Increasing rates of cesarean birth in Bangladesh: A household-level pooled analysis.

BACKGROUND: Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh. METHODS: We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15-49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables. RESULTS: The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003-04; this rate increased to 33.22% in 2017-18. The annual percentage change in CB rate was 16.34% from 2004 to 2017-18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh. CONCLUSIONS: This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.

Winquist View of the Femoral Neck: Ideal Visualization of Femoral Neck Fixation.

Background: Despite the increased frequency of cephalomedullary fixation for unstable intertrochanteric hip fractures, failure with screw cut-out and varus collapse remains a significant failure mode. Proper positioning of implants into the femoral neck and head directly influences the stability of fracture fixation. Visualization of the femoral neck and head can be challenging and failure to do so may lead to poor results; Obstacles include patient positioning, body habitus, and implant application tools. We present the "Winquist View," an oblique fluoroscopic projection that shows the femoral neck in profile, aligns the implant and cephalic component, and assists in implant placement. Methods: With the patient in the lateral position, the legs are scissored when possible. Following standard reduction techniques, the Winquist view is used to check reduction prior to surgical draping. Intraoperatively, we rely on a perfect image to place implants in the ideal portion of the femoral neck, with a trajectory that achieves the center-center or center-low position of the femoral neck. This is achieved by incorporating the anterior-posterior, lateral, and Winquist view. Results: We present 3 patients who underwent fixation with a cephalomedullary nail for intertrochanteric hip fractures. The Winquist view facilitated excellent visualization and positioning in all cases. All postoperative courses were uneventful, without failures or complications. Conclusion: While standard intraoperative imaging may be adequate in many cases, the Winquist view facilitates optimal implant positioning and fracture reduction. With lateral imaging, implant insertion guides may obscure visualization of the femoral neck during which Winquist view is the most helpful. Level of Evidence: V.

Pooling sputum testing to diagnose tuberculosis using xpert MTB/RIF and xpert ultra: a cost-effectiveness analysis.

BACKGROUND: The World Health Organization (WHO) recommends the diagnosis of tuberculosis (TB) using molecular tests, such as Xpert MTB/RIF (MTB/RIF) or Xpert Ultra (Ultra). These tests are expensive and resource-consuming, and cost-effective approaches are needed for greater coverage. METHODS: We evaluated the cost-effectiveness of pooling sputum samples for TB testing by using a fixed amount of 1,000 MTB/RIF or Ultra cartridges. We used the number of people with TB detected as the indicator for cost-effectiveness. Cost-minimization analysis was conducted from the healthcare system perspective and included the costs to the healthcare system using pooled and individual testing. RESULTS: There was no significant difference in the overall performance of the pooled testing using MTB/RIF or Ultra (sensitivity, 93.9% vs. 97.6%, specificity 98% vs. 97%, p-value > 0.1 for both). The mean unit cost across all studies to test one person was 34.10 international dollars for the individual testing and 21.95 international dollars for the pooled testing, resulting in a savings of 12.15 international dollars per test performed (35.6% decrease). The mean unit cost per bacteriologically confirmed TB case was 249.64 international dollars for the individual testing and 162.44 international dollars for the pooled testing (34.9% decrease). Cost-minimization analysis indicates savings are directly associated with the proportion of samples that are positive. If the TB prevalence is ≥ 30%, pooled testing is not cost-effective. CONCLUSION: Pooled sputum testing can be a cost-effective strategy for diagnosis of TB, resulting in significant resource savings. This approach could increase testing capacity and affordability in resource-limited settings and support increased testing towards achievement of WHO End TB strategy.

Phenotypic Plasticity Strategy of Aeluropus lagopoides Grass in Response to Heterogenous Saline Habitats.

Understanding the response variation of morphological parameters and biomass allocation of plants in heterogeneous saline environments is helpful in evaluating the internal correlation between plant phenotypic plasticity mechanism and biomass allocation. The plasticity of plants alters the interaction among individuals and their environment and consequently affects the population dynamics and aspects of community and ecosystem functioning. The current study aimed to assess the plasticity of Aeluropus lagopoides traits with variation in saline habitats. Understanding the habitat stress tolerance strategy of A. lagopoides is of great significance since it is one of the highly palatable forage grass in the summer period. Five different saline flat regions (coastal and inland) within Saudi Arabia were targeted, and the soil, as well as the morphological and physiological traits of A. lagopoides, were assessed. Comprehensive correlation analyses were performed to correlate the traits with soil, region, or among each other. The soil analysis revealed significant variation among the five studied regions for all measured parameters, as well as among the soil layers showing the highest values in the upper layer and decreased with the depth. Significant differences were determined for all tested parameters of the morphological and reproductive traits as well as for the biomass allocation of A. lagopoides, except for the leaf thickness. In the highly saline region, Qaseem, A. lagopoides showed stunted aerial growth, high root/shoot ratio, improved root development, and high biomass allocation. In contrast, the populations growing in the low saline region (Jizan) showed the opposite trend. Under the more stressful condition, like in Qaseem and Salwa, A. lagopoides produce low spikes in biomass and seeds per plant, compared to the lowest saline habitats, such as Jouf. There was no significant difference in physiological parameters except stomatal conductance (gs), which is highest in the Jizan region. In conclusion, the population of A. lagopoides is tolerant of harsh environments through phenotypic plasticity. This could be a candidate species to rehabilitate the saline habitats, considering saline agriculture and saline soil remediation.

Promising Application of Automated Liquid Culture System and Arbuscular Mycorrhizal Fungi for Large-Scale Micropropagation of Red Dragon Fruit.

Red dragon fruit (Hylocereus polyrhizus) is an economic and promising fruit crop in arid and semi-arid regions with water shortage. An automated liquid culture system using bioreactors is a potential tool for micropropagation and large-scale production. In this study, axillary cladode multiplication of H. polyrhizus was assessed using cladode tips and cladode segments in gelled culture versus continuous immersion air-lift bioreactors (with or without a net). Axillary multiplication using cladode segments (6.4 cladodes per explant) was more effective than cladode tip explants (4.5 cladodes per explant) in gelled culture. Compared with gelled culture, continuous immersion bioreactors provided high axillary cladode multiplication (45.9 cladodes per explant) with a higher biomass and length of axillary cladodes. Inoculation of H. polyrhizus micropropagated plantlets with arbuscular mycorrhizal fungi (Gigaspora margarita and Gigaspora albida) significantly increased the vegetative growth during acclimatization. These findings will improve the large-scale propagation of dragon fruit.

Radiolabeled EGFR TKI as predictive imaging biomarkers in NSCLC patients - an overview.

Non-small cell lung cancer (NSCLC) has one of the highest cancer-related mortality rates worldwide. In a subgroup of NSCLC, tumor growth is driven by epidermal growth factor receptors (EGFR) that harbor an activating mutation. These patients are best treated with EGFR tyrosine kinase inhibitors (EGFR TKI). Identifying the EGFR mutational status on a tumor biopsy or a liquid biopsy using tumor DNA sequencing techniques is the current approach to predict tumor response on EGFR TKI therapy. However, due to difficulty in reaching tumor sites, and varying inter- and intralesional tumor heterogeneity, biopsies are not always possible or representative of all tumor lesions, highlighting the need for alternative biomarkers that predict tumor response. Positron emission tomography (PET) studies using EGFR TKI-based tracers have shown that EGFR mutational status could be identified, and that tracer uptake could potentially be used as a biomarker for tumor response. However, despite their likely predictive and monitoring value, the EGFR TKI-PET biomarkers are not yet qualified to be used in the routine clinical practice. In this review, we will discuss the currently investigated EGFR-directed PET biomarkers, elaborate on the typical biomarker development process, and describe how the advances, challenges, and opportunities of EGFR PET biomarkers relate to this process on their way to qualification for routine clinical practice.

Pooling samples to increase testing capacity with Xpert Xpress SARS-CoV-2 during the Covid-19 pandemic in Lao People's Democratic Republic.

The COVID-19 pandemic created the need for large-scale testing of populations. However, most laboratories do not have sufficient testing capacity for mass screening. We evaluated pooled testing of samples, as a strategy to increase testing capacity in Lao PDR. Samples of consecutive patients were tested in pools of four using the Xpert Xpress SARS CoV-2 assay. Positive pools were confirmed by individual testing, and we describe the performance of the test and savings achieved. We also diluted selected positive samples to describe its effect on the assays CT values. 1,568 patients were tested in 392 pools of four. 361 (92.1%) pools were negative and 31 (7.9%) positive. 29/31 (93.5% (95%CI 77-99%) positive pools were confirmed by individual testing of the samples but, in 2/31 (6.5%) the four individual samples were negative, suggesting contamination. Pools with only one positive sample had higher CT values (lower RNA concentrations) than the respective individual samples, indicating a dilution effect, which suggested an increased risk of false negative results with dilutions >1:10. However, this risk may be low if the prevalence of infection is high, when pools are more likely to contain more than one positive sample. Pooling saved 67% of cartridges and substantially increased testing capacity. Pooling samples increased SARS-CoV-2 testing capacity and resulted in considerable cartridge savings. Given the need for high-volume testing, countries may consider implementation of pooling for SARS-CoV-2 screening.

Factors Influencing the Efficiency of Public Hospitals in Saudi Arabia: A Qualitative Study Exploring Stakeholders' Perspectives and Suggestions for Improvement.

Objective: Despite an extensive literature on efficiency, qualitative evidence on the drivers of hospital efficiency is scant. This study examined the factors that influence the efficiencies of health service provision in public hospitals in the Kingdom of Saudi Arabia (KSA) and their potential remedies. Design: We employed a qualitative design involving semi-structured interviews conducted between July and September 2019. Participants were purposively selected and included policymakers and hospital managers drawn from districts, regional and national levels. Data were analyzed in Nvivo 12 based on a thematic approach. Setting: Key informants of Ministry of health in the KSA. Results: Respondents identified a range of different factors across the community, facility and the wider health system that influence inefficiencies in public hospitals in KSA. Ineffective hospital management, lack of strategic planning and goals, weak administrative leadership, and absence of monitoring hospital performance was noted to have a profound impact on hospital efficiency. The conditions of healthcare staff in respect to both skills, authority and psychological factors were considered to influence the efficiency level. Further, lack of appropriate data for decision making due to the absence of an appropriate health informatics system was regarded as a factor of inefficiency. At the community level, respondents described inadequate information on the healthcare needs and expectations of patients and the wider community as significant barriers to the provision of efficient services. To improve hospital efficiencies, respondents recommended that service delivery decisions are informed by data on community health needs; capacity strengthening and effective supervision of hospital staff; and judicious resource allocation. Conclusion: The study demonstrates that inefficiencies in health services remain a critical challenge in public hospitals in KSA. Extensive awareness-raising and training on efficient resource utilization among key health systems stakeholders are imperative to improving hospital performance. More research is needed to strengthen knowledge on hospital efficiency in light of the limited data on the topic in KSA and the wider Gulf region.

Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience.

ABSTRACT: One of the challenges in military medicine is ensuring that the medical force deployed to the theater of combat operations is prepared to perform life, limb, and eyesight saving care at a level of care comparable to our top civilian Level I trauma centers. There is increasingly more evidence demonstrating that the majority of military physicians are not exposed to trauma or combat casualty care-relevant surgical cases on a consistent basis in their daily practice at their garrison military treatment facility (MTF). To prevent this widening skills and experience gap from become more of a reality, the 2017 National Defense Authorization Act called for the expansion of military and civilian (Mil-Civ) medical partnerships, working toward embedding military medical providers and surgical teams in busy civilian trauma centers. Vanderbilt University Medical Center is one of the busiest trauma centers in the country and being in close proximity to the local MTF at Fort Campbell, KY, it is primed to become one of the premier Mil-Civ partnerships. Creating a strategy that builds the partnership in a calculated and stepwise fashion through multiple avenues with centralized leadership has resulted in the early success of the program. However, Vanderbilt University Medical Center is not immune to challenges similar to those at other Mil-Civ partnerships, but only by sharing best practices can we continue to make progress.

Factors affecting the healthcare utilization from Shasthyo Suroksha Karmasuchi scheme among the below-poverty-line population in one subdistrict in Bangladesh: a cross sectional study.

BACKGROUND: Financing healthcare through out-of-pocket (OOP) payment is a major barrier in accessing healthcare for the poor people. The Health Economics Unit (HEU) of the Ministry of Health and Family Welfare of the government of Bangladesh has developed Shasthyo Suroksha Karmasuchi (SSK), a health protection scheme, with the aim of reducing OOP expenditure and improving access of the below-poverty-line (BPL) population to healthcare. The scheme started piloting in 2016 at Kalihati sub-district of Tangail District. Our objective was to assess healthcare utilization by the enrolled BPL population and to identify the factors those influencing their utilization of the scheme. METHOD: A cross-sectional household survey was conducted from July to September 2018 in the piloting sub-district. A total of 806 households were surveyed using a semi-structured questionnaire. Information on illness and sources of healthcare service were captured for the last 90 days before the survey. Multiple logistic regression models were applied to determine the factors related to utilization of healthcare from the SSK scheme and other medically trained providers (MTPs) by the SSK members for both inpatient and outpatient care. RESULT: A total of 781 (24.6%) people reported of suffering from illness of which 639 (81.8%) sought healthcare from any sources. About 8.0% (51 out of 639) of them sought healthcare from SSK scheme and 28.2% from other MTPs within 90 days preceding the survey. Households with knowledge about SSK scheme were more likely to utilize healthcare from the scheme and less likely to utilize healthcare from other MTPs. Non-BPL status and suffering from an accident/injury were significantly positively associated with utilization of healthcare from SSK scheme. CONCLUSION: Among the BPL population, healthcare utilization from the SSK scheme was very low compared to that of other MTPs. Effective strategies should be in place for improving knowledge of BPL population on SSK scheme and the benefits package of the scheme should be updated as per the need of the target population. Such initiative can be instrumental in increasing utilization of the scheme and ultimately will reduce the barriers of OOP payment among BPL population for accessing healthcare.

Extraction of Gelatin From Poultry Byproduct: Influence of Drying Method on Structural, Thermal, Functional, and Rheological Characteristics of the Dried Gelatin Powder.

The poultry processing industrial wastes are rich sources of gelatin protein, which can be utilized for various industrial sectors. The present investigation was conducted to evaluate the effect of freeze-drying (FD) and hot air drying (HAD) on the physicochemical, structural, thermal, and functional characteristics of chicken feet gelatin. The yield (%) of extracted FD and HAD gelatin was 14.7 and 14.5%, respectively. The gelatin samples showed lower percent transmittance in the UV region. The FTIR bands were at 3,410-3,448 cm-1, 1,635 cm-1, 1,527-334 cm-1, and 1,242-871 cm-1 representing amide-A, amide-I, amide-II, and amide-III bands, respectively. The water activity of HAD was higher (0.43) than in FD (0.21) samples and pH were 5.23 and 5.14 for HAD and FD samples, respectively. The flow index (n) of 6.67% gelatin solutions was 0.104 and 0.418 with consistency coefficient (k) of 37.94 and 31.68 for HAD and FD samples, respectively. The HAD sample shows higher gel strength (276 g) than the FD samples (251 g). The foaming capacity (FC) and foaming stability (FS) of FD samples were 81 and 79.44% compared to 62 and 71.28% for HAD, respectively. The emulsion capacity and emulsion stability of HAD gelatin were higher at 53.47 and 52.66% than FD gelatin. The water holding capacity (WHC) and oil binding capacity (OBC) of FD were lower, that is, 14.3 and 5.34 mL/g compared to HAD gelatin having 14.54 and 6.2 mL/g WHC and OBC, respectively. Hence, the present study indicated that gelatin samples can be utilized in various food products for enhancing functionality and can be used for developing edible packaging materials.

Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016.

BACKGROUND: Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households. METHODS: We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment. RESULTS: The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment. CONCLUSION: The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.

Synthesis and characterization of ZnGa2O4 composites and its photocatalytic properties for energy applications.

ZnGa2O4 nanocomposites have been widely used for photocatalytic degradation of industrial dyes. In this work, ZnGa2O4 was synthesized from zinc sulphate heptahydrate ZnSO4.10H2O and Gallium (III) oxide (Ga2O3) by hydrothermal method. As prepared, ZnGa2O4 nanocomposites was used as a photocatalyst degradation of three organic dyes rhodamine-B, methylene blue, and methyl orange, under ultraviolet (UV) light irradiation. The ZnGa2O4 nanocomposites structure, morphology, size and optical properties were studied by X-ray diffraction (XRD), Fourier transform Raman spectroscopy (FT-Raman), scanning electron microscopy (SEM), Transmission electron microscopes (TEM) and photoluminescence spectra (PL). Moreover, the results explained the rate-controlling mechanisms of the dye degradation process followed by second-order kinetics. After 100 min of adsorption kinetic models, the decomposition of rhodamine-B (7.2 Ct mg/L, 5.2 Ct mg/L, and 4.1 Ct mg/L), methylene blue (42.8 qt mg/g, 44.8 qt mg/g, and 45.9 qt mg/g), and methyl orange (42.8 qe mg/g, 44.8 qe mg/g, and 45.9 qe mg/g) respectively. This investigation study offers a promising method to design more efficient ZnGa2O4 nanocomposites based photocatalytic degradation of industrial organic dyes.

The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh.

BACKGROUND: Rotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. METHODS: We estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. RESULTS: The total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116-136) and total household costs were 161 USD (95% CI: 145-177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. CONCLUSIONS: A substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.

Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach.

BACKGROUND: National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. METHODS: HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. RESULTS: Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. CONCLUSION: HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider's costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.

The Association Between Financial Hardship and Mental Health Difficulties Among Adult Wage Earners During the COVID-19 Pandemic in Bangladesh: Findings From a Cross-Sectional Analysis.

Background: The ongoing COVID-19 pandemic has created several challenges including financial burdens that may result in mental health conditions. This study was undertaken to gauge mental health difficulties during the COVID-19 pandemic and gain an insight into wage earners' mental health. Method: This cross-sectional study was conducted through an online survey. A t total of 707 individual Bangladeshi wage earners were enrolled between 20 and 30 May 2020. The questionnaire had sections on sociodemographic information, COVID-19 related questions, PHQ-9 and GAD-7 scales. STATA version 14.1 program was used to carry out all the analyses. Results: The study revealed that 58.6 and 55.9% of the respondents had moderate to severe anxiety and depressive symptoms, respectively. The total monthly income was <30,000 BDT (353.73USD) and displayed increased odds of suffering from depressive symptoms (OR = 4.12; 95% CI: 2.68-6.34) and anxiety (OR = 3.31; 95% CI: 2.17-5.03). Participants who did not receive salary income, had no income source during the pandemic, had financial problems, and inadequate food supply and were more likely to suffer from anxiety and depressive symptoms (p ≤ 0.01). Perceiving the upcoming financial crisis as a stressor was a potential risk factor for anxiety (OR = 1.91; 95% CI:1.32-2.77) and depressive symptoms (OR = 1.50; 95% CI:1.04-2.16). Limitations: The online survey method used in this study limits the generalizability of the findings and self-reported answers might include selection and social desirability bias as a community-based survey was not possible during the pandemic. Conclusion: Wage earners in a low resource setting like Bangladesh require mental health attention and financial consideration to deal with mental health difficulties.

Nano-Targeting of Thyrointegrin αvß3 Receptor in Solid Tumors and Impact on Radiosensitization.

Tetraiodothyroacetic acid is a ligand of thyrointegrin αvß3, a protein that is highly expressed in various solid tumors and surrounding neovascular regions. Its nano derivative, Nano-diamino-tetrac (NDAT), has anticancer properties in preclinical models, enhances radiosensitivity, and inhibits cancer cell growth in vitro after X-ray irradiation. Using a novel experimental system developed to deliver accurate radiation dose to tumors under sterile conditions, this study establishes NDAT's radiosensitizing effect in SUIT-2 pancreatic cancer and H1299 non-small cell lung carcinoma xenografts in athymic mice for tumor-targeted radiation. In this work, low-melting-point Lipowitz alloy was used to shield normal organs and allow accurate tumor-targeted irradiation. Over a three-week period, mice with SUIT-2 xenografts received daily NDAT treatment at different doses (0, 1, 3, or 10 mg/kg body weight) and tumor-targeted irradiation (1 or 5 Gy). Validation was performed with a test dose of 30 Gy to mice bearing SUIT-2 xenografts and resulted in more than 80% reduction in tumor weight, compared to nonirradiated tumor weight. The results of this work showed that NDAT had a radiosensitizing effect in a dose-dependent manner in decreasing tumor growth and viability. An enhanced anticancer effect of NDAT (1 mg/kg body weight) was observed in mice with H1299 xenografts receiving 5 Gy tumor-targeted irradiation, indicated by decreased tumor weight and increased necrosis, compared to nonirradiated tumors. This technique demonstrated accurate tumor-targeted irradiation with new shielding methodology, and combined with thyrointegrin antagonist NDAT treatment, showed anticancer efficacy in pancreatic cancer and non-small cell lung carcinoma.

Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study.

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household's income. Preventing diarrhea preserves health and supports financial livelihoods.

Effects of xanthan gum, canning and storage period on fatty acid profile and cholesterol oxidation of restructured low-fat meat product of India.

This study evaluated the impact of xanthan gum (XG), canning and storage on fatty acids (FAs) contents and formation of cholesterol oxidation products (COPs) in low-fat meat product (goshtaba) of Jammu and Kashmir (J&K), India. The FAs composition i.e. saturated FAs, monounsaturated FAs, polyunsaturated FAs and trans FAs during processing and storage showed non-significant difference in all goshtaba products (P > 0.05). The cholesterol content decreased significantly after canning in all products (P < 0.05) while, maximum reduction was observed in high-fat goshtaba (HFC). During storage all products exhibited significant decrease in cholesterol upto 6th month, thereafter showed non-significant variation. The COPs determined were 7-ß-OH-ch, 5-ch-3ß-ol-7-one and 25-OH-ch. After canning two COPs (7-ß-OH-ch, 5-ch-3ß-ol-7-one) were produced in all products. But during storage there was formation of 25-OH-ch, increase in 7-ß-OH-ch and decrease in 5-ch-3ß-ol-7-one and lower COPs were observed in low-fat goshtaba containing 1.5% XG. The results concluded that fat replacer (XG), processing and storage had no significant effect on the FAs compositions of all goshtaba products including HFC. However, cholesterol content exhibited significant variation and minimum reduction in cholesterol and formation of lower COPs were observed in low-fat goshtaba formulated with 1.5% XG.