Secondhand smoke exposure and associated factors among city residents living in multiunit housing in Bangladesh.

BACKGROUND: Secondhand smoke (SHS) poses a high health risk to those living in multiunit housing (MUH) since it can easily spread from unit to unit and throughout the building's communal areas. MUH residents in Bangladesh are particularly vulnerable to SHS due to the absence of smoking restrictions within a housing complex. Therefore, this study aimed to assess the prevalence of SHS exposure and its associated factors among MUH residents living in seven divisional cities of Bangladesh- Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. METHODS: From April 2019 to November 2019, a cross-sectional survey was conducted with 616 MUH residents aged 18 or older who had been residing in MUH for at least two years in the seven divisional cities of Bangladesh. A multivariable logistic regression model was performed to determine the associated factors of SHS exposure. RESULTS: In MUH complexes, more than half (54.9%) of the 616 respondents were exposed to SHS. The key factors positively associated with SHS exposure were females (aOR: 1.8, 95% CI:1.236-2.681), residents with a low monthly family income (aOR: 1.9, 95% CI: 1.162-3.220), those whose family members smoked (aOR: 2.4, 95% CI: 1.537-3.746), and Dhaka city residents (aOR: 1.9, 95% CI: 1.013-3.440). CONCLUSIONS: This study revealed a high prevalence of SHS exposure among Bangladeshi MUH residents. Therefore, a smoking ban is needed in and around MUH complexes to protect non-smoking residents from SHS exposure.

Compliance with smoke-free legislation in public places: An observational study in a northeast city of Bangladesh.

BACKGROUND: Bangladesh is one of the highest tobacco-consuming countries in the world, with a large number of adult users of a variety of smoked and/or smokeless tobacco products. Bangladesh tobacco control act prohibits smoking in public places and requires the owners of public places to display 'no smoking' signages. OBJECTIVES: The objective of this study was to assess the level of compliance with the tobacco control act (smoke-free laws) in public places in a northeast city of Bangladesh. METHODS: This cross-sectional study was conducted between June 1 and August 25, 2020, across 673 public places in Sylhet city, Bangladesh. The data was collected using a structured observational checklist that included variables such as the presence of active smoking, the presence of designated smoking areas, the display of 'no smoking' signages, evidence of recent smoking such as ashes, butts/bidi ends, and the presence of smoking aids. RESULTS: Among 673 public places, a total of 635 indoor locations and 313 outdoor locations were observed. Only 70 (11%) indoor locations were found to be in good compliance, and 388 (61.1%) indoor locations were found to be in moderate compliance with smoke-free laws. On the other hand, only 5 (1.6%) outdoor locations were in good compliance, and 63 (20.1%) outdoor locations were in moderate compliance with smoke-free laws. The overall compliance with smoke-free laws at indoor locations was 52.7%, and at outdoor locations was 26.5%. The highest compliance was observed at healthcare facilities (58.6%) and the least at transit points (35.7%) for indoor locations. In outdoor locations, the highest compliance was observed at offices and workplaces (37.1%) and the least at transit points (2.2%). Higher active smoking was observed in public places where there was an absence of 'no smoking' signage and the presence of points of sale (POSs) (p-value <0.05). Further, higher active smoking was observed in places where any smoking aids, cigarette butts, bidi ends, or ashes were present (p-value <0.05). CONCLUSION: This study found moderate compliance at indoor locations and very low compliance at outdoor locations. The government should focus more on implementing smoke-free laws in all kinds of public places, particularly at most frequently visited places and transit sites. 'No smoking' signages should be displayed per legislation across all public places. Policymakers should consider the prohibition of POS in/around a public place as it has a positive effect on smoking.

Tobacco Industry Branding Strategies and Its Influence on Young Adults.

Every year, tobacco industries are spending millions of dollars targeting youths and non-smokers with tactful advertisements and promotion, which has impact on early initiation, increasing overall smoking rate and further upsurge the disease and early death. The study aimed to explore the tobacco industry's branding strategies that influences youth to early initiation of tobacco in Bangladesh. This study was a cross-sectional design with mixed method approach and implemented during March - December 2019. Survey was conducted using semi-structured questionnaire through face-to-face interview among 208 students in different educational institutions of the selected areas of Dhaka city as well as twenty-five (25) KIIs were conducted with different experts personnel. Descriptive and inferential analysis were performed for quantitative data. Thematic analysis was done for qualitative data. Among student respondents, 71.0% were smokers and their average age of initiation was 13.8 years. Study revealed that 21% students attended or exposed to different types of tobacco industry's (TI) promotional programs including one-to-one/group campaign (61%), corporate programs (23%), seminar (21%), career counseling (21%) and sports event (2%). Among them, 70.0% students received free promotional items, such as T-shirt, lighter, cap, wrist belt, free cigarette, etc. at these programs and 65% students were interested in the motivational speech given by the TI representatives. Three-fourths (75%) were familiar with misleading branding terms such as light, tar, full flavor, filter and menthol. The initiation age of the smoking was associated with observing the arrangement of the smoking product in the retail shop (p <0.05), attracted to cigarette stick and packet color (p<0.05) and attracted to smell/flavor (p<0.05) and attracted to role model/celebrity's smoking (p<0.05). Among retailers, 59.3% received TI assistance including showcase decoration with brand color, receiving model box and mounting board. Besides, 59.3% retailers mentioned promoting new brands to the non-user including students through promotional campaign, convince/persuasion, giving free samples, etc. TI is undertaking aggressive marketing and promoting brands targeting the youth around educational institutions that are ultimately contributing to early smoking initiation. A Strong monitoring system should be in place to stop direct and indirect branding and promotional activities.

Secondhand smoke and illness: are mother-child pairs from low socio-economic strata at increased risk in Bangladesh?

To examine: 1) whether exposure to secondhand smoke (SHS) at home is associated with symptoms of self-reported illness among mother-child pairs (MCPs); and 2) the relationship between low socio-economic status and SHS exposure and the role these play as obstacles to the reduction of risk of illness in MCPs. A cross-sectional study was conducted in Rajshahi District, Bangladesh, from May to July 2017. A total of 541 MCPs were interviewed. The prevalence of SHS exposure at home in our sample data was 49.0%. SHS exposure was found to be associated with a higher likelihood of any self-reported rhinitis, any respiratory symptoms and any reproductive health problems among mothers. SHS exposure in children was found to be associated with a higher likelihood of any self-reported rhinitis and food sensitisation, any respiratory symptoms and otitis media. Our findings also suggested that although SHS had an independently adverse effect on MCPs, wealth moderated the likelihood of illness. MCPs who were both poor and exposed to SHS were uniquely disadvantaged in terms of their poor health conditions than MCPs who were wealthier and exposed to SHS. .

Socio-economic inequalities in secondhand smoke exposure at home in the context of mother-child pairs in Bangladesh.

OBJECTIVES: This study aimed to examine socio-economic disparities in mother-child pairs' self-reported and cotinine-measured secondhand smoke (SHS) exposure at home. STUDY DESIGN: This is a cross-sectional study. METHODS: This study was conducted in the Rajshahi district of Bangladesh from May to July 2017. A total of 541 mother-child pairs were interviewed for self-reported measured SHS; cotinine-measured saliva test was performed on 263 mothers and 236 children. Mother-child pairs' SHS exposure at home was the outcome of interest. RESULTS: Overall self-reported prevalence of SHS exposure at home was 49.0%. Self-reported SHS exposure among mothers (50.2%) and children (51.3%) were lower than the prevalence rate of cotinine-measured exposure for mothers (60.5%) and their children (58.9%). Maternal rich bands of wealth were found to be associated with lower likelihood of self-reported (adjusted odds ratio [AOR] = 0.59, 95% confidence interval [CI] = 0.35-0.99) and cotinine-measured SHS exposure among mothers (AOR = 0.17, 95% CI = 0.08-0.37). Maternal rich bands of wealth were also found to be associated with lower likelihood of cotinine-measured SHS exposure among children (AOR = 0.11, 95% CI = 0.07-0.26). CONCLUSIONS: Socio-economic inequalities exist in exposure to SHS at home. Interventional approaches aimed at reducing SHS at home are urgently needed at public health and healthcare service level, with special focus given to the socioeconomically disadvantaged groups.

Plasma Neutrophil Gelatinase Associated Lipocalin (pNGAL) Level to Identify AKI Early in Patients Undergoing Cardiac Valve Surgery.

Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period. This prospective observational study was carried out in the Department of Nephrology of National Institute of Kidney Diseases & Urology in collaboration with National Institute of Cardiovascular Diseases (NICVD) & Dhaka Shisu Hospital (DSH) from January 2015 to December 2016. Total 120 patients were selected from inpatient ward of cardiovascular surgery department. According to inclusion & exclusion criteria total 80 patients were included who was undergone cardiac valve surgery. Serum samples for pNGAL were collected from study population 6 hours after completion of surgery & stored at -80°C, serum samples were also collected for serum creatinine day before surgery, in 1st post operative day (POD1) & 2nd post operative day (POD2). Total 79 patients undergoing cardiac surgery, who met the inclusion & exclusion criteria, were consecutively included. There were 44 male (55.69%) and 35 female (40.31%) ranged from 15-60 years, with mean age of 36 years. pNGAL level in the blood of AKI patients (244.19±59.61ng/ml) 6 hours after completion of surgery was significantly higher from the non AKI patients (171.73±68.63ng/ml). A positive significant correlation was found between pNGAL 6 hours after completion of surgery & serum creatinine at POD1, POD2. This study demonstrated that level of pNGAL concentration 6 hours after completion of cardiac valve surgery increased before the rise of serum creatinine level & can thus AKI can be detected earlier by pNGAL.

Processable dodecylbenzene sulfonic acid (DBSA) doped poly(N-vinyl carbazole)-poly(pyrrole) for optoelectronic applications.

A soluble poly (n-vinyl carbazole)-polypyrrole (PNVC-Ppy) copolymer was prepared through oxidative chemical polymerization wherein dodecyl benzene sulfonic acid (DBSA) was used as a dopant to facilitate polymer-organic solvent interaction and ammonium persulfate (APS) was used as an oxidant. Compared with undoped PNVC-Ppy, the DBSA-doped PNVC-Ppy copolymer showed higher solubility in some selected organic solvents. The composition and structural characteristics of the DBSA-doped PNVC-Ppy were determined by Fourier transform infrared, ultraviolet-visible, and X-ray diffraction spectroscopic methods. Field emission scanning electron microscopic method was employed to observe the morphology of the DBSA-doped PNVC-Ppy copolymer. The electrical conductivity of the DBSA-doped PNVC-Ppy copolymer was measured at room temperature. The conductivity increased with increasing concentration of APS oxidant, and the highest conductivity was recorded at 0.004 mol/dm3 APS at a polymerization temperature of -5 °C. The increased conductivity can be explained by the extended half-life of pyrrole free radical at a lower temperature and a gradual increase in chain length over a prolonged time due to the slow addition of APS. Furthermore, the obtained soluble copolymer exhibits unique optical and thermal properties different from those of PNVC and Ppy.

Insights in dynamic kinome reprogramming as a consequence of MEK inhibition in MLL-rearranged AML.

Single kinase-targeted cancer therapies often failed prolonged responses because cancer cells bypass through alternative routes. In this study, high-throughput kinomic and proteomic approaches enabled to identify aberrant activity profiles in mixed lineage leukemia (MLL)-rearranged acute myeloid leukemia (AML) that defined druggable targets. This approach revealed impaired activity of proteins belonging to the mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathway. Pharmacological druggable MAPK pathway targets tested in primary MLL-rearranged AML included MAPKK1/2 (MEK), cyclic AMP-responsive element-binding protein (CREB) and MAPK8/9 (JNK). MEK inhibition showed to severely decrease MLL-rearranged AML cell survival without showing cytotoxicity in normal controls, whereas inhibition of CREB and JNK failed to exhibit MLL selectivity. Exploring the working mechanism of MEK inhibition, we assessed proteome activity in response to MEK inhibition in THP-1. MAPK1/3 (Erk) phosphorylation was instantly decreased in concurrence with a sustained Akt/mammalian target of rapamycin (mTOR) phosphorylation that enabled a subpopulation of cells to survive MEK inhibition. After exhaustion of MEK inhibition the AML cells recovered via increased activity of vascular endothelial growth factor receptor-2 (VEGFR-2) and Erk proteins to resume their proliferative state. Combined MEK and VEGFR-2 inhibition strengthened the reduction in MLL-rearranged AML cell survival by blocking the Akt/mTOR and MAPK pathways simultaneously. The generation of insights in cancerous altered activity profiles and alternative escape mechanisms upon targeted therapy allows the rational design of novel combination strategies.

Genetic classification of Echinococcus granulosus cysts from humans, cattle and camels in Libya using mutation scanning-based analysis of mitochondrial loci.

We genetically classified Echinococcus granulosus from humans, cattle and camels in Libya utilizing DNA regions (designated pcox1 and pnad1) within the cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase 1 (nad1) mitochondrial genes, respectively. Polymerase chain reaction (PCR)-based single-strand conformation polymorphism (SSCP) analysis of pcox1 and pnad1 amplicons derived from genomic DNA samples from individual cysts (n = 176) revealed four distinct electrophoretic profiles for each locus. Direct sequencing of selected amplicons representing each of these profiles defined four different sequence types for each locus, which were present in five different combinations (designated haplotypes A-E) amongst all 176 isolates. Phylogenetic analysis of concatenated sequence data for these five haplotypes, together with a range of well-defined reference sequences, inferred that all cyst isolates from humans (n = 55) and a small number from cattle (13% of 38) belonged to the G1-G3 complex of E. granulosus (or E. granulosus sensu stricto), whereas most (87%) cysts from cattle and all 83 of them from camels were linked to the G6-G10 complex (or Echinococcus canadensis). The present study provides a foundation for future large-scale studies of the epidemiology and ecology of E. granulosus in Libya and other African countries.

Participation of leukotriene C(4) in the regulation of suicidal erythrocyte death.

Eryptosis, the suicidal death of erythrocytes, is characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine exposure at the erythrocyte surface. Eryptosis is triggered by increase in cytosolic Ca(2+) concentration upon energy depletion. The present study explored the involvement of leukotrienes. Western blotting was employed to detect the cysteinyl-leukotriene receptor cysLT1, competitive immune assay to determine leukotriene release from erythrocytes, Fluo3 fluorescence to estimate cytosolic Ca(2+) concentration, forward scatter to analyse cell volume and annexin V-binding to disclose phosphatidylserine exposure. As a result, erythrocytes expressed the leukotriene receptor CysLT1. Glucose depletion (24 hours) significantly increased the formation of the cysteinyl-leukotrienes C(4)/D(4)/E(4). Leukotriene C(4) (10 nM) increased Ca(2+) entry, decreased forward scatter, activated caspases 3 and 8, and stimulated annexin V-binding. Glucose depletion similarly increased annexin V-binding, an effect significantly blunted in the presence of the leukotriene receptor antagonist cinalukast (1 microM) or the 5-lipoxygenase inhibitor BW B70C (1 microM). In conclusion, upon energy depletion erythrocytes form leukotrienes, which in turn activate cation channels, leading to Ca(2+) entry, cell shrinkage and cell membrane scrambling. Cysteinyl-leukotrienes thus participate in the signaling of eryptosis during energy depletion.

Sociocultural aspects of arsenicosis in Bangladesh: community perspective.

This was a cross-sectional study under taken to explore the socioeconomic perspective of the arsenicosis problem, carried out in arsenic contaminated Upazillas where at least 100 arsenicosis patients had been identified. Two of the Upazillas with significant arsenic mitigation intervention and three of the Upazillas with limited interventions were selected for the study. Seven hundred fifty respondents were included in the study from 25 villages of the 5 Upazillas. Arsenicosis became a serious problem for the affected communities. Majority (71.31%) of respondents obtained their drinking water from tubewells, almost one third (29%) of the respondents still knowingly using arsenic contaminated water. Primary reason identified for this practice was distance of safe water source. Majority (58.6%) of the respondents said to face economic and 17.9% said to face social problem of varied range. Patients of lower income group were particularly more likely to face economic problems (P< .001) as well as social problem (P< .01). About half (50.7%) of the arsenicosis patients faced difficulty whilst receiving treatment, particularly female patients were more likely to face problem than male (P< .05). Several concerns also were surfaced regarding the heath care service provider particularly to the women patients, some of which are: long waiting time for receiving treatment (15%), discrimination in service delivery (10.7%) and inadequate separate facility for female patients (14.3%). Moreover the issues of financial burden raised by the respondents seem to have emerged as significant in terms of health care access. Access to Health service was particularly difficult for poor patients, as they often had to face problems associated with accessing service like, non availability of medicines in the hospitals (50.7%), traveling long distance (26.7%), purchasing medicine in most cases (32.4%) etc. Their dissatisfaction was compounded by negligent behavior of health care staff and nature of treatment provided. Furthermore length of time needed for reversal of symptoms led to loosing faith on efficacy of treatment, which cascades to negligence of patient's part in seeking health care. Women are less likely to get treatment for arsenicosis than men (P< .01). As there appear to be specific difficulties for women particularly for poor women in accessing health care, social and cultural values make it difficult for them to attend to their own health needs and to travel to service providers. Study findings suggest that a significant proportion (79.9%) of arsenicosis patient was found to access alternative health care. This includes; Homeopath, village doctors, Kabiraj and local pharmacists. Respondents in high intervention Upazillas were significantly more likely to get treatment (P< .05), to face fewer problems and to be satisfied with the facility (P< .001). Provision of safe water options, periodic screening of water source for arsenic, availability of trained doctor, regular availability of medicine, doorstep treatment, follow up on severe patients were the suggestions came from community for improvement.

Cardiovascular health--behaviour of medical students in Karachi.

OBJECTIVE: To assess the health behaviour and perceptions of medical students towards cardiovascular disease. METHODS: This descriptive cross-sectional survey was conducted on 203 Pakistani medical students enrolled in a private medical college in Karachi, Pakistan using systematic random sampling. It was based on a self-administered questionnaire. RESULTS: Eight percent smoked, 9% were overweight, 33% had a family history of coronary artery disease, 32% regulated dietary fat intake, 28% exercised regularly, 62.1% knew personal blood pressure and 5.4% personal cholesterol levels. Regarding developing cardiovascular disease in the future, 62% showed concern but only 54% of these adopted preventive practices. About 46% believed medical college life had a harmful effect on their health. Gender, family history and personal health status perception were behavior modifying influences (p<0.05). Reasons reported for their behavior were: no need of prevention at their age (38.3%) and never thinking about these issues (37.0%). CONCLUSIONS: The study shows a high prevalence of coronary artery disease family history, inappropriate dietary intake, physical inactivity; poor screening practices and lack of awareness. The results underscore the urgent need to promote preventive knowledge and practices among medical students, if they are to become prevention oriented physicians and counsel patients on preventive strategies to counter the rapidly increasing burden of cardiovascular diseases effectively.

[Hiatal hernia--reflux disease. Indications for surgery and initial results of a new treatment method]. / Hiatushernie--Refluxkrankheit. Operationsindikation und erste Ergebnisse eines neuen Behandlungsverfahrens.

Indications for the operative treatment of hiatus hernia with reflux oesophagitis are grade III and IV reflux oesophagitis; if the total acid period equals or exceeds 1.3% of the time of the period of time during which the patient was in supine position (pH-examination); if acid clearance lasts 2.86 min or more after a single reflux period; if radioisotopic counts over the sternal region exceed 3.5--4% of those obtained over the stomach area. Since 1977 we performed a new anti-reflux-operation, which we call "Teres-plasty"in 42 patients with axial hiatus hernia. The procedure is a modified gastropexy by using the ligamentum teres. First results seem to prove that this method can avoid reflux without postoperative syndromes as gas bloat syndrome and dysphagia, which are known to occur after fundoplication.

[Surgery of esophageal cancer]. / Zur Chirurgie des Speiseröhrencarcinoms.

In the last 12 months 40 patients underwent surgery for carcinoma of the esophagus. In 18 cases the tumor was located in the lower third of the esophagus. An abdomino-thoracic approach was employed and a 2/3 resection of the esophagus and an esophagogastrostomy were performed. The resected area was bridged by an isoperistaltic gastric tissue tube and anastomosis was carried out using the EEA stapler. A telescope antirefluxplasty was performed to protect the anastomosis and to prevent a gastroesophageal reflux. One patient died of pneumonia. In all cases a secure anastomosis was achieved and in most cases gastroesophageal reflux was prevented.