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.

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.

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.

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.

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.

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.

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.

Risk assessment of heavy metals in marine fish and seafood from Kedah and Selangor coastal regions of Malaysia: a high-risk health concern for consumers.

The heavy metals namely Fe, As, Cu, Cd, and Pb were investigated in two marine fishes silver pomfret (Pampus argentus) and torpedo scad (Megalaspis cordyla), and three seafoods sibogae squid (Loligo sibogae), Indian white prawn (Fenneropenaeus indicus), and mud crab (Scylla serrata) by using inductively coupled plasma spectrophotometer (ICP-MS) from two renowned fish harvesting coastal area of Malaysia named as Kedah and Selangor. Among the target heavy metals, highest mean concentration of As and Fe were found in Scylla serrata (72.14±7.77 µg/g) in Kedah and Megalaspis cordyla (149.40±2.15 µg/g) in Selangor. Pearson's correlation results showed As-Fe-Cd-Cu originated from the same source. Maximum estimated daily intake (EDI) values of Scylla serrata were found 175.25 µg/g/day and 100.81 µg/g/day for child in both Kedah and Selangor areas respectively. Hazard quotient (HQ) and hazard index (HI) results revealed that local consumers of Kedah and Selangor will face high chronic risk if they consume Scylla serrata, Fenneropenaeus indicus, and Megalaspis cordyla on regular basis in their diet. Carcinogenic risk results suggested that all the studied species pose very high risk of cancer occurrences to the consumers in both areas. Therefore, it could be recommended that consumers should be aware when they are consuming these marine species since they can pose serious health risk associated with prolonged consumption.

Trace metals contamination potential and health risk assessment of commonly consumed fish of Perak River, Malaysia.

The rapid growth of industrial and agricultural activities in Malaysia are leading to the impairment of most of the rivers in recent years through realising various trace metals. This leads to toxicity, particularly when the toxic has entered the food chain. Perak River is one of the most dynamic rivers for the Malaysian population. Therefore, in consideration of the safety issue, this study was conducted to assess the concentration of such metals (Cd, Cu, Zn, Fe, and Pb) in the muscles of most widely consumed fish species (Barbonymus schwanenfeldii, Puntius bulum, Puntius daruphani, Hexanematichthys sagor, Channa striatus, Mystacoleucus marginatus, and Devario regina) from different locations of Perak River, Malaysia by employing inductively coupled plasma optical emission spectroscopy (ICP-OES). Among the trace metals, Fe and Cd were found to be the highest (29.33-148.01 µg/g) and lowest (0.16-0.49 µg/g) concentration in all of the studied species, respectively. Although the estimated daily intakes (µg/kg/day) of Cd (0.65-0.85), Fe (79.27-352.00) and Pb (0.95-12.17) were higher than their reference, the total target hazard quotients values suggested that the local residents would not experience any adverse health effects from its consumption. In contrast, the target cancer risk value suggested that all fish species posed a potential cancer risk due to Cd and cumulative cancer risk values, strongly implying that continuous consumption of studied fish species would cause cancer development to its consumers.

Applicability of machine learning in modeling of atmospheric particle pollution in Bangladesh.

Atmospheric particle pollution causes acute and chronic health effects. Predicting the concentrations of PM2.5 and PM10, therefore, is a prerequisite to avoid the consequences and mitigate the complications. This research utilized the machine learning (ML) models such as linear-support vector machine (L-SVM), medium Gaussian-support vector machine (M-SVM), Gaussian process regression (GPR), artificial neural network (ANN), random forest regression (RFR), and a time series model namely PROPHET. Atmospheric NOX, SO2, CO, and O3, along with meteorological variables from Dhaka, Chattogram, Rajshahi, and Sylhet for the period of 2013 to 2019, were utilized as exploratory variables. Results showed that the overall performance of GPR performed better particularly for Dhaka in predicting the concentration of both PM2.5 and PM10 while ANN performed best in case of Chattogram and Sylhet for predicting PM2.5. However, in terms of predicting PM10, M-SVM and RFR were selected respectively. Therefore, this study recommends utilizing "ensemble learning" models by combining several best models to advance application of ML in predicting pollutants' concentration in Bangladesh.

Renal insufficiency among urban populations in Bangladesh: A decade of laboratory-based observations.

OBJECTIVE: The objective of this study was to describe the age and sex-specific prevalence of renal insufficiency, and observe its trends over a decade at an urban Bangladesh setup. METHOD: This was a cross-sectional study, in which we observed the Estimated Glomerular Filtration Rate (eGFR) of 218,888 adults, aged ≥19 years, who had submitted their blood specimen to the Clinical Biochemistry Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during the years 2006-2015. We applied CKD-EPI definition in estimating eGFR using their age-and sex-specific serum creatinine concentrations. Based on the eGFR, we classified the population into five stages of renal insufficiency (stage-1 to stage-5), at age intervals of five-years. Data were analysed using the Linear Regression and Multinomial Logistic Regression models. RESULTS: Females constituted 43% (n = 94,931) of the study population; and 34% (n = 42,576) of the males and 31% (n = 29,830) of the females had their serum creatinine concentrations above the upper limit of the laboratory reference cut-off. The overall prevalence of stage-2 to stage-5 renal insufficiency were 24% (n = 52,126), 17% (n = 38,539), 8% (n = 16,504) and 6% (n = 12,665) respectively; the prevalence were 23% (n = 1,890), 19% (n = 1,579), 9% (n = 769) and 9% (n = 770) respectively in 2006, and 24% (n = 10,062), 17% (n = 6,903), 6% (n = 2,537) and 5% (n = 1,924) respectively in 2015. The prevalence was higher among the females. At least 2% of the adults, younger than <44 years, had stage-4 and stage-5 in 2015. The age-adjusted eGFR was significantly lower among the post-menopausal females (aged ≥46 y) compared to the same age group males (64.08±10.83 vs. 66.83±10.41 mL/min/1.73 m2; p<0.001). Compared to 2006, the number of individuals with renal insufficiency (stage 2 and above) had increased at least two times, irrespective of age, in 2015. A single year of increase in the age was significantly associated with 1.32 unit reductions in the eGFR; and the reductions were higher for females who also had higher odds of renal insufficiency stages-2 and beyond. CONCLUSION: This study observed high prevalence of stage-2 to stage-5 renal insufficiency in Bangladeshi populations, irrespective of age, and especially among the females.

Diagnosis of Tuberculosis Following World Health Organization-Recommended Criteria in Severely Malnourished Children Presenting With Pneumonia.

Evidences on diagnosis of tuberculosis (TB) following the World Health Organization (WHO) criteria in children with severe acute malnutrition (SAM) are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388). However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture-confirmed TB, sensitivity and specificity (95% confidence interval) of WHO criteria were 40 (14% to 73%) and 84 (80% to 87%), respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43%) and 83 (79% to 87%), respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings.

Impact of Diarrhea on the Clinical Presentation and Outcome of Severe Pneumonia in Bangladeshi Children.

We compared clinical presentation and outcome of 225 children with severe pneumonia between those with and those without diarrhea. Having diarrhea was associated with metabolic acidosis (P < 0.001) and hypocalcemia (P = 0.002) on presentation, and with a fatal outcome: 20/113 (20%) died with diarrhea versus 3/112 (3%) without diarrhea. Diarrhea is an important comorbidity in Bangladeshi children with severe pneumonia requiring attention for improved case management.

Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death.

We sought to investigate the magnitude, clinical features, treatment, and outcome of children suffering from hypernatremic diarrhea and to identify risk factors for fatal outcome among them. We reviewed 2 data sets of children <15 years admitted to the in-patient ward of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) with diarrhea and hypernatremia (serum sodium ≥150 mmol/L): (a) March 2001 to March 2002 (n = 371) and (b) March 2009 to August 2011 (n = 360). We reviewed their records and collected relevant information for analyses. The prevalence of hypernatremia was 5.1% (371/7212) and 2.4% (360/15 219), case fatality rate was 15% and 19%, respectively. In logistic regression analysis, the risk for death significantly increased in association with serum sodium ≥170 mmol/L, nutritional edema, hypoglycemia, respiratory distress, and absent peripheral pulses and reduced with the sole use of oral rehydration salts (ORS) or ORS following intravenous fluid, if indicated (for all, P < .05). Thus, managing children with hypernatremia using only ORS or ORS following intravenous fluid may help reduce the number of deaths.

Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia.

BACKGROUND: Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. METHODS: We prospectively enrolled SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. RESULTS: SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). CONCLUSION AND SIGNIFICANCE: The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who had WHO-defined danger signs of severe pneumonia more often had treatment failure and fatal outcome compared to those without the danger signs. In addition to danger signs of severe pneumonia, other common causes of both treatment failure and deaths were dehydration, hypocalcaemia, and bacteraemia on admission. The result underscores the importance for further research especially a randomized, controlled clinical trial to validate standard WHO therapy in SAM children with pneumonia especially with danger signs of severe pneumonia to reduce treatment failures and deaths.

Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

BACKGROUND: In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children. METHODS: In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline. RESULTS: The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons). CONCLUSION AND SIGNIFICANCE: We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

Efficacy of Ciprofloxacin for Treatment of Cholera Associated with Diminished Susceptibility to Ciprofloxacin to Vibrio cholerae O1.

OBJECTIVE: We identified a poor clinical response to treatment of cholera with a single 1 g dose of ciprofloxacin, a standard treatment for cholera. METHODS: To determine reasons for the poor response and better therapeutic approaches we examined the minimal inhibitor concentration (MIC, n = 275) and disc-diffusion zone sizes (n = 205) for ciprofloxacin and nalidixic acid of V. cholerae O1 strains isolated in Bangladesh from 1994 to 2012, and reexamined data from 161 patients infected with Vibrio cholerae O1 recruited in four clinical trials who received single- or multiple-dose ciprofloxacin for treatment of cholera and compared their clinical response to the V. cholerae O1 susceptibility. RESULTS: Although all 275 isolates of V. cholerae O1 remained susceptible to ciprofloxacin using standard MIC and disc-diffusion thresholds, the MIC90 to ciprofloxacin increased from 0.010 in 1994 to 0.475 µgm/ml in 2012. Isolates became frankly resistant to nalidixic with the MIC90 increasing from 21 µgm/ml in 1994 to >256 µgm/ml and 166 of 205 isolates from 1994 to 2005 being frankly resistant using disc-diffusion testing. Isolates resistant to nalidixic acid by disc-diffusion testing had a median ciprofloxacin MIC of 0.190 µgm/ml (10th-90th centiles 0.022 to 0.380); nalidixic acid-susceptible isolates had a median ciprofloxacin MIC of 0.002 (0.002 to 0.012).The rate of clinical success with single-dose ciprofloxacin treatment for nalidixic acid-susceptible strains was 94% (61 of 65 patients) and bacteriologic success 97% (63/65) compared to 18% (12/67) and 8% (5/67) respectively with nalidixic acid-resistant strains (P<0.001 for both comparisons). Multiple-dose treatment with ciprofloxacin had 86% and 100% clinical and bacteriologic success rates respectively in patients infected with nalidixic acid-susceptible strains of V. cholerae O1 compared to clinical success 67% and bacteriologic success 60% with nalidixic acid-resistant strains. CONCLUSIONS: Single-dose ciprofloxacin is not effective for treating cholera caused by V. cholerae O1 with diminished susceptibility to ciprofloxacin, and nalidixic acid disc-diffusion testing effectively screens for such isolates.

Validity of antibodies in lymphocyte supernatant in diagnosing tuberculosis in severely malnourished children presenting with pneumonia.

BACKGROUND: The diagnosis of tuberculosis (TB) in young children can be challenging, especially in severely malnourished children. There is a critical need for improved diagnostics for children. Thus, we sought to evaluate the performance of a technique that measures antibodies in lymphocyte supernatant (ALS) for the diagnosis of TB in severely malnourished children presenting with suspected pneumonia. METHODS: Children less than 5 years with severe acute malnutrition and radiological features of pneumonia admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, were enrolled consecutively following informed written consent. In addition to clinical and radiological assessment, samples taken for TB diagnosis included gastric lavage fluid and induced sputum for microbiological confirmation. ALS was measured from venous blood, and results were evaluated in children classified as "confirmed", "non-confirmed TB" or "not TB". RESULTS: Among 224 children who had ALS analysis, 12 (5.4%) children had microbiologically "confirmed TB", a further 41 (18%) had clinically diagnosed "non-confirmed TB" and the remaining 168 (75%) were considered not to have TB. ALS was positive in 89 (40%) and negative in 85 (39%) of children, with a large number (47 or 21%) reported as "borderline". These proportions were similar between the three diagnostic groups. The sensitivity and specificity of ALS when comparing "Confirmed TB" to "Not TB" was only 67% (95% CI: 31-91%) and 51% (95% CI: 42-60%), respectively. CONCLUSIONS AND SIGNIFICANCE: Our data suggest that ALS is not sufficiently accurate to improve the diagnosis of TB in children with severe malnutrition.

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.