Physiological and molecular changes of onion (Allium cepa L.) seeds under different aging conditions.

BACKGROUND: Onion seeds have limited storage capacity compared to other vegetable seeds. It is crucial to identify the mechanisms that induce tolerance to storage conditions and reduce seed deterioration. To address this goal, an experiment was conducted to evaluate changes in germination, biochemical, physiological, and molecular characteristics of onion seed landraces (Horand, Kazerun landraces and Zargan cultivar) at different aging levels (control, three-days and six-days accelerated aging, and natural aging for one year). RESULTS: The findings suggest that there was an increase in glucose, fructose, total sugar, and electrolyte leakage in the Horand (HOR), Kazerun (KAZ) landraces, and Zarghan (ZAR) cultivar, with Kazerun exhibiting the greatest increase. The percentage and rate of germination of Kazerun decreased by 54% and 33%, respectively, in six-day accelerated aging compared to the control, while it decreased by 12% and 14%, respectively, in Horand. Protein content decreased with increasing levels of aging, with a decrease of 26% in Kazerun landrace at six days of aging, while it was 16% in Horand landrace. The antioxidant activities of catalase, superoxide dismutase, and glutathione peroxidase decreased more intensively in Kazerun. The expression of AMY1, BMY1, CTR1, and NPR1 genes were lower in Kazerun landraces than in Horand and Zargan at different aging levels. CONCLUSIONS: The AMY1, BMY1, CTR1, and NPR1 genes play a pivotal role in onion seed germination, and their downregulation under stressful conditions has been shown to decrease germination rates. In addition, the activity of CAT, SOD, and GPx enzymes decreased by seed aging, and the amount of glucose, fructose, total sugar and electrolyte leakage increased, which ultimately led to seed deterioration. Based on the results of this experiment, it is recommended to conduct further studies into the molecular aspects involved in onion seed deterioration. More research on the genes related to this process is suggested, as well as investigating the impact of different priming treatments on the genes expression involved in the onion seed aging process.

Evaluating the bio-removal of crude oil by vetiver grass (Vetiveria zizanioides L.) in interaction with bacterial consortium exposed to contaminated artificial soils.

Remediation of crude oil-impacted areas is a major pervasive concern in various environmental conditions. The major aim of this study was to investigate the collaboration of vetiver grass (Vetiveria zizanioides L.) and petroleum hydrocarbon-degrading bacteria to clean up contaminated soils. Vetiver grass and five native bacterial isolates were used in one consortium to remediate contaminated soil by crude oil at various concentrations (2.0, 4.0, 6.0 8.0, 10, and 12.0% woil/wsoil). The presence of isolated bacteria caused a significant (p < 0.05) increment of root-shoot ratio of vetiver in contaminated soils in comparison to non-contaminated soil. The combination of vetiver and bacterial consortium revealed efficient dissipation of more than 30% of low-molecular-weight polycyclic aromatic hydrocarbons (PAHs) and more than 50% of high-molecular-weight PAHs in all crude oil concentrations. The removal of n-alkanes in the simultaneous presence of the bacteria and plant was more than 70.0% at 10.0% of oil concentration, whereas the removals in control were 20.7, 13.7 and 9.2%, respectively. The hydrocarbons dissipation efficiency of applied treatments decreased at 12.0% of contamination. It is concluded that a combination of vetiver grass and the isolated bacteria could be a feasible strategy for remediation of crude oil-polluted soils. Novelty statementDetermination of the responses of vetiver grass under different crude oil concentrations is one of the novelties of the present study, which is helpful for demonstrating plant tolerance on polluted environments. Also, it adds information about the potential of this grass to clean up crude oil-polluted soils solely as well as in the presence of promising selected bacterial strains.

ABA and BAP improve the accumulation of carbohydrates and alter carbon allocation in potato plants at elevated CO2.

Elevated CO2 interactions with other factors affects the plant performance. Regarding the differences between cultivars in response to CO2 concentrations, identifying the cultivars that better respond to such conditions would maximize their potential benefits. Increasing the ability of plants to benefit more from elevated CO2 levels alleviates the adverse effects of photoassimilate accumulation on photosynthesis and increases the productivity of plants. Despite its agronomic importance, there is no information about the interactive effects of elevated CO2 concentration and plant growth regulators (PGRs) on potato (Solanum tuberosum L.) plants. Hence, the physiological response and source-sink relationship of potato plants (cvs. Agria and Fontane) to combined application of CO2 levels (400 vs. 800 µmol mol-1) and plant growth regulators (PGR) [6-benzylaminopurine (BAP) + Abscisic acid (ABA)] were evaluated under a controlled environment. The results revealed a variation between the potato cultivars in response to a combination of PGRs and CO2 levels. Cultivars were different in leaf chlorophyll content; Agria had higher chlorophyll a, b, and total chlorophyll content by 23, 43, and 23%, respectively, compared with Fontane. The net photosynthetic rate was doubled at the elevated compared with the ambient CO2. In Agria, the ratio of leaf intercellular to ambient air CO2 concentrations [Ci:Ca] was declined in elevated-CO2-grown plants, which indicated the stomata would become more conservative at higher CO2 levels. On the other hand, the increased Ci:Ca in Fontane showed a stomatal acclimation to higher CO2 concentration. The higher leaf dark respiration of the elevated CO2-grown and BAP + ABA-treated plants was associated with a higher leaf soluble carbohydrates and starch content. Elevated CO2 and BAP + ABA shifted the dry matter partitioning to the belowground more than the above-media organs. The lower leaf soluble carbohydrate content and greater tuber yield in Fontane might indicate a more efficient photoassimilate translocation than Agria. The results highlighted positive synergic effects of the combined BAP + ABA and elevated CO2 on tuber yield and productivity of the potato plants.

Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection.

BACKGROUND: The aim of the present study was to determine whether postprocedural antibiotic reduces the risk of infection related to the cardiac implantable electronic device (CIED) implantations. METHODS: The present investigation is a randomized, prospective, single-blinded controlled trial. All consecutive patients who presented for new CIED implantation, generator replacement, or upgrade were randomized into the following three groups: (A) no antibiotic, (B) intravenous (IV) antibiotic for 1 day, (C) 1 day IV plus 7 days oral antibiotic. Follow-up was performed on 10-12 days; 1, 3, 6 months; and then every 6 months for 2 years. The primary endpoint was any evidence of infection at the generator pocket or systemic infection related to the procedure at short-term (6-month) and long-term (2-year) follow-ups. RESULTS: Of the 450 patients (72 patients with cardiac resynchronization device) included in the study, the primary endpoint of short-term infection was reached in one patient (0.2%) in group A and no patients in groups B and C. The endpoint of long-term infection was reached in nine patients (2%) with equal frequency between three randomized groups (three patients in each group). On multivariable analysis, the only independent predictor of infection was defibrillator implantation (odds ratio, 8.5; 95% confidence interval, 1.6-45). CONCLUSIONS: The results of this prospective study showed no benefit for the postoperative antibiotic for the prevention of CIED infection.

Nipah Virus Contamination of Hospital Surfaces during Outbreaks, Bangladesh, 2013-2014.

Nipah virus (NiV) has been transmitted from patient to caregivers in Bangladesh presumably through oral secretions. We aimed to detect whether NiV-infected patients contaminate hospital surfaces with the virus. During December 2013-April 2014, we collected 1 swab sample from 5 surfaces near NiV-infected patients and tested surface and oral swab samples by real-time reverse transcription PCR for NiV RNA. We identified 16 Nipah patients; 12 cases were laboratory-confirmed and 4 probable. Of the 12 laboratory-confirmed cases, 10 showed NiV RNA in oral swab specimens. We obtained surface swab samples for 6 Nipah patients; 5 had evidence of NiV RNA on >1 surface: 4 patients contaminated towels, 3 bed sheets, and 1 the bed rail. Patients with NiV RNA in oral swab samples were significantly more likely than other Nipah patients to die. To reduce the risk for fomite transmission of NiV, infection control should target hospital surfaces.

Atrioventricular nodal echoes over a wide echo window as a therapeutic end point for the catheter-guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia: a prospective study.

Aims: In previous retrospective studies, it was shown that the presence of residual single atrioventricular node (AVN) echoes with an echo zone longer than 30 ms may increase the rate of recurrence after radiofrequency ablation (RFA) of slow pathway in patients with AVN reentrant tachycardia (AVNRT). Based on that, some centres perform additional RFA in these patients. However, this opinion has never been tested prospectively and many centres do not perform re-ablation in these patients. The purpose of this study was to test whether persistence of a single AVN echo over a wide echo zone is a valid end point for RFA. Methods and results: In this prospective study, 576 patients who had a non-inducible arrhythmia post-RFA of AVNRT were divided into those with a remnant echo over a wide echo zone (case group) and those reaching classical end points (control group). The primary end point of the study was recurrence and patients were followed for 34.5 ± 18.8 months. In the control group (n = 510), 14 patients (2.7%) had a recurrence while no recurrence was seen in the case group (n = 66) (final cure rate, 97.3 vs. 100%; difference, 2.7%; upper bound of the 98% CI, 0.0488; P < 0.0001 for non-inferiority). Two complete heart blocks (0.4%) happened in the control group and none in the case group (P = 0.784). Conclusion: Non-inducibility in the presence of a wide echo window is non-inferior to non-inducibility in the presence of narrow echo window or no AVN echoes. In general, the presence of a single echo beat is not an indication for further ablation and this applies for both narrow and wide windows.

The Efficacy of Different Antibiotic Compounds in Regenerative Treatment of Immature Necrotic Teeth.

Objectives: Endodontic treatment of immature teeth poses a significant challenge, especially in achieving a proper seal using traditional obturation methods. Revascularization presents itself as an alternative approach to this problem, and the application of triple antibiotic paste (TAP) has been suggested as a means to achieve disinfection during the procedure. This study aims to compare the antibacterial properties of three different antibiotic combinations to assess their effectiveness on root canal disinfection. Materials and Methods: Eighty samples were employed to assess the impact of three antibiotic combinations on Enterococcus faecalis, Escherichia coli, Streptococcus mutans, and a combination thereof. The antibiotics included metronidazole, ciprofloxacin, and cefaclor (CCM), the commonly used TAP, and a double antibiotic paste (DAP) composed of metronidazole and ciprofloxacin. Dentin shavings collected using Gates-Glidden drills were placed in microtubes containing a 2ml standard bacterial suspension. Microtube contents were diluted and cultured on BHI agar plates, with colony counts calculated based on dentine shavings' weight in CFU/mg. Kruskal-Wallis and Dunn's post-hoc tests were used for statistical analysis and P<0.05 was considered significant. Results: A significant difference in mean CFU was observed among all bacterial groups (P<0.05). Dunn's post-hoc analysis showed a significant difference only between the control group (methylcellulose) and the other antibiotic groups. There was no significant difference between the other antibiotic groups in two-by-two comparisons. Conclusion: There was no significant difference in the antimicrobial properties of DAP, TAP and CCM. Therefore, DAP and CCM may be used during regenerative treatment.

Care pathways of individuals with tuberculosis before and during the COVID-19 pandemic in Bandung, Indonesia.

The COVID-19 pandemic is thought to have undone years' worth of progress in the fight against tuberculosis (TB). For instance, in Indonesia, a high TB burden country, TB case notifications decreased by 14% and treatment coverage decreased by 47% during COVID-19. We sought to better understand the impact of COVID-19 on TB case detection using two cross-sectional surveys conducted before (2018) and after the onset of the pandemic (2021). These surveys allowed us to quantify the delays that individuals with TB who eventually received treatment at private providers faced while trying to access care for their illness, their journey to obtain a diagnosis, the encounters individuals had with healthcare providers before a TB diagnosis, and the factors associated with patient delay and the total number of provider encounters. We found some worsening of care seeking pathways on multiple dimensions. Median patient delay increased from 28 days (IQR: 10, 31) to 32 days (IQR: 14, 90) and the median number of encounters increased from 5 (IQR: 4, 8) to 7 (IQR: 5, 10), but doctor and treatment delays remained relatively unchanged. Employed individuals experienced shorter delays compared to unemployed individuals (adjusted medians: -20.13, CI -39.14, -1.12) while individuals whose initial consult was in the private hospitals experienced less encounters compared to those visiting public providers, private primary care providers, and informal providers (-4.29 encounters, CI -6.76, -1.81). Patients who visited the healthcare providers >6 times experienced longer total delay compared to those with less than 6 visits (adjusted medians: 59.40, 95% CI: 35.04, 83.77). Our findings suggest the need to ramp up awareness programs to reduce patient delay and strengthen private provide engagement in the country, particularly in the primary care sector.

Effect of NaCl and EDDS on Heavy Metal Accumulation in Kosteletzkya pentacarpos in Polymetallic Polluted Soil.

The ability of plants to accumulate heavy metals is a crucial factor in phytoremediation. This study investigated the effect of NaCl and S,S-ethylenediaminesuccinic acid (EDDS) on heavy metal accumulation in Kosteletzkya pentacarpos in soil polluted with arsenic, cadmium, lead, and zinc. The addition of NaCl reduced the bioavailability of arsenic and cadmium, while EDDS increased the bioavailability of arsenic and zinc. The toxicity of the polymetallic pollutants inhibited plant growth and reproduction, but NaCl and EDDS had no significant positive effects. NaCl reduced the accumulation of all heavy metals in the roots, except for arsenic. In contrast, EDDS increased the accumulation of all heavy metals. NaCl reduced the accumulation of arsenic in both the main stem (MS) and lateral branch (LB), along with a decrease in cadmium in the leaves of the main stem (LMS) and zinc in the leaves of the lateral branch (LLB). Conversely, EDDS increased the accumulation of all four heavy metals in the LB, along with an increase in arsenic and cadmium in the LMS and LLB. Salinity significantly decreased the bioaccumulation factor (BF) of all four heavy metals, while EDDS significantly increased it. NaCl had different effects on heavy metals in terms of the translocation factor (TFc), increasing it for cadmium and decreasing it for arsenic and lead, with or without EDDS. EDDS reduced the accumulation of all heavy metals, except for zinc, in the presence of NaCl in polluted soil. The polymetallic pollutants also modified the cell wall constituents. NaCl increased the cellulose content in the MS and LB, whereas EDDS had little impact. In conclusion, salinity and EDDS have different effects on heavy metal bioaccumulation in K. pentacarpos, and this species has the potential to be a candidate for phytoremediation in saline environments.

Trends and correlates of low HIV knowledge among ever-married women of reproductive age: Evidence from cross-sectional Bangladesh Demographic and Health Survey 1996-2014.

BACKGROUND: The human immunodeficiency virus (HIV) burden has frequently been changing over time due to epidemiological and demographic transitions. To safeguard people, particularly women of reproductive age, who can be exposed to transmitting this burden to the next generation, knowledge regarding this life-threatening virus needs to be increased. This research intends to identify the trends and associated correlates of "low" HIV knowledge among ever-married women of reproductive age in Bangladesh from 1996 to 2014. METHODS: We analyzed data derived from six surveys of Bangladesh Demographic and Health Surveys conducted in 1996, 1999, 2004, 2007, 2011, and 2014. Analyses were primarily restricted to ever-married women aged 15-49 years who had ever heard of HIV. The correlates of "low" HIV knowledge were investigated using multiple binary logistic regression models. RESULTS: The study found that the proportion of women with "low" HIV knowledge decreased from 72% in 1996 to 58% in 2014. In adjusted models, age at first marriage, level of education, wealth quintile, and place of residence (except in the survey year 2011) were found to be potential correlates of "low" HIV knowledge in all survey years. In the pooled analysis, we found lower odds of "low" HIV knowledge in the survey years 1999 (Adjusted Odds Ratio: 0.67; 95% CI: 0.57, 0.78), 2004 (AOR: 0.60; 95% CI: 0.52, 0.70), 2007 (AOR: 0.51; 95% CI: 0.44, 0.60), 2011 (AOR: 0.36; 95% CI: 0.32, 0.42) and 2014 (AOR: 0.47; 95% CI: 0.41, 0.54) compared to the survey year 1996. CONCLUSION: The proportion of "low" HIV knowledge has declined over time, although the proportion of women with "low" HIV knowledge still remains high. The prevention of early marriage, the inclusion of HIV-related topics in the curricula, reduction of disparities between urban-rural and the poorest-richest groups may help to improve the level of HIV knowledge among ever-married Bangladeshi women.

Assessing sustained uptake of latrine and child feces management interventions: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh 1-3.5 years after intervention initiation.

BACKGROUND: Sanitation interventions typically result in modest increases in latrine access, and any gains in latrine access and use are often not sustained over time. Sanitation programs also rarely include child-focused interventions such as potties. We aimed to assess the sustained effect of a multi-component sanitation intervention on access to and use of latrines and child feces management tools in rural Bangladesh. METHODS: We conducted a longitudinal substudy nested within the WASH Benefits randomized controlled trial. The trial provided latrine upgrades, child potties and sani-scoops for feces removal, along with behavior change promotion to encourage use of the delivered hardware. Promotion visits to intervention recipients were frequent during the first 2 years after intervention initiation, decreased in frequency between years 2-3, and ceased after 3 years. We enrolled a random subset of 720 households from the sanitation and control arms of the trial in a substudy and visited them quarterly between 1 and 3.5 years after intervention initiation. At each visit, field staff recorded sanitation-related behaviors through spot-check observations and structured questionnaires. We assessed intervention effects on observed indicators of hygienic latrine access, potty use and sani-scoop use and investigated whether these effects were modified by duration of follow-up, ongoing behavior change promotion and household characteristics. RESULTS: The intervention increased hygienic latrine access from 37% among controls to 94% in the sanitation arm (p < 0.001). Access among intervention recipients remained high 3.5 years after intervention initiation, including periods with no active promotion. Gains in access were higher among households with less education, less wealth and larger number of residents. The intervention increased availability of child potties from 29% among controls to 98% in the sanitation arm (p < 0.001). However, fewer than 25% of intervention households reported exclusive child defecation in a potty or had observed indicators of potty and sani-scoop use, and gains in potty use declined over the follow-up period, even with ongoing promotion. CONCLUSION: Our findings from an intervention that provided free products and intensive initial behavior change promotion suggest a sustained increase in hygienic latrine access up to 3.5 years after intervention initiation but infrequent use of child feces management tools. Studies should investigate strategies to ensure sustained adoption of safe child feces management practices.

Exposure to Brucella spp. in Humans and Cows in a High Milk-Producing Area of Bangladesh.

Brucellosis is a zoonotic disease, caused by some species within the Brucella genus. The primary and secondary objectives of this cross-sectional study were to determine the seroprevalence of Brucella antibodies in humans and cows and identify risk factors for exposure to Brucella spp. among people in Shahjadpur sub-district, Bangladesh. Twenty-five villages were randomly selected from the 303 milk-producing villages in the sub-district. We randomly selected 5% of the total households from each village. At each household, we collected demographic information and history of potential exposure to Brucella spp. in humans. In addition, we collected serum from household participants and serum and milk from cattle and tested to detect antibodies to Brucella sp. Univariate analysis was performed to detect associations between seropositivity and demographics, risk factors, and behaviors in households. We enrolled 647 households, 1313 humans, and 698 cows. Brucella antibodies were detected in sera from 27 household participants (2.1%, 95% confidence interval [95%CI]: 1.2-2.9%). Eleven (1.6%, 95%CI 0.6-2.4%) cows had detectable Brucella antibodies in either milk or serum. About half (53%) of the 698 cows exhibited more than one reproductive problem within the past year; of these, seven (2%) had Brucella antibodies. Households with seropositive individuals more frequently reported owning cattle (78% vs. 32%, P < 0.001). Despite a low prevalence of Brucella seropositivity in the study, the public health importance of brucellosis cannot be ruled out. Further studies would help define Brucella prevalence and risk factors in this region and nationally.

Interpretation of molecular detection of avian influenza A virus in respiratory specimens collected from live bird market workers in Dhaka, Bangladesh: infection or contamination?

OBJECTIVES: Interpreting real-time reverse transcription-polymerase chain reaction (rRT-PCR) results for human avian influenza A virus (AIV) detection in contaminated settings like live bird markets (LBMs) without serology or viral culture poses a challenge. METHODS: During February-March 2012 and November 2012-February 2013, we screened workers at nine LBMs in Dhaka, Bangladesh, to confirm molecular detections of AIV RNA in respiratory specimens with serology. We tested nasopharyngeal (NP) and throat swabs from workers with influenza-like illness (ILI) and NP, throat, and arm swabs from asymptomatic workers for influenza virus by rRT-PCR and sera for seroconversion and antibodies against HPAI A(H5N1) and A(H9N2) viruses. RESULTS: Among 1273 ILI cases, 34 (2.6%) had A(H5), 56 (4%) had A(H9), and six (0.4%) had both A(H5) and A(H9) detected by rRT-PCR. Of 192 asymptomatic workers, A(H5) was detected in eight (4%) NP and 38 (20%) arm swabs. Of 28 ILI cases with A(H5) or A(H9) detected, none had evidence of seroconversion, but one (3.5%) and 12 (43%) were seropositive for A(H5) and A(H9), respectively. CONCLUSION: Detection of AIV RNA in respiratory specimens from symptomatic and asymptomatic LBM workers without evidence of seroconversion or virus isolation suggests environmental contamination, emphasizing caution in interpreting rRT-PCR results in high viral load settings.

Women empowerment and sexually transmitted infections: Evidence from Bangladesh demographic and health survey 2014.

BACKGROUND: Sexually transmitted infections (STIs) among women have led to substantial public health and economic burdens in several low-middle-income countries. However, there is a paucity of scientific knowledge about the relationship between empowerment and symptoms of STIs among married Bangladeshi women. This article aimed to examine the association between women empowerment and symptoms of STIs among currently married Bangladeshi women of reproductive age. MATERIALS AND METHODS: We extracted data from the Bangladesh Demographic and Health Survey (BDHS), conducted from June 28, 2014, to November 9, 2014. We utilised cross-tabulation, the conceptual framework and multivariable multilevel mixed-effect logistics regression to explore the association between women's empowerment indicators and women's self-reported symptoms of genital sore and abnormal genital discharge. All of the analysis was adjusted using cluster weight. RESULTS: We found that among 16,858 currently married women, 5.59% and 10.84% experienced genital sores and abnormal genital discharge during the past 12 months, respectively. Women who depended on husbands to make decisions regarding their health care (AOR = 0.75, 95% CI = 0.67-0.84), significant household purchases (AOR = 0.79, 95% CI = 0.71-0.88), and visiting family or relatives (AOR = 0.72, 95% CI = 0.64-0.80) were less likely to report signs of abnormal genital discharge. Women who could make joint healthcare decisions with their husbands were also less likely to report genital sores (AOR = 0.78, 95% CI = 0.67-0.90). CONCLUSION: Genital sores and abnormal genital discharge were prevalent across all parameters of women empowerment among currently married women in Bangladesh. Our estimates show that the husband plays a significant role in decision-making about sexual and reproductive health. Efforts need to be invested in establishing culturally relevant gender policies which facilitate the involvement of women in joint decision-making.

Electrical storm in Brugada syndrome during pregnancy.

Clinical and molecular characterization of the Brugada syndrome has progressed rapidly since its initial description. The role of hormonal changes during pregnancy and postpartum period on the pathogenesis of Brugada syndrome has not been studied. Herein, we describe a case of revelation of Brugada syndrome during pregnancy in a young woman who presented with electrical storm as the first manifestation. Low-dose isoproterenol infusion followed by oral quinidine inhibited the recurrence of ventricular tachyarrhythmia and normalized the electrocardiographic pattern. We emphasize the importance of hormonal changes during pregnancy as a precipitating factor for arrhythmic events in Brugada syndrome.

Antibiotic use for acute respiratory infections among under-5 children in Bangladesh: a population-based survey.

INTRODUCTION: Despite acute respiratory infections (ARIs) being the single largest reason for antibiotic use in under-5 children in Bangladesh, the prevalence of antibiotic use in the community for an ARI episode and factors associated with antibiotic use in this age group are unknown. METHODS: We analysed nationally representative, population-based, household survey data from the Bangladesh Demographic and Health Survey 2014 to determine the prevalence of antibiotic use in the community for ARI in under-5 children. Using a causal graph and multivariable logistical regression, we then identified and determined the sociodemographic and antibiotic source factors significantly associated with the use of antibiotics for an episode of ARI. RESULTS: We analysed data for 2 144 children aged <5 years with symptoms of ARI from 17 300 households. In our sample, 829 children (39%) received antibiotics for their ARI episode (95% CI 35.4% to 42.0%). Under-5 children from rural households were 60% (adjusted OR (aOR): 1.6; 95% CI 1.2 to 2.1) more likely to receive antibiotics compared with those from urban households, largely driven by prescriptions from unqualified or traditional practitioners. Private health facilities were 50% (aOR: 0.5; 95% CI 0.3 to 0.7) less likely to be sources of antibiotics compared with public health facilities and non-governmental organisations. Age of children, sex of children or household wealth had no impact on use of antibiotics. CONCLUSION: In this first nationally representative analysis of antibiotic use in under-5 children in Bangladesh, we found almost 40% of children received antibiotics for an ARI episode. The significant prevalence of antibiotic exposure in under-5 children supports the need for coordinated policy interventions and implementation of clinical practice guidelines at point of care to minimise the adverse effects attributed to antibiotic overuse.

Negative current of injury due to inadvertent polarity reversal during active atrial lead implantation.

We report an example of the negative current of injury (COI) during permanent pacemaker implantation. Cardiac perforation was our first priority. However, patient had stable hemodynamics, and the fluoroscopic location of the atrial lead was acceptable. Therefore, the connections were checked revealing the cause of the negative COI; the red (+) clips was attached to the tip of the atrial lead rather than anodal ring. Correcting the connections resolved the problem. This report shows that a negative COI might not only be due to cardiac perforation or right ventricular ischemia but that checking the lead connectivity should be carried out first.

Knowledge and attitudes associated with menopause among women aged 45 to 60 years: a pilot study among rural and urban women in Bangladesh.

OBJECTIVE: To assess knowledge and attitudes associated with the menopause transition among women in Bangladesh. METHODS: A cross-sectional survey was conducted among women (age range 45-60 y), 160 participants were selected from both urban and rural settings using a systematic sampling procedure. We used face-to-face interview techniques employing a semistructured questionnaire. Bivariate and multivariate regression analyses were done to assess the associated factors. RESULTS: Around one-fourth (23%) of the participants did not have a basic understanding about symptoms of menopause. Knowledge about menopause increased proportionately with higher education levels (primary education, risk ratio [RR] = 3.91, 95% confidence interval [CI] = 0.66-22.92; secondary education, RR = 6.10, 95% CI = 1.26-29.41; higher education, RR = 6.74, 95% CI = 1.33-34) and was more common among urban than rural women (P = 0.001). In addition, women who were service holders had greater knowledge about menopause compared with women who worked in the home (RR = 8.67, 95% CI = 1.94-38.58). Most of the women (96%) suffered from different kinds of depression during the menopause transition. Key barriers to gaining knowledge about menopause included access to information (63%), social stigma (57%), and shame (52%). CONCLUSIONS: Menopause is a neglected issue in Bangladesh. Accurate and appropriate information regarding premenopause and menopause can help women cope with this life transition. Social and familial support may also play a role in minimizing isolation and depression. Public health messaging to increase awareness and knowledge about menopause should be undertaken to overcome the stigma and shame associated with menopause in Bangladesh. : Video Summary:http://links.lww.com/MENO/A556.

Video Summary:http://links.lww.com/MENO/A556.

Epidemiology and genotypes of group A rotaviruses in cattle and goats of Bangladesh, 2009-2010.

Group A rotavirus (RVA) is recognized as a major cause of severe gastroenteritis in newborn calves and goat kids. We estimated the proportion of ruminants infected with rotavirus and identified the circulating genotypes in cattle and goats in Bangladesh. Between May 2009 and August 2010, fecal samples were collected from 520 cattle and goats presenting with diarrhea at three government veterinary hospitals in three districts of Bangladesh. All samples were screened for RVA RNA using real-time, one-step, reverse transcription polymerase chain reaction (qRT-PCR). Of the 520 animals tested, 11.7% (61) were positive for RVA RNA, with 6.2% (15/241) and 16.5% (46/279) positivity in cattle and goats, respectively. RVA positive samples were further characterized by nucleotide sequence analysis of two structural protein gene fragments, VP7 (G genotype), and VP4 (P genotype). Among 17 successfully sequenced strains, G8 (17.9%) was the most prevalent G-genotype followed by G10 (8%) and G6 (1.6%). P[1] (11.3%) was the most frequently detected P-genotype followed by P[11] (3.2%) and P[15] (1.6%). The most common VP7/VP4 combinations for cattle were G10P[11], G10P[15], and G6P[11], and for goat, G8P[1], and G10P[1]. Phylogenetic analysis of the RVA strains showed clustering with bovine and caprine strains from neighboring India. The study adds to our understanding of the genetic diversity of bovine and caprine rotavirus strains in Bangladesh. Our findings highlight the importance of rotavirus surveillance in cattle and goat populations, which may serve as a potential source for genetic reassortment and zoonotic transmission.

Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea.

Child open defecation is common in low-income countries and can lead to fecal exposure in the domestic environment. We assessed associations between child feces management practices vs. measures of contamination and child diarrhea among households with children <5 years in rural Bangladesh. We visited 360 households quarterly and recorded caregiver-reported diarrhea prevalence, and defecation and feces disposal practices for children <5 years. We examined caregiver and child hands for visible dirt and enumerated E. coli in child and caregiver hand rinse and stored drinking water samples. Safe child defecation (in latrine/potty) and safe feces disposal (in latrine) was reported by 21% and 23% of households, respectively. Controlling for potential confounders, households reporting unsafe child defecation had higher E. coli prevalence on child hands (prevalence ratio [PR] = 1.12, 1.04-1.20) and in stored water (PR = 1.12,1.03-1.21). Similarly, households reporting unsafe feces disposal had higher E. coli prevalence on child hands (PR = 1.11, 1.02-1.21) and in stored water (PR = 1.10, 1.03-1.18). Effects on E. coli levels were similar. Children in households with unsafe defecation and feces disposal had higher diarrhea prevalence but the associations were not statistically significant. Our findings suggest that unsafe child feces management may present a source of fecal exposure for young children.