Assessment of Heavy Metal Contamination and Health Risk Associated with Cultivated Vegetables along Dhaka-Mymensingh Highway, Bangladesh.

The purpose of this research work is to evaluate the degree of eight heavy metals (Fe, Mn, Cu, Zn, Cd, Pb, Cr, and Ni) contamination and health risks of three regularly consumed vegetables (papaya, bottle gourd, and esculent) near one of Bangladesh's busiest roadways, the Dhaka-Mymensingh highway. The heavy metal concentrations in 45 vegetable samples were analyzed using an atomic absorption spectrometer (AAS). These samples were collected from five different sampling sites based on various land use patterns adjacent to the highway. The average concentrations (mg/kg) of Cu, Fe, Mn, Zn, Cr, and Ni were found to be 9.86, 246.8, 16.9, 28.0, 9.02, and 2.02, respectively, for papaya; 14.9, 281.2, 387.6, 49.0, 10.1, and 2.92, respectively, for bottle gourd; and 17.6, 183.4, 107.2, 80.7, 7.98, and 2.34, respectively, for esculent. The mean concentrations of Cr, Zn, and Mn in papaya, bottle gourd, and esculent were higher than the acceptable limit. Correlation analysis revealed a significant positive correlation between Fe-Cu, Zn-Fe, Cu-Fe, and Fe-Zn in papaya; Cu-Zn, Fe-Cr, Zn-Ni, and Cr-Fe in bottle gourd; and Mn-Cr, Mn-Ni, Mn-Fe, and Cr-Ni in esculent, thereby indicating their common anthropogenic sources like agricultural activities, waste from the commercial area, filling station, and vehicular emissions. Health risk assessment through target hazard quotient (THQ) revealed the highest THQ of 9.52 for Cr in bottle gourd, which poses a high non-carcinogenic health risk to the localities upon the intake of these contaminated vegetables. Target cancer risk (TCR) was found to be highest for Cr in papaya (0.013) and bottle gourd (0.014). TCR trends were found for Cr in the following order: bottle gourd > esculent > papaya. This study contributed the greatest concern for both carcinogenic and non-carcinogenic health impacts through ingesting contaminated vegetables.

Tracing and source fingerprinting of metals from the southern coastal sediments in Bangladesh.

Trace element pollution from anthropogenic sources is increasingly widespread. This pollution in terrestrial environments threatens agricultural crop production, while in aquatic environments, it threatens fish cultivation. The contamination of these crucial food sources raises significant concerns regarding food safety, security, and its potential adverse effects on human health. Coastal areas are particularly vulnerable to heavy metal pollution due to their proximity to industrial and urban centres, as well as their susceptibility to contamination from marine sources. In attempting to identify the sources of heavy metals (As, Cu, Cr, Cd, Fe, Hg, Mn, Ni, Pb, and Zn) and measure their contributions, we collected soil samples from thirty sites along the three coastal districts (Patuakhali, Barguna, and Bhola) in Bangladesh. Using atomic absorption spectroscopy, heavy metal concentrations in soil samples were measured and three receptor models (PMF, PCA-MLR, and UNMIX) were applied to detect their sources. Pairwise correlation analysis of metal concentrations in 30 sites across 3 coastal districts showed all possible patterns, including both significant and insignificant positive and negative relationships between different metals, except for As and Hg which did not display any significant relationships with other metals. The concentrations of Cu, Fe, Mn, Ni, and Zn exceed the US-EPA sediment quality standard. The applied PCA-MLR, PMF, and UNMIX models identified several sources of heavy metal contamination, including (i) mixed anthropogenic and natural activities: contribution of 59%, 37%, and 43%, and (ii) vehicle emissions: contribution of 23%, 26% and 29%. The recognized metal sources should be prioritised to avoid the discharge of poisonous pollutants from anthropogenic factors and any possible future exposure. This study's findings have implications for ongoing monitoring and management of heavy metal contamination in coastal environments to mitigate potential health and ecological impacts and can inform policy development and management strategies.

Spatial distribution of heavy metal abundance at distance gradients of roadside agricultural soil from the busiest highway in Bangladesh: A multi-index integration approach.

Bangladesh is currently experiencing significant infrastructural development in road networking system through the construction or reconstruction of multiple roads and highways. Consequently, there is a rise in traffic intensity on roads and highways, along with a significant contamination of adjacent agricultural soils with heavy metals. The purpose of this study was to evaluate the ecological risk, health risk and the abundance of seven heavy metals (Cu, Mn, Pb, Cd, Cr, As, and Ni) in three distance gradients (0, 300, and 500 m) of agricultural soil along the Dhaka-Chattogram highway. The concentration of heavy metals was measured with an Atomic Absorption Spectrophotometer (AAS) on a total of 36 soil samples that were taken from 12 different sampling sites. Based on the findings, Cd had a high contamination factor for all distance gradients, whereas Cr had a moderate contamination factor in 67% of the study areas. According to the Pollution Load Index (PLI), Cd, Cr, and Pb were the predominant pollutants. Principal component analysis (PCA) result shows these metals mainly came from anthropogenic sources. The considerable positive correlations between Cu-Pb, Cu-Cd, Pb-Cd, and Cr-Ni all pointed to shared anthropogenic origins. As per Potential Ecological Risk Assessment (PERI) analysis, Pb, Cd, Cr, and Ni each contribute significantly and pose a moderate threat. The Target Hazard Quotient (THQ) values for all pathways of exposure to Pb and Cr in soils were more than 1, which would pose a significant risk to human health in the following order: THQadult female > THQadult male > THQchildren. This study will help to evaluate the human health risk and develop a better understanding of the heavy metal abundance scenario in the agricultural fields adjacent to this highway.

Classification of aerosols using particle linear depolarization ratio (PLDR) over seven urban locations of Asia.

Active lidar remote sensing has been used to obtain detailed and quantitative information about the properties of aerosols. We have analyzed the spatio-temporal classification of aerosols using the parameters of particle linear depolarization ratio and single scattering albedo from Aerosol Robotic Network (AERONET) over seven megacities of Asia namely; Lahore, Karachi, Kanpur, Pune, Beijing, Osaka, and Bandung. We find that pollution aerosols dominate during the winter season in all the megacities. The concentrations, however, vary concerning the locations, i.e., 70-80% pollution aerosols are present over Lahore, 40-50% over Karachi, 90-95% over Kanpur and Pune, 60-70% and over Beijing and Osaka. Pure Dust (PD), Pollution Dominated Mixture (PDM), and Dust Dominated Mixture (DDM) are found to be dominant during spring and summer seasons.This proposes that dust over Asia normally exists as a mixture with pollution aerosols instead of pure form. We also find that black carbon (BC) dominated pollution aerosols.

Systematic review and meta-analysis of the potential threats to respiratory health from microbial Bioaerosol exposures.

Infectious diseases are a part of everyday life, and acute respiratory diseases are the most common. Many agents carrying out respiratory infections are transmitted as bioaerosols through the air, usually, particulate matter containing living organisms. The purpose of the study is to conduct a systematic review and meta-analysis to assess the likelihood that people exposed to bioaerosols may experience severe respiratory diseases. Nine digital databases and bibliographies were assessed for papers conducted between January 1960 and April 2021. A total of 35 health and exposure studies were included from 825 studies for the systematic review, while only 17 contented the meta-inclusion analysis's criteria. This systematic review found higher bacterial bioaerosol concentrations in poultry farms, waste dumpsites, composting plants, and paper industries. The meta-analysis's Standard Mean Difference (SMD) measurement indicates a substantially positive association between bioaerosol exposure and respiratory disease outcomes in targeted populations. The value is 0.955 [95% CI, range 0.673-1.238; p < 0.001]. As per the Risk of Bias (ROB) findings, most of findings (30 out of 35 [85.71%]) were judged to have low ROB. From the random effect probit model, the total relative risk is 1.477 (95% CI, range 0.987-2.211), indicating a higher risk of respiratory diseases from bioaerosol exposure than the control groups. The total risk difference is 0.121 (95% CI, -0.0229 to 0.264), which means intervention groups may have a higher risk of respiratory diseases from continuous bioaerosol exposure than the control groups. The dose-response relationship revealed a strong positive linear coefficient correlation between bacterial & fungal bioaerosol exposure to respiratory health. Based on self-reported outcomes in those studies, The systematic review and meta-analysis stated that bioaerosol exposure had an effect on pulmonary health.

Heavy metals in popularly sold branded cigarettes in Bangladesh and associated health hazards from inhalation exposure.

Tobacco products are widely recognized as a major contributor to death. Cigarette smoke contains several toxic chemicals including heavy metals particulate causing high health risks. However, limited information has been available on the health risks associated with the heavy metals in cigarettes commonly sold in the Bangladeshi market. This study evaluated the concentrations and potential health risks posed by ten concerned heavy metals in ten widely consumed cigarette brands in Bangladesh using an atomic absorption spectrometer. The concentration (mg/kg) ranges of heavy metals Pb, Cd, Cr, As, Co, Ni, Mn, Fe, Cu, and Zn vary between 0.46-1.05, 0.55-1.03, 0.80-1.2, 0.22-0.40, 0.46-0.78, 2.59-3.03, 436.8-762.7, 115.8-184.4, 146.6-217.7, and 34.0-42.7, respectively. We assume that the heavy metals content among cigarette brands is varied due to the differences in the source of tobacco they use for cigarette preparation. The carcinogenic risks posed by heavy metals follow the order of Cr > Co > Cd > As > Ni > Pb, while the non-carcinogenic risks for Cu, Zn, Fe, and Mn were greater than unity (HQ > 1), except for Fe. The existence of toxic heavy metals in cigarette tobacco may thus introduce noticeable non-carcinogenic and carcinogenic health impacts accompanying inhalation exposure. This study provides the first comprehensive report so far on heavy metal concentration and associated health risks in branded cigarettes commonly sold in Bangladesh. Hence, this data and the information provided can serve as a baseline as well as a reference for future research and have potential implications for policy and legislation in Bangladesh.

Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis.

Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included 53 patients with a male-to-female ratio of 16 (30.2%) to 37 (69.8%); 25 eyes underwent flapless DCR (group 1) and 28 eyes underwent anterior flap suturing DCR (group 2). The two groups had comparable demographic characteristics (all P > 0.05). Furthermore, anatomical (92.0% in group 1 and 92.9% in group 2) and functional (84.0% in group 1 and 92.9% in group 2) success rates at final follow-up were comparable between groups (both P > 0.05). At the one-month postoperative examination, premature tube extrusion was more often reported in group 1 (12.0%) compared to group 2 (7.1%). At the two-month follow-up examination, tube extrusion was noted in 4.0% in group 1 and 0.0% in group 2, yet the difference failed to attain statistical significance (P > 0.05). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.

Modified Anterior Lamellar Recession for All Grades of Upper Eyelid Trachomatous Cicatricial Entropion.

Purpose: This study aims to assess the combination of anterior lamellar recession (ALR) with blepharoplasty, suprasternal fixation, and internal eyelash bulb extirpation of aberrant lashes posteriorly located in patients with any grade of upper eyelid trachomatous cicatricial entropion. Patients and Methods: We reviewed the clinical data of eighty-six patients (143 eyelids) including age, gender, systemic medical illnesses, and comprehensive ophthalmological assessment. Eyelid evaluation was recorded, including laterality, previous surgical technique used, possible trichiasis etiology, abnormality of the lid margin, tarsal plate consistency (shrinkage or loosening), skin fold overhanging, laxity of the pretarsal skin, margin reflex distance 1 (MRD1), lagophthalmos, and lid retraction. The success rate was assessed at 3, 6, 9, and 12 months postoperative. Results: The success rate was 97.2% in the third month, which decreased significantly to 92.3% in the 6th month and 90.2% in the 9th month (P = 0.01, and 0.001 respectively). In the 9th month, we had fourteen failed cases. All of them were submitted for a second intervention. Three underwent electrolysis, four cases underwent re-internal bulb extirpation, four cases underwent the same procedure, and three cases underwent epilation. The success of the failed cases after the second intervention was significantly associated with the type of reintervention (P = 0.03), in which all of them succeed except two cases that underwent epilation. Kaplan-Meier analysis showed that the mean recurrence time in our study was 6.8 months (95% CI = 5.8-7.7 months). Conclusion: This study showed the combination of ALR with blepharoplasty, suprasternal fixation, and cauterization or internal bulb extirpation of posteriorly located lashes procedure resulted in a high success rate in patients with any form of UCE with no increase in incidence or degree of lagophthalmos associated with UCE.

Assessment of remote sensing-based indices for drought monitoring in the north-western region of Bangladesh.

Drought is a widespread hazard that can tremendously affect the biodiversity, habitat of wild species, and ecosystem functioning and stability, especially in the dry region. Due to its geographic location, the north-western region of Bangladesh has a comparatively arid climate which is very much susceptible to drought occurrence and is marked as a red zone. Despite the growing evidence of the impact of drought on food security and ecosystem functioning, little effort has been paid to mitigate the drought in this region. The present study aimed to assess the drought condition of the north-western region of Bangladesh using earth observation techniques. For this purpose, Landsat data from 1990 to 2020 was used to determine various vegetation indices such as Normalized Difference Vegetation Index (NDVI), Water Index (NDWI), Moisture Index (NDMI) and Soil Adjusted Vegetation Index (SAVI), along with Land Surface Temperature (LST). Results show that the depletion of forests (2832 km2) and water bodies (6773 km2) resulted from the expansion of settlement (6563 km2) and agricultural land (1802 km2) for the period 1990-2020. Examination of the temporal changes of vegetation indices and LST showed that the values of all indices decreased while the LST increased. The negative correlation between NDVI value and LST indicates that the vegetation in our study was subject to drought-induced shocks. This study reveals the current situation of the vegetation health in the north-western region of Bangladesh in relation to the drought conditions. The findings of this study have practical implications for the policymakers in implementing necessary measures for agriculture, forests, water development, and economic zone planning.

Natural history of antiplatelet nonresponders undergoing carotid artery stenting.

OBJECTIVE: Routine antiplatelet responsiveness testing for patients undergoing carotid artery stenting procedures is not performed at most endovascular centers and remains a topic of controversy within the neurointerventional community. The objective of this study was to determine if nonresponsiveness to acetylsalicylic acid or clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing carotid stenting procedures. METHODS: A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada, from August 2019 to July 2021. Patients undergoing carotid artery stenting procedures and who were receiving dual antiplatelet therapy were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry. The primary outcome was development of a symptomatic thromboembolic event within 90 days after the procedure. The treating physicians were blinded to the aggregometry results for the duration of the study. RESULTS: One hundred two procedures were performed in 100 patients. Eight thromboembolic events (8%) occurred during the study. Age (p = 0.03) and nonresponsiveness to clopidogrel (p = 0.003) were associated with the development of thromboembolic events. The multivariable model showed that clopidogrel nonresponsiveness was independently associated with the development of a thromboembolic event (adjusted OR 6.14, 95% CI 1.25-30.11, p = 0.03). CONCLUSIONS: This study demonstrated that patients who were identified as clopidogrel nonresponders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Larger studies are needed to assess the utility of routine platelet function testing prior to carotid artery stenting procedures.

IgG4-Related Dacryoadenitis in Egyptian Patients: A Retrospective Study.

Purpose: To report clinical, serological, and histopathological findings in Egyptian patients with dacryoadenitis associated with ImmunoglobulinG4-related disease (IgG4-RD). Methods: We retrospectively revised medical records of patients presented to Al-Azhar University Hospitals with lacrimal gland (LG) swelling between June 2016 and February 2022. We included patients with definite IgG4-related disease (IgG4-RD) diagnosis and excluded those with possible, probable, or unlikely IgG4-RD based on The Japanese Ministry of Health, Labour, and Welfare's 2011 guidelines. Results: Sixteen cases were included in the study (Fourteen females and two males, mean age 39.2±12.2 years); Seven cases met the criteria of Mikulicz disease, and nine cases met full clinical, serological, and histopathological criteria. Mean reported serum IgG was 1792.5 ± 313.7 (range 1063-2134) mg/dl, mean serum IgG4 was 576.25±215.3 (range 112-841) mg/dl, and mean Serum IgG4/IgG ratio was 31.9 ± 12.4%. The mean number of IgG4+ plasma cells/HPF was 74 ± 21.2, and the mean IgG4+ plasma cell percentage was 55 ± 9.7%. Serum IgG4 level showed a positive correlation to tissue IgG4+plasma cell percentage, while serum IgG4/IgG ratio positively correlated to both percentage and number of IgG4+plasma cells. Steroids had a good initial response, but recurrences were common. Conclusion: A considerable proportion of patients with lacrimal gland swelling fall within the range of IgG4-RD. Proper diagnosis requires clinical, serological, and histopathologic correlation. Patients require long follow-up periods.

Risk assessment of heavy metals in marine fish and seafood from Kedah and Selangor coastal regions of Malaysia: a high-risk health concern for consumers.

The heavy metals namely Fe, As, Cu, Cd, and Pb were investigated in two marine fishes silver pomfret (Pampus argentus) and torpedo scad (Megalaspis cordyla), and three seafoods sibogae squid (Loligo sibogae), Indian white prawn (Fenneropenaeus indicus), and mud crab (Scylla serrata) by using inductively coupled plasma spectrophotometer (ICP-MS) from two renowned fish harvesting coastal area of Malaysia named as Kedah and Selangor. Among the target heavy metals, highest mean concentration of As and Fe were found in Scylla serrata (72.14±7.77 µg/g) in Kedah and Megalaspis cordyla (149.40±2.15 µg/g) in Selangor. Pearson's correlation results showed As-Fe-Cd-Cu originated from the same source. Maximum estimated daily intake (EDI) values of Scylla serrata were found 175.25 µg/g/day and 100.81 µg/g/day for child in both Kedah and Selangor areas respectively. Hazard quotient (HQ) and hazard index (HI) results revealed that local consumers of Kedah and Selangor will face high chronic risk if they consume Scylla serrata, Fenneropenaeus indicus, and Megalaspis cordyla on regular basis in their diet. Carcinogenic risk results suggested that all the studied species pose very high risk of cancer occurrences to the consumers in both areas. Therefore, it could be recommended that consumers should be aware when they are consuming these marine species since they can pose serious health risk associated with prolonged consumption.

Trace metals contamination potential and health risk assessment of commonly consumed fish of Perak River, Malaysia.

The rapid growth of industrial and agricultural activities in Malaysia are leading to the impairment of most of the rivers in recent years through realising various trace metals. This leads to toxicity, particularly when the toxic has entered the food chain. Perak River is one of the most dynamic rivers for the Malaysian population. Therefore, in consideration of the safety issue, this study was conducted to assess the concentration of such metals (Cd, Cu, Zn, Fe, and Pb) in the muscles of most widely consumed fish species (Barbonymus schwanenfeldii, Puntius bulum, Puntius daruphani, Hexanematichthys sagor, Channa striatus, Mystacoleucus marginatus, and Devario regina) from different locations of Perak River, Malaysia by employing inductively coupled plasma optical emission spectroscopy (ICP-OES). Among the trace metals, Fe and Cd were found to be the highest (29.33-148.01 µg/g) and lowest (0.16-0.49 µg/g) concentration in all of the studied species, respectively. Although the estimated daily intakes (µg/kg/day) of Cd (0.65-0.85), Fe (79.27-352.00) and Pb (0.95-12.17) were higher than their reference, the total target hazard quotients values suggested that the local residents would not experience any adverse health effects from its consumption. In contrast, the target cancer risk value suggested that all fish species posed a potential cancer risk due to Cd and cumulative cancer risk values, strongly implying that continuous consumption of studied fish species would cause cancer development to its consumers.

Applicability of machine learning in modeling of atmospheric particle pollution in Bangladesh.

Atmospheric particle pollution causes acute and chronic health effects. Predicting the concentrations of PM2.5 and PM10, therefore, is a prerequisite to avoid the consequences and mitigate the complications. This research utilized the machine learning (ML) models such as linear-support vector machine (L-SVM), medium Gaussian-support vector machine (M-SVM), Gaussian process regression (GPR), artificial neural network (ANN), random forest regression (RFR), and a time series model namely PROPHET. Atmospheric NOX, SO2, CO, and O3, along with meteorological variables from Dhaka, Chattogram, Rajshahi, and Sylhet for the period of 2013 to 2019, were utilized as exploratory variables. Results showed that the overall performance of GPR performed better particularly for Dhaka in predicting the concentration of both PM2.5 and PM10 while ANN performed best in case of Chattogram and Sylhet for predicting PM2.5. However, in terms of predicting PM10, M-SVM and RFR were selected respectively. Therefore, this study recommends utilizing "ensemble learning" models by combining several best models to advance application of ML in predicting pollutants' concentration in Bangladesh.

Renal insufficiency among urban populations in Bangladesh: A decade of laboratory-based observations.

OBJECTIVE: The objective of this study was to describe the age and sex-specific prevalence of renal insufficiency, and observe its trends over a decade at an urban Bangladesh setup. METHOD: This was a cross-sectional study, in which we observed the Estimated Glomerular Filtration Rate (eGFR) of 218,888 adults, aged ≥19 years, who had submitted their blood specimen to the Clinical Biochemistry Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during the years 2006-2015. We applied CKD-EPI definition in estimating eGFR using their age-and sex-specific serum creatinine concentrations. Based on the eGFR, we classified the population into five stages of renal insufficiency (stage-1 to stage-5), at age intervals of five-years. Data were analysed using the Linear Regression and Multinomial Logistic Regression models. RESULTS: Females constituted 43% (n = 94,931) of the study population; and 34% (n = 42,576) of the males and 31% (n = 29,830) of the females had their serum creatinine concentrations above the upper limit of the laboratory reference cut-off. The overall prevalence of stage-2 to stage-5 renal insufficiency were 24% (n = 52,126), 17% (n = 38,539), 8% (n = 16,504) and 6% (n = 12,665) respectively; the prevalence were 23% (n = 1,890), 19% (n = 1,579), 9% (n = 769) and 9% (n = 770) respectively in 2006, and 24% (n = 10,062), 17% (n = 6,903), 6% (n = 2,537) and 5% (n = 1,924) respectively in 2015. The prevalence was higher among the females. At least 2% of the adults, younger than <44 years, had stage-4 and stage-5 in 2015. The age-adjusted eGFR was significantly lower among the post-menopausal females (aged ≥46 y) compared to the same age group males (64.08±10.83 vs. 66.83±10.41 mL/min/1.73 m2; p<0.001). Compared to 2006, the number of individuals with renal insufficiency (stage 2 and above) had increased at least two times, irrespective of age, in 2015. A single year of increase in the age was significantly associated with 1.32 unit reductions in the eGFR; and the reductions were higher for females who also had higher odds of renal insufficiency stages-2 and beyond. CONCLUSION: This study observed high prevalence of stage-2 to stage-5 renal insufficiency in Bangladeshi populations, irrespective of age, and especially among the females.

In-Cell Titration of Small Solutes Controls Protein Stability and Aggregation.

The components of the intracellular environment vary widely in size: from large multiprotein complexes to atomic ions. Besides water, low-molecular-weight solutes (<1 kDa) such as electrolytes, metabolites, and carbohydrates are by far the most abundant of these components. Small solutes are thus key contributors to the solvation environment in the cell. Small solutes have been known for decades to alter protein structure or activity in vitro, through their interactions with protein surfaces or hydration shells. Here we use the cell itself as our test tube, by titrating its hydration, ion, or carbohydrate composition systematically. We trigger the selective uptake of specific solutes by exposing cells to hyperosmotic media. We then measure protein structure, stability, unfolding kinetics, and aggregation in these different intracellular environments by using fast relaxation imaging. We compare these results with controls where solutes cannot enter the cell and only hydration is altered. Protein structure, thermal stability, and aggregation onset all depend on the concentration and chemical nature of the solute titrated into the cell. Our work highlights the important contributions of small solutes in defining how proteins interact within the cell and suggests that intracellular variation of the solute composition could be an important regulator of protein function.

Diagnosis of Tuberculosis Following World Health Organization-Recommended Criteria in Severely Malnourished Children Presenting With Pneumonia.

Evidences on diagnosis of tuberculosis (TB) following the World Health Organization (WHO) criteria in children with severe acute malnutrition (SAM) are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388). However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture-confirmed TB, sensitivity and specificity (95% confidence interval) of WHO criteria were 40 (14% to 73%) and 84 (80% to 87%), respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43%) and 83 (79% to 87%), respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings.

Impact of Diarrhea on the Clinical Presentation and Outcome of Severe Pneumonia in Bangladeshi Children.

We compared clinical presentation and outcome of 225 children with severe pneumonia between those with and those without diarrhea. Having diarrhea was associated with metabolic acidosis (P < 0.001) and hypocalcemia (P = 0.002) on presentation, and with a fatal outcome: 20/113 (20%) died with diarrhea versus 3/112 (3%) without diarrhea. Diarrhea is an important comorbidity in Bangladeshi children with severe pneumonia requiring attention for improved case management.