Spatial distribution of heavy metal abundance at distance gradients of roadside agricultural soil from the busiest highway in Bangladesh: A multi-index integration approach.

Bangladesh is currently experiencing significant infrastructural development in road networking system through the construction or reconstruction of multiple roads and highways. Consequently, there is a rise in traffic intensity on roads and highways, along with a significant contamination of adjacent agricultural soils with heavy metals. The purpose of this study was to evaluate the ecological risk, health risk and the abundance of seven heavy metals (Cu, Mn, Pb, Cd, Cr, As, and Ni) in three distance gradients (0, 300, and 500 m) of agricultural soil along the Dhaka-Chattogram highway. The concentration of heavy metals was measured with an Atomic Absorption Spectrophotometer (AAS) on a total of 36 soil samples that were taken from 12 different sampling sites. Based on the findings, Cd had a high contamination factor for all distance gradients, whereas Cr had a moderate contamination factor in 67% of the study areas. According to the Pollution Load Index (PLI), Cd, Cr, and Pb were the predominant pollutants. Principal component analysis (PCA) result shows these metals mainly came from anthropogenic sources. The considerable positive correlations between Cu-Pb, Cu-Cd, Pb-Cd, and Cr-Ni all pointed to shared anthropogenic origins. As per Potential Ecological Risk Assessment (PERI) analysis, Pb, Cd, Cr, and Ni each contribute significantly and pose a moderate threat. The Target Hazard Quotient (THQ) values for all pathways of exposure to Pb and Cr in soils were more than 1, which would pose a significant risk to human health in the following order: THQadult female > THQadult male > THQchildren. This study will help to evaluate the human health risk and develop a better understanding of the heavy metal abundance scenario in the agricultural fields adjacent to this highway.

In-Cell Titration of Small Solutes Controls Protein Stability and Aggregation.

The components of the intracellular environment vary widely in size: from large multiprotein complexes to atomic ions. Besides water, low-molecular-weight solutes (<1 kDa) such as electrolytes, metabolites, and carbohydrates are by far the most abundant of these components. Small solutes are thus key contributors to the solvation environment in the cell. Small solutes have been known for decades to alter protein structure or activity in vitro, through their interactions with protein surfaces or hydration shells. Here we use the cell itself as our test tube, by titrating its hydration, ion, or carbohydrate composition systematically. We trigger the selective uptake of specific solutes by exposing cells to hyperosmotic media. We then measure protein structure, stability, unfolding kinetics, and aggregation in these different intracellular environments by using fast relaxation imaging. We compare these results with controls where solutes cannot enter the cell and only hydration is altered. Protein structure, thermal stability, and aggregation onset all depend on the concentration and chemical nature of the solute titrated into the cell. Our work highlights the important contributions of small solutes in defining how proteins interact within the cell and suggests that intracellular variation of the solute composition could be an important regulator of protein function.

Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial.

BACKGROUND: In developing countries, mortality in children with very severe pneumonia is high, even with the provision of appropriate antibiotics, standard oxygen therapy, and other supportive care. We assessed whether oxygen therapy delivered by bubble continuous positive airway pressure (CPAP) improved outcomes compared with standard low-flow and high-flow oxygen therapies. METHODS: This open, randomised, controlled trial took place in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We randomly assigned children younger than 5 years with severe pneumonia and hypoxaemia to receive oxygen therapy by either bubble CPAP (5 L/min starting at a CPAP level of 5 cm H2O), standard low-flow nasal cannula (2 L/min), or high-flow nasal cannula (2 L/kg per min up to the maximum of 12 L/min). Randomisation was done with use of the permuted block methods (block size of 15 patients) and Fisher and Yates tables of random permutations. The primary outcome was treatment failure (ie, clinical failure, intubation and mechanical ventilation, death, or termination of hospital stay against medical advice) after more than 1 h of treatment. Primary and safety analyses were by intention to treat. We did two interim analyses and stopped the trial after the second interim analysis on Aug 3, 2013, as directed by the data safety and monitoring board. This trial is registered at ClinicalTrials.gov, number NCT01396759. FINDINGS: Between Aug 4, 2011, and July 17, 2013, 225 eligible children were recruited. We randomly allocated 79 (35%) children to receive oxygen therapy by bubble CPAP, 67 (30%) to low-flow oxygen therapy, and 79 (35%) to high-flow oxygen therapy. Treatment failed for 31 (14%) children, of whom five (6%) had received bubble CPAP, 16 (24%) had received low-flow oxygen therapy, and ten (13%) had received high-flow oxygen therapy. Significantly fewer children in the bubble CPAP group had treatment failure than in the low-flow oxygen therapy group (relative risk [RR] 0·27, 99·7% CI 0·07-0·99; p=0·0026). No difference in treatment failure was noted between patients in the bubble CPAP and those in the high-flow oxygen therapy group (RR 0·50, 99·7% 0·11-2·29; p=0·175). 23 (10%) children died. Three (4%) children died in the bubble CPAP group, ten (15%) children died in the low-flow oxygen therapy group, and ten (13%) children died in the high-flow oxygen therapy group. Children who received oxygen by bubble CPAP had significantly lower rates of death than the children who received oxygen by low-flow oxygen therapy (RR 0·25, 95% CI 0·07-0·89; p=0·022). INTERPRETATION: Oxygen therapy delivered by bubble CPAP improved outcomes in Bangladeshi children with very severe pneumonia and hypoxaemia compared with standard low-flow oxygen therapy. Use of bubble CPAP oxygen therapy could have a large effect in hospitals in developing countries where the only respiratory support for severe childhood pneumonia and hypoxaemia is low-flow oxygen therapy. The trial was stopped early because of higher mortality in the low-flow oxygen group than in the bubble CPAP group, and we acknowledge that the early cessation of the trial reduces the certainty of the findings. Further research is needed to test the feasibility of scaling up bubble CPAP in district hospitals and to improve bubble CPAP delivery technology. FUNDING: International Centre for Diarrhoeal Disease Research, Bangladesh, and Centre for International Child Health, University of Melbourne.

PERIPHERAL AVASCULAR RETINA WITH DISK ANOMALY AND HIGH MYOPIA: A Novel Association in a Hereditary Isolated Ocular Disorder.

PURPOSE: To describe a family pedigree with a previously undescribed association of autosomal dominantly inherited ocular abnormalities. METHODS: Case series study performed on 15 family members. Examination included history taking, visual acuity, intraocular pressure, slit-lamp, gonioscopy, indirect ophthalmoscopy (10 members), fluorescein angiography (5 members), general examination and renal ultrasound (4 members), and hemoglobin electrophoresis for the proband and another member. RESULTS: Family pedigree revealed autosomal-dominant inheritance. Visual acuity ranged from 6/36 to no light perception. Examination revealed rubeosis in 7 eyes and atrophia bulbi in 11 eyes. Indirect ophthalmoscopy for 11 eyes revealed evidence of an ocular triad of peripheral avascular retina, disk anomaly (cavitary optic disk anomaly or disk dysplasia), and tessellated fundus of high myopia. The authors also observed new vessels elsewhere with or without extensive subretinal exudations in 6 eyes. All patients with any residual vision (up to perception of light) had nystagmus. Four affected members underwent general examination, renal ultrasound, and serum creatinine level (to exclude papillorenal syndrome), and all were normal. Hemoglobin electrophoresis (to exclude sickle cell retinopathy) revealed within normal values. CONCLUSION: To the authors' knowledge, the aforementioned ocular triad has not been previously described, in association, with an autosomal-dominant pattern of inheritance.

Changing childhood malnutrition in Bangladesh: trends over the last two decades in urban-rural differentials (1993-2012).

OBJECTIVE: The present study determined trends in malnutrition among under-5 children in urban and rural areas of Bangladesh. DESIGN: Surveillance. SETTING: The study was conducted in the urban Dhaka and the rural Matlab hospitals of the International Centre for Diarrhoeal Disease Research, Bangladesh, where every fiftieth patient and all patients coming from the Health and Demographic Surveillance System were enrolled. SUBJECTS: A total of 28,816 under-5 children were enrolled at Dhaka from 1993 to 2012 and 11,533 at Matlab between 2000 and 2012. RESULTS: In Dhaka, 46% of the children were underweight, 39% were stunted and 28% were wasted. In Matlab, the corresponding figures were 39%, 31% and 26%, respectively. At Dhaka, 0.5% of the children were overweight and obese when assessed by weight-for-age Z-score >+2.00, 1.4% by BMI-for-age Z-score >+2.00 and 1.4% by weight-for-height Z-score >+2.00; in Matlab the corresponding figures were 0.5%, 1.4% and 1.4%, respectively. In Dhaka, the proportion of underweight, stunting and wasting decreased from 59% to 28% (a 53% reduction), from 54% to 22% (59% reduction) and from 33 % to 21% (36% reduction), respectively, between 1993 and 2012. In Matlab, these indicators decreased from 51% to 27% (a 47% reduction), from 36% to 25% (31% reduction) and from 34% to 14% (59% reduction), respectively, from 2000 to 2012. On the other hand, the proportion of overweight (as assessed by BMI-for-age Z-score) increased significantly over the study period in both Dhaka (from 0.6% to 2.6%) and Matlab (from 0.8% to 2.2%). CONCLUSIONS: The proportion of malnourished under-5 children has decreased gradually in both urban and rural Bangladesh; however, the reduction rates are not in line with meeting Millennium Development Goal 1. Trends for increasing childhood obesity have been noted during the study period as well.

Anti-rotavirus protein reduces stool output in infants with diarrhea: a randomized placebo-controlled trial.

BACKGROUND & AIMS: Rotavirus infection is a leading cause of morbidity and mortality in children younger than 5 years of age. Current treatment options are limited. We assessed the efficacy of a llama-derived, heavy-chain antibody fragment called anti-rotavirus protein (ARP1), in modifying the severity and duration of diarrhea in male infants with rotavirus infection. METHODS: We performed a double-blind, placebo-controlled trial of 176 male infants (6-24 months old) with severe rotavirus-associated diarrhea at Dhaka Hospital, Bangladesh. The infants were randomly assigned to groups given oral ARP1 (15-30 mg/kg/day, n = 88) or placebo (maltodextrin, n = 88) for a maximum of 5 days. The primary outcomes were severity (stool output) and duration of diarrhea and fecal excretion of rotavirus. Secondary outcomes were intake of oral rehydration salt solution, severity of vomiting, and serum levels of rotavirus-specific IgA. RESULTS: In infants with only rotavirus infection, total cumulative stool output was 305.47 g/kg body weight among those given placebo (n = 63) and 237.03 g/kg body weight among those given ARP1 (n = 61) (a difference of 68.44 g/kg body weight or 22.5%; 95% confidence interval: 18.27-118.59 g/kg body weight; P =.0079). There was a significant reduction in rate of stool output (g/kg/d) in the ARP1 group compared with the placebo group (61%; P = .002). ARP1 had no significant effect in infants with concomitant infections or on any other measured outcomes. No adverse events could be linked to ARP1. CONCLUSIONS: In a placebo-controlled trial, ARP1 reduced stool output in male infants with severe rotavirus-associated diarrhea. Clinicaltrials.gov number: NCT01259765.

Urban-rural differentials in overweight and obese individuals with diarrhea in bangladesh.

OBJECTIVE: The study aimed to determine urban and rural differences in overweight and obesity (OO) with diarrhea regarding subjects' sociodemographic, clinical characteristics, etiology, and antimicrobial susceptibility. METHODS: Relevant information from 2000 to 2011 were extracted from the data archive of the Diarrheal Disease Surveillance System of urban Dhaka (1248, 4.5%) and rural Matlab (615, 3.4%) hospitals of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). RESULTS: The proportion of OO significantly increased in both urban (3-7%; chi-square for trend p < 0.001) and rural (1-6%; p < 0.001) areas over the study period. In multivariate modeling, monthly income more than US$100 (odds ratio [OR] = 54.44, 95% confidence interval [CI], 25.37-116.82, p < 0.001), high wealth quintile (OR = 18.23, 95% CI, 8.63-38.49, p < 0.001), access to sanitary toilet (OR = 3.07. 95% CI. 1.76-5.26. p < 0.001), boiled drinking water (OR = 2.77, 95% CI, 1.09-7.05, p = 0.032), antimicrobial use before hospitalization (OR = 4.99, 95% CI, 2.85-8.74, p < 0.001), fever (OR = 0.14, 95% CI, 0.37, 0.50, p < 0.001), watery stools (OR = 5.59, 95% CI, 2.11-14.80, p < 0.001), dehydrating diarrhea (OR = 5.17, 95% CI, 2.54-10.52, p < 0.001), intravenous saline infusion after hospitalization (OR = 2.65, 95% CI, 1.28-5.49, p = 0.009), and Salmonella infection (OR = 0.20, 95% CI, 0.50-0.83, p = 0.027) remained significantly associated with urban OO individuals. At least 88% of Shigella isolates were susceptible to ciprofloxacin in both urban and rural areas; for mecillinum it was 90%. Ciprofloxacin had the least detected resistance for Vibrio cholerae (0%) and trimethoprim-sulfamethoxazole (TMP-SMX) showed the greatest resistance (Dhaka 86%; Matlab 98%). Susceptibility for Salmonella showed ampicillin (95%), chloramphenecol (100%), ciprofloxacin (95%), ceftraxone (93%), TMP-SMX (95%) at both sites. CONCLUSION: Urban OO with diarrheal illnesses was significantly different from that in rural areas, including antimicrobial susceptibility.

Gastroenteritis due to typhoidal Salmonella: a decade of observation at an urban and a rural diarrheal disease hospital in Bangladesh.

BACKGROUND: The study aimed to compare the socio-demographic, host and clinical characteristics, seasonality and antimicrobial susceptibility of Typhoidal Salmonella (Salmonella enterica serovar Typhi and Paratyphi) (TS) with diarrhea between urban and rural Bangladesh. METHODS: Relevant information of 77/25,767 (0.30%) and 290/17,622 (1.65%) patients positive with TS (in stool) were extracted from the data archive of Diarrheal Disease Surveillance System of icddr,b (urban Dhaka and rural Matlab Hospitals respectively) during 2000-2012. Comparison group (diarrhea patients negative for TS) was randomly selected from the database (1:3 ratio). Two poisson regression models were investigated for modelling seasonal effects on the number of cases. RESULTS: Salmonella Typhi was more frequently isolated in Dhaka than Matlab (57% vs. 5%, p < 0.001); while Salmonella Paratyphi was more frequent in Matlab than Dhaka (96% vs. 43%; p < 0.001). Fever [adj. OR-5.86 (95% CI: 2.16, 15.94)], antimicrobial use at home [5.08 (2.60, 9.90)], and fecal red blood cells [2.53 (1.38, 4.64)] were significantly associated with detection of TS in stool of patient from Dhaka. For Matlab, the correlates were, vomiting [1.88 (1.35, 2.64)], fecal macrophage [1.89 (1.29, 2.74)] in addition to fever and duration of diarrhea and antimicrobial use. At Dhaka, all Salmonella Typhi isolates were susceptible to ceftriaxone; while in Dhaka and Matlab however, for ciprofloxacin it was 45% and 91%, respectively. Susceptibility to chloramphenicol, ampicillin, trimethoprim-sulphamethoxazole and nalidixic acid ranged from 12%-58%. Salmonella Paratyphi were susceptible to ceftriaxone (99%). A significant seasonal trend and year difference (before and after 2007) for Matlab was observed (p < 0.001 for all effects). Dhaka does not show significant year or seasonal effects (p = 0.07 for years and p = 0.81 and p = 0.18 for the cos and sin components, respectively). While not significant, two seasonal peaks were observed in Dhaka (January-February and September-November); while a single peak (August-November) was observed in Matlab. CONCLUSIONS: Proportion of serovar distribution of TS and their clinical characteristics, antimicrobial susceptibility and seasonal pattern were different among diarrhea patients in urban Dhaka and rural Matlab of Bangladesh.

Antimicrobial drugs for treating cholera.

BACKGROUND: Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. OBJECTIVES: To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. SEARCH METHODS: We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. SELECTION CRITERIA: Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. MAIN RESULTS: Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43.51 to -30.03, 19 trials, 1013 participants, moderate quality evidence). Antimicrobial therapy also reduced the total stool volume by 50% (ROM 0.5, 95% CI 0.45 to 0.56, 18 trials, 1042 participants, moderate quality evidence) and reduced the amount of rehydration fluids required by 40% (ROM 0.60, 95% CI 0.53 to 0.68, 11 trials, 1201 participants, moderate quality evidence). The mean duration of fecal excretion of vibrios was reduced by almost three days (MD 2.74 days, 95% CI -3.07 to -2.40, 12 trials, 740 participants, moderate quality evidence).There was substantial heterogeneity in the size of these benefits, probably due to differences in the antibiotic used, the trial methods (particularly effective randomization), and the timing of outcome assessment. The benefits of antibiotics were seen both in trials recruiting only patients with severe dehydration and in those recruiting patients with mixed levels of dehydration. Comparisons of antimicrobials In head-to-head comparisons, there were no differences detected in diarrhoea duration or stool volume for tetracycline compared to doxycycline (three trials, 230 participants, very low quality evidence); or tetracycline compared to ciprofloxacin or norfloxacin (three trials, 259 participants, moderate quality evidence). In indirect comparisons with substantially more trials, tetracycline appeared to have larger benefits than doxycycline, norfloxacin and trimethoprim-sulfamethoxazole for the primary review outcomes.Single dose azithromycin shortened the duration of diarrhoea by over a day compared to ciprofloxacin (MD -32.43, 95% CI -62.90 to -1.95, two trials, 375 participants, moderate quality evidence) and by half a day compared to erythromycin (MD -12.05, 95% CI -22.02 to -2.08, two trials, 179 participants, moderate quality evidence). It was not compared with tetracycline. AUTHORS' CONCLUSIONS: In treating cholera, antimicrobials result in substantial improvements in clinical and microbiological outcomes, with similar effects observed in severely and non-severely ill patients. Azithromycin and tetracycline may have some advantages over other antibiotics.

Diagnosis of pneumonia in children with dehydrating diarrhoea.

The World Health Organization (WHO) guidelines for diagnosis of pneumonia are based on the history of cough or difficult breathing and age-adjusted respiration rates. Metabolic acidosis associated with dehydrating diarrhoea also influences the respiration rate. Two hundred and four children, aged 2 to 59 months, with dehydrating diarrhoea and a history of cough and/or fast breathing, were enrolled in a prospective study. Pneumonia diagnoses were made on enrollment and again 6 hours post-enrollment (after initial rehydration), using the WHO guidelines. These were compared with investigators' clinical diagnosis based on history and findings of physical examination and a chest x-ray at the same time points. Using the WHO guidelines, 149/152 (98%) infants in the 2-11 months age-group and 38/40 (95%) children in the 12-59 months age-group were diagnosed to have pneumonia on enrollment, which dropped to 107 (70%) and 30 (75%) respectively at 6 hours post-enrollment. The specificity of the WHO guidelines for diagnosis of pneumonia was very low (6.9%) at enrollment but increased to 65.5% at 6 hours post-enrollment, after initial rehydration. The specificity of the WHO guidelines for diagnosis of pneumonia in young children is significantly reduced in dehydrating diarrhoea. For young children with dehydrating diarrhoea, rehydration, clinical and radiological assessments are useful in identifying those with true pneumonia.

Observational follow-up study on a cohort of children with severe pneumonia after discharge from a day-care clinic in Dhaka, Bangladesh.

Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (approximately 90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death.

Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study.

Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely-malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled. Those who presented with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the cases (n=87), and those admitted without hypocalcaemia (n=246) constituted the control group in our analysis. The prevalence of hypocalcaemia among severely-malnourished under-five children was 26% (87/333). The fatality rate among cases was significantly higher than that in the controls (17% vs 5%; p < 0.001). Using logistic regression analysis, after adjusting for potential confounders, such as vomiting, abdominal distension, and diastolic hypotension, we identified acute watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p = 0.030), convulsion on admission (OR 21.86, 95% CI 2.57-185.86, p = 0.005), and lethargy (OR 2.70, 95% CI 1.633-5.46, p = 0.006) as independent predictors of hypocalcaemia in severely-malnourished children. It is concluded, severely-malnourished children presenting with hypocalcaemia have an increased risk of death than those without hypocalcaemia. AWD, convulsion, and lethargy assessed on admission to hospital are the clinical predictors of hypocalcaemia in such children. Presence of these features in hospitalized children with severe acute malnutrition (SAM) should alert clinicians about the possibility of hypocalcaemia and may help undertake potential preventive measures, such as calcium supplementation, in addition to other aspects of management of such children, especially in the resource-poor settings.

Systematic review and meta-analysis of the potential threats to respiratory health from microbial Bioaerosol exposures.

Infectious diseases are a part of everyday life, and acute respiratory diseases are the most common. Many agents carrying out respiratory infections are transmitted as bioaerosols through the air, usually, particulate matter containing living organisms. The purpose of the study is to conduct a systematic review and meta-analysis to assess the likelihood that people exposed to bioaerosols may experience severe respiratory diseases. Nine digital databases and bibliographies were assessed for papers conducted between January 1960 and April 2021. A total of 35 health and exposure studies were included from 825 studies for the systematic review, while only 17 contented the meta-inclusion analysis's criteria. This systematic review found higher bacterial bioaerosol concentrations in poultry farms, waste dumpsites, composting plants, and paper industries. The meta-analysis's Standard Mean Difference (SMD) measurement indicates a substantially positive association between bioaerosol exposure and respiratory disease outcomes in targeted populations. The value is 0.955 [95% CI, range 0.673-1.238; p < 0.001]. As per the Risk of Bias (ROB) findings, most of findings (30 out of 35 [85.71%]) were judged to have low ROB. From the random effect probit model, the total relative risk is 1.477 (95% CI, range 0.987-2.211), indicating a higher risk of respiratory diseases from bioaerosol exposure than the control groups. The total risk difference is 0.121 (95% CI, -0.0229 to 0.264), which means intervention groups may have a higher risk of respiratory diseases from continuous bioaerosol exposure than the control groups. The dose-response relationship revealed a strong positive linear coefficient correlation between bacterial & fungal bioaerosol exposure to respiratory health. Based on self-reported outcomes in those studies, The systematic review and meta-analysis stated that bioaerosol exposure had an effect on pulmonary health.

Tracing and source fingerprinting of metals from the southern coastal sediments in Bangladesh.

Trace element pollution from anthropogenic sources is increasingly widespread. This pollution in terrestrial environments threatens agricultural crop production, while in aquatic environments, it threatens fish cultivation. The contamination of these crucial food sources raises significant concerns regarding food safety, security, and its potential adverse effects on human health. Coastal areas are particularly vulnerable to heavy metal pollution due to their proximity to industrial and urban centres, as well as their susceptibility to contamination from marine sources. In attempting to identify the sources of heavy metals (As, Cu, Cr, Cd, Fe, Hg, Mn, Ni, Pb, and Zn) and measure their contributions, we collected soil samples from thirty sites along the three coastal districts (Patuakhali, Barguna, and Bhola) in Bangladesh. Using atomic absorption spectroscopy, heavy metal concentrations in soil samples were measured and three receptor models (PMF, PCA-MLR, and UNMIX) were applied to detect their sources. Pairwise correlation analysis of metal concentrations in 30 sites across 3 coastal districts showed all possible patterns, including both significant and insignificant positive and negative relationships between different metals, except for As and Hg which did not display any significant relationships with other metals. The concentrations of Cu, Fe, Mn, Ni, and Zn exceed the US-EPA sediment quality standard. The applied PCA-MLR, PMF, and UNMIX models identified several sources of heavy metal contamination, including (i) mixed anthropogenic and natural activities: contribution of 59%, 37%, and 43%, and (ii) vehicle emissions: contribution of 23%, 26% and 29%. The recognized metal sources should be prioritised to avoid the discharge of poisonous pollutants from anthropogenic factors and any possible future exposure. This study's findings have implications for ongoing monitoring and management of heavy metal contamination in coastal environments to mitigate potential health and ecological impacts and can inform policy development and management strategies.

Classification of aerosols using particle linear depolarization ratio (PLDR) over seven urban locations of Asia.

Active lidar remote sensing has been used to obtain detailed and quantitative information about the properties of aerosols. We have analyzed the spatio-temporal classification of aerosols using the parameters of particle linear depolarization ratio and single scattering albedo from Aerosol Robotic Network (AERONET) over seven megacities of Asia namely; Lahore, Karachi, Kanpur, Pune, Beijing, Osaka, and Bandung. We find that pollution aerosols dominate during the winter season in all the megacities. The concentrations, however, vary concerning the locations, i.e., 70-80% pollution aerosols are present over Lahore, 40-50% over Karachi, 90-95% over Kanpur and Pune, 60-70% and over Beijing and Osaka. Pure Dust (PD), Pollution Dominated Mixture (PDM), and Dust Dominated Mixture (DDM) are found to be dominant during spring and summer seasons.This proposes that dust over Asia normally exists as a mixture with pollution aerosols instead of pure form. We also find that black carbon (BC) dominated pollution aerosols.

Assessment of Heavy Metal Contamination and Health Risk Associated with Cultivated Vegetables along Dhaka-Mymensingh Highway, Bangladesh.

The purpose of this research work is to evaluate the degree of eight heavy metals (Fe, Mn, Cu, Zn, Cd, Pb, Cr, and Ni) contamination and health risks of three regularly consumed vegetables (papaya, bottle gourd, and esculent) near one of Bangladesh's busiest roadways, the Dhaka-Mymensingh highway. The heavy metal concentrations in 45 vegetable samples were analyzed using an atomic absorption spectrometer (AAS). These samples were collected from five different sampling sites based on various land use patterns adjacent to the highway. The average concentrations (mg/kg) of Cu, Fe, Mn, Zn, Cr, and Ni were found to be 9.86, 246.8, 16.9, 28.0, 9.02, and 2.02, respectively, for papaya; 14.9, 281.2, 387.6, 49.0, 10.1, and 2.92, respectively, for bottle gourd; and 17.6, 183.4, 107.2, 80.7, 7.98, and 2.34, respectively, for esculent. The mean concentrations of Cr, Zn, and Mn in papaya, bottle gourd, and esculent were higher than the acceptable limit. Correlation analysis revealed a significant positive correlation between Fe-Cu, Zn-Fe, Cu-Fe, and Fe-Zn in papaya; Cu-Zn, Fe-Cr, Zn-Ni, and Cr-Fe in bottle gourd; and Mn-Cr, Mn-Ni, Mn-Fe, and Cr-Ni in esculent, thereby indicating their common anthropogenic sources like agricultural activities, waste from the commercial area, filling station, and vehicular emissions. Health risk assessment through target hazard quotient (THQ) revealed the highest THQ of 9.52 for Cr in bottle gourd, which poses a high non-carcinogenic health risk to the localities upon the intake of these contaminated vegetables. Target cancer risk (TCR) was found to be highest for Cr in papaya (0.013) and bottle gourd (0.014). TCR trends were found for Cr in the following order: bottle gourd > esculent > papaya. This study contributed the greatest concern for both carcinogenic and non-carcinogenic health impacts through ingesting contaminated vegetables.

Pulmonary tuberculosis in severely-malnourished or HIV-infected children with pneumonia: a review.

Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score <-3 of the WHO median, or presence of nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children from other studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were identified respectively. Children from South Africa were infected with HIV without specification of their nutritional status whereas children from other countries had SAM but without indication of their HIV status. Our review of the existing data suggests that pulmonary tuberculosis may be more common than it is generally suspected in children with acute pneumonia and SAM, or HIV infection. Because of the scarcity of data, there is an urgent need to investigate PTB as one of the potential aetiologies of acute pneumonia in these children in a carefully-conducted larger study, especially outside Africa.

Assessment of remote sensing-based indices for drought monitoring in the north-western region of Bangladesh.

Drought is a widespread hazard that can tremendously affect the biodiversity, habitat of wild species, and ecosystem functioning and stability, especially in the dry region. Due to its geographic location, the north-western region of Bangladesh has a comparatively arid climate which is very much susceptible to drought occurrence and is marked as a red zone. Despite the growing evidence of the impact of drought on food security and ecosystem functioning, little effort has been paid to mitigate the drought in this region. The present study aimed to assess the drought condition of the north-western region of Bangladesh using earth observation techniques. For this purpose, Landsat data from 1990 to 2020 was used to determine various vegetation indices such as Normalized Difference Vegetation Index (NDVI), Water Index (NDWI), Moisture Index (NDMI) and Soil Adjusted Vegetation Index (SAVI), along with Land Surface Temperature (LST). Results show that the depletion of forests (2832 km2) and water bodies (6773 km2) resulted from the expansion of settlement (6563 km2) and agricultural land (1802 km2) for the period 1990-2020. Examination of the temporal changes of vegetation indices and LST showed that the values of all indices decreased while the LST increased. The negative correlation between NDVI value and LST indicates that the vegetation in our study was subject to drought-induced shocks. This study reveals the current situation of the vegetation health in the north-western region of Bangladesh in relation to the drought conditions. The findings of this study have practical implications for the policymakers in implementing necessary measures for agriculture, forests, water development, and economic zone planning.

Natural history of antiplatelet nonresponders undergoing carotid artery stenting.

OBJECTIVE: Routine antiplatelet responsiveness testing for patients undergoing carotid artery stenting procedures is not performed at most endovascular centers and remains a topic of controversy within the neurointerventional community. The objective of this study was to determine if nonresponsiveness to acetylsalicylic acid or clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing carotid stenting procedures. METHODS: A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada, from August 2019 to July 2021. Patients undergoing carotid artery stenting procedures and who were receiving dual antiplatelet therapy were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry. The primary outcome was development of a symptomatic thromboembolic event within 90 days after the procedure. The treating physicians were blinded to the aggregometry results for the duration of the study. RESULTS: One hundred two procedures were performed in 100 patients. Eight thromboembolic events (8%) occurred during the study. Age (p = 0.03) and nonresponsiveness to clopidogrel (p = 0.003) were associated with the development of thromboembolic events. The multivariable model showed that clopidogrel nonresponsiveness was independently associated with the development of a thromboembolic event (adjusted OR 6.14, 95% CI 1.25-30.11, p = 0.03). CONCLUSIONS: This study demonstrated that patients who were identified as clopidogrel nonresponders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Larger studies are needed to assess the utility of routine platelet function testing prior to carotid artery stenting procedures.

Heavy metals in popularly sold branded cigarettes in Bangladesh and associated health hazards from inhalation exposure.

Tobacco products are widely recognized as a major contributor to death. Cigarette smoke contains several toxic chemicals including heavy metals particulate causing high health risks. However, limited information has been available on the health risks associated with the heavy metals in cigarettes commonly sold in the Bangladeshi market. This study evaluated the concentrations and potential health risks posed by ten concerned heavy metals in ten widely consumed cigarette brands in Bangladesh using an atomic absorption spectrometer. The concentration (mg/kg) ranges of heavy metals Pb, Cd, Cr, As, Co, Ni, Mn, Fe, Cu, and Zn vary between 0.46-1.05, 0.55-1.03, 0.80-1.2, 0.22-0.40, 0.46-0.78, 2.59-3.03, 436.8-762.7, 115.8-184.4, 146.6-217.7, and 34.0-42.7, respectively. We assume that the heavy metals content among cigarette brands is varied due to the differences in the source of tobacco they use for cigarette preparation. The carcinogenic risks posed by heavy metals follow the order of Cr > Co > Cd > As > Ni > Pb, while the non-carcinogenic risks for Cu, Zn, Fe, and Mn were greater than unity (HQ > 1), except for Fe. The existence of toxic heavy metals in cigarette tobacco may thus introduce noticeable non-carcinogenic and carcinogenic health impacts accompanying inhalation exposure. This study provides the first comprehensive report so far on heavy metal concentration and associated health risks in branded cigarettes commonly sold in Bangladesh. Hence, this data and the information provided can serve as a baseline as well as a reference for future research and have potential implications for policy and legislation in Bangladesh.