Religious minority identity associates with stress and psychological health among Muslim and Hindu women in Bangladesh and London

OBJECTIVES

This study examined the association of minority religious identification (Hindu or Muslim) with self-reported stress and psychological symptoms among sedentee and immigrant Bangladeshi women.

METHODS

Women, aged 35-59 (n = 531) were drawn from Sylhet, Bangladesh and London, England. Muslim immigrants in London and Hindu sedentees in Sylhet represented minority religious identities. Muslim sedentees in Sylhet and Londoners of European descent represented majority religious identities. In bivariate analyses, minority religious identity was examined in relation to self-reported measures of stress, nervous tension, and depressed mood. Logistic regression was applied to examine the relationship between these variables while adjusting for marital status, parity, daily walking, and perceived financial comfort.

RESULTS

In bivariate analyses, religious minorities reported more stress than religious majorities in all group comparisons (p < .05), and minority Muslims reported more nervous tension and depressed mood than majority Muslims (p < .05). In logistic regression models, minority Muslims had greater odds of high stress than majority Muslims (OR 2.00, 95% CI 1.18-3.39). Minority Muslims had greater odds of stress (OR 3.05, 95% CI 1.51-6.17) and nervous tension (OR 3.37, 95% CI 1.66-6.87) than majority Londoners. Financial comfort reduced odds of stress and symptoms in all models.

CONCLUSIONS

Socioeconomic situation, immigration history, and minority ethnicity appear to influence the relationship between religious identity and psychosomatic symptoms in Bangladeshi women. Attention to personal and socioeconomic context is important for research examining the association between religion and mental health.

Comparison of Decaying Antibody Level After SARS-CoV-2 Infection in Case of Home Treated and Hospital Treated Patients at Different Interval

The aim of the study was to evaluate the quantities difference and persistence of antibody in home and hospital treated patients at different interval. A cross-sectional study was conducted in the Department of Biochemistry and Molecular Biology, BIRDEM General Hospital, from July, 2020 to June, 2021. This study protocol was approved by Institutional Review Board (IRB), BIRDEM. SARS-CoV-2 caused death of huge number of people. The disease most commonly represents with fever, cough, loss of smell sensation, fatigue etc. Who had mild symptoms did not admit at hospital. But when the disease progress to respiratory distress, involvement of lung field more than 50.0% and other complications then the patients need hospital admission. Hospital treated patients showed higher antibody status in comparison to home treated patients. Moreover it was reported that increased amount of antibody developed after 3rd and 4th months of SARS-CoV-2 infection. In this study, statistically significant difference of decaying antibody level between home and hospital treated patients was observed.

Role of Transabdominal Ultrasonogram for Evaluation of Placental Maturity in Relation with Fetal Gestational Age

In this study our main goal is to evaluate the role of ultrasonography (USG) for determination of placental maturity and fetal gestational age. This cross-sectional study was done at the Department of Radiology and Imaging (USG section) Mymensingh Medical College and Hospital, Mymensingh from July 2008 to June 2010, where 60 patients included in this study, who was attending in the department of Radiology & Imaging for transabdominal ultrasonography with early and late pregnancy related complaints. In this study among the 60 patients, the youngest one was eighteen years and oldest one was thirty-nine years old age. Thirty five percent (35.0%) patients were from 26-30 years age group. About 33 patients out of 60(55.0%) were house wives. Most of the patients were presented with amenorrhea (65.0%) 39 out of 60. Among 60 patients, 20 patients (33.3%) were in gestational age within 12-28 weeks, 20 patients (33.3%) were in gestational age within 29-36 weeks and 20 patients (33.3%) were within >36 weeks gestational age. Among them, 20 patients (33.3%) had grade III placenta, 20 patients (33.3%) had grade II placenta, 12 patients (20%) had grade I placenta and 08 patients (13.3%) had grade 0 placenta. Out of 60 patients, 18 patients (30.0%) were in high risk group and 70.0% were normal. Six (6) patients (10.0%) suffered from HTN, 3 patients had RH negative (5.0%) blood group, 3(5.0%) patients suffered from APH, 3 patients suffer from DM and 3 from IUGR. In this study showed hypertension and IUGR had strong correlation with accelerated placental maturation. Maternal DM and Rh sensitization were associated with delayed maturation of the placenta. This study concludes that, USG appears to be the best imaging modality for the evaluation of placenta and its grading. USG is relatively less expensive and it is good considering the diagnostic accuracy in pregnancy profile. It is noninvasive procedure without any radiation hazards and better visualization of the lesion in different section, but this study is not a complete reflection of overall incidence and statistics regarding the ailment in our country. For this a more extensive study over a longer period covering different section of society is very much needed for better outcome.

The HRCT Evaluation of 105 Suspected COVID 19 Patients of MMCH and RT-PCR Correlation

In this study our main goal is to evaluate the HRCT evaluation of 105 suspected COVID 19 patients of MMCH and RT-PCR correlation. This experimental and observational study was done at Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from May 2020 to October 2020. Where 105 suspected COVID 19 patients of MMCH and RT-PCR correlation were included in the study. During the study, 43.05% of the patients exposed indirectly to the virus, followed by 44.1% didn't exposed any virus, 21% exposed directly. Diabetes mellitus was 35.7%, HTN - 46.2%, 82.95% had fever, 72.45% had cough, 78.75% had respiratory distress and 49.35% had no diseases. After CT scan diagnosis, positive to infection were found in 98 patients, among them 34 patients had mild type, 22 had severe type of infection where as in RT-PCR diagnosis 69 were positive and 36 were negative to infection. From our study we can conclude that, the most common pattern of COVID-19 pneumonia on HRCT images are pure GGO and GGO and Crazy Paving. Also GGO with consolidation with prominent distribution in the posterior and peripheral part of the lung. Further study is very much needed for better outcome.

Traditional knowledge about medicinal plant in the remote areas of Wari Tehsil, Dir Upper, Pakistan

Traditional medicine is cheaper and easily available to local people, to care for most frequent diseases in the Northern parts of Pakistan. Our study aimed at inventorying medicine from local plants, documenting their uses, and assessing their market value in 2015-2018 during spring, summer, and winter seasons. A total of 15 trips were made, 5 in each season. Semi-structured interviews with 165 inhabitant's age range between 20-80 years were conducted, analyzed the data is analyzed using Relative frequency of citation(RFC), Use Value(UV), Fidelity Level(FL), Informants consensus factor(ICF), and Jaccard index(JI) to find the most frequent and well-known used species in the area. A total of 86 species belonging to 39 vascular plant families, 33 genera were documented as medicinally important. Family Asteraceae was observed as the dominant family among all the families with 10 species, the leaf was the most used parts and decoction 36% was the most preferred preparation type. Herb was the predominant life form (67%). The maximum UV (0.92) was demonstrated by J. adhatoda L. species, while A. sativum L. shows maximum RFC (0.58), the highest ICF value represented by diarrhea and dermatitis 0.92, and high FL value is recorded 100%. According to our collections, wild species were 45%, invasive species were 38% and cultivated 17% recorded, dicots species were recorded more 81%. Seven 7 medicinal species is being economically important and export to the local and international market of the world, whereas P. integrima L. species were the most exported species according to the local dealers. The investigated area is rural and the local people depend on the area's plants for their health needs, and other uses like a vegetable, fuelwood, fodder, etc. The current result of RFC, UV, ICF, FL, and JI shows that medicinal flora needs to be pharmacologically and phytochemically investigated to prove their efficacy. The documentation of medicinal knowledge is important to preserve this precious old knowledge before it is lost forever, due to technological and environmental changes in the world.

A Rare Case of Polyorchidism: Sonographic and MR Evaluation of Four Testes

Polyorchidism is a rare congenital anomaly reported about 200 cases in the world text. A number of theories have been planned concerning the making of polyorchidism, but the real explanation is still not acknowledged. Here we are going to present a case study of polyorchidism. A 70 years old gentleman complained with left supernumerary testes in the left hemiscrotum. His left hemiscrotum was painless with mass. Polyorchidism without malignancy or any other concomitant features were revealed by both ultrasound and MRI examinations. In most cases the ultrasonograph alone is diagnostic. In complicated cases of polyorchidism MRI may provide additional information.

Risk Factors of UTI in Children with Nephrotic Syndrome

Urinary tract infection (UTI) is a common complication in nephrotic children and leads to most morbidity and mortality in developing countries like Bangladesh. This case control study was conducted in the Department of Pediatrics and Pediatric Nephrology ward of Dhaka Medical College Hospital, Dhaka from July 2016 to June 2018 to identify the risk factors of UTI in children with nephrotic syndrome. Total 90 patient of nephrotic children aged 2-12 years, who were fulfilling the inclusion and exclusion criteria were selected as Group I (case) and Group II (control) according to urine culture report. Group I was UTI positive and Group II was UTI negative. The mean age of Group I was 5.26±3.18 years and Group II was 6.03±2.85 years. There was male predominance in both groups. No significant difference has been found regarding age and sex (p>0.05). No significant difference was also observed regarding economic status and educational level of mother among both groups (p>0.05). Fever, dysuria, abdominal pain, anasarca, vomiting and pallor were found as common presentations in Group I. Children with dysuria and abdominal pain were significantly higher in Group I than Group II (p value <0.001). UTI was found more in relapsed cases than initial attack. E. coli was the most common etiologic agent (37.8%). Mean Hb (gm/dl), serum total protein, serum albumin and serum IgG level were found significantly lower and spot urine protein creatinine ratio was significantly higher in Group I, which implies that those biochemical factors were associated with development of UTI in nephrotic children. Younger age group (<6 years), Constipation and uncircumcised male were found as risk factors and has association with UTI in nephrotic children.

Chest Radiography in the Evaluation of Mitral Valvular Disease and it's Correlation with Echocardiography

This study is aimed to find out various clinical, radio-graphical and echocardiographic variables to predict mitral valvular disease and their correlation with Echocardiography. This cross-sectional observational study was conducted in the Department of Radiology and Imaging, in collaboration with Department of Cardiology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2017 to December 2018. Total 50 consecutive cases enrolled in this study who was the patients of mitral valvular disease. Both chest radiograph and echocardiograph were done for each patient. There were 76% female and 26% male with a female-male ratio 3.16:1 with mean±SD (41.54±12.44). About 42% patients had previous history of rheumatic fever. The most common x-ray findings of heart were increased central density (90%) followed by enlargement in transverse diameter (88%), straightening of the left border (88%), widening of the carina (86%), full pulmonary conus (84%) and double contour of right border (76%). About 47(94%) patients confirmed mitral valvular heart disease on echocardiography. The prominent findings included left atrium was predominantly severely dilated (50%), severely reduced mitral valve orifice area (68%), mild mitral regurgitation (46%) and mild pulmonary hypertension (38%). And overall sensitivity, specificity, PPV, NPV and accuracy of chest radiograph in the detection of mitral valvular heart disease were 85.11%, 66.67%, 97.56%, 14.89% and 84%, respectively. These findings suggest that chest radiograph could be used as an adjunct tool with echocardiography.

Association between Child Undernutrition and Maternal Undernutrition: A Study in a Tertiary Care Hospital

Undernutrition in children under five years remains a significant health problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although Bangladesh has made rapid progress over the last decade in the field of health and nutrition, there has been very slow progress in improving the state of child nutrition. Studies aiming at determination of interrelationship between child undernutrition and maternal undernutrition are to be scientifically established if appropriate intervention policy is to be introduced. This study was undertaken to see whether this assumption has a statistically proven basis that maternal undernutrition influences child undernutrition. The objective of this cross sectional analytical study was to evaluate the association between child undernutrition and their maternal undernutrition in child-mother pair in a tertiary care hospital and was conducted from July 2017 to April 2018 in the department of General Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study subjects were 196 children between the ages of six months to five years who were admitted in BSMMU and their accompanying mothers. Children who had any known chronic diseases or clinically obvious syndrome were excluded. Before enrollment, parents of all the patients were informed about the study & its objectives. Anthropometric measurements of children and mothers were done by standard procedure. Demographic profile and relevant maternal information were collected by interviewing the mothers. Among the undernourished children, 17.3% were found underweight, 7.1% stunted, 16.3% wasted. Combined underweight & wasted were 34.7%, underweight & stunted 9.2%, stunted & wasted 5.1%, underweight, stunted and wasted 10.2%. Maternal undernutrition was more common (95.7%) in undernourished children group. Undernutrition was significantly higher in mothers of children with undernutrition (OR=40.75, p<0.001). Children having a better nutrition were born from mothers who were well nourished, educated, had good childcare knowledge and higher family income. This emphasized the need to provide the guideline for appropriate measure to be taken to reduce child undernutrition.

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.

Risk factors for non-communicable diseases related to obesity among first- and second-generation Bangladeshi migrants living in north-east or south-east England

BACKGROUND

Obesity is a global burden, which significantly increases the risk of non-communicable diseases (NCDs). More than a quarter of adults in the United Kingdom are obese, but prevalence varies by ethnicity, and South Asians have the largest burden of NCDs. This paper assesses how sex, generation, and region interplay to vary the predisposition to obesity-related (OR) NCDs among UK Bangladeshis.

METHODS

We used National Institute for Health and Care Excellence suggested grading for combining body mass index and waist circumference to define populations at risk of OR-NCDs. Data from 517 adults of Bangladeshi origin from a cross-sectional study (March 2013 to April 2015) were analysed. Male and female participants from London and north-east England were equally sampled including: (1) adult migrants, who came to the UK aged >16 years; (2) child migrants, who came to the UK aged ≤16 years; and (3) second-generation Bangladeshis (who were born and brought up in the UK). A generalised estimating equation using a binomial distribution and a logit link was used to explore the relationship between the binary outcome of being 'at risk of OR-NCDs' and associated factors.

RESULTS

Females, married individuals, those living in London, the second-generation, and those of lower self-assessed financial status, with low acculturation status, or who did not walk daily for at least 20 min were more likely to develop OR-NCDs. A striking sex difference was found with more females prone to OR-NCD risk in the north-east than in London.

CONCLUSIONS

Our study observed important inter- and intra-regional inequality in OR-NCD risk which worsens the health of ethnic minorities and widens inequality.

Leaving no one behind: using action research to promote male involvement in maternal and child health in Iringa region, Tanzania

INTRODUCTION

Male involvement has been reported to improve maternal and child health (MCH) outcomes. However, most studies in low-income and middle-income countries have reported low participation of men in MCH-related programmes. While there is a growing interest in the involvement of men in MCH, little is known on how male involvement can be effectively promoted in settings where entrenched unequal gender roles, norms and relations constrain women from effectively inviting men to participate in MCH.

METHODS AND ANALYSIS

This paper reports participatory action research (PAR) aimed to promote male participation in pregnancy and childbirth in Iringa Region, Tanzania. As part of the Innovating for Maternal and Child Health in Africa project, PAR was conducted in 20 villages in two rural districts in Tanzania. Men and women were engaged separately to identify barriers to male involvement in antenatal care and during delivery; and then they were facilitated to design strategies to promote male participation in their communities. Along with the PAR intervention, researchers undertook a series of research activities. A thematic analysis was used to analyse the data. The common strategies designed were: engaging health facility committees; using male champions and male gatekeepers; and using female champions to sensitise and provide health education to women. These strategies were validated during stakeholders' meetings, which were convened in each community.

DISCUSSION

The use of participatory approach not only empowers communities to diagnose barriers to male involvement and develop culturally acceptable strategies but also increases sustainability of the interventions beyond the life span of the project. More lessons will be identified during the implementation of these strategies.

Characterization of Clostridioides difficile ribotypes in domestic dogs in Rio de Janeiro, Brazil

Clostridioides difficile is the major etiologic agent of nosocomial bacterial diarrhoea and pseudomembranous colitis. The pathogenesis of C. difficile infection (CDI)involves two cytotoxic enzymes (TcdA, TcdB) that cause colonic epithelial damage, fluid accumulation and enteritis. CDI has been demonstrated in a variety of animal species and some reports have recently raised the importance of wild animals as a reservoir of this pathogen and possible transmission to humans and domestic animals. The aim of this study was to characterize C. difficile isolates obtained from pet dogs in Rio de Janeiro, Brazil. A total of 50 faecal samples were obtained from healthy and diarrheic dogs. Five of fifty samples (10%) grew C. difficile. Of those, three belonged to the PCR ribotype 106 (ST 42) and were toxigenic (A⁺B⁺). The other two strains belonged to the PCR ribotype 010 (ST 15) and were not toxin producers (A^-B^-). None of the isolates tested positive for the binary toxin genes. Considering the antimicrobial resistance patterns of all isolates using EUCAST breakpoints, all strains were sensitive to metronidazole and vancomycin. However, two strains (ribotype 106 and ribotype 010), were resistant to clindamycin (≤256 μg/mL). All strains were strong biofilm producers. Our study provides evidence that dogs can act as reservoirs for C. difficile epidemic ribotypes.

Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron-folic acid supplementation among pregnant women in Zinder, Niger

The World Health Organization recommends iron and folic acid (IFA) supplementation for pregnant women. The high prevalence of anaemia among pregnant women in Niger warrants better understanding of the utilization of antenatal care (ANC) and IFA. We aimed to assess the prevalence of and factors associated with ANC coverage and adherence to IFA recommendation among pregnant women. Pregnant women (n = 923) from 64 randomly selected villages within the catchment area of 12 health centres were interviewed during a baseline household survey in Zinder, Niger. ANC and IFA coverage were 60.1% and 43.6%, respectively. Only 71.7% of women who attended ANC received IFA. Of the 401 women who reportedly received any IFA supplements, 99.3% had attended any ANC during their current pregnancy and 68.6% reported adherence to recommended IFA supplementation (i.e., consumed IFA every day in the previous week). Women with gestational age ≥27 weeks were more likely to have attended ANC than women with gestational age <27 weeks (85.9% vs. 27.5%, odds ratio [OR]: 21.81, 95% confidence interval [CI]: 13.81, 34.45). Women who reportedly received husbands' advice about attending ANC were more likely to attend ANC (OR: 1.48, 95% CI [1.03, 2.11]) and adhere to IFA recommendations (OR: 1.80, 95% CI [1.04, 3.13]) compared to those who did not receive any advice. ANC attendance is crucial to ensure distribution of IFA supplementation among pregnant women in Zinder. Interventions to improve ANC and IFA adherence will require promotion of early ANC, ensure availability of IFA at ANC, and involve husbands in ANC.

Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh

Background

Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision.

Methods

In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors.

Results

Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives.

Conclusions

Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.

Substance Use among the Patients with First Episode Psychosis

Substance Use Disorder is a frequent problem in Bangladesh and many of these patients develop psychosis. Substance use can cause psychosis and it can modify the course of psychosis. This cross-sectional study was done to see the proportion of substance use in patients with First-Episode Psychosis (FEP) in two tertiary care hospitals in Dhaka, Bangladesh mentioned here as Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital; from November 2007 March 2009. Fifty consecutive FEP patients were taken as subjects and 50 healthy attendants were recruited as control. Mean age of the patients was 27.24, male (62%) are more having first-episode psychosis than female (38%). Majority of the patients were unmarried (64%). Regarding occupation students were 34%, followed by unemployed 24% and service18%. In control group's occupation; service 34%, housewife 22%. Life time substance use was found double in patients with first-episode psychosis than control. Cannabis was found to be the most common substance causing psychosis. Among the lifetime substance users in fist-episode psychosis patients 77.78% were male where as, in control group 100% patients were male. However, the researcher did not find any of the first-episode psychosis patients taking current use of substance (abuse and /or dependence). The small size of the present study was only 50. Future prospective study is required having large sample size to see the outcome of substance use in first-episode psychosis.

Ultrasonographic Evaluation of Malignant Pediatric Abdominal Tumour with Histopathological Correlation

Ultrasonography is a very useful diagnostic tool to evaluate pediatric abdominal mass. This cross sectional study was conducted among clinically suspected patients having malignant abdominal mass attending in the department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2008 to December 2009. Total 56 patients were included in this study. Patients were scanned by high resolution gray scale ultrasonography of the abdominal masses. After surgical procedure, biopsy specimen were collected in a container containing 10% formalin and sent for histopathological examination. Mean age of the patients group was 5.91 years with a standard deviation of ±3.21 years. All patients were within 2 to 13 years age. Out of all patients, male were 33(58.9%) and 23(41.1%) were female. Male and female ratio was 1.4:1. Ultrasonographic diagnosis as Wilm's tumour were 27(48.2%), hepatoblastoma 8(14.3%), lymphoma 7(12.5%), neuroblastoma 6(10.7%), suspected malignancy 6(10.7%) and lastly teratoma were 2(3.6%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasonography in the evaluation of Wilm's tumour were 100.0%, 90.6%, 88.9%, 100.0% and 94.6% for neuroblastoma 83.3%, 98.0%, 83.3%, 98.0% and 96.4% for lymphoma 83.3%, 96.0%, 71.4%, 98.0% and 94.6% and for hepatoblastoma 100.0%, 100.0%, 100.0%, 100.0% and 100.0% respectively. It is a noninvasive and cost effective modality. Carefully performed ultrasonographic study would give reliable and accurate information needed in the diagnosis of abdominal malignancy in children.

Risk Factors and Immediate Outcome of Very Low Birth Weight Babies (Appropriate For Gestational Age) In Newly Established SCANU, Mymensingh Medical College Hospital

Low birth weight (LBW) is the most important preventable cause in the neonatal period leading to very high neonatal mortality and morbidity in developing countries like Bangladesh. A cross sectional study was conducted in the neonatology ward, Mymensingh Medical College Hospital, Mymensingh from July 2014 to December 2014 to identify the risk factors and immediate hospital outcome of Very Low Birth Weight (VLBW) Appropriate for Gestational Age (AGA) babies in context of present neonatal hospital care standard. Total 100 preterm very low birth weight babies were enrolled and selected by weight, intra uterine growth chart and new ballad score. There is slight preponderance of male babies (64%) over female babies (36%). The overall survival and mortality rate was 50% and 50% respectively in the present study. Mortality is highest (76.47%) in babies whose gestational age 28 weeks and the mortality rate gradually decrease as gestational age increases. Correlation co-efficient (r) between gestational age and number of died is -0.85. It indicates highly opposite relation between the variables, p value (<0.069) which is strong opposite relation. Mortality is highest (66.66%) in babies whose birth weight below1100gm, in comparison to those whose birth weight above 1100gm and correlation co-efficient (CC) r = -0.433 (p<0.466) which is not significant. That means not only birth weight but also other factors are responsible for mortality of very low birth weight baby. Neonatal mortality bears inverse relationship with birth weight and gestational age. This emphasized the need for large scale study which will provide the guideline for appropriate measures to be taken to combat the situation.

Granulomatosis with Polyangiitis (Wegener Granulomatosis) with Unusual Presentation

We came across a 32 years old male admitted in our hospital with prolonged low-grade fever, haemoptysis, leg swelling, weight loss, purpuric rashes and malaena. He received anti-TB treatment at another hospital without any improvement. He was pale with bullous and purpuric lesions over legs and feet. He also had features of consolidation over both lung fields. His CRP was 312mg/L, Urine R/M/E showed 40-50 RBC/HPF, Chest X-ray showed features of bilateral consolidation, c-ANCA-10U/L (positive); Tracheal aspirate for AFB was found to be negative. We diagnosed the case as Granulomatosis with Polyangitis (WG) and started treatment with steroid and cyclophosphamide. But the patient could not be saved probably due to delay in starting management.

Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Bis[S-hexyl 3-(thiophen-2-ylmethylidene)dithiocarbazato-κ2N3,S]palladium(II)

In the title complex, [Pd(C12H17N2S3)2], the PdIIatom exhibits a square-planar coordination geometry with theN,S-chelating ligands arranged in atransconfiguration. Intramolecular C—H...S hydrogen bonds are observed. In the crystal, molecules are linked by weak C—H...N hydrogen-bond interactions, forming chains parallel to thebaxis.

Correlation between Umbilical Cord Diameter and Cross Sectional Area with Gestational Age and Foetal Anthropometric Parameters

The objective of the study was to find out correlation between umbilical cord diameter, cross sectional area with gestational age and foetal anthropometric parameters. This cross sectional study was conducted among healthy women between the 24(th) and 40(th) completed weeks of a normal pregnancy in the Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh during the study period, from July 2009 to June 2011. A total of 230 consecutive normal pregnancy patients were included in the study. The diameter & cross-sectional area of the umbilical cord were measured on a plane adjacent to the junction of the umbilical cord and the fetal abdomen, in cross-section, with maximum magnification of the image. The cord was manually circled, and it's cross sectional areas was automatically calculated by the ultrasonograph. The mean±SD age was 24.3±4.7 years with range from 19 to 36 years. The mean gestational age was 32.1±4.5 weeks and more than a half (56.4%) of the pregnant women were nulliparas. A positive significant (p<0.001) correlation were found between umbilical cord diameter with bi-parietal diameter (r=0.548); head circumference (r=0.411); abdominal circumference (r=0.444); femur length (r=0.366) and gestational age gestation age (r=0.643). Similarly, a significant (p<0.001) positive week correlation were found between umbilical cross sectional area with bi-parietal diameter (r=0.3303); head circumference (r=0.3202); abdominal circumference (r=0.2651); femur length (r=0.3307) and gestation age (r=0.4051). A positive significant better correlation was found with umbilical cord diameter than cross sectional area with foetal anthropometric parameters.

Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women

A cross sectional study was carried out from January 2007 to December 2008 in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka in collaboration with Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Pregnant women with pre-eclampsia attending at Out-patient Department (OPD) and admitted in In-patient Department of Obstetrics and Gynaecology Dhaka Medical College Hospital, Dhaka were selected as cases. Healthy and uncomplicated pregnant women admitted in the same hospital were taken as controls. The study showed that 26-30 years and 21-25 years age category was higher in the case and control groups and the mean age was significantly higher in case group compared to control group (p=0.025). The study showed that 44% of case group had a significantly high level of plasma D-dimer (>0.5μg/ml) as opposed to control group (8%) (p<0.001). Estimation of odds ratio demonstrates that pre-eclamptic women (case) had 9 times (95% of CI = 2.8 - 28.9) more risk of having plasma D-dimer >0.5μg/ml than that of normal pregnant women (control). The mean systolic and diastolic blood pressures in patients with plasma D-dimer >0.5μg/ml were considerably higher than those who had plasma D-dimer ≤0.5μg/ml (p<0.001). The study showed that majority (81.8%) of pre-eclamptic women with plasma D-dimer >0.5μg/ml had systolic blood pressure ≥ 160 mm Hg compared to 46.4% of those who had plasma D-dimer ≤0.5μg/ml (p=0.010). And ninety percent of pre-eclamptic women with plasma D-dimer >0.5μg/ml had exhibited severe proteinuria as opposed to 53.6% of those who had plasma D-dimer ≤0.5μg/ml (p=0.017). The study concludes that plasma D-dimer level can easily be used in screening for the hypercoagulable state in pre-eclamptic patients which have preventive and therapeutic implications.

Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh

BACKGROUND

The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities.

OBJECTIVES

To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision.

METHODS

Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities.

FINDINGS

Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities.

CONCLUSION

IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular supervision and task shifting the management of sick under-five children to lower-level service providers.

Measuring coverage in MNCH: a prospective validation study in Pakistan and Bangladesh on measuring correct treatment of childhood pneumonia

BACKGROUND

Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh.

METHODS AND FINDINGS

Caregivers of 950 children under 5 y with pneumonia and 980 with "no pneumonia" were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry.

CONCLUSIONS

Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time.

Long-term consequences of stunting in early life

This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood.

trans-(5,7,7,12,14,14-Hexamethyl-1,4,8,11-tetra-aza-cyclo-tetra-deca-4,11-diene-κN,N',N'',N''')bis-(nitrito-κN)cobalt(III) perchlorate hemihydrate

The asymmetric unit of the title Co^III complex, [Co(NO₂)₂(C₁₆H₃₂N₄)]ClO₄·0.5H₂O, comprises two complex cations, two perchlorate anions and a water mol­ecule of crystallization. The Co^III atoms exist within distorted octa­hedral N₆ geometries defined by four N atoms of the macrocycle ligand and trans-N atoms derived from the nitrite anions. Systematic variations in the Co—N bond lengths are correlated with the presence of intra­molecular N—H⋯O(nitrite) hydrogen bonds. In the crystal, water-O—H⋯O(perchlorate) hydrogen bonds, involving one of the independent perchlorate anions only, lead to supra­molecular chains along the b-axis direction. The three-dimensional architecture is consolidated by numerous C—H⋯O inter­actions. The crystal studied was a non-merohedral, racemic twin.

Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial

BACKGROUND

WHO and UNICEF launched the Integrated Management of Childhood Illness (IMCI) strategy in the mid-1990s to reduce deaths from diarrhoea, pneumonia, malaria, measles, and malnutrition in children younger than 5 years. We assessed the effect of IMCI on health and nutrition of children younger than 5 years in Bangladesh.

METHODS

In this cluster randomised trial, 20 first-level government health facilities in the Matlab subdistrict of Bangladesh and their catchment areas (total population about 350 000) were paired and randomly assigned to either IMCI (intervention; ten clusters) or usual services (comparison; ten clusters). All three components of IMCI-health-worker training, health-systems improvements, and family and community activities-were implemented beginning in February, 2002. Assessment included household and health facility surveys tracking intermediate outputs and outcomes, and nutrition and mortality changes in intervention and comparison areas. Primary endpoint was mortality in children aged between 7 days and 59 months. Analysis was by intention to treat. This study is registered, number ISRCTN52793850.

FINDINGS

The yearly rate of mortality reduction in children younger than 5 years (excluding deaths in first week of life) was similar in IMCI and comparison areas (8.6%vs 7.8%). In the last 2 years of the study, the mortality rate was 13.4% lower in IMCI than in comparison areas (95% CI -14.2 to 34.3), corresponding to 4.2 fewer deaths per 1000 livebirths (95% CI -4.1 to 12.4; p=0.30). Implementation of IMCI led to improved health-worker skills, health-system support, and family and community practices, translating into increased care-seeking for illnesses. In IMCI areas, more children younger than 6 months were exclusively breastfed (76%vs 65%, difference of differences 10.1%, 95% CI 2.65-17.62), and prevalence of stunting in children aged 24-59 months decreased more rapidly (difference of differences -7.33, 95% CI -13.83 to -0.83) than in comparison areas.

INTERPRETATION

IMCI was associated with positive changes in all input, output, and outcome indicators, including increased exclusive breastfeeding and decreased stunting. However, IMCI implementation had no effect on mortality within the timeframe of the assessment.

FUNDING

Bill & Melinda Gates Foundation, WHO's Department of Child and Adolescent Health and Development, and US Agency for International Development.

Determination of toxic trace elements in foodstuffs, soils and sediments of bangladesh using instrumental neutron activation analysis technique

The concentrations of arsenic (As), chromium (Cr) and iron (Fe) were determined in the foodstuffs, soils and sediments from various areas in Bangladesh and new data for these toxic trace elements were given. The arsenic pollution problems in the most of the areas of Bangladesh are of geological origin. The high level of As in foodstuffs, soils and sediments, except for tannery sediments is probably positively correlated to the Fe concentration. An excessive amount of chromium was found in the sediments from the tannery area of Bangladesh.

Care at first-level facilities for children with severe pneumonia in Bangladesh: a cohort study

BACKGROUND

Guidelines on integrated management of childhood illness (IMCI) for severe pneumonia recommend referral to hospitals. However, in many settings, children who are referred do not actually attend hospital, which severely limits appropriate care. We aimed to assess the safety and effectiveness of modified guidelines that allowed most children with severe pneumonia to be treated locally in first-level facilities, with referral only for those with danger signs or other severe classifications.

METHODS

We did an observational cohort study in ten first-level health facilities in Matlab, rural Bangladesh that had implemented IMCI guidelines. We assessed children with severe pneumonia who were aged between 2 and 59 months, and for whom we could obtain complete information, in two cohorts: 261 children who presented to these facilities between May, 2003, and April, 2004 (before implementation of the modified guidelines) and 1271 children between September, 2004, and August, 2005 (after full implementation). We obtained information about the characteristics and management of their illness, including referrals and admissions to hospital, from facility records. Staff visited households to obtain details of treatment, socioeconomic information, and final outcome, including mortality data.

FINDINGS

245 (94%) of 261 children who had severe pneumonia were referred to hospital before the guidelines were modified, compared with 107 (8%) of 1271 after implementation (p<0.0001). 94 (36%) children with severe pneumonia received correct management before the guidelines were modified, compared with 1145 (90%) children after implementation (p<0.0001). Before modification of the guidelines, three children with severe pneumonia who presented at first-level facilities died, with a case-fatality rate of 1.1%; after modification, seven children died, with a case-fatality rate of 0.6% (p=0.39).

INTERPRETATION

Local adaptation of the IMCI guidelines, with appropriate training and supervision, could allow safe and effective management of severe pneumonia, especially if compliance with referral is difficult because of geographic, financial, or cultural barriers.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Endometriosis association research center

Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age. Pain syndrome, however, represents the major clinical problem of this disease, manifested as dysmenorrhea, pelvic pain, lower abdominal pain, and dyspareunia. About 32 literatures are reviewed in recent advancement for diagnosis of endometriosis. The magnifications of its managements are understood. In outdoor, the management is only depending on clinical findings and on some non invasive procedures without any definitive diagnosis. So, research activities should be done on the basis of recent advancement of endometriosis.

Synthesis and fungicidal activity of some 5-aryl/aryloxymethyl-2-[5-aryl-3-methyl-1,2,4-triazol-2-yl]-1,3,4-thiadiazoles and 5-aryl/aryloxymethyl-2[5-aryl-2-phenylimino-1,3,4- thiadiazolin-3-yl]-1,3,4-thiadiazoles

5-Aryl/aryloxymethyl-2-[5-aryl-2-methyl-1,2,4-triazol-2-yl]- 1,3,4-thiadiaxoles 4 and 5-Aryl/aryloxymethyl-2-[5-aryl-2-phenylimino-1,3,4- thiadiazolin-3-yl]-1,3,4-thiadiazoles 5 have been obtained from the cyclocondensation of 5-aryl/aryloxymethyl-2-arylidene hydrazino-1,3,4-thiadiazoles 3 with methyl cyanide and phenyl isothiocyanate respectively. Compounds 4 & 5 have been screened for their fungicidal activity against R. solani, F. oxysporum and P. oryzae. Based on screening data some structure-activity relationship is given.

Analysis of Pfmdr 1 gene in mefloquine-resistant Plasmodium falciparum

Drug resistance in Plasmodium falciparum is a serious problem in most endemic areas. Recent studies have suggested the potential involvement of genes in the MDR gene family in resistance to quinoline-containing compounds in P. falciparum. In our present studies, a molecular analysis of pfmdr 1 in isolate strain of P. falciparum, 523a R, from Japanese mefloquine-resistant patient was done to determine the reported association of pfmdr 1 intragenic alleles and mefloquine resistance, and to examine the antimalarial activities of several antimalarial agents against the P. falciparum strain. The antimalarial activities against the strain was decreased susceptibility to mefloquine, artemisinin and halofantrine, in contrast increased susceptibility to chloroquine. The DNA sequence analysis of pfmdr 1 gene in a strain reveled no association of intragenic alleles with mefloquine resistance. Furthermore, the overexpression of pfmdr1 mRNA have been observed and it is about 7.2 times higher than sensitive strain. Our data shows that overexpression of pfmdr1 gene may be associated in mefloquine-resistance mechanism.

Extensive repertoire of membrane-bound and soluble dendritic cell-specific ICAM-3-grabbing nonintegrin 1 (DC-SIGN1) and DC-SIGN2 isoforms. Inter-individual variation in expression of DC-SIGN transcripts

Expression in dendritic cells (DCs) of DC-SIGN, a type II membrane protein with a C-type lectin ectodomain, is thought to play an important role in establishing the initial contact between DCs and resting T cells. DC-SIGN is also a unique type of human immunodeficiency virus-1 (HIV-1) attachment factor and promotes efficient infection in trans of cells that express CD4 and chemokine receptors. We have identified another gene, designated here as DC-SIGN2, that exhibits high sequence homology with DC-SIGN. Here we demonstrate that alternative splicing of DC-SIGN1 (original version) and DC-SIGN2 pre-mRNA generates a large repertoire of DC-SIGN-like transcripts that are predicted to encode membrane-associated and soluble isoforms. The range of DC-SIGN1 mRNA expression was significantly broader than previously reported and included THP-1 monocytic cells, placenta, and peripheral blood mononuclear cells (PBMCs), and there was cell maturation/activation-induced differences in mRNA expression levels. Immunostaining of term placenta with a DC-SIGN1-specific antiserum showed that DC-SIGN1 is expressed on endothelial cells and CC chemokine receptor 5 (CCR5)-positive macrophage-like cells in the villi. DC-SIGN2 mRNA expression was high in the placenta and not detectable in PBMCs. In DCs, the expression of DC-SIGN2 transcripts was significantly lower than that of DC-SIGN1. Notably, there was significant inter-individual heterogeneity in the repertoire of DC-SIGN1 and DC-SIGN2 transcripts expressed. The genes for DC-SIGN1, DC-SIGN2, and CD23, another Type II lectin, colocalize to an approximately 85 kilobase pair region on chromosome 19p13.3, forming a cluster of related genes that undergo highly complex alternative splicing events. The molecular diversity of DC-SIGN-1 and -2 is reminiscent of that observed for certain other adhesive cell surface proteins involved in cell-cell connectivity. The generation of this large collection of polymorphic cell surface and soluble variants that exhibit inter-individual variation in expression levels has important implications for the pathogenesis of HIV-1 infection, as well as for the molecular code required to establish complex interactions between antigen-presenting cells and T cells, i.e. the immunological synapse.

Synthesis and antimalarial activity of novel medium-sized 1,2,4,5-tetraoxacycloalkanes

CsOH- or Ag(2)O-mediated cycloalkylation of (alkylidene)bisperoxides 3 and 1,n-dihaloalkanes (n = 3-8) provided the corresponding medium-sized 1,2,4,5-tetraoxacycloalkanes 4-8 in moderate yields. Subsequent evaluation of the antimalarial activity of the cyclic peroxides 4-8 in vitro and in vivo revealed that 1,2,6,7-tetraoxaspiro[7.11]nonadecane 4a has considerable potential as a new, inexpensive, and potent antimalarial drug.

Health gain and outcome predictors during inpatient and related day treatment in child and adolescent psychiatry

OBJECTIVE

To investigate health gain and its predictors during inpatient and associated day patient treatment.

METHOD

Consecutive admissions to two inpatient units for children and young adolescents in northwest England were studied (N = 55). Ascertainments were made from multiple perspectives, including family, teacher, clinician, and an independent researcher. Measures were taken at referral, admission, discharge, and 6-month follow-up; health gain was inferred from change scores on measures. Recruitment lasted from late 1995 to 1997; follow-up was completed during 1998. Independent variables tested as predictors included assessments of presenting symptoms, therapeutic alliance, and family functioning.

RESULTS

Significant health gain during hospitalization was found on most measures and sustained to follow-up. There was no symptom change during the waiting-list control condition. Health gain was predicted independently by child and parental therapeutic alliance with the unit early in hospitalization and by preadmission family functioning. Externalizing problems did well if accompanied by good alliance.

CONCLUSIONS

Assessment of health gain from multiple perspectives is possible and valuable. Inpatient treatment has significant therapeutic effect. Predictors for health gain lie in process variables of therapeutic alliance and family functioning rather than presenting symptoms. The results are discussed in relation to clinical practice and future research.

Microwave drying of selected greens and their sensory characteristics

Green leafy vegetables which supply minerals and vitamins to the diet, are highly perishable. Therefore, post harvest losses are extremely high. Limited studies are available in the literature with regard to preservation of greens. The effect of microwave drying and storage on physical and sensory properties of selected greens (coriander, mint, fenugreek, amaranth and shepu) were therefore studied. Microwave drying was carried out at 100% power and a frequency of 2450 mHz. The drying time varied from 10 to 16 min for different greens. Microwave drying affected color, appearance and odor of all the greens. The relative reconstitution capacity (RRC) for different greens was coriander-10.3, mint-10.3, amaranth-38.3, fenugreek-31.7 and shepu-32.8. The RRC appeared to influence acceptability. Coriander and mint, which exhibited the lowest RRC (10.3%), had the lowest scores for flavor and color while amaranth, with the highest RRC (38.3%), had scores similar to those of fresh amaranth. Scores for the products prepared with dried fenugreek and shepu, although low, were not statistically significant. Microwave drying was highly suitable for greens such as amaranth; moderately suitable for shepu and fenugreek and less suitable for coriander and mint.

Evolution of human and non-human primate CC chemokine receptor 5 gene and mRNA. Potential roles for haplotype and mRNA diversity, differential haplotype-specific transcriptional activity, and altered transcription factor binding to polymorphic nucleotides in the pathogenesis of HIV-1 and simian immunodeficiency virus

Polymorphisms in CC chemokine receptor 5 (CCR5), the major coreceptor of human immunodeficiency virus 1 (HIV-1) and simian immunodeficiency virus (SIV), have a major influence on HIV-1 transmission and disease progression. The effects of these polymorphisms may, in part, account for the differential pathogenesis of HIV-1 (immunosuppression) and SIV (natural resistance) in humans and non-human primates, respectively. Thus, understanding the genetic basis underlying species-specific responses to HIV-1 and SIV could reveal new anti-HIV-1 therapeutic strategies for humans. To this end, we compared CCR5 structure/evolution and regulation among humans, apes, Old World Monkeys, and New World Monkeys. The evolution of the CCR5 cis-regulatory region versus the open reading frame as well as among different domains of the open reading frame differed from one another. CCR5 cis-regulatory region sequence variation in humans was substantially higher than anticipated. Based on this variation, CCR5 haplotypes could be organized into seven evolutionarily distinct human haplogroups (HH) that we designated HHA, -B, -C, -D, -E, -F, and -G. HHA haplotypes were defined as ancestral to all other haplotypes by comparison to the CCR5 haplotypes of non-human primates. Different human and non-human primate CCR5 haplotypes were associated with differential transcriptional regulation, and various polymorphisms resulted in modified DNA-nuclear protein interactions, including altered binding of members of the NF-kappaB family of transcription factors. We identified novel CCR5 untranslated mRNA sequences that were conserved in human and non-human primates. In some primates, mutations at exon-intron boundaries caused loss of expression of selected CCR5 mRNA isoforms or production of novel mRNA isoforms. Collectively, these findings suggest that the response to HIV-1 and SIV infection in primates may have been driven, in part, by evolution of the elements controlling CCR5 transcription and translation.

Detection of hepatitis B surface antigen in pregnant women attending a public hospital for delivery: implication for vaccination strategy in Bangladesh

Routine antenatal hepatitis B surface antigen (HBsAg) screening and immunization of risk babies is very effective in preventing perinatal transmission of hepatitis B virus (HBV). We studied 1,800 parturients attending a public hospital to assess the rationale for such vaccination in Bangladesh. In one in every 29 deliveries (63 of 1,800 or 3.5%), the mother was found to be HBsAg positive. All were asymptomatic and many (41 of 63 or 65%) without risk factors would remain undetected if HBsAg screening were performed on selected groups. Most of the HBsAg-positive mothers (54 of 63 or 85.7%) were found to be chronic carriers and 30.2% (19 of 63) were also hepatitis B e antigen (HBeAg) positive, indicating high infectivity. Although 23 cord blood were positive for HBsAg or HBeAg, none were positive for IgM antibody to hepatitis B core antigen (IgM anti-HBc), suggesting transplacental transmission of the antigens rather than intrauterine infection. These findings are discussed in relation to the cost-effectiveness of routine prenatal screening and immunization of risk babies compared with universal infant immunization.