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Ethnopharmacological relevance: Pelvic inflammatory disease (PID) is a frequently occurring gynecological disorder mainly caused by the inflammation of a woman’s upper genital tract. Generally, antibiotics are used for treating PID, but prolonged use poses potential risks of gut bacterial imbalance, bacterial resistance, super bacteria production, and associated adverse reactions. Traditional Chinese medicine (TCM) has shown unique advantages in various ailments and has received widespread clinical research attention. Fuke Qianjin (FUKE) capsule is an approved National Medical Products Administration (NMPA License No. Z20020024) Chinese herbal prescription that has been widely used individually or in combination with other Western medicines for the treatment of various gynecological inflammatory diseases, including chronic cervicitis, endometritis, and chronic PID.Aim: This clinical trial was designed to assess the safety and efficacy of FUKE capsule in mild-to-moderate symptomatic PID patients.Materials and methods: This phase 2, randomized, double-blind, positive controlled clinical trial was conducted in mild-to-moderate symptomatic PID patients at a single center in Pakistan from 21 September 2021 to 11 March 2022. Eligible female participants were randomly assigned to a test and a control group with a ratio of 1:1. The test group subjects received two metronidazole (METRO) tablets and one doxycycline hyclate (DOXY) simulant at a time, twice daily for 14 days, and two Fuke Qianjin (FUKE) capsules, three times a day after a meal for 28 days. Subjects in the control group received two METRO tablets and one DOXY tablet at a time, twice daily for 14 days, and two FUKE simulant capsules, three times a day after meal for 28 days. The primary efficacy outcome was an improvement in pelvic pain symptoms assessed through a visual analog scale (VAS). The secondary outcomes were the improvement in secondary efficacy symptoms like local physical signs, clinical assessment of leucorrhea and cervical secretions through laboratory examination, and improvement in the maximum area of pelvic effusion assessed through gynecological ultrasound after the treatment. The safety outcomes were assessed through vital signs, laboratory tests, electrocardiogram findings, and adverse events/serious adverse events.Results: A total of 198 subjects with active PID were randomly assigned to a test group (n = 99) and a control group (n = 99). The baseline characteristics of the subjects in the two groups were similar. In the intention-to-treat analysis, the primary efficacy was 84.9% for the test group and 71.6% for the control group, with a statistically significant difference (p = 0.0370; 95% CI −0.2568 to −0.0088). The secondary clinical efficacy was 88.4% for the test group and 82.7% for the control group, with no significant difference (p = 0.2977; 95% CI −0.1632 to 0.0501). The improvement in local physical signs was 95.8% for the test group and 76.9% for the control group, with no significant difference (p = 0.0542; 95% CI −0.3697 to −0.0085). The inter-group non-inferiority comparison showed that the upper limit of the 95% CI was less than 0.15 and thus met the non-inferiority requirements of the test group to the control group. The results of clinical signs of leucorrhea and cervical secretions showed that there was no difference in the rate of improvement between the test and control groups, indicating that FUKE was non-inferior to DOXY. A total of 14 adverse events in eight subjects were observed in the trial, with an incidence rate of 4.7%. Four subjects in each group experienced seven adverse events with 4.5% and 4.8% incidence rates of adverse reactions in the test and control groups, with no statistically significant differences (p = 0.2001). No serious adverse events occurred in the trial.Conclusion: The results of this trial indicate that the test drug (Fuke Qianjin capsule) is non-inferior to the control drug (doxycycline hyclate tablet) in treating mild-to-moderate PID patients with comparable efficacy, safety, and tolerability to the control drug.Clinical Trial Registration:www.clinicaltrials.gov, identifier NCT04723069.

Abstract Background In Bangladesh, safely managed sanitation (SMS) coverage is low, and diarrheal disease is a significant health problem. This study estimated the inequality in access to SMS facilities at the national and sub-national levels and assessed the prevalence of diarrheal diseases in connection with these improved facilities. Methods Data were extracted from the Bangladesh Demographic and Health Survey, conducted during 2017–2018. SMS was defined as using an improved sanitation facility, which designed to hygienically separate excreta from human contact and include the use of a flush toilet connected to piped sewer system, septic tank, ventilated improved pit latrine, pit latrine with a slab, and composting toilet. The slope index of inequality (SII) and multi-level regression models were used for inequality and risk factors of SMS respectively. Results The national coverage of SMS was 44.0% (45.3% and 43.5% in urban and rural areas, respectively). At the sub-national level, the lowest and highest coverage of SMS was observed in Mymensingh (32.9%) and Chittagong (54.1%) divisions, respectively. The national level SII indicated that wealthy households had access to higher SMS by 60.8 percentage points than poor households. Additionally, greater inequality was observed in rural areas, which was 71.9 percentage points higher in the richest households than in the poorest households. The coverage gap between the rich and poor was highest in the Sylhet division (85.3 percentage points higher in rich than in poor) and lowest in Dhaka (34.9 percentage points). Old and highly educated household heads and richest households had better access to higher levels of adequate sanitation. After adjusting for confounding variables, the prevalence of diarrheal disease was 14.0% lower in the SMS user group than in their counterparts. Conclusion Substantial inequalities in access to SMS exist at both national and sub-national levels of Bangladesh, with the prevalence of diarrhea being lower among SMS users. These findings may help to prioritize resources for reducing inequality and expanding the coverage of improved sanitation in Bangladesh.

Abstract Background Sleep deprivation is widely recognized as a potential contributor to childhood obesity. However, few studies have addressed this issue in low-income settings. The aim of this study was to determine the association of both sleep duration and sleep quality with overweight/obesity among adolescents of Bangladesh. Methods A cross-sectional study was conducted in four randomly selected schools in Gazipur, Bangladesh, from May to August 2019. Using a self-administered semi-structured questionnaire, data on sleep duration and sleep quality were collected from 1,044 adolescents between 13 and 17 years of age. The body mass indices of the study participants were evaluated using their objectively-assessed anthropometric measurements (weight and height). Multilevel logistic regression was used for data analysis. Results The prevalence of underweight, overweight and obesity in adolescents in this study were 14.9, 18 and 7.1%, respectively. More than 15% of the students reported sleep disturbance and poor sleep quality. After adjusting for confounders, reduced (

Abstract Background Child malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh. This study aims to determine the prevalence and identify the associated risk factors of child malnutrition in Bangladesh using multilevel logistic regression model on data from the Bangladesh Demographic and Health Survey (BDHS), 2014. Methods A total sample of 6965 children aged 0–59 months was extracted from BDHS 2014. We performed descriptive analysis and multilevel generalized linear regression analysis with clustered data structure. Results Our findings show that among children the prevalence of moderate and severe values was respectively: 25 and 12% for stunting; 11 and 3.1% for wasting; 25 and 7.9% for underweight. The probability of stunting increased with age, with highest rate among children aged 36–47 months, which was significantly higher than children aged less than 6 months (OR = 6.71, 95% CI = 4.46, 10.10). Female children are found to be 11% less likely to be stunted than male children (OR = 0.89, 95% CI = 0.78, 1.02). Children with birth interval less than 24 months were significantly more likely to be stunted than children of first birth by 36% (OR = 1.36, 95% CI = 1.11, 1.67). Mothers with a normal BMI were 16% less likely to have children with stunting compared to mothers who are underweight (OR = 0.84, 95% CI = 0.76, 0.93). Other factors which were associated with a higher risk of stunting included parents with lower educational levels, children from the poorest wealth index, and mothers aged less than 20 years as first birth. Conclusion Government and non-government organization should generate effective program to aware women of reproductive age about adverse effect of short birth interval, and to aware parents about standard height and weight according to age and gender of children. Overall, necessary steps may be taken to make people educated and to reduce household wealth inequality to improve nutritional status of children.

Background Nephrotic syndrome (NS) is one of the most common glomerular disease in children, characterized by massive proteinuria, hypoalbuminemia, dyslipidemia and edema. Steroid-resistant nephrotic syndrome (SRNS) and steroid-dependent nephrotic syndrome (SDNS) present challenges in pharmaceutical management. Patient need several immunosuppressant for optimal control, each of which has significant side effect and difficult to get desired results. Rituximab (RTX) is a monoclonal antibody that targets B cells and has been shown to be effective for patients with SRNS and SDNS. Objective To see efficacy of RTX in pediatric patients with SRNS. Method This retrospective study took place in Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from July 2017 to June 2019. Patients diagnosed with SRNS who were treated with RTX and followed up for 6 months were enrolled in this study. Primary endpoint was achievement of remission after rituximab infusion; secondary endpoint was relapse-free survival rate in 6 months period following rituximab infusion. Results Total 7 patients were recruited in this study. Among them 4 were male. Clinical and lab parameters of all patients before and after RTX were compared. Complete remission achieved in 4/7 patients, partial remission in 2/7 patients and no response in 1/7 patient. Mean number of relapse in 3 patients before RTX infusion was 3.67 (SD 0.57) and after 0.33 (SD 0.00) (P=0.038). Conclusion RTX is a biological agent that is effective and promising drug in children with SRNS. Rituximab is useful to induce and maintain remission.

Background: A newly developed drug trastuzumab emtansine (T-DM1) has improved the survival of breast cancer (BC) patients. Despite an impressive initial clinical response, a subgroup of patient develop resistance and present therapeutic challenges. The underlying resistance mechanisms are not fully investigated. We report that T-DM1 treatment modulates the expression of ROR1 (type 1 receptor tyrosine kinase-like orphan receptor) and induces self-renewal of cancer stem cells (CSCs) leading to therapeutic resistance. Methods: Using BC patient tumor samples, and BC cell lines we gained insight into the T-DM1 treatment induced ROR1 overexpression and resistance. In vitro sphere forming assays and in vivo extreme dilution assays were employed to analyze the stemness and self-renewal capacity of the cells. A series of molecular expression and protein assays including qRT-PCR, FACS-sorting, ELISA, immunostaining, Western blotting were used to provide evidence. Findings: Exposure of cells to T-DM1 shifted ROR1 expression from low to high, enriched within the CSC subpopulation, coincident with increased Bmi1 and stemness factors. T-DM1 induced ROR1 cells showed high spheroid and tumor forming efficiency in vitro and in an animal model exhibiting shorter tumor-free time. Mechanistically, the overexpression of ROR1 is partly induced by the activation of YAP1 and its target genes. Silencing of ROR1 and YAP1 by pharmacologic inhibitors and/or sh/siRNA inhibited spheroid formation, the initiation of tumors and the capacity for self-renewal and ROR1 overexpression. Interpretations: The results presented here indicate that simultaneous targeting of ROR1 and YAP1 may suppress CSC self-renewal efficacy and inhibit tumor progression in BC. In this manner such treatments may overcome the T-DM1 mediated therapeutic resistance and improve clinical outcome. Fund: This study was supported by Neurogen Technologies for interdisciplinary research.

Genetic risk of substance abuse is encoded mainly by central neurochemical pathways(mostly dopaminergic system) related to reinforcement and reward. In this study a functionalpolymorphism in Catechol-O-methyltransferase (COMT) (Val158Met) and the Dopamine receptor D4 gene (DRD4) (120 bp tandem duplication) has been studied in substance abused subjects. The study was carried out with 183 substance abused subjects and 175 healthy persons with no history of substance abuse. DNA was extracted and polymorphisms were analyzed using allele-specific PCR. The impact of these two polymorphisms was also analyzed on addictive characteristics (age of starting abuse, a pattern of drug habit, and period of addiction). It was found that only the heterozygous variant of COMT polymorphism (Val/Met) (p2 drugs) subjects (p

In August 2017, almost a million Rohingya people fled to Bangladesh to escape violence and persecution in Myanmar; 55 percent of them were children. BRAC, one of the largest non-governmental organizations in the world, operates an initiative called the Humanitarian Play Lab model for children ages 0-6 in the Rohingya refugee camps in Bangladesh. The intervention combines play-based learning with psychosocial support from para-counselors to promote positive developmental outcomes for children in crisis settings. Designed using a community-based participatory approach that promotes a sense of pride and belonging among those living in a displaced community, the play model strongly emphasizes the importance indigenous cultural practices play in healing and learning. This field note, which describes the key features of the play model, covers the period of implementation from its start in October 2017 up to December 2019. Our intended audience includes policymakers, practitioners, and other advocates for early childhood development and play who are working to promote child development and well-being in humanitarian settings. We offer this description as a case study of how providing play-based learning to children in emergency situations may help mitigate the detrimental long-term effects of displacement and trauma.

BACKGROUND:Bangladesh is one of the highest tobacco consuming countries in the world, with reported 21.2% of the population as daily smokers, 24.3% as smokeless tobacco users, and 36.3% as adult passive smoker. Given the high prevalence and established harmful effects of passive tobacco smoking, this study aimed to estimate of pattern of smoking policies in residential and work place, and to identify the associated socio-economic and demographic correlates in Bangladesh. DATA AND METHODS:Secondary data of sample size 9629 collected by the Global Adult Tobacco Survey (GATS) 2010 has been used. Along with descriptive analysis, binary logistic regression model has been used to analyze the socio-demographic and economic correlates to tobacco smoking policy. RESULTS:The prevalence of male and female passive tobacco smokers was 74.3% and 25.8% respectively. Among the passive tobacco smokers, 22.2% reported that smoking was allowed at their home and 29.8% reported that there was no such smoking policy at their home. Alternatively, 26.0% passive tobacco smokers reported that smoking was allowed and 27.5% reported that there was no such smoking policy at their work place. Logistic regression analysis indicated that for tobacco smokers group, the odds of allowing smoking at home was 4.85 times higher than the non-smoker respondent (OR = 4.85, 95% CI = 4.13, 5.71), 1.18 times more likely to be allowed at home in rural areas than urban areas (OR = 1.18, 95% CI = 1.06,1.32) and less for college/university completed and (or) higher educated respondent than no formal schooling (OR = 0.35, 95% CI = 0.24, 0.52). On the other hand, smoking was 1.70 times more likely to be allowed at work place for tobacco smokers than their counter part respondent (OR = 1.70, 95% CI = 1.36, 2.14) and was less likely to be allowed for college/university completed and (or) higher educated respondent (OR = 0.26, 95% CI = 0.14, 0.45) than respondent with no formal schooling. CONCLUSION:To reduce the passive smoking, lower educated people and people in urban areas should advocate more about the adverse effect of active and passive tobacco smoking. Also, smoking policy should reform introducing smoking zone at work places and residential buildings.

Background: Comprehension of risks, benefits and alternative treatment options is poor among patients referred for cardiac surgery interventions. We sought to explore the impact of a formalized shared decision-making (SDM) process on patient comprehension and decisional quality among older patients referred for cardiac surgery. Methods: We developed and evaluated a paper-based decision aid for cardiac surgery within the context of a prospective SDM design. Surgeons were trained in SDM through a Web-based program. We acted as decisional coaches, going through the decision aids with the patients and their families, and remaining available for consultation. Patients (aged [greater than or equal to] 65 yr) undergoing isolated valve, coronary artery bypass graft (CABG) or CABG and valve surgery were eligible. Participants in the non-SDM phase followed standard care. Participants in the SDM group received a decision aid following cardiac catheterization, populated with individualized risk assessment, personal profile and comorbidity status. Both groups were assessed before surgery on comprehension, decisional conflict, decisional quality, anxiety and depression. Results: We included 98 patients in the SDM group and 97 in the non-SDM group. Patients who received decision aids through a formalized SDM approach scored higher in comprehension (median 15.0, interquartile range [IQR] 12.0-18.0) than those who did not (median 9.0, IQR 7.0-12.0, p < 0.001). Decisional quality was greater in the SDM group (median 82.0, IQR 73.0-91.0) than in the non-SDM group (median 76.0, IQR 62.0-82.0, p < 0.05). Decisional conflict scores were lower in the SDM group (mean 1.76, standard deviation [SD] 1.14) than in the non-SDM group (mean 5.26, SD 1.02, p < 0.05). Anxiety and depression scores showed no significant difference between groups. Conclusion: Institution of a formalized SDM process including individualized decision aids improved comprehension of risks, benefits and alternatives to cardiac surgery, as well as decisional quality, and did not result in increased levels of anxiety. Contexte : La patientele orientee vers une chirurgie cardiaque n'a pas une bonne comprehension des risques et des avantages de l'intervention ni des autres options therapeutiques. Nous voulions done explorer les effets du processus de prise de decision partagee (PDP) sur cette comprehension et sur la qualite des decisions chez la tranche la plus agee de cette patientele. Methodes : Nous avons concu et evalue un document papier d'aide a la decision concernant les chirurgies cardiaques dans le contexte d'un concept potentiel de PDP. Les chirurgiennes et chirurgiens ont ete formes a la PDP dans un programme en ligne. Nous avons assume le role de coachs pour accompagner la patientele et les families dans l'usage du materiel d'aide a la decision, et sommes restes disponibles pour des consultations. Les patientes et patients de 65 ans ou plus se preparant a une chirurgie valvulaire, a un pontage aorto-coronarien par greffe, ou a la double intervention etaient admissibles. Les participantes et participants hors du groupe de PDP sont passes par le protocole de soins habituel; celles et ceux du groupe de PDP ont recu a la suite de leur catheterisme cardiaque un document d'aide a la decision qui presentait revaluation individualisee de leurs risques ainsi que leur profil personnel et leurs comorbidites. Les 2 groupes ont ete evalues avant l'intervention chirurgicale sur les plans de la comprehension, du conflit decisionnel, de la qualite des decisions, de l'anxiete et de la depression. Resultats : Nous avons inclus 98 patientes et patients dans le groupe de PDP et 97 dans le groupe temoin. II en ressort que la patientele qui a recu le materiel d'aide a la decision dans le cadre d'un processus de PDP officiel obtient un meilleur resultat au chapitre de la comprehension (mediane 15,0, ecart interquartile [EI] 12,0-18,0) que celle de l'autre groupe (mediane 9,0, EI 7,0-12, p < 0,001). La qualite des decisions etait aussi meilleure chez le groupe de PDP (mediane 82,0, EI 73,0-91,0) que le groupe temoin (mediane 76,0, EI 62,0-82,0, p < 0,05). Le score de conflit decisionnel etait plus bas dans le groupe de PDP (moyenne 1,76, ecart type [ET] 1,14) que dans l'autre groupe (moyenne 5,26, ET 1,02, p < 0,05). Pour ce qui est de I' anxiete et de la depression, il n'y avait aucune difference significative entre les groupes. Conclusion : II appert que l'instauration d'un processus officiel de PDP qui s'accompagne de materiel individualise pour l'aide a la decision ameliore a la fois la qualite des decisions et la comprehension des risques et avantages de la chirurgie cardiaque ainsi que des autres options therapeutiques, et ce, sans venir accroitre le niveau d'anxiete., Despite consensus on the importance of patient-centred care, including elicitation of patient preference in arriving at a treatment plan, effective implementation of shared decision-making (SDM) in surgery has been sparse. [...]

Aims Suicide poses a significant public health issue, and the presence of suicidal thoughts stands out as a prominent risk factor, highlighting the importance of addressing this aspect for early intervention and prevention efforts. While older adults face an elevated risk of attempted suicide, research in this domain is currently constrained. This study aims to enhance and evaluate the efficacy of an E-CMAP (Culturally Manual Assisted psychological intervention for Elderly) in mitigating suicidal ideation among individuals aged 55 years and older in Pakistan. Methods The study will be carried out in 2 phases. Phase 1 is cultural adaptation and refinement of the intervention and phase 2 is exploratory randomised control trial. In Phase 1, focus groups were conducted (N = 2) with Health professionals and service users and carers for adaptation of CMAP manual for suicidal ideation. In Phase 2 randomized exploratory trial will be conducted with 192 older adults with suicidal ideation randomized either to 1) E-CMAP added to Treatment As Usual (TAU) or TAU arm. ECMAP is a problem solving intervention comprising 6 sessions delivered one to one over 3 months by trained therapists. All participants will be assessed at baseline and after intervention (i.e. 3 months) for suicidal ideation, hopelessness, depression, health-related quality of life, coping resources, satisfaction with intervention, and episodes of self-harm. Results Thematic Analysis of focus group discussions indicates that participants expressed a preference for incorporating a religious element into distraction techniques, delivering information about the significance of medical treatment, showcasing recorded sessions illustrating problem-solving techniques, and involving family throughout the intervention period. Conclusion A culturally tailored psychosocial intervention that incorporates problem-solving and cognitive components has the potential to decrease the risk of suicide among older adults.

In recent years, there has been a growing recognition of language teaching being more and more communication oriented. The traditional classroom teaching is facing a big challenge and is gradually being replaced by learner-centered approaches putting learner as individual into the core of learning process. This means learner autonomy gets to be enhanced to meet the need of the new teaching mode. While a great deal of researches have been done on the concept and development of learner autonomy , limited studies have investigated the ways and means of classroom practices of teachers in fostering learner autonomy in tertiary level EFL/ESL classrooms in Bangladesh. This paper examines what teachers think about learner autonomy as well as the strategies they use to develop learners autonomy in a university setting using a qualitative approach. The findings revealed that although university teachers are acquainted with what learner autonomy means, there are some challenges of developing learner autonomy in the classroom due to a number of lacking, such as teacher's preparation, students' reluctant attitude, suitability for different disciplined students and class timing.

ObjectivesComputed tomography (CT), the reference standard for diagnosis of intraabdominal injury (IAI), carries risk including ionizing radiation. CT-sparing clinical decision rules for children have relied heavily on physical examination, but they did not include focused assessment with sonography for trauma (FAST), which has emerged into widespread use during the past decade. We sought to determine the independent associations of physical examination, laboratory studies, and FAST with identification of IAI in children and to compare the test characteristics of these diagnostic variables. We hypothesized that FAST may add incremental utility to a physical examination alone to more accurately identify children who could forgo CT scan.MethodsWe reviewed a large trauma database of all children with blunt torso trauma presenting to a freestanding pediatric emergency department during a 20-month period. We used logistic regression to evaluate the association of FAST, physical examination, and selected laboratory data with IAI in children, and we compared the test characteristics of these variables.ResultsAmong 354 children, 50 (14%) had IAI. Positive FAST (odds ratio [OR] = 14.8, 95% confidence interval [CI] = 7.5 to 30.8) and positive physical examination (OR = 15.2, 95% CI = 7.7 to 31.7) were identified as independent predictors for IAI. Physical examination and FAST each had sensitivities of 74% (95% CI = 60% to 85%). Combining FAST and physical examination as FAST-enhanced physical examination (exFAST) improved sensitivity and negative predictive value (NPV) over either test alone (sensitivity = 88%, 95% CI = 76% to 96%) and NPV of 97.3% (95% CI = 94.5% to 98.7%).ConclusionsIn children, FAST and physical examinations each predicted the identification of IAI. However, the combination of the two (exFAST) had greater sensitivity and NPV than either physical examination or FAST alone. This supports the use of exFAST in refining clinical predication rules in children with blunt torso trauma.

In August 2017, almost a million Rohingya people fled to Bangladesh to escape violence and persecution in Myanmar; 55 percent of them were children. BRAC, one of the largest nongovernmental organizations in the world, operates an initiative called the Humanitarian Play Lab model for children ages 0-6 in the Rohingya refugee camps in Bangladesh. The intervention combines play-based learning with psychosocial support from para-counselors to promote positive developmental outcomes for children in crisis settings. Designed using a community-based participatory approach that promotes a sense of pride and belonging among those living in a displaced community, the play model strongly emphasizes the importance indigenous cultural practices play in healing and learning. This field note, in which we describe the key features of the play model, covers the period of implementation from its start in October 2017 up to December 2019. Our intended audience includes policymakers, practitioners, and other advocates for early childhood development and play who are working to promote child development and wellbeing in humanitarian settings. We offer this description as a case study of how providing play-based learning to children in emergency situations may help mitigate the detrimental long-term effects of displacement and trauma.