Changes in the determinants and spatial distribution of under-five stunting in Bangladesh: Evidence from Bangladesh Demographic Health Surveys (BDHS) 1996-97, 2014 and 2017/18.

BACKGROUND: Bangladesh has experienced tremendous change in child nutrition over the past few decades, but there are large differences between different regions in progress made. The question is whether continuation of current policies will bring the progress needed to reach national and international targets on child nutrition security. DATA AND METHODS: Using national data BDHS 1996/97, 2014, and 2017, this study attempts to map such reductions across Bangladesh and to explore the distribution of covariate effects (joint effects) that are associated with childhood stunting over these two periods, overall and by region. The main contribution of this paper is to link observed stunting scores to a household profile. This implies that different variables are evaluated jointly with stunting to assess the likelihood of being associated with stunting. RESULTS: Overall, the covariates: 'Parental levels of education', 'children older than one year old', 'children live in rural area', 'children born at home' formed the country winning profile in 1996/97, whereas parental levels of education disappear in the winning profile for children stunted in 2014. This implies that over the years, Bangladesh has been successful in addressing parental education for long-term reductions in child undernutrition. In addition, the diversity of profiles of households with stunted children increases over time, pointing at successful targeting of policies to increase food security among children over the period. However, in areas where improvements have been insignificant, also the profiles remain stable, indicating a failure of policies to reach the target populations. The analysis for 2017 confirms this picture: the diversity of profiles remains high, with little change in the dominant profiles. CONCLUSION: Further decline in stunting is possible through region specific multipronged interventions, targeting children older than one year among vulnerable groups, in addition with strengthening family planning programs as larger families also have a higher risk to have stunted children. In general, the profiles in 2014 and 2017/18 are much more diverse than in 1996, which can be explained by the relative success of specific targeted policies in some divisions, while being much less successful in other regions. In sum, our results suggest that the challenge lies in the implementation of policies, rather than in the generic approach and assumed theory of change.

Epidemiology of stroke: findings from a community-based survey in rural Bangladesh.

OBJECTIVES: This study was designed to determine the epidemiology of stroke in a rural population of Bangladesh. STUDY DESIGN: In a cross-sectional study, we surveyed stroke patients. METHODS: The survey was conducted in a rural community of Bangladesh from January 2016 to June 2016. All community members 15 years and older in a surveillance system were included in this study. The Questionnaire for Verifying Stroke-Free Status was used to screen stroke cases at household level which were again examined by the neurologist for confirmatory diagnosis. RESULTS: The prevalence of stroke was 1.96 (95% confidence interval [CI] 1.69-2.26) per 1000 population. The highest prevalence was 9.65 (95% CI 7.42-12.33) per 1000 population, identified among patients aged 65-79 years. Males had higher prevalence (2.38 per 1000 population) than females (1.55 per 1000 population). Of the 24% of patients who had radiological examination (magnetic resonance imaging and computed tomography scan) reports, 17.2% of stroke cases were ischemic, 4.8% were intracerebral, and about 1.1% were subarachnoid. The ratio of infarction to hemorrhage was 2.91. Approximately 67% of patients were diagnosed as hypertensive, and 37% of patients had elevated blood glucose level. While 15% of patients were found to be overweight or obese, 45% of patients had raised blood cholesterol level. More than 10% of patients reported that they had heart disease before the occurrence of stroke. About 40% of patients had the history of tobacco consumption. CONCLUSIONS: The prevalence of stroke is higher among elderly and male populations. A significant proportion of patients presented with hypertension and/or diabetes.

Soil pollution at outdoor shooting ranges: Health effects, bioavailability and best management practices.

The total lead (Pb) concentrations of the surface soil, sub surface soil, vegetation and surface waters of outdoor shooting ranges are extremely high and above regulatory limits. Lead is dangerous at high concentrations and can cause a variety of serious health problems. Shooters and range workers are exposed to lead dust and can even take Pb dust home to their families while some animals around the shooting range can ingest the Pb bullets. The toxicity of Pb depends on its bioavailability which has been determined to be influenced greatly by the geochemical properties of each site. The bioavailability of Pb in shooting ranges has been found to be higher than other metal contaminated soils probably because of its very low residual Pb (<1%). Despite being an immobile element in the soil, migration of Pb within shooting ranges and offsite has been reported in literature. Best management practices to reduce mobility of Pb in shooting ranges involve an integrated Pb management program which has been described in the paper. The adoption of the non-toxic "green bullet" which has been developed to replace Pb bullets may reduce or prevent environmental pollution at shooting ranges. However, the contaminated soil resulting from decades of operation of several shooting ranges still needs to be restored to its natural state.

Subthalamic deep brain stimulation at individualized frequencies for Parkinson disease.

OBJECTIVES: The oscillation model of Parkinson disease (PD) states that, in the subthalamic nucleus (STN), increased θ (4-10 Hz) and ß (11-30 Hz) frequencies were associated with worsening whereas γ frequencies (31-100 Hz) were associated with improvement of motor symptoms. However, the peak STN frequency in each band varied widely from subject to subject. We hypothesized that STN deep brain stimulation (DBS) at individualized γ frequencies would improve whereas θ or ß frequencies would worsen PD motor signs. METHODS: We prospectively studied 13 patients with PD. STN local field potential (LFP) was recorded after electrode implantations, in the OFF and then in ON dopaminergic medication states while patients performed wrist movements. Six individual peak frequencies of the STN LFP power spectra were obtained: the greatest decrease in θ and ß and greatest increase in γ frequencies in the ON state (MED) and during movements (MOVE). Eight DBS frequencies were applied including 6 MED and MOVE frequencies, high frequency (HF) used for chronic stimulation, and no stimulation. The patients were assessed using the motor Unified Parkinson's Disease Rating Scale (mUPDRS). RESULTS: STN DBS at γ frequencies (MED and MOVE) and HF significantly improved mUPDRS scores compared to no stimulation and both γ frequencies were not different from HF. DBS at θ and ß frequencies did not worsen mUPDRS scores compared to no stimulation. CONCLUSION: Short-term administration of STN DBS at peak dopamine-dependent or movement-related γ frequencies were as effective as HF for reducing parkinsonian motor signs but DBS at θ and ß frequencies did not worsen PD motor signs. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that STN DBS at patient-specific γ frequencies and at usual high frequencies both improved mUPDRS scores compared to no stimulation and did not differ in effect.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh.

SUMMARY OBJECTIVE: To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. METHODS: A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). RESULTS: The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). CONCLUSION: A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Surface coverage effects on the desorption kinetics of selenite from a hydroxyaluminum-montmorillonite complex.

Information on the desorption of metals and metalloids from soils and clays are essential for a better understanding of their mobility, transport, and fate in natural environments. We investigated nitrate-, phosphate-, and citrate-induced desorption kinetics of preadsorbed selenite (presented as Se henceforth) from a hydroxyaluminum-montmorillonite (HyA-Mt) complex at three different surface coverages of 8%, 25%, and 69% of its Langmuir predicted adsorption maximum (262.61 mmole kg(-1)). Generally the mole fraction of preadsorbed Se released after the attainment of desorption equilibrium was significantly higher with increasing surface coverage. Desorption kinetics of Se from the clay was best described by the Elovich model. The Elovich model parameter beta representing the rate of Se desorption increased as the surface coverage increased. Both kinetic data and mole fraction of Se released at desorption equilibrium supported the contention that adsorption bond strength progressively decreases with increasing surface coverage. Both citrate and phosphate remobilized Se at significantly faster rates than nitrate at any surface coverage level. Citrate showed a significantly faster rate of Se release than phosphate only at 8% surface coverage but not at 25% and 69% surface coverages, suggesting that differential ability of these two ligands to influence the kinetics of Se release was also surface coverage dependent. The findings of the present study would help better understand the consequences of different surface coverages on soil colloids by preadsorbed Se as well as the impacts of phosphate fertilization and rhizospheric processes in influencing Se mobility in soil and related environments.

Introduction of routine zinc therapy for children with diarrhoea: evaluation of safety.

On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with routine administration of zinc, particularly unusual or excess vomiting. The study assessed, in a phase IV trial, i.e. post-marketing surveillance of zinc, the occurrence of adverse events during the first hour after the administration of the first dose of zinc in children with acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of ICDDR,B and at an outpatient clinic operated by a local health NGO-Progoti Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-59 months, were treated with 20 mg of zinc sulphate provided in a dispersible tablet formulation. The children were observed for 60 minutes following the initial treatment with zinc for adverse events, with particular attention given to vomiting or regurgitation. During the one-year observation period, 42,440 children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5% more than twice. No children revisited the hospital for recurrent vomiting following their discharge. A significant proportion of infants and children may experience vomiting or regurgitation, usually once, following the administration of the first dose of zinc. This is a transient phenomenon that did not impact on continuation of treatment with zinc.

Pseudoaneurysm following lateral wall myocardial infarction.

Pseudoaneursym (PA) formation of left ventricle (LV) following acute myocardial infarction (AMI) is uncommon and is usually believed to be associated with a grave prognosis. We describe a case of 55 year old male patient presented with AMI and heart failure with a systolic murmur later diagnosed to have PA of the lateral wall of LV on echocardiography (transthoracic and transesophageal, TTE andTEE). Cardiac MRI and coronary angiogram (CAG) were performed. CAG showed 60% lesion at origin of major obtuse marginal artery (OM1). The patientwas advised surgical treatment, but he refused and took discharge against medical advice on 27th dayof admission on stable condition.

Drug use among the urban poor in Kolkata: behaviour and environment correlates of low HIV infection.

BACKGROUND: HIV infection in injecting drug users (IDUs) has worked as a driving force for further spread of the virus in other population groups. Major metropolitan cities such as Mumbai, Kolkota, Chennai and Delhi have seen a diffusion of injecting drug use within the last decade. The prevalence of HIV infection among injectors ranges from 2% to 30%. Identifying effective interventional elements that have kept the prevalence of HIV low for the past 7 years among IDUs of Kolkata is thus of public health importance. METHODS: A purposive sample of opioid/opiate users was studied. Primary and secondary data on drug users, law-enforcement environment, records at drug treatment centres, jail admission data related to the 'Narcotic Drug and Psychotropic Substance Act' and interventions in other risk groups were collected. Laboratory tests for HIV, hepatitis B surface antigen and syphilis were done on consenting IDUs (n=129) and non-IDUs (n=120). For univariate and multivariate analysis, IDUs were taken as cases and non-IDUs as controls. RESULT: Of the IDUs, 2% were positive for HIV. No non-IDU was HIV-positive. Significantly more non-IDUs (10% v. 4%, p=0.05) were positive for syphilis. Sharing injection equipment within the past 6 months was reported by 71% of IDUs; sharing partners were stable and ranged from 1 to 3. More IDUs compared to non-IDUs reported being in touch with intervention programmes. The police has been tolerant to needle-syringe exchange and oral sublingual buprenorphine substitution conducted in Kolkata. Unlike in the early 1990s, non-IDUs did not switch to injecting during non-availability of brown sugar in the latter half of the 1990s and instead sought tratment. The availability of high quality heroin (>20%-50%) was low and the proportion of moderate quality heroin (>10%-20%) went up during these times due to increased police seizures. No intervention exists in jails despite the fact that a large number of drug users spend time in jail. CONCLUSION: Stable and few injection equipment-sharing partners of IDUs, launching of early targeted interventions among IDUs and sex workers in the city, police tolerance to harm reduction activities and preference of non-IDUs for detoxification during heroin draught periods have kept HIV prevalence at a low level among drug users of Kolkata for the past 7 years. immediate launching of interventions for drug users in jails seems necessary. Similar multi-pronged strategies with targeted and environmental intervention could work in other settings as well.

An overview of the socio-economic and demographic transition among the Santal: a census analysis.

The Santals are described as the largest most integrated and possibly the most resilient tribe in eastern India. "The paper aims at looking into the parameters that set Santals in the process of socio-economic and demographic transformation and subsequently search for, the plausible explanation for the underlying mechanism for such changes.... The paper discusses the growth of their population and finds that Santals are growing below national average with increase in concentration in some of the pockets in Bihar and West Bengal, while it is spreading towards evenness in Orissa. In the absence of 1991 census data on the tribe wise breakdown the analysis has been restricted to the 1961, 1971 and 1981 census returns and availability of the literature on the tribe."

Sexually transmitted diseases in leprosy patients in north and northeastern India. A futile search for human immunodeficiency virus antibody.

Three-hundred-eighty-four leprosy patients were clinically examined for sexually transmitted diseases (STD) in north and northeastern India, revealing a high incidence (5.2%) of STD among them. Eighteen males, one female, and one eunuch were found to have chancroid ulcer, gonococcal urethritis, lymphogranuloma inguinale, and primary chancre. Of these patients, only 100, selected randomly, could be screened serologically for STD due to Treponema pallidum, herpes simplex (type 1 and 2), Entamoeba histolytica, hepatitis-associated virus, cytomegalovirus, Chlamydia trachomatis and human immunodeficiency virus (HIV); 100 control sera were included for comparison. In addition, sera from another 133 normal subjects and another 176 lepromatous patients were also screened for HIV antibody. Thus, a total of 233 normal sera and 276 leprosy sera were tested for HIV antibody. Although our leprosy patients have shown significantly high incidences of clinical STD and also high seropositivity against T. pallidum, herpes-simplex viruses types 1 and 2, hepatitis-associated virus, and cytomegalovirus, the search for antibody against HIV was negative. Our clinical and serological data suggest promiscuity in our patient population. The absence of HIV antibody in this high-risk population, however, seems to be an enigma.

Spectrophotometric determination of tetracyclines in pharmaceutical preparations, with uranyl acetate.

Uranyl acetate is proposed as a reagent for the spectrophotometric determination of the tetracycline group of antibiotics. The reagent forms orange-red 1:1 complexes with the drugs in N,N-dimethylformamide medium. The complexes show absorption maxima at 414, 406, 419, 405 and 402 nm for tetracycline hydrochloride (TCH), oxytetracycline hydrochloride (OTCH), chlortetracycline hydrochloride (CTCH), doxycycline hydrochloride (DCH) and methacycline hydrochloride (MCH), respectively. Beer's law is valid over the concentration ranges 0-115, 0-120, 0-125, 0-135 and 0-110 microg/ml for TCH, OTCH, CTCH, DCH and MCH, respectively.

Effects of aspirin and paracetamol on ATPases of human fetal brain: an in vitro study.

In vitro effects of aspirin and paracetamol at the doses 200, 400, 600, 800 nmole/mg protein on ATPases activity were studied in the cerebrum and cerebellum of human fetus covering the age range from 10 weeks to 32 weeks of gestation. Both aspirin and paracetamol inhibit Na+K+ ATPase and Mg2+ ATPase in a dose dependent manner. The inhibition of Na+K+ ATPase and Mg2+ ATPase activity which may affect the release and uptake of biogenic amines in CNS, hinders the maturation of human fetal brain.

Colorimetric determination of tetracycline derivatives in pharmaceutical preparations.

A quick colorimetric method is reported for the determination of tetracycline derivatives such as oxytetracycline hydrochloride (OTCH), chlortetracycline hydrochloride (CTCH), methacycline hydrochloride (MCH), and doxycycline hydrochloride (DCH). The method involves complexation of the above derivatives with cupric chloride in alkaline medium. The yellowish green copper complexes of OTCH, CTCH, MCH, and DCH show maximum absorbance at 395, 410, 400, and 400 nm, respectively. The color intensity obeys Beer's law in the concentration range of 0-20 micrograms/mL.

Biochemical studies on the in vitro effect of doxepin on Mg2+ & Na+, K+)-ATPases of human foetal & adult brain.

The in vitro effect of doxepin at 10, 50 and 200 micrograms/mg protein on Mg2+ and (Na+ K+)-ATPases (EC 3.6.1.3) activities of human foetal and adult brain (crude homogenate of cerebrum and cerebellum) were studied at 10-30 wk of gestation. Both Mg2+ and (Na+, K+)-ATPases of human foetal and adult brain were found to be inhibited by doxepin in a dose dependent manner. The inhibitory effect neither varied with respect to the region (i.e., cerebrum and cerebellum) nor with the gestational ages. Inhibition of ATPases activity by doxepin may affect the release and uptake of biogenic amines in the CNS, which may hamper the maturation of brain.

In vitro effect of lorazepam on Mg2+ and (Na+,K+) ATPases of human foetal brain.

Lorazepam (LZ), a benzodiazepine group of drug, inhibits Mg2+ and (Na+,K+) ATPases (EC 3.6.1.3) activity of human foetal and adult brain. The inhibitory effect neither varied with respect to the region (i.e. cerebrum and cerebellum) nor with the age of the foetus. The inhibition of ATPases activity indicates that the neuronal transmission processes, may be affected and raises the possibility of developmental disturbances.