Role of Mifepristone in Trial of Labour after Previous Caesarean Delivery in Intrauterine Fetal Death.

When a baby dies in utero, the options are either to wait for spontaneous labour or to induce it. An obstetrician, encounters with a perplexity of choosing a management plan when this worst situation of IUFD coalesced by history of previous caesarean delivery. The ideal drug for the termination should not only be efficacious and cost-effective, but also be convenient enough to avoid operative interference arising from a wasted pregnancy. The study was aimed to evaluate efficacy, safety and compliance of oral mifepristone in trial of labour in case of IUFD after previous caesarean section. This was a cross sectional descriptive type of observational study conducted in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Bangladesh from February 2018 to August 2018. Total 50 patients were selected purposively based on inclusion criteria and diagnosed as IUFD with previous caesarean delivery. The patients were received mifepristone once and reviewed after 48 hours and those who were not attained favourable Bishop's score were counseled for mechanical induction. Antibiotics and analgesia were administered according to requirement. Data analysis was done using SPSS version 22.0. All the 50 women received 200 mg oral mifepristone. Forty-four 44(88.0%) women was delivered vaginally among them 18(36.0%) were delivered following mifepristone induction only and 26(52.0%) required additional induction method. The earliest induction to delivery interval following mifepristone was 13 hours. Twenty eight (63.6%) cases were discharged within 72-120 hours. After 48 hours following induction there was significant improvement of Bishop's score. In this study 6(12.0%) out of 50 cases were reasoned for laparotomy and blood transfusion was required for them. There was no statistically significant difference according to gestational age in mode of delivery (p>0.05). There was no difference observed in mean induction to delivery interval between second and third trimester at 5% level of significance (p>0.05). In this study, the women showed drastic improvement in cervical score following induction with mifepristone and decreased repeat caesarean rate. Eventually, the length of agony of receiving dead baby was cut short without much more ailments. Hence, mifepristone may be considered as a safe, efficacious, convenient and cost-effective induction agent for labour induction in women with dead fetus in utero in previously scarred uterus.

Association of Low Vitamin D Level with Pelvic Organ Prolapse in Post Menopausal Women: A Case Control Study.

Pelvic organ prolapse refers to protrusion of the pelvic organ into or out of the vaginal canal. One in four women in the USA suffer from some type of pelvic floor disorder including pelvic organ prolapse and frequency of pelvic organ prolapse is more with increasing age. In Bangladesh, 15.6% women suffered from pelvic organ prolapse and more than 11.0% of women require surgical correction of prolapse in their life times. According to few researches, there is an observed association between low vitamin D levels with pelvic organ prolapse but this finding is not unequivocal. This case control study has been conducted in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from October 2018 to August 2020 to investigate the level of vitamin D in patients with and without pelvic organ prolapse to explore the association of low vitamin D with pelvic organ prolapse. A total 148 participants of 52 years or older attending the out or inpatient department were enrolled in the study. The study population was divided into two groups, a case group (n=74) consisting of patients with pelvic organ prolapse and a control group (n=74) comprising of women without pelvic organ prolapse. After taking informed written consent the serum vitamin D level of all participants was measured by CMIA technology with flexible assay protocols at Biochemistry and Molecular Biology department of the same institute. All necessary Data were collected on variables of interest by using the structured questionnaire pre-designed for interview, observation, clinical examination, and biochemical Data collection. Distributions were expressed by mean and standard deviation for continuous variables and by frequency and percentage for qualitative variables. Student's t-test and Chi square test were done to see the significance of differences between Group I and Group II. Odds ratio, correlation coefficient, and multivariate logistic regression analysis was done to assess the association of low vitamin D level with pelvic organ prolapse. Mean±SD level of Vitamin D in the case group was 13.96±5.18ng/ml and in the control group was 21.08±5.77ng/ml respectively. The difference was statistically significant (p<0.05). Moreover, the vitamin D levels were inversely proportionate with the severity of pelvic organ prolapse. OR (95% CI), of two groups showed risk of developing pelvic organ prolapse 5.63 times higher in women with decreased vitamin D level. Thus it can be concluded that women having low level of vitamin D have more chance of developing pelvic organ prolapse.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination.

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Detection and Primary Analysis of Antibacterial Activity in the Ethyl Acetate Extract of Lantana camara L. Leaves.

Lantana camara L. is generally considered an invasive plant species throughout the world. Research works carried out in recent years have proved its significance as a source of antimicrobial lead molecules. The aim of this research was to identify the antibacterial substance(s) in this plant species found locally and to test its antibacterial effect against selected bacterial strains. Plant samples were collected from the University of Dhaka campus. Ethanol and ethyl acetate extracts of the plant leaves were tested against Escherichia coli, Bacillus subtilis, Pneumococcus and Klebsiella. Both the ethanol and the ethyl acetate extracts showed significant activity against Bacillus subtilis. In disk diffusion antibacterial assay, ethanol extract showed greater activity than ethyl acetate extract against Bacillus subtilis and the zones of inhibition were 14 mm and 12 mm respectively. However, ethyl acetate extract showed greater activity than ethanol extract in TLC bioautography assay. Ethyl acetate and ethanol extracts showed very little activity against Pneumococcus and Klebsiella, but no antibacterial potential against Escherichia coli. Fractionation of the ethyl acetate extract by TLC and bioautography detection of antibacterial activity in TLC encouraged further purification of the lead active compound(s). Phytochemical composition analysis of the ethyl acetate extract showed the presence of alkaloids, steroids, phenolic compounds and glycosides.

Gender and urban-rural influences on antibiotic purchasing and prescription use in retail drug shops: a one health study.

INTRODUCTION: Few studies have reported antibiotic purchases from retail drug shops in relation to gender in low and middle-income countries (LMICs). Using a One Health approach, we aimed to examine gender dimensions of antibiotic purchases for humans and animals and use of prescriptions in retail drug shops in Bangladesh. METHODS: We conducted customer observations in 20 drug shops in one rural and one urban area. Customer gender, antibiotic purchases, and prescription use were recorded during a four-hour observation (2 sessions of 2 hours) in each shop. We included drug shops selling human medicine (n = 15); animal medicine (n = 3), and shops selling both human and animal medicine (n = 2). RESULTS: Of 582 observations, 31.6% of drug shop customers were women. Women comprised almost half of customers (47.1%) in urban drug shops but only 17.2% of customers in rural drug shops (p < 0.001). Antibiotic purchases were more common in urban than rural shops (21.6% versus 12.2% of all transactions, p = 0.003). Only a quarter (26.0%) of customers who purchased antibiotics used a prescription. Prescription use for antibiotics was more likely among women than men (odds ratio (OR) = 4.04, 95% CI 1.55, 10.55) and more likely among urban compared to rural customers (OR = 4.31 95% CI 1.34, 13.84). After adjusting for urban-rural locality, women remained more likely to use a prescription than men (adjusted OR = 3.38, 95% CI 1.26, 9.09) but this was in part due to antibiotics bought by men for animals without prescription. Customers in drug shops selling animal medicine had the lowest use of prescriptions for antibiotics (4.8% of antibiotic purchases). CONCLUSION: This study found that nearly three-quarters of all antibiotics sold were without prescription, including antibiotics on the list of critically important antimicrobials for human medicine. Men attending drug shops were more likely to purchase antibiotics without a prescription compared to women, while women customers were underrepresented in rural drug shops. Antibiotic stewardship initiatives in the community need to consider gender and urban-rural dimensions of drug shop uptake and prescription use for antibiotics in both human and animal medicine. Such initiatives could strengthen National Action Plans.

Use of Drugs Considering Route of Administration on Drug Prescription Pattern for Bronchial Asthma in a Tertiary Level Hospital.

Bronchial asthma is one of the much known long-term respiratory conditions. Incidence is increasing, in developing countries like Bangladesh. Cross-sectional type of observational study was carried out over one year (July 2017 to June 2018) in the department of Pharmacology with collaboration of the department of Respiratory Medicine and Medicine, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh. A total of 160 patients were selected non-randomly for the study. Inhalation route (52.35%) was the most preferred one over oral route (47.65%). In total 245 drugs, 131 FDC drugs (Salmeterol + Fluticasone) were prescribed with inhalation therapy which is 53.46%, another 9 FDC drugs that is (Ipratropium bromide + Salbutamol) were prescribed with inhalation therapy which is 3.67%, 101 drugs (Salbutamol) were prescribed with inhalation therapy that is 41.23%, 4 drugs (Beclomethasone) were prescribed with inhalation therapy that is 1.64%. Majority of patient were taking inhalation form of anti-asthmatic drugs.

Procalcitonin versus C-Reactive Protein as a Biomarker for Prediction of Bacterial Infection in Children with Febrile Neutropenia in Acute Leukemia.

Febrile neutropenia (FN) is a frequently occurring treatment-related complication with significant morbidity and mortality for childhood acute leukemia. Early diagnosis and assessment of severity are essential steps for early comprehensive treatment to reduce FN-related morbidity and mortality. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can be used to assess and predict the bacterial infection in children with febrile neutropenia. The objective of the study was to determine the role of procalcitonin and CRP as a biomarker for prediction of bacterial infection in children with FN in acute leukemia. This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2020 to July 2021. Total 58 Children with acute leukemia aged 1 to <18 years with FN were analyzed in this study. A proper history and thorough physical examination were carried out. The blood sample was sent for biomarkers (Procalcitonin and CRP) within 24 hours of the onset of FN and other investigations, such as Complete blood count, Blood C/S, Urine R/E and C/S. Metabolic workup (SGPT, Serum Creatinine, Serum Electrolytes, Serum Ca+) was also done in every patient. Stool R/E & C/S, Chest X-ray, Wound swab for C/S were done when the patient presented with diarrhoea, cough, respiratory distress and focal sepsis respectively. In this study, the mean age of the patients was 6.62±4.07 years (1.10-16.0 years) and 34 patients (58.6%) were male. In 65.5% of patients, localizing signs of infection were not identified. Of the 58 patients, 12 patients (20.7%) showed positive blood culture and 2 patients (3.4%) showed positive urine culture. Klebsiella spp (41.0%) was the most frequent organism isolated followed by Acinetobacter (17.0%), Pseudomonas (17.0%) and E. coli (17.0%). The median PCT levels were significantly higher in patients with bacterial infection than patients without bacteremia (26.10µg/l versus 0.78µg/l, p=0.002) and PCT level >2µg/l was significantly associated with bacteremia. The median CRP levels in the bacteremia and without-bacteremia patients were 137.4mg/L and 54.17mg/L, respectively (p=0.036). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.797 (95% CI 0.651-0.943) for PCT and 0.697 (95% CI 0.54-0.855) for CRP in predicting the bacterial infection. PCT and CRP both are useful biomarkers for the prediction of bacteremia, but PCT may be a superior early biomarker as compared to CRP to predict bacterial infection in children with febrile neutropenia in acute leukemia.

Label free flexible electrochemical DNA biosensor for selective detection of Shigella flexneri in real food samples.

An effective tool for early-stage selective detection of the foodborne bacterial pathogen Shigella flexneri (S. flexneri) is essential for diagnosing infectious diseases and controlling outbreaks. Here, a label-free electrochemical DNA biosensor for monitoring S. flexneri is developed. To fabricate the biosensor, detection probe (capture probe) is immobilized on the surface of poly melamine (P-Mel) and poly glutamic acid (PGA), and disuccinimidyl suberate (DSS) functionalized flexible indium tin oxide (ITO) electrode. Anthraquinone-2-sulfonic acid monohydrate sodium salt (AQMS) is used as a signal indicator for the detection of S. flexneri. The proposed DNA biosensor exhibits a wide dynamic range with concentration of the targets ranging from 1 × 10-6 to 1 × 10-21 molL-1 with a limit of detection (LOD) of 7.4 × 10-22 molL-1 in the complementary linear target of S. flexneri, and a detection range of 8 × 1010-80 cells/ml with a LOD of 10 cells/ml in real S. flexneri sample. The proposed flexible biosensor provides high specificity for the detection of S. flexneri compared to other target signals such as discrete base mismatches and different bacterial species. The developed biosensor displayed excellent recoveries in detecting S. flexneri in spiked food samples. Therefore, the proposed biosensor can serve as a model methodology for the detection of other pathogens in a broad span of industries.

Development of a hematite nanotube and tyramine-based drug carrier against drug-resistant bacteria Klebsiella pneumoniae.

In this study, hematite nanotube (HNT) and tyramine-based advanced nano-drug carriers were developed for inhibiting the growth of Klebsiella pneumoniae (K. pneumoniae). The HNT was synthesized by following the Teflon line autoclaved assisted hydrothermal process and tyramine was incorporated on the surface of the HNT to fabricate the formulated nano-drug. The nano-drug was prepared by conjugating meropenem (MP) on the surface of Tyramine-HNT and characterized using different techniques, such as scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared (ATR-FTIR), etc. Furthermore, the drug-loading efficiency and loading capacity were measured using a UV-vis spectrometer. The pH, amount of Tyr, and HNT required for drug loading were optimized. A controlled and gradual manner of pH-sensitive release profiles was found after investigating the release profile of MP from the carrier drug. The antibacterial activity of MP@Tyramine-HNT and MP was compared through the agar disc diffusion method which indicates that antibacterial properties of antibiotics are enhanced after conjugating. Surprisingly, the MP@Tyramine-HNT exhibits a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of K. pneumoniae lower than MP itself. These results indicate the nanocarrier can reduce the amount of MP dosed to eradicate K. pneumoniae.

Evaluation of Liver Function Tests in ß-Thalassemia Major Children.

Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However these recurrent blood transfusions result in iron overload which along with chelation therapy causes deterioration of liver function. Aim of the study was to evaluate the liver function tests in ß-thalassemia major patients. This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. In this study, 50 diagnosed patients of ß Thalassemia major (Group A) and 50 apparently healthy children (Group B) of both sexes were selected from the department of Paediatrics, Dhaka medical college. The study parameters were serum ferritin, bilirubin, AST, ALT, ALP. The results were compared statistically between groups. Serum ferritin level (mean±SD) in thalassemic major patients in Group A (890±446.38 microgram/L) which is significantly higher above normal level. Serum bilirubin in Group A (3.27±2.62 mg/dl) and in Group B (0.48±0.24 mg/dl), Serum ALT in Group A (53.06±34.0 U/L) and in Group B (16.70±4.81 U/L), AST in Group A (84.56±33.54 U/L) and in Group B (11.60±2.72 U/L) and ALP levels in Group A (422.42±226.99 IU/L) and in Group B (221.86±80.54 IU/L). All the values were significantly higher (p<0.001) in ß-thalassemia patient than that of normal children. This study concludes that liver function parameters are significantly higher in ß thalassemia major patients. So routine evaluation of liver function tests may be advocated for thalassemic patients to predict early onset of hepatic dysfunction.

Clinical and Demographic Predictor of the Advanced Stage of Carcinoma Cervix in a Tertiary Level Hospital of Bangladesh.

Though cervical cancer is a preventable disease it is the most progressive and devastating diseases posing a threat of mortality for women of developing countries. Majority of the cases present to hospital at advanced stage when treatment is less feasible. Objective is to determine the factors associated with the advanced stage presentation to the hospital, socio-demographic factor, patterns of complications and histological types among patients with carcinoma cervix. This was an observational descriptive type of cross-sectional study carried out in the department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from 15 January to 27 September 2017. Women who were newly confirmed to have cervical cancer by histology were enrolled. Stages IIB and above was considered as advanced disease. The patients were interviewed face to face by the researcher for the purpose of collection of data. Then the patients were examined by the researcher for certain sings and those would be recorded in the check-list. Histopathological report was noted in data collection sheet. In this study data analysis was done by SPSS version 22.0. Total 66 clinically and histologically confirmed advanced ca-cervixes were taken up during this study. Most common stage was stage III, 49(74.2%) out of 66 population. Majority of female were found 34(51.5%) in age group 51-60. More than half of population 54(81.8%) were living with their husband and 12(18.1%) were widow at the time of study. High level of illiteracy among women and their problematic health seeking behavior for gynecological symptoms are responsible for advanced diagnosis of cervical cancer.

Malignant Infantile Osteopetrosis with Bone Marrow Involvement.

Osteopetrosis (Marble bone disease) is a very rare congenital genetic disease of skeleton, resulting from defective bone resorption, due to functionally defective osteoclast, leading to accumulation of excessive bone mass. Malignant infantile osteopetrosis (MIO) is one of the varieties of osteopetrosis, which is fatal and is diagnosed in early infancy. Malignant infantile osteopetrosis is present with abnormal bone remodeling, hematological abnormities, features of extramedullary hematopoiesis. Radiology is the key of diagnosis. In this case, we present a 5-monthold male infant diagnosed as malignant infantile osteopetrosis, who presented with bronchopneumonia, anemia, thrombocytopenia, hepatosplenomegaly, failure to thrive (FTT).

A DNA functionalized advanced electrochemical biosensor for identification of the foodborne pathogen Salmonella enterica serovar Typhi in real samples.

An efficient platform for the detection of Salmonella enterica serovar Typhi (S. Typhi) is essential for early-stage diagnosis of typhoid to prevent and contain outbreaks. Here, we fabricated an electrochemical DNA biosensor for selective identification of S. Typhi in real samples. The biosensor has been fabricated by immobilizing an amine labelled S. Typhi specific single-strand capture probe on the surface of gold nanoparticles (AuNP) and poly cysteine (P-Cys) modified screen-printed electrode. Differential pulse voltammetry (DPV) of anthraquinone-2-sulfonic acid monohydrate sodium salt (AQMS) as a signal indicator was monitored to detect S. Typhi by hybridization of target DNA with the probe DNA. The fabricated biosensor shows a detection range of 1 × 10-6 to 1 × 10-22 molL-1 with a LOD of 6.8 × 10-25 molL-1 in S. Typhi complementary linear target and 1.8 × 105 to 1.8 CFUml-1 with a LOD of 1 CFUml-1 in a real S. Typhi sample. The biosensor shows excellent discrimination ability to some bases mismatched and different bacterial cultures (same and distant genera). The most beneficial points of the proposed DNA biosensor are the lower limit of detection and the ability to reuse the biosensor more than 6 to 7 times. In addition, the practicability of the biosensor was investigated via detecting S. Typhi in blood, poultry feces, egg, and milk whereby excellent recoveries ranging from 96.54 to 103.47% were demonstrated indicating that this biosensor might be the most promising diagnostic tool for monitoring S. Typhi in clinical and food samples.

Efficacy of Carbetocin versus Oxytocin for the Prevention of Primary Post Partum Haemorrhage after Caesarean Section in Mymensingh Medical College Hospital, Bangladesh.

Prevention of postpartum haemorrhage has been a major issue for its life threatening impact on maternal morbidity and mortality worldwide. Conventional continuous infusion of oxytocin has been employed for this condition. Apparently, in place of conventional oxytocics, application of carbetocin with longer half-life shows the same clinical benefits. This requires doing this present study. To compare the effectiveness of I/V bolus cabetocin and oxytocin infusion used for prevention of primary PPH after caesarean section. This descriptive cross-sectional comparative study was carried out in Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from November 2015 to April 2016. A total of 100 pregnant women undergoing elective or emergency caesarean section were enrolled and divided into two groups on the basis of exclusion and inclusion criteria. Group I (n=50) received bolus of 100µgm IV carbetocin after delivery of the baby & Group II (n=50) received 20 IU of oxytocin in 1000ml of Hartman solution I/V in 8 hours continuous infusion after delivery of the baby. Baseline demographic and obstetric profile, indications for C/S, estimated blood loss, hemoglobin level, additional uterotonic agents, blood pressure and the diuresis were compared immediate postoperatively and 24 hours after operation. The patients were followed up for 24 hours after operation regarding outcomes variables. Baseline profiles were similar between two groups. Regarding haemodynamic effects, both drugs have a hypotensive effect but a greater reduction in blood pressure is found in oxytocin group. There was no significant difference in respect of estimated blood loss, blood transfusion, additional oxytocics and diuresis between two groups. It can be concluded that a single injection of carbetocin is as effective as continuous oxytocin infusion to prevent postpartum haemorrhage, with similar haemodynamic profile. So, carbetocin as a uterotonic agent is an acceptable alternative for prevention of postpartum haemorhage after caesarean section.

Three-Jaw Chuck Pinch Strength and its Correlation with Hand Depth in Electronics Technicians.

The three jaw chuck pinch is a variety of pinch technique where thumb opposes both middle and index fingers. Pinch strength is generally influenced by the health status and level of physical activity of a person. The present study was conducted to measure the correlation of three-jaw chuck pinch strength with hand depth in electronics technicians working in Dhaka Metropolitan City. The data obtained from the study may be used as a base line for other professions as well as for research in our country. This cross sectional, analytical study was carried out in the department of Anatomy, Dhaka Medical College, Dhaka, Bangladesh from July 2015 to June 2016 on 100 adults male electronics technicians and 100 adult sedentary workers. Electronics technicians were considered as case group and sedentary workers were considered as control group. Case group was further subdivided according to their working experiences. Study subjects were selected by convenient purposive sampling technique. Hand depth was measured by digital slide calipers and pinch gauge was used to measure the three-jaw chuck pinch strength. The mean three-jaw chuck pinch strength was significantly higher (p<0.05) in case group than in the control group. Significant difference were also observed between case group and control group in the mean hand depth (p<0.05). Mean hand depth was greater in case group than that of control group. Three-jaw chuck pinch strength showed significant positive correlation with hand depth in case group. Case group was further subdivided according to their working experiences, the mean three-jaw chuck pinch strength and hand depth was significantly higher (p<0.05) in more working experience group than in less working experience group. Three-jaw chuck pinch strength showed significant positive correlation with hand depth.

Ceftizoxime loaded ZnO/L-cysteine based an advanced nanocarrier drug for growth inhibition of Salmonella typhimurium.

L-Cysteine coated zinc oxide (ZnO) nano hollow spheres were prepared as a potent drug delivery agent to eradicate Salmonella enterica serovar Typhimurium (S. typhimurium). The ZnO nano hollow spheres were synthesized by following the environmentally-friendly trisodium citrate assisted method and L-cysteine (L-Cys) conjugate with its surface. ZnO/L-Cys@CFX nanocarrier drug has been fabricated by incorporating ceftizoxime with L-Cys coated ZnO nano hollow spheres and characterized using different techniques such as scanning electron microscope (SEM), attenuated total reflection Fourier transform infrared (ATR-FTIR), and X-ray diffraction (XRD) etc. Furthermore, the drug-loading and encapsulation efficiency at different pH levels was measured using UV-vis spectrometer and optimized. A control and gradual manner of pH-sensitive release profile was found after investigating the release profile of CFX from the carrier drug. The antibacterial activity of ZnO/L-Cys@CFX and CFX were evaluated through the agar disc diffusion method and the broth dilution method, which indicate the antibacterial properties of antibiotics enhance after conjugating. Surprisingly, the ZnO/L-Cys@CFX exhibits a minimum inhibitory concentration (MIC) of 5 µg/ml against S. typhimurium is lower than CFX (20 µg/ml) itself. These results indicate the nanocarrier can reduce the amount of CFX dosed to eradicate S. typhimurium.

Development of an advanced DNA biosensor for pathogenic Vibrio cholerae detection in real sample.

Due to the epidemics of emerging microbial diseases worldwide, the accurate and rapid quantification of pathogenic bacteria is extremely critical. In this work, a highly sensitive DNA-based electrochemical biosensor has been developed to detect Vibrio cholerae using gold nanocube and 3-aminopropyltriethoxysilane (APTES) modified glassy carbon electrode (GCE) with DNA carrier matrix. Electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) experiments were performed to interrogate the proposed sensor at each stage of preparation. The biosensor has demonstrated high sensitivity with a wide linear response range to target DNA from 10-8 to 10-14 (R2= 0.992) and 10-14 to 10-27 molL-1 (R2= 0.993) with a limit of detection (LOD) value of 7.41 × 10-30 molL-1 (S/N = 5). The biosensor also exhibits a selective detection behavior in bacterial cultures that belong to the same and distant genera. Moreover, the proposed sensor can be used for six consecutive DNA assays with a repeatability relative standard deviations (RSD) value of 5% (n = 5). Besides, the DNA biosensor shows excellent recovery for detecting V. cholerae in poultry feces, indicating that the designed biosensor could become a powerful tool for pathogenic microorganisms screening in clinical diagnostics, food safety, and environmental monitoring.

Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel.

BACKGROUND: South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural change communication (SBCC) to increase the appropriate use of antibiotics. METHODS: We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) registered physicians and 4) pharmaceutical companies/medical sales representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, prioritise audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. RESULTS: Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritised as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change: suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek registered physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, important antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions, referring them to registered physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. CONCLUSIONS: We prioritised drug shops for intervention delivery to all drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and address the impact on profit and livelihoods for drug shop staff for optimal compliance.

Panhypopituitarism in an Adult Male and Hypogonadism as a First Clue.

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.

What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study.

BACKGROUND: Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore understandings of the use and functions of antibiotics; awareness of AMR and perceived patient or customer demand and adherence among HCPs for human and animal medicine in Bangladesh. METHODS: We used an ethnographic approach to conduct face-to-face, in-depth interviews with 46 community HCPs in one urban and one rural area (Gazipur and Mirzapur districts respectively). We purposefully selected participants from four categories of provider in human and veterinary medicine: qualified; semi-qualified; auxiliary and unqualified. Using a grounded theory approach, thematic analysis was conducted using a framework method. RESULTS: Antibiotics were considered a medicine of power that gives quick results and works against almost all diseases, including viruses. The price of antibiotics was equated with power such that expensive antibiotics were considered the most powerful medicines. Antibiotics were also seen as preventative medicines. While some providers were well informed about antibiotic resistance and its causes, others were completely unaware. Many providers mistook antibiotic resistance as the side effects of antibiotics, both in human and animal medicine. Despite varied knowledge, providers showed concern about antibiotic resistance but responsibility for inappropriate antibiotic use was shifted to the patients and clients including owners of livestock and animals. CONCLUSIONS: Misconceptions and misinformation led to a wide range of inappropriate uses of antibiotics across the different categories of human and animal healthcare providers. Low awareness of antibiotic action and antibiotic resistance were apparent among healthcare providers, particularly those with little or no training and those in rural areas. Specific and targeted interventions to address AMR in Bangladesh should include educational messages on the rational use of antibiotics and how they work, targeting all types of healthcare providers. While tailored training for providers may increase understanding of antibiotic action and improve practices, more far-reaching structural changes are required to influence and increase responsibility for optimising antibiotic dispensing among all HCPs.