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Lipoid proteinosis is a rare multisystem genodermatosis inherited as autosomal recessive trait. We report a case of lipoid proteinosis in a 10-year-old boy born to first-degree consanguineous parents presented with marked hoarseness of voice, accelerated photoaging appearance, enlarged and erythematous tongue with restricted movement and widespread dermatoses. Biopsy of oral mucosa revealed Periodic acid-Schiff (PAS)-positive amorphous eosinophilic hyaline deposits. Mutational analysis revealed a homozygous nonsense mutation with C to T substitution at nucleotide position 1246(c.1246C>T) in exon-8 of the extracellular matrix protein 1 gene leading to a stop codon. Both the parents were unaffected heterozygous carriers. To our knowledge, this is the first case report of lipoid proteinosis with evidence of a novel nonsense genetic mutation from Bangladesh. doi: https://doi.org/10.12669/pjms.39.4.7437 How to cite this: Khan MAH, Reza MA, Sharaf IM, Alam MJ, Rahman MM, Chandra P, et al. Lipoid Proteinosis: Identification of a Novel Nonsense Mutation c.1246C>T:p.R416X in ECM1 gene from Bangladesh. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7437 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective Hand, foot, and mouth disease (HFMD), caused by various human enteroviruses (EVs), has emerged in the children of Bangladesh in recent years. However, the etiological agents of HFMD in Bangladeshi children are not yet elucidated. This study aimed to investigate the causative agents with molecular characterization. Methods Viral RNAs were detected from the blister fluid samples by reverse transcription polymerase chain reaction; genotyping was done by sequence-based analysis of the partial viral capsid protein 1 (VP1) region, and the evolutionary relationships among the genotypes were investigated by phylogenetic analysis. Results EV-RNAs were identified in 14 (61%) blister fluid samples out of 23 children who were suspected of HFMD during an outbreak in Rajshahi in 2020. Genome sequence analysis of the VP1 gene was performed on four strains: all the four were coxsackievirus A16 (CVA16) that clustered in B1c subgenotype. These strains showed 95 to 98% nucleotide identity with those reported in India in 2013/2018. Conclusion After our first report on clinical evidence of childhood HFMD in Bangladesh, this time, we provided laboratory confirmation of the emergence of CVA16 as a causative agent of HFMD in Bangladeshi children. There is an urgent need for nationwide, in-depth, clinicoepidemiological surveillance on HFMD including its virology and genetics before it becomes endemic in Bangladesh.

Bivalve molluscan shellfish like clams and oysters, etc., are capable to bioaccumulate surrounding contaminants from waters into their digestive systems and posing serious threats of food poisoning. Detection of rotaviruses (RVs) in shellfish is of particular importance because RVs are prone to genome reassortment resulting in the emergence of new RV variants that may compromise vaccine safety. Herein, we have detected the wild-type RVs and Rotarix/RotaTeq vaccine strains in freshwater clams collected on the riverside, Kawasaki city, from July 2019 to January 2020 and correlated the detected genotypes with that of gastroenteritis cases of nearby clinics to understand the transmission of RVs in the environment. The wild-type RVs were detected in 62 (64.6%) out of 96 freshwater clams in every study month: July, September, November, and January that are considered as off-season for RV infections. The most frequent genotypes were G2 (42.9%), G8 (28.6%), G3 (14.3%), G1 (7.1%), and G10 (7.1%), which remained comparable with genotypic distribution found in the clinical samples over the last few years indicating that these RVs may accumulate in clams since a long time. However, G10 genotype was detected in clam but not in clinical samples suggesting the presence of asymptomatic infection or RVs could be carried out from a long distance. Importantly, vaccine strains, RotaTeq (1%) but not Rotarix (0%), were also detected in a clam. Attention must be paid to monitoring the potential transmission of wild-type and vaccine RV strains in the environment to prevent the emergence of new variants generated from genome reassortment with vaccine strains.

Infodemics, often including rumors, stigma, and conspiracy theories, have been common during the COVID-19 pandemic. Monitoring social media data has been identified as the best method for tracking rumors in real time and as a possible way to dispel misinformation and reduce stigma. However, the detection, assessment, and response to rumors, stigma, and conspiracy theories in real time are a challenge. Therefore, we followed and examined COVID-19–related rumors, stigma, and conspiracy theories circulating on online platforms, including fact-checking agency websites, Facebook, Twitter, and online newspapers, and their impacts on public health. Information was extracted between December 31, 2019 and April 5, 2020, and descriptively analyzed. We performed a content analysis of the news articles to compare and contrast data collected from other sources. We identified 2,311 reports of rumors, stigma, and conspiracy theories in 25 languages from 87 countries. Claims were related to illness, transmission and mortality (24%), control measures (21%), treatment and cure (19%), cause of disease including the origin (15%), violence (1%), and miscellaneous (20%). Of the 2,276 reports for which text ratings were available, 1,856 claims were false (82%). Misinformation fueled by rumors, stigma, and conspiracy theories can have potentially serious implications on the individual and community if prioritized over evidence-based guidelines. Health agencies must track misinformation associated with the COVID-19 in real time, and engage local communities and government stakeholders to debunk misinformation.

Introduction Because of the large animal reservoirs and reassortment capacity of rotaviruses (RVs) that pose the possibilities of waning the effectiveness of RV-vaccines, it remains essential to monitor vaccine effectiveness (VE) regularly. Although reverse transcription polymerase chain reaction (RT-PCR) remains sensitive for RV detection, physicians, especially in Japan, frequently use immunochromatography (IC)-based kits for RV diagnosis. Recently, IC is being used to calculate VE also. Herein, we investigated the validity of VEs determined by IC compared to that by RT-PCR during an outbreak in Shizuoka Prefecture, Japan. Methods RVs in the stool or rectal swabs from children with acute gastroenteritis (AGE) were tested first by IC in the clinic and then by RT-PCR in the laboratory. A test-negative study design was used to examine VE. Results Although the specificity of IC assay revealed 100%, its sensitivity remained weaker (67%) than that of RT-PCR that increased up to 88% depending on disease severity. VE assessed by IC remained stronger than that by RT-PCR: 79% (95% CI: 39–93%) by IC, and 58% (95% CI: −20% to 90%) by RT-PCR. However, VEs by IC and RT-PCR appeared almost similar in higher disease severity: 81.5% (95% CI: 40–94%) by IC and 72% (95% CI: 7–92%) by RT-PCR at severity ≥7, while 97.5% (95% CI: 77–99.7%) by IC and 92% (95% CI: 58–98%) by RT-PCR at severity ≥11. We showed that RV-vaccinated children had 80% [OR = 0.192 (95% CI: 0.052–0.709) less chance to be detected by IC. Conclusion Although the sensitivity and specificity of IC differ by brand type, generally, IC is not as sensitive as RT-PCR. Despite the VEs remain higher by IC, it looks comparable with that of RT-PCR in severe cases implying that VEs evaluated by IC against severe illness remain useful for VE-monitoring.

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Objective : Medicinal plants remain in vogue to treat some diseases in lower socio-economic communities, despite the availability of antimicrobials, often. Majority of rural Bangladeshi and tribal people being grossly illiterate and ignorant, use various herbs to treat a wide range of diseases. Of several medicinal-plants, neem is reported to have enormous impact in treating inflammation and infections. We, therefore, compared the antimicrobial effect of ethanolic neem leave extract (ENLE) on Escherichia coli ( E. coli ), with that of Ciprofloxacin. Materials & Methods : This experimental study compared the in vitro antimicrobial activity between ENLE and Ciprofloxacin on E. coli carried out in Department of Pharmacology and Therapeutics of SS-Medical College, Dhaka, Bangladesh. Antimicrobial efficacy of ENLE and ciprofloxacin (5µg; Oxoid, UK) was determined against E. coli following minimum inhibitory concentration. By filtration and evaporation of Neem leaves ENLE was prepared. Antibiotic Sensitivity Test was performed on Muller-Hinton agar using a twofold serial dilution. Results : ENLE showed an inhibitory effect on the growth of E. coli at the concentration of 3.125 mg/ml. Antibacterial susceptibility of E. coli was performed on MHA and diameters of zone of inhibition by both ENLE and Ciprofloxacin were measured after overnight aerobic incubation at 37°C. Diameter of zone of inhibition against E. coli was 28 ± 0.16 mm with ENLE, 36 ± 0.07 mm with Ciprofloxacin (5µg/disk) (p

Due to lack of robust data on childhood cystic fibrosis (CF) in Bangladesh we sought to evaluate their clinico-epidemiology. A cross-sectional observation was conducted adopting CF-foundation consensus-panel-diagnostic criteria in 3 tertiary-care-hospitals in Bangladesh from 2000 to 2017. Clinically suspected 95 CF-cases were subjected to sweat-chloride testing using locally-developed a fast, cheap and effective indigenously body-wrapped sweating technique measured by US-Easy Lyte-automated microprocessor-controlled analyzer marking ≥60 mmol/L as positive. Mean-age of CF-cases at disease-onset was 16.9 ± 26.6 months that significantly differed with age-at-diagnosis ( P

Background and objectives Globally, coronary artery disease (CAD) remains one of the leading causes of death, both in developed and less economically developed countries (LEDC) including Bangladesh. Diet plays a key role in the pathogenesis processes of atherosclerosis and coronary artery disease (CAD). The purpose of this study was to assess the dietary habit of heart disease cases that had CAD against matched controls. Methodology Complying Helsinki ethical norms, with written consent, this case-control study was performed among 210 subjects: 105 CAD-hospitalized patients (selected from Lab Aid Cardiac and Specialized Hospitals) and 105 healthy subjects from local urban communities having their body mass index (BMI: ranging between ≥18.5 and 27 socio-demographic status, detailed-dietary patterns and blood pressure levels were recorded, anthropometric indices measured, and serum biochemistry (complete lipid profile) tested/analyzed for both the cases and controls. All visually re-checked data were analyzed using appropriate statistical tools (t test/conditional-logistic regressions) on SPS/Windows V.21.0. Result Almost half (45%) CAD patients had hypertriglyceridemia and higher levels of low-density lipoprotein, significantly higher BMA (p=0.001), waist circumference, and waist to hip ratio in male patients (p=0.005 and p=0.020, respectively) than their peer controls. Serum lipid profiles, sugar concentrations, and blood pressure levels of CAD patients revealed higher levels than clinically defined cut-off values as established risk factors for CAD. Odds ratios (CI 95%) as risk factors for consuming junk food {OR=5.49 (2.25–13.38)}, chicken {OR=4.54 (1.89–10.9) was the most, followed by beef {OR=2.68 (1.19–4.98)}, eggs {OR=2.38 (1.14–10.92)}, fish {OR=2.81 (1.31–6.04)}, and vegetables {0R=.968 (0.510–1.839)}. However, fat-free milk, ghee/butter oil, curd/yogurt, and fruits had lower ORs revealing no or less risks for CAD. Conclusion Food habits of CAD patients (with higher BMI level and biochemical indicators of the blood) statistically revealed that consuming junk food, meat, and eggs being riskier, fruits, fat-free milk, yogurt, and vegetable remains have protective effects on CAD.

Global burden of acute viral gastroenteritis remains high, particularly in developing countries including Bangladesh. Sewage water (SW) is an important node to monitor enteric pathogens both in the environment and among the population. Analysis of SW in Dhaka city deems crucially important because a large number of urban-city dwellers live in Dhaka city, the capital of Bangladesh, under a constant threat of precarious sewerage system. In this study, we collected raw SW from five locations of Dhaka city every month from June 2016 to May 2017. It was concentrated with polyethylene glycol (PEG) and investigated for three major enteric viruses, rotavirus A (RVA), norovirus GII (NoV GII) and adenovirus (AdV) using polymerase chain reaction (PCR). Most of these SW samples collected from both hospitals and non-hospital areas yielded enteric viruses: 76% samples were positive for AdV, followed by 53% NoV GII and 38% RVA. Viral load was determined as much as 1 × 107 copies/ml for RVA and 3.5 × 103 copies/ml for NoV GII. Importantly, NoV GII and AdV that can affect people of all ages were predominated during monsoon also when SW overflows and spreads over a wide and crowded area. Genotypes G1, G2, G3, G8, and G9 for RVA, GII.4 for NoV, and type 41 for AdV were detected representing the current profile of circulating genotypes in the population. This study provides the first evidence of distribution of major diarrheal viruses in SW in Dhaka city which is alarming showing grave risk of impending outbreaks through exposure.

Introduction Getting in the dissection hall remains the first-hand experience toward medical training. It is considered as the fundamental part in medical curriculum for centuries, too. Notably, trend of dissection by medicos is often bypassed due to multifaceted reasons, with stress being the main one. We aim to elucidate if any adverse consequence remains on the very first exposure to cadaver dissection and to describe the need of pre-dissection session for newly admitted students. Methods This cross-sectionally designed, descriptive study was conducted at the Holy Family Red Crescent Medical College, Dhaka, Bangladesh. Total 249 undergraduate medical students having at least six months of exposure on human anatomy were subjected to evaluate their primary perception on cadaver dissection employing a pre-tested self-administered, structured questionnaire. Recorded data were analyzed by using SPSS 16. Results Among all respondents, 229 (92%) found dissection exciting and 241 (96.8%) pretty interesting. However, certain negative feeling like agony was reported by 123 (49.4%) while 102 (41%) felt bit uncomfortable. Significantly more negative effect on day-to-day activities pertaining to cadaver dissection was reported by female students ( p Discussion To start the MBBS course, facing the cadaver suddenly may induce sort of negative reactions in student's mind. Since there is no substitute for cadaveric-lessons in medical education, the pre-dissection sessions should gradually be introduced to optimize the learning more productively.

Background In this study, we examined the effectiveness of RV1 and RV5 vaccines during an outbreak of G8P[8] rotavirus group A strain (G8P[8]-RVA). These vaccines were originally designed to provide protection against severe diseases caused by common circulating strains, whereas G8P[8]-RVA remains emerging strain and partially heterotypic to the vaccines. It is imperative to investigate vaccine effectiveness (VE) against G8P[8]-RVA because this strain appears to be predominant in recent years, particularly, in post-vaccine era. Methods RVA infection and genotypes were confirmed by polymerase chain reaction (PCR) followed by sequence-based genotyping. VE was determined during an outbreak of G8P[8]-RVA in Shizuoka Prefecture, Japan, in February-July 2017, retrospectively, by comparing vaccination status of children suffering from acute gastroenteritis (AGE) between ‘PCR-positive’ and ‘PCR-negative’ cases using conditional logistic regression adjusted for age. Results Among 80 AGE children, RVA was detected in 58 (73%), of which 53 (66%) was G8P[8]-RVA. The clinical characteristics of G8P[8]-RVA and other RVA strains were identically severe. Notably, the attack rates of G8P[8]-RVA in vaccinated (61.1%) and unvaccinated (65.5%) children were almost similar. Indeed, no substantial effectiveness were found against G8P[8]-RVA (VE, 14% [95% CI: −140% to 70%]) or other RVA strains (VE, 58% [95% CI: −20% to 90%]) for mild infections. However, these vaccines remained strongly effective against moderate (VE, 75% [95% CI: 1% to 40%]) and severe (VE, 92% [95% CI: 60% to 98%]) RVA infections. The disease severity including Vesikari score, duration and frequency of diarrhea, and body temperature were significantly lower in vaccinated children. Conclusions This study demonstrates the effectiveness of current RV vaccines against moderate and severe, but not against the mild infections during an outbreak caused by unusual G8P[8]-RVA, which was virtually not targeted in the vaccines.

The postnatal transmission of human immunodeficiency virus (HIV) from mothers to children occurs through breastfeeding. Although heat treatment of expressed breast milk is a promising approach to make breastfeeding safer, it is still not popular, mainly because the recommended procedures are difficult to follow, or time-consuming, or because mothers do not know which temperature is sufficient to inactivate HIV without destroying the nutritional elements of milk. To overcome these drawbacks, a simple and rapid method of heat treatment that a mother could perform with regular household materials applying her day-to-day art of cooking was examined. This structured experiment has demonstrated that both cell-free and cell-associated HIV type 1 (HIV-1) in expressed breast milk could be inactivated once the temperature of milk reached 65°C. Furthermore, a heating method as simple as heating the milk in a pan over a stove to 65°C inhibited HIV-1 transmission retaining milk's nutritional key elements, for example, total protein, IgG, IgA, and vitamin B12. This study has highlighted a simple, handy, and cost-effective method of heat treatment of expressed breast milk that mothers infected with HIV could apply easily and with more confidence. J. Med. Virol. 85:187–193, 2013. © 2012 Wiley Periodicals, Inc.

Background: Hand, foot and mouth disease (HFMD) is a common contagious disease among children under 5 years, particularly in the Asia-Pacific-region. We report a localized outbreak of childhood HFMD for the first time from Bangladesh, diagnosed only based on clinical features due to lack in laboratory-diagnostic facilities. Methods: Following the World Health Organization’s case-definition, we conducted a rapid-appraisal of HFMD among all of the 143 children attending Pabna Medical College and General Hospital with fever, mouth ulcers and extremity rash. Data were collected between September and November 2017 using a preset syndromic approach and stringent differential diagnostic-protocols. Results: The mean age of children was 2.9±2.3 years. There was a significant difference among the age and sex of children (P=0.98), first sibling being more belonging to middle-income families (62%). Younger children ( Conclusions: Our findings highlight potential usefulness in diagnosing HFMD based on clinical parameters, although stringent differential diagnosis remains indispensable, which is particularly applicable for resource-constrained countries lacking appropriate virology/essential laboratories. Since no specific treatment or effective vaccination is available for HFMD, supportive therapy and preventive measures remain the primary methods to circumvent disease-transmission augmented by climate-related factors. Standardized virology laboratory warrants appropriate diagnosis and globally representative multivalent-vaccine deem essential towards preventing HFMD.

Objective: To ascertain that antibiotics have no role in the management of bronchiolitis. Design: Multicentre randomized control trial (RCT). Setting: Five purposively selected teaching hospitals in Bangladesh. Patient: Children under 24 months old with bronchiolitis. Interventions: Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. Main outcome measures: Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of ‘rapid’ and ‘gradual’, indicating improvement within ‘four days’ and ‘beyond four days’, respectively. Results: Each intervention group consisted of 98 ± 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p

Antigenic determinants expressed on the bacterial cell surface are of importance in the serological characterization and microbiological diagnosis. The bacterial strains carrying these identical or similar antigenic epitopes might react with antibodies produced against other strains. In this study, strong immunogenicity and antigenic cross reactivity were demonstrated among V. cholerae O1, S. flexnerii 2a and H. influenzae b surface components. The enzyme linked immunosorbent assay (ELISA) results were supported by Western blot analysis, where at least 20 antigenic bands, were obtained in each of the reactions, when the surface components were reacted with the homologous antisera. The indirect ELISA results also demonstrated high degree of antigenic relatedness between the surface components of these species, where each surface component was reacted with the heterologous antisera. Western blot analysis also revealed cross reactions between the surface components suggesting common distribution of antigens/epitopes in these bacterial species. This study, thus, gave a clear idea of the level of antigenic sharing and variations among the pathogenic V. cholerae O1, S. flexneri 2a and H. influenzae b strains, which in future, may help in selecting a proper candidate for vaccines and immunodiagnostics development.

Despite major improvements in the diagnosis of pathogenic organisms causing acute respiratory infections (ARIs), details of infections caused by atypical pathogens are not well understood, particularly in developing countries. This clinical and epidemiological research was conducted in Bangladesh to explore the prevalence of atypical pathogens in causing childhood pneumonia. Sixty-four children with ARI were studied at the Pediatric Outpatient Department of Dhaka Medical College Hospital, Bangladesh, during September through December 2000. In addition to clinical examination, hematological, radiological, and bacteriological examinations were performed. Antibody titers from paired sera against Mycoplasma pneumoniae and Legionella spp. in the acute and convalescent phases revealed that none of these children were infected with M. pneumoniae, while only one serum sample was positive for L. pneumophila serogroup 4. Antibody titers against Chlamydophila (Chlamydia) pneumoniae, determined by an indirect microimmunofluorescence method, and by an enzyme-linked immunosorbent assay (ELISA) kit (HITAZYME C. pneumoniae kit) indicated that 13 children (20.3%) were infected with C. pneumoniae. Our results indicate a high prevalence rate of C. pneumoniae, suggesting it is as an important causative pathogen of childhood pneumonia in Bangladesh.

Poultry is a rampantly expanding agro-industry in Bangladesh like other developing countries. Several studies have detected multidrug resistance (MDR) Proteus mirabilis from poultry meat globally; however, no similar data was available for poultry samples in Bangladesh. P. mirabilis is a zoonotic human pathogen of urinary tract infection (UTI), nosocomial infection and wound infection, therefore, a potential threat to public health. We isolated P. mirabilis from chicken droppings collected from local commercial poultry farms and examined their antimicrobials susceptibilities. Chicken droppings were streak-cultured onto xylose lysine deoxycholate agar plates after enriching in buffered peptone water. Selective colonies were identified by biochemical test and API20E kits. Antimicrobial susceptibilities were tested by Kirby-Bauer disk diffusion method. Total 36 P. mirabilis were isolated from 39% (27 of 70) chicken droppings. Tetracycline evidenced as the highest individually-resistant (94%, 34/36) antibiotic (AB) while ciprofloxacin was the lowest (17%, 6/36). Hazard lies when 83% P. mirabilis were proved to be MDR (30/36), being resistant to three or more AB. Findings provide a baseline data on MDR P. mirabilis circulating around these PFs, it would assist the veterinarian in rational treatment and biosafety planning. More detail studies will be required to clarify their antimicrobial resistance and clinical relevance.

The Ascaris lumbricoides expelled by 1765 people in a poor urban community in Bangladesh were recovered and counted after the subjects had been treated with pyrantel pamoate. The subjects were divided into 22 classes by age and sex (mean n = 80) to examine how prevalence, mean worm burdens and measures of aggregation of worms varied with age and between the sexes, and to see how a measure of aggregation, k, calculated in 3 ways (by maximum likelihood, from moments, or from the percentage uninfected) compared with an empirical aggregation index (the percentage of subjects who expelled an arbitrary 80% of all worms) and with the proportion who were moderately to heavily infected (defined as > or = 15 worms). The prevalence of infection ranged from 64% to 95%, mean worm burdens ranged from 7 to 23 worms, and k ranged from 0.3 to 1.2. There were significant differences between adult males and females in the prevalence of infection, mean worm burdens and measures of aggregation, differences which are probably driven more by behaviour than immunity. The parameter k was better described in terms of the proportion who were moderately to heavily infected (linear; range 0.15-0.58) than by the empirical aggregation index (non-linear; range 0.30-0.49).

Strongyloides stercoralis infections were shown to be aggregated in households in an urban slum community in Dhaka, Bangladesh. Parasitological data on 880 residents living in 280 households were analysed statistically using 3 different tests, each of which yielded significant evidence of household aggregation of S. stercoralis infection. One test was applied to the data after stratification for 4 variables which were previously shown to be independently associated with infection. Evidence of household aggregation of infection remained after stratification, suggesting that aggregation is due not only to shared risk factors, but also to either familial genetic predisposition to infection or close contact person to person transmission of infection within households.

Background Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management. Findings Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks. Conclusions We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.

Stool samples from 880 residents in an urban slum in Dhaka, Bangladesh, were collected on 3 occasions over one year, and examined for intestinal parasites. Information on many potential risk factors for infection was obtained by questionnaire from a respondent in each household studied. In a crude univariate analysis of the data, several of the factors were found to be significantly associated with Strongyloides stercoralis infection. Most of these factors were co-variate with one another, and with poverty generally. Using Mantel-Haenszel χ 2 tests to control for confounding effects of each variable individually, the following 4 factors remained independently associated with S. stercoralis infection: respondent's use of a community latrine rather than a private latrine, living in a house with an earth floor rather than a cement floor, being of Bihari ethnicity, and being 7–10 years of age. Implications of these results for the epidemiology and control of strongyloidiasis are briefly discussed.

Objective: Since the underlying mechanisms of febrile seizure (FS) having multi-factorial aetiology yet remains unclear, we conducted this prospectively designed cross-sectional study to determine if there was any simultaneous change in zinc (Zn) concentration (conc.) in serum and cerebrospinal fluid (CSF) among the FS children in comparison to their matched non-seizure febrile (NSF) peers. Methods: Zn concentration (level) in both serum (intravenous blood) and CSF (lumber puncture: LP) of 50 children with FS and 30 NSF peers (serving as control) were measured employing graphite furnace atomic absorbance spectrophotometer. Data were analysed to compare Zn level between two groups using appropriate statistical tools employing SPSS/Windows 12.0. Results: Mean Zn conc. in both serum and CSF was less in FS children (464.60 ± 64.57 and 46.28 ± 7.46, respectively) than their matched NSF peers (749.33 ± 73.19 μg/L and 111.28 ± 19.11 μg/L, respectively) showing significant differences both in serum (p < 0.001) and CSF (p < 0.001). None of serum or CSF-Zn differed significantly with age, degree and duration of fever between FS and NSF peers. CSF-Zn among these children showed an upward trend in LP specimen taken beyond 12 h following FS episodes. Conclusion and recommendation: Serum and CSF-Zn simultaneously decreased in FS children in comparison to their matched NSF peers. Further prospectively designed multicentral studies are recommended to conduct in geographically diverse regions involving larger sample to confirm or refute our findings. It remains crucial in standardizing/strengthening national seizure prevention protocol with adequate Zn supplementation.

Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh.A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used.To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children.Direct interviews were used to collect the data and clinical check up was performed in all children.In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P0.001) and bed linen (P0.001), overcrowded sleeping arrangements (P0.001) and infrequent bathing (P0.001) with soap (P0.001). This was further related to household income (P0.001 for both).The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.

Arsenic contamination of ground water is a major public health problem in Bangladesh. It is estimated that more than 20 million people are potentially exposed to arsenic poisoning. This cross-sectional study was carried out in Haziganj Upazila under Chandpur district between September to December, 2001 with the objectives to assess the socioeconomic consequences and disease burden in terms of Disability Adjusted Life Years (DALYs). A total of 168 subjects suffering from arsenicosis were studied. Both age and disability weights were considered to calculate DALYs. Agricultural labour and housewives suffered more from the disease. A strong relationship (p0.005) was found between duration of suffering and occupation of the subjects. Also, there was a strong relationship between age of onset and education of the study subjects (p0.006). No deaths directly from arsenicosis were reported. It may be noticed that 47% of the patients would be living with disability for more than 51 years. A strong relationship exists (p0.002) between educational level and Years Lived with Disability (YLDs). A total of 7930 YLDs were lost due to arsenicosis, which accounts for 1908 DALYs.

Transfusion-dependent children are more prone to acquiring various transfusion-transmitted infections (TTIs), such as hepatitis B (HBV), hepatitis C (HCV), HIV, and others. Since the magnitude of these infections among thalassaemic children in Bangladesh is not well-known, this study was conducted to assess the prevalence of TTIs among them (who received more than three blood transfusions) compared to their age- and sex-matched controls (non-thalassaemics and those who had never had a transfusion). Seromarkers for HBV, HCV, HDV, Treponema pallidum, and HIV were tested, and the results were analyzed using SPSS/Windows 10.5. Of 259 children studied, 152 (58.69%) were thalassaemic (mean age 6.8 +/- 3.6 years), and 107 were controls (mean age 6.7 +/- 3.53 years). The HBV and HCV-markers were found significantly more often among multi-transfused thalassaemic children than among the controls in terms of HBsAg (13.8% vs 6.5%, p0.04), anti-HBc total (39.5% vs 9.4%, p0.0001), and anti-HCV (12.5% vs 0.9%, p0.0001). HBeAg did not differ (p = 0.82) between the thalassaemics (9.52%) and the controls (14.28%), whereas anti-HBe differed (0% vs 57.14%, p0.003). Neither the thalassaemics nor the controls were positive for HDV, HIV, or T. pallidum. Since more thalassaemic children acquired hepatitis B and C infections through multiple blood transfusions, it is recommended that the safe blood-transfusion programme be strengthened and mass vaccination against HBV (even who suffer from HCV) in Bangladesh be undertaken.

This randomized double blind community trial was conducted on Ascaris infested children (n = 85) aged 2 to 12 years and was aimed to study the impact of deworming on nutritional status, in an urban slum of Dhaka, Bangladesh. The change of weight gain was significantly higher in children given anthelmintics than those given placebo (0.92 kg vs. 0.54 kg). A multiple linear regression model shows that after controlling sex, deworming and height were positively correlated while age and weight were negatively correlated with weight change.

Transfusion-transmitted infections (TTIs) remain a major global public health problem and a challenge to transfusion services worldwide particularly in developing countries in managing transfusion-dependent children especially the thalassaemics. However developed countries are not exempt from TTIs despite multiple layers of protection in their advanced blood collection centres. The magnitude of this problem is directly related to the prevalence of TTIs among blood donors. To assess the global burden of TTIs the World Health Organization (WHO) estimated that 3% of the world’s population (.170 million people) are infected with hepatitis C virus (HCV). The global prevalence of HCV reported by the WHO ranges from 10 to 15% to as little as 0.04%. HCV in blood donors varies from 0.4 to 19% including 0.9% among Namibian first-time blood donors. The overall prevalence of HCV in Bangladesh as documented in the WHO’s records ranges between 1 and 2.5% whereas it was observed in 2.4% of professional donors (poor people who sell their own blood to make a living and who have had no evident disease) in Bangladesh. However in voluntary donors (healthy adults who only donate blood in emergencies) in India the prevalence of HCV ranged from 0.8 to 1.78%. In Japan and Germany figures of 0.6% and 0.2–0.8% respectively have been reported. (excerpt)

SUMMARYAntibody responses to Ascaris lumbricoides worm antigens were examined by ELISA in a case-control study of 2 groups of Bangladeshi children, one of which had been shown over a period of 12 months to be consistently lightly infected (controls) and the other consistently heavily infected (cases). The children showed a wide range in intensity of infection; children identified as cases were on average 4 times more heavily infected than the controls. There were no significant differences in weight, height, mid-upper arm circumference and skinfold thickness between the case or control subjects at the time blood samples for analyses by ELISA were collected. Children with repeatedly heavy infections with A. lumbricoides had higher concentrations of antibody isotypes to the antigens of A. lumbricoides than children who are repeatedly lightly infected. IgG1, IgG4 and IgE to worm antigens occurred in significantly higher concentrations in heavily infected subjects. This suggests that these antibody responses simply reflect the intensity of infection and may not play a significant role in protecting against heavy infections.

Background The UN-Resolution defines violence against women-VAW as any-act of gender-based violence resulting in physical/sexual/psychological-harm/threat to women, coercion or arbitrary-deprivation of liberty, in her life. Despite several national/global initiatives (Nairobi-Strategy'85,Beijing-Platform'95),promoting/enforcing women's-rights remains slower. In Asia, prevalence/magnitude of VAW is being-rampant. Here, we present preliminary-findings on family-violence (FV) from Bangladesh and its' negative-impact on child's health and psycho-social state. Purpose Study occurrences of husband-perpetuated FV and assess its effect on child's health and psycho-social state (school-performances). Methods This cross-sectional survey was conducted among 72 married-women living-in 64 households in randomly-selected three rural-villages. Adopting a 2-tier-methodology we interviewed all women using a pre-tested structured-questionnaire, and assessed their perception on-VAW, qualitatively (using FGDs, In-depth-Interview/IDIs). Outcome Of 72 women, 94% were less/ill-literate, 53% poor, majority being 1st wives. Of 68% (n=49) with some-degree of family-violence, 45% tolerated mild-form(mostly verbal and rarely physical abusing/slapping), 37% endured moderate-form (verbal/physical-abusing 3-4 times/year) and 18% sustained severe-form(physical torturing every1-2 weeks-apart) of VAW. While verbal-abusing was confined in rebuking/reprimand; physical-abuse ranged from scolding to battering: fist-hitting/hand-twisting, beating, punching, kicking/knocking. Few severe-cases sustained throat-grabbing/knife-charging/burnt-off body-parts/forced-sex and suicidal attempts. Attesting these findings, post-FGD/IDI-transcript analysis revealed dowry-demand, gross-poverty and/or husband-dependency was prime-causes of FV. But, FV-victims never raised voice to avoid social-chaos/gossip and/or pro-male(husband)-biased unfair-judgment(s). Severity of FV-cases was associated with child's health(pre-set-parameters), (p Significance/Contribution Occurrence of FV in rural-Bangladesh (breeching women-right) and exerting negative-impact on child's health/psycho-social state(violating child-right) remains imperative for immediate intervention towards stopping male-driven socio-cultural-epidemics right now if not possible to combat it instantly. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background Parents often possess unrealistic expectation on the ability of school-bound children in crossing roads safely. Little is known about mothers9 understanding of such unwise-behaviour plunging them into serious road-traffic/RT-injuries. Here, we report mothers9 perception on RT-regulations with certain plausible-factor(s) predisposing reckless-attempts of fatal-RTAs. Purpose Study perception of such mothers9 accompanying school-bound children on RT-regulations/laws; and, examine if mothers9 education/knowledge remains plausible-predisposing factor(s) in taking such deadly-attempts of road-crossings. Methods We conducted this study among 148 mothers accompanying school-bound-pedestrian children crossing busy city-roads adjacent to nine randomly-selected school-fringes in Dhaka city. Two-tier-methodology was used: assessed mothers9 knowledge (using structured-questionnaire), quantitatively and determined perception, qualitatively (Focus Group Discussion-FGDs). Outcome Lower-maternal-education (Lo-Mat-Ed) was associated with running-off roads (p Significance/Contribution Parental-education, a primary determinant of health-related-behaviour, requires RT-safety adaptation. Since knowledge alone is not sufficient to institute RT-safety, developing instructive/environment strategies remains imperative, but mother9s proficiency on road-safety must be assessed prior to confer responsibility of pedestrian-school-bound-children, as our findings suggest along with imparting intensive-training/education on road-safety.

Background: Outbreaks of scabies in residential institutions is not reported so far particularly on socio-economic consequences. Study design: Community-based clinico-epidemiological study in children from randomly selected 6 institutions in Dhaka. Objectives: Study socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children. Methodology: Prospective study (clinical Check up & direct interviews). Results: Of 492 scabies-infested-children, 92.5% were boys (mean age:11.2±2.4 years), 63% of fathers and 98% mothers of whom were illiterate/had primary education. While 55% of their fathers were low-paid workers, 99% mothers were housewives. Of 98% children with scabies, 71% had been re-infected (96% during winter), randomly assigned anti-scabies drugs revealing a cure rate of 85.5%. Majority(74%) used to live in poorly-ventilated damp rooms with bizarre/overcrowded sleeping arrangements and had poor personal hygiene:21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on same communal string/shelf. Sanitation was poor too:39% bathed infrequently, although 97% used to do mandatory ablution. Most children(61%) washed their clothes(including undergarments) 2-3times a fortnight, 35% did so every 2-3 days and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P< 0.001) and bed linen(P< 0.001), overcrowded sleeping arrangements(P< 0.001) and infrequent bathing without(P< 0.001) & with soap(P< 0.001)-which was related to family income(P< 0.001, both). Conclusion: These findings having potentially dangerous implications for public health, demands immediate attention to developing sustainable long-term intervention programs to combat scabies hyperendemicity (?silent epidemics) to save thousands of children from impending serious complications.

Intestinal helminths are among the most common and widespread of human infections. Because it is typical to find that most worms are aggregated in a few potential hosts it has been suggested that some individuals are predisposed to heavy infections and that morbidity could be controlled by the treatment of heavily infected individuals only. We have studied the prevalence and intensity of reinfection with the intestinal nematode Ascaris lumbricoides among people living in Dhaka, Bangladesh. 880 people were treated with pyrantel pamoate three times at six month intervals, and on each occasion they collected all their stools for 48 h after treatment. Worms expelled by each subject were counted and weighed. The prevalence of infection at round 1 of treatment was 89% and the mean burden was 18.5 worms. Reinfection was rapid and at rounds 2 and 3 the prevalence was 82% and 80%, respectively, with mean burdens of 14.0 and 11.5 worms. The intensity of reinfection was not random: more subjects than expected became heavily reinfected (greater than or equal to 15 worms) and more subjects than expected remained lightly infected (less than or equal to 14 worms) (p less than 0.001). Worms were highly aggregated at each round of treatment but although just over 10% of all subjects were heavily infected at each and every round of treatment, over 60% of all subjects were heavily infected at least once. The findings show that some individuals seem to be susceptible to heavy infection whereas others are not, that deworming has a greater effect on the intensity of infection than on the prevalence, and that mass chemotherapy is likely to be a more effective means to control morbidity than is selective treatment of heavily infected individuals only.

DOI: 10.3329/jbcps.v27i1.4236 J Bangladesh Coll Phys Surg 2009; 27: 1-3