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Background: Maternal post-natal depression is a global public health problem. Parenting interventions targeting children's development may also bring benefits to mothers, but few parenting interventions have been studied thoroughly., Objectives: The study aimed to measure the effect of a parenting intervention using culturally appropriate and locally made toys, along with nutrition education and unconditional cash, on maternal depressive symptoms (MDS) and quality of life (QoL)., Methods: The study was a cluster randomised controlled trial with two arms: i) intervention: parenting with nutrition education and unconditional cash and ii) comparison: unconditional cash in an urban setting in Bangladesh. Twenty clusters were randomised to either the intervention or control group. Community Health Workers (CHWs) delivered parenting and nutrition education sessions fortnightly in households for one year. The participants were mother-child (6-16 months) dyads. The MDS and QoL were measured using the Self-Reporting Questionnaire-20 and a brief version of the QoL questionnaire. Linear regression analysis was used to assess the treatment effects., Results: After one year of intervention, 547 mothers (93%) completed the study. The mothers in the intervention group had lower MDS [Regression coefficient (β)=-1.53, Confidence interval (95% CI)=-2.28, -0.80] and higher QoL scores in physical health [β = 4.21 (95% CI = 1.71, 6.73)], psychological health [β = 3.14 (95% CI = 1.10, 5.19)], social relationships [β = 3.21 (95% CI = 0.76, 5.66)] and environment [β = 3.40 (95% CI = 1.37, 5.44)] compared with the comparison group., Conclusion: Parenting interventions including nutrition education and unconditional cash, aimed at improving children's development, resulted in a reduction in maternal depressive symptoms and improvement in quality of life.

COVID-19 vaccination has been instrumental in fighting the pandemic, but evidence on the actual costs associated with delivering these vaccines in resource-constrained settings has been limited. We estimated the cost of delivering COVID-19 vaccines in Bangladesh through five delivery strategies in 2021 and 2022, including Ministry of Health (MOH) hospitals, non-MOH government hospitals, outreach at Expanded Program on Immunization (EPI) centers, mass campaigns, and schools. This was a bottom-up costing study, estimating costs from a payer and beneficiary perspective. We also mapped the funding flows for COVID-19 vaccination activities and analyzed programmatic and financial challenges. The economic cost incurred by the health system to deliver COVID-19 vaccines was $1.05 per dose, excluding vaccine costs. This was made up of a financial cost of $0.29 per dose and an opportunity cost of $0.75 per dose. School-based delivery incurred the lowest financial cost of $0.27, while outreach at EPI centers incurred the highest at $0.44 per dose. The low financial cost per dose is attributed to the high daily volumes delivered at sampled sites, minimal additional resources provided to sites to implement the COVID-19 vaccination program, and a reliance on the existing workforce. Beneficiaries spent an average of $1.63 to receive a single dose of COVID-19 vaccination at fixed sites, with transport representing the largest cost driver ($0.75 per dose). The economic cost to receive one dose of the COVID-19 vaccine was $4.78. Findings can support the Government of Bangladesh to make efficient and equitable resource allocation decisions for vaccination programs.

To probe the understanding of healthcare providers regarding occupational exposure to human papillomavirus and their knowledge about human papillomavirus vaccination in relation to the American Society for Colposcopy and Cervical Pathology (ASCCP) recommendations. In this cross-sectional study, the healthcare providers at Mayo Clinic Arizona, Florida, and Minnesota were delivered an electronic survey. The survey was completed by 349 healthcare providers, with one respondent excluded for inconsistent entry. The mean age of respondents was 42.7 ± 10.9, and of those, 68% were female and 32% were male. Of the unvaccinated respondents, 43.3% were ≤ 45 y of age (eligible for vaccination), while those vaccinated formed 41% of the respondents. Healthcare providers are highly concerned about their cancer safety, as shown by their awareness of occupational human papillomavirus hazards and broad knowledge about vaccine efficacy. The use of personal protective equipment varied widely, including eyewear, double gloving, procedural face mask, N95 face mask, and/or nothing. Human papillomavirus and cancer risk was clearly perceived by healthcare providers. For professions, pairwise comparisons revealed that nurse practitioners, physician assistants, certified registered nurse anesthetists, and allied healthcare providers had lower scores than medical doctors. Despite the high level of understanding among healthcare providers of occupational human papillomavirus exposure, only a few of them knew of the recommendations of the ASCPP for vaccination of healthcare providers treating human papillomavirus-related diseases. In such cases, most of those surveyed embraced vaccination, which was considered 100% safe by medical doctors and allied health professionals.

Immunology-based therapies are emerging as an effective cancer treatment, using the body's immune system to target tumors. Immune checkpoints, which regulate immune responses to prevent tissue damage and autoimmunity, are often exploited by cancer cells to avoid destruction. The discovery of checkpoint proteins like PD-1/PD-L1 and CTLA-4 was pivotal in developing cancer immunotherapy. Immune checkpoint inhibitors (ICIs) have shown great success, with FDA-approved drugs like PD-1 inhibitors (Nivolumab, Pembrolizumab, Cemiplimab), PD-L1 inhibitors (Atezolizumab, Durvalumab, Avelumab), and CTLA-4 inhibitors (Ipilimumab, Tremelimumab), alongside LAG-3 inhibitor Relatlimab. Research continues on new checkpoints like TIM-3, VISTA, B7-H3, BTLA, and TIGIT. Biomarkers like PDL-1 expression, tumor mutation burden, interferon-γ presence, microbiome composition, and extracellular matrix characteristics play a crucial role in predicting responses to immunotherapy with checkpoint inhibitors. Despite their effectiveness, not all patients experience the same level of benefit, and organ-specific immune-related adverse events (irAEs) such as rash or itching, colitis, diarrhea, hyperthyroidism, and hypothyroidism may occur. Given the rapid advancements in this field and the variability in patient outcomes, there is an urgent need for a comprehensive review that consolidates the latest findings on immune checkpoint inhibitors, covering their clinical status, biomarkers, resistance mechanisms, strategies to overcome resistance, and associated adverse effects. This review aims to fill this gap by providing an analysis of the current clinical status of ICIs, emerging biomarkers, mechanisms of resistance, strategies to enhance therapeutic efficacy, and assessment of adverse effects. This review is crucial to furthering our understanding of ICIs and optimizing their application in cancer therapy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Hypertension is a prevalent health issue in Bangladesh, impacting a significant portion of the population. This meta-analysis explored how social status inequalities impact hypertension risk in Bangladesh. We systematically searched various electronic databases and rigorously selected 12 studies for inclusion in the analyses. The I 2 statistic measured between study heterogeneity, and pooled effect estimates were obtained using the DerSimonian and Laird random effects model to address this variability. Publication bias was assessed through a funnel plot and Egger's test. Sensitivity analysis was conducted to evaluate the robustness of the findings. All analyses were performed using STATA 17. The analyses indicated that females had a significantly higher risk of developing hypertension compared to males, with a pooled odds ratio (OR) of 1.15 (95% confidence interval [CI]: 1.02-1.27). Urban residents showed a pooled OR of 1.11 (95% CI: 1.03-1.19) compared to rural residents. The pooled ORs for hypertension were 1.02 (95% CI: 0.89-1.14) for primary education, 1.07 (95% CI: 0.94-1.21) for secondary education, and 1.25 (95% CI: 1.03-1.47) for higher secondary education, suggesting an increasing risk with higher education levels. Wealth status showed a pooled OR of 1.08 (95% CI: 0.87-1.29) for the poorer class, 1.13 (95% CI: 1.04-1.22) for the middle class, 1.38 (95% CI: 0.68-2.07) for the richer class, and 1.49 (95% CI: 0.97-2.00) for the richest class, indicating a greater risk of hypertension among wealthier individuals. Working individuals had a 39% lower risk of hypertension (OR = 0.61, 95% CI: 0.43-0.80) compared to nonworking individuals., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Purpose: The rising prevalence of ASD has prompted extensive research into potential environmental risk factors, with air pollution particularly emerging as a major concern. A systematic review and meta-analysis on the effect of air pollutants and time of exposure (particularly, PM 2.5 , PM 10 , NO 2 , and O 3 ) and the risk of ASD was therefore performed., Methods: Following PRISMA guidelines and PROSPERO registration (Ref: CRD42023464592), a thorough literature search was conducted across multiple databases, including Scopus, PubMed/MEDLINE, Embase, PsycINFO, Web of Science, and Cochrane Library. The analysis included 27 studies encompassing 369,460 participants, 47,973 of whom were diagnosed with ASD., Results: Preconception exposure to air pollutants showed a protective trend for PM 2.5 , PM 10 , and O 3 with a 10%, 5%, and 19% reduced risk of ASD, whereas NO 2 had a 28% higher likelihood of ASD. During gestation, PM 2.5 exposure increased ASD risk by 15%, with 13% and 9%, 25% and 7%, and 25% and 10% increases in ASD risk with PM 2.5 and NO 2 for the first, second, and third trimesters, respectively. In the first year of life, 20%, 8%, 33%, and 14% increases in risk were found for PM 2.5 , PM 10 , NO 2 , and O 3 , respectively, while such risk estimates increased to 179%, 60%, 12%, and 179% for the second year of life., Conclusions: In this meta-analysis, the relationships between air pollutants and ASD risk revealed significant associations, particularly for PM 2.5 and NO 2 . Exposure during preconception exhibited a protective trend, while postnatal exposure, particularly during the second year of life uncovered substantially higher ASD risk., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: An ethics statement is not applicable because this study is based exclusively on published literature., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Urban air quality stands as a pressing concern in cities globally, with airborne particulate matter (PM) emerging as a significant threat to human health. An investigation was carried out to examine the potential of four prevalent evergreen roadside tree species grown at different locations in Dhaka to capture PM using their leaves. The distribution of PM by mass and quantity in Dhaka are presented for the first time for Bangladesh and these results will also be applicable to countries with similar climates and tree species. Separate gravimetric analyses were carried out to quantify PM in three different size ranges (0.2-2.5 μm, 2.5-10 μm, and 10-100 μm) accumulated on surfaces and trapped within waxes by using the rinse and weigh method. The method is validated for the first time through SEM-EDX analysis, which confirmed that the increase in weight from chloroform-rinsed leaves was exclusively attributable to particle deposition on the filter. The chemical composition of the deposited PM 2.5 was analyzed quantitatively by determining the concentration of twenty-five trace elements employing ICP-MS. SEM-EDX analysis revealed the significance of leaf microstructural traits in effectively capturing PM. Significant variations in the deposition of PM were found among different species for two PM categories (surface PM and wax-embedded PM) and three size fractions (large, coarse, and fine) (one-way ANOVA; p < 0.05). The quantity of wax retained on the foliage of trees documented in these locations also varied (p < 0.05). Among the species studied, Ficus benghalensis demonstrated a greater ability to retain PM. Mangifera indica was identified to be the most efficient collector of wax-related PM and appears to be the ideal species for traffic-heavy areas distinguished by high concentrations of organic compounds from vehicle emissions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Record-breaking hot weather (exceptional heatwaves) has been increasingly common worldwide, posing a significant threat to human health. However, little is known about the effect of these exceptional heatwaves on mortality in Europe, especially since the coronavirus disease 2019 (COVID-19) outbreak, which converges with climate change to affect healthcare systems and human lives. We collected mortality data of 967 regions in 30 European countries over the last decade (2014-2023) from the Eurostat. A standard time-series analysis was used to estimate the effect of exceptional heatwaves by quasi-Poisson regression model, including the main effect (effect from heatwave intensity) and the added effect (effect from heatwave duration), on mortality for each region during two periods (before and since the COVID-19 outbreak). We used random effects meta-analysis to pool the mortality risk (i.e., relative risk [RR]) and burden (i.e., attributable fraction [AF]) associated with exceptional heatwaves, at the country level and for Europe as a whole. In Europe, the mortality burden attributable to main and added effects increased from 0.492% (95% CI: 0.488%-0.496%) to 1.276% (95% CI: 1.266%-1.285%) and from 0.307% (95% CI: 0.294%-0.318%) to 0.428% (95% CI: 0.407%-0.448%), respectively. Furthermore, substantial variations across countries were observed, with some countries such as France and Spain experiencing a large increase in the mortality burden attributable to exceptional heatwaves since the COVID-19 outbreak. Our findings underscore the urgent need for heat-health actions to consider the multi-effects of exceptional heatwaves amidst a warming climate., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Meeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions., Methods: Serial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6-17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021. The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity., Results: Data on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (-0.8 % [95%CI, -1.0 % to -0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines., Discussion: The temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Question: Is electrical stimulation (ES) combined with strength training and usual care more effective than usual care alone in increasing the strength of very weak muscles in people with recent spinal cord injury (SCI)?, Design: A randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors., Participants: Sixty participants with recent SCI were recruited from three SCI units in Australia and Bangladesh., Interventions: Participants were randomised to either a treatment or control group. A major muscle group of the upper or lower limb with Grade 1 or Grade 2 strength on a standard 6-point manual muscle test was selected. Participants in the experimental group received strength training combined with ES and usual care for the target muscle group over 8 weeks. Participants in the control group received only usual care., Outcome Measures: Assessments were undertaken by a blinded assessor at baseline and 8 weeks. The primary outcome was voluntary muscle strength on a modified 13-point manual muscle test. The three secondary outcomes were participants' perceptions of strength, function and ability to perform self-selected goals., Results: The mean between-group difference for voluntary strength at 8 weeks was 0.7 out of 13 points (95% CI -0.7 to 2.1), where the clinically worthwhile treatment effect was deemed a priori as 1 point. None of the secondary outcomes demonstrated a clinically important effect., Conclusion: Strength training combined with ES over 8 weeks has a negligible effect on the strength of very weak muscles in people with SCI., Registration: ACTRN12621000197831., (Copyright © 2024 Australian Physiotherapy Association. All rights reserved.)

Objectives: Underutilisation of thrombolysis is a major problem in patients with stroke in Bangladesh as patients do not arrive within the therapeutic window due to delays in their way to emergency department. This study aims to assess the time delay from patients' symptom onset to arrival in the hospital and the factors that are associated with it., Methods: This cross-sectional survey of a prospective cohort of stroke patients was conducted between January and March 2023. 448 stroke patients meeting the inclusion criteria were enrolled in the study from five tertiary-level hospitals in Bangladesh. After obtaining informed consent, trained data collectors conducted face-to-face interviews of the patient/patients' guardians via a pretested structured questionnaire. Stata (V.16) was used to analyse data. Median and IQRs were used to summarise quantitative variables, and qualitative variables were summarised using frequency and relative frequency. Pearson's χ 2 test and Mann-Whitney U test were used to explore the bivariate relationship between predictor and outcome variables. Finally, a binary logistic regression model was fit to explore the factors associated with delayed arrival (>4.5 hours) at the hospital., Results: The median age of the patients was 61 years (54-70) and 63% were men. The majority hailed from rural (59.6%) areas and had primary (25.89%) education. The patients had an overall median prehospital delay of 14 (8-28) hours, 3 (1-6) hours of decision delay, 1 (0-2) hours of medical contact delay, and 14 (6.5-25.75) hours of referral delay. Patients with master's education (adjusted OR (AOR): 0.04, p=0.023) and private transport (AOR: 0.26, p=0.029) had a lower chance of late arrival. However, patients having unknown onset, self-medicating, having a previous history of stroke, and being admitted to a private hospital had a significantly higher chance of late arrival., Conclusion: Nearly 90% of the patients were late to arrive (>4.5 hours) at hospital and referral delay comprises the majority of the prehospital delay. Therefore, fast symptom recognition and the urgency of seeking healthcare as soon as symptoms appear should be the focus of public awareness efforts., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Owing to the extensive use of antibiotics in hospitals, animal husbandry, and various human activities, antibiotic contamination is becoming an increasing global concern, including in Bangladesh. In Bangladesh, the Buriganga River is heavily polluted with multiple antibiotics, which can lead to antibiotic resistance in bacteria. In this study, we performed the first investigation of seasonal variations in the occurrence and spatial distribution of 29 antibiotics in the Buriganga River, Bangladesh, from dry season (August 2019) and wet season (February 2020). We also evaluate the potential environmental and resistance risks related to antibiotic contamination. The concentrations of metronidazole (9.1-970 ng L -1 ), sulfadiazine (below the limit of detection (-1 ), and levofloxacin (-1 ) were the highest, and metronidazole, amoxicillin, and doxycycline were detected in all samples during both seasons. The number of antibiotics detected, and their overall concentrations were higher during the dry season (August) than that during the wet season (February). Ecological risk assessment using risk quotients (RQs) indicated that levofloxacin (maximum RQ = 90), amoxicillin (58), and ciprofloxacin (21) could pose a high risk to aquatic organisms, whereas sulfamethazine, trimethoprim, doxycycline, and lincomycin pose a medium risk. The levels of seven antibiotics, trimethoprim, ciprofloxacin, levofloxacin, amoxicillin, ampicillin, cefotaxime, and metronidazole exceeded the antibiotic resistance thresholds. In conclusion, this study highlights the urgent need for further research and to improve wastewater management practices and implement stricter regulations on antibiotic use to protect aquatic ecosystems and public health in Bangladesh., Competing Interests: Declaration of Competing Interest ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Masahiro Tokumura reports financial support was provided by Ministry of the Environment. Masahiro Tokumura reports financial support was provided by Kurita Water and Environment Foundation. Masahiro Tokumura reports financial support was provided by Steel Foundation for Environmental Protection Technology. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

We describe two locally acquired cases of Mycobacterium ulcerans infection (Buruli ulcer) in the town of Batemans Bay on the east coast of New South Wales (NSW), Australia, 150 km north of Eden, the only other place in NSW where Buruli ulcer has likely been locally acquired. Genomic analysis showed that the bacterial isolates from the cases were identical but belonged to a phylogenetically distinct M. ulcerans clade that was most closely related to the isolate from the earlier case in Eden to the south. It is proposed that Batemans Bay is a new endemic focus of human Buruli ulcer transmission., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hossain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Obsessive-compulsive disorder (OCD) is a prevalent mental health condition that impacts daily life. It is thought to be associated with genetic, biological, and structural brain changes, serotonergic abnormalities, altered neuromodulation, and environmental factors. Limited observational studies have examined cytokines in Bangladeshi patients with OCD. This study aimed to assess the levels of eotaxin-1 and interleukin (IL)-34 in individuals with this disorder., Methods: This case-control observational study included 58 patients with OCD and 30 healthy controls (HCs) matched for age, sex, and body mass index. The severity of OCD was assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). Psychiatrists evaluated participants according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Serum levels of eotaxin-1 and IL-34 were measured using enzyme-linked immunosorbent assay kits., Results: Patients with OCD exhibited significantly higher serum eotaxin-1 levels (121.13±7.84 pg/mL) than HCs (85.52±9.42 pg/mL). Conversely, IL-34 levels were considerably lower in patients than in HCs (119.02±14.53 pg/mL vs. 179.96±27.88 pg/mL). The Cohen d values for eotaxin-1 and IL-34 were 0.55 and -0.48, respectively. Among patients with OCD, a significant positive correlation was found between serum eotaxin-1 level and Y-BOCS score, along with a negative correlation between serum eotaxin-1 and IL-34 levels., Conclusion: The findings suggest that altered eotaxin-1 and IL-34 levels may be associated with OCD. These chemokines and cytokines could serve as primary tools for assessing the risk of OCD, warranting further clinical investigation. This could potentially support more extensive research and the development of diagnostic and therapeutic strategies targeting these pathways.

Insulin-like peptide 5 (INSL5) targets the G protein-coupled receptor, relaxin family peptide receptor 4 (RXFP4), predominantly coexpressed in the colorectum. While INSL5 also binds to the related receptor RXFP3, it does not activate it. The INSL5/RXFP4 axis is a promising target for treating gastrointestinal disorders such as constipation. Despite its therapeutic potential, the clinical application of INSL5 has been hindered by synthesis complexities, necessitating the need for more accessible yet potent mimetics. In this study, we engineered an INSL5 analogue A13:B7-24-GG, featuring a simplified two-chain, two-disulfide scaffold with 32 amino acids, as opposed to the 45 amino acids found in native INSL5 (two-chain, three-disulfide), improving the synthesis yield by 19.5-fold. Additionally, A13:B7-24-GG demonstrates ∼4-fold higher potency (EC 50 = 1.17 nM vs 4.57 nM) and ∼11 times greater selectivity than native INSL5, with significantly reduced RXFP3 binding affinity, positioning it as a promising new therapeutic candidate for the treatment of constipation.

Importance: There is sparse literature on whether routine cholangiography (RC) vs selective cholangiography (SC) during cholecystectomy is associated with improved perioperative outcomes, regardless of whether an intraoperative cholangiogram (IOC) is performed., Objective: To compare perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform IOC., Design, Setting, and Participants: This retrospective cohort study was conducted from January 2015 through June 2023 and took place within the Cleveland Clinic Enterprise, which includes 18 hospitals and 9 ambulatory surgery centers in 2 states (Ohio and Florida). Participants included adult patients who underwent cholecystectomy for benign biliary disease. Data analysis was conducted between July 2023 and August 2024., Exposure: Routine cholangiography, defined as more than 70% of cholecystectomies performed with IOC per surgeon over the study period., Main Outcome(s) and Measure(s): The primary outcome was major bile duct injury (BDI). Hierarchical mixed-effects models with patients nested in hospitals adjusted for individual- and surgeon-level characteristics were used to assess the odds of major BDI and secondary outcomes (minor BDI, operative duration, and perioperative endoscopic retrograde cholangiopancreatography [ERCP])., Results: A total of 134 surgeons performed 28 212 cholecystectomies with 10 244 in the RC cohort (mean age, 52.71 [SD, 17.78] years; 7102 female participants [69.33%]) and 17 968 in the SC cohort (mean age, 52.33 [SD, 17.72] years; 12 135 female participants [67.54%]). Overall, 26 major BDIs (0.09%) and 105 minor BDIs (0.34%) were identified. Controlling for patient and surgeon characteristics nested in hospitals, RC was associated with decreased odds of major BDI (odds ratio [OR], 0.16; 95% CI, 0.15-0.18) and minor BDI (OR, 0.83; 95% CI, 0.77-0.89) compared with SC. Major BDIs were recognized intraoperatively more often in the RC cohort than the SC cohort (76.9% vs 23.0%; difference, 53.8%; 95% CI, 15.9%-80.2%). Lastly, RC was not significantly associated with increased perioperative ERCP utilization (OR, 1.01; 95% CI, 0.90-1.14) or negative ERCP rate (RC, 27 of 844 [3.2%] vs SC, 57 of 1570 [3.6%]; difference, -0.3%; 95% CI, -1.9% to 1.0%)., Conclusions and Relevance: In this study, RC was associated with decreased odds of major and minor BDI, as well as increased intraoperative recognition of major BDI when it occurred. RC could be considered as a health systems strategy to minimize BDI, acknowledging the overall low prevalence but high morbidity from these injuries.

This study explores the effect of climate factors on dengue incidence in Bangladesh and Singapore from 2000 to 2020. Various forecasting models, including Seasonal ARIMA, Poisson regression, artificial neural networks (ANN), support vector machines (SVM), and other statistical techniques, were applied to forecast dengue trends and generate future datasets. The results showed that Bangladesh has higher mean temperatures. The Poisson regression indicated that rainfall positively correlated with dengue cases in Bangladesh, while humidity and sunshine showed negative associations. In Singapore, temperature was positively associated with dengue cases, while rainfall and humidity had inverse relationships. ARIMA models predicted Singapore would experience the highest dengue cases by 2023. Based on the Root Mean Square Error (RMSE), the TBATS model was most accurate for predicting dengue cases in Bangladesh, while both ARIMA and TBATS models performed well in Singapore. This study provides valuable insights for policymakers in Singapore and Bangladesh to develop climate-based warning systems.

Background: The prevalence and impact of obesity and overweight is one of the main concerns among researchers worldwide. There are several consequences of overweight and obesity among students in developing countries like Bangladesh. Therefore, this study aims to explore the prevalence and impact of overweight or obesity on individuals' self-esteem and academic performance among university students in Bangladesh., Methods and Materials: This study is based on primary data that was collected from 600 students of Jahangirnagar University using a well-structured questionnaire. The questionnaire included demographic information, the Rosenberg Self-Esteem Scale (RSES), and the International Physical Activity Questionnaire (IPAQ-7). The summary statistics, the Fisher exact test, the Chi-square test, and the Pearson correlation matrix were computed. A logistic regression model assessed the relationship between low self-esteem and other variables such as demographic characteristics, BMI status, and physical activities., Results: The findings indicate that 38.2% of the students are overweight or obese, and the prevalence rate is high among males. The lowest academic performance across all disciplines is observed among obese students. A negative correlation is observed between BMI and self-esteem (r = -0.41) and academic performance is negatively linked with overweight or obese (r = -0.26) Results depict that overweight/obese students are 7.11 times more likely to have low self-esteem (AOR: 7.11, 95% CI: 4.59-11.02) compared to normal students., Conclusions: Overweight and obese students are more prone to lower academic performance and low self-esteem, considering physical inactivity and irregular dietary patterns. Therefore, university authorities ought to encourage students to engage in physical activities and should create awareness among students about the beneficial effects of nutritious foods and the importance of physical exercise., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Emon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The striped snakehead, Channa striata, is commercially and nutritionally important due to its medicinal properties, such as wound healing and antimicrobial abilities. This study investigated the reproductive biology of C. striata in relation to hydro-climatic changes using a fuzzy logic approach for long-term management in the wetland ecosystem (Gajner beel), Bangladesh. A total of 1200 C. striata individuals were collected monthly during January to December 2019 using various fishing methods. Measurements of total length (TL), body weight (BW), and gonad weight (GW) were taken with a precision of 0.01 cm and 0.01 g, respectively. The GSI (gonadosomatic index in %), MGSI (modified gonadosomatic index in %), and DI (Dobriyal index) were used to determine size at sexual maturity (L m ) and the spawning season. Results revealed a wide range of TL, ranging from 12.7 to 46 cm. The L m was estimated between 21.7 and 25.33 cm based on various model as TL vs. GSI, MGSI, and DI; TL-fork length (FL) regressions; and maximum length (L max ) for this species. The spawning period was observed from April to July, peaking in May, indicated by higher GSI, MGSI, and DI values. Eco-climatic factors showed a significant relationship with GSI, except for total dissolved solids (TDS). Rising temperatures and declining rainfall could delay spawning of C. striata. A fuzzy logic approach was employed to predict future GSI changes over extended periods (e.g., 50 or 60 years), enabling anticipation of shifts in the timing and duration of the spawning season. Finally, the findings of our research might be effective to carry out specific conservation efforts of C. striata in response to climate variability in sub-tropical water., Competing Interests: Declarations. Ethics approval: Every stage of the procedure utilized in this investigation adhered to ethical standards. Consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Shigella flexneri serotype 6 ( Sf 6) is one of the most common serotypes recovered from surveillance studies of moderate to severe diarrhea. Despite the clinical significance of Sf 6, this serotype is understudied. In this work, we have performed both serotype-specific genomic and phenotypic comparisons of Sf 6 isolates to one another and non- S . flexneri serotypes. Comparative genomic analyses identified significant nucleotide homology between Sf 6 strains ( n = 325), despite a broad range of collection timeframes and geographic locations. We identified Sf 6 specific factors, including a potential novel Shigella virulence factor (type II secretion system). Additionally, we identified established Shigella virulence genes ( ospG ) and metabolic genes ( rutABCDEFGR ) that were absent in Sf 6 strains while present in the majority of 728 non- Sf 6 strains. Complete sequencing of 11 clinical Sf 6 strains, demonstrated that the Sf 6 virulence plasmid (pINV) is ~38 kb smaller than the average non- Sf 6 pINV (~228 kb). Comparisons of S. flexneri species level antibiotic susceptibility highlighted that clinical Sf 6 isolates from Africa in the Global Enteric Multicenter Study (GEMS) and Vaccine Impact on Diarrhea in Africa (VIDA) study demonstrated geographic, serotype-specific susceptibility pattern. Phenotypic analyses of Sf 6 identified reduced intracellular invasion and cytokine induction from HT-29 cells, as well as reduced Ipa protein effector secretion, compared with S. flexneri serotype 2a strain 2457T. Together these data highlight conserved and unique serotype-specific genotypic and phenotypic features for Sf 6. This level of conservation has not been noted for other S. flexneri serotypes and is promising for vaccine and diagnostic assays to provide global Sf 6-specific coverage.IMPORTANCEShigellosis is an ongoing global public health crisis with >270 million annual episodes among all age groups; however, the greatest disease burden is among children in low- and middle-income countries (LMIC). The lack of a licensed Shigella vaccine and the observed rise in antimicrobial-resistant Shigella spp. highlights the urgency for effective preventative and interventional strategies. The inclusion of S. flexneri serotype 6 ( Sf 6) is a necessary component of a multivalent vaccine strategies based on its clinical and epidemiological importance. Given the genomic diversity of Sf 6 compared with other S. flexneri serotypes and Sf 6 unique O-antigen core structure, serotype-specific characterization of Sf 6 is a critical step to inform Shigella -directed vaccine and alternative therapeutic designs. Herein, we identified conserved genomic content among a large collection of temporally and geographically diverse Sf 6 clinical isolates and characterized genotypic and phenotypic properties that separate Sf 6 from non- Sf 6 S. flexneri serotypes.

The emergence of reconfigurable field effect transistors has introduced a more efficient method for realizing reconfigurable circuits, significantly lowering hardware overhead and enhancing versatility. However, these devices often suffer from asymmetric transfer curves, impacting logic gate performance and reliability. This work investigates the use of the van der Waals junction field effect transistor (JFET) for reconfigurable circuit applications. We present a reconfigurable JFET realized through WSe 2 /MoS 2 van der Waals integrated heterojunctions with an optimized polarity gate design that effectively addresses the issues of unmatched threshold voltages between n- and p- FETs while also anchoring threshold voltages and reducing subthreshold swing. A complementary reconfigurable JFET inverter with the proposed gate design was demonstrated, showcasing excellent switching characteristics, symmetric transfer characteristics, and reduced power consumption, achieving a noise margin of 96.3% and a high gain of 153.82. The study further demonstrates the construction of reconfigurable NOR/NAND and XOR/XNOR logic gates with symmetric profiles and sharp switching, underscoring the versatility and effectiveness of the proposed approach. These findings highlight the potential of WSe 2 /MoS 2 JFETs in advancing low-power, high-performance, reconfigurable electronic circuits within the CMOS framework.

Pseudomonas aeruginosa, an opportunistic bacterial pathogen of public health concern, is known for its metabolic versatility, adaptability in harsh environment, and pathogenic aggressiveness. P. aeruginosa relies on various regulatory networks modulated by small non-coding RNAs, which in turn influence different physiological traits such as metabolism, stress response, and pathogenesis. In this study, srbA sRNA has been shown to play a diverse role in regulating cellular metabolism and the production of different virulence factors in P. aeruginosa. srbA was found to control the TCA cycle, a key regulatory pathway for cellular metabolism and energy production, by regulating three main enzymes: citrate synthase (gltA), isocitrate dehydrogenase (icd), and α-ketoglutarate dehydrogenase E1 subunit (sucA) at both the transcriptional and translational levels. By modulating the TCA cycle, srbA could help the bacteria to adapt nutritional stress by lowering energy consumption. Additionally, srbA has been found to differentially regulate production of various virulence factors such as rhamnolipid, elastase, LasA protease, and pyocyanin under both nutrient-rich and nutrient-limiting conditions. It could also influence motilities in P. aeruginosa, linked to biofilm formation and pathogenicity. Thus, srbA might hold a promise in the research area for identifying virulence pathways and developing novel therapeutic targets to combat the global pathogenic threat of P. aeruginosa., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This study investigates non-communicable disease (NCD) risk factors, specifically hypertension and diabetes, among Bangladeshi adults with lower educational attainment. With an increasing global burden of NCDs, understanding the dynamics in lower-educated populations becomes crucial for targeted interventions and achieving Sustainable Development Goal 3.4-curtailing premature mortality from non-communicable diseases by one-third by 2030 through prevention and treatment., Methods: Utilizing data from the Bangladesh Demographic and Health Survey (2017-2018), a two-stage stratified sampling design identified 7287 lower-educated individuals. Bayesian logistic regression was applied for risk factor analysis., Results: The prevalence of hypertension and diabetes among lower-educated people was 31% and 9.3%, respectively. NCD prevalence (37.3%) underscored a significant health burden. Factors such as gender, age, wealth status, working status, residence and region showed significant associations with NCDs. Bayesian analysis revealed that females were 1.30 times more likely to develop NCDs, while older age groups demonstrated 4.30 times greater likelihood. Employed individuals exhibited a 43% lower risk. Wealthier households showed higher NCD likelihood and residence in the central region was associated with an 11% lower risk., Conclusions: This study highlights the high risk of developing NCDs among lower-educated females, particularly those ≥35 y of age in Bangladesh. Therefore, targeted interventions for this group are critical to reducing NCD risks, supporting national health objectives and advancing progress toward the Sustainable Development Goals., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Importance: For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain., Objective: To determine whether decisions based on assessment of CRP or PCT safely results in a reduction in the duration of antibiotic therapy., Design, Setting, and Participants: A multicenter, intervention-concealed randomized clinical trial, involving 2760 adults (≥18 years), in 41 UK National Health Service (NHS) intensive care units, requiring critical care within 24 hours of initiating intravenous antibiotics for suspected sepsis and likely to continue antibiotics for at least 72 hours., Intervention: From January 1, 2018, to June 5, 2024, 918 patients were assigned to the daily PCT-guided protocol, 924 to the daily CRP-guided protocol, and 918 assigned to standard care., Main Outcomes and Measures: The primary outcomes were total duration of antibiotics (effectiveness) and all-cause mortality (safety) to 28 days. Secondary outcomes included critical care unit data and hospital stay data. Ninety-day all-cause mortality was also collected., Results: Among the randomized patients (mean age 60.2 [SD, 15.4] years; 60.3% males), there was a significant reduction in antibiotic duration from randomization to 28 days for those in the daily PCT-guided protocol compared with standard care (mean duration, 10.7 [SD, 7.6] days for standard care and 9.8 [SD, 7.2] days for PCT; mean difference, 0.88 days; 95% CI, 0.19 to 1.58, P = .01). For all-cause mortality up to 28 days, the daily PCT-guided protocol was noninferior to standard care, where the noninferiority margin was set at 5.4% (19.4% [170 of 878] of patients receiving standard care; 20.9% [184 of 879], PCT; absolute difference, 1.57; 95% CI, -2.18 to 5.32; P = .02). No difference was found in antibiotic duration for standard care vs daily CRP-guided protocol (mean duration, 10.6 [7.7] days for CRP; mean difference, 0.09; 95% CI, -0.60 to 0.79; P = .79). For all-cause mortality, the daily CRP-guided protocol was inconclusive compared with standard care (21.1% [184 of 874] for CRP; absolute difference, 1.69; 95% CI, -2.07 to 5.45; P = .03)., Conclusions and Relevance: Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive., Trial Registration: isrctn.org Identifier: ISRCTN47473244.

Fusion of intrinsically disordered and globular proteins is a powerful strategy to create functional nanomaterials. However, the immutable nature of genetic encoding restricts the dynamic adaptability of nanostructures postexpression. To address this, we envisioned using a myristoyl switch, a protein that combines allostery and post-translational modifications─two strategies that modify protein properties without altering their sequence─to regulate intrinsically disordered protein (IDP)-driven nanoassembly. A typical myristoyl switch, allosterically activated by a stimulus, reveals a sequestered lipid for membrane association. We hypothesize that this conditional exposure of lipids can regulate the assembly of fusion proteins, a concept we term "liposwitching". We tested this by fusing recoverin, a calcium-dependent myristoyl switch, with elastin-like polypeptide, a thermoresponsive model IDP. Biophysical analyses confirmed recoverin's myristoyl-switch functionality, while dynamic light scattering and cryo-transmission electron microscopy showed distinct calcium- and lipidation-dependent phase separation and assembly. This study highlights liposwitching as a viable strategy for controlling DP-driven nanoassembly, enabling applications in synthetic biology and cellular engineering.

Mitragyna speciosa Korth. Havil (MS) has a traditional use in relieving pain, managing hypertension, treating cough, and diarrhea, and as a morphine substitute in addiction recovery. Its potential in addressing Alzheimer's disease (AD), a neurodegenerative condition with no effective treatments, is under investigation. This study aims to explore MS mechanisms in treating AD through network pharmacology, molecular docking, and in vitro studies. Using network pharmacology, we identified 19 MS components that may affect 60 AD-related targets. The compound-target network highlighted significant interactions among 60 nodes and 470 edges, with an average node degree of 15.7. The KEGG enrichment analysis revealed Alzheimer's disease (hsa05010) as a relevant pathway. We connected 20 targets to tau and β-amyloid proteins through gene expression data from the AlzData database. Docking studies demonstrated high binding affinities of MS compounds like acetylursolic acid, beta-sitosterol, isomitraphylline, and speciophylline to AD-related proteins, such as AKT1, GSK3B, NFκB1, and BACE1. In vitro studies showed that ethanolic (EE), distilled water (DWE), and pressurized hot water (PHWE) extracts of MS-treated 100 μM H 2 O 2 -induced SH-SY5Y cells significantly reduced oxidative damage. This research underscores the multi-component, multi-target, and multi-pathway effects of MS on AD, providing insights for future research and potential clinical applications.

Background/Objectives: Accurate liver and tumor detection and segmentation are crucial in diagnosis of early-stage liver malignancies. As opposed to manual interpretation, which is a difficult and time-consuming process, accurate tumor detection using a computer-aided diagnosis system can save both time and human efforts. Methods: We propose a cascaded encoder-decoder technique based on self-organized neural networks, which is a recent variant of operational neural networks (ONNs), for accurate segmentation and identification of liver tumors. The first encoder-decoder CNN segments the liver. For generating the liver region of interest, the segmented liver mask is placed over the input computed tomography (CT) image and then fed to the second Self-ONN model for tumor segmentation. For further investigation the other three distinct encoder-decoder architectures U-Net, feature pyramid networks (FPNs), and U-Net++, have also been investigated by altering the backbone at the encoders utilizing ResNet and DenseNet variants for transfer learning. Results: For the liver segmentation task, Self-ONN with a ResNet18 backbone has achieved a dice similarity coefficient score of 98.182% and an intersection over union of 97.436%. Tumor segmentation with Self-ONN with the DenseNet201 encoder resulted in an outstanding DSC of 92.836% and IoU of 91.748%. Conclusions: The suggested method is capable of precisely locating liver tumors of various sizes and shapes, including tiny infection patches that were said to be challenging to find in earlier research.

Microplastics (MPs) have recently gained attention as emerging environmental contaminants, yet knowledge of their distribution, sources, and risks in freshwater lakes remains limited. This study examined the occurrence and risk of MPs in water and sediment samples from eight locations in Mohamaya Lake (Bangladesh) collected in April and May 2023. MPs were identified using stereomicroscopy and FTIR, revealing concentrations of 20-95 particles/L in water and 550-1900 particles/kg (d.w.) in sediment, with mean values of 50.62 ± 9.95 particles/L and 1068.75 ± 521.49 particles/kg (d.w.). Dominant MPs were blue fibers, 0-0.5 mm in size, with HDPE, PET and LDPE as the most common polymers. This study used four indices (nemerow pollution index-NPI, contamination factor-CF, pollution load index-PLI, and polymer hazard index-PHI) to assess MP pollution, revealing light to high contamination levels. While NPI indicated light pollution, CF, PLI, and PHI highlighted areas of moderate to high risk, with certain polymers showing high to extreme toxicity. This study deepens understanding of MP contamination in Bangladesh's freshwater lakes, underscoring the need for research on ecotoxicology, regulation, and associated challenges., Competing Interests: Declaration of competing interest The authors declare no personal or financial interests that may have influenced the work presented in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In low- and middle-income countries, living in homes with soil floors and animal cohabitation may expose children to fecal organisms, increasing risk of enteric and antimicrobial-resistant infections. Our objective was to understand whether cow cohabitation in homes with soil floors in rural Bangladesh contributed to the presence and diversity of potential pathogens and antimicrobial resistance genes (ARGs) in the home. In 10 randomly selected households in rural Sirajganj District, we sampled floor soil and cow dung, which is commonly used as sealant in soil floors. We extracted DNA and performed shotgun metagenomic sequencing to explore potential pathogens and ARGs in each sample type. We detected 6 potential pathogens in soil only, 49 pathogens in cow dung only, and 167 pathogens in both soil and cow dung. Pathogen species with relative abundances >5% in both soil floors and cow dung from the same households included E. coli (N=8 households), Salmonella enterica (N=6), Klebsiella pneumoniae (N=2), and Pseudomonas aeruginosa (N=1). Cow dung exhibited modestly higher pathogen genus richness compared to soil floors (Wilcoxon signed-rank test p=0.002). Using Bray-Curtis dissimilarity, pathogen species community composition differed between floors and cow dung (PERMANOVA p<0.001). All soil floors and cow dung samples contained ARGs against antibiotic classes including sulfonamides, rifamycin, aminoglycosides, lincosamides, and tetracycline. Paired floor and cow dung samples shared ARGs against rifamycin. Our findings support the development of interventions to reduce soil and animal feces exposure in rural, low-income settings., Importance: In low-income countries, inadequate housing materials and animal cohabitation can lead to fecal contamination of rural homes. Contaminated soil floors are difficult to clean and may harbor organisms causing illness and antibiotic resistance, especially in young children, who frequently ingest soil. We sequenced soil floor and cow dung samples from households in Sirajganj district, Bangladesh and identified pathogens and antibiotic resistance genes. We detected 167 pathogens in both soil and cow dung; pathogens present in both sample types at the highest relative abundances were E. coli , Salmonella enterica , Klebsiella pneumoniae, and Pseudomonas aeruginosa . Antibiotic resistance genes were found in all samples. In cow dung, the most common genes conferred resistance to the antibiotics lincosamide, rifamycin, cephamycin, and tetracycline. In soil floors, the most common genes conferred resistance to rifamycin, sulfonamides, and aminoglycosides. Household soil and cow dung may be important reservoirs of pathogens and antimicrobial resistance in low-income countries.

Blockchain technology has revolutionized the management of Unmanned Aerial Vehicle (UAV) networks by enhancing security, enabling decentralized control, and improving operational efficiency. This study assesses the efficiency of private blockchain architectures in UAV networks, specifically examining important performance metrics such as throughput, latency, scalability, and packet size. Furthermore, we evaluate the effectiveness of UAV networks when integrating private blockchain technologies, focusing particularly on key performance indicators such as area, altitude, and data rate. The scope of our work includes extensive simulations that employ a private blockchain to assess its impact on UAV operations. In the blockchain network, throughput decreased as the number of UAVs and transactions increased, while delay remained constant up to a certain point. In contrast, the UAV network saw improved throughput but increased delay with more UAVs and transactions. Changes in area and altitude had little impact on the blockchain network but increased delays in the UAV network. Higher data rates enhanced the UAV network by reducing latency and improving throughput, though this effect was less pronounced in the blockchain network. The aforementioned results highlight the potential and limitations of private blockchains in enhancing the durability and efficiency of UAV networks.

Non-structural protein 2 (nsP2), which plays an essential role in replication of CHIKV, contains a protease, helicase, and methyltransferase-like domain. We executed a simple a screen using malachite green to detect compounds that decreased ATP hydrolysis and tested a library of diverse compounds to find inhibitors of CHIKV nsP2 helicase.

Background: There is limited data on the effects of therapeutic anticoagulation on stroke and bleeding risk in patients with sepsis-induced AF., Objective: To determine the effect of therapeutic anticoagulation (AC) on the development of inpatient strokes and significant bleeding in hospitalized patients with septic shock and AF., Methods: This single center, retrospective study examined 604 patients with septic shock and AF. The total AF population was further subdivided into new onset AF. Propensity score matching (PSM) was used to match patients with similar comorbidities who received and did not receive AC. The risk of bleeding, in-hospital stroke, increased length of stay, and mortality were compared between propensity matched cohorts., Results: BARC 2 and 3a bleeding events were the most common. After PSM, the relative risk of bleeding on AC was not significantly higher in either group (AF: 1.33, 95% CI, 0.81-2.17; new onset AF: 1.60, 95% CI, 0.72-3.54). AC also did not decrease the number of ischemic strokes (AF: 1.34% with AC vs. 1.34% without AC, p = 1.00; new onset AF: 0.89% with AC vs. 1.79% without AC, p = 0.56). There was significantly reduced mortality among patients who received AC (AF: 52.35% with AC vs. 66.44% without AC, p = 0.01; new onset AF: 46.43% with AC vs. 66.07% without AC, p = 0.04)., Conclusion: In patients with septic shock and AF, AC was not associated with a higher incidence of bleeding or lowering of in-hospital strokes but was associated with decreased mortality, potentially protecting against DIC or other embolic phenomena., (Copyright © 2024. Published by Elsevier Inc.)

We present a facile strategy for synthesizing magnetically retrievable carbon-wrapped CNT/Ni nanospheres (C-wrapped CNT/Ni) that enhance the catalytic performance of metals for environmental pollutant reduction. Structural and compositional analyses using X-ray diffraction (XRD), Raman spectroscopy, energy-dispersive X-ray spectroscopy (EDS), and field emission scanning electron microscopy (FESEM) confirmed the phase purity, morphology, and structure of the C-wrapped CNT/Ni. XRD, Raman, and EDS data validate the formation of the nanospheres, while FESEM images reveal uniform Ni nanospheres wrapped with a carbon layer through interconnected, evenly dispersed CNTs. Initially, Ni nanoparticles were anchored onto multiwalled carbon nanotubes to form magnetic CNT/Ni nanospheres, which were then coated with a carbon layer to prevent aggregation, improve Ni particle stability, and introduce additional surface functionalities. The catalytic efficacy of C-wrapped CNT/Ni was assessed through the reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). The reaction rate constant ( k app = 0.6167 min -1 ) with C-wrapped CNT/Ni is approximately six times higher than that with bare Ni nanospheres ( k app = 0.1056 min -1 ). This enhanced catalytic activity is attributed to the synergistic effect between the spherical Ni core and the wrapped carbon layer, mediated by the interconnected CNT, which promotes efficient hydride formation. Additionally, C-wrapped CNT/Ni demonstrates exceptional reusability in the 4-NP reduction process. The integration of these features within a single framework suggests its significant potential for diverse engineering and environmental applications., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

In this research, nano-hydroxyapatite synthesized from Conus litteratus seashells (Ss/nHAp) and the potential of Ss/nHAp as an adsorbent for eliminating Congo Red (CR) dye from aqueous solutions were explored. The synthesized Ss/nHAp was subjected to characterization using various techniques, including XRD, XPS, FTIR, Raman, BET, FESEM etc. in order to understand the material thoroughly. Batch adsorption experiments were conducted to establish the optimal conditions for removing the dye, considering variables such as adsorbent dosage, contact time, pH and initial dye concentration. 85% of the CR dye was eliminated within a short span of 10 minutes using a minimal adsorbent dose of 0.1 g, under neutral pH and room temperature, showcasing its efficiency. The adsorption process adhered to pseudo second order kinetics and was best fitted by the Langmuir isotherm model, with a maximum adsorption capacity ( q max ) of 24 mg g -1 . The material's reusability was demonstrated through regeneration studies, with efficiency slightly decreasing to 74% by the fifth cycle due to adsorbent loss. This study establishes Ss/nHAp as a low-cost, eco-friendly, and effective adsorbent for dye-contaminated water treatment, paving the way for future applications in industrial wastewater remediation., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

A 7-month-old girl had been suffering from progressively deteriorating pneumonia despite getting multiple courses of broad-spectrum antibiotics as well as anti-fungal drugs for adequate duration. To find out the cause behind this deterioration, the patient underwent thorough clinical and relevant laboratory evaluation including chest radiology & imaging, screening for primary immune deficiency disorders (PID), cystic fibrosis, tuberculosis, invasive fungal pneumonia, congenital heart disease, covid pneumonia, TORCH etc. but failed to solve the mystery. Upon further detailed re-evaluation, it was discovered that the child had a history of being forcefully fed lentil-based khichuri (a rice-lentil mixed dish) during her weaning process and diagnosis was finally confirmed as hypersensitive pneumonia due to lentil aspiration by a high level of IgG, specific to lentil antigen. Treatment was commenced with prednisolone resulting in significant improvement in her clinical and radiological condition within 72 hours., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging., Material and Method: We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography. Patient demographics and risk factors for stroke as well as therapeutic intervention was assessed., Conclusion and Result: Of the 90 patients studied, 59 had large vessel ischemia (66%) with 26 (44%) having large vessel occlusion and one had symptomatic high-grade middle cerebral artery stenosis. Conversely, none of the 31 patients with small vessel presentation (34%) had large vessel occlusion or high-grade stenosis. In addition, 19 out of 59 (32%) large vessel patients compared to 2 of 31 (6%) of the small vessel patients had atrial fibrillation identified as a potential mechanism with a p-value of 0.01 by univariate analysis and 0.17 by multivariate analysis. The routine use of vascular imaging in acute ischemic stroke is of very low yield in small vessel presentation with the presence of potential cardiogenic emboli is also relatively low. Efforts at accelerated identification of a small vessel mechanism, to avoid unnecessary testing, should provide significant value from both a patient management and cost standpoint., Competing Interests: Declaration of competing interest All authors declare a state of interest for the submission of this article: None, (Copyright © 2024. Published by Elsevier Inc.)

Oligopool synthesis and next-generation sequencing enable the construction and characterization of large libraries of designed genetic parts and systems. As library sizes grow, it becomes computationally challenging to optimally design large numbers of primer binding sites, barcode sequences, and overlap regions to obtain efficient assemblies and precise measurements. We present the Oligopool Calculator, an end-to-end suite of algorithms and data structures that rapidly designs many thousands of oligonucleotides within an oligopool and rapidly analyzes many billions of barcoded sequencing reads. We introduce several novel concepts that greatly increase the design and analysis throughput, including orthogonally symmetric barcode design, adaptive decision trees for primer design, a Scry barcode classifier, and efficient read packing. We demonstrate the Oligopool Calculator's capabilities across computational benchmarks and real-data projects, including the design of over four million highly unique and compact barcodes in 1.2 h, the design of universal primer binding sites for one million 200-mer oligos in 15 min, and the analysis of about 500 million deep sequencing reads per hour, all on an 8-core desktop computer. Overall, the Oligopool Calculator accelerates the creative use of massively parallel experiments by eliminating the computational complexity of their design and analysis.

Background: Persistent immune activation is linked to elevated cardiovascular diseases in people with HIV on antiretroviral therapy. The fat attenuation index (FAI) is a measure of peri-coronary inflammation that independently predicts cardiovascular disease risk in people without HIV. Whether FAI is associated with immune activation is unknown., Methods: Peripheral blood T-cell activation and homing phenotypes were measured in people with HIV (n=58) and people without HIV (n=16) without known cardiovascular disease who underwent coronary computed tomography angiography and had FAI measurements. A cross-sectional analysis of an observational cohort was performed. The primary aim was to evaluate associations of T-cell activation and phenotypes with the outcome variables, FAI values of the right coronary artery and left anterior descending artery, which were assessed using multivariable regression models adjusted for age, natal sex, race, low-density lipoprotein cholesterol, body mass index, and use of lipid-lowering medication., Results: T cells from people with HIV showed greater activation, as measured by cluster of differentiation (CD) 38/human leukocyte antigen - DR isotype coexpression on CD4 central memory and terminally-differentiated effector memory subsets and on CD8 effector memory (TEM), than did cells from people without HIV. Expression of the chemokine receptor C-C Chemokine Receptor 2 was reduced on CD4 central memory and TEM and CD8 TEM and terminally-differentiated effector memory subsets in people with HIV. Among all participants, PD-1 (programmed cell death 1) in CD8 central memory was associated with worsened peri-coronary inflammation of the right coronary artery, whereas perforin/granzyme B on CD8 TEM was associated with improved peri-coronary inflammation of the right coronary artery and left anterior descending artery in adjusted analyses. When accounting for HIV serostatus, CD38/human leukocyte antigen - DR isotype coexpression on CD8 central memory, TEM, and terminally-differentiated effector memory cells was associated with more peri-coronary inflammation of the left anterior descending artery., Conclusions: The associations between T-cell activation with FAI are novel and suggest that T-cell activation may be an important driver of peri-coronary inflammation, occurring at an early stage of atherosclerosis, even before the development of clinical disease.

Background: An effective health management information system plays a pivotal role in evidence-based decision-making and strengthening health service delivery in a country. The Directorate General of Health Services and the Directorate General of Family Planning of Bangladesh have adopted digital health management information system platforms named district health information system and management information system, respectively. Despite its significance, health management information system data has numerous issues, such as missing values, inaccuracies, lack of internal consistency, and the presence of outliers. This study aims to assess the data quality of reproductive health indicators in the health management information system of the Directorate General of Health Services and the Directorate General of Family Planning., Methods: The study examined two aspects of data quality: a) completeness of data, subdivided into completeness of facility reporting (report submission rate) and completeness of indicator data (presence of missing values); b) internal consistency of reported data, subdivided into presence of outliers, inter-indicator consistency, and consistency between reported data and original records (accuracy rate). The study utilised retrospective monthly data gathered from July 2021 to June 2022, covering 21 reproductive health indicators. Multi-stage cluster sampling was employed to select 112 health facilities for data collection, including 48 facilities from Directorate General of Health Services and 64 from Directorate General of Family Planning, representing various administrative levels across the country., Result: The report submission rate for Directorate General of Health Services facilities was 98%, while for the Directorate General of Family Planning facilities, it was 86%. However, 35% of data points were missing in the district health information system server of Directorate General of Health Services, whereas no missing values were observed in the management information system server of Directorate General of Family Planning. Less than 3% of outliers were detected in the server data of both directorates. Inter-indicator consistency was maintained at a high rate of 98% in health facilities under both directorates. The accuracy of reported data varied across indicators and facility types: Directorate General of Health Services facilities showed accuracy rates ranging between 75 and 92%, with an aggregated rate of 86%. Different tiers of the Directorate General of Family Planning facilities had accuracy rates ranging from 92 to 96%., Conclusion: This research emphasises the significance of rectifying missing values, ensuring consistency, and improving reporting systems, with a particular focus on lower-tier health facilities, to enhance the validity and reliability of reproductive health data in Bangladesh., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Aims: This study aimed to evaluate the symptomatic efficacy and tolerability of three different radiotherapy (RT) regimens for patients with vertebral metastases in a low-middle-income country setting, focusing specifically on the effectiveness of single-fraction radiotherapy., Methods: Conducted at the National Institute of Cancer Research and Hospital, Bangladesh, from July 1, 2020, to June 30, 2021, this prospective, non-randomized study enrolled 90 patients aged 18 to 75 years with histologically confirmed primary malignancies and vertebral metastases. Patients were allocated to one of three treatment arms: 8 Gy in a single fraction (Arm A), 20 Gy in 5 fractions (Arm B), or 30 Gy in 10 fractions (Arm C). The primary endpoint was pain response at 12 weeks, assessed by the Visual Analogue Scale and International Bone Metastases Consensus. Secondary endpoints included toxicity, measured by the Common Terminology Criteria for Adverse Events, and overall survival., Results: Pain control at 12 weeks showed no significant differences among the treatment groups, with 70% of patients in Arm A, 67% in Arm B, and 70% in Arm C experiencing either partial or complete pain relief (p = 0.95). The overall survival rates were comparable across the groups (median survival, 7 months for arms A and C, 6 months for Arm B). Skin toxicity was significantly lower in Arm A (10% incidence) compared to arms B (30%) and C (47%) (p = 0.017). There were no reports of Grade 3 or higher toxicities., Conclusion: The study confirms the efficacy and safety of single-fraction RT for spinal bone metastases, providing significant pain relief and lower skin toxicity relative to multiple fraction regimens. These results confirm the efficacy of single-fraction RT in the treatment of vertebral metastases also in resource-limited settings, suggesting its broader adoption to reduce toxicity and treatment burdens in low-middle-income countries., Competing Interests: Declarations. Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh. Informed consent statement: Informed consent was obtained from all subjects involved in the study. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: The prevalence of tobacco use is high in Bangladesh, with a cigarette being the most consumed tobacco product. Taxing tobacco is highly effective for tobacco control, raising costs and encouraging smokers to quit or reduce cigarette consumption. Garment workers are the major group of low-wage earners in Bangladesh. This study aims to determine the perceived effects of raising cigarette prices on smoking behaviors and their influences on quitting the decision of male garment workers in Bangladesh., Study Design: Cross-sectional study., Methods: The Study adopted a cross-sectional method among 739 male garment workers from Gazipur and Savar, Dhaka, for six months, using a semi-structured questionnaire. Factors such as the prevalence of lifetime tobacco use and rising cigarette prices on smoking behaviors were analyzed., Results: The study found that most participants began smoking before age 16, and increased tobacco prices influenced quitting decisions for both smoking and smokeless tobacco users, with reductions of 79% and 68%, respectively. Higher prices notably impacted smoking cessation among lower-income individuals, decreasing smoking frequency by 12-fold. Significantly changing their smoking behavior, on average, daily cigarette or biri consumption decreased from 7 to 5, with some participants switching to less expensive tobacco products., Conclusion: Findings from the study depict that imposing a high tax on tobacco products such as cigarette or biri has a desirable impact on the smoking behavior of low earning community. The price of all tobacco products should be increased to auspicate a considerable positive change in the community., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

An attempt was made to develop a novel dairy-based dip-like product from heat-acid-induced milk gel and whey. Based upon preliminary trials, the combination of cream (15-35%), whey (60-70%) and common salt (0.8-1.0%, all three as weight of heat-acid-induced milk gel) was selected for optimization of the dairy dip through factorial design of response surface methodology (RSM). Addition of glycerol monostearate, trisodium citrate and sodium hexametaphosphate each at the rate of 0.3% (as weight of heat-acid-induced milk gel) in the formulation was previously standardized. The optimization was carried out by analysing the textural and sensorial parameters of the dairy-based dip. The sensorial parameters (flavour, body and texture, colour and appearance and overall acceptability) and textural parameters (firmness, stickiness, work of shear and work of adhesion) were significantly ( P < 0.05) correlated with the ingredient formulation. RSM analysis suggested the use of cream, whey and common salt at amounts of 27.92, 60.26 and 0.8% of the weight of heat-acid-induced milk gel for preparing dairy-based dip with a desirability of 0.84. The formulated product contained a lower fat but higher protein and lactose content than cheese dip.

Background: Ehrlichia canis, a rickettsial organism, is responsible for causing ehrlichiosis, a tick-borne disease affecting dogs., Objectives: This study aimed to estimate ehrlichiosis prevalence and identify associated risk factors in pet dogs., Methods: A total of 246 peripheral blood samples were purposively collected from pet dogs in Dhaka, Mymensingh, and Rajshahi districts between December 2018 and December 2020. Risk factor data were obtained through face-to-face interviews with dog owners using a pre-structured questionnaire. Multivariable logistic regression analysis identified risk factors. Polymerase chain reaction targeting the 16S rRNA gene confirmed Ehrlichia spp. PCR results were further validated by sequencing., Results: The prevalence and case fatality of ehrlichiosis were 6.9% and 47.1%, respectively. Dogs in rural areas had 5.8 times higher odds of ehrlichiosis (odd ratio, OR: 5.84; 95% CI: 1.72-19.89) compared to urban areas. Dogs with access to other dogs had 5.14 times higher odds of ehrlichiosis (OR: 5.14; 95% CI: 1.63-16.27) than those without such access. Similarly, irregularly treated dogs with ectoparasitic drugs had 4.01 times higher odds of ehrlichiosis (OR: 4.01; 95% CI: 1.17-14.14) compared to regularly treated dogs. The presence of ticks on dogs increased ehrlichiosis odds nearly by 3 times (OR: 3.02; 95% CI: 1.02-8.97). Phylogenetic analysis, based on 17 commercially sequenced isolates, showed different clusters of aggregation, however, BAUMAH-13 (PP321265) perfectly settled with a China isolate (OK667945), similarly, BAUMAH-05 (PP321257) with Greece isolate (MN922610), BAUMAH-16 (PP321268) with Italian isolate (KX180945), and BAUMAH-07 (PP321259) with Thailand isolate (OP164610)., Conclusions: Pet owners and veterinarians in rural areas should be vigilant in monitoring dogs for ticks and ensuring proper preventive care. Limiting access to other dogs in high-risk areas can help mitigate disease spread. Tick prevention measures and regular treatment with ectoparasitic drugs will reduce the risk of ehrlichiosis in dogs. The observed genetic similarity of the Bangladeshi Ehrlichia canis strain highlights the need for ongoing surveillance and research to develop effective control and prevention strategies, both within Bangladesh and globally., Competing Interests: All authors declare that they have no conflicts of interest., (Copyright: © 2024 Kabir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition's role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network., Methods: We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age <-2), stunting (length-for-age <-2), and wasting (weight-for-length or MUAC Z-scores <-2)., Results: Of 1601 infant and child deaths, malnutrition was considered a causal or significant condition in 632 (39.5%) cases, including 85 (13.4%) with HIV infection. Postmortem measurements indicated 90.1%, 61.2% and 94.1% of these cases were underweight, stunted and wasted, respectively. Most malnutrition-related deaths (n=632) had an infectious cause (89.1%). The adjusted odds of having malnutrition as causal or significant condition were 2.4 (95% CI 1.7 to 3.2) times higher for deaths involving infectious diseases compared with other causes. Common pathogens in the causal pathway for malnutrition-related deaths included Klebsiella pneumoniae (30.4%), Streptococcus pneumoniae (21.5%), Plasmodium falciparum (18.7%) and Escherichia coli/Shigella (17.2%)., Conclusion: Malnutrition was identified as a causal or significant factor in 39.5% of under-5 deaths in the CHAMPS network, often in combination with infectious diseases. These findings highlight the need for integrated interventions addressing both malnutrition and infectious diseases to effectively reduce under-5 mortality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Current approaches to regulating osteoarthritis primarily focus on symptom management; however, these methods often have significant side effects and may not be suitable for long-term care. As an alternative to conventional treatments, injecting stem cells into knee joint cartilage is a promising option for repairing damaged cartilage. In this review, we outline the general procedure for stem cell treatment of knee joint cartilage regeneration, emphasizing the potential of intra-articular stem cell injections as a therapeutic option for osteoarthritis. We examined and summarized patient evaluation and preparation for knee joint stem cell therapy, stem cell harvesting, stem cell preparation, injection procedures for stem cell therapy, post-injection care and monitoring, potential outcomes of stem cell therapy, and considerations and risks associated with stem cell therapy. Overall, stem cell injections for knee joint cartilage damage represent a promising frontier in orthopedic care. They offer potential benefits such as pain and inflammation reduction, promotion of cartilage repair and regeneration, and the possibility of avoiding more invasive treatments such as knee surgery. Ongoing collaboration among researchers, clinicians, and regulatory organizations is crucial for advancing this field and translating scientific discoveries into effective clinical applications.

Background: The prevalence of caesarean sections (C-sections) has remarkably increased in the past few decades worldwide, especially in the lower and middle-income countries (LMICs). To our best knowledge, no studies focused on and compared the C-section scenarios of Bangladesh, Nepal, and Pakistan based on the latest demographic and health survey (DHS) data., Objectives: To assess the trends and factors associated with C-sections in the three South Asian countries., Study Population: Mothers aged 15-49 years participated in DHS 1990 to 2017-2018 and gave birth within three years of each of the surveys in Bangladesh, Nepal, and Pakistan., Materials and Methods: This study analyzed data from five recent DHS rounds in Bangladesh and four in Nepal and Pakistan. Multivariable logistic regression was used to assess the association between C-sections and sociodemographic characteristics., Results: The results show that institutional delivery and C-sections have increased throughout the period in all three countries. In Bangladesh, the hospital birth rate increased from 10.0% in 2004 to 49.9% in 2017, and the corresponding figures [S1 Appendix: Figure A1 and Figure A2] for C-sections increased from 3.5% to 32.8%. In Nepal, the hospital birth rate increased from 11.0% in 2001 to 58.6% in 2016, and the C-sections from 0.8% to 11.0%. Pakistan observed a sharp increase from 13.7% to 66.3% and 2.7% to 22.3% in the respective cases from 1990 to 2017. Results from regression reveal that the mother's age, place of residence, education, partner's education, wealth status, birth order, number of antenatal care visits, and body mass index are associated with C-section deliveries in all three countries., Conclusions: Our findings regarding the association of sociodemographic factors with increased C-sections may help identify subgroups of women susceptible to C-sections and offer better support regarding C-sections plans. However, the substantial increase in C-sections across the three countries warrants further investigation to identify the reasons., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Rana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study presents a comprehensive assessment of the fresh state, rheological, and mechanical properties of alkali-activated mortars (AAMs) developed by incorporating magnesium oxide (MgO) and nanomaterials. A total of 24 AAM mixes with varying content of MgO, multi-walled carbon nanotube (MWCNT), and reduced graphene oxide (rGO) were developed following the one-part dry mix technique using powder-based activators/reagents. The effects of the types/combinations of source materials (binary or ternary)/reagents, MgO (0 to 5%), MWCNT (0 to 0.6%), and rGO (0 to 0.6%) were evaluated in terms of the mini-slump flow, setting times, viscosity, yield stress, compressive strength, ultrasonic pulse velocity (UPV), and microstructural properties. The results showed that the addition of finer MgO/nano-fillers produced a higher viscosity and yield stress accompanied by a lower slump flow and setting times. The addition of 5% MgO resulted in the lowest slump flow of 80 mm, 2-2.5 times higher viscosity, and the reduction in the initial and final setting times of about 21% and 16%, respectively. Mixes with MWCNT showed about 5-10% higher viscosity whereas for mixes with rGO, the values were noted to be 8% higher, on average, than the mixes with no MWCNT or rGO. All the developed AAMs exhibited shear-thinning behavior. The 28-day compressive strength of the AAMs ranged from 37 MPa to 49 MPa with 5% MgO and up to a 0.3% MWCNT/rGO addition increased the compressive strength. Correlations among the fresh state, rheological, and mechanical properties such as the viscosity, slump flow, setting time, compressive strength, and UPV are also described.