The Demographic Analysis of the Probable COVID-19 Cases in Terms of RT-PCR Results and Age.

BACKGROUND: Despite global prevention and quarantine efforts, the incidence of COVID-19 disease continues to increase. As a possible cause, our aim was to investigate which parameters increase the sensitivity or protection against COVID-19 between RT-PCR positive and RT-PCR negative cases in patients admitted to the emergency department. METHODS: In the pandemic process, patients admitted to the hospital with suspicion of COVID-19 were evaluated retrospectively. RT-PCR test was divided into + (for Group 1) and - (Group 2). The gender, age, clinical information, application symptoms, and comorbidity data of the patients were evaluated. RESULTS: One hundred and sixty-seven cases were evaluated in the study. Group 1: 88 cases, M/F ratio: 46/42 and average age 48 ± 17.3 years, Group 2: 79 cases, M/F ratio was approximately 3/2, and the average age was 48.3 ± 19.4 years. When the groups were compared in terms of symptoms, fever, cough, weakness, and headache were prominent in Group 1, whereas the contact was significantly higher in Group 2 (p < 0.05). Among the comorbid diseases, only COPD showed a significant difference between the groups, and it was found significantly higher in Group 2 (p < 0.05). CONCLUSIONS: Cough, headache, and fever were found valuable in the detection of cases. Attention should be paid to contact isolation to circumvent the pandemic process with less damage. Having chronic diseases, especially COPD, increases the risk of infection with SARS-CoV-2. Close monitoring and control of chronic diseases can positively change the course of COVID-19.

Hesperidin, a citrus flavonoid ameliorates hyperglycemia by regulating key enzymes of carbohydrate metabolism in streptozotocin-induced diabetic rats.

The present study investigated the protective effect of hesperidin on carbohydrate metabolizing enzymes in streptozotocin-induced diabetic rats. Hesperidin was administered to streptozotocin-induced (40 mg/kg b.w.) diabetic rats at different dosages of (25, 50, 100 mg/kg b.w.) respectively for 30 days to evaluate its effect on fasting plasma glucose, insulin, glycosylated hemoglobin, hemoglobin, and carbohydrate metabolic enzymes. The plasma glucose levels were significantly reduced in a dose-dependent manner in hesperdin-treated group of rats when compared to the diabetic control rats. In addition, concomitant increase in hemoglobin and insulin levels and a decrease in glycosylated hemoglobin were observed in treated group of rats. The activities of the hepatic key enzymes of carbohydrate metabolism such as hexokinase and glucose-6-phosphate dehydrogenase were significantly increased, whereas glucose-6-phosphatase and fructose-1,6-bisphosphatase were significantly decreased. Furthermore, hesperidin administration prevented the loss in body weight and improved the glycogen content in the hepatic tissue of diabetic animals by reinstating the activities of glycogen synthase and glycogen phosphorylase. These results showed that hesperidin has potential antihyperglycemic activity in streptozotocin-induced diabetic rats. This was further supported by the histological studies of pancreas and liver.

Zr4+ ions embedded chitosan-soya bean husk activated bio-char composite beads for the recovery of nitrate and phosphate ions from aqueous solution.

Removal of nitrate and phosphate ions using Zr4+ ions embedded chitosan-soya bean husk activated bio-char composite beads (Zr-CS-SAC) was carried out by batch mode to overcome the environmental problems due to eutrophication. The adsorbent was well characterized by using Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) analysis with energy dispersive X-ray analyzer (EDX), X-ray diffraction analysis (XRD), Brunauer-Emmett-Teller surface analyzer (BET), thermo-gravimetric analysis (TGA) and differential thermal analysis (DTA) etc. The adsorption equilibrium models of Langmuir, Freundlich and D-R isotherms were evaluated and the results described that the Freundlich model was the best for both the adsorbates of nitrate and phosphates ions with respective capacities of 90.09 and 131.29 mg g-1 at 30 °C. Studies on thermodynamic parameters revealed the endothermic and spontaneous nature of the adsorption. Different kinetic models were studied and found that pseudo-second-order kinetic data were well fitted for adsorption process. These results suggested that Zr-CS-SAC composite beads as a promising adsorbent for the removal of nitrate and phosphate ions from water with good removal efficiency, adsorbability, recyclability and non- toxicity.

Lanthanum (III) encapsulated chitosan-montmorillonite composite for the adsorptive removal of phosphate ions from aqueous solution.

In the present work, lanthanum (III) encapsulated chitosan-montmorillonite composite (La-CS-MMT) was prepared as an adsorbent for the effective removal of phosphate ions from aqueous solution. Characterization of the adsorbent using FT-IR, XRD, SEM with EDX, TGA and DTA techniques were carried out. Batch adsorption experiments were carried out to optimize the effects of various operating parameters viz., shaking time, initial concentration of phosphate ions, dosage, competitor co-existing ions, pH and temperature. Phosphate ions adsorbed effectively on La-CS-MMT composite through hydrogen bonding and by outer-sphere complex formation mechanism. Freundlich isotherm model fit well with the equilibrium isotherm data. The experimental values of ∆G°, ∆S° and ∆H° revealed that the nature of adsorption was feasible, spontaneous and exothermic. The kinetic study was well fitted with pseudo-second-order model. Regeneration study of the spent La-CS-MMT-P composite was carried out upto five cycles and found that about 70% of adsorption efficiency was retained.

One pot synthesis of chitosan grafted quaternized resin for the removal of nitrate and phosphate from aqueous solution.

The present study deals with the synthesis of chitosan quaternized resin for efficient removal of nitrate and phosphate from aqueous solution. The resin was characterized with FTIR, SEM with EDX and XRD. Batch method was carried out to optimize various parameters such as contact time, initial concentration of nitrate and phosphate, dosage, pH, co-anions and temperature on the adsorption capacity of the adsorbent. The adsorption process illustrated that the Freundlich isotherm and the pseudo-second order are the best fitted models for the sorption of both anions. The respective negative values of ΔH° and ΔG° revealed that the adsorption of both the anions were exothermic and spontaneous. The removal efficiency of nitrate and phosphate on chitosan quaternized resin were 78% and 90% respectively with 0.1g of adsorbent and the initial concentration as 100mg/L. Nitrate and phosphate anions adsorbed effectively on chitosan quaternized resin by replacing Cl- ions from quaternary site through electrostatic attraction as well as ion-exchange mechanism. Hydrogen bonding also played important role in adsorption process. Even after 7th regeneration cycle the adsorbent retained its adsorption capacity as 23.7mg/g and 30.4mg/g for both nitrate and phosphate respectively.

Beyond pregnancy--the neglected burden of mortality in young women of reproductive age in Bangladesh: a prospective cohort study.

OBJECTIVE: To describe proportionate mortality and causes of death unrelated to pregnancy. DESIGN: Prospective cohort study. SETTING: Rural northwest Bangladesh. POPULATION: A cohort of 133,617 married women of reproductive age. METHODS: Verbal autopsies were conducted for women who died whilst under surveillance in the cohort trial. Physician-assigned causes of death based on verbal autopsies were used to categorise deaths. MAIN OUTCOME MEASURES: The proportion of deaths due to non-communicable diseases, infectious diseases, injury or pregnancy. RESULTS: Of the 1107 deaths occurring among women between 2001 and 2007, 48% were attributed to non-communicable diseases, 22% to pregnancy, 17% to infections, 9% to injury and 4% to other causes. CONCLUSIONS: Although focus on pregnancy-related mortality remains important, more attention is warranted on non-communicable diseases among women of reproductive age.

Assessment of occupational and patient dose from diagnostic and therapeutic radiation exposure using thermoluminescent dosimetry.

Radiation doses of occupational personnel exposed from diagnostic x rays, therapeutic installations, and patients were measured using thermoluminescent dosimeters. The monthly occupational doses from diagnostic x ray ranged from 0.1076 mSv to 0.5774 mSv, and those from therapeutic treatment ranged from 0.365 mSv to 0.657 mSv, which is within the dose limit recommended by ICRP 60. The patient organ doses were evaluated and found to range from 0.0615 mSv s(-1) to 2.8823 mSv s(-1) for gonad, 0.3676 mSv s(-1) to 2.1088 mSv s(-1) for thyroid, and 0.00972 mSv s(-1) to 4.01 mSv s(-1) for eyes.

Observations questioning a protective role for breast-feeding in severe rotavirus diarrhea.

To investigate whether breast-feeding protects children against rotavirus diarrhea (RVD), we compared rates of breast-feeding by age and enteric pathogens among 2,276 children with diarrhea 0-4 years of age who attended a diarrhea hospital in Bangladesh. Infants 0-5 months were less likely to be breast-fed than children 6-11 months of age suggesting that some protection against diarrhea with all agents was associated with early breast-feeding. In every age group studied, breast-feeding was more common among children with RVD than among children with non-RVD whereas it was less common among children with cholera and shigellosis. Twenty percent of breast milks consumed by infants less than 1 year of age had high levels of neutralizing activity (greater than or equal to 320) to the Wa strain of rotavirus but this activity did not appear to be protective since the 30 infants with RVD consumed milk which had titers that did not differ significantly from those consumed by 44 infants with diarrhea of other cause. Despite the prolonged breast-feeding which is common in Bangladesh, the mean age of hospitalization with RVD is approximately the same as in countries where the duration of breast-feeding is quite short. None of these 3 independent observations support a protective role for breast-feeding against rotavirus diarrhea after the first months of life.

Breast feeding as a determinant of severity in shigellosis. Evidence for protection throughout the first three years of life in Bangladeshi children.

Little is known about the effect of breast feeding upon the severity of illness due to specific diarrheal pathogens. Using a systematically sampled and evaluated population of children aged less than 3 years, who attended a diarrheal disease hospital in Bangladesh, the authors performed a case-control study that assessed whether breast feeding reduces the severity of illness in shigellosis. From 540 children presenting with shigellosis between 1980-1982, they created a group of cases (n = 53) with severe illness and controls (n = 487) with non-severe illness. Overall, the odds ratio relating breast feeding to the severity of shigellosis (0.49, p = 0.01) suggested a substantial mitigating effect of breast feeding upon clinical severity. The high degree of protection against severe shigellosis was evident for breast-fed children up to 35 months of age, as well as for children at high risk for death because of severe malnutrition or measles. Because shigellosis continues to account for substantial morbidity and mortality in children in developing countries, the results support prolonged breast feeding in these settings.

PIP: The influence of breastfeeding on the severity of illness in shigellosis was assessed in a case-control study involving 540 children presenting with shigellosis to a Bangladesh diarrheal disease hospital in 1980-82. The 53 cases were children under 3 years of age with severe illness (i.e., rectal temperature above 102 F, severe neurologic manifestations, or severe dehydration), while the 487 age-matched controls had non-severe shigellosis. 42% of the cases compared with 59% of controls were breastfed, yielding an odds ratio of 0.49 (95% confidence interval, 0.28-0.86). This finding suggests that breastfeeding substantially shifts the spectrum of severity in Shigella infections from severe to non-severe illness. The high degree of protection against severe shigellosis was also seen in malnourished children and in children reporting a recent history of measles. The protective effect of breastfeeding persisted even when the analysis was corrected for the confounding effects of age, nutritional status, and earlier receipt of medication. These results are consistent with data from both developed and developing countries indicating that breastfeeding reduces the severity of illness in childhood diarrhea. In Bangladesh, about 1/3 of mothers breastfeed for 3 years. In other areas of the developing world, however, breastfeeding beyond infancy is relatively uncommon. Because shigellosis accounts for substantial morbidity and mortality in developing countries, prolonged breastfeeding is recommended.

Changing pattern of resistant Shiga bacillus (Shigella dysenteriae type 1) and Shigella flexneri in Bangladesh.

Shigella dysenteriae type 1 (Shiga bacillus) has made a dramatic comeback in Bangladesh after 10 years when Shigella flexneri was the dominant serogroup. Whereas S. flexneri showed little increase in resistance to the commonly used antimicrobial agents--namely, trimethoprim-sulfamethoxazole (TMP-SMX) and ampicillin-over the years, S. dysenteriae type 1 underwent rapid changes with regard to sensitivity pattern during the last two years. The first TMP-SMX-resistant strain of S. dysenteriae type 1 was detected in September 1982; however, by mid-1984 most strains were resistant while retaining sensitivity to ampicillin. During this period, the ratio of S. flexneri to S. dysenteriae type 1 narrowed from 0.15 to 1. Such propagation of high resistance to TMP-SMX might have been due to widespread use of the drug imported into the country in large quantities. Resistance to ampicillin is increasing rapidly, particularly in S. dysenteriae type 1.

Value of stool examination in patients with diarrhoea.

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.

Enteric fever in patients admitted to a diarrhoeal disease hospital in Bangladesh.

The hospital records of 62 patients with blood culture-proven enteric fever admitted to the Dacca Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, over a one-year period were reviewed. Older children and young adults had the highest age-specific rates of disease. The clinical, epidemiological and laboratory features of patients with enteric fever were compared with similar information from patients in hospital for cholera and shigellosis. Patients with enteric fever had a significantly longer prodrome of illness and were more likely to have fever than patients in the other groups. Our hospital cares primarily for patients with diarrhoeal diseases and while 94% of enteric fever patients had diarrhoea, only 5% had the recognized diarrhoeal pathogens Shigella or Vibrio cholerae identified, compared to 25% of the total hospital in-patient group, suggesting that Salmonella typhi itself may be a cause of diarrhoea. Antibiotic resistance patterns of S. typhi isolates were reviewed, and one isolate was found to be multiply antibiotic resistant. The advent of an effective oral typhoid vaccine makes further work on the epidemiology of enteric fever in endemic areas such as Bangladesh a high priority.

Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh.

In October 1979 a surveillance system was set up at the International Centre for Diarrhoeal Disease Research, Bangladesh, Hospital at Dacca to study a 4% systematic sample of the 100 000 patients with diarrhoea who come to the hospital for care each year. From December 1979 to November 1980 inclusive, 3550 patients were studied. A recognised pathogenic organism was identified for 66% of patients screened for all pathogens, one-third of whom had a mixed infection with two or more agents. Enterotoxigenic Escherichia coli was the most common enteropathogen detected in all age groups (detection rate 20%), followed by rotavirus (19%), Campylobacter jejuni (14%), and Shigella (12%). Infants and young children (up to 5 years) were most often infected with rotavirus, enterotoxigenic E coli, and C jejuni and older children (5-14 years) had more infections with enterotoxigenic E coli, Shigella, and E histolytica. Surveillance has helped to define the range of disease among patients attending the Dacca Hospital. Sixty-five per cent of patients complained of watery diarrhoea, a presentation that was significantly more common in patients with Vibrio cholerae 0:1 (91%), enterotoxigenic E coli (78%), rotavirus (77%), and C jejuni (71%) than in all patients studied. Dysentery, defined as a history of diarrhoea with blood, was the presenting complaint of 20% of all patients but 55% of those with Shigella. Only patients with V cholerae 0:1 and enterotoxigenic E coli were at increased risk for severe dehydration. In addition surveillance has been used to identify areas where patient care can be improved and to generate new ideas for research.

Epidemiologic and clinical features of patients infected with Shigella who attended a diarrheal disease hospital in Bangladesh.

The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.