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To evaluate the persistence and factors associated with sleep disturbances among COVID-19 patients with a history of sleep disturbances 2 months after discharge from the hospital. A total of 400 patients admitted at Dhaka Medical College Hospital during July and August were diagnosed as suffering from sleep disturbances during their hospital stay using a standardized scale. They were followed up 2 months later through telephone, and a total of 322 participants were interviewed (excluding 63 nonresponders and five deceased) regarding the persistence of disturbances in sleep through a structured questionnaire. Patient demographic, clinical, and epidemiological data including history regarding in-hospital sleep disturbance were retrieved from hospital treatment sheets. Results revealed, 35% of study participants (n = 113) were still experiencing symptoms of sleep disturbances during the interview by telephone. Age (p = 0.015), diabetes mellitus (relative risk [RR]: 1.21; confidence interval [CI]: 1.02-1.42, p = 0.022), on admission SPO2 (p = 0.009), C-reactive protein (CRP) (p = 0.025), serum ferritin (p = 0.014), and d-dimer (p = 0.030) were independently associated with sleep disturbances among participants (p < 0.05). Binary and fitting logistic regression through repeated K folds cross-validation revealed 1.65 (CI: 1.02-2.66), 1.07 (CI: 1.01-1.14), and 1.07 (CI: 1.00-1.15) times higher odds of persistence of sleep disturbances among patients with diabetes mellitus, increased neutrophil, and lymphocyte percentages, respectively. Findings of this study need to be validated and patients should be further followed up with more in-depth studies conducted 6 or 12 months after initial infection, possibly with the help of higher sample size and in-person interview.

Objective To evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older. Methods Secondary analyses were performed on 9518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006–2014) were associated with time-to-onset of [1] physician-diagnosed “memory-related disease”, “Alzheimer's disease” and/or “dementia, senility or any other serious memory impairment” and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics. Results In fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006–2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41–72% increased risks of physician-diagnosed memory problems and 45–58% increased risks of dementia diagnosis based on HRS criteria. Conclusions When severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools.

Importance: Hypokalemia is a neglected common manifestation in COVID-19 patients admitted in hospital though it has serious consequences. Coronavirus may cause hypokalemia through disruptions of rennin-angiotensin system, gastrointestinal loss or other unknown mechanisms. Objective: To investigate the prevalence of hypokalemia among patients with moderate to severe COVID-19 and its association with other clinical and laboratory parameters. Design, Setting, and Participants: This was cross sectional observational study conducted at Dhaka medical College Hospital of Bangladesh from June, 2020, to August 2020. Participants were included who were positive for rt-PCR for COVID-19 according to the national guideline. The patients were classified as having severe hypokalemia (plasma potassium 3.5 mmol/L). Results: Prevalence of hypokalemia among patients with COVID-19 was 20.2%, severe hypokalemia (2 patients [1.5%]) and hypokalemia (25 patients [18.7%]). One thirty four (134) patients with positive COVID-19 were included. The mean [SD] age of these 134 patients according to different potassium levels appear to be : 68 [2.83] years for severe hypokalemia , 51.93[11.68] years for hypokalemia and 50.73[14.7] years for normokalemia. Among them, 46 patients were females [34.32%]) and rest were males [65.68%]. Within the total sum of 134 patients, 107 were identified having normokalemia, [79.9%]. 25 patients [18. 7%] had hypokalemia and only two patients [1.5%] were found having normokalemia. Among 134 patients, three commonest symptoms were fever (132 patients [98.5%]), dry cough (123 patients (91.79%) and shortness of breath (122 patients [91.04%]), followed by less common symptoms like fatigue (89 patients [66.410%]), sore throat (60 patients [44.77%]), and diarrhea (44 patients, [32.83%]). Shortness of breath was associated with grades of hypokalemia (P=0.022). Only 26 patients (19.4%) manifested having vomiting/Nausea. The predominant comorbidities found among these 134 participants were Hypertension (68 patients [64.2%]), Diabetes (54 patients [52.9%]), Ischemic heart disease (37 patients [38.1%]) and Asthma (27 patients [31.0%]). The prevalence of comorbidities was not associated with Hypokalemia. Conclusions Prevalence of hypokalemia among patients with COVID-19 is high (20.2%) and appropriate treatment is highly required. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 131-137

BACKGROUND It is relatively unknown as to how dietary bioactive compound sulforaphane (SFN) and vitamin D regulate gene expression in colorectal cancer. We hypothesized that a combination of SFN with vitamin D would prove beneficial in colorectal cancer. A combinatorial chemo-preventive strategy was employed to investigate the impact of SFN on chromatin remodeling in colorectal carcinoma. To understand the epigenetics-mediated changes in gene expression in response to SFN and vitamin D, Caco-2 cells were exposed for 24 h to vitamin D (100 nmol L-1 ) either alone or in combination with SFN and trichostatin A (20 and 1 μmol L-1 , respectively) at 70% confluency (proliferating) and after 13 days post-confluency (fully differentiated). Changes to VDR, CYP24A1, CYP27B1 and TRPV6 gene expressions were quantified using real-time PCR-based assays. Histone deacetylase (HDAC) inhibitor activity was assessed using HDAC I/II assay that measured global changes in acetylation status. RESULTS In differentiated Caco-2 cells, none of the genes had significant changes from D alone group. D + SFN (P = 0.99) demonstrated an opposing effect from D alone and decreased VDR expression. However, in proliferating Caco-2 cells, D + SFN (P

Co-infection between Helicobacter pylori (Hp) and groups of periodontal pathogens may alter the onset of Alzheimer's disease (AD) and all-cause dementia. We examined the interactive associations among Hp sero-positivity, periodontal disease (Pd), and infections with incident AD and all-cause dementia, among older adults (≥65 years at baseline). Up to 1431 participants from phase 1 of the National Health and Nutrition Survey III (1988-1991) had complete data till January 1st, 2014 on Hp sero-positivity with a mean follow-up of 10-11 years for AD and all-cause dementia incidence. Exposures consisted of 19 periodontal pathogens, constructed factors and clusters, and two Pd markers- probing depth and clinical attachment loss (CAL). Cox proportional hazards models were performed. Around 55% of the selected sample was Hp+. We found that Prevotella intermedia, Campylobacter Rectus, Factor 2 (Pi/Prevotella nigrescens/Prevotella melaninogenica), and the Orange-Red cluster interacted synergistically with Hp sero-positivity, particularly with respect to AD incidence. The presence of higher levels of Actinomyces Naeslundii (An) enhanced the effect of being Hp+ on both AD and all-cause dementia incidence. In contrast, Fusobacterim nucleatum (Fn), and Factor 1 (which included Fn), exhibited an antagonistic interaction with Hp in relation to all-cause dementia. Both probing depth and CAL had direct associations with all-cause dementia among Hp+ individuals, despite nonsignificant interaction. Selected periodontal pathogen titers, factors, and clusters interacted mostly synergistically, with Hp sero-positivity, to alter the risk of AD and all-cause dementia. Ultimately, a randomized controlled trial is needed, examining effects of co-eradication of Hp and select periodontal pathogens on neurodegenerative disease.

Poor diet quality (DQ) is associated with poor cognition and increased neurodegeneration, including Alzheimer’s disease (AD). We are interested in the role of DQ on cognitive functioning (by sex and increasing genetic risk for AD), in a sample of African American (AA) middle-aged adults. We analysed a sub-group of participants (about 55 % women; mean follow-up time of about 4·7 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a genetic risk score for AD (hAlzScore). The Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension and the mean adequacy ratio computed at baseline (2004–2009) and follow-up visits (2009–2013) were used to assess initial DQ and change over time. Linear mixed-effects regression models were utilised, adjusting for select covariates, selection bias and multiple testing. DQ change (ΔDQ) was associated with California Verbal Learning Test-List A – overall (0·15 (se 0·06), P = 0·008) and in women (0·21 (se 0·08), P = 0·006), at highest AD risk, indicating protective effects over time. Greater AD risk was longitudinally associated with poorer Clock Command Test scores in men. Poor DQ was positively and cross-sectionally associated with Trails B scores, but in women only. Better-quality diet was associated with a slower decline in verbal memory among AA women, with greater AD risk. Insufficient clinical evidence and/or mixed findings dictate that more studies are needed to investigate brain morphology and volume changes in relation to DQ in an at-risk population for AD, over time.

Background: To examine patterns and outcomes of bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB), among women diagnosed with polycystic ovarian syndrome (PCOS). Materials and Methods: Retrospective cohort study using 1998–2011 Nationwide Inpatient Sample data. A total of 52,668 hospital discharge records met eligibility criteria among PCOS women, 18–49 years. Of those, 17,759 had an obesity/overweight diagnosis and 4310 underwent bariatric surgery. Furthermore, 3086 underwent RYGB (n = 2411), LSG (n = 126), or LAGB (n = 549), and were compared to 78,931 non-PCOS controls. Multiple regression models were constructed to examine patient- and hospital-level predictors of obesity/overweight and bariatric surgery, as well as type of bariatric surgery (RYGB, LSG, or LAGB) as a predictor of in-hospital outcomes and PCOS status. Results: The prevalence of obesity/overweight (≈34%) among women diagnosed with PCOS, and of bariatric surgery (≈24%) among women diagnosed with PCOS and obese/overweight varied by patient- and hospital-level characteristics. Women having PCOS and overweight/obesity, who underwent LSG or LAGB, had shorter hospital stay, reduced hospital charges, and better disposition at discharge compared to those who underwent RYGB. PCOS cases and non-PCOS controls experienced similar treatment selection and in-hospital outcomes after bariatric surgery. Also, PCOS cases and non-PCOS controls experienced similar in-hospital outcomes after undergoing RYGB, LSG, or LAGB. Conclusions: Compared to RYGB, LSG and LAGB resulted in improved in-hospital outcomes among obese/overweight PCOS and non-PCOS patients. Further research is needed to examine health care disparities in the context of PCOS, obesity/overweight, and bariatric surgery.

BACKGROUND: Epidemiological evidence suggests that both anemia and elevated red cell distribution width (RDW) are associated with cognitive impairment. However, the interplay between these 2 predictors has been understudied. OBJECTIVES: We examined sex- and anemia-specific associations between RDW and cognitive performance among urban adults in the United States. METHODS: Data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study (Baltimore, MD; participants aged 30–65 y at baseline, ∼59% African-American, 45% men) were used. Participants were selected based on the completion of 11 cognitive tasks at baseline (2004–2009) and follow-up (2009–2013) visits (mean time between visits: 4.64 ± 0.93 y) and availability of exposure and covariate data, yielding a sample of between 1526 and 1646 adults out of the initial 3720 adults recruited at baseline. Multiple linear mixed-effects regression models were conducted with RDW as the main exposure of interest and anemia/sex as the key effect modifiers. RESULTS: Overall, high RDWs were linked to poorer baseline performance on the California Verbal Learning Test (CVLT) List A (per 1 unit increase in RDW %, main effect: γ(01 )= −0.369 ± 0.114; P = 0.001) and to slower rates of decline on the CVLT Delayed Free Recall (per 1 unit increase in RDW %, RDW × time: γ(11 )= +0.036 ± 0.013; P = 0.007). Among nonanemic participants, RDWs were consistently associated with poorer baseline performance on the Trailmaking Test, Part A (γ(01 )= +3.11 ± 0.89; P

Background and aims Dyspnea is one of the most common symptoms associated with the COVID‐19 caused by novel coronavirus SARS‐CoV‐2. This study aimed to assess the prevalence of dyspnea, observe co‐variables, and find predictors of dyspnea after 2 months of recovery from COVID‐19. Methods A total of 377 patients were included in the study based on their responses and clinical findings during initial admission to the hospital with COVID‐19. After excluding five deceased patients, a total of 327 patients were interviewed through telephone using a 12‐point dyspnea scale and using relevant questions to gauge the patient clinically. Interviews were carried out by trained physicians, and responses were recorded and stored. All analyses were carried out using the statistical programming language R. Results Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after 2 months of COVID‐19. The study demonstrated that patient oxygen saturation level SpO2 (P = .03), D‐dimer (P = .001), serum ferritin (P = .006), and the presence and severity of dyspnea are significantly correlated. In addition to that, patient smoking history (P = .012) and comorbidities such as chronic obstructive pulmonary disease (COPD) (P = .021) were found to be statistically significant among groups. Conclusion These findings of this study can be useful for predicting and managing long‐term complications of COVID‐19.

Background Associations of Apolipoprotein (APOE) ε2 or ε4 (APOE2 or APOE4) dosages with cognitive change may differ across racial groups. Methods Longitudinal data on 1770 middle-aged White and African American adults was compiled from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS 2004-2013) study. APOE2 and APOE4 dosages were the two main exposures, while v1 and annual rate of change in cognitive performance (between v1 and v2) on 11 test scores were the main outcomes of interest (v1: 2004–2009 and v2: 2009–2013). Mixed-effects linear regression models were conducted adjusting for socio-demographic, lifestyle, and health-related potential confounders. Race (African American vs. White) and sex within racial groups were main effect modifiers. Results Upon adjustment for multiple testing and potential confounders, APOE4 allelic dosage was associated with faster decline on a test of verbal memory among Whites only (CVLT-List A: γ12 = − 0.363 ± 0.137, p = 0.008), but not among African Americans. In contrast, among African American women, APOE4 dosage was linked to slower decline on a test of attention (BTA: γ12 = + 0.106 ± 0.035, p = 0.002), while no association was detected among African American men. APOE2 and APOE4 dosages showed inconsistent results in other domains of cognition overall and across racial groups that did not survive correction for multiple testing. Conclusions In conclusion, APOE4 dosage was associated with faster decline on a test of verbal memory among Whites only, while exhibiting a potential protective effect among African American women in the domain of attention. Further longitudinal studies are needed to replicate our race and sex-specific findings.

BACKGROUND: Elevated levels of inflammatory biomarkers are consistently associated with chronic conditions, for which periodontitis and sleep are established risk factors. We examined the relationships between periodontitis, hours of sleep and white blood cell (WBC) markers among a nationally representative sample of US adults. METHODS: Cross-sectional study using existing demographic, examination, laboratory and questionnaire data on 11,813 participants (5,814 men and 5,999 women, mean age ± SE; range: 52.74 ± 0.24; 30 to 80 years) from the 2009 to 2014 National Health and Nutrition Examination Surveys. Unadjusted, sex- and age-adjusted, as well as fully adjusted linear and logistic regression models were conducted in addition to generalized structural equations models, while considering sampling design complexity. β, odds ratios with their 95% confidence intervals, indirect effects and mediation proportions were estimated. RESULTS: The weighted mean WBC count was 7,130 cells/μL, with the WBC 5-part differential estimated in terms of percentages of lymphocytes (29.50%), monocytes (7.99%), neutrophils (59.03%), eosinophils (2.84%), and basophils (71.88%). Furthermore, 36.2% of participants reported

CONTEXT: Breast cancer (BC) is the most common malignancy among women in the US. Vitamin D status and intakes are thought to be inversely associated with BC occurrence. OBJECTIVES: In our systematic review and meta-analysis, we evaluated evidence linking serum 25(OH)D (both in serum and diet) with breast cancer (BC) occurrence. DATA SOURCES AND EXTRACTION: Only observational studies from databases such as PubMed and Cochrane (January 1st 2000 through March 15th, 2018) were included using PRISMA guidelines. Publication bias and consistency upon replication were assessed, while harmonizing risk ratios (RR, 95% CI) of BC, per fixed increment of 5 exposures [10 ng/mL of 25(OH)D; 100 IU/d for total/dietary vitamin D intakes; vitamin D deficiency; supplement use). RRs were pooled using random effect models. DATA ANALYSIS: Pooled findings from 22 studies suggested a net direct association between 25(OH)D deficiency and BC, with RR(pooled) = 1.91, 95% CI: 1.51–2.41, P < 0.001). Total vitamin D intake (RR(pooled) = 0.99, 95% CI: 0.97–1.00, P = 0.022, per 100 IU/d) and supplemental vitamin D (RR(pooled) = 0.97, 95% CI:0.95–1.00, P = 0.026) were inversely associated with BC. No evidence of publication bias was found; all 5 exposures of interest were consistent upon replication. CONCLUSIONS: 25(OH)D deficiency was directly related to BC while total vitamin D and supplemental vitamin D intakes had an inverse relationship with this outcome. Randomized clinical trials are warranted pending further evidence from primary meta-analyses of observational studies.

Context Serum anti-Müllerian hormone level (AMH) and body mass index may be jointly associated with cardiometabolic risk. Objectives Examine the contribution of AMH to cardiometabolic disturbances by weight status among US adult men. Design Cross-sectional analysis using data from the 1999 to 2004 waves of the National Health and Nutrition Examination Survey. Setting Multistage probability sampling of the noninstitutionalized US population. Participants US men aged ≥18 years. Final analytic sample sizes ranged from 517 to 1063 participants. Main Outcome and Exposure Measures Cardiometabolic disturbances (metabolic syndrome and its components, insulin resistance, diabetes, and chronic inflammation) and AMH were obtained from trained staff and nurses in a mobile examination center or during in-home visits. Results AMH was directly associated with insulin resistance among obese men [OR 1.08 (95% CI 1.00, 1.15); P = 0.046; N = 146], whereas AMH was inversely associated with waist circumference (WC) among obese men [OR 0.95 (95% CI 0.91, 0.99); P = 0.049; N = 146]. An inverse relationship was also observed between categorical AMH and diabetes status [medium vs low AMH; OR 0.19 (95% CI 0.043, 0.84); P = 0.030; N = 145] among obese men, with a strong inverse relationship also detected among overweight men [high vs low AMH; OR 0.011 (95% CI 0.0004, 0.27); P = 0.007; N = 193]. An inverse relationship between continuous AMH and diabetes [OR 0.75 (95% CI: 0.59, 0.93); P = 0.011; N = 193] was also detected among overweight men. Conclusions AMH was associated with specific cardiometabolic risk factors, including WC, diabetes status, and insulin resistance, in overweight and obese US men.

Objective This study aimed to examine patterns of sleep disorders among hospitalized adults 65 years and older as related to Parkinson's disease (PD) status and to evaluate sex differences in the associations between PD with sleep disorders. Methods A cross-sectional study was conducted using 19,075,169 hospital discharge records (8,169,503 men and 10,905,666 women) from the 2004-2014 Nationwide Inpatient Sample databases. PD and sleep disorder diagnoses were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification coding. Logistic regression models were constructed for each sleep disorder as a correlate of PD status; adjusted odds ratios (aOR) with their 95% confidence intervals (CIs) were calculated taking into account patient and hospital characteristics. Results Period prevalences of PD and sleep disorder were estimated to be 2.1% and 8.1%, respectively. Most sleep disorder types, with the exception of sleep-related breathing disorders, were positively associated with PD diagnosis. Statistically significant interactions by sex were noted for associations of insomnia (men: aOR = 1.29, 95% CI = 1.24-1.36; women: aOR = 1.17, 95% CI = 1.12-1.22), parasomnia (men: aOR = 3.74, 95% CI = 3.44-4.07; women: aOR = 2.69, 95% CI = 2.44-2.96), sleep-related movement disorder (men: aOR = 1.09, 95% CI = 1.07-1.11; women: aOR = 1.22, 95% CI = 1.20-1.25), and any sleep disorder (men: aOR = 1.06, 95% CI = 1.05-1.08; women: aOR = 1.15, 95% CI = 1.13-1.17) with PD status. Conclusions Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.

Background and objectives: Lower vitamin status has been linked to cognitive deficits, pending mechanistic elucidation. Serum 25-hydroxyvitamin D [25(OH)D], folate and cobalamin were explored against brain volumes and white matter integrity (WMI). Methods: Three prospective waves from Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study were used [Baltimore, City, MD, 2004-2015, N = 183-240 urban adults (Agev1: 30-64 years)]. Serum vitamin 25-hydroxyvitamin D [25(OH)D], folate and cobalamin concentrations were measured at visits 1 (v1: 2004-2009) and 2 (v2: 2009-2013), while structural and diffusion Magnetic Resonance Imaging (sMRI/dMRI) outcomes were measured at vscan: 2011-2015. Top 10 ranked adjusted associations were corrected for multiple testing using familywise Bonferroni (FWER 50 years: +205 ± 54]; parietal WM; [overall: +251 ± 77, males: +486 ± 129 and Agev1 > 50 years: +393 ± 108] and left occipital pole volume [overall: +15.70 ± 3.83 and above poverty: 19.0 ± 4.3], findings replicated for 25(OH)D (v2-v1) annualized exposure, which was also linked with greater WMI (fractional anisotropy, FA) in the anterior limb of the internal capsule (ALIC); FWER < 0.05 [Overall: +0.0020 ± 0.0004; Whites: +0.0024 ± 0.0004] and in the cingulum (hippocampus) [Overall: +0.0016 ± 0.0004]. Only trends were detected for cobalamin exposures (q < 0.10), while serum folate (v1) was associated with lower mean diffusivity (MD) in ALIC, reflecting greater WMI, overall. Conclusions: Among urban adults, serum 25(OH)D status and increase were consistently linked to larger occipital and parietal WM volumes and greater region-specific WMI. Pending longitudinal replication of our findings, randomized controlled trials of vitamin D supplementation should be conducted against brain marker outcomes.

Despite its public health significance, TBI management across US healthcare institutions and patient characteristics with an emphasis on utilization and outcomes of TBI-specific procedures have not been evaluated at the national level. We aimed to characterize top 10 procedure codes among hospitalized adults with TBI as primary diagnosis by injury severity. A Cross-sectional study was conducted using 546, 548 hospitalization records from the 2004 to 2014 Nationwide Inpatient Sample were analyzed. Data elements of interest included injury, patient, hospital characteristics, procedures, in-hospital death and length of stay. Ten top procedure codes were “Closure of skin and subcutaneous tissue of other sites”, “Insertion of endotracheal tube”, “Continuous invasive mechanical ventilation for less than 96 consecutive hours”, “Venous catheterization (not elsewhere classified)”, “Continuous invasive mechanical ventilation for 96 consecutive hours or more”, “Transfusion of packed cells”, “Incision of cerebral meninges”, “Serum transfusion (not elsewhere classified)”, “Temporary tracheostomy”, and “Arterial catherization”. Prevalence rates ranged between 3.1% and 15.5%, with variations according to injury severity and over time. Whereas “Closure of skin and subcutaneous tissue of other sites” was associated with fewer in-hospital deaths and shorter hospitalizations, “Temporary tracheostomy” was associated with fewer in-hospital deaths among moderate-to-severe TBI patients, and “Continuous invasive mechanical ventilation for less than 96 consecutive hours” was associated with shorter hospitalizations among severe TBI patients. Other procedures were associated with worse outcomes. Nationwide, the most frequently reported hospitalization procedure codes among TBI patients aimed at homeostatic stabilization and differed in prevalence, trends, and outcomes according to injury severity.

Background: Anemia and red cell distribution width (RDW) have been linked to poor cognitive performance, pending studies of underlying mechanisms. Objective: We examined cross-sectional relationships of initial RDW status (v1), RDW change (δ), and anemia with brain structural magnetic resonance imaging (sMRI) markers, including global and cortical brain and hippocampal and white matter lesion (WML) volumes, 5–6 years later. Methods: Data were used from three prospective visits within the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study with complete v1 (2004–2009) and v2 (2009–2013) exposures and ancillary sMRI data at vscan (2011–2015, n = 213, mean v1 to vscan time: 5.7 years). Multivariable-adjusted linear regression models were conducted, overall, by sex, by race, and within non-anemics, correcting for multiple testing with q-values. Results: In minimally adjusted models (socio-demographics and follow-up time), anemiav1 and RDWv1 were consistently associated with smaller bilateral hippocampal volumes overall, and among females (q

Anemia (blood hemoglobin [Hb]

Background: Infectious agents including periodontal pathogens and their neuroinflammatory sequelae have been at the forefront of Alzheimer's Disease (AD) pathology. We investigated whether periodontal disease (Pd) markers and periodontal pathogens in mid-life are associated with clinical outcomes of cognitive impairment after decades of follow-up. Methods: We conducted a retrospective cohort analysis using data from the third National Health and Nutrition Examination Surveys (NHANES III) linked with restricted mortality and incident outcomes derived from the National Death Index and Medicare data [≥45y, 43% men, Nmax=6,650, 1988-1994 through January 1st, 2014, mean follow-up times (45+, all outcomes): 15-17y]. Outcomes of interest included AD mortality (nmax=102), incidence of AD (nmax=888) and all-cause dementia (nmax=1,737). Exposures included Pd markers [mean clinical attachment loss (CAL) and Probing Depth (PD)] and 19 periodontal pathogens (1988-1994: k=19; 1991-1994 (phase 2): k=2). Multiple Cox proportional hazards models were conducted, stratified by age and sex. Findings: In those ≥65 years old, AD incidence was associated with a composite factor comprised of C. Rectus and P. Gingivalis (Pg) titers (per SD, aHR=1.22; 95% CI, 1.04-1.43, P=0.012), whereas AD mortality risk increased with higher baseline levels in a factor comprised of Pg, P. intermedia, P. nigrescens, F. nucleatum, Cr, S. intermedius, C. ochracea and P. melaninogenica (per SD, aHR=1.46; 95% CI, 1.09-1.96, P=0.017). In both the 55+ and 65+ age groups, the Orange-Red cluster (Pm, Pi, Pn, Pg) was associated with increased AD mortality risk. PD and phase 2 (1991-1994) measured Pg were consistently and directly associated with incident AD among older individuals. Interpretation: Evidence for an association between periodontal pathogens and AD and dementia-related outcomes was stronger for older adults. This study presents information that may inform periodontists who treat older adults and calls for a line of inquiry between practitioners focused on Pd and neurodegenerative processes. Funding Statement: This study was entirely supported by the National Institute on Aging, Intramural Research Program (NIA/NIH/IRP). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: The present study was approved for ethical treatment of participants by the Institutional Review Board of the National Institute on Aging, Intramural Research Program.

Objective. We examined relationships of vitamin D status with over time changes in patterns of sleep in a longitudinal study of Whites and African-American urban middle-aged adults, while further testing effect modification by age group, sex and race and the potential roles of dietary and supplemental vitamin D. Methods. Data on 1,760 middle-aged participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS study: Age range at v2: 33-71y, mean±SD:53.0±8.8, % women: 58.4%, % African-American:60.3%) were used, with complete baseline 25-hydroxyvitamin D [25(OH)D] serum concentration data, initial selected covariates and mediators, and initial and/or follow-up data on five sub-scales (sleep duration, daytime dysfunction, sleep disturbance, sleep latency and sleep quality) of the Pittsburgh Sleep Quality Index. Mean±SD time between initial and follow-up visits: 4.1±1.5 years. Time-interval multiple mixed-effects linear regression models were used. Results. Upon multiple testing adjustment, among Whites, initial 25(OH)D was associated with better sleep duration [25(OH)D × TIME γ±SE: -0.027±0.011, P=0.017] and sleep quality [25(OH)D × TIME γ±SE: -0.026±0.010, P=0.008] over time, with heterogeneity by race found for both relationships (P Limitations. Limitations included small sample size, selection bias, residual confounding and lack of objective sleep measures. Conclusions Vitamin D status, possibly through mechanisms involving sunlight exposure, was linked to a potential improvement in sleep duration and quality among White urban adults.

OBJECTIVES: Prior studies on caregivers have focused mainly on the diet quality of their recipients, especially children. We investigated both cross-sectional and longitudinal associations of caregiver status and diet quality in older adults (mean 53.0 ± 9.0 years). METHODS: We studied participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American) between wave 3 (2009–2013) and wave 4 (2013–2018). Caregiving was assessed at both waves, starting at wave 3. Healthy Eating Index-2010 (HEI2010) score, a measure of diet quality, was assessed from two 24-hour recalls at each wave on both occasions (mean 4.1 years follow-up). Baseline caregiving (at wave 3) was examined in relation to change in HEI between waves 3 and 4. Multivariable linear regression was performed for cross-sectional analysis; mixed-effects regression was performed for longitudinal analyses. Results are expressed as β-coefficients ± standard error of means (β±SE). RESULTS: After adjusting for age, sex, race and poverty status, more time spent taking care of grandchildren (N = 2033) was associated with poor diet quality (–1.51 ± 0.55, P = 0.006) in cross-sectional analysis (wave 4 caregiving and wave 4 HEI). However, in a separate cross-sectional analysis (wave 4 only) on dual (caring for both grandchildren and an elderly person) vs. single caregivers (either grandchildren or elderly) (N = 73; 24 men & 49 women) we found no difference in diet quality. The longitudinal analyses (N = 1848) demonstrated that diet quality did not change with caregiving over time for either grandchildren (P = 0.16) or others (not children & grandchildren) (P = 0.88). Overall, women tended to have better quality diet (P

Complex processes appear to link sleep duration and quality with dietary patterns. Numerous studies show healthful benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, but few have examined its association with sleep duration or quality. The current study tested cross-sectional associations of DASH diet quality score with sleep quality among adults. Analyses of participants were from the 2005&ndash, 2008 wave of the National Health and Nutrition Examination Surveys (n = 3941 adults &ge, 30 years of age, complete data). We performed sex- and age group-stratified multiple OLS regression analyses with DASH total score and components as main predictors and sleep quality as main outcomes, adjusting sequentially for socio-demographic, behavioral and health-related factors. Sex and age differences in associations of DASH with sleep quality, adjusting for covariates, were also examined by incorporating two-way interaction terms between sex/age and the DASH score in each unstratified model. We found that the DASH diet score was inversely related to poor sleep-related daytime dysfunction adjusted by age, sex, demographic and socio-economic factors. Some sex-specific associations were detected between DASH diet component scores and sleep quality. Notably, the potassium DASH component was inversely associated with Factor 1 (&ldquo, sleepiness and sleep disturbance&rdquo, ) among women. The fiber DASH component was associated with better sleep quality and inversely related to Factor 2 (&ldquo, sleep-related daytime dysfunction&rdquo, ) in younger subjects. This study indicates health benefits of the DASH diet for sleep duration and quality. Future longitudinal studies and randomized placebo-controlled trials are required to ascertain protective effects.

Background: Socio- economic condition plays a role on taking decision for cancer treatment beside this out pocket expenditure is a headache for cancer patients. For that, pattern of financial assistance for breast cancer treatment and associated factors were explored. Method: A cross sectional study was carried out with 200 samples; those were selected randomly from the listed patients who attended in the day care centre of chemotherapy. Results: Maximum respondents first visited to health care provider at II and III stage with first symptom as lump on breast or axilla, no patients came at stage I. Along with family and neighbor, social welfare also play a positive role to assist finance . Donation was the major means to collect money and two or three sources were needed at a time for collecting money. In chi square (χ 2) test, economic condition had a significant role on care seeking. Simultaneously by ANOVA it was found that mean difference was more at age 31-40 year of age. After 50 years, care seeking time was intersect, here Main effect of age was F (1, 192) = 1.92, p=0.162; Main effect of economic condition was F (3, 192) =0.27, p=0.847; Inter effect was F (2, 192) = 1.77, p=0.154. Conclusion: After knowing cancer, she and her family member become puzzled to collect money. For that necessary measure should be taken to easy availability of expenditure cost. It is recommended to launch public health insurance as soon as possible.

Microbial agents including periodontal pathogens have recently appeared as important actors in Alzheimer's disease (AD) pathology. We examined associations of clinical periodontal and bacterial parameters with incident all-cause and AD dementia as well as AD mortality among US middle-aged and older adults. Clinical [Attachment Loss (AL); probing pocket depth (PPD)] and bacterial [pathogen immunoglobulin G (IgG)] periodontal markers were investigated in relation to AD and all-cause dementia incidence and to AD mortality, using data from the third National Health and Nutrition Examination Surveys (NHANES III, 1988-1994) linked longitudinally with National Death Index and Medicare data through January 1, 2014, with up to 26 years of follow-up. Sex- and age-specific multivariable-adjusted Cox proportional hazards models were conducted. Among those ≥65 years, AD incidence and mortality were consistently associated with PPD, two factors and one cluster comprised of IgG titers against Porphyromonas gingivalis (P. gingivalis), Prevotella melaninogenica (P. melaninogenica) and Campylobacter rectus (C. rectus) among others. Specifically, AD incidence was linked to a composite of C. rectus and P. gingivalis titers (per SD, aHR = 1.22; 95% CI, 1.04-1.43, p = 0.012), while AD mortality risk was increased with another composite (per SD, aHR = 1.46; 95% CI, 1.09-1.96, p = 0.017) loading highly on IgG for P. gingivalis, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, C. rectus, Streptococcus intermedius, Capnocylophaga Ochracea, and P. melaninogenica. This study provides evidence for an association between periodontal pathogens and AD, which was stronger for older adults. Effectiveness of periodontal pathogen treatment on reducing sequelae of neurodegeneration should be tested in randomized controlled trials.

Elevated blood homocysteine (Hcy) among middle-aged adults can increase age-related disease risk, possibly through other biochemical and hematological markers. We selected markers for hyperhomocysteinemia among middle-aged adults, studied time-dependent Hcy-marker associations and computed highly predictive indices of hyperhomocysteinemia, with cross-sectional and longitudinal validations. We used data from the National Health and Nutrition Examination Survey (NHANES III, phase 2, nmax = 4000), the NHANES 1999&ndash, 2006 (nmax = 10,151) and pooled NHANES (cross-sectional validation). Longitudinal validation consisted of mixed-effects linear regression models (Hcy predicting markers&rsquo, annual rates of change), applied to the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS, n = 227&ndash, 244 participants, k = 2.4 repeats/participant, Agebase: 30&ndash, 65 years) data. Machine learning detected nine independent markers for Hcy &gt, 14 &micro, mol/L (NHANES III, phase 2): older age, lower folate and B-12 status, higher serum levels of creatinine, uric acid, alkaline phosphatase, and cotinine, mean cell hemoglobin and red cell distribution widths (RDW), results replicated in the 1999&ndash, 2006 NHANES [AUC = 0.60&ndash, 0.80]. Indices combining binary markers increased elevated Hcy odds by 6.9&ndash, 7.5-fold. In HANDLS, first-visit Hcy predicted annual increase in creatinine, RDW and alkaline phosphatase, with third-visit index (2013&ndash, 2018) directly predicting Hcy (2004&ndash, 2009). We provide evidence of the internal and external validity of indices composed of several biomarkers that are strongly associated with elevated Hcy.

Dickkopf Wnt Signaling Pathway Inhibitor-1 gene (DKK-1) encodes a member of the Dickkopf family of proteins and is involved primarily in the embryonic development and bone formation in adults. Based on its known relationship to Wnt signaling pathway, we set out to determine how this gene is affected by dietary agents- vitamin D and sulforaphane (SFN). Cells were exposed for 24 hours to vitamin D3 [1,25(OH)2D3] (100nM) either alone or in combination with L-sulforaphane and TSA (20μM and 1μM respectively) at 70% confluency. We hypothesized that DKK-1 expression will be increased in both cancer cells using our select treatments. In proliferating Caco-2 cells, treatment with 1,25(OH)2D3 had nearly a 3-fold increase in DKK-1 (p

It is relatively unknown how dietary bioactive compound, sulforaphane, in partnership with active vitamin D3, 1,25(OH)2D3, regulates vitamin D‐dependent gene expression in breast cancer (BC). It has been suggested that the combination of various bioactive components with vitamins is crucial for their potential anticancer activities. METHODS: This study employed a combinatorial chemopreventive strategy to investigate the impact of dietary histone deacetylase (HDAC) inhibitor, that is, sulforaphane on chromatin remodeling in BC. To understand the epigenetics‐mediated changes in gene expression, MCF‐7 cells were exposed for 24 hr to 1,25(OH)2D3 (100nM) either alone or in combination with L‐sulforaphane and TSA (20μM and 1μM, respectively) at 70% confluency. Changes in VDR, CYP24A1, CYP27B1, and TRPV6 gene expressions were quantified using real‐time PCR‐based assays. HDAC inhibitor activity was assessed using HDAC I/II assay that measured global changes in acetylation status. Cell viability was measured using ATP and MT assays. Clonogenic and migration assays were performed to analyze the ability of single cells to grow into colonies and % closure (migration ability) upon treatments, respectively. Results were expressed as ΔCT ± standard error of means (SEM) from One‐way ANOVA analyses for mRNA expressions and mean ± SEM for all other assays. RESULTS: In MCF‐7 cells, treatment with 1,25(OH)2D3 tended to decrease VDR (13 ± 0.4) and CYP27B1 (12 ± 0.96), while significantly increased TRPV6 (p = .02, 14 ± 0.1) and CYP24A1 (p

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is linked to slower weight gain over time. Elevated depressive symptoms may lead to poor quality diets, potentially increasing Body Mass Index (BMI). This study explored these pathways using longitudinal data extracted from 1201&ndash, 1458 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants. DASH mean score was computed using four 24 h recalls [visits(v)1 + v2/2: 2004&ndash, 2013] and depressive symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale (v1 + v2/2: 2004&ndash, 2013). BMI was measured at v2: 2009&ndash, 2013 and v3: 2013&ndash, 2017. Multiple linear mixed regression and mediation modeling were conducted, linking CES-D(mean) and DASH(mean) to BMI [v2 and annualized change &Delta, BMI (v3-v2)] and exploring mediation of the CES-D(mean)&ndash, BMI(v3) and DASH(mean)&ndash, BMI(v3) associations through DASH(mean) and CES-D(mean), respectively. Models were further stratified by sex, race and poverty status. Inverse cross-sectional and longitudinal relationships of DASH(mean) with BMI(v2) and &Delta, BMI were detected, mainly in women and &lt, 125% of poverty participants. CES-D(mean) was not associated with BMI(v3), no mediation was detected through DASH(mean) in all socio-demographic strata. Moreover, the inverse DASH(mean)&ndash, BMI(v3) total effect was not mediated through CES-D(mean). Future studies should explore other pathways aside from depressive symptoms by which DASH can have a preventive effect on weight status over time.

Perception on breast cancer influences the help seeking pattern of breast cancer patients. Negative perception causes delay in help seeking. Outcome or survival rate of breast cancer has a relation on perception. A cross sectional study was done during July 2015-June 2016, to assess the perception on breast cancer and to find out the help seeking pattern and extent of help seeking time among breast cancer patients. A total of 200 patients were selected following the convenient method of sampling from National Institute of Cancer Research and Hospital. Dhaka. Face to face interviews were taken from the diagnosed breast cancer patients admitted in the hospital. Forty five percent patients were illiterate and 83% were house wife. The mean age was 42 and mean monthly family income was around 9000 taka. Two thirds of the respondents were present with locally advance stage (stage III) and three fourth of the patients identified the lump as 1st symptom. Four of 10 patients first sought help to homeopathy for their cancer diagnosis and treatment. Mean help seeking time was 11 months. Nine out of 10 patients were agreed with the statement, ‘I was healthy’. Maximum respondents (81.0%) agreed with the statement, ‘wait and see what would be happened’. Results showed that there was a relationship between delay help seeking and the statement of perception. There were significant associations between the perception on expensive treatment, perception on ‘I am healthy’, perception on ‘lump related with menstruation’, perception on ‘wait and see what would be happened’, perception on ‘feared to do operation, it may cause death’ and perception on family income and the delay in help seeking. Along with perception on breast cancer use of alternative medicine, lack of social support, health care delivery system, economic factor etc. influence the pattern and delay in help seeking. Further to the existing efforts to correct the perception for early diagnosis and treatment to overcome this problem is suggested.Bangladesh Med Res Counc Bull 2018; 44(1):39-44

Context Serum 25-hydroxyvitamin D [25(OH)D], and dietary and supplemental vitamin D may influence cognitive outcomes. Objectives Sex-, age-, and race-specific associations of vitamin D status and intake with longitudinal change in various cognitive domains were examined in a large sample of ethnically and socioeconomically diverse US urban adults. Design Two prospective waves of data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study were used. Participants Adults in Baltimore, Maryland, aged 30 to 64 years at baseline (n = 1231 to 1803), were followed for a mean (± standard deviation) of 4.64 ± 0.93 years. Visit 1 occurred between 2004 and 2009; visit 2, between 2009 and 2013; there were 1.5 to 2.0 visits per participant. Main outcome and exposure measures Cognitive performance was assessed using 11 test scores covering domains of global cognition, attention, learning/memory, executive function, visuospatial/visuoconstruction ability, psychomotor speed, and language/verbal. Serum 25(OH)D, vitamin D intake, and use of supplements containing vitamin D were the key exposures. Results A consistent relationship was found between vitamin D status (overall) and supplemental intake (older women and black adults), with a slower rate of decline in the domain of verbal fluency. Higher dietary intake of vitamin D was linked to slower rate of decline in verbal memory among younger women, and a slower rate of decline in visual memory/visuoconstructive abilities among white adults. All other associations were inconsistent. Conclusions Vitamin D status and intakes were inversely related to domain-specific cognitive decline in US urban adults.

Personality and disturbed sleep are tied to medical morbidity in older adults. We examined associations of personality dimensions and facets from the five-factor model with reports of insomnia symptoms in 1,069 well-functioning older adults 60-97 (SD=8.64) years (51% women) from the Baltimore Longitudinal Study of Aging. Personality was assessed by the Revised NEO Personality Inventory, and insomnia symptoms measured by the Women’s Health Initiative Insomnia Rating Scale. Adjusting for demographics and depressive symptoms, higher neuroticism (B=0.05, SE=-0.01, p

Background Increased awareness amongst large population groups is a major determinant for the prevention of diabetes and its complications as well as related metabolic disorders. Knowledge and attitude are the principal markers of awareness that need to be studied in various population groups in specific racial and cultural contexts. The present study was undertaken to explore knowledge, attitude and practice (KAP) regarding -diabetes mellitus (DM) among nondiabetic (nonDM) and type 2 diabetes mellitus (T2DM) patients in Bangladesh. Methods A cross-sectional study was conducted among 18,697 adults (aged 18 years and above; 7796 male and 10,901 female; 6780 nonDM and 11,917 T2DM) selected purposively from the OPD of 19 healthcare centres in and around Dhaka and in northern parts of Bangladesh. KAP were assessed by a pre-structured, interviewer-administered questionnaire and categorised using predefined scores of poor (mean + 1 SD). Univariate and bivariate statistical analysis were done as appropriate. Multivariate linear regression was done to examine the association between diabetes related KAP and other covariates. Results The mean (±SD) age (years) of all the study participants was 46 ± 14, mean BMI 24.4 ± 4.1 and mean waist-hip ratio (WHR) was 0.93 ± 0.07. The proportion of poor, average and good knowledge scores among T2DM subjects were 17%, 68% and 15% respectively. The corresponding values for attitude score were 23%, 67% and 10% respectively. The KAP regarding diabetes was found to be better among people who were living with diabetes compared to their counterparts. DM males showed better knowledge and practice regarding diabetes, compared to nonDM counterparts (M ± SD; 44.18 ± 16.13 vs 40.88 ± 15.62, p =

Introduction: Medical educationists in the field of anatomy are in search of alternative to the traditional anatomy education based on topographical structural anatomy. The integration of newer teaching modalities and modern technology is encouraging interest and enhancing retention of anatomical knowledge and its clinical relevance. Objective: This study was designed to build an instructional infrastructure keeping in mind the demand of students as well as teachers and to analyze the effect of developed models on the learning of anatomy of undergraduate students.Materials and Methods: This prospective descriptive study was carried out at the department of anatomy, Armed Forces Medical College (AFMC), Dhaka Cantonment in two stages, during the period of January 2016 to December 2016. In the first stage, infrastructural facilities were developed for intervention in target population. Anatomical models were prepared by copying selected real abdominal viscera and models. During the second stage, the term II students were exposed to the newly developed learning environment and they got assistance from teachers. At the end of the term, students’ views were taken using structured questionnaires. After the term examination opinion of the teachers were taken using separate structured questionnaires. Result of the term final was analyzed. Statistical analysis was made using Microsoft Excel and SPSS 19. Results: As per the opinion of the user around 3/4th perfection level was achieved in preparing model (students’ view 72.17±15.51% and teachers’ opinion 77.56±10.13%; p=0.31). Both students and teachers opined that they got good benefit (mean score 3.82± 0.64 and 4.11±0.33 respectively out of total score 1 to 5) from the use of models prepared at the department and issued to students. Of the studied students 96.9%, 87.5%, 87.5% and 90.6% expressed that figure/pictures, models, animations and movies and Power Point presentation respectively created positive interest among them and on their learning of anatomy. Only 7%, 6.1% and 2.6% students expressed that models, animations and movies and Power Point presentation respectively do not have positive role on their learning process. On the other hand 100% teachers opined that figure/pictures, models, animations and movies and Power Point presentation created positive interest in the students and on their learning of anatomy. Analysis of result of oral and practical part of top 80 students (65% of total) was done. Mean of percentage score of the students in term I and II examinations were 60.92±7.54 and 66.39±6.51 (p=00) and ranges 82.25 to 49.50 and 79.5 to 53.75 respectively. Conclusion: Both the teachers and students advised to make the training aids more available to the students by increasing the number and also emphasized on the improvement of quality. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 50-55

Background We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barre syndrome (GBS). Methods In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002-2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. Results Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. Conclusions TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.

We examined the interactive associations of poor diet quality and Alzheimer&rsquo, s Disease (AD) genetic risk with cognitive performance among 304 African American adults (mean age~57 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. In this cross-sectional study, selected participants had complete predictors and covariate data with 13 cognitive test scores as outcomes. Healthy Eating Index-2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), and mean adequacy ratio (MAR) were measured. A genetic risk score for AD in HANDLS (hAlzScore) was computed from 12 selected single nucleotide polymorphisms (SNPs). Our key hypotheses were tested using linear regression models. The hAlzScore was directly associated with poor performance in verbal memory (&minus, 0.4 &plusmn, 0.2, 0.01) and immediate visual memory (0.4 &plusmn, 0.2, 0.03) measured in seconds, in women only. The hAlzScore interacted synergistically with poorer diet quality to determine lower cognitive performance on a test of verbal fluency. Among numerous SNP &times, diet quality interactions for models of cognitive performance as outcomes, only one passed correction for multiple testing, namely verbal fluency. Our results suggest that improved diet quality can potentially modify performance on cognitive tests of verbal fluency among individuals with higher AD genetic risk.

Response or reaction of the mind to the pressure of life is stress. Medical students of Bangladesh are in stress to meet the demands of the curriculum. This study was conducted on the regularly passed final year students of a medical college to find out the nature of stresses perceived by them. The response was collected on a validated structured set of questionnaire, 3 weeks prior to the University level summative examination and 63 students (33 male and 30 female) participated in the study. Stress was expressed in five levels and scored as 0 to 4. Academic related factors were identified as maximum stress provoking (2.5 ± 1.3) than group activity (1.6 ± 1.4), drive (1.4 ± 1.5), teaching-learning (2.3 ± 1.3), personnel (1.8 ± 1.6) or social (1.9 ± 1.5) related factors. Of that group of stress, ‘falling behind reading schedule’ and ‘large amount of content to be learned’ were revealed as heavy stressors. Examination was identified as a severe stressor in 42.4% male, but was marked less (16.7%) in the female. ‘Too much restriction in the campus’ was observed as heavy stressors among the factors other than the academic related stressors. Students may be motivated to develop a coping strategy for academic and teaching-learning related stress.

Objective This study tests associations of DNA methylation-based (DNAm) measures of epigenetic age acceleration (EAA) with cross-sectional and longitudinal depressive symptoms in an urban sample of middle-aged adults. Methods White and African–American adult participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study for whom DNA samples were analyzed (baseline age: 30–65 years) we included. We estimated three DNAm based EAA measures: (1) universal epigenetic age acceleration (AgeAccel); (2) intrinsic epigenetic age acceleration (IEAA); and (3) extrinsic epigenetic age acceleration (EEAA). Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression scale total and sub-domain scores at baseline (2004–2009) and follow-up visits (2009–2013). Linear mixed-effects regression models were conducted, adjusting potentially confounding covariates, selection bias and multiple testing (N = 329 participants, ∼52% men, k = 1.9 observations/participant, mean follow-up time∼4.7 years). Results None of the epigenetic age acceleration measures were associated with total depressive symptom scores at baseline or over time. IEAA – a measure of cellular epigenetic age acceleration irrespective of white blood cell composition – was cross-sectionally associated with decrement in “positive affect” in the total population (γ011± SE = −0.090 ± 0.030, P = 0.003, Cohen's D: −0.16) and among Whites (γ011 ± SE = −0.135 ± 0.048, P = 0.005, Cohen's D: −0.23), after correction for multiple testing. Baseline “positive affect” was similarly associated with AgeAccel. Limitations Limitations included small sample size, weak-moderate effects and measurement error. Conclusions IEAA and AgeAccel, two measures of EAA using Horvath algorithm, were linked to a reduced “positive affect”, overall and among Whites. Future studies are needed to replicate our findings and test bi-directional relationships.

Background: Infectious agents including periodontal pathogens and their neuroinflammatory sequelae have been at the forefront of Alzheimer's Disease (AD) pathology. We investigated whether periodontal disease (Pd) markers and periodontal pathogens in mid-life are associated with clinical outcomes of cognitive impairment after decades of follow-up. Methods: We conducted a retrospective cohort analysis using data from the third National Health and Nutrition Examination Surveys (NHANES III) linked with restricted mortality and incident outcomes derived from the National Death Index and Medicare data [≥45y, 43% men, Nmax=6,650, 1988-1994 through January 1st, 2014, mean follow-up times (45+, all outcomes): 15-17y]. Outcomes of interest included AD mortality (nmax=102), incidence of AD (nmax=888) and all-cause dementia (nmax=1,737). Exposures included Pd markers [mean clinical attachment loss (CAL) and Probing Depth (PD)] and 19 periodontal pathogens (1988-1994: k=19; 1991-1994 (phase 2): k=2). Multiple Cox proportional hazards models were conducted, stratified by age and sex. Findings: In those ≥65 years old, AD incidence was associated with a composite factor comprised of C. Rectus and P. Gingivalis (Pg) titers (per SD, aHR=1.22; 95% CI, 1.04-1.43, P=0.012), whereas AD mortality risk increased with higher baseline levels in a factor comprised of Pg, P. intermedia, P. nigrescens, F. nucleatum, Cr, S. intermedius, C. ochracea and P. melaninogenica (per SD, aHR=1.46; 95% CI, 1.09-1.96, P=0.017). In both the 55+ and 65+ age groups, the Orange-Red cluster (Pm, Pi, Pn, Pg) was associated with increased AD mortality risk. PD and phase 2 (1991-1994) measured Pg were consistently and directly associated with incident AD among older individuals. Interpretation: Evidence for an association between periodontal pathogens and AD and dementia-related outcomes was stronger for older adults. This study presents information that may inform periodontists who treat older adults and calls for a line of inquiry between practitioners focused on Pd and neurodegenerative processes. Funding Statement: This study was entirely supported by the National Institute on Aging, Intramural Research Program (NIA/NIH/IRP). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: The present study was approved for ethical treatment of participants by the Institutional Review Board of the National Institute on Aging, Intramural Research Program.

Introduction: Enteric fever is highly prevalent in Bangladesh. Multidrug resistant salmonella Typhi is emerging throughout the world as well as in Bangladesh. Observing recent sensitivity pattern will help in choosing proper empirical antibiotics in resource limited country like Bangladesh as culture facilities is not available throughout the country.Materials and Methods: The study included 86 S. typhi isolates from blood cultures of patients suffering from suspected typhoid fever who attended the outpatient clinics or were admitted in Islami Bank hospital in Dhaka during January 2015 to July 2017.Results: A total of 86 S. typhi isolates were included in the study. Mean age of the study population was 22.06±17.1 and there was male 44 (51.2%) predominance. All the isolates of S. typhi were sensitive to Meropenem. Highest resistance was observed against Amikacin (62.4%) closely followed by Co-timoxazole (48.4%) and Amoxiclav (46.5%). The S. typhi isolates showed low-level resistance against Ceftriaxone (1.16%), Cefuroxime (4.6%), Azithromycin(13.9%), Levofloxacin (11.6%).Conclusions: According to findings of this study it can be advised that oral form of Cefuroxime, Levofloxacin and Azithromycin can be used as a first line. Then if patient is nonresponsive Ceftriaxone might be used. Meropeman should be reserved for selective cases.J MEDICINE Jan 2018; 19 (1) : 15-17

Objective: We investigated cross-sectional and longitudinal associations of diet quality with middle-aged caregiver status. Methods: Caregiving in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American (AA)) was measured at waves 3 (2009–2013) and 4 (2013–2017) (mean follow-up time 4.1 years). Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010) derived from two separate 24 h diet recalls. Multivariable ordinary least square regression was performed for cross-sectional analyses of the association of wave 4 caregiving with wave 4 HEI-2010. Wave 3 caregiving was examined both cross-sectionally and with annual rate of change in HEI using mixed-effects linear regression Models. Multivariable models were adjusted for age, sex, and poverty status. Results: Cross-sectional analyses at wave 4 demonstrate an inverse association of frequent caregiving (“Daily or Weekly” vs. “Never”) for grandchildren with HEI-2010 total score (i.e., lower diet quality) among Whites (β = −2.83 ± 1.19, p = 0.03, Model 2) and AAs (β = −1.84 ± 0.79, p = 0.02,). The “cross-sectional” analysis pertaining to grandchildren caregiving frequency suggested that frequent caregiving (i.e., “Daily or Weekly” vs. “Never” (β = −2.90 ± 1.17, p = 0.04)) only among Whites was inversely related to HEI-2010 total score. Total HEI-2010 score was also related to caring (Model 1), for the elderly over “5 years vs. Never” among Whites (−7.31 ± 3.54, p = 0.04, Model 2). Longitudinally, we found slight potential improvement in diet quality over time (“Daily or Weekly” vs. Never by TIME interaction: +0.88 ± 0.38, p = 0.02) with frequent caregiving among Whites, but not so among AAs. Conclusions: Frequent caring for grandchildren had an inverse relationship with the diet quality of White and AA urban middle-aged caregivers, while caring for elderly was inversely linked to diet quality among Whites only. Longitudinal studies should address the paucity of research on caregivers’ nutritional quality.

Background: Knowledge about diabetes is the cornerstone of self-management, which is crucial for diabetes care. Improving patients’ knowledge and self-management toward their condition can achieve better control, delay complications, and improve their quality of life. However, there are great variations in the level of knowledge from population to population and this needs to be explored in different ethnic and sociocultural groups for designing appropriate preventive strategies. Due to lack of adequate studies in Bangladesh, this study aimed at assessing diabetes-related knowledge, its determinants and examined which subgroups of patients have the largest knowledge deficits. Materials and Methods: This cross-sectional study was carried out among 504 study participants with type 2 diabetes in the outpatient clinic of the Bangladesh Institute of Health Sciences (BIHS) hospital, a tertiary care center in Dhaka, Bangladesh. Sociodemographic information, anthropometric knowledge about diabetes were collected by semistructured, interviewer-administered questionnaires by the face-to-face interview technique. Respondents who achieved a 50% or higher score from a 16-item diabetic knowledge assessment questionnaire were considered to have good knowledge and their counterparts were considered as possessing poor knowledge about diabetes. Descriptive statistics was used to estimate the prevalence of knowledge. A univariate and multivariate logistic regression was carried out to identify significant factors associated with diabetic knowledge. Results: The participants’ mean age (±SD) was 52 ± 11years; among them, 57.3% were women, 17.1% were illiterate, and 31.5% belonged to a lower-income family. About one-third of them (29.2%) had good knowledge, and male participants were more educated and had higher diabetes knowledge compared with their counterparts. In particular, gender, education, occupation, monthly family income, and duration of diabetes showed a significant correlation with overall knowledge. On multivariate regression, age, education, duration of diabetes, and family members correlated independently with knowledge. Conclusions: On the basis of the current study, it is suggested that about two-third of the patients attending a tertiary care hospital had poor knowledge about diabetes. These results highlight the need for a coordinated educational program with a prioritized focus on older, newly diagnosed, and less educated groups, which reinforces the necessity for patient education.