Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh.

BACKGROUND: In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. METHOD: The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation. RESULTS: Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease. CONCLUSION: A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.

Positive influence of short message service and voice call interventions on adherence and health outcomes in case of chronic disease care: a systematic review.

BACKGROUND: Chronic diseases have emerged as a serious threat for health, as well as for global development. They endenger considerably increased health care costs and diminish the productivity of the adult population group and, therefore, create a burden on health, as well as on the global economy. As the management of chronic diseases involves long-term care, often lifelong patient adherence is the key for better health outcomes. We carried out a systematic literature review on the impact of mobile health interventions -mobile phone texts and/or voice messages- in high, middle and low income countries to ascertain the impact on patients' adherence to medical advice, as well as the impact on health outcomes in cases of chronic diseases. METHODS: The review identified fourteen related studies following the defined inclusion and exclusion criteria, in PubMed, Cochrane Library, the Library of Congress, and Web Sciences. All the interventions were critically analysed according to the study design, sample size, duration, tools used, and the statistical methods used for analysing the primary data. Impacts of the different interventions on outcomes of interest were also analysed. RESULTS: The findings showed evidence of improved adherence, as well as health outcomes in disease management, using mobile Short Message Systems and/or Voice Calls. Significant improvement has been found on adherence with taking medicine, following diet and physical activity advice, as well as improvement in clinical parameters like HbA1c, blood glucose, blood cholesterol and control of blood pressure and asthma. CONCLUSIONS: Though studies showed positive impacts on adherence and health outcomes, three caveats should be considered, (i) there was no clear understanding of the processes through which interventions worked; (ii) none of the studies showed cost data for the m-health interventions and (iii) only short term impacts were captured, it remains unclear whether the effects are sustained. More research is needed in these three areas before drawing concrete conclusions and making suggestions to policy makers for further decision and implementation.

Classification of EEG Signals Using Neural Network for Predicting Consumer Choices.

EEG, or Electroencephalogram, is an instrument that examines the brain's functions while it is executing any activity. EEG signals to aid in the identification of brain processes and movements and are thus useful in the detection of neurobiological illnesses. Pulses have a very weak magnitude and are recorded from peak to peak, with pulse width ranging from 0.5 to 100 V, which is around 100 times below than ECG signals. As a result, many types of noise can easily influence them. Because EEG signals are so important in detecting brain illnesses, it is critical to preprocess them for accurate assessment and detection. The crown of your head The EEG is a weighted combination of the signals generated by the different small locations beneath the electrodes on the cortical plate. The rhythm of electrical impulses is useful for evaluating a broad range of brain diseases. Hypertension, Alzheimer, and brain damage are all possibilities. We can compare and distinguish the brainwaves for different emotions and illnesses linked with the brain by studying the EEG signal. Multiple research studies and methodologies for preprocessing, extraction of features, and evaluation of EEG data have recently been created. The use of EEG in human-computer communication could be a novel and demanding field that has acquired traction in recent years. We present predictive modeling for analyzing the customer's preference of likes and dislikes via EEG signal in our report. The impulses were obtained when clients used the Internet to seek for multiple items. The studies were carried out on a dataset that included a variety of consumer goods.

Homozygous Hemoglobin Lepore: A Rare Condition Seen in a Bangladeshi Family.

Hb Lepore is one type of hemoglobin disorder in which there is structurally abnormal hemoglobin (Hb) that results from in-frame fusion between the 5 end of the δ-globin gene and the 3 end of the ß-globin gene, due to misalignment of homologous chromosomes during meiosis..Hb Lepore homozygous patients have clinical features indistinguishable from thalassemia major or intermedia. On 22 March 2018 a severely anaemic 2 year old child was referred to Dhaka Shishu Hospital Thalassaemia Center in Dhaka Shishu Hospital, Dhaka Bangladesh for thalassemia screening. HPLC report showed a very high level of Hb F 80.7% and Hb A2 level 16.16%. HPLC of both mother and father revealed a high A2 level and a hump in the download slope of Hb A2 peak and diagnosed as Hb Lepore. This was confirmed by GAP PCR and DNA analysis of the child and the parents and the child was diagnosed as suffering from homozygous Hb Lepore. Here we discuss Hb Lepore a rare homozygosity in a child seen in a Bangladeshi family.

QS-21 enhances the early antibody response to oil adjuvant foot-and-mouth disease vaccine in cattle.

PURPOSE: One of the most important tools against foot-and-mouth disease, a highly contagious and variable viral disease of cloven-hoofed animals, is vaccination. However, the effectiveness of foot-and-mouth disease vaccines on slowing the spread of the disease is questionable. In contrast, high potency vaccines providing early protection may solve issues with the spread of the disease, escaping mutants, and persistency. To increase the potency of the vaccine, additives such as saponin and aluminium hydroxide are used. However, the use of saponin with an oil adjuvant is not common and is sometimes linked to toxicity. QS-21, which is less toxic than Quil A, has been presented as an alternative for use with saponin. In this study, the addition of QS-21 to a commercially available foot-and-mouth disease water-in-oil-in-water emulsion vaccine was evaluated in cattle. MATERIALS AND METHODS: After vaccination, serum samples were collected periodically over 3 months. Sera of the QS-21 and normal oil vaccine groups were compared via serum virus neutralization antibody titre and liquid phase blocking enzyme-linked immunosorbent assay antibody titre. RESULTS: The results showed that there was a significant early antibody increase in the QS-21 group. CONCLUSION: Strong early virus neutralizing antibody response will be useful for emergency or ring vaccinations against foot-and-mouth disease in target animals.

Risk factors for mortality due to shigellosis: a case-control study among severely-malnourished children in Bangladesh.

To determine the risk factors for death of severely-malnourished Bangladeshi children with shigellosis, a case-control study was conducted at the Clinical Research and Service Centre of ICDDR,B: Centre for Health and Population Research in Dhaka, Bangladesh. One hundred severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics), with a positive stool culture for Shigella dysenteriae type 1 or S. flexneri, who died during hospitalization, were compared with another 100 similar children (weight-for-age <60% and with S. dysenteriae type 1 or S. flexneri-associated infection) discharged alive. Children aged less than four years were admitted during December 1993-January 1999. The median age of the cases who died or recovered was 9 months and 12 months respectively. Bronchopneumonia, abdominal distension, absent or sluggish bowel sound, clinical anaemia, altered consciousness, hypothermia, clinical sepsis, low or imperceptible pulse, dehydration, hypoglycaemia, high creatinine, and hyperkalaemia were all significantly more frequent in cases than in controls. In multivariate regression analysis, altered consciousness (odds ratio [OR]=2.6, 95% confidence interval [CI] 1.0-6.8), hypoglycaemia (blood glucose <3 mmol/L (OR=7.8, 95% CI 2.9-19.6), hypothermia (temperature <36 degrees C) (OR=5.7, 95% CI 1.5-22.1), and bronchopneumonia (OR=2.5, 95% CI 1.1-5.5) were identified as significant risk factors for mortality. Severely-malnourished children with shigellosis having hypoglycaemia, hypothermia, altered consciousness and/or bronchopneumonia were at high risk of death. Based on the findings, the study recommends that early diagnosis of shigellosis in severely-malnourished children and assertive therapy for proper management to prevent development of hypothermia, hypoglycaemia, bronchopneumonia, or altered consciousness and its immediate treatment are likely to reduce Shigella-related mortality in severely-malnourished children.

Florid cemento-osseous dysplasia in a young Indian woman. A case report.

We present a rare case of florid cemento-osseous dysplasia (FCOD) occurring in a 27-year-old Indian woman. She presented with three lesions, two of them symmetrical, at the posterior region of the mandible. Another lesion appeared nine months later, symmetrical to the existing third lesion. This confirmed the diagnosis of florid cemento-osseous dysplasia as being symmetrical asymptomatic bone lesions occurring in the jaw. The diagnosis was made radiographically depending on a series of radiographs, as biopsy is contraindicated. No treatment was required as the lesions were asymptomatic, causing no problem to the patient. The patient continues to be reviewed annually. The case is rare in its unusual combination of the disease itself (FCOD), age (27 years) and race (Indian). Clinical and radiological features are presented.

Paraesthesia of the lip and chin area resolved by endodontic treatment: A case report and review of literature.

Lower lip numbness is a symptom that may be due to entirely benign causes, or it may be the first sign of a more sinister problem. It has been reported as being the sole symptom of pathological lesions and metastatic tumours in the mandible.

Role of circulating adipocytokines vaspin, apelin, and visfatin in the loss of appetite in underweight children: a pilot trial.

OBJECTIVES: To investigate serum concentrations of vaspin, apelin, and visfatin in underweight children and their association with anthropometric and nutritional markers of malnutrition. SUBJECTS AND METHODS: We recruited 44 underweight prepubertal children (youngest age = 2 years) with thinness grades of 1, 2, and 3, and body weights < 90% of ideal body weight due to loss of appetite and less frequent hunger episodes. Forty-one healthy age- and gender-matched controls were also included in the study. Serum fasting vaspin, apelin, and visfatin concentrations were measured by enzyme immunoassay technique. RESULTS: Mean vaspin and apelin levels were significantly lower in underweight children compared to controls (vaspin: 0.44 ± 0.18 vs. 0.58 ± 0.35 pg/mL, p = 0.024; apelin: 483.37 ± 333.26 vs. 711.71 ± 616.50 pg/mL, p = 0.041). Visfatin levels were lower in underweight children compared to controls, but the values were not statistically significant (177.81 ± 158.01 vs. 221.15 ± 212.94 pg/mL, p = 0.119). CONCLUSIONS: In underweight children, decreased vaspin and apelin levels should be considered in the etiology of anorexia.

In vivo genotoxic effects of mercuric chloride in rat peripheral blood leucocytes using comet assay.

DNA damage induced by Mercuric chloride (HgCl2) in leucocytes of Wistar albino male rats has been studied in vivo. The comet assay or the alkaline single cell gel electrophoresis (SCGE) assay was used to measure the DNA damage. The rats were administered orally with doses ranging from 0.0054, 0.0108, 0.0216, 0.0432 to 0.0864 mg/kg body weight (b.wt.) of HgCl2. The assay was performed on whole blood at 24, 48, 72 h, 1st and 2nd week. The reason leucocytes were used was to reflect biomarker studies in humans. A significant increase in mean comet tail length indicating DNA damage was observed at all time intervals with HgCl2 except in 2nd week post treatment when compared to controls. The mean comet tail length revealed a clear dose dependent increase from 0.0054 to 0.0432 mg/kg b.wt. A maximum increase in mean comet tail length was observed at 0.0432 mg/kg b.wt. 24 h after treatment. From 48 h post treatment, the mean comet tail lengths of all the doses gradually decreased and by week 2 of post treatment, they had approached control levels, pointing to repair of the damaged DNA. These findings suggest that the comet assay is a highly sensitive technique to study DNA damage caused by metals.

Genotoxic effect of lead nitrate on mice using SCGE (comet assay).

Single stranded DNA breakage induced by lead nitrate in mice has been studied in vivo using alkaline single cell gel electrophoresis (comet assay). Mice were administered orally 0.7, 1.4, 2.8, 5.6, 11. 2, 22.4, 44.8 and 89.6 mg/kg body weight of lead nitrate and the assay was performed on whole blood at 24, 48, 72 h, 1st and 2nd week. Significant increase in mean tail-length of DNA was observed at all time intervals after treatment with lead nitrate when compared to controls. The mean tail-length did not show a dose-related increase and the elevation in the mean tail-length was of a fluctuating type. Increase in mean tail-lengths clearly gives evidence that lead nitrate causes DNA damage effectively. The study indicates that the alkaline comet assay is a sensitive and rapid method to detect DNA damage caused by heavy metals.

In vivo genotoxic effect of arsenic trioxide in mice using comet assay.

Although arsenic has been the subject of toxicological research, acute in vivo genotoxic studies using relevant animal models and uniform methodology are lacking. Hence, the present study aims to study DNA damage caused by arsenic trioxide in mice in in vivo using alkaline single cell gel electrophoresis (Comet) assay. Mice were administered orally 0,0.13,0.27,0.54,1.08,2.15,4.3 and 6.45 mg/kg body weight of arsenic trioxide dissolved in distilled water. The samples of whole blood were collected at 24,48,72 h, first and second week post-treatment and the assay was carried out to determine DNA damage as represented by comet tail-length. All the doses induced significant increase in comet tail-length at 24 h post-treatment (P<0.05) showing a clear dose dependent increase from 0.13 to 2.15 mg/kg b.wt. and a dose dependent decrease in higher doses (4.3-6.45 mg/kg b.wt). At 48 h post-treatment all the doses showed a significant increase (P<0.05) in comet tail-length when compared to 24 h post-treatment. A gradual decrease in the comet tail-length was observed for all the doses from 72 h post-treatment onwards indicating a gradual repair in DNA damage. This indicates a non-linear dose and time response between DNA damage and different doses of arsenic trioxide at different time-intervals. A significant increase in comet tail-length at all the doses clearly gives evidence that arsenic trioxide cause DNA damage effectively. The study indicates that the alkaline comet assay is a reliable and effective method to detect DNA damage caused by metals.

DNA damage in workers exposed to lead using comet assay.

Lead (Pb) is a ubiquitous and toxic metal. Secondary Pb recovery unit workers are prone to possible occupational Pb exposure. Hence, this investigation was conducted to assess the genotoxic effect of Pb exposure in these workers. In the study, 45 workers were monitored for DNA damage in blood leucocytes. Simultaneously 36 subjects were used as control group in this study. All the subjects were estimated for Pb content in whole blood by ICP-MS. The alkali single cell gel electrophoresis assay (comet assay) was adopted for detecting the DNA damage. The air inside the premises of the unit had Pb concentrations of 4.2 microg/m(3). The level of DNA damage was determined as the percentage of cells with comets. The mean Pb content was found to be significantly higher in the study group (248.3 microg/l) when compared with the controls (27.49 microg/l). Significantly more cells with DNA damage (44.58%) were observed in the study group than in the control persons (21.14%). Smoking had a significant effect on DNA damage in the control group whereas an insignificant effect was noticed in the exposed workers. Study as well as the control group failed to show a significant effect on DNA damage with age (P>0.05). Pb content and years of exposure significantly correlated with DNA damage in the study group (r=0.602, r=0.690; P<0.01). The increased levels of DNA damage observed in the exposed workers, justifies the use of the comet assay for the evaluation of genotoxic effects in humans exposed to Pb.

Assessment of genotoxic effects of chloropyriphos and acephate by the comet assay in mice leucocytes.

Two organophosphorus (OP) pesticides (chloropyriphos and acephate) and cyclophosphamide (CP) (positive control) were tested for their ability to induce in vivo genotoxic effect in leucocytes of Swiss albino mice using the single cell gel electrophoresis assay or comet assay. The mice were administered orally with doses ranging from 0.28 to 8.96 mg/kg body weight (b. wt.) of chloropyriphos and 12.25 to 392.00 mg/kg b.wt. of acephate. The assay was performed on whole blood at 24, 48, 72 and 96 h. A significant increase in mean comet tail length indicating DNA damage was observed at 24h post-treatment (P<0.05) with both pesticides in comparison to control. The damage was dose related. The mean comet tail length revealed a clear dose dependent increase. From 48 h post-treatment, a gradual decrease in mean tail length was noted. By 96 h of post-treatment the mean comet tail length reached control levels indicating repair of the damaged DNA. From the study it can be concluded that the comet assay is a sensitive assay for the detection of genotoxicity caused by pesticides.

In vivo genotoxic effect of nickel chloride in mice leukocytes using comet assay.

DNA damage induced by nickel chloride (NiCl2) in leucocytes of Swiss albino mice has been studied in vivo. The comet assay or the alkaline single cell gel electrophoresis (SCGE) assay was used to measure the DNA damage. The mice were administered orally with acute doses of 3.4, 6.8, 13.6, 27.2, 54.4 and 108.8 mg/kg body weight (b.wt.) NiCl2. Samples of whole blood were collected at 24, 48 and 72 h, first week and second week post-treatment for alkaline SCGE assay to study single/double strand breaks in DNA. A significant increase in mean comet tail length indicating DNA damage was observed with NiCl2 at 24, 48 and 72 h post-treatment (P<0.05). A gradual decrease in the mean tail length was observed at 72 h post-treatment indicating repair of the damaged DNA. The mean tail length showed a dose-related increase and time dependent decrease after treatment with NiCl2 when compared to controls. The study also confirms that the comet assay is a sensitive and rapid method to detect DNA damage caused by heavy metals like nickel (Ni).

DNA damage in leukocytes of mice treated with copper sulfate.

Single stranded DNA breaks induced by copper sulfate (CuSO(4)) in mice has been studied in vivo using Alkaline Single Cell Gel Electrophoresis (Comet assay). Mice were administered orally with doses of 0, 1.25, 2.50, 5.00, 7.50, 10.00 and 12.50 mg/kg body weight (b.wt.) of CuSO4 respectively. The samples of whole blood were collected at 24, 48, 72 h, first week and second week post-treatment and the assay was carried out to determine single strand DNA breaks as represented by comet tail-length. In addition, the sample was used to study the repair efficiency by incubating the samples with RPMI medium for 2 h. Results indicated a significant DNA damage at all the doses after treatment with CuSO4 when compared to controls showing a clear dose-dependent response (p < 0.05). A gradual decrease in the tail-lengths from 48 h post-treatment was observed and by second week, the values returned to control levels at all doses. The study on the repair efficiency indicated that mice treated with all the doses of CuSO4 showed decrease in mean comet tail-length indicating repair efficiency capacity but less when compared to those of controls. The study also reveals that comet assay is a sensitive and rapid method for detecting DNA damage caused by trace metals such as copper (Cu).

In vivo genotoxic effect of potassium dichromate in mice leukocytes using comet assay.

Hexavalent chromium is a well-known mutagen and carcinogen. In the present investigation, single-/double-stranded DNA breaks by potassium dichromate (K2Cr2O7) in mice, a sensitive model for genotoxic effects, have been studied in vivo using alkaline single-cell gel electrophoresis (SCGE)/comet assay. Mice were administered orally with a range of doses starting from 0.59 to 76.0 mg/kg body weight of K2Cr2O7 and samples of whole blood were collected at 24, 48, 72, 96 h, week 1 and week 2 post-treatment for alkaline SCGE assay to study DNA damage. The rationale for using leukocytes was to reflect biomarker analysis in humans. Significant increase in mean comet tail length (5.7-24.25 microM) indicating DNA damage was observed at all the doses with K2Cr2O7 when compared with controls (3.26 microM). Maximum increase in mean comet tail length was observed at 9.5 mg/kg body weight at 48 h post-treatment (24.25 microM). The mean comet tail length showed a clear dose-dependent increase from 0.59 to 9.5 mg/kg body weight and a dose-dependent decrease in higher doses (19.0-76.0 mg/kg body weight). A gradual decrease in the tail lengths from 72 h post-treatment was observed by the second week, and values had returned to control levels at all doses, indicating repair of the damaged DNA and/or loss of heavily damaged cells. The study also reveals that comet assay is a sensitive and rapid method for detecting DNA damage caused by heavy metals such as chromium (Cr).

Genotoxic effect of monocrotophos to sentinel species using comet assay.

Monocrotophos is the single largest selling agrochemical in India. Sensitive biomarkers to study the genotoxic effects caused by monocrotophos in aquatic organisms, especially fish, are lacking. The fish used in this study are Tilapia mossambica, which are edible, commercially valuable and distributed all over India. The objective of this study was to study DNA strand breaks induced by monocrotophos in T. mossambica in vivo using single-cell micro gel electrophoresis/comet assay. Tilapia were treated orally with 0.313, 0.625, 1.25, 1.875, 2.5, 3.125, 3.75 and 4.375 ppm of monocrotophos and the assay was performed on nucleated erythrocytes after 24, 48, 72 and 96 h. A significant increase in mean comet tail-length (5.21-7.46 microM), indicating DNA damage, was observed at all the doses with monocrotophos when compared to controls (3.36 microM). The mean tail-length showed a dose-related increase and time-dependent decrease. The maximum increase in mean comet tail-length was observed at 24 h. Relative to these effects, reductions in mean comet tail-length were seen at 48 and 72 h. By 96 h, values had returned to control levels at all doses, indicating repair of the damaged DNA and/or loss of heavily damaged cells. The study reveals that the comet assay is a sensitive and rapid method to detect genotoxicity of monocrotophos and other environmental pollutants in sentinel species.

Modified apically repositioned flap in the treatment of unerupted maxillary central incisors.

The successful management of labially unerupted maxillary central incisors requires a coordinated surgical, orthodontic and general practitioner approach. The key to achieving maximal eruption of these teeth is their surgical exposure, central to which is the philosophy that the surgeon must provide a functional width of attached gingiva on the labial surface. This case describes the incorporation of palatal mucosa into an apically repositioned flap, resulting in the successful establishment of an attached gingival margin, where routine flap design would have seriously compromised the eventual outcome.

Synthesis and biological evaluation of N-dehydrodipeptidyl-N,N'-dicyclohexylurea analogs.

Some N-[(N-benzoyldehydrophenylalalnyl)glycinyl/cysteinyl]-N,N'-dicyclohexylurea analogs (3a-3o) were synthesized by conjugating different substituted N-benzoyldehydrophenylalanyl glycines/cysteines (differing substitutions on benzylidene ring) and dicyclohexyl carbodiimide (DCC) using base as a catalyst. The synthesized compounds were characterized and evaluated for biological activities. Compounds 3a and 3h with unsubstituted dehydrophenylalanyl glycinyl/cysteinyl moiety exhibited moderate anti-inflammatory and analgesic activities. Compound 3j bearing 4-hydroxy substitution on benzylidene ring of dehydrophenylalanyl cysteinyl moiety displayed potent antimicrobial and antioxidant activities. The results obtained from docking studies on compound 3j with penicillin binding protein and protease supported the results.