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Bioethanol is one of the most important biofuel due to its positive impact on the environment. However, its economic production is dependent primarily on the raw materials used and the fermentation potentiality of the microorganisms. Therefore, this study was aimed to screen for thermotolerant Saccharomyces cerevisiae yeast isolates from common fruits of Bangladesh and produce bioethanol from decaying fruit wastes. Nine different fruits were collected and subjected for anaerobic growth. Colonies similar to S. cerevisiae yeast were isolated based on cultural (colony shape, size, color, elevation, surface edge, consistency), morphological (bud, cell shape) and biochemical characteristics (carbohydrate fermentation). Molecular confirmation was done using S. cerevisiae RSP5-C allele specific primer. Six isolates were confirmed as S. cerevisiae based on cultural, morphological, biochemical and molecular characteristics studied. From the four isolates that showed the growth capacity at a higher (41 °C) temperature than optimum (30 0C), SC-Gr, the isolate from grape, showed the most active growth at 41 °C and used to produce bioethanol from decaying fruits like banana, papaya, apple and grape. The significantly highest amount of bioethanol concentration (7.92 %) was obtained from the grape waste at 37 °C, at pH 5 after 48 hrs of the fermentation period and the lowest amount of bioethanol (2.37 %) was obtained from decaying banana at 45 °C and pH 5.0 after 72 hrs of fermentation period. This study suggested that decaying fruits could be better utilized in the industry of renewable fuel energy using thermotolerant yeast isolate from grapes. [ABSTRACT FROM AUTHOR]

Background: Around 5.29% of the world population is suffering from ADHD, and 60 million people are suffering from CVS, with an increasing rate of prevalence of these disorders. This study aimed to determine the prevalence rate of ADHD and CVS symptoms among the Bangladeshi population. Results: To assess the aim of the study, a cross-sectional survey was conducted online through stratified sampling, and 197 responses were collected from the participants. Our survey method follows these criteria where the ARSV1.1 standard questionnaire was followed for the ADHD questionnaire, and a self-administered questionnaire was established based on the symptoms of CVS. The male age ranges from 18–24 have the highest value of ADHD (34%) coincided with > 6 h digital device usage (51%), and the Stroop effect is significantly correlated with the ADHD score (0.498, p < 0.01). The Stroop effect value is also higher among the males aged 18–24, digital device users for > 6 h (48%). Conclusions: With the advent of science, it is impossible to avoid digital devices as necessary. Notwithstanding, safe and appropriate use of digital media is a must for healthy living. [ABSTRACT FROM AUTHOR]

Campylobacter jejuni-related diarrheal diseases is one of the major health issues among young children (0-59 months old) in low-income countries. Monitoring of the capsular (capsule polysaccharide, CPS) types of virulent C. jejuni strains in regions where the disease is endemic is of great importance for the development of a customized capsule-based multivalent vaccine. Therefore, we aimed to determine the prevalence of CPS genotypes among C. jejuni strains isolated from young children with enteritis (n = 152) and asymptomatic carriers matched by age, sex, and residence defined as the control group (n = 215) in Bangladesh. CPS genotyping was performed using a newly established multiplex polymerase chain reaction (PCR) method and lipooligosaccharide (LOS) locus classes (A-E) were characterized using PCR as well. We identified 24 different CPS genotypes among the 367 isolates. Four prevalent capsular types, HS5/31 complex (n = 27, 18%), HS3 (n = 26, 17%), HS4A (n = 10, 7%), and HS8/17 (n = 10, 7%) covered almost 50% of the strains from enteritis patients and 43% of the isolates from controls. In combination, the CPS genotype and LOS class was not discriminative between cases and controls. Dominant capsular types previously identified in C. jejuni strains isolated from patients with Guillain--Barré syndrome in Bangladesh were rarely detected in strains isolated from the young children. A similar distribution was evident among enteritis- and control-related strains when comparison was done between CPS types and LOS classes. This is the first systematic study presenting the distribution of CPS genotypes of C. jejuni strains isolated in Bangladesh from children with diarrhea and controls, with capsular genotypes HS5/31 complex, HS3, HS4A, and HS8/17 being prevalent in both. In conclusion, systematic studies are required to develop a multivalent capsule-based vaccine for children in low-income countries. [ABSTRACT FROM AUTHOR]

Acute transverse myelitis (ATM) is an inflammatory neurological disorder causing spinal-cord injury characterized by sensory, motor or autonomic dysfunction. Till date, most studies conducted worldwide on ATM were among pediatric patients and population-based studies are limited. We aimed to describe the clinical presentation, severity and outcome of ATM in Bangladesh. We conducted a prospective case-control study from 2015 to 2019 at Dhaka Medical College Hospital, Dhaka, Bangladesh with standard time-points of follow-up for 1 year. Patients were enrolled using diagnostic criteria by TM Consortium Group. Detailed history, physical examination and MRI were performed and biological samples were collected as per pre-defined protocol. A total of 97 ATM cases were enrolled with 55% female and median age of 28 years (IQR, 19-39). Presented first symptoms were muscle/joint pain (34%), muscle weakness (31%) and urinary retention (17%). Preceding events within 6 weeks prior to weakness were reported by 29% patients, predominantly respiratory illness (N=20), followed by diarrhea (N=11). At enrollment, 87% patients were bed bound. Most of the patients had symmetrical (82%) and ascending (42%) type of motor weakness. Definite sensory level, bowel-bladder involvement and cranial-nerve involvement were found in 81%, 83% and 20% patients respectively. Mortality was 14% and poor outcome (Hughes disability score ≥2) were found in 36% and 22% patients after week 2 and 6 months of disease onset respectively. At week 2 and 6 months, 35% and 17% patients had total/severe dependency for activities of daily living (Barthel score ≤60). No clinical associated factors have been found for poor outcome and death of ATM patients in Bangladesh. In Bangladesh, most patients presented with severe form of disease and significant proportion of patients had poor outcome even after 6 months of disease onset. Population-based studies are needed to evaluate the risk factors of poor outcome among ATM patients. [ABSTRACT FROM AUTHOR]

Campylobacter jejuni is the most important cause of antecedent infections leading to Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS). The objective of the present study was to define the genetic diversity, population structure, and potential role of poultry in the transmission of Campylobacter to humans in Bangladesh. We determined the population structure of C. jejuni isolated from poultry ( n = 66) and patients with enteritis ( n = 39) or GBS ( n = 10). Lipooligosaccharide (LOS) typing showed that 50/66 (76 %) C. jejuni strains isolated from poultry could be assigned to one of five LOS locus classes (A-E). The distribution of neuropathy-associated LOS locus classes A, B, and C were 30/50 (60 %) among the typable strains isolated from poultry. The LOS locus classes A, B, and C were significantly associated with GBS and enteritis-related C. jejuni strains more than for the poultry strains [(31/38 (82 %) vs. 30/50 (60 %), p < 0.05]. Multilocus sequence typing (MLST) defined 15 sequence types (STs) and six clonal complexes (CCs) among poultry isolates, including one ST-3740 not previously documented. The most commonly identified type, ST-5 (13/66), in chicken was seen only once among human isolates (1/49) ( p < 0.001). Amplified fragment length polymorphism (AFLP) revealed three major clusters (A, B, and C) among C. jejuni isolated from humans and poultry. There seems to be a lack of overlap between the major human and chicken clones, which suggests that there may be additional sources for campylobacteriosis other than poultry in Bangladesh. [ABSTRACT FROM AUTHOR]

The finding of neonatal whale sharks from Northern Indian Ocean waters off of Pakistan and Bangladesh and the description of several very small whale sharks from around Seychelles during the last few years are reported. These findings are discussed in relation to published reports of growth rates, the areas of occurrence and segregation by sex, and the behaviour of very young whale sharks, which are key factors in their conservation management. [ABSTRACT FROM AUTHOR]

At enrollment, 84 (87%) patients were bedbound (Hughes disability score=4) and 71 (73%) patients had complete dependency on others for daily activities (Barthel Score=0-20). ATM was confirmed by spinal MRI among 64% patients within first week of disease onset. B Background: b Acute transverse myelitis (ATM) is a heterogeneous inflammatory disorder of spinal cord and is characterized by acute onset of motor, sensory, and autonomic dysfunction. [Extracted from the article]

Background: Bangladesh has achieved a remarkable success with the eradication of poliomyelitis. However, non-polio acute flaccid paralysis and its clinical presentation as the Guillain-Barré syndrome (GBS) is still frequently diagnosed. GBS has a diverse clinical phenotype that varies according to geography. Campylobacter jejuni enteritis is the predominant bacterial infection preceding GBS. The purpose of the study was to define the clinical phenotype of GBS and the relation with preceding C. jejuni infection and antiganglioside antibodies (GM1, GD1 and GQ1b) in a large GBS cohort from Bangladesh. Methods & Materials: We conducted a hospital based observational study including 403 patients fulfilling the National Institute of Neurological Disorders and stroke (NINDS) criteria for GBS patients between 2010 and 2013 in Dhaka Medical College Hospital, Dhaka, Bangladesh. Detailed clinical, electrophysiological, serologic and microbiological data were obtained. Results: GBS affected predominantly in young adults males (M/F = 2:1) living in rural areas. Antecedent events were recorded in 76% of patients. The most frequent events being gastroenteritis (46%) and upper respiratory tract infection (18%). Sixty-five percent of the patients were bed-bound (Hugh's F-score, 4) at entry and 17% patients required mechanical ventilator (F-score 5). Electrophysiological studies showed that 54% of patients had an axonal variant of GBS. About 90% patients did not receive specific treatment either Intravenous Immunoglobulin (IVIg) or plasmapheresis due to high expensive treatment cost. After 6 months follow up, 13% patients had died and 15% were still disabled. Evidence for a recent C. jejuni infection was found in 55% of GBS patients. In a GBS-associated strains collection from Bangladesh, capsular types HS23/36c, HS19, and HS41 were most prevalent. MLST analysis showed that HS19 (ST-22), HS23 (ST-3219) and HS41 (ST-362) were prevalent. Antiganglioside antibodies (GM1, GD1a and GQ1b) were frequently detected in GBS patients. Conclusion: GBS in Bangladesh is a severe, predominantly pure motor and axonal neuropathy with a high mortality rate. Recent C. jejuni infection and anti-ganglioside antibodies accounted for a significant proportion of GBS. Majority of the patients do not receive specific and standard treatment.with IVIg in view of its high price. Therefore, low-cost treatment strategies are required for GBS patients in developing countries. [ABSTRACT FROM AUTHOR]

Campylobacter jejuni is the leading cause of gastroenteritis and associated with Guillain-Barré syndrome (GBS) in both developed and developing countries. We provided distinct genomic features of a highly pathogenic C. jejuni strain, BD-67, associated with severe axonal variant of GBS. C. jejuni BD-67 strain was isolated from stool sample of GBS patient in Bangladesh and sequenced in Illumina NextSeq-500 platform. The genome was analyzed using multiple bioinformatics approaches. Auto-antibodies were measured by enzyme-linked immunosorbent assays (ELISAs). C. jejuni BD-67 was associated with severe axonal form of GBS (GBSDS 4; [bed bound] with ophthalmoplegia and reached nadir on day 6. Patient was serologically positive for C. jejuni LOS, GM1, GD1a, and GQ1b antibodies. C. jejuni BD-67 genome exhibited uniqueness in potential virulent genes of lipooligosaccharide (LOS) region, phage integration, and glycosyltransferase genes. BD-67 strain exhibited penner-serotype HS:23 and LOS class B. In-silico multilocus sequence typing (MLST) exhibited BD-67 belongs to sequence-type ST-985 and clonal complex ST-403 that appeared as the most diverse node in MLST-based minimum spanning tree analysis. Comparative analysis of LOS cluster and its components demonstrated that the β-1,3-glycosyltransferase and β-1,4-N-acetylgalactosaminyltransferase genes of LOS were truncated and produce 3 & 2 truncated complete DNA sequences (CDSs), respectively. The cstII gene was highly diversified with amino acid identity of 90.41% and belongs to a distinct clade with BD-10 in global phylogeny. BD-67 strain harbored 2 C. jejuni integrated elements (CJIE1 and CJIE3) which is rare in GBS-associated C. jejuni strains. Pangenomic analysis unveiled the presence of a unique genomic region in BD-67 which encoded different glycosyltransferase genes, phage integration (int A), flagellar protein (flg E_1). The atypical virulence factors, truncated CDSs of LOS cluster, and different unique structural genes of BD-67 might be associated with the severe form of GBS. Multi-omics study may unveil the key of C. jejuni associated GBS pathogenesis and severity. [ABSTRACT FROM AUTHOR]

Multi-drug resistance (MDR) in Shigella remains public health burden, especially in resource-limited settings like Bangladesh. However, genome-wide studies to track the origination and epidemiology of antimicrobial resistant (AMR) genes are scarce here. Therefore, the study was designed to assess outraging drug resistance in Shigella and to map AMR genes in the genome. Shigella strains were isolated from stool specimens of diarrheal patients in Bangladesh. MDR phenomena were determined by antimicrobial susceptibility tests (AST). Whole-genome sequencing (WGS) was performed on the Illumina platform and the genomes were analyzed using many bioinformatics approaches. We screened 11 MDR and 2 non-MDR Shigella strains from the AST results and subjected them to WGS analysis. Analyzing the genomes, we identified 27 AMR genes of 9 different classes arrayed as pathogenicity islands in mobile genetic elements (MGEs). The extended-spectrum beta-lactamase (ESBL) gene bla CTX-M-15 was present in 4 MDR strains as IS 1380 - bla CTX-M-15- Wbu C gene cassette in Tn7 transposon. The bla CTX-M-15 gene was not novel but the island was very new in Shigella. Another plasmid-mediated ESBL-gene bla TEM-1 was neighboring the erm B-IS 26-mph (A) -mrx-mph (R)(A)-IS 6100 macrolideresistant gene cluster. The aminoglycoside-resistant gene aad A1 was found in the Tn7 transposon of 6 MDR strains arrayed with dfr A gene, integrases (int 1 and int 2), and different transposes. Macrolide resistance genes were identified in two separate plasmid-borne gene cassettes like erm B-IS 26-mph (A) -mrx-mph (R)(A)-IS 6100 and unique mph (E)- msr (E)-IS 482 -IS 6 in 3 and 2 MDR Shigella strains respectively. The incidence rate of the highly pathogenic erm B-IS 26-mph (A) -mrxmph (R)(A)-IS 6100-bla TEM-1 containing plasmid was found to be exponentially increasing globally. Type-1 CRISPRs were identified in 85% of the strains where most of the spacers were incorporated from the Escherichia coli H240 plasmid. Drug-resistant gene clusters evolve and propagate among enteropathogens through MGEs. The rise of stronger Shigella superbug can be predicted from the study, however, global epidemiological tracking of MDR related MGEs in Shigella is needed to unveil the AMR-network. [ABSTRACT FROM AUTHOR]

Guillain-Barre syndrome (GBS), an immune-mediated polyneuropathy with variable clinical manifestation, prognosis and outcome. Despite of the proven efficacy of intravenous immunoglobulin (IVIg), 20% patients remain disabled with 2-19% mortality. Biomarker associated with clinical prognosis and outcome of GBS is needed to improve clinical management and effective treatment at early stage of GBS. In this study, we assessed the association between serum albumin levels, a relatively easily measurable biomarker of health and inflammation, and the clinical prognosis of GBS. We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. Detailed neurological examinations and measurement of serum albumin were done at baseline and pre-defined follow-up. Statistical comparisons between serum albumin and disease prognosis were performed using spearman correlation, ANOVA and student t-test. The median (IQR) age of 140 patients was 35 (21) years with male predominance (71%); 53 patients treated with IVIg, 29 with plasmapheresis and 58 with supportive care. Severity was higher (88%) and 48 patients required mechanical ventilation (32%). The median of serum albumin was significantly lower in severely affected patients compared to the mild cases (media [IQR]; 39.04 [7.9] vs. 42.14 [5.32], P = 0.001). Serum albumin levels had strong negative correlation with GBS disability score at enrolment (r= -0.663, P <0.0001) and moderate negative correlation at 4 weeks (r= -0.484, P <0.0001). Serum albumin level declined significantly at 2 weeks (P =0.002) and gradually increased significantly at 13 weeks (P<0.0001) and 26 weeks (P <0.0001) after treated with IVIg or plasmapheresis. Hypoalbuminemia (<34.0 g/L) was significantly associated with severity (P =0.010), mechanical ventilation and poor prognosis at 13 weeks (P =0.001) and 26 weeks (P <0.0001). In conclusion, serum albumin can be a strong prognostic biomarker to predict the disease severity and prognosis of GBS. Large sample size is required to validate the clinical relevance of the biomarkers in future. [ABSTRACT FROM AUTHOR]

Lipo-oligosaccharide (LOS) is the most important virulence factor of Campylobacter jejuni that structurally mimics human nerve ganglioside and consequently triggers Guillain-Barre´ syndrome (GBS) as a post-infectious sequela of gastroenteritis. We investigated the variations within the genomic content of LOS in C. jejuni isolated from patients with GBS or enteritis to find out their contribution to GBS induction. Seven GBS-associated C. jejuni strains were isolated and sequenced using Illumina NextSeq platform. We analyzed LOS-region of GBS-associated C. jejuni strains (n =7, Bangladesh ; n =10, Peru, USA, Netherlands) with respect to enteritis-associated strains (n =16, Bangladesh, Netherlands & Canada) and reference genome C. jejuni NCTC11168 using bioinformatics pipelines. The frequency of nucleotide-variation within LOS region of C. jejuni was substantially greater in GBS-associated strains than enteritis-associated strains (p =0.002). However, no unique single-nucleotide polymorphism (SNP), multiple-nucleotide polymorphism (MNP), or complexes of SNPs were detected in GBS-associated genes (cgtA, cgtB, cstII, cstIII, and wlaN). The cst-II gene (n=15) was predominant in GBS-associated strains compared to cst-III gene (n =2). The cst-II (Thr51) gene was frequently present in GBS-associated strains of Bangladesh, USA, and Netherlands with expression of GM1/GD1 epitope (78%), whereas those with cst-II (Asn51) had the GA2 and GD3 epitopes. cst-II (Asn51) was common in Peruvian strains. Peruvian strains isolated from acute motor axonal neuropathy (AMAN) variant were identical and closely related to 2 strains of AMAN variant from Bangladesh. Phase variable (PV) genes were prevalent in LOS-regions of Bangladeshi and Canadian strains. Among the 34 PV genes possessing repeat tracts, most short sequence repeats were identified as poly-G while five were poly-T and one poly-TA. The frequency of cst-II (Thr51) gene and nucleotide-variation were higher within LOS locus of GBS-associated C. jejuni. Our results support that genetic polymorphism of C. jejuni modifies the substrate specificity of LOS biosynthesis enzyme and autoantibody reactivity that determines the clinical presentation of GBS. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS), a life-threatening autoimmune disorder, triggered by an antecedent infection mostly by Campylobacter jejuni through molecular mimicry against host nerve gangliosides. Apart from humoral immunity, innate and cell-mediated immunity, are equally involved initiating this autoimmunity. Mechanical ventilation (MV) is required by 30% patients and 20% of patients had poor prognosis after 6 months. Identifying inflammatory markers to predict GBS severity and MV in early disease stage, lead to ameliorate disease prognosis and improve clinical management. We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. The disease severity and MV were assessed by GBS- disability score (GBS-DS) and neutrophil and lymphocyte count were measured using automated hematology analyser. The median (IQR) age was 35 (21) years with male predominance (71%); 73% patients had preceding events and 34% had cranial nerves involvement, 88% were severity affected (GBS-DS> 3) and 32% required MV. The median of neutrophil count and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients compared to mild patients (P=0.005 and 0.001), however, no differences were found for platelet lymphocyte ratio (PLR) and monocyte lymphocyte ratio (MLR). NLR and MLR revealed moderate positive correlation with disease severity at enrolment (r=0.538 and 0.417) and with poor prognosis at 4 weeks (r=0.423 and 0.429). Multiple logistic regression revealed, NLR, an autonomous risk factor with 2.9 times higher risk of increasing severity and 1.6 times for MV (95% CI=1.29-6.64 and 1.15-2.18). ROC curve revealed, cut-off value of NLR was 2.432, with 71% sensitivity and 75% specificity for predicting disease severity (AUC=0.750, 95% CI=0.651-0.849, P=0.001). The cut-off of NLR with 4.4423, can predict MV with 65.9% sensitivity, 81.7% specificity (AUC=0.804, 95% CI=0.724-0.884; P= <0.001). In conclusion, NLR, can be an independent predictor of the progression of disability and requirement of MV at the early stage of GBS. [ABSTRACT FROM AUTHOR]

The Salmonella enterica cause 21.6 49 million illnesses and 216,000 deaths worldwide during 2000 and remains a substantial global health concern. Multidrug-resistance (MDR) in Salmonella is increasing but its whole-genome sequence (WGS) based resistome profile was merely evaluated in Bangladesh. In this study, we aimed to identify the key genomic features of MDR Salmonella. Both Salmonella strains (Z12888 and Z13019) were isolated from diarrheal patients and subjected to WGS analysis based on their antimicrobial resistant (AMR) profiles to the five different classes of antibiotics (Macrolides, Penicillins, Tetracycline, Quinolones and Cephems). Genomes were sequenced on Illumina MiSeq platform and analyzed using several bioinformatics approaches. The MDR Z12888 strain was resistant to all five groups of antibiotics and its genome was substantially rich with AMR genes, virulence factors and mobile genetic elements (MGEs). Five different types of plasmid (IncHI2, IncN, IncQ1, Col440I and ColpVC) were identified in Z12888 strain. It also possessed 17 AMR genes (against 7 classes of antibiotics) of which seven genes were plasmid-borne. The AMR genes were arrayed as resistance gene cassettes like int 1- aac C -aad A7- qac Edelta1- sul 1 in an integron region, and sul 2- aph (3) Ib and ant (2) Ia- dfr A14 were in plasmids. We found 117 MGEs in the MDR strain Z12888 of which 31 were plasmid borne. Fimbrial protein encoding genes (fae C-F and fae H), secretion system effector genes (sse K1 and ste B), and flagellar chemotaxis associated gene tsr were uniquely found virulence factors in Z12888 strain. Additionally, 6 phage integrations were detected in Z12888. On the other hand, non-MDR Salmonella enterica Z13019 was harboring one IncX3 family plasmid with quinolone resistant gene qnr B7. Three phages and 68 MGEs (5 plasmid borne MGEs) were also detected in Z13019. The AMR genes were originated as pathogenicity islands in chromosome or MGEs. Epidemiological mapping of AMR profiles in large population may guide the current treatment strategy more precisely and effectively. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has achieved a remarkable success to eradicate poliomyelitis, however, Guillain-Barré syndrome (GBS) is frequently diagnosed. GBS is an autoimmune mediated disease of the peripheral nervous system preceded by infections. Campylobacter jejuni has been identified as the predominant cause of antecedent infection in GBS. C. jejuni lipopolysaccharide (LPS) induces antibodies cross-reactive with gangliosides and has shown to be involved in peripheral nerve damage. Toll-like receptor 4 (TLR4) is an important pathogen recognition receptor that recognizes mainly lipopolysaccharide (LPS) of gram-negative bacteria. In this study, we investigated functional single nucleotide polymorphisms (SNPs) in the extracellular domain of TLR4 (Asp299Gly and Thr399Ile), and assessed their association for GBS susceptibility, disease pathogenesis and disease outcome. Methods & Materials: A hospital based case controlled study was conducted in Dhaka Medical College Hospital (DMCH) in Dhaka, Bangladesh in between 2010 to 2013. A total of 210 genomic DNA (105 consecutive patients with GBS and 105 healthy controls of Bangladeshi population) were isolated using QIAGEN (DNA) blood midi kit and genotyped by using polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP). Results: TLR4 (Asp299Gly) polymorphism were significantly associated with GBS patients compared with healthy controls (p < 0.05). Gly299Gly homozygote increased the susceptibility of GBS patients compared with healthy controls (p = 0.0365, OR= 8.9, 95% CI = 1.1-73.2). Acute motor axonal neuropathy (AMAN) was significantly associated with Gly299Gly homozygote (p=0.0093, OR=14.6, 95% CI = 1.6-130.7). TLR4 variant genotype Asp/Gly (p = 0.0441, OR= 2.6, 95% CI = 1.1-6.5) was associated with poor outcome (unable to walk after 6 months); suggesting that these genotype might be one of the factors contributing to a severe form of GBS. No significant association of TLR4 polymorphism (Asp299Gly and Thr399Ile) with anti-ganglioside antibodies was found. In addition, TLR4 Thr399Ile polymorphism had no role in GBS susceptibility as compared with controls. Conclusion: TLR4 Gly299Gly homozygote is associated with the increased disease susceptibility to GBS. Gly299Gly homozygote is also associated with the axonal variant of GBS. However, TLR4 Asp299Gly polymorphism is prevalently significant with the disease outcome of GBS. Therefore, further study is required to confirm this association using a large cohort. [ABSTRACT FROM AUTHOR]

Anaemia is a major public health concern in developing countries, particularly among children, adolescents, and women of reproductive age. The study aimed to assess the anaemia status among adolescent girls, pregnant, and lactating women with their contributing factors in the southern rural regions of Bangladesh. This cross-sectional study was conducted among 400 adolescent girls, 375 pregnant, and 375 lactating women using a multistage cluster-random sampling technique. Anaemia was measured through haemoglobin concentration in blood capillaries collected with a Hemocue 301 machine. Multinomial logistic regression was used to determine the factors associated with anaemia. The average age of pregnant and lactating women was 24 years and 15.2 years for girls. Overall, the prevalence of anaemia was 50% among pregnant women, 46% among lactating women, and 38% among adolescent girls. The risk of anaemia among adolescent girls was higher among non-Muslim (aOR = 2.13, 95%CI:1.05-4.31), belonged to families having >5 members (aOR = 2.24, 95%CI:1.16-4.31) while exposure to media reduced their risk (aOR = 0.33, 95%CI:0.15-0.74). Pregnant women who consumed a diversified diet, washed their hands after toilet, and received ≥4 ANC visits had a lower likelihood of developing anaemia. Lactating women who were employed, consumed a diversified diet, washed their hands before preparing food, and after toilet, had been exposed to media, received ≥4 ANC visits, and consumed ≥90 IFA, had a lower risk of developing anaemia. However, anaemia was more likely to be associated with lactating women who were non-Muslim (aOR = 3.75; 95%CI:1.26-11.22). The high prevalence of anaemia emphasizes the need to reconsider the existing strategy for the prevention and control of micronutrient deficiencies in Bangladesh., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ara 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.)

Electronic waste (e-waste) contains numerous metals and organic pollutants that have detrimental impacts on human health. We studied 199 e-waste recycling workers and 104 non-exposed workers; analyzed blood, urine, and hair samples to measure heavy metals, hormonal, liver, and renal function. We used quantile regression models to evaluate the impact of Pb, Cd, and Hg on hormonal, liver and renal function, and the role of DNA oxidative damage in mediating the relationship between exposures and outcomes. Exposed workers had higher blood lead (Pb) (median 11.89 vs 3.63 µg/dL), similar blood cadmium (Cd) (1.04 vs 0.99 µg/L) and lower total mercury (Hg) in hair (0.38 vs 0.57 ppm) than non-exposed group. Exposed workers also had elevated median concentrations of total triiodothyronine (TT 3 ), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urinary albumin, albumin creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were significantly higher than non-exposed group (p≤0.05). Sex hormones including luteinizing hormone, follicle stimulating hormone, estrogen, progesterone and testosterone concentrations were not significantly different between exposed and non-exposed (all p≥0.05). The median concentration of ALT was 4.00 (95% CI: 0.23, 7.77), urinary albumin was 0.09 (95% CI: 0.06, 0.12) and ACR was 1.31 (95% CI: 0.57, 2.05) units higher in the exposed group compared to non-exposed group. Pb was associated with a 3.67 unit increase in the ALP (95% CI: 1.53, 5.80), 0.01 unit increase in urinary albumin (95% CI: 0.002, 0.01), and 0.07 unit increase in ACR (95% CI: 0.01, 0.13). However, no hormonal, renal, and hepatic parameters were associated with Cd or Hg. Oxidative DNA damage did not mediate exposure-outcome relationships (p≥0.05). Our data indicate e-waste exposure impairs liver and renal functions secondary to elevated Pb levels. Continuous monitoring, longitudinal studies to evaluate the dose-response relationship and effective control measure are required to protect workers from e-waste exposure., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

Hospital wastewater has been identified as a hotspot for the emergence and transmission of multidrug-resistant (MDR) pathogens that present a serious threat to public health. Therefore, we investigated the current status of antibiotic resistance as well as the phenotypic and genotypic basis of biofilm formation in Pseudomonas aeruginosa from hospital wastewater in Dhaka, Bangladesh. The disc diffusion method and the crystal violet assay were performed to characterize antimicrobial resistance and biofilm formation, respectively. Biofilm and integron-associated genes were amplified by the polymerase chain reaction. Isolates exhibited varying degrees of resistance to different antibiotics, in which >80% of isolates showed sensitivity to meropenem, amikacin, and gentamicin. The results indicated that 93.82% of isolates were MDR and 71 out of 76 MDR isolates showed biofilm formation activities. We observed the high prevalence of biofilm-related genes, in which algD + pelF + pslD + (82.7%) was found to be the prevalent biofilm genotypic pattern. Sixteen isolates (19.75%) possessed class 1 integron ( int1 ) genes. However, statistical analysis revealed no significant association between biofilm formation and multidrug resistance ( χ 2 = 0.35, P = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P. aeruginosa , and therefore, the adequate treatment of wastewater is recommended to reduce the occurrence of outbreaks., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

Background: Hypertension is a major cause of death worldwide. Although arsenic exposure has been associated with the risk of hypertension, this association appears nonuniform due to inconsistent results from studies conducted in different populations. Moreover, hypertension is a complex condition with multiple underlying mechanisms and factors. One factor is impaired production and bioavailability of vascular nitric oxide (NO). However, the implications of the effects of arsenic exposure on circulating NO and its association with hypertension in humans are largely unknown., Objective: We investigated the dose-response relationship between arsenic exposure and hypertension with vascular NO levels as a potential mediator of arsenic-related hypertension in individuals exposed to a broad range of arsenic., Methods: A total of 828 participants were recruited from low- and high-arsenic exposure areas in Bangladesh. Participants' drinking water, hair, and nail arsenic concentrations were measured by inductively coupled plasma mass spectroscopy. Hypertension was defined as a systolic blood pressure (SBP) value of ≥ 140 and a diastolic (DBP) value of ≥ 90  mmHg . Serum NO levels reflected by total serum nitrite concentrations were measured by immunoassay. A formal causal mediation analysis was used to assess NO as a mediator of the association between arsenic level and hypertension., Results: Increasing concentrations of arsenic measured in drinking water, hair, and nails were associated with the increasing levels of SBP and DBP. The odds of hypertension were dose-dependently increased by arsenic even in participants exposed to relatively low to moderate levels ( 10 - 50 μ g / L ) of water arsenic [odds ratios (ORs) and 95% confidence intervals (CIs): 2.87 (95% CI: 1.28, 6.44), 2.67 (95% CI: 1.27, 5.60), and 5.04 (95% CI: 2.71, 9.35) for the 10 - 50 μ g / L , 50.01 - 150 μ g / L , and > 150 μ g / L groups, respectively]. Causal mediation analysis showed a significant mediating effect of NO on arsenic-related SBP, DBP, and hypertension., Conclusion: Increasing exposure to arsenic was associated with increasing odds of hypertension. The association was mediated through the reduction of vascular NO bioavailability, suggesting that impaired NO bioavailability was a plausible underlying mechanism of arsenic-induced hypertension in this Bangladeshi population. https://doi.org/10.1289/EHP13018.

Background: Electronic waste (e-waste) recycling activities release toxic metals, which pose substantial hazard to the environment and human health. We evaluated metal concentrations in biological and environmental samples, and examined the associations between biological lead (Pb), cadmium (Cd), and mercury (Hg) with soil and dust metals, and other possible determinants, among populations exposed and non-exposed to e-waste in Bangladesh., Methods: A total of 199 e-waste workers and 104 non-exposed individuals were recruited. We measured blood Pb (BPb) and Cd (BCd) concentrations and total Hg (THg) from hair samples. Data were collected on occupational, and behavioral factors. We fitted an elastic net regression (ENET) to model the relationship between a set of influencing factors and metals as outcome variables while controlling for potential covariates., Results: The median concentrations of BPb (11.89 μg/dL) and BCd (1.04 μg/L) among exposed workers were higher than those of non-exposed workers (BPb: 3.63 μg/dL and BCd: 0.83 μg/L respectively). A 100 ppm increment in soil Pb level was associated with an increase in ln-Pb (transformed) in blood (β = 0.002; 95% CI = 0.00, 0.02). Similarly, ln-BCd level increased (β = 0.02; 95% CI = 0.001, 0.07) with every ppm increase in dust Cd level. The number of years worked in e-waste activities was associated with elevated ln-BPb (β = 0.01; 95% CI = 0.01, 0.02) and ln-BCd levels (β = 0.003; 95% CI = 0.00, 0.05). Smoking significantly contributed to elevated levels of ln-BCd (β = 0.46; 95% CI = 0.43, 0.73). An increment of 100 kg of e-waste handling per week led to an increase in ln-BPb levels (β = 0.002; 95% CI = 0.00, 0.01), while respondents knowledge about adverse impact on e-waste reduced the ln-BPb level (β = -0.14; 95% CI = -0.31, -0.03). Fish consumption frequency had a positive association with THg in hair., Conclusions: Our data show the need for workplace controls to reduce exposure to Pb and Cd with a broader view of exposure source taken., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Since August 2020; the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in collaboration with UNICEF has been operating a COVID-19 field hospital at the Teknaf sub-district of Cox's Bazar in Bangladesh. This paper is focused on estimating the effects of a history of tobacco smoking and pre-existing co-morbidities on the severity of COVID-19 infection among adult patients admitted into the aforesaid hospital. We conducted a retrospective data analysis of COVID-19 adult patients hospitalized from August 27, 2020 to April 20, 2022. Based on inclusion criteria; a total of 788 admitted patients were included in the analysis. We conducted a Chi-squared test and Fisher's exact test for the categorical variables to see their associations. Multinomial logistic regression models were performed to explore the risk factors for the severity of COVID-19 infection. Among 788 patients, 18.4%, 18.8%, 13%, 7.1%, 3.4%, and 1.9% have had a history of smoking, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), and asthma respectively. Overall, the mean age of the patients was 40.3 ± 16.4 years and 51% were female. In multivariate analysis, history of smoking and co-morbidities were identified as the risk factors for the severity of COVID-19 infection; the history of smoking was found linked with an increase in the risk of developing critical, severe, and moderate level of COVID-19 infection- notably 3.17 times (RRR = 3.17; 95% CI: 1.3-7.68), 2.98 times (RRR = 2.98; 95% CI: 1.87-4.76) and 1.96 times (RRR = 1.96; 95% CI: 1.25-3.08) respectively more than the patients who never smoked. It was evident that patients with at least one of the selected co-morbidities such as hypertension, diabetes, COPD, CVD, and asthma exhibited a significantly higher likelihood of experiencing severe illness of COVID-19 compared to patients without any co-morbidity. History of tobacco smoking and pre-existing co-morbidities were significantly associated with an increased severity of COVID-19 infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Islam 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.)

Drinking water treatment plants (DWTPs) are intended to provide safe water to the municipality, typically by treating surface waters from rivers, lakes, and streams. Regrettably, all of these water sources for DWTPs have been reported to be contaminated by microplastics (MPs). Hence, there is an urgent need to investigate the removal efficiencies of MPs from raw waters in the conventional DWTPs anticipating public health concerns. In this experiment, MPs in the raw and treated waters of the three major DWTPs of Bangladesh, having different water treatment processes, were evaluated. The concentrations of MPs in the inlet points of Saidabad Water Treatment Plant phase-1 and 2 (SWTP-1 and SWTP-2), which share a similar water source of the Shitalakshya River, were 25.7 ± 9.8 and 26.01 ± 9.8 items L -1 . The third plant, Padma Water Treatment Plant (PWTP) utilizes water from the Padma River and had an initial MP concentration of 6.2 ± 1.6 items L -1 . The studied DWTPs, with their existing treatment processes, were found to reduce the MP loads substantially. The final MP concentrations in treated waters of SWTP-1, SWTP-2, and PWTP were 0.3 ± 0.03, 0.4 ± 0.01, and 0.05 ± 0.02 items L -1 with the removal efficiencies of 98.8, 98.5, and 99.2 %, respectively. The considered size range of MP was 20 μm to <5000. Fragments and fibers were the two predominant MP shapes. In terms of polymer, the MPs were polypropylene (PP, 48 %), polyethylene (PE, 35 %), polyethylene terephthalate (PET, 11 %), and polystyrene (PS, 6 %). The field emission scanning electron microscopy-energy dispersive X-ray spectroscopy (FESEM-EDX) revealed the fractured and rough surfaces of the remaining MPs, which were also found to be contaminated with heavy metals, like lead (Pb), cadmium (Cd), chromium (Cr), arsenic (As), copper (Cu), and zinc (Zn). Hence, additional initiatives are required to remove the residual MPs from the treated waters to safeguard the city dwellers from potential hazards., 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 © 2023. Published by Elsevier B.V.)

The application of biosecurity measures in the poultry sector are essential. Developing and implementing daily biosecurity activities are considered effective methods to prevent infectious diseases on poultry farms. Appropriate farm settings and management reduce the possibility of disease transmission between farms. This study aimed to assess the current biosecurity status of commercial poultry farms in the Rajshahi district of Bangladesh. A cross-sectional study was conducted from June to November 2021, involving 204 poultry farmers in the Rajshahi district, using a multistage sampling technique. Data were collected through face-to-face interviews using a semi-structured questionnaire. The statistically significant (p < 0.05) results found were: most farmers reported that the visitors could not access their farms (broiler vs. layer: 68.1%, 77.0%). A higher proportion of broilers compared to layer farms used company's supplied feed (81.2% vs. 66.7%). A higher proportion of layer (97.8%) farms cleaned the farm's litter within 24 h compared to broiler farms (72.5%). Broiler farms had better records animal mortality than layer farms (76.8% vs. 60.0%). More layer (96.3%) farms compared to broiler (87.0%) farms implemented a vaccination program. The findings of this study revealed that biosecurity measures are well-practiced and implemented in most broiler and layer farms in this region except in a small number of farms. Government authorities should strictly enforce and monitor biosecurity measures in farms that do not practice essential biosecurity measures., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Adolescents frequently engage in risky behaviors that negatively influence their health and pose a serious public health concern. This study aimed to examine the clustering pattern of health risk behaviors among school-going adolescents in Bangladesh., Methods: A cross-sectional study was conducted from 15 April to 27 June 2022 among 412 school-going adolescents in Mymensingh district of Bangladesh through a convenience sampling technique. Data were collected via face-to-face interviews using a modified Global School-Based Student Health Survey (GSHS) 2021 questionnaire. Cluster membership was identified using the k-means clustering algorithm. The chi-square test was adopted to explore the association between sociodemographic variables and each cluster membership. The ordinal logistic regression model was employed to examine the predictors associated with cluster membership., Results: Most of the respondents were female (55.3%) and belonged to the 16-19 years (74.5%) age group. Three behavioral clusters were identified, including Cluster 1: Low-risk taker (50.2%), Cluster 2: Moderate risk taker (39.6%), and Cluster 3: High-risk taker (10.2%). Influential factors of high-risk behavior among adolescents were significantly associated with their age (p = 0.03), father's education who were illiterate (p = 0.02), monthly family income >30000 BDT (p = 0.04), parent's those were understanding their child's problems in most of the time (p = 0.001)., Conclusions: The study found that high-risk behaviors are significantly higher among late adolescents, those whose fathers are illiterate, whose monthly income is higher, those whose parents or guardians never realize their child's complications and worries, and those whose parents or guardians never recognize what they did in their leisure time. These findings will help to develop intervention programs, policies, strategies, and curricula in school by the experts following the necessity to adopt the adolescent toward healthy behavior and help to reduce the prevalence of health risk behavior., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Bangladesh National Tuberculosis (TB) Control Programme (NTP) has deployed improved diagnostic technologies which may drive up the programme costs. We aimed to estimate the supply-side costs associated with the delivery of the NTP and the funding gap between the cost of implementation and available funding for the Bangladesh NTP., Methods: An ingredient-based costing approach was applied using WHO's OneHealth Tool software. We considered 2016, as the base year and projected cost estimates up to 2022 using information on NTP planned activities. Data were collected through consultative meetings with experts and officials/managers, review of documents and databases, and visits to five purposively selected TB healthcare facilities. The estimated costs were compared with the funds allocated to the NTP between 2018 and 2022 to estimate the funding gap., Findings: The estimated total cost of NTP was US$ 49.22 million in 2016, which would increase to US$ 146.93 million in 2022. Human resources (41.1%) and medicines and investigations/ supplies (38.0%) were the major two cost components. Unit costs were highest for treating extensively drug-resistant TB at US$ 7,422.4 in 2016. Between 2018-2022, NTP would incur US$ 536.8 million, which is US$ 235.18 million higher than the current allocation for NTP., Conclusion: Our results indicated a funding gap associated with the NTP in each of the years between 2018-2022. Policy planners should advocate for additional funding to ensure smooth delivery of TB services in the upcoming years. The cost estimates of TB services can also be used for planning and budgeting for delivering TB services in similar country contexts., Competing Interests: All other authors declare no conflicts of interest., (Copyright: © 2023 Hasan 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.)

Seaweed cultivation is an eco-friendly method and attracts growing interest which needs a multi-criteria approach for its sustainability. In our present study, an economically significant red alga, Gracilariopsis longissima was cultured using a floating raft method on the coast of Cox's Bazar, Bangladesh for a period of 90 days from January to March 2022. The effects of different factors such as rope materials, culture type, raft shape, seeding intensity, harvesting phase and water depth on the biomass yield production of G. longissima were evaluated during a 90-day culture period. The biomass yield production and daily growth rate (DGR% day -1 ) were estimated to evaluate the possibilities of G. longissima cultures in a floating raft culture method. The range of biomass yield production (3.03-13.37 kg/m 2 ) and DGR (3.08-4.72% day -1 ) is satisfactory in the floating raft culture method. Different water quality variables, the seasonal appearance of epiphytic algae and a cost-benefit analysis of seaweed culture were also performed. A total of eight epiphytic algal species were recorded, which resulted in major challenges for the growth of Gracilariopsis. The per month income for a seaweed farmer was estimated to be US$175.17 for 20 rafts. Our research concluded that farming of G. longissima in the floating raft method could be successfully performed from January to March on the coast of Cox's Bazar., (© 2023. The Author(s).)

Microplastics (MPs), together with microfibers, have emerged as a contaminant of concern all around the globe. MPs have been detected in freshwater, seawater, sediment, and aquatic species among others. As suggested by several recent investigations, sea salts, a daily intake item by humans, are also contaminated by MPs. The current article describes MPs' occurrence, distribution, type, and timeline variation in raw sea salts from Cox's Bazar, Bangladesh. MPs have been detected in every collected salt sample, and quantity varied from 28.53 ± 2.43 to 93.53 ± 4.21 particles per kg, which was about 52.48 ± 1.72 to 67.46 ± 3.81 µg/kg of raw salt. Microfibers were MPs' dominant shape category, and the plastic types were mainly polyester or nylon. Other types of MPs were polyethylene (PE), polypropylene (PP), polycarbonate (PC), polyurethane (PU), and polystyrene (PS) in decreasing amounts. The majority of the MPs in the sea salts were in the size range of ˂ 3-1 mm. The total amount of MPs and plastic-type variation due to sampling location (p ˃ 0.05) and because of the time period (p ˃ 0.05) was found insignificant. Acetaldehyde, a volatile toxic substance produced by the degradation of polyester polymer chains, was detected in MPs in the range of 0.37 to 1.72 µg/g by headspace GC-MS analysis. Hence, the sea salts contaminated with MPs pose a public health hazard. Microplastics extraction from sea salts and their characterization., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Microplastics (MPs) are an emerging environmental problem due to their all-around existence and extraordinary stability. A significant number of studies are found in recent literature on the occurrence, distribution, transport, and fate of the MPs in several environmental compartments. In this study, we have investigated the occurrence and characteristics of MPs in the surface water and sediment of the Buriganga river, located beside the mega-city of Dhaka in Bangladesh. In the Buriganga river, the concentration of MPs in the surface water was found from 4.33 ± 0.58 to 43.67 ± 0.58 items L -1 , and in the sediment, MPs varied from 17.33 ± 1.53 to 133.67 ± 5.51 items kg -1 of dry sediment. Fragment-type MPs were predominant in the surface water and sediment, which was 72.7% and 85.5% respectively. The most abundant polymer type polypropylene (PP) was found -to be 46% in the surface water and 61% in the sediment sample. The next major category, polyethylene (PE) was found to be 26% and 21%, respectively. Polystyrene (PS), polyvinyl chloride (PVC), polyethylene terephthalate (PET), and polyamide (PA) were other commonly detected polymer types. The MPs were found to be contaminated by Pb, Cd, Cr, Zn, Cu, and Sn from Energy dispersive-X-ray fluorescence (ED-XRF) analysis. Tannery-induced Cr was detected in the highest concentrations in the MPs, which were 20.67 ± 1.66 mg kg -1 (in surface water) and 14.2 ± 1.25 mg kg -1 (in sediment). The pollution load index (PLI) of the MPs contamination in different sampling sites along the Buriganga river was found in the risk level category of I and II. The anthropogenic influence of the city area was reflected in the PLI values, which had an increasing trend from the upstream sampling points (1.00 ± 1.00, 1.00 ± 1.00) to the downstream sites (10.09 ± 1.00, 7.71 ± 3.60)., 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 © 2022 Elsevier Ltd. All rights reserved.)

Shigella is the second leading cause of diarrheal deaths worldwide. Azithromycin (AZM) is a potential treatment option for Shigella infection; however, the recent emergence of AZM resistance in Shigella threatens the current treatment strategy. Therefore, we conducted a comprehensive whole genome-based approach to identify the mechanism(s) of AZM resistance in Shigella . We performed antimicrobial susceptibility tests, polymerase chain reaction (PCR), Sanger (amplicon) sequencing, and whole genome-based bioinformatics approaches to conduct the study. Fifty-seven (38%) of the Shigella isolates examined were AZM resistant; Shigella sonnei exhibited the highest rate of resistance against AZM (80%). PCR amplification for 15 macrolide resistance genes (MRGs) followed by whole-genome analysis of 13 representative Shigella isolates identified two AZM-modifying genes, mph (A) (in all Shigella isolates resistant to AZM) and mph (E) (in 2 AZM-resistant Shigella isolates), as well as one 23S rRNA-methylating gene, erm (B) (41% of AZM-resistant Shigella isolates) and one efflux pump mediator gene, msr (E) [in the same two Shigella isolates that harbored the mph (E) gene]. This is the first report of msr (E) and mph (E) genes in Shigella . Moreover, we found that an IncFII-type plasmid predominates and can possess all four MRGs. We also detected two plasmid-borne resistance gene clusters: IS 26 - mph (A)- mrx (A)- mph (R)(A)-IS 6100 , which is linked to global dissemination of MRGs, and mph (E)- msr (E)-IS 482 -IS 6 , which is reported for the first time in Shigella . In conclusion, this study demonstrates that MRGs in association with pathogenic IS 6 family insertion sequences generate resistance gene clusters that propagate through horizontal gene transfer (HGT) in Shigella . IMPORTANCE Shigella can frequently transform into a superbug due to uncontrolled and rogue administration of antibiotics and the emergence of HGT of antimicrobial resistance factors. The advent of AZM resistance in Shigella has become a serious concern in the treatment of shigellosis. However, there is an obvious scarcity of clinical data and research on genetic mechanisms that induce AZM resistance in Shigella , particularly in low- and middle-income countries. Therefore, this study is an approach to raise the alarm for the next lifeline. We show that two key MRGs [ mph (A) and erm (B)] and the newly identified MRGs [ mph (E) and msr in Bangladesh. Overall, this study predicts an abrupt decrease in the effectiveness of AZM against Shigella in Bangladesh. Overall, this study predicts an abrupt decrease in the effectiveness of AZM against Shigella in the very near future and suggests prompt focus on seeking a more effective treatment alternative to AZM for shigellosis.

Objective: We have assessed and improved the performance of the modified Erasmus GBS Outcome Score (mEGOS) among patients with Guillain-Barré syndrome (GBS) from Bangladesh., Methods: Validation cohort consisted of patients with GBS from two prospective cohort studies in Bangladesh. Poor outcome was defined as being unable to walk independently at week 4 and week 26. We excluded patients able to walk independently, patients who died within the first week, or with missing GBS disability scores. Performance of mEGOS at entry and week 1 was determined based on the discriminative ability (ability to differentiate between patients able and unable to walk independently; measured using the area under the receiver operating characteristic curves [AUC]) and calibration (observed probability versus predicted probability of poor outcome)., Results: A total of 506 patients aged ≥6-year-old were enrolled, with 471 and 366 patients included in mEGOS validation analysis at entry and week 1, respectively. The AUC values for predicting poor outcome (1) at week 4 were 0.69 (mEGOS entry) and 0.78 (mEGOS week 1) and (2) at week 26 were 0.67 (mEGOS entry) and 0.70 (mEGOS week 1). Mean predicted probabilities of poor outcome corresponded with observed outcomes except for the probability of poor outcome at week 4 which was overestimated by mEGOS week 1. This was resolved by updating the model intercept., Interpretation: The mEGOS shows valid outcome predictions among patients with GBS from Bangladesh. The model can aid the identification of patients at high risk of poor outcome and help to adequately allocate healthcare resources in low-resource settings., (© 2022 International Centre for Diarrhoeal Disease Research, Bangladesh. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Background: Financing healthcare through out-of-pocket (OOP) payment is a major barrier in accessing healthcare for the poor people. The Health Economics Unit (HEU) of the Ministry of Health and Family Welfare of the government of Bangladesh has developed Shasthyo Suroksha Karmasuchi (SSK), a health protection scheme, with the aim of reducing OOP expenditure and improving access of the below-poverty-line (BPL) population to healthcare. The scheme started piloting in 2016 at Kalihati sub-district of Tangail District. Our objective was to assess healthcare utilization by the enrolled BPL population and to identify the factors those influencing their utilization of the scheme., Method: A cross-sectional household survey was conducted from July to September 2018 in the piloting sub-district. A total of 806 households were surveyed using a semi-structured questionnaire. Information on illness and sources of healthcare service were captured for the last 90 days before the survey. Multiple logistic regression models were applied to determine the factors related to utilization of healthcare from the SSK scheme and other medically trained providers (MTPs) by the SSK members for both inpatient and outpatient care., Result: A total of 781 (24.6%) people reported of suffering from illness of which 639 (81.8%) sought healthcare from any sources. About 8.0% (51 out of 639) of them sought healthcare from SSK scheme and 28.2% from other MTPs within 90 days preceding the survey. Households with knowledge about SSK scheme were more likely to utilize healthcare from the scheme and less likely to utilize healthcare from other MTPs. Non-BPL status and suffering from an accident/injury were significantly positively associated with utilization of healthcare from SSK scheme., Conclusion: Among the BPL population, healthcare utilization from the SSK scheme was very low compared to that of other MTPs. Effective strategies should be in place for improving knowledge of BPL population on SSK scheme and the benefits package of the scheme should be updated as per the need of the target population. Such initiative can be instrumental in increasing utilization of the scheme and ultimately will reduce the barriers of OOP payment among BPL population for accessing healthcare., (© 2022. The Author(s).)

Background: Seroprevalence studies have been carried out in many developed and developing countries to evaluate ongoing and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data on this infection in marginalized populations in urban slums are limited, which may offer crucial information to update prevention and mitigation policies and strategies. We aimed to determine the seroprevalence of SARS-CoV-2 infection and factors associated with seropositivity in slum and non-slum communities in two large cities in Bangladesh., Methods: A cross-sectional study was carried out among the target population in Dhaka and Chattogram cities between October 2020 and February 2021. Questionnaire-based data, anthropometric and blood pressure measurements and blood were obtained. SARS-CoV-2 serology was assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay., Results: Among the 3220 participants (2444 adults, ≥18 years; 776 children, 10-17 years), the overall weighted seroprevalence was 67.3% (95% confidence intervals (CI) = 65.2, 69.3) with 71.0% in slum (95% CI = 68.7, 72.2) and 62.2% in non-slum (95% CI = 58.5, 65.8). The weighted seroprevalence was 72.9% in Dhaka and 54.2% in Chattogram. Seroprevalence was positively associated with limited years of formal education (adjusted odds ratio [aOR] = 1.61; 95% CI = 1.43, 1.82), lower income (aOR = 1.23; 95% CI = 1.03, 1.46), overweight (aOR = 1.2835; 95% CI = 1.26, 1.97), diabetes (aOR = 1.67; 95% CI = 1.21, 2.32) and heart disease (aOR = 1.38; 95% CI = 1.03, 1.86). Contrarily, negative associations were found between seropositivity and regular wearing of masks and washing hands, and prior BCG vaccination. About 63% of the population had asymptomatic infection; only 33% slum and 49% non-slum population showed symptomatic infection., Conclusion: The estimated seroprevalence of SARS-CoV-2 was more prominent in impoverished informal settlements than in the adjacent middle-income non-slum areas. Additional factors associated with seropositivity included limited education, low income, overweight and pre-existing chronic conditions. Behavioral factors such as regular wearing of masks and washing hands were associated with lower probability of seropositivity., Competing Interests: The authors have declared that no competing interests exist.

In this article, we have developed a deterministic Susceptible-Latent-Infectious-Recovered (SLIR) model for diphtheria outbreaks. Here, we have studied a case of the diphtheria outbreak in the Rohingya refugee camp in Bangladesh to trace the disease dynamics and find out the peak value of the infection. Both analytical and numerical investigations have been performed on the model to find several remarkable behaviors like the positive and bounded solution, basic reproductive ratio, and equilibria such as disease extinction equilibrium and disease persistence equilibrium which are characterized depending on the basic reproductive ratio and global stability of the model using Lyapunov function for both equilibria. Parameter estimation has been performed to determine the values of the parameter from the daily case data using numerical technique and determined the value of the basic reproductive number for the outbreak as ℛ 0 = 5.86., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Zahurul Islam et al.)

Background: Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households., Methods: We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment., Results: The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment., Conclusion: The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes., Methods: HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care., Results: Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme., Conclusion: HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider's costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Sayem Ahmed – none declared Md. Zahid Hasan – none declared Nausad Ali – none declared Mohammad Wahid Ahmed – none declared Emranul Haq – works at the Concern Worldwide Bangladesh Sadia Shabnam – works at the scheme implementing organization, BRAC Morseda Chowdhury – works at the scheme implementing organization, BRAC Breda Gahan – works at the funding organization, Concern Worldwide Christine Bousquet – works at the funding organization, Concern Worldwide Jahangir A. M. Khan – none declared Ziaul Islam – none declared This does not alter our adherence to PLOS ONE policies on sharing data and materials.

We evaluated the presence of influenza A(H5) virus environmental contamination in live bird markets (LBMs) in Dhaka, Bangladesh. By using Bernoulli generalized linear models and multinomial logistic regression models, we quantified LBM-level factors associated with market work zone-specific influenza A(H5) virus contamination patterns. Results showed higher environmental contamination in LBMs that have wholesale and retail operations compared with retail-only markets (relative risk 0.69, 95% 0.51-0.93; p = 0.012) and in March compared with January (relative risk 2.07, 95% CI 1.44-2.96; p<0.001). Influenza A(H5) environmental contamination remains a public health problem in most LBMs in Dhaka, which underscores the need to implement enhanced biosecurity interventions in LBMs in Bangladesh.

Background: Acceptance of the COVID-19 vaccine by the target groups would play a crucial role in stemming the pandemic. Healthcare professionals (HCPs) are the priority group for vaccination due to them having the highest risk of exposure to infection. This survey aimed to assess their acceptance of COVID-19 vaccines in Bangladesh., Research Design and Methods: A cross-sectional survey using an online questionnaire was conducted between January 3 to 25, 2021, among HCPs (n = 834) in Bangladesh., Results: Less than 50% of HCPs would receive the vaccine against COVID-19 if available and 54% were willing to take the vaccine at some stage in the future. Female participants (OR:1.64;95%CI:1.172-2.297), respondents between 18-34 years old (OR:2.42; 95% CI:1.314-4.463), HCPs in the public sector (OR:2.09; 95% CI:1.521-2.878), and those who did not receive a flu vaccine in the previous year (OR:3.1; 95% CI:1.552-6.001) were more likely to delay vaccination., Conclusions: The study revealed that, if available, less than half of the HCPs would accept a COVID-19 vaccine in Bangladesh. To ensure the broader success of the vaccination drive, tailored strategies and vaccine promotion campaigns targeting HCPs and the general population are needed.

Limited information is available regarding the effects of arsenic exposure on immune function. We have recently reported that chronic exposure to As was associated asthma, as determined by spirometry and respiratory symptoms. Because T helper 2 (Th2)-driven immune responses are implicated in the pathogenesis of allergic diseases, including asthma, we studied the associations of serum Th1 and Th2 mediators with the As exposure markers and the features of asthma among individuals exposed to As. A total of 553 blood samples were selected from the same study subjects recruited in our previous asthma study. Serum levels of Th1 and Th2 cytokines were analyzed by immunoassay. Subjects' arsenic exposure levels (drinking water, hair and nail arsenic concentrations) were determined by inductively coupled plasma mass spectroscopy. Arsenic exposure levels of the subjects showed significant positive associations with serum Th2-mediators- interleukin (IL)-4, IL-5, IL-13, and eotaxin without any significant changes in Th1 mediators- interferon-γ and tumor necrosis factor-α. The ratios of Th2 to Th1 mediators were significantly increased with increasing exposure to As. Notably, most of the Th2 mediators were positively associated with serum levels of total immunoglobulin E and eotaxin. The serum levels of Th2 mediators were significantly higher in the subjects with asthma than those without asthma. The results of our study suggest that the exacerbated Th2-driven immune responses are involved in the increased susceptibility to allergic asthma among individuals chronically exposed to As., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. The objective of this study was to investigate the preceding infections, clinical, serological and electrophysiological characteristics and outcome of childhood GBS in Bangladesh. We included 174 patients with GBS aged <18 years from a prospective cohort in Bangladesh between 2010 and 2018. We performed multivariate logistic regression to determine the risk factors for poor outcome. Among 174 children with GBS, 74% (n = 129) were male. Around half of the patients (49%, n = 86) had severe muscle weakness, 65% (n = 113) were bedbound (GBS disability score 4) and 17% (n = 29) patients required mechanical ventilation at admission. Campylobacter jejuni serology and anti-GM1 IgG antibody were positive in 66% and 21% of the patients respectively. One hundred and forty-three (82%) patients did not receive standard treatment and half of them recovered fully or with minor deficits at 6-month. Twenty patients (11%) died throughout the study period. At 3-month of onset of weakness, complete recovery or recovery with minor deficit was significantly higher in demyelinating GBS patients compared to axonal GBS patients (86% vs 51%, P = .001). Cranial nerve palsy (OR = 4.00, 95%CI = 1.55-10.30, P = .004) and severe muscle weakness (OR = 0.16, 95%CI = 0.06-0.45, P = .001) were the important risk factors of poor outcome in children with GBS. Further large-scale studies are required for better understanding of factors associated with mortality and morbidity in childhood GBS., (© 2021 Peripheral Nerve Society.)

Background: The increased global incidence of hepatitis E virus (HEV) infections, warrants accurate and affordable diagnostics across different geographical regions. The soluble and highly conserved HEV open reading frame 2 (ORF2) capsid antigen (HEV-Ag) is detectable in self-limited acute enteric hepatitis by HEV-Ag ELISA which is a promising serological assay in settings where HEV-RNA testing is not feasible. Our aim was to assess the HEV-Ag biomarker in an HEV outbreak in a low income country., Methods: A prospective single center longitudinal study during HEV outbreaks in the Chittagong, Bangladesh region between October 2018 and October 2019 was conducted based on recruitment of acute jaundice cases with clinical signs and symptoms of suspect HEV infections. Acute HEV infection was defined as a positive test result for anti-HEV IgM antibodies., Results: Forty four of the 51 enrolled enteric hepatitis cases (86 %) were confirmed HEV by anti-HEV IgM ELISA at day 0 hospital entry. The anti-HEV-IgM and IgG were positive in all patients and did not reveal significant differences; neither between the time points day 0 and follow-up hospitalization on day 2-6 or day 7-10 nor between RNA-positive (n = 36) versus RNAnegative (n = 8) HEV groups. The HEV-Ag positivity was higher in viral RNA-positive (29/36, 81 %) than the viral RNA-negative (1/8, 12 %) group, p < 0.001 and the HEV-Ag levels positively correlated with viremia, r = 0.77, p < 0.0001. All non-HEV cases; n = 7 tested negative anti-HEV IgM and HEV-Ag and 5 of 7 (71 %) tested anti-HAV IgM positive., Conclusions: The HEV-Ag ELISA is a reliable and practical diagnostic tool in this acute HEV outbreak., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To determine the predictors of mortality within 30 days of hospital admission in a diarrhoeal disease hospital in Bangladesh., Methods: Cohort study of hospitalised children aged 0-59 months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30 days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30 days of hospital admission., Results: We enrolled 191 children. Mortality within 30 days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR = 5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR = 6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0 × 10 9 /L) (aOR = 1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality., Conclusions: The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population., (© 2020 John Wiley & Sons Ltd.)

Background: Alargebodyof evidence has shown a link between arsenic exposure and diabetes, but the underlying mechanisms have not yet been clarified., Objective: We explored the association between arsenic exposure and the reduction of skeletal muscle mass as a potential mechanism of insulin resistance for developing arsenic-related hyperglycemia., Methods: A total of 581 subjects were recruited from arsenic-endemic and non-endemic areas in Bangladesh and their fasting blood glucose (FBG), serum insulin, and serum creatinine levels were determined. Subjects' arsenic exposure levels were assessed by arsenic concentrations in water, hair, and nails. HOMA-IR and HOMA-β were used to calculate insulin resistance and β-cell dysfunction, respectively. Serum creatinine levels and lean body mass (LBM) were used as muscle mass indicators., Results: Water, hair and nail arsenic concentrations showed significant positive associations with FBG, serum insulin and HOMA-IR and inverse associations with serum creatinine and LBM in a dose-dependent manner both in males and females. Water, hair and nail arsenic showed significant inverse associations with HOMA-β in females but not in males. FBG and HOMA-IR were increased with the decreasing levels of serum creatinine and LBM. Odds ratios (ORs)of hyperglycemia were significantly increased with the increasing concentrations of arsenic in water, hair and nails and with the decreasing levels of serum creatinine and LBM. Females' HOMA-IR showed greater susceptibility to the reduction of serum creatinine and LBM, possibly causing the greater risk of hyperglycemia in females than males. Path analysis revealed the mediating effect of serum creatinine level on the relationship of arsenic exposure with HOMA-IR and hyperglycemia., Conclusion: Arsenic exposure elevates FBG levels and the risk of hyperglycemia through increasing insulin resistance with greater susceptibility in females than males. Additionally, arsenic exposure-related reduction of skeletal muscle mass may be a mechanism underlying the development of insulin resistance and hyperglycemia., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh., Methods: A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates., Results: The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones., Conclusions: The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage., (© The Author(s) 2019. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Alternate nostril breathing (ANB) is one of the best and easiest breathing exercises. ANB exercise has beneficial effects on cardiac function in healthy and diseased people. The objectives of this study were to assess the effects of ANB exercise on cardiac physiology among healthy medical students. This was a prospective interventional study that was conducted in the Department of Physiology, Chittagong Medical College (CMC), Chattogram, Bangladesh, from July 2017 to June 2018. A total of 100 research participants (RPs) aged 18-20 years, Year-I medical students of CMC, were selected. A simple random sampling method was adopted. The selection was done after the inclusion and exclusion criteria were applied. The age and body mass index (BMI) of the RPs were analogous in both the control and experimental groups. Cardiac parameters, like pulse and blood pressure (BP), were measured. The initial baseline data were recorded for both groups and after 4 weeks. The research respondents of the experimental group performed ANB exercise for 4 weeks. The mean value pulse and BP were significantly (p < 0.001) changed after breathing exercise, compared to the values before the breathing exercise. The results of this study suggest that cardiac function significantly improves after the breathing exercise. Therefore, ANB can be recommended for increasing cardiac efficiency., Competing Interests: The authors report no conflict of interest., (© 2020 Journal of Population Therapeutics and Clinical Pharmacology. All rights reserved.)