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Background & objectives: Bangladesh is afflicted with periodic dengue outbreak every few years and one of the worst upsurges was recorded in 2019 during which there was an increasing trend of dengue with unusual symptoms which were not so common before. This study aims to describe the experience of three tertiary care centres of Dhaka regarding the clinical and laboratory, hospital outcome and management profile of the Expanded Dengue Syndrome (EDS) cases admitted from the 2019 outbreak. Methods: The current work was a cross-sectional observational study which took place from August 1 to December 31 2019 at three major tertiary care centres in Dhaka, Bangladesh. Out of total 2017 screened dengue cases, 49 met the inclusion criteria and 39 were enrolled after taking informed written consent. Data was analysed using Microsoft Excel and Graph pad prism 9.3.1. A probability value of p

Introduction COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.Methods We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).Results Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p

BackgroundIn Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups.MethodologyBayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups.Principal findingsThe population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh.Conclusions/significanceFor each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence.

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT-PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07-9.77). Female participants were 5.50 times (95% CI: 2.22-13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13-3.20), pain/discomfort (OR 1.82, 95% CI: 1.04-3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22-3.84). Comorbid patients were 1.75 times (95% CI: 1.07-2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31-8.18), usual-activity (OR 3.08, 95%CI: 1.21-7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09-6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35-8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients.

Abstract Background Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. Methods A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. Results A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months. Conclusions The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cause severe life-threatening diseases called acute respiratory distress syndrome (ARDS) owing to cytokine storms. The mortality rate of COVID-19-related ARDS is as high as 40% to 50%. However, effective treatment for the extensive release of acute inflammatory mediators induced by hyperactive and inappropriate immune responses is very limited. Many anti-inflammatory drugs with variable efficacies have been investigated. Colchicine inhibits interleukin 1 beta (IL-1β) and its subsequent inflammatory cascade by primarily blocking pyrin and nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 (NLRP3) activation. Therefore, this cheap, widely available, oral drug might provide an added benefit in combating the cytokine storm in COVID-19. Here, we sought to determine whether adding colchicine to other standards of care could be beneficial for moderate COVID-19 pneumonia in terms of the requirement for advanced respiratory support and mortality.Methods and findingsThis blinded placebo-controlled drug trial was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 300 patients with moderate COVID-19 based on a positive RT-PCR result were enrolled based on strict selection criteria from June 2020 to November 2020. Patients were randomly assigned to either treatment group in a 1:1 ratio. Patients were administered 1.2 mg of colchicine on day 1 followed by daily treatment with 0.6 mg of colchicine for 13 days or placebo along with the standard of care. The primary outcome was the time to clinical deterioration from randomization to two or more points on a seven-category ordinal scale within the 14 days post-randomization. Clinical outcomes were also recorded on day 28. The primary endpoint was met by 9 (6.2%) patients in the placebo group and 4 (2.7%) patients in the colchicine group (P = 0.171), which corresponds to a hazard ratio (95% CI) of 0.44 (0.13-1.43). Additional analysis of the outcomes on day 28 revealed significantly lower clinical deterioration (defined as a decrease by two or more points) in the colchicine group, with a hazard ratio [95%CI] of 0.29 [0.098-0.917], (P = 0.035). Despite a 56% reduction in the need for mechanical ventilation and death with colchicine treatment on day 14, the reduction was not statistically significant. On day 28, colchicine significantly reduced clinical deterioration measured as the need for mechanical ventilation and all-cause mortality.ConclusionColchicine was not found to have a significant beneficial effect on reducing mortality and the need for mechanical ventilation. However, a delayed beneficial effect was observed. Therefore, further studies should be conducted to evaluate the late benefits of colchicine.Clinical trial registrationClinical trial registration no: ClinicalTrials.gov Identifier: NCT04527562 https://www.google.com/search?client=firefox-b-d&q=NCT04527562.

BackgroundWearing masks or personal protective equipment (PPE) has become an integral part of the occupational life of physicians due to the coronavirus disease 2019 (COVID-19) pandemic. Most physicians have been developing various health hazards related to the use of different protective gears. This study aimed to determine the burden and spectrum of various health hazards associated with using masks or PPE and their associated risk factors.MethodsThis cross-sectional survey was conducted in Dhaka Medical College from March 01-May 30, 2021, among physicians from different public hospitals in Dhaka, Bangladesh. We analyzed the responses of 506 physicians who completed case record forms through Google forms or hard copies.FindingsThe mean (SD) age of the respondents was 35.4 [7.7], and 69.4% were men. Approximately 40% were using full PPE, and 55% were using N-95 masks. A total of 489 (96.6%) patients experienced at least one health hazard. The reported severe health hazards were syncope, severe dyspnea, severe chest pain, and anaphylaxis. Headache, dizziness, mood irritation, chest pain, excessive sweating, panic attack, and permanent facial disfigurement were the minor health hazards reported. Extended periods of work in the COVID-19-unit, reuse of masks, diabetes, obesity, and mental stress were risk factors for dyspnea. The risk factors for headaches were female sex, diabetes, and previous primary headaches. Furthermore, female sex and reusing masks for an extended period (> 6 h) were risk factors for facial disfigurement. The risk factors for excessive sweating were female sex and additional evening office practice for an extended period.ConclusionsHealthcare workers experienced several occupational hazards after using masks and PPE. Therefore, an appropriate policy is required to reduce such risks.

BackgroundPost-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome.MethodsWe conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate 93% without assisted oxygen inhalation.FindingsAmong the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02-1.48, p = 0.03), those who required a prolonged time for clinical improvement (pConclusionFemale sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome.

BackgroundGlobally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection.ObjectiveTo observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases.Design, setting, and participantsThis was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II.ResultsThe cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)].ConclusionsThe prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.

Objectives To determine the national prevalence of risk factors of non-communicable diseases (NCD) in the adult population of Bangladesh.Design The study was a population-based national cross-sectional study.Setting This study used 496 primary sampling units (PSUs) developed by the Bangladesh Bureau of Statistics. The PSUs were equally allocated to each division and urban and rural stratum within each division.Participants The participants were adults aged 18 to 69 years, who were usual residents of the households for at least 6 months and stayed the night before the survey. Out of 9900 participants, 8185 (82.7%) completed STEP-1 and STEP-2, and 7208 took part in STEP-3.Primary and secondary outcome The prevalence of behavioural, physical and biochemical risk factors of NCD. Data were weighted to generate national estimates.Results Tobacco use was significantly (p

Recommender systems suggest items of interest to users based on their preferences. These preferences are typically generated from user ratings of the items. If there are no ratings for a certain user or item, it is said that there is a cold start problem, which leads to unreliable recommendations. Existing studies that reviewed and examined cold start in recommender systems have not explained the process of deriving and obtaining the auxiliary information needed for cold start recommendation. This study surveys the existing literature in order to explain the various approaches and techniques employed by researchers and the challenges associated with deriving and obtaining the auxiliary information necessary for cold start recommendation. Results show that auxiliary information for cold start recommendation is obtained by adapting traditional filtering and matrix factorization algorithms typically with machine learning algorithms to build learning prediction models. The understanding of similar or connected user profiles can be used as auxiliary information for building cold start user profile to enable similar recommendations in social networks. Similar users are clustered into sub-groups so that a cold start user could be allocated and inferred to a sub-group having similar profiles for recommendations. The key challenges of the process for obtaining the auxiliary information involve: (1) two separate recommendation processes of conversion from pure cold start to warm start before eliciting the auxiliary information; (2) the obtained implicit auxiliary information is usually ranked and sieved in order to select the top rated and reliable auxiliary information for the recommendation. This study also found that cold start user recommendation has frequently been researched in the entertainment domain, typically using music and movie data, while little research has been carried out in educational institutions and academia, or with cold start for mobile applications.

Reattachment of a fractured fragment to the remaining tooth is challenging but one of the best treatment protocol in regards to aesthetics, function as well as patients acceptance. This case report presents a 20 years old male with an oblique complicated crown fracture of maxillary left central incisor tooth. The procedure used to repair the fracture regarding this case included flap surgery with endodontic treatment. The root canal was filled with a root canal sealer and gutta-percha. After root canal obturation, fragments were reattached with duel cure composite resin using a glass fibre post. After 12 months evaluation, clinical and radiographic examinations showed a stable re-attachment, good aesthetics and healthy periodontium. DOI: http://dx.doi.org/10.3329/updcj.v3i1.17983 Update Dent. Coll. j: 2013; 3 (1): 37-40

Background: The greatest threats to developing teeth are dental caries and traumatic injury. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. Objectives: This prospective study was conducted to observe the clinical and radiological findings of pulpotomies done with Mineral Trioxide Aggregate (MTA) &Calcium Hydroxide{Ca(OH)2} and to evaluate success rate of MTA in maintaining pulpal health in teeth with carious lesion. Materials and Methods: In this clinical trial study, 40 primary molars were treated by a conventional pulpotomy technique. They all fulfill the inclusion criteria and gave consent regarding this study. All selected teeth were evenly divided into 2 test groups. In group 1, the MTA pulpotomy (experimental) was performed, whereas in group 2, the conventional Ca(OH)2 pulpotomy (control) was done. The teeth of both groups were finally restored by Glass Ionomer Cement (GIC). The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. Result: The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 3 teeth treated with Ca(OH)2 and one treated with MTA. The remaining 36 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 4 teeth treated with MTA and 2 teeth treated with Ca(OH)2. Conclusion: Based on this clinical and radiographical evaluation study of 3, 6, and 12 months follow-up, MTA could be used as a safe material for pulpotomy in cariously and mechanically exposed primary molars and seems to be a suitable alternative to calcium hydroxide. Further research, however, is required to clarify this conclusion. DOI: http://dx.doi.org/10.3329/updcj.v3i1.17981 Update Dent. Coll. j: 2013; 3 (1): 24-31

In the present study, a conservative approach for removal of a fractured instrument located at the apical root area of maxillary left central incisor of a 35 years old male was performed and the clinical outcome was evaluated. On clinical examination, localized swelling associated with discharge of pus was seen near to the affected tooth. Furthermore, the tooth was restored with temporary filling and it was severely discolored. On radiographic examination, a radiolucent area around the apex was seen and there was a fractured instrument at the apex of the tooth. Tooth was then treated as nonsurgical endodontic technique and an attempt to remove the fractured instrument was undertaken. The results confirms that fractured instrument was successfully removed by using the File Braiding technique and after 3 months follow up, the tooth was asymptomatic and radiograph shows complete healing of the periapical lesion. DOI: http://dx.doi.org/10.3329/updcj.v2i1.13957 Update Dent. Coll. j: 2012; 2 (1): 25-30

A 18-year-old boy came with the complaints of mild pain during mastication on the lower right posterior tooth for two weeks. He gave the history of severe pain on offending tooth one month before, which subsided within a few days after taking medication from a local pharmacy. On clinical examination, a deep occlusal caries was present on the lower right first molar tooth. The tooth was tender to the vertical percussion but not associated with any swelling or discharge. The vitality test revealed that the tooth was non-vital.

A 22-year-old male reported to the outpatient department with the complaints of occasional pain and tingling sensation on his maxillary left posterior teeth and mandibular anterior teeth for 3 to 4 months with slight mobility of mandibular anterior teeth. He had no significant medical history as well as no history of trauma and familial history of similar disease. He also stated that he went to Dhaka Dental College where he received clinical and radiological investigations and diagnosed as a case of external tooth resorption. In the Dhaka Dental College, upper left 1st and 2nd premolar, mandibular right central and lateral incisor teeth were extracted.

A 16-year-old boy referred to our department with chronic discharging sinus during the course of root canal treatment on the upper left lateral incisor tooth from a private dental clinic. The patient had a history of trauma to the tooth 1 year back. On clinical examination, the coronal portion of the upper left lateral incisor tooth was found to have filled with temporary restorative material. The tooth was sensitive to palpation and percussion with the presence of a sinus tract. On vitality test, there was no response to heat and cold test.

ABSTRACT: The present paper reports on the effect of poly(ethylene glycol) (PEG) addition on injectability, setting behaviour, and mechanical properties of calcium phosphate cement (CPC) for injectable bone filling applications. Calcium hydroxide, Ca(OH)2, and diammonium hydrogen phosphate, (NH4)2HPO4, have been used as precursors in wet chemical precipitation synthesis of hydroxyapatite powder. Cement paste was prepared with different powder-to-liquid ratios, varied at 1.0, 1.3, 1.5 and 2.0. The incorporation of PEG was also varied at 1, 2, 3, 4 and 5 wt% at the powder-to-liquid ratio of 1.3. The CPC produced was then evaluated in terms of injectability, setting time and mechanical strength. The results indicated that PEG addition significantly improved setting time, injectability, as well as compressive strength of CPC. Without PEG, the initial setting time ranged between 3 and 122 min, while the final setting time ranged between 5 and 277 min. The addition of PEG has significantly improved setting time where the initial setting time ranged from 47 to 88 min and the final setting time ranged from 182 to 228 min. The extrusion load decreased when PEG was added, which revealed an improvement in injectability; 82.5% without PEG addition and 95.5% when 5% PEG was added. The compressive strength of CPC is in the range of 0.59 to 1.344 MPa and its porosity is in the range of 39.2% to 47.1%. With the incorporation of PEG, the compressive strength greatly increased to the range of 1.167 and 1.786 MPa.. ABSTRAK: Penyelidikan ini melaporkan tentang kesan menambah polietilina glikol (PEG) terhadap sifat-sifat simen kalsium fosfat seperti keupayaan suntikan, masa pengerasan dan kekuatan mekanikal. Kalsium hidroksida dan diammonium hidrogen fosfat digunakan sebagai reagen dalam kaedah pemendakan kimia basah bagi menghasilkan serbuk hidroksiapatit. Pes simen disediakan dengan nisbah serbuk kepada cecair yang berbeza, dengan nisbah 1.0, 1.3, 1.5 dan 2.0. Kemudian, PEG ditambah ke dalam simen kalsium fosfat dengan kepekatan yang berbeza, bernilai 1, 2, 3, 4 dan 5 wt% bagi 1.3 nisbah serbuk kepada cecair. Simen yang terhasil diuji bagi menilai keupayaan suntikan, masa pengerasan dan kekuatan mekanikal. Keputusan ujian-ujian tersebut menunjukkan bahawa penambahan PEG ke dalam simen telah meningkatkan kebolehan simen untuk disuntik, mengurangkan masa pengerasan simen dan meningkatkan kekuatan mekanikal simen. Simen tanpa PEG mempunyai masa pengerasan awal daripada 3 min kepada 122 min dan masa pengerasan akhir daripada 5 min kepada 277 min. Apabila PEG ditambah, masa pengerasan simen menjadi lebih baik dengan masa pengerasan awal daripada 47 min kepada 88 min dan masa pengerasan akhir daripada 182 min kepada 228 min. Peningkatan dalam keupayaan simen untuk disuntik telah dibuktikan dengan pengurangan beban penyempitan apabila PEG ditambah ke dalam simen. Simen tanpa PEG mempunyai 82.5% keupayaan suntikan dan meningkat kepada 95.5% apabila 5% PEG ditambah. Kekuatan mampatan simen bernilai antara 0.59 dan 1.334 MPa dan keliangan simen bernilai antara 39.2% dan 47.1%. Kekuatan mampatan simen meningkat dengan ketara apabila PEG ditambah, bernilai antara 1.167 dan 1.786 Mpa.

Background: Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh. Materials and Methods: This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured. Results: There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form,

A 33 year old male patient came to the outpatient Department complaining of the bad appearance of his upper left central incisor tooth. He had no history of trauma in that area but the tooth was discolored gradually (Figure 1A). Furthermore, the tooth was asymptomatic. There was no pain and discomfort during mastication. The patient had gastric irritation for the last 5 years and still using omeprazole irregularly. The clinical examination indicates that the left central incisor tooth was yellowish in color and the dentine was found to be exposed (Figure 1B). There was gross tooth tissue loss at the labial surface that includes the incisal edge of the tooth.

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The purpose of the present study was to assess the giomer retention following application of one step self etch adhesive and one-step self-etch adhesive plus an extra hydrophobic adhesive layer in non-carious cervical lesion. Twenty four participants having bilateral cervical lesion at the maxillary premolars teeth were selected. Following cleaning of the cervical lesions, 24 left premolar teeth were restored with giomer by using the one-step self-etch system (Group A) and 24 right premolar teeth were restored with giomer by using one-step self-etching plus extra hydrophobic adhesive layer (Group B). Participants were recalled at 6 and 15 months for evaluating the clinical outcome. The results showed that at 15 months, 18 giomer restorations in Group A and 21 in Group B were intact inside the cavity and no significant difference was found between the two groups. It can be concluded that giomer restoration used with one-step self- etching plus additional adhesive layer slightly improved the retention of the material.

The supply of water for rural populations in developing countries continues to present enormous problems, particularly where there is arsenic contamination in the groundwater, as exists over significant parts of Bangladesh. In response, improvements in the sustainability of water supplies are feasible through the use of a combination of water sources wherein rainwater harvesting is employed for a portion of the year. This can potentially reduce the duration of the year during which arsenic-contaminated groundwater is utilized. As demonstrated, a rainwater cistern volume of 0.5 m3 in the Jessore district area of Bangladesh can provide rainwater for periods averaging 266 days of the year, which allows groundwater at 184 µg/L arsenic to be used as a water supply for the remainder of the year. This dual supply approach provides the body burden equivalent to the interim drinking water guideline of arsenic concentration of 50 µg/L for 365 days of the year (assuming the water consumption rate is 4 L/cap/day for a family of five with a rainwater collection area of 15 m2). If the water use rate is 20 L/cap/day, the same cistern can provide water for 150 days of the year; however, although this is insufficient to supply water to meet the body burden equivalent guideline of 50 µg/L. Results are provided also for different rooftop areas, sizes of cisterns and alternative arsenic guidelines [World Health Organization (WHO) and Bangladeshi]. These findings provide useful guidelines on supply options to meet sustainability targets of water supply. However, they also demonstrate that the use of cisterns cannot assist the meeting of the 10 µg/L WHO target arsenic body burden, if the arsenic contamination in the groundwater is high (e.g., at 100 µg/L).

The dental implant is used to replace the natural tooth system. It requires comprehensive preoperative planning and precise surgical execution. In this case report, a 45 year old male presented with missing upper left maxillary central incisor which was extracted 5 months back. He had discomfort during function and unwillingness to smile. He wanted to replace that edentulous area. The treatment options for replacing the missing tooth were discussed with the patient. Finally, with patient's consent the decision was made to replace that edentulous area with an implant supported porcelain fused to metal prosthesis in an esthetic manner. Recall visits exhibited patient's high-level confidence of smile with optimum satisfaction and successful aesthetic outcome.

Esthetic rehabilitation of crown fractured anterior teeth is one of the greatest challenges to the dental specialists in concern of long-term biological function. Traditional views demonstrate limitations with much controversy in MICD (Minimally invasive cosmetic dentistry) concept. To meet the challenge a new biological approach in endo esthetic view is considered. This case report represents the management of a fractured right maxillary central incisor tooth of 27 year-old-male patient where his own fractured tooth fragment restored by reattachment technique. The clinical examination revealed complicated crown fracture extended horizontally from mesial to distal and angulated incisally from palatal to labial with pulp exposure. The fracture was not evident labially. In this case, the procedure was used to repair the fracture tooth fragment included root canal treatment and glass fiber post for reinforcement. The tooth fragment was luted with light activated flowable composite resin. Onward assessment showed a stable reattachment, good esthetic and function with healthy periodontium.