Antenatal Dexamethasone for Early Preterm Birth in Low-Resource Countries.

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P = 0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. (Funded by the Bill and Melinda Gates Foundation and the World Health Organization; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000476336; Clinical Trials Registry-India number, CTRI/2017/04/008326.).

Dose-time-response modeling using negative binomial distribution.

People exposed to certain diseases are required to be treated with a safe and effective dose level of a drug. In epidemiological studies to find out an effective dose level, different dose levels are applied to the exposed and a certain number of cures is observed. Negative binomial distribution is considered to fit overdispersed Poisson count data. This study investigates the time effect on the response at different time points as well as at different dose levels. The point estimation and confidence bands for ED(100p)(t) and LT(100p)(d) are formulated in closed form for the proposed dose-time-response model with the negative binomial distribution. Numerical illustrations are carried out in order to check the performance level of the proposed model.

SnapFib: An easy build Arduino based tabletop prototype for thin film deposition by Successive Ionic Layer Adsorption and Reaction method.

Non-vacuum-based techniques are suitable for thin-film deposition with precision stoichiometric control. Among those, the Successive Ionic Layer Adsorption and Reaction (SILAR) method is gaining popularity for its aqueous-based almost room temperature deposition option. This method has many advantages, including the ability to control the elemental composition and stoichiometry of precursors. It is also suitable for large-area deposition. It has many runtime parameters, e.g., the number of cycles, dip time, rinse time, etc., that control the quantitative and qualitative physical properties of the deposited film. But manually controlling all these parameters for the whole process is very difficult and cumbersome. Although there are several reports published on this similar type of home-built prototype, for fast, accurate, and economically affordable deposition operations, we need to develop a machine that maintains all the properties of the SILAR process and can be made using cheap technologies. Here we report the SnapFib, a cost-effective automated tabletop prototype machine that is easy to build for thin-film deposition on soda-lime glass substrates by the SILAR method without almost any human intervention. SnapFib is built using linear actuators, an ATmega328P (a microcontroller available on Arduino boards), and some other parts collected from laboratory sites. The whole firmware needed for this device has been developed and maintained using the Arduino IDE (Integrated Development Environment). All required functional features and control parameters are encoded in the microcontroller firmware. The construction cost of this prototype is around 600 USD. We validated our construction through XRD (X-ray Diffraction) and FESEM (Field Emission Scanning Electron Microscope) characterizations of thin films that were deposited by SnapFib. Since this is built under the CC-BY license, students and researchers can freely perform and validate their experiments and modify the hardware and software as required. With how easy it is to make and how much it costs; we hope that many thin-film deposition labs will quickly start using SnapFib as an added benefit.

Synthesis and characterization of nanozeolite based composite fertilizer for sustainable release and use efficiency of nutrients.

In this research work, we propose macronutrients incorporated slow-release based nano-fertilizer using nanozeolite as a carrier. A simple chemical approach was used to synthesis the proposed nanozeolite composite fertilizer (NZCF). To gain an insight into the properties, morphology and structure of the synthesized NZCF, it was further characterized by different techniques such as powder XRD, FT-IR, SEM, and TG/DTA. A considerable enhancement of the quality and the water retention capacity of the soil was observed as a result of applying the proposed NZCF when compared with a commercial fertilizer. Furthermore, the swelling ratio and the equilibrium water content of NZCF were compared to the commercial fertilizer and their effect on plant growth was observed. Slow-release studies were carried out for both NZCF and the commercial fertilizer. The results of these studies reveled that NZCF possessed a long-term release pattern of the macronutrients and that showed a great potential for promoting plant growth. Hence, the prepared nanocomposite fertilizer can be safely used as an environment-friendly source of nutrients to enhance plant growth.

Evaluation of splicing efficiency in lymphoblastoid cell lines from patients with splicing-factor retinitis pigmentosa.

PURPOSE: Retinitis pigmentosa (RP) is caused by mutations in a variety of genes, most of which have known functions in the retina. However, one of the most perplexing findings of recent retinal genetics research was the discovery of mutations causing dominant RP in four ubiquitously expressed splicing factors. The aim of this study was to use lymphoblast cell lines derived from RP patients to determine whether mutations in two of these splicing factors, PRPF8 and PRPF31, cause measurable deficiencies in pre-mRNA splicing. METHODS: cDNA was prepared from lymphoblastoid cell lines derived from RP patients bearing mutations in the splicing factor genes and controls, grown under a variety of conditions. Introns representing the U2 and U12 intron classes, with both canonical and noncanonical donor and acceptor sequences, were analyzed by real-time PCR to measure the ratio of spliced versus unspliced transcripts for these introns. In addition, plasmids encoding the retinal outer segment membrane protein-1 (ROM-1; exon 1 to exon 2) gene, both in the wild-type form and with mutations introduced into the splice donor sites, were transfected into cell lines. The spliced versus unspliced cDNA ratios were measured by real-time RT-PCR. RESULTS: Splicing of four canonical U2 introns in the actin beta (ACTB), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), PRPF8, and retinitis pigmentosa GTPase regulator (RPGR) genes was unaffected in PRPF8 mutant cells. However, the splicing efficiency of RPGR intron 9 was significantly decreased in PRPF31 mutant cell lines. In contrast, a consistent decrease in the splicing efficiency of all U12 and noncanonical U2 introns was seen in PRPF8, but not in PRPF31, mutant cells, with statistical significance for STK11 intron 3. CONCLUSIONS: In spite of the ubiquitous expression patterns of the genes implicated in splicing factor RP, no pathology has yet been documented outside the retina. The observed differences in splicing efficiency described herein favor the hypothesis that these mutations may have a subpathological effect outside the retina. These observations argue against a defect in some yet to be discovered additional function of these proteins and support the alternative hypothesis that this form of RP does indeed result from aberrant splicing of retinal transcripts.

Characterization of Mycobacterium africanum subtype I among cows in a dairy farm in Bangladesh using spoligotyping.

Acid-fast bacilli (AFB) were detected in the autopsy lung tissue homogenate samples of four cows (variety Frisian cross) in a dairy farm in Bangladesh. Histopathological examination of the lung tissue demonstrated prominent granulomas, caseating necrosis and calcification indicative of tuberculosis (TB) infection. Mycobacteria could not be cultured from the tissue homogenate samples by Lowenstein-Jensen based conventional culture method though AFB were evident by Ziehl-Neelsen (ZN) staining of the smears of tissue homogenate and in paraffin embedded tissue slices. Spoligotyping performed on DNA extracts of paraffin embedded lung tissue samples confirmed the AFB as a member of the M. tuberculosis complex (MTBC) with a pattern assigned to M. africanum subtype I. This characterization by spoligotyping was confirmed by subjecting M. africanum subtype I isolates from other parts of the world to an alternative identification method based on DNA polymorphism in the gyrB gene (Hain Life Science, GmbH, Nehren, Germany). Since M. africanum is believed to be a human pathogen, general infection in cattle may be a public health threat. The presence of these bacteria in the animal reservoir most likely originated from a caretaker.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh.

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Cerebral glycogenolysis and glycolysis in malathion-treated hyperglycaemic animals.

Treatment with malathion resulted in an increase in the level of blood glucose and lactate and reduced cerebral glycogen, 2 hr after its administration. The blood pyruvate level was not changed. The activities of glycogenolytic enzymes (glycogen phosphorylase and phosphoglucomutase) were increased significantly in the brain, whereas that of glucose-6-phosphatase remained unchanged. The activity of the glycolytic enzyme-hexokinase was increased significantly in malathion-treated animals, whereas those of the glucose-6-phosphate and lactate dehydrogenases were not significantly changed. The changes in enzyme activities may be a compensatory mechanism to provide energy in the form of glucose to cerebral tissue on account of stimulatory effects in malathion-treated animals.

Modification of diazinon-induced changes in carbohydrate metabolism by adrenalectomy in rats.

Treatment with diazinon (40 mg/kg, i.p.) resulted in hyperglycemia and depletion of glycogen from cerebral and peripheral tissues 2 hr after its administration in rats. The activities of the glycogenolytic enzymes glycogen phosphorylase and phosphoglucomutase were increased significantly in brain and liver, whereas that of glucose-6-phosphatase was not altered. The activities of the glycolytic enzymes hexokinase and lactate dehydrogenase were increased only in the brain. The cholinesterase activity of the brain was reduced by treatment with diazinon. The activities of the hepatic gluconeogenic enzymes fructose 1,6-diphosphatase and phosphoenolpyruvate carboxykinase were also increased significantly in diazinon-treated animals. The level of lactate was increased in brain and blood, whereas that of pyruvate was not changed. The activity of glucose-6-phosphate dehydrogenase was not changed significantly. The cholesterol and ascorbic acid contents of adrenals were depleted in diazinon-treated animals. The hyperglycemia and changes in carbohydrate metabolism were abolished by adrenalectomy, suggesting the possible involvement of the adrenals in the induced changes in diazinon-treated animals.

Role of striatal dopamine in delayed neurotoxic effects of organophosphorus compounds.

Mipafox administered to rats daily for 35 days produced ataxia and a reduction in the level of dopamine in the corpus striatum. Treatment with Leptophos for the same period produced slight motor dysfunction and a small but significant reduction in the level of striatal dopamine. Fenitrothion neither produced motor dysfunction nor changed the level of striatal dopamine. The cholinesterase activity of corpus striatum was inhibited by all the compounds. The results suggest the possible involvement of striatal dopamine in the delayed neurotoxic effects of certain organophosphorus compounds.

Landholding, wealth and risk of blinding malnutrition in rural Bangladeshi households.

The 1982-1983 Bangladesh nutritional blindness study visited 11,618 rural households and examined 18,660 preschool-age children in an effort to determine the prevalence and determinants of eye lesions and loss of sight due to vitamin A deficiency (xerophthalmia). Risk of xerophthalmia was significantly higher for children from households without any of the indicators of relative wealth used. Almost 80% of blind children from landless households, and even a very small garden reduced considerably the chances of a household having a xerophthalmic child. Poorer households with access to less than 0.3 acres land or no garden or without a tin roof, wristwatch, radio or cycle were at least twice as likely as their more fortunate neighbours to have a young child with any type of xerophthalmia. Taking account of such socio-environmental risk factor weightings would direct the scarce resources of intervention programmes to households and children who most need them.

Convulsions as the etiology of lactic acidosis in acute diazinon toxicity in rats.

Diazinon, in acute doses (40 mg/kg, i.p.) in rats produced tremors and convulsions with lactic acidosis which was accompanied by depletion of glycogen and activation of glycogen phosphorylase activity in triceps and diaphragm muscles, 2 h after its administration. Prevention of convulsions with phenobarbitone administered immediately before diazinon, resulted in neither the development of lactic acidosis nor mobilization of muscle glycogen or activation of glycogen phosphorylase. Lactic acidosis was due to depletion of glycogen through enhanced activity of glycogen phosphorylase in muscles on account of tremors and convulsions induced by diazinon in rats.

Effect of intratracheally administered lindane on aldrin and benzo(a)pyrene contents in lungs of rats.

Pretreatment with lindane resulted in inhibition of benzo(a)pyrene hydroxylase activity in the lungs of rats. The enzyme activity tended to return to normal 5 days after the administration of lindane. Studies with benzo(a)pyrene and aldrin indicated reduced elimination of these compounds from the lungs of lindane-treated animals, suggesting that lindane may alter the clearance of certain substances or compounds from lungs. The delayed clearance of these compounds from lungs may be an indirect effect of lindane related to inhibition of certain metabolizing enzymes.

Striatal neurochemical changes and motor dysfunction in mipafox-treated animals.

5 mg/kg mipafox [N,N'-bis(1-methylethyl)phosphordiamidic fluoride] was administered s.c. daily for 60 days in rats. The animals developed motor dysfunction-muscle twitchings, fasciculations and slight ataxia towards the end of the experimental period; the motor dysfunction was accompanied by neurochemical changes in the corpus striatum which included significantly reduced levels of cholinesterase, neurotoxicesterase, dopamine and GABA. The neurochemical imbalance in the corpus striatum may be related to motor dysfunction in mipafox-treated animals.

Prescribing pattern in acute diarrhoea in three districts in Bangladesh.

PIP: Since the irrational administration of drugs in diarrhea cases is a serious problem, a prescribing survey was made among 10 government health facilities (GHF) and private dispensaries (PD) in the Dhaka, Tangail, and Serajgong districts of Bangladesh. Using standard indicators on prescribing, patient care, and drug supply developed by the International Network for the Rational Use of Drugs, 12 prescriptions written for children under 5 years old with acute diarrhea were studied from each center (total = 120). It was found that the average number of drugs administered per encounter was 1.82 and 2.30 in the GHFs and PDs, respectively. Almost every prescription (0.79 and 0.96 in the GHFs and PDs, respectively) had an antimicrobial component, with metronidazole used in most cases despite the fact that it is not indicated in acute diarrhea and treatment guidelines advise against its use in children under age 5 years in Bangladesh. Oral rehydration salt solution was used in each facility in about 80% of cases (vs. 11% of cases in the community). Because of the inclusion of the antimicrobial, standard treatment guidelines were followed in only 17 and 23% of cases in the GHFs and PDs, respectively. Patient care indicators revealed that 1.8% of patients were examined in the GHFs vs. 65% in the PDs. 50% of patients in both facilities could report the correct dosing schedule for the drugs they were given. The GHFs do not label prescriptions, but all the drugs administered by the PDs remain in manufacturer-labeled containers. The existence of an essential drugs list and the distribution of standard treatment guidelines have not ensured good prescribing habits among health professionals for this common disease. Additional efforts are required to improve this situation.^ieng

Distribution of neurotoxic esterase in certain brain regions of laboratory animals.

Certain organophosphorous compounds caused the inhibition of 'neurotoxic esterase' present in central nervous system. The role of this enzyme is different from that of cholinesterase. The level of neurotoxic esterase in brain, corpus striatum and spinal cord of rats, mice, guineapigs and hens was measured. Maximum level of the enzyme was found in hens, followed by guineapigs, rats and mice in the order. The concentration of the enzyme was higher in corpus striatum greater than whole brain greater than spinal cord. The determination of the normal level of neurotoxic esterase may be useful in monitoring the exposure to organophosphorous compounds.

Etiology and clinical profile of hepatocellular carcinoma in Bangladesh.

Sixty-four consecutive subjects with hepatocellular carcinoma were prospectively studied in the department of Hepatology, IPGMR, Dhaka. Their mean age was 50.11 years. Fifty-two were male and 12 female. Cirrhosis was present in 12 (18.75%) subjects. Thirty subjects (46.88%) had HBsAg in their sera. Seven (58.33% of females) patients gave history of use of oral contraceptives. Cirrhosis, HBV infection, male sex, middle age, and probably the use of oral contraceptives in females appeared to be important risk factors for development of HCC in Bangladesh. Majority of patients presented with upper abdominal pain, weight loss and anorexia. Hepatomegaly was invariably present. Alpha fetoprotein was significantly higher in cirrhotic HCC patients than in non-cirrhotic ones. Median survival was two months. None of the clinical or laboratory features predicted the prognosis.

The role of adrenals in diazinon-induced changes in carbohydrate metabolism in rats.

Treatment of rats with diazinon (40 mg/kg, i.p.) resulted in hyperglycaemia and depletion of glycogen from the brain and peripheral tissues two hours after administration. The activities of glycogen phosphorylase and phosphoglucomutase were significantly higher in the brain and liver; that of glucose-6-phosphatase was not altered. The activities of the glycolytic enzymes hexokinase and lactate dehydrogenase were increased only in the brain. The cholinesterase activity in the brain was reduced by treatment with diazinon. The activities of the hepatic gluconeogenic enzymes fructose 1,6-diphosphatase and phosphoenolpyruvate carboxykinase were significantly increased. The lactate level was increased in the brain and blood, whereas that of pyruvate was not changed. The activity of glucose-6-phosphate dehydrogenase was not changed to any major extent. Cholesterol and ascorbic acid contents of adrenals were depleted in diazinon-treated animals. The changes were pronounced after intraperitoneal administration of 40 mg/kg diazinon, they were slight but significant after 20 mg/kg, and absent after 10 mg/kg. Hyperglycaemia and changes in carbohydrate metabolism were abolished by adrenalectomy suggesting possible involvement of adrenals.

A profile of 100 complicated cases of chronic suppurative otitis media.

A two year study of cases of chronic suppurative otitis media admitted in the Ear, Nose and Throat (ENT) Department of Sir Salimullah Medical College and Mitford Hospital from January 1991 to December 1992 was done. 112 patients of chronic suppurative otitis media (CSOM) were admitted during this two year period, out of which 100 patients (89.3%) presented with different types of complications and only 12 patients (10.7%) presented with no complications. Factors associated with the late presentation of the disorder, including poor socioeconomic conditions and lack of hospital facilities, are identified. Measures to prevent the rate of complications and hearing loss in children are suggested.

A novel and simple mixture as point-of-use water treatment agent to produce safe drinking water.

BACKGROUND: People in rural Bangladesh have a poor understanding of the link between use of contaminated surface water and disease. An inexpensive point-of-use water treatment agent was developed to purify surface water. METHODS: Surface water was collected from various sources in Bangladesh from February 2007 to January 2008. Microbiological and physicochemical parameters of raw and treated surface water were analysed. Water was treated with a mixture of alum potash, bleaching powder and lime, or with each agent individually. RESULTS: Raw water was contaminated with bacteria, the counts for total coliforms, faecal coliforms and faecal streptococci being 26,431, 14,548 and 240 colony-forming units (cfu) 100 ml(-1), respectively. These counts fell to 0 cfu 100 ml(-1) after treatment with the mixture. The count of artificially introduced Vibrio cholerae was also reduced to 0 cfu 100 ml(-1) after treatment. Treatment of raw water altered the pH from 6.90 to 6.87, turbidity from 21.61 to 3.55 nephelometric turbidity units (NTU), residual chlorine from 0 to 0.09 mg litre(-1), conductivity from 124.03 to 229.96 µS cm(-1), and total dissolved solids from 59.40 to 199.25 mg litre(-1). All these results of treatment were within the range recommended by the WHO as acceptable for drinking water. CONCLUSION: The mixture of alum potash, bleaching powder and lime described can be safely used to disinfect contaminated surface water to make it suitable for drinking and other household purposes in Bangladesh.