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BackgroundSoil transmitted helminths (STH) infect >1.5 billion people. Mass drug administration (MDA) effectively reduces infection; however, there is evidence for rapid reinfection and risk of potential drug resistance. We conducted a randomized controlled trial in Bangladesh (WASH Benefits, NCT01590095) to assess whether water, sanitation, hygiene and nutrition interventions, alone and combined, reduce STH in a setting with ongoing MDA.Methodology/principal findingsIn 2012-2013, we randomized 720 clusters of 5551 pregnant women into water treatment, sanitation, handwashing, combined water+sanitation+handwashing (WSH), nutrition, nutrition+WSH (N+WSH) or control arms. In 2015-2016, we enrolled 7795 children, aged 2-12 years, of 4102 available women for STH follow-up and collected stool from 7187. We enumerated STH infections with Kato-Katz. We estimated intention-to-treat intervention effects on infection prevalence and intensity. Participants and field staff were not blinded; laboratory technicians and data analysts were blinded. Prevalence among controls was 36.8% for A. lumbricoides, 9.2% for hookworm and 7.5% for T. trichiura. Most infections were low-intensity. Compared to controls, the water intervention reduced hookworm by 31% (prevalence ratio [PR] = 0.69 (0.50,0.95), prevalence difference [PD] = -2.83 (-5.16,-0.50)) but did not affect other STH. Sanitation improvements reduced T. trichiura by 29% (PR = 0.71 (0.52,0.98), PD = -2.17 (-4.03,-0.38)), had a similar borderline effect on hookworm and no effect on A. lumbricoides. Handwashing and nutrition interventions did not reduce any STH. WSH and N+WSH reduced hookworm prevalence by 29-33% (WSH: PR = 0.71 (0.52,0.99), PD = -2.63 (-4.95,-0.31); N+WSH: PR = 0.67 (0.50,0.91), PD = -3.00 (-5.14,-0.85)) and marginally reduced A. lumbricoides. Effects on infection intensity were similar.Conclusions/significanceIn a low-intensity infection setting with MDA, we found modest but sustained hookworm reduction from water treatment and combined WSH interventions. Impacts were more pronounced on STH species with short vs. long-term environmental survival. Our findings suggest possible waterborne transmission for hookworm. Water treatment and sanitation improvements can augment MDA to interrupt STH transmission.Trial registrationNCT01590095.

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial's control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog10 = -0.88 (-1.01, -0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.

Background: Fistula in ano has been a troublesome pathology to both patients and surgeons throughout surgical history. Several techniques have been described for the management of fistula-in-ano but all carry their own risks of recurrence and incontinence. To overcome this problem, a novel technique called distal laser and proximal ligation (DLPL) was developed using a newly invented radial emitting laser probe. This study is aimed to see the outcome in terms of recurrence and incontinence of newly described technique. Materials and methods: This prospective study was conducted in a single private institute in The Dhaka city between January 2018 and July 2019. All patients with fistula in ano of cryptoglandular origin are included in this study and evaluated in outpatient department. Fistulogram done beforehand only those with recurrent fistula tract. Patients having fistula with chron’s disease, abscess cavity, side tract or malignancy were excluded from this study. A total of fifty two (52) male patients were selected. All patients were followed up and results were evaluated. Results: The median age of the patients was 46 years (range 22-60 years), 39 patients were primary fistula, 9 patients were recurrent fistula with history of previous fistula surgery and 4 patients were bilateral anal fistula. All patients underwent DLPL (distal laser proximal ligation) operation by radial emitting Laser probe. The mean follow up was 11 months (range 6-24 months). Forty three out of 52 fistulas showed primary healing (82.6 %) without any problem of anal incontinence. Only 6 patients developed recurrent fistula (11.53%) within 3 months of Surgery. Conclusion: The use of a diode laser source and a radial emitting laser probe in addition to conventional surgery in treating different types of anal fistula for selected group of patients is a very promising new technique in sphincterpreserving anal fistula repair. [ABSTRACT FROM AUTHOR]

Background: Congenital heart diseases (CHD) are associated with an increased risk for the development of pulmonary vascular disease. Severe and irreversible pulmonary hypertension may then ensue and, eventually, leads to reversal of the shunt. Oral sildenafil is used for preoperative and postoperative treatment of pulmonary hypertension. Methods: A total of 30 patients, who underwent surgical closure of congenital anomaly i.e. ASD and VSD with High Pulmonary Pressure were included in the study. Patients were initially selected by echocardiogram showing pulmonary arterial systolic pressure (PASP) more than 40 mm of Hg. The Group A (sildenafil group) consisted of 15 patients and had received sildenafil during and after operation was given to these patients initially through nasogastric tube and later via the oral route 6 hourly for 44 hours. Results: Reduction in the PA pressure in sildenafil group was found statistically significant (p=.044). ICU stay and total hospital stay were shorter in the intervention group than the control but not statistically significant possibly due to smaller sample size. Conclusion: We conclude that oral sildenafil treatment is a safe, simple and effective alternate for persistent pulmonary hypertension early after congenital cardiac surgery. [ABSTRACT FROM AUTHOR]