Biodentin' found to be most immediate pulpal tissue reactive (reactive in 100% cases), Whereas, MTA produced immediate tissue reaction only in 50.0% cases. Immediate pulpal inflammatory reaction in response to tested material found to be statistically significant different between 'Biodentin' and 'MTA' (p=0.001). According to present study Biodentin is found to be more immediate pulpal tissue reactive than MTA when used as a pulp capping material.

Combined application of EPANET and empirical model for possible formation of trihalomethanes in water distribution network of Chattogram city to identify potential carcinogenic health risk zone

The study identifies potential carcinogenic health risk-zone of Chattogram city for the occurrence of trihalomethanes (THMs) at its water distribution network. The EPANET-THMs simulation model along with an empirical model have been adopted in the study to predict THMs content of supply water of the distribution network of the city's Karnaphuli service area. The empirical model has estimated THMs level of supply water based on influential water quality parameters, and few of these have been used as pre-set values for subsequent EPANET simulation. The simulation (R²= 0.7) shows that THMs' concentrations throughout the network vary from 33 to 486 μg/L. Around 60% of total junctions showed THMs concentrations above 150 μg/L, while that is above 50 μg/L for most (99%) of the junctions. Residual Free chlorine, one of the precursors for the THMs formation in distribution line, has also been simulated by EPANET considering varying applied chlorine dose at the water purification unit and wall (K_w) and bulk (K_b) decay constants. The simulated free residual chlorine peaks are found to be closer to the actual values with chlorine dose of 2 mg/L, and decay constants, K_w = 1 d^-1 and K_b = 1 d^-1. A mean lifetime total risk of cancer due to the presence of THMs has been found to be very high. Spatial distribution of carcinogenic risk shows that the central zone of the service area is the most vulnerable zone, followed by the western and northern zone. The first ever zone wise risk identification could be used as baseline data for operational and regulatory purposes and may raise awareness among the city's inhabitants. Furthermore, the application of EPANET in combination with an empirical model could be an effective tool for predicting THMs' concentration in water distribution networks in developing countries like Bangladesh to minimize the expenses of measuring THMs.

Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan

Abstract Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

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.

Prevalence of intestinal nematodes infection in school children of urban areas of district Lower Dir, Pakistan

Abstract Intestinal parasitism is the main cause of disease all over the world and described as a significant community health problem. The current study intended to find out the occurrence and identification of hazard factors linked with IPIs among 4-12 years aged shool-age children residing in Lower Dir district, Pakistan during 2019 - 2020. A cross-sectional school-based study was conducted using a pre-arranged pre-tested survey. Anthropometric data and stool collection were done to obtain the findings. The direct wet mount preparation in saline/iodine/methods was used for stool examination. Data were investigated using the GraphPad Prism 5. A total of 400 children studied (mean age of 8.6±3.6 years) the total incidence rate for the intestinal parasitic disease was established to be 71.75%. Of the 400 children studied, the overall prevalence rate for intestinal parasitic infections was found to 71.75% Ascaris lumbricoides (33.1%), Trichuris trichiura (1.04%), E. vermicularis (1.39%), Hookworm (19.86%) were identified in children living in the study area. We concluded that there is a mass scale campaigns were required to generate alertness about health and sanitation in children and the need for the development of effective poverty control programs because deworming (killing of worm with drugs) alone is not adequate to control parasitic infections.

New record of parasitic infection among school children of Lower Dir Pakistan

Abstract Intestinal parasitic infections (IPIs) are a major cause of morbidity worldwide and have been described as an important public health problem. The present study aimed to determine the un usual parasitic infection and identification of risk factors among 4-12years old school age children residing in lower dir district, Pakistan from 2018- 2019. Of the 400 children studied in which the overall prevalence rate for intestinal parasitic infections was found to be 71.75%. Children infected with single parasite accounted for 67.94% and 32.05% were detected with poly-parasitism. Shistosoma japonicum (0.69%), Taxocara spp (0.69%) and cryptosporidium (0.69%), were identified in children living in studied areas. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programmes.

Parasitic contamination of fresh vegetables sold in open markets: a public health threat

Vegetables eating raw are a leading source of transmission of infective forms of pathogenic internal parasites among human beings. This research was conducted from April to October, 2017 to assess the parasitic contamination of vegetables sold at main vegetable markets in districts Lower Dir and Peshawar, Pakistan. Eight hundred specimens of different vegetables were purchased and soaked in physiological saline solution, shaken with a mechanical shaker for 20 minutes and processed by sedimentation concentration method. Results revealed that only 19.7% (n=158/800) of the vegetables were found to be contaminated with single or multiple parasite species. Ascaris lumbricoides (the large round worm) 12.3% (n=99/800) was the most commonly detected pathogen and Taenia saginata (the beef tapeworm) 1.62% (n=13/800) was the least frequently detected one. Interestingly, significant p value (p>0.05 at 95%CI) between the number of examined and contaminated for all the variables studied including education status of the vendors, markets location, type of vegetables, means of display, washed before display, washing source of water and market type. The findings of this study evidenced that consumption of raw vegetables possesses great risk of getting parasitic infections in Lower Dir and Peshawar districts, Pakistan. Instructing the sellers and the public about parasitic disease transfer and their hygiene can reduce the infection rate of parasites of human origin.

Prevalence of intestinal parasitic diseases in school children of rural areas of district Lower Dir, Pakistan

Present study was conducted among school children to recognize the prevalence of IPIs in rural communities of district Dir Lower, Pakistan. A sum of 324 samples of stool were collected (210 boys and 114 girls). Used direct smear method and formol ether sedimentation concentration technique for processing the samples. The result shows that 82% (n=266) were found infected comprised 64.8% male and 35.1% females. Children of the age group 10 to 12 years were found extremely infected 94.2% while 4-6 year age group were having minimum ratio of infection 72%. Current study shows mono parasitism in 50.6% of the students while 22.2% were infected with 2 species and 7.40% were infected with three species of parasites. Seven species of intestinal parasites were reported include Ascaris lumbricoid in male (n=122) 58.0% and in female (n=65) 57.0% followed by Hook worm (n=88) 41.9% and (n=44) 38.5%; Tania saginata (n=44) 20.9% and (n=24) 21.0%; Entrobius vermicularis (n=32) 15.2% and (n=16) 14.0%; Trichuris trichura (n=25) 11.9% and (n=22) 19.2%; Hymenolepis nana (n=24) 11.4% and (n=18) 15.7% and Entameoba histolytica (n=16) 7.61% and (n=14) 12.2% in male and females respectively. The study indicates that most occurring intestinal parasite in the current study were Ascaris lumbricoides 58.0% (n=122) followed by hookworms 41.9% (n=88). Male students were more infected than females in the present study.

Noise Removal of Tracheal Sound Recorded During CPET to Determine Respiratory Rate

This study aimed to extract respiratory signal from tracheal sound recordings during cardio-pulmonary exercise test (CPET), which is the state-of-the-art diagnosis of cardiovascular and respiratory diseases. However, the availability of CPET is limited due to its expense. Physiological signal analysis is a convenient alternative to measure clinical parameters. We collected data from 30 healthy adults and applied wavelet transform thresholding (WTT), empirical mode decomposition (EMD), and Synchrosqueezing transform filtering (SST) to de-noise the raw data. Signal to noise ratio (SNR) was calculated as a quantitative measure of signal quality. We observed that SST yielded the highest SNR and introduced lowest signal distortion by visual-auditory inspection. Respiratory rate was then determined using the signal extracted by SST. Discrepancy of respiratory rate determined from the signal and the gold standard CPET was within 1.2 breaths per minute. In conclusion, SST effectively removed noises in tracheal sound recorded during CPET and provided analyzable respiratory signal for clinical parameter determination.

Chebyshev collocation computation of magneto-bioconvection nanofluid flow over a wedge with multiple slips and magnetic induction

In this article, the steady two-dimensional stagnation point flow of a viscous incompressible electrically conducting bio-nanofluid over a stretching/shrinking wedge in the presence of passively control boundary condition, Stefan blowing and multiple slips is numerically investigated. Magnetic induction is also taken into account. The governing conservation equations are rendered into a system of ordinary differential equations via appropriate similarity transformations. The reduced system is solved using a fast, convergent Chebyshev collocation method. The influence of selected parameters on the dimensionless velocity, induced magnetic field, temperature, nanoparticle volume fraction and density of motile microorganisms as well as on the local skin friction, local Nusselt number, local Sherwood number and density of motile microorganism numbers is discussed and presented graphically. Validation with previously published results is performed and an excellent agreement is found. The study is relevant to electromagnetic manufacturing processes involving bio-nanofluids.

Nutritional Status and Age at Secondary Sterility in Rural Bangladesh

This paper suggests that there may be an inverse relationship between age at menopause and nutritional status, as determined by anthropometry, in poorly nourished populations.

INTEND II randomized clinical trial of intraoperative duct endoscopy in pathological nipple discharge

BACKGROUND

The majority of lesions resulting in pathological nipple discharge are benign. Conventional surgery is undirected and targeting the causative lesion by duct endoscopy may enable more accurate surgery with fewer complications.

METHODS

Patients requiring microdochectomy and/or major duct excision were randomized to duct endoscopy or no duct endoscopy before surgery. Primary endpoints were successful visualization of the pathological lesion in patients randomized to duct endoscopy, and a comparison of the causative pathology between the two groups. The secondary endpoint was to compare the specimen size between groups.

RESULTS

A total of 68 breasts were studied in 66 patients; there were 31 breasts in the duct endoscopy group and 37 in the no-endoscopy group. Median age was 49 (range 19-81) years. Follow-up was 5·4 (i.q.r. 3·3-8·9) years in the duct endoscopy group and 5·7 (3·1-9·0) years in no-endoscopy group. Duct endoscopy had a sensitivity of 80 (95 per cent c.i. 52 to 96) per cent, specificity of 71 (44 to 90) per cent, positive predictive value of 71 (44 to 90) per cent and negative predictive value of 80 (52 to 96) per cent in identifying any lesion. There was no difference in causative pathology between the groups. Median volume of the surgical resection specimen did not differ between groups.

CONCLUSION

Diagnostic duct endoscopy is useful for identifying causative lesions of nipple discharge. Duct endoscopy did not influence the pathological yield of benign or malignant diagnoses nor surgical resection volumes. Registered as INTEND II in CancerHelp UK clinical trials database (https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-at-changes-inside-the-breast-ducts-of-women-who-have-nipple-discharge).

Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia

BACKGROUND

Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group.

METHODS

Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments.

RESULTS

Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team.

CONCLUSION

Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.

International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction

Background

The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.

Methods

The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.

Results

A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P &lt; 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.

Conclusion

The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.

CABG - Challenging Cases in Apollo Hospitals Dhaka, A Decade of Experience

Objective: To show outcome of challenging cases of Coronary Artery Bypass Graft (CABO)Methods: A retrospective study, done in Apollo Hospitals Dhaka from 02-05-2005 to 13.12.2014. Total 1892 CABO cases were reviewed- Emergency: 22 cases, Off-pump: 1257 cases, Arrested heart: 554 cases, On-pump beating heart: 81 cases, MIDCAB: 2 cases. Female - 213 (11.25%), male -1679 (88.74%). Associated co-morbities: peripheral vascular disease: 19 cases, COPD: 78 cases, on dialysis: 17 cases, ventricular septal ruptures :10 cases, carotid occlusive disease: 88 cases, old stroke: 58 cases, permanent pacemaker: 4 cases, preoperative ventilator: 29 cases, left ventricular aneurysm: 58 cases, severe mitral regurgitation: 5 cases, EF: 31-50% =260 cases, 21-30% =147 cases, 15- 20% = 8 cases. Associated procedures -left ventricular aneurysm repair: 42 cases, mitral valve replacement: 30 cases, aortic valve replacement: 25 cases ,double valve replacement: 3 cases, RA myxoma removal: 1 case, LV aneurysm repair with mitral valve procedure: 5 cases , LV aneurysm repair with ventricular septal rupture repair: 5 cases, ventricular septal rupture repair: 10 cases, aorto-femoral bypass: 3 cases, ileo femoral bypass: 1 case, left aorto-axillary bypass: 1 case , Bentall procedure with Brachio-cephalic artery re-implantation: 1 case, Aorto-bifemoral bipopliteal bypass: 1 case, redo CABO-7, IABP preoperatively: 12 cases.Results: Overall mortality rate 2.12% (39 cases), emergency 9.09 % (2 cases) mortality, routine mortality 1.97% (37 cases).Conclusion: Challenging cases of CABO can be done with acceptable morbidity and mortality with good long term outcome.Pulse Vol.9 January-December 2016 p.6-14

Major neonatal surgery under local anesthesia: a cohort study from Bangladesh

BACKGROUND

Surgeons and anesthetists must respond to the perioperative mortality associated with general anesthesia in developing countries. The safety of performing major neonatal surgery under local anesthesia is one pragmatic response. This study describes and evaluates such practice in a tertiary pediatric surgery center in Bangladesh.

METHODS

Seven hundred and twenty neonates were admitted for major surgery during a 3.5-year study period. Hundred and fifty two neonates died pre-operatively, and 568 underwent major neonatal surgery. 352 (62.0%) neonates were operated under general anesthesia, while the 216 most fragile neonates (38.0%) were operated with local infiltrative anesthesia alone. Medical files were reviewed; data were collected prospectively; mortality risk factors were assessed by univariate and multivariate analysis.

RESULTS

Two hundred and sixteen procedures were performed under local anesthesia: sigmoid colostomies (37.5%), laparotomies with anastomosis (21.3%), anoplasties (18.1%), laparotomies with enterostomy (8.3%), closures of abdominal wall defects (6.9%), fixations of silastic bags (3.7%), peritoneal tube drainage (2.3%), and gastrostomies (1.9%). Median weight was 2,400 g (2,200-2,460), median gestational age was 37.0 weeks (36.0-38.0), and median age at surgery was 5.0 days (3.0-14.7). In-hospital postoperative mortality was 10.6% among those selected for local anesthesia, and 11.4% among neonates operated under general anesthesia. Low birth weight was an independent risk factor for mortality on multivariate analysis (OR 1.002 g(-1), 95% CI [1.000-1.004], p = 0.029).

CONCLUSIONS

Local anesthesia is an established option for the most fragile neonates with major surgical disease. Safe anesthesia ought to be accessible to all children of the world. The global pandemic of perioperative mortality needs to be addressed.

Management of non-muscle-invasive (superficial) bladder cancer

Non-muscle-invasive (superficial) bladder cancer (NMIBC) represents 80% of incident cases of bladder cancer, and is characterized by a generally good prognosis, with a tendency to remain localized. Only 10%-20% of cases progress to invasion and/or metastasis. The biggest problem in management is the potential for local recurrence, and this will occur with relatively predictable prognostic determinants. Gene expression and other cell surface determinant are associated with outcome. In most cases, successful management is predicated on careful history taking and physical assessment, meticulous endoscopic assessment, and transurethral resection of bladder tumor tissue where indicated. Histology determines the potential for recurrence. Options of treatment include repeat resection, immunologic therapy via intravesical instillation, and the use of intravescally administered cytotoxic agents, including mitomycin C, doxorubicin, gemcitabine, and selected investigational compounds. Of importance, as some cases have the potential to invade and metastasize, timing of cystectomy for recurrent, high-risk tumors is important to avoid unnecessary morbidity and mortality.

Evidence for a link between locus R-R sequence type and outcome of infection with Entamoeba histolytica

The results of Entamoeba histolytica infections range from asymptomatic colonization to variable disease outcomes. However, markers that may predict infection outcomes are not known. Here, we investigated sequence types of a non-coding tRNA-linked locus R-R to identify surrogate markers that may show association with infection outcomes. Among 112 clinical samples--21 asymptomatic, 20 diarrhoea/dysentery and 71 liver abscesses--we identified 11 sequence types. Sequence type 5RR was mostly associated with asymptomatic samples, and sequence type 10RR was predominantly associated with the symptomatic (diarrhoea/dysentery and liver abscess) samples. This is the first report that identifies markers that may predict disease outcomes in E. histolytica infection.

PCR for diagnosis and assessment of cure in kala-azar patients in Bangladesh

The study evaluated the usefulness of Leishmania-nested polymerase chain reaction (Ln-PCR) for diagnosis of kala-azar and assessed its role as a test of cure among kala-azar patients in Bangladesh. Peripheral blood buffy coat Ln-PCR was done in ninety-seven (97) clinically suspected patients of kala-azar, in forty (40) healthy controls from both endemic and non-endemic areas, and in forty-six (46) patients after completion of treatment with sodium stibogluconate (SSG). The Ln-PCR results were compared with Leishmania donovani parasite load graded by 1+ to 6+ in all smear-positive L. donovani cases. Out of 97 clinically suspected kala-azar patients, 94 were parasitologically confirmed. Ln-PCR was found positive in 91 of 94 parasitologically positive patients of kala-azar at diagnosis, indicating its diagnostic sensitivity as 97%. None of the controls was found positive for Ln-PCR, indicating its diagnostic specificity to be 100%. About 9% of kala-azar patients having been graded 1+ parasitic load had negative Ln-PCR results. After completion of treatment, Ln-PCR was positive in 4 patients (8.4%) out of 46 cases, indicating its role in demonstrating the absence of parasites 30 days after completion of treatment in 91.6% of the treated patients. This limited study suggests that Ln-PCR is a highly sensitive and specific test for the diagnosis of visceral leishmaniasis and can be used as a test of cure. Thus, efforts should be made to establish this useful method at least in the tertiary care hospitals and, if possible, at the district-level hospitals, especially in the endemic areas of Bangladesh.

Adolescent knowledge and awareness about AIDS/HIV and factors affecting them in Bangladesh

BACKGROUND

Adolescents are more vulnerable than adults of unplanned pregnancies, sexually transmitted diseases and HIV/AIDS. Among the adolescents, girls are more vulnerable to STDs including HIV/AIDS. Their knowledge about different diseases is very poor. This paper investigated adolescent's knowledge about sexually transmitted diseases including HIV/AIDS, its mode of transmission and ways of its prevention.

METHODS

Cross sectional study design was adopted for this study. A multistage cluster sampling technique was used to select the sample. Data on 3362 female adolescents irrespective of their marital status was analyzed.

RESULTS

The study found that a large proportion of adolescents were not aware about sexually transmitted diseases and AIDS. More than half (54.8%) of the adolescents ever heard about AIDS respectively. On an average, about one tenth of them had better knowledge on AIDS in terms of mode of transmission and prevention. The multivariate logistic regression analysis revealed that adolescent age, years of schooling and knowledge on STDs appeared to be important predictors of the awareness about AIDS (p < 0.05).

CONCLUSIONS

Useful and fruitful media campaigns to educate the adolescents regarding the health consequences of STDs including HIV/AIDS and integrated approach is strongly suggested for creating knowledge and awareness to control the spread of HIV and AIDS among young people in Bangladesh.

Active or passive pain coping strategies in hip and knee osteoarthritis? Results of a national survey of 4,719 patients in a primary care setting

OBJECTIVE

To study pain coping strategies in patients with hip and knee osteoarthritis (OA), and to assess the psychometric qualities of the French version of the Pain Coping Inventory (PCI).

METHODS

We conducted a national, cross-sectional survey in a primary care setting in France. A total of 1,811 general practitioners included 5,324 patients with hip and knee OA who completed several questionnaires, including the PCI, which assesses ability to cope with pain.

RESULTS

The records of 4,719 (86.4%) patients were analyzed (knee 2,781; hip 1,553; hip and knee 385). Supporting the structure of the original questionnaire, we found that the 33 PCI questionnaire items could be grouped into 3 domains defining active coping strategies and 3 defining passive coping strategies. Acceptable convergent validity was found for the PCI (Cronbach's alpha coefficient for each domain >0.68). Coping strategy scores were significantly higher in patients with both knee and hip involvement (mean +/- SD 2.3 +/- 0.4) than for patients with OA at 1 site (mean +/- SD 2.1 +/- 0.4), and in women compared with men (P < 0.001). The use of passive pain coping strategies increased with OA duration, and was greater in older and overweight patients, in patients with no current physical activity or major impairment, in retired and nonworking patients, and in patients who were not married, and to a lesser extent in patients with higher pain intensity. Compared with previous data, patients with OA demonstrated lower active and higher passive strategies than patients with rheumatoid arthritis and other chronic painful conditions.

CONCLUSION

The PCI has good structural validity and is highly suitable for analyzing active and passive pain coping strategies in OA. In OA, active and passive coping strategies differ significantly as a function of age, body mass index, OA involvement, professional and marital status, sport activities, and OA duration, with pain intensity having a weaker effect.

Survival of newborns: implications for achieving the millennium development goal in Bangladesh

The global burden of neonatal deaths is around 37% of all under-five deaths (UNICEF 2008). In Bangladesh, neonatal deaths account for almost half of all under-five mortality. Most newborn deaths in Bangladesh take place at home and in the absence of a skilled hand. The target of Millennium Development Goal 4 for Bangladesh is to reduce under-five mortality by two thirds by 2015 from 1990 levels. The objectives of this article are to give an overview of newborn health in Bangladesh and provide a strategy for further reducing under-five mortality to achieve MDG 4. Data for this study were obtained from the Bangladesh Demographic and Health Survey (BDHS) 2004 data set (National Institute of Population and Training [NIPORT] et al. 2005). According to the BDHS, under-five mortality in Bangladesh declined from 133 per 1000 live births in 1991 to 88 per 1000 in 2001, about 4.1% per year. However, the decline was faster between 1991 and 1997 than from 1997 to 2001. The BDHS shows that while neonatal deaths were 39% of all under-five deaths in 1991, they constituted almost half in 2001. The highest concentration of newborn deaths occurred during delivery and within the first 24 hours of birth. Reducing newborn deaths will be an important strategy to achieve MDG 4.

Inequalities in reproductive healthcare utilization: evidence from Bangladesh Demographic and Health Survey 2004

Utilization of reproductive healthcare services such as antenatal care (ANC), delivery place facilities and postnatal care (PNC) is essential and a basic need for mothers around the globe. However, in Bangladesh inequalities in many forms affect the use of these facilities. These inequalities include socio-economic status, age, education, household size, existence of living children, occupation and household location. Using the database from the Bangladesh Demographic and Health Survey (BDHS) 2004, this study investigated the inequalities and implications of receiving facility-based maternity care such as ANC, delivery place and PNC in Bangladesh. Based on our findings, it is assumed that with the current inequalities in wealth and education, less attention to mothers with bigger family size and to mothers those existing children, lack of facilities and awareness, in rural areas, increased use of reproductive healthcare is unlikely without a change in wealth inequalities and attention to more equity in the health sector. Bivariate and multivariate analyses were done for the study, including tests of significance. Overall, findings revealed significant socio-economic inequalities in the use of reproductive healthcare services. Use of services was much lower among the poor than the rich. These socio-economic inequalities may be reduced by expanding outreach health programs and bringing services closer to the disadvantaged (poor people). The study concluded that many of these inequalities are social constructs that can be reduced by prioritizing the needs of the poor and disadvantaged and adopting appropriate policy change options.

Child mortality inequalities and linkage with sanitation facilities in Bangladesh

Principal component analysis (PCA) was applied to assets and other household data, collected as part of the Bangladesh Demographic and Health Survey (BDHS) in 2004, to rank individuals according to a household socioeconomic index and to investigate whether this predicts access to the sanitation system or outcomes. PCA was used for determining wealth indices for 11,440 women in 10,500 households in Bangladesh. The index was based on the presence or absence of items from a list of 13 specific household assets and three housing characteristics. PCA revealed 35 components, of which the first component accounted for 18% of the total variance. Ownership of assets and housing features contributed almost equally to the variance in the first component. In this study, ownership of latrines was examined as an example of sanitation-intervention access, and rates of mortality of neonates, infant, and children aged less than five years (under-five mortality) as examples of health outcomes. The analysis demonstrated significant gradients in both access and outcome measures across the wealth quintiles. The findings call for more attention to approaches for reducing health inequalities. These could include reforms in the health sector to provide more equitable allocation of resources, improvement in the quality of health services offered to the poor, and redesigning interventions and their delivery to ensure that they are more pro-poor.

Why males in Bangladesh do not participate in reproductive health: lessons learned from focus group discussions

The article explores male perception, attitude, and knowledge on reproductive health issues and their opinions on how men's participation in reproductive health could be increased. Data were obtained from six focus groups' sessions organized among the men aged 18-59. The participants indicated that males are not motivated to be involved in reproductive health issues in Bangladesh. The participants feel that men also have unmet reproductive and sexual health needs. Their needs are not addressed and traditionally they are not encouraged to participate in reproductive health services. In Bangladesh poor interaction between husband and wife often makes it difficult to understand reproductive health problems of women. Because of prevailing culture and myth men do not visit health facilities with their wives; they do not feel comfortable to take their wives to the health facility because they do not like to discuss sexual reproductive health issues with the service providers. The analysis suggests that a complex web of social and cultural factors impedes spousal communication regarding reproductive health issues and that discourages them to take their wives to health clinics. In the focus group discussions men said that they do not feel comfortable in discussing sexually transmitted diseases with their wives. Generally women come to the health facility for the treatment of RTIs/STDs. Men do not bring their wives to the health facility because they feel shy to discuss such diseases with service providers. In order to increase male participation in reproductive health, males suggested introduction of male workers like the present female workers and visiting at the household level to counsel and mobilize them to participate in reproductive health. The analysis indicates that male involvement will be an important strategy to reach demographic goals in Bangladesh.

Inequalities in Infant Immunization Coverage in Bangladesh

Background

Although, health status of Bangladeshis has improved, levels of child mortality in Bangladesh remain unacceptably high. This paper reviews household wealth inequalities in immunization coverage in Bangladesh. The objective of the study is to examine how household wealth status and socio-demographic characteristics relate to immunization status of children.

Methods

Using data from the 2004 Bangladesh Demographic and Health Survey (BDHS), this paper investigated the inequalities and implications of infant immunization coverage in Bangladesh. To prepare the proxy variable of household wealth status we applied principal component analysis (PCA) technique based on variables such as assets, utilities and services available at household level. And then scores of the proxy variable was transferred into quintiles.

Results

The difference in immunization status between the richest and the poorest quintiles was significant (crude OR 5.2, p < 0.001). The addition of education to the multivariate model lowered the impact of wealth index by almost half. Increasing education levels were positively associated with achieving full vaccination status. Sex of children and age of mothers were not associated with the child's immunization status.

Conclusions

Despite free immunizations, use is not uniform throughout the population. Access to wealth and education may contribute to disparities in achieving full immunization. Minimizing indirect costs of immunizations may reduce disparities. Health education needs to be intensified for parents with minimal education.

Knowledge of AIDS and condom as a preventive measure against AIDS among married males and factors influencing it in Bangladesh

BACKGROUND

The acquired immunodeficiency syndrome (AIDS) is now a global scourge of mankind. Nevertheless, Bangladesh is categorized as a low HIV prevalence country, from an epidemiological point of view, the HIV epidemic in Bangladesh is evolving rapidly. The majority of the studies on HIV/AIDS and condom use were carried out among the risk segment of people in the country. This study aimed to investigate the knowledge of AIDS and use of condoms among general population for prevention of HIV/AIDS in Bangladesh.

METHODS

Both quantitative and qualitative study designs were adopted in this study. Cross-sectional data were collected from rural and urban areas. Married males aged 20 years and above constituted the study population. Data on 524 male respondents were analyzed using SPSS software version 11.5. For qualitative data, selective in-depth interview was done using unstructured guidelines.

RESULTS

Analysis indicated that 26 of the respondents had no knowledge about AIDS. More than one-fifth 23 had poor, 26 had well and 25 had excellent knowledge on AIDS. Only 29 reportedly mentioned that condom might be a preventive measure against AIDS. Multivariate logistic regression analysis revealed that urban residents with access to electronic and printed media, better socioeconomic condition and service holders appeared to be significantly associated with knowledge of condom as a preventive measure for AIDS p<0.05. However, in the social context, the respondents had different views about use of condom as a preventive measure against AIDS.

CONCLUSION

Useful and fruitful media campaigns to educate the people regarding the health consequences of STDs including HIV/AIDS and integrated approach is strongly suggested for disseminating knowledge and awareness to control the spread of HIV/AIDS among people in Bangladesh.

Determinants of drinking arsenic-contaminated tubewell water in Bangladesh

Bangladesh has already experienced the biggest catastrophe in the world due to arsenic contamination of drinking water. This study investigates the association of drinking arsenic-contaminated water (DACW) with both personal and household characteristics of 9116 household respondents using the household data of the Bangladesh Demographic and Health Survey (BDHS) 2004. Here DACW means that arsenic level in the drinking water is greater than the permissible limit (50 microg/l) of Bangladesh. The overall rate of DACW was 7.9%. It was found to be significantly associated with education, currently working, and division of Bangladesh, either by cross tabulation or multivariate logistic regression analyses or both. Similarly, household characteristics -- namely television, bicycle, materials of the wall and floor, total family members, number of sleeping rooms, and availability of foods -- were significantly associated in bivariate analyses. Many household characteristics -- namely electricity, television, wall and floor materials, and number of sleeping rooms -- revealed significant association in the logistic regression analysis when adjusted for age, education and division. This study indicates that respondents from Chittagong division and lower socio-economic groups (indicated by household characteristics) are at significantly higher risk of DACW. These findings should be taken into account during the planning of future intervention activities in Bangladesh.

Effects of underfeeding on semen quality of Rhode Island cocks

Fifty Rhode Island chickens were randomly assigned to five treatments with ten cocks in each treatment. Group I cocks (full fed control) received 140 g of a 16% CP growers ration per cock per day. Cocks in Group II, III, IV and V received 98, 70, 42 and 28 g of the same ration per cock per day, representing 70, 50, 30 and 20% of Group I intake, respectively. The feeding trials lasted for 8 weeks during which one ejaculate per day was collected from each cock using the massage technique. The ejaculated semen samples were subjected to both physical and biochemical evaluations. Results showed that cocks that were severely underfed (i.e., Groups IV and V) took significantly longer time (p<0.01) to ejaculate. In addition, ejaculation failures were encountered more frequently with the severely underfed cocks than in cocks that were moderately underfed (i.e., Groups II and III). There were however, no significant differences in most of the biochemical parameters between cocks I all the treatment groups. Ejaculate volume, progressive sperm motility and sperm concentration were significantly depressed (p<0.01) in the severely underfed cocks than in the moderately underfed cocks. Thus, this study revealed that providing Rhode Island red and white cocks with one-halfto three-quarter (i.e., 50-70%) of their normal daily ration would neither undermine their semen producing ability nor affect their semen quality adversely.