Functional Assessment of Stable Chronic Obstructive Pulmonary Disease Patients Using Squat-to-stand Test.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease of airflow limitation that is not fully reversible. COPD affects the lungs and produces significant systemic consequences. In Bangladesh, the prevalence of COPD after 40 years of age is 21.24% and the general population is 4.3%. COPD leads to a sedentary life, which reduces the functional status of the individual. Functional status assessment is vital for appropriate therapy and rehabilitation programs in COPD patients. A Sit-to-stand test (STST) has been proposed as a better alternative to 6MWT, but a Squat-to-stand test (SqTST) to test their ability to stand from the squatting position will be more appropriate in rural patients. This study was conducted using a cross-sectional observational design from July 2020 and September 2021 in the Department of Respiratory Medicine at the National Institute of Diseases of the Chest and Hospital, Bangladesh. Sixty (60) diagnosed cases of COPD patients were enrolled in this study. Severities of airflow obstruction according to GOLD were categorized on the basis of post-bronchodilator FEV1 by spirometry. SqTST was performed on all patients, and functional status was recorded. All data were collected using a preformed questionnaire. Statistical analyses of the findings were carried out using SPSS version 23.0. In this study, the majority of 21(35.0%) patients had very severe COPD, and almost half (48.3%) of the patients had abnormal SqTST. A significant relation was found between the severity of COPD with SqTST (p=0.001). Based on the receiver-operator characteristic (ROC) curve, SqTST had an area under curve 0.901. SqTST had 82.1% sensitivity, 85.7% specificity, 83.3% accuracy, 91.4% positive predictive value, and 72.0% negative predictive value to find severe COPD cases in stable COPD patients. ROC was constructed using SqTST, which gave a cut-off value <7.0, with 82.1% sensitivity and 85.7% specificity for predicting severe COPD. From this study, it may be concluded that SqTST is a clinically useful tool to assess the functional status of stable COPD patients.

Assessment of Kidney Function among the Employees of Sylhet MAG Osmani Medical College and Hospital.

The kidney carries out a variety of physiological processes, including the excretion of nitrogenous waste products, maintenance of fluid, electrolyte, acid-base, and mineral homeostasis, regulation of blood pressure, as well as the synthesis and release of erythropoietin and other endocrine substances. Chronic kidney disease (CKD) can lead to end-stage renal disease (ESRD) and increased cardiovascular morbidity and mortality. CKD has a long period of asymptomatic stage. The symptoms of CKD usually present at the advanced stage of the disease. Chronic kidney disease (CKD) is a potentially fatal that impacts various physiological systems. This cross-sectional observational study was conducted in the Department of Physiology in collaboration with the Department of Nephrology, Sylhet MAG Osmani Medical College Hospital (SMAGOMC&H), from July 2022 to June 2023 to observe the status of kidney function among the employees of SMAGOMC&H, Bangladesh. The study population consisted of all willingly participating volunteers working at SMAGOMC&H between the ages of 18 and 59 years. Participants with acute illness, malignancy, pregnancy, diagnosed case of CKD, and history of kidney transplant were excluded from the study. A thorough history was taken, and a physical examination was done. Serum creatinine, and spot urine albumin creatinine ratio (ACR) of each participant were measured. eGFR (estimated glomerular filtration rate) was estimated by using NKF (National Kidney Foundation) eGFR calculator app. A Semi-structured questionnaire was used for data collection. Most of the participants were between 50-59 years (46.0%). The mean age of these study subjects was 45.25±10.08 years. The mean serum creatinine level was 0.85±0.18 mg/dl, the mean eGFR was 102.92±16.21 ml/min/1.73m² and the mean urinary ACR was 27.44±12.48 mg/gm found in this study. Out of the total participants, 16.5% were at stage 1 CKD, 6.5% were at stage 2 CKD and 2.5% were at stage 3 CKD, according to eGFR by CKD-EPI (Chronic kidney disease epidemiology collaboration) equation. Seventy five percent (75.0%) of the participants had normal to mildly increased ACR and 25.0% had moderately increased ACR. Pearson's correlation test revealed a significant negative correlation of eGFR with age, serum creatinine, and urinary ACR (p<0.001). This study revealed that 16.5%, 6.5% and 2.5% of the study participants were at CKD stage 1, stage 2, and stage 3, respectively. Assessment of renal function can help early identification of CKD in apparently healthy asymptomatic subjects.

Investigating safety and cost-effectiveness of cable median barriers in Louisiana.

OBJECTIVES: Cable median barriers (CMBs) are installed on freeway medians to prevent cross-median crashes and reduce the severity of median-related crashes. Though CMBs are effective in preventing cross-median crashes, they are also known to increase the number of property damage-only (PDO) crashes. The higher frequency of PDO crashes could result in increased CMB maintenance and repair expenses. The aim of this study is to evaluate the safety impact and economic justification of CMBs in Louisiana. METHODS: Initially, a flowchart was developed using Louisiana crash data to identify targeted crashes, such as median-related and cross-median crashes. This was followed by a 3-year observational before-and-after crash analysis with an emphasis on head-on collisions and crashes involving large trucks. Using a 4-step improved prediction method, crash modification factors were then developed to quantitatively assess the impact of CMBs on crash outcomes, accounting for and adjusting to changes in the annual average daily traffic (AADT) and relevant crash frequencies before and after CMB implementation. Finally, an exhaustive benefit-cost analysis was conducted to determine the cost-effectiveness of CMBs. RESULTS: The results revealed that CMBs significantly reduced cross-median crashes of all severities. However, an increase in PDO crashes was observed in both total and median-related crashes. Large truck cross-median crashes and head-on collisions also decreased significantly after CMB implementation. Testing Level 4 (TL-4) CMBs were found to be more effective in preventing vehicles from crossing the median and in reducing crashes of higher severity levels. The benefit-cost ratios, calculated using economic crash unit costs for both total and targeted crashes, were greater than 1. Notably, the estimated benefit-cost ratios were considerably higher, demonstrating that CMBs are cost-effective countermeasures for enhancing traffic safety. CONCLUSION: This study contributes to the understanding of CMB performance from both traffic safety and economic perspectives. The findings may assist transportation agencies in making decisions regarding the management of CMB systems. Based on the comprehensive analysis of CMBs on Louisiana freeways, this project has revealed that CMBs are an effective and economically justified crash countermeasure. Thus, further implementation of CMBs is recommended until better alternatives are available.

Assessment of Serum Homocysteine Level to Predict Early Prognosis of Ischaemic Stroke.

Cerebrovascular disease is the third most familiar cause of mortality worldwide and in Bangladesh. The reported prevalence of stroke in Bangladesh is 0.3%. Age, high serum glucose, elevated admission blood pressure, fever, large infarction size, and hyperhomocysteinemia has been reported to be risk factor for early post-stroke neurological deterioration. Early serum homocysteine level estimation can predict the early prognosis of ischemic stroke. In a developing country like Bangladesh, an earlier stroke outcome prediction for guiding therapeutic approach is essential. This study aimed to specify the role of estimating serum homocysteine during the early phase of acute ischemic stroke to assume an early prognosis that would guide- a management plan, the need to stay in the hospital and the need for intervention. This cross-sectional descriptive study was performed at the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from October 2021 to April 2022. Radiologically confirmed all ischemic stroke patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, during the study period fulfilling the inclusion and exclusion criteria were included in this study. Non-probability purposive sampling technique was used. Data was collected using a pre-designed case record form. Quantitative data were represented as mean and standard deviation and qualitative data as frequency and percentage. The comparison was made by Chi-square test and independent samples t-test using SPSS (version 26.0). During the study period, among 716 stroke patients, 59 ischemic stroke patients were included in this study. The mean age of the patients was 64.0±11.72 years. After 72 hours of supportive treatment, early neurological outcomes were observed using NIHSS scoring. Out of 59 patients, the condition of 45(76.0%) patients improved or remained stable (END-) and the state of 14(24.0%) patients worsened (END+). Elderly age-raised temperature and elevated blood glucose level are known to increase infarction size, but only elevated temperature (p value 0.009) has statistical significance in this study. The mean homocysteine level ±SD was 20.22±6.95µmol/L, which is above the normal (<15µmol/L). The level was above average for both outcome groups. Serum homocysteine level was significantly higher in END(+) group (31.59±2.98µmol/L) than END(-) group (16.69±2.66µmol/L) and p value was <0.001.

Assessing demographic and economic vulnerabilities to sea level rise in Bangladesh via a nighttime light-based cellular automata model.

The Intergovernmental Panel on Climate Change (IPCC) 6th Assessment Report (AR6) forecasts a sea level rise (SLR) of up to 2 m by 2100, which poses significant risks to regional geomorphology. As a country with a rapidly developing economy and substantial population, Bangladesh confronts unique challenges due to its extensive floodplains and 720 km-long Bay of Bengal coastline. This study uses nighttime light data to investigate the demographic repercussions and potential disruptions to economic clusters arising from land inundation attributable to SLR in the Bay of Bengal. By using geographical information system (GIS)-based bathtub modeling, this research scrutinizes potential risk zones under three selected shared socioeconomic pathway (SSP) scenarios. The analysis anticipates that between 0.8 and 2.8 thousand km2 of land may be inundated according to the present elevation profile, affecting 0.5-2.8 million people in Bangladesh by 2150. Moreover, artificial neural network (ANN)-based cellular automata modeling is used to determine economic clusters at risk from SLR impacts. These findings emphasize the urgency for land planners to incorporate modeling and sea inundation projections to tackle the inherent uncertainty in SLR estimations and devise effective coastal flooding mitigation strategies. This study provides valuable insights for policy development and long-term planning in coastal regions, especially for areas with a limited availability of relevant data.

Socioeconomic disparities in diabetes-concordant comorbidity: national health interview survey, 1997-2018.

OBJECTIVE: Although social disparities in morbidity and mortality are well-documented, little is known how socioeconomic status (SES) shapes diabetes-concordant comorbidity (DCC). This study examines socioeconomic inequalities in DCC among adults with diabetes in the United States. STUDY DESIGN: The study incorporated a cross-sectional nationally representative household health survey. METHODS: This study used data from the National Health Interview Survey, 1997-2018. The analysis included 56,192 adults aged 30 or above with diabetes. Multinomial logistic regression was used to obtain relative risk ratios in gender-stratified models after adjusting for sociodemographic covariates. RESULTS: The multivariable-adjusted analyses suggest that across all SES indicators and in both men and women, individuals with lower SES had greater odds of DCC than individuals with higher SES. The associations of SES indicators with DCC were larger in magnitude among women than in men. For example, compared to individuals with a college or higher degree, men with less than a high school degree were 2.06 times (95% confidence interval = 1.76-2.41) and women with less than a high school degree were 3.19 times (95% confidence interval = 2.67-3.82) more likely to have 3 or more DCCs. Similar associations were observed for other indicators of SES. CONCLUSION: Study findings suggest strong social status and gender-based patterns in DCC. Identifying population groups with poor social status may be useful for informing interventions aiming to improve healthcare services of diabetes-related complications.

Socio-economic inequalities in undiagnosed, untreated, and uncontrolled diabetes mellitus in Bangladesh: is there a gender difference?

OBJECTIVES: We aimed to determine: (1) the prevalence and socio-economic distribution of undiagnosed, untreated, and uncontrolled diabetes mellitus (DM); (2) the relationship between socio-economic status (SES) and undiagnosed, untreated, and uncontrolled DM; and (3) if this relationship is mediated by gender. STUDY DESIGN: Cross-sectional nationally representative household-based survey. METHODS: We used data from the Bangladesh Demographic Health Survey from 2017 to 18. Our findings were based on the responses of 12,144 individuals aged 18 years and older. As a measure of SES, we focused on standard of living (hereinafter referred to as wealth). The study's outcome variables were prevalence of total (diagnosed + undiagnosed), undiagnosed, untreated, and uncontrolled DM. We used three regression-based approaches-adjusted odds ratio, relative inequality index, and slope inequality index-to assess different aspects of SES differences in the prevalence of total, undiagnosed, untreated, and uncontrolled DM. We used logistic regression analysis to look at the adjusted association between SES and the outcomes after gender stratification to see whether gender status moderates the association between SES and the targeted outcomes. RESULTS: In our sample analysis, the age-adjusted prevalence of total, undiagnosed, untreated, and uncontrolled DM was 9.1%, 61.4%, 64.7%, and 72.1%, respectively. Females had a higher prevalence of DM and undiagnosed, untreated, and uncontrolled DM than males. When compared to people in the poor SES group, people in the rich and middle SES groups had 2.60 times (95% confidence interval [CI] 2.05-3.29) and 1.47 times (95% CI 1.18-1.83) higher chance of developing DM. When compared to individuals in the poor SES group, those in the rich SES groups were 0.50 (95% CI 0.33-0.77) and 0.55 times (95% CI 0.36-0.85) less likely to have undiagnosed and untreated DM. CONCLUSIONS: In Bangladesh, rich SES groups were more likely than poor SES groups to have DM, whereas poor SES groups with DM were less likely than rich SES groups to be aware of their disease and obtain treatment. The government and other concerned parties are urged by this study to pay more attention to developing suitable policy measures to reduce the risk of DM, particularly among rich SES groups, as well as targeted efforts to screen for and diagnose DM in socio-economically disadvantaged groups.

Contamination status and associated ecological risk assessment of heavy metals in different wetland sediments from an urbanized estuarine ecosystem.

Sediment samples of different wetland types (saltmarsh, mangrove, tidal pool, mudflat and sandflat) from an urbanized estuary were analyzed to evaluate the contamination level and ecological risks of five heavy metals (Pb, Fe, Zn, Ni and Cr). The findings showed that the mean concentration (mg/kg) of heavy metals followed the order of Fe > Zn > Ni > Pb > Cr, while Pb and Fe concentrations exceeded the recommended guidelines. Heavy metals levels were highest in saltmarsh and mudflats. Contamination assessment indices e.g., contamination factor (CF), degree of contamination (CD), enrichment factor (EF), and geo-accumulation index (Igeo) revealed that the studied wetlands had low to moderate levels of pollution, meaning these sites receive medium levels of anthropogenic contamination compared with background values. For some of the studied metals, such as Pb, Zn, Fe, and Ni, the EF value was >1 in certain types of wetland, indicating anthropogenic sources, while Cr was <1 indicating natural sources. The pollution load index (PLI) value was determined to be <1, indicating perfection of soil, and was in the following order: mudflat> saltmarsh> tidal pool> mangrove > sandflat. The ecological risk (RI) value was the highest for saltmarsh and the lowest for sandflats. However, the RI value for Cr, Zn, Ni, and Pb was <30 suggesting that these metals pose a low risk in the local ecosystem. Cluster analysis (CA), principal component analysis (PCA), and Pearson's correlation specified that anthropogenic sources of metals.

Assessment of heavy metals and radionuclides in groundwater and associated human health risk appraisal in the vicinity of Rooppur nuclear power plant, Bangladesh.

This study was carried out to assess the groundwater quality through estimating trace and heavy metal concentration and radionuclide levels in the vicinity of the Rooppur Nuclear Power Plant (RNPP) sites. Twenty-six (26) parameters, including major cations (K, Na, Mg, Ca) and anions (SO4-2, NO3-), trace and heavy metals (Mn, Fe, Zn, Ni, Co, Pb, Cd, As, Hg, Cu, Li, Be, B, V, Ga, Sr, Ag, Ba) and radionuclides (137Cs, 226Ra, 228Ra, and 40K) were estimated in water samples in the study area. This study revealed that the concentration values (µg/L) of Mn (667.091 ± 7.481), Fe (191.477 ± 3.756), Sr (105.218 ± 13.424), and Zn (23.493 ± 1.134) were the dominant metals in the study area. Different pollution evaluation indices (i.e., HPI, HEI, NI, Cd) data revealed that the study area was under a low to medium level of pollution due to the presence of metals in water. Subsequently, non-carcinogenic and carcinogenic health risks assessments for both adults and children were conducted, which indicated that health risk for the carcinogenic metals were below the threshold level except As through oral exposure for both adult and children. The activity concentrations of 226Ra, 228Ra, and 40K were measured to demonstrate probable radioactivity pollution using Gamma-ray spectrometry (High-resolution HPGe detector). The highest activity concentration of 226Ra, 228Ra, and 40K in groundwater samples were 4.9 ± 1.24 Bq/L (RNPP-15), 1.71 ± 0.43 Bq/L (RNPP-15), and 15.43 ± 3.08 Bq/L (RNPP-15). Among the three studied radionuclides, 40K has the highest average activity concentration. The radiological indicators referred to the annual effective dose (AED) is 0.4273 mSv yr-1, which implies no significant cause of radiological risks and hazards (UNSCEAR guideline value). This study provides a baseline of trace and toxic metal contamination, radioactivity, and radiation levels in the groundwater of the nuclear power plant (being built) area.

Impact of Industrially Affected Soil on Humans: A Soil-Human and Soil-Plant-Human Exposure Assessment.

Heavy metal (HM) contaminated soil can affect human health via ingestion of foodstuffs, inhalation of soil dust, and skin contact of soil. This study estimates the level of some heavy metals in soils of industrial areas, and their exposures to human body via dietary intake of vegetables and other pathways. Mean concentrations of Cr, Fe, Cu, Zn, As and Pb in the studied soil were found to be 61.27, 27,274, 42.36, 9.77, 28.08 and 13.69 mg/kg, respectively, while in vegetables the respective values were 0.53, 119.59, 9.76, 7.14, 1.34 and 2.69 mg/kg. Multivariate statistical analysis revealed that Fe, Cu, Zn, and Pb originated from lithogenic sources, while Cr and As are derived from anthropogenic sources. A moderate enrichment was noted by Cr, As, and Pb in the entire sampling site, indicating a progressive depletion of soil quality. The bioaccumulation factor (BCF) value for all the vegetables was recorded as BCF < 1; however, the metal pollution index (MPI) stipulates moderately high value of heavy metal accumulation in the vegetable samples. Hazard Index (HI) of >0.1 was estimated for adults but >1 for children by direct soil exposure, whereas HI < 1 for both children and adults via dietary intake of vegetables. Estimated Total carcinogenic risk (TCR) value due to soil exposure showed safe for adults but unsafe for children, while both the population groups were found to be safe via food consumption. Children are found more vulnerable receptors than adults, and health risks (carcinogenic and non-carcinogenic) via direct soil exposure proved unsafe. Overall, this study can be used as a reference for similar types of studies to evaluate heavy metal contaminated soil impact on the population of Bangladesh and other countries as well.

Quality of Life Assessment by SF-36 among the Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) patients have substantial functional disability which poses a significant impact on the quality of life (QoL). So, this study aims to assess the QoL of RA patients by the Short Form Health Survey-36 (SF-36) questionnaire. Total sixty-two (62) rheumatoid arthritis patients were included in this cross-sectional observational study and were performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2018 to September 2019 according to selection criteria. A Bengali validated version of Medical Outcomes Study-36: Item Short Form Health Survey (SF-36) questionnaire was used to assess QoL. Among the sixty-two (62) patients, mean age was 44.18±12.14 years with female preponderance (77.4%). About one-fifth of the patients (19.4%, n=12) were illiterate and the majority (71.0%, n=44) were housewives. Amongst all, 53.2% (n=33) had monthly family income >20,000 taka. Forty percent (n=25) had a disease duration of 1 to 5 years. According to Disease Activity Score Sheet 28 (DAS-28), 36(58.1%) patients had moderate disease activity and 26(41.9%) patients had high disease activity. Among the 8 domains, the mental health domain had the highest score (42.77±13.78) and the role physical domain had the lowest (35.89±15.43). Male, literate patients with higher income had relatively better QoL. Patients with prolonged disease, high disease activity and irregular taking of Disease Modifying Anti-Rheumatic Drugs (DMARDs) had poor quality of life. A significant negative correlation was present between SF-36 scores and the DAS-28 scores (r = -0.803, p<0.001). Rheumatoid arthritis had a relatively poor quality of life regarding both physical and mental health components, but the physical health component was predominantly affected.

Assessment of Nutritional Status of Children with Chronic Kidney Disease in a Tertiary Care Level Hospital, Dhaka, Bangladesh.

Malnutrition is recognized to be a serious and common complication of chronic kidney disease (CKD) and is associated with increased morbidity and mortality in children. Early identification and swift intervention is the key in the management of malnutrition in CKD. The objective of the study was to determine the prevalence of malnutrition in children with CKD, to see the prevalence of malnutrition according to different anthropometric indices, to see the prevalence of malnutrition in different stages of CKD, to compare the nutritional status of children with CKD according to chronological age and height age. This analytical cross sectional study was done in the Department of Pediatric Nephrology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2014 to May 2015. Thirty children were enrolled in the study by purposive sampling. Nutritional assessment was done from dietary assessment by 72 hours recall and anthropometric measurements. Anthropometric indices were expressed in Z-scores and percentiles according to both chronological age and height age. Numeric data was analyzed by ANOVA and categorical data was tested by chi-square test. Difference between proportions was tested by Z-test of proportion. P value (<0.05) was considered significant. Data shows that the mean age of the studied population was 10.99±3.5 years with a male predominance. Eighteen (60.0%) children were on hemodialysis and rests on conservative management. Average calorie intake was 74.31±9.34% of estimated energy requirement (EER). The prevalence of malnutrition was 70.0% (95% CI: 53.6-86.4) according to height Z-score (HAZ), 66.7% (95% CI: 45.8-80.2) for weight Z-score (WAZ) and mid upper arm circumference (MUAC) Z-score, according to BMI percentile it was 56.7% (95% CI: 39-74.4), for mid arm muscle circumference (MAMC) the prevalence was 53.3% (95% CI: 35.5-71.1), according to arm muscle area (AMA) and arm fat area (AFA) the prevalence was 50.0% (95% CI: 38.1-67.9) and for triceps skin fold thickness (TST) it was 43.3% (95% CI: 25.5-61). Height was the most affected parameter and triceps skin fold thickness was the least affected parameter. When anthropometric indices were adjusted for height age, the prevalence was 36.7% according to BMI and TST, 30.0% according to AFA, 13.3% according to MUAC, 10.0% each for MAMC and AMA and 3.3% for WAZ. The difference in the prevalence of malnutrition according to this two approach was statistically significant in all parameters accept BMI, TST and AFA. Malnutrition was more associated with advanced stage of CKD. Low calorie intake was associated with low BMI and low serum albumin level. Serum albumin level was low in the present study population. In conclusion, prevalence of malnutrition is very high in children with CKD.

Antitubercular activity assessment of fluorinated chalcones, 2-aminopyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives: In vitro, molecular docking and in-silico drug likeliness studies.

A series of newer previously synthesized fluorinated chalcones and their 2-amino-pyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives were screened for their in vitro antitubercular activity and in silico methods. Compound 40 (MIC~ 8 µM) was the most potent among all 60 compounds, whose potency is comparable with broad spectrum antibiotics like ciprofloxacin and streptomycin and three times more potent than pyrazinamide. Additionally, compound 40 was also less selective and hence non-toxic towards the human live cell lines-LO2 in its MTT assay. Compounds 30, 27, 50, 41, 51, and 60 have exhibited streptomycin like activity (MIC~16-18 µM). Fluorinated chalcones, pyridine and pyran derivatives were found to occupy prime position in thymidylate kinase enzymatic pockets in molecular docking studies. The molecule 40 being most potent had shown a binding energy of -9.67 Kcal/mol, while docking against thymidylate kinase, which was compared with its in vitro MIC value (~8 µM). These findings suggest that 2-aminopyridine-3-carbonitrile and 2-amino-4H-pyran-3-carbonitrile derivatives are prospective lead molecules for the development of novel antitubercular drugs.

Psychological Assessment of Health-Care Workers Working during COVID-19 Pandemic Condition in Bangladesh.

The study was aimed to assess the psychological aspects and relevant factors of the health-care workers (HCWs) working in COVID 19 pandemic condition in Bangladesh. This online cross-sectional survey was conducted from different tertiary, secondary and primary hospitals in Bangladesh. Eligible 638 HCWs who were directly involved in the caring of confirmed or suspected COVID-19 patients were recruited in this study. The mental health was assessed by the Patient Health Questionnare-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Athens Insomnia Scale (AIS). High frequency of depression 536(84.0%), anxiety 386(60.5%) and insomnia 302(47.3%) was found among the HCWs, which were significantly higher in physicians (p<0.001) than nurses. Moderate to severe depression was significantly higher in female, whereas minimal to mild depression was significant in male HCWs (p=0.014). Symptoms of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.004) were significantly higher among the HCWs of primary and secondary compared to the tertiary level. The HCWs developed psychological trauma due to family health (45.3%) and contagious disease property (66.6%). After adjusting confounders, multivariable logistic regression analysis showed that physicians and HCWs of secondary hospital had significant symptoms of severe depression (OR=2.95, 95% CI=0.50-17.24; p<0.001), anxiety (OR=2.64, 95% CI=0.80-8.72; p<0.001) and insomnia (OR=2.67, 95% CI=1.23-5.84; p=0.018); whereas female HCWs had more risk of developing symptoms of severe insomnia (OR= 1.84; 95% CI=1.23-2.75; p=0.003). High rate of depression, anxiety and insomnia was found among HCWs working in the COVID-19 pandemic condition in this survey.

Quantitative assessment of dry mouth in scrub typhus using salivary scintigraphy.

Scrub typhus is an acute febrile illness caused by the intracellular pathogen Orientia tsutsugamushi. The clinical features include fever, myalgia, lymphadenopathy, and dry mouth. However, no studies have assessed the symptom of dry mouth in patients with scrub typhus. We investigated the pattern of salivary scintigraphy during the acute febrile state and compared it with any changes after treatment. Fourteen patients underwent both pre- and post-treatment salivary scintigraphy. Imaging analysis was conducted using radioactivity in the oral cavity, parotid glands, and submandibular glands. During the acute phase, the radioactivity in the oral cavity markedly decreased, while that in the parotid and submandibular glands was preserved. After treatment, radioactivity in the oral cavity showed a significant increase at 20-min, 40-min, and after wash-out. The ejection fraction (%) of the parotid glands also increased after treatment. In contrast, the radioactivity levels of the parotid and submandibular glands were not statistically different after treatment. Salivary scintigraphy indicated that insufficient saliva excretion from the salivary glands into the oral cavity was one reason for the dry mouth reported by patients with scrub typhus. In the future, salivary scintigraphy imaging could contribute to the evaluation of dry mouth in patients with scrub typhus.

Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach.

INTRODUCTION: Maintaining access to antimicrobials while preventing misuse is essential to combating the threat of antimicrobial resistance (AMR). The study objectives are to propose a framework of 16 indicators that can be used at the national level to assess the capacity to ensure access and curtail inappropriate use and to profile the antimicrobial supply chain for Bangladesh. METHODS: Using a framework based on a rational construct, we assessed the antimicrobial supply chain of Bangladesh, with a focus on key players and products using a scoping review to obtain and describe information on 16 indicators. With players, we mapped linkages, manufacturers' production capacity, and ownership, among others, and demand point characteristics-pharmacy and pharmacist density, pharmacy/medicine outlets dispersion, veterinary clinic/hospitals, veterinarians' density, product quality, and regulation. We assessed product characteristics including listing on the World Health Organization (WHO) Model Essential Medicines List (EML) and WHO Access, Watch, and Reserve (AWaRe) classification of the major (top 10) antibiotics for human use; the proportion of medically important antimicrobials (MIAs) in veterinary use; and pricing. Production capacity and price controls were used to assess access and listing on the WHO EML, AWaRe/MIA classification, and a calculated pharmacy-to-pharmacist ratio to assess use. RESULTS: Bangladesh has a high (98%) local antibiotic production capacity with pricing controls indicating the ability to ensure access. The presence of a high proportion of medicine outlets not under the control of pharmacists (4:1) and the high percentages of WHO Watch (54%) and MIAs (90%) of the major antibiotics are indicators of possible misuse. DISCUSSION: Most of the data used in the framework were publicly available. Bangladesh has the capacity to ensure access but needs to strengthen its ability to regulate the quality of antimicrobials and prevent their inappropriate use through antimicrobial stewardship at the community (medicine outlet) levels to check AMR. There may also be a need for more regulations on licensing of MIAs.

Infection with Blastocystis spp. and its association with enteric infections and environmental enteric dysfunction among slum-dwelling malnourished adults in Bangladesh.

BACKGROUND: Blastocystis spp. (Blastocystis) is a widely distributed gastrointestinal protist frequently reported in countries with tropical and sub-tropical climate. We sought to determine the factors associated with Blastocystis infection and investigate its role on biomarkers of intestinal health among slum-dwelling malnourished adults in Bangladesh. METHODOLOGY: Total 524 malnourished adults with a body mass index ≤18.5 kg/m2 were included in this analysis. Presence of Blastocystis in feces was evaluated by TaqMan Array Card assays. PRINCIPAL FINDINGS: Blastocystis was tested positive in 78.6% of the participants. Prevalence of infection with atypical strains of enteropathogenic Escherichia coli (aEPEC) (56% vs. 38%, p<0.001), and Trichuris trichiura (28% vs. 15%, p-value = 0.02) was significantly greater in adults with Blastocystis, while Giardia intestinalis was significantly lower (8% vs. 14%, p-value = 0.04) in Blastocystis positive adults. Malnourished adults who were living in households with high crowding index (aOR = 2.18; 95% CI = 1.11, 4.65; p-value = 0.03), and infected with aEPEC (aOR = 2.14; 95% CI = 1.35, 3.44; p-value = 0.001) and Trichuris trichiura (aOR = 1.97; 95% CI = 1.08, 3.77; p = 0.03) were more likely to be infected with Blastocystis. A significant negative relationship was observed between Blastocystis and fecal concentrations of alpha-1 antitrypsin (ß = -0.1; 95% CI = -1.7, -0.1; p-value<0.001) and Reg1B (ß = -3.6; 95% CI = -6.9, -3.0; p-value = 0.03). CONCLUSIONS: The study findings suggest that the presence of Blastocystis in human intestine influences gut health and may have potential pathogenic role in presence of other pathogens.

Clinical Presentation, Management and In-Hospital Outcome of COVID-19 among Non-Healthcare Personnel and Healthcare Personnel in a Tertiary Cardiac Care Hospital.

The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95±13.82 years vs. 34.08±11.11 years; p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%; p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%; p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.

3D-TTN: a power efficient cost effective high performance hierarchical interconnection network for next generation green supercomputer.

Green computing is an important factor to ensure the eco-friendly use of computers and their resources. Electric power used in a computer converts into heat and thus, the system takes fewer watts ensuring less cooling. This lower energy consumption allows to be less costly to run as well as reduces the environmental impact of powering the computer. One of the most challenging problems for the modern green supercomputers is the reduction of current power consumptions. Consequently, regular conventional interconnection networks also show poor cost performance. On the other hand, hierarchical interconnection networks (like-3D-TTN) can be a possible solution to those issues. The main focus for this paper is the estimation of power usage at the on-chip level for 3D-TTN with the various other networks along with the analysis of static network performance. In our analysis, 3D-TTN requires about 32.48% less router power usage at the on-chip level and can also achieve near about 21% better diameter performance as well as 12% better average distance performance than the 5D-Torus network. Similarly, it also requires only about 14.43% higher router power usage; however, can achieve 23.21% better diameter performance and 26.3% better average distance than recent hierarchical interconnection network- 3D-TESH. The most attractive feature of this paper is the static hop distance parameter and per watt analysis (power-performance). According to our power-performance results, 3D-TTN can also show better result than the 3D-Mesh, 2D-Mesh, 2D-Torus and 3D-TESH network even at the lowest network level. Moreover, this paper is also featured with the static effectiveness analysis, which ensures cost and time efficiency of 3D-TTN.