Hypothyroidism in Bangladesh: Is Autoimmunity the Next Big Threat?

In many low and middle-income countries, iodine-deficient hypothyroidism leads to complex public health consequences. However, increasing evidence from population-based studies has linked thyroid autoimmunity with excess iodine intake. The iodine supplementation program in Bangladesh was a success story. This cross-sectional study aims to assess the pattern and predictors of autoimmunity among Bangladeshi hypothyroid patients. In this study, 154 consecutive, newly detected, biochemically-confirmed patients with primary hypothyroidism were recruited from the Endocrinology outpatient department of Bangabandhu Sheikh Mujib Medical University and tested for anti-thyroid peroxidase and anti-thyroglobulin antibody levels from October 2015 and November 2016. Patterns of thyroid autoimmunity were assessed via descriptive statistics. Predictors of autoimmunity were assessed with multivariable mixed-effect logistic regression. The mean age of participants was 36.1±11.0 years, and 70.1% were female. The frequency of thyroid autoimmunity in the study subjects was very high, 89.0% were positive for either anti-TPO or anti-Tg antibodies and 48.7% were positive for both. More participants were positive for anti-TPO antibodies (82.5%) than anti-Tg antibodies (55.2%). The risk of autoimmunity was associated with the thyroid's structural abnormalities but not with functional status. Weight gain and hypertension were associated with autoimmunity, whereas diabetes was protective against autoimmunity.

Risk of depression among Bangladeshi type 2 diabetic patients.

OBJECTIVE: The objective of this study was to examine the strength and consistency of the relationship between depression and diabetes in Bangladeshi population. METHODS: The study was conducted at the medicine department of Bangabandhu Shiekh Mujib Medical University (BSMMU) during May 2012 to May 2013. Equal number of type 2 diabetes mellitus (T2DM) patients and non-diabetic subjects (patient attendants) were recruited from outpatient department matching for age (±2 years) and gender. Demographic and anthropometric data were collected from all the subjects. Depression was assessed using, Hospital Anxiety and Depression Scale (HADS) questionnaire. A subject with a score above 8 was considered as depressive. Baseline characteristics of diabetic and non-diabetic participants were compared using chi square test. Multivariable logistic regression was performed to assess the association between diabetes and depression adjusting for all plausible confounders in the model. RESULTS: 24.8% non-diabetic and 56.2% diabetic subjects were found to have depression. Statistically significant difference was found in income, waist-to-hip ratio between diabetic and non-diabetic subjects (P<0.001). Diabetic patients show 7-fold greater odds of having depression in comparison to their non-diabetic counterpart [OR 7.0, 95% CI (3.4, 14.3)]. Female gender appeared as significant predictor of depression [OR 4.3, 95% CI (2.1, 8.9)]. CONCLUSIONS: In Bangladeshi population, people with diabetes are 7 times more likely to have co-existing depression in comparison to non-diabetic subjects. Further studies are required to establish the nature of the relationship between depression and T2DM.

Development of highly digestible animal feed from lignocellulosic biomass Part 1: Oxidative lime pretreatment (OLP) and ball milling of forage sorghum.

To feed a growing population, alternative sources of animal feed (e.g., lignocellulose) are needed to replace grains (e.g., corn). Oxidative lime pretreatment (OLP) increases lignocellulose digestibility by removing lignin and hemicellulose acetyl content. Adding a mechanical pretreatment (e.g., ball milling) further improves digestibility. This study determines the effectiveness of OLP and ball milling to enhance the ruminant digestibility of lignocellulose. For forage sorghum, the 48-h in vitro TDN were 40, 64, and 84 g nutrients digested/100 g organic matter (OM) for raw, short-term OLP, and short-term OLP + ball milling, respectively. In terms of compositional changes, OLP increases NDF and decreases non-fiber carbohydrate (NFC) and crude protein (CP), all of which would normally be associated with a decrease in digestibility. However, because OLP and ball milling beneficially change composition (lignin removal) and structural features (reduced crystallinity), digestibility actually increases. Although ball milling increases digestibility according to standard laboratory assays, it reduces particle size possibly allowing fine particles to escape from the rumen before they are digested, thus limiting its practical application. Nonetheless, this study indicates that mechanical pretreatment greatly increases digestibility, and therefore it is desirable to identify an effective mechanical treatment that retains fiber integrity.

Development of highly digestible animal feed from lignocellulosic biomass Part 2: Oxidative lime pretreatment (OLP) and shock treatment of corn stover.

Oxidative lime pretreatment (OLP) increases lignocellulose digestibility by removing lignin and hemicellulose acetyl content. Digestibility is improved further by adding mechanical shock treatment, which subjects aqueous slurry of biomass to an explosive pressure pulse. Shock treatment mechanically disrupts the microscopic structure while maintaining the macroscopic integrity of the biomass particle. This study determined the effectiveness of these pretreatments to enhance the ruminant digestibility of corn stover. In terms of compositional changes, OLP and shock treatment should negatively affect the feed value of corn stover; however, digestibility analysis provides a significantly different conclusion. With corn stover, shock + OLP improved the 48-h neutral detergent fiber digestibility (NDFD) to 79.0 g neutral detergent fiber (NDF) digested/100 g NDF fed, compared to 49.3 for raw corn stover. The 48-h in vitro total digestible nutrients (TDNom, g nutrients digested/100 g OM) was 51.9 (raw), 59.7 (OLP), and 72.6 (shock + OLP). Adding extracted corn stover solubles to shock + OLP increased TDNom to 74.9. When enough solubilized chicken feathers were added to match the protein content of corn grain, TDNom increases to 75.5, which is only 12.6 less than corn grain.

Oral antivirals for preventing recurrent herpes simplex keratitis in people with corneal grafts.

BACKGROUND: Ocular herpes is a viral infection of the eye caused by the herpes simplex virus (HSV), a double-stranded DNA virus. Corneal scarring caused by herpes simplex keratitis (HSK) is the leading infectious cause of penetrating corneal graft in high-income countries. Acyclovir is an antiviral drug known to have a protective effect against recurrences in herpetic eye disease. While there are some studies which have evaluated the effects of intervention with oral antiviral in preventing such recurrences in people with corneal grafts, a systematic review of all comparative clinical trials has not been previously undertaken. OBJECTIVES: To assess the efficacy of oral antivirals such as acyclovir in any dosage when taken for six months or more, in preventing recurrence of herpetic keratitis in people having corneal graft surgery for herpetic keratitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 1 June 2016. We handsearched conference proceedings and contacted authors of the included studies and researchers active in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs). People enrolled in these trials had corneal grafts for HSK. The intervention was oral antivirals for six months or more following the corneal graft surgery, and this was compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We contacted trial investigators for any clarification or missing information. We graded the certainty of the evidence using GRADE. MAIN RESULTS: We included three trials, involving 126 participants, comparing the use of oral acyclovir to no treatment or placebo. Two studies were conducted in single centres in Turkey and the USA, and one was multi-centred in the Netherlands. In general, the studies were poorly reported and it was difficult to judge the extent to which bias had been avoided.Oral acyclovir may reduce the risk of recurrence of herpetic keratitis (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.13 to 0.64, 126 people, low-certainty evidence). Based on data from the included trials, this corresponds to approximately 23 fewer cases of HSK recurrence (95% CI 29 fewer cases to 12 fewer cases) per 100 corneal graft operations if oral acyclovir is used.Oral acyclovir may reduce the risk of graft failure (RR 0.40, 95% CI 0.16 to 0.97, 126 people, low-certainty evidence). Based on data from the included trials, this corresponds to approximately 13 fewer cases of graft failure (95% CI 18 fewer cases to 1 fewer cases) per 100 corneal graft operations if oral acyclovir is used.None of the studies reported any serious side effects of the antivirals necessitating stoppage or change. None of the trials reported outcomes over the long term (more than two years) or any data on quality of life. AUTHORS' CONCLUSIONS: Compared to placebo or to no treatment, oral antiviral (acyclovir) may reduce the risk of recurrence of herpetic keratitis in the first 12 months in eyes that have undergone corneal graft surgery.

Risk factors of hemorrhagic and ischemic stroke among hospitalized patients in Bangladesh--A case control study.

The risk factor profiles, management and outcome have significant difference between stroke subsets. Aim of this study was to investigate the risk for the two most common subtypes of stroke in Bangladeshi population. Seventy cases of hemorrhagic stroke (HS) and 105 cases of confirmed ischemic stroke (IS) were recruited from the Shaheed Suhrawardy Medical College Hospital (ShSMCH) and Dhaka Medical College Hospital between January-June 2011. Total 171 age, sex matched controls were selected from the hospitalized patients with history of no stroke ever. Average hemorrhagic stroke patients (60.4 ± 12.3 years) were younger than both ischemic strokes (63.5 ± 13 years). Family history of premature cardiovascular death was found more in HS patients (p = 0.001). Multivariate logistic regression showed, in IS model 'less fruit consumption (OR 4.6), table salt intake (OR 8.15), psychosocial stress (OR 3.5), abnormal ECG (OR 3.6) and Increased WHR (OR 6.9) appeared as significant predictors adjusted for all potential candidate confounders. In HS model less fruit consumption (OR 5.0), table salt intake (OR 9.9), Stress (OR 4.1), family history of cardiovascular disease (CVD) death (OR 11.3), hypertension (OR 43), aspirin intake (OR 4.5) and increased WHR (OR 3.7) remained as significant predictors.

An epidemiological study of injury in a rural community in Bangladesh.

Injuries are a focus of public health practice because they pose a serious health threat, occur frequently and are preventable. The evidence regarding injury, its contributing factor and its consequence in rural population of Bangladesh is scarce. Present study aimed to assess the epidemiology of injury in a rural area. The study was conducted in the 'Bairag' Union of Anwara upazilla in Chittagong district of Bangladesh. Data of 6256 individuals were collected from 1016 households. Three structured and standardized questionnaires were used for data collection. The questionnaires were pretested and validated prior to final survey. Severity of injury was assessed based on the number of days with restricted activity and consequences of injury were considered as a measure of severity of injury. A total of six people died due to injury in last one year in the survey, the death tolls to 0.096% (95% CI 0.037%-0.199%). A total of 392 experienced an injury that at least hampered one day's routine activity. Crude prevalence of injury over last one year is calculated to be 6.27% (95% CI 5.69%-6.89%). Of injured subject's majority (77.2%) were aged between 10 to 59 years, 73% were male, 55.6% were of lower class and among them 7.9 % suffered multiple injuries. More than 80% of the incident leading to injury happened during the day, (8 am to 6 pm). Daytime injury mostly occurs in afternoon. The mechanism of injury of 30% subjects were road accident, of 29.5% subjects was slip, trip or fall. In 17.9% victims' mechanism of injury was collision with a person or object. Around 10% had deep cut, 1.4% had superficial cut, and 3.3% patient had burn through contact with heat. Among the injured only 19.2% escaped any physical consequence, 27.2% suffered from decrease in work capacity, 48.1% developed temporary disability, 3.8% developed permanent disability, and 1.2% suffered disfiguration.

Removal of lens epithelial cells and the effect on capsulorhexis size.

PURPOSE: To assess the long-term effects of lens epithelial cell (LEC) removal on capsulorhexis opening size. SETTING: Dorset County Hospital, Dorchester, United Kingdom. METHODS: This prospective randomized control study included 39 eyes of 38 patients. Twenty eyes were selected randomly for removal of LECs from the anterior capsule as part of routine cataract operation comprising phacoemulsification with intraocular lens (IOL) implantation. The other 19 eyes were used as controls in which the LECs were not removed. All surgeries were performed by 1 surgeon (A.T.). All patients had silicone IOL (Allergan SI-40) implantation. The capsulorhexis opening size was determined immediately after surgery and 2 weeks and 6 months after surgery. Data on treatment outcome of the cataract surgery were analyzed statistically. RESULTS: Six months postoperatively, the size of the capsulorhexis had statistically significant increased in the study group that had LECs removed (mean increase 1.07 +/- 1.70 mm(2); paired Student t test P=.01), whereas the capsulorhexis size had statistically significant decreased in the control group (mean decrease -3.38 +/- 2.37 mm(2); paired Student t test, P<.0001). The difference in changes in the capsulorhexis areas between the 2 groups was also highly statistically significant (independent-sample Student t test, P<.0001). CONCLUSION: Removal of anterior subcapsular LECs by aspiration helped maintain the size of the capsulorhexis opening and thus can help prevent capsule contraction syndrome.

Identification and control of dissolved oxygen in hybridoma cell culture in a shear sensitive environment.

The productivity of mammalian cells can be enhanced by facilitating adequate oxygen transfer into the cultivation medium. However, current methods of controlling dissolved oxygen (DO) fail to account for alterations in medium composition during the course of the fermentation. These changes, which directly affect gas solubility and overall mass transfer coefficient, may be significant and deteriorate controller's performance in the long run. In this paper, the applications of Generalized Predictive Controllers (GPC) to DO control were investigated in a shear sensitive environment and compared to PID and Model Predictive Controllers (MPC). Input and output data for system identification were initially generated by varying the composition of oxygen fed into the bioreactor from 0 to 0.21 mol % while keeping the total inlet gas flow rate at 8.75 vvm. The process was identified using an AutoRegressive model with eXogeneous inputs (ARX) model and tested on different data sets. The model parameters were then correlated with the overall mass transfer coefficients. In simulation tests, the output of the PID controller switched from minimum to maximum values while more continuous control signals were obtained with the MPC and GPC controllers. When tested in a cell-free medium, all three controllers were able to track setpoint changes with some chattering observed in the control signals. The GPC outperformed the MPC and PID controllers when applied to the cultivation of hybridoma cells.

Adaptive pole placement control algorithm for DO-control in beta-lactamase production.

The dissolved oxygen (DO) is an important variable in aerobic fermentations and affects the cell growth and product formation. Dissolved oxygen control is difficult in batch fermentations because of the time-varying conditions, time delays, and the probe dynamics. Modeling of the various patterns of biological activity in fermentations and their impact on the DO process dynamics is essential to both achieve a satisfactory control and to track the aforementioned patterns. An adaptive pole placement algorithm with time-delay compensation was used for controlling the DO, coupled with system identification using recursively estimated autoregressive models with exogeneous inputs (ARX). The flow rate of O2 in a constant flow rate gas inlet mixture is used as the manipulated variable. Supervision and coordination techniques are applied to improve the control performance. The control performance is affected by the accuracy of the model prediction and the selected time delay. The effect of DO level on the productivity of beta-lactamase using Bacillus subtilis under oxygen-limited conditions is investigated. Beta-lactamase stability is improved under prolonged growth conditions with low DO levels.

Experimental optimization of a real time fed-batch fermentation process using Markov decision process.

This article describes a methodology that implements a Markov decision process (MDP) optimization technique in a real time fed-batch experiment. Biological systems can be better modeled under the stochastic framework and MDP is shown to be a suitable technique for their optimization. A nonlinear input/output model is used to calculate the probability transitions. All elements of the MDP are identified according to physical parameters. Finally, this study compares the results obtained when optimizing ethanol production using the infinite horizon problem, with total expected discount policy, to previous experimental results aimed at optimizing ethanol production using a recombinant Escherichia coli fed-batch cultivation. (c) 1997 John Wiley & Sons, Inc. Biotechnol Bioeng 55: 317-327, 1997.

Optimization of an industrial microalgae fermentation.

Optimization of cellular productivity of an industrial microalgae fermentation was investigated. The fermentation was carried out at Coors Biotech Products Company, Fort Collins, Colorado. A mathematical model was developed based on the data collected from pilot plant test runs at different operating conditions. Pontryagin's maximum principle was used for determining the optimal feed policy. A feedback control algorithm was also studied for maximizing the cellular productivity. During continuous operation, the optimum dilution rate was determined by an adaptive optimization scheme based on the steepest descent technique and a recursive least squares estimation of model parameters. A direct search algorithm was also applied to determine the optimum feed rate. Comparison of the theoretical results of the different optimization schemes revealed that the direct search algorithm was preferable because of its simplicity. The experimental results of real time application of the feedback algorithm agreed fairly well with those of the theoretical analyses. (c) 1994 John Wiley & Sons, Inc.

Effect of operating conditions on solid substrate fermentation.

In this work the effects of environmental parameters on the performance of solid substrate fermentation (SSF) for protein production are studied. These parameters are (i) air flow rate, (ii) inlet air relative humidity, (iii) inlet air temperature, and (iv) the heat transfer coefficient between the outer wall of the fermentor and the air in the incubator. The air flow is supplied to effect cooling of the fermented mass by evaporation of water. A dynamic model is developed, which permits estimation of biomass content, total dry matter, moisture content, and temperature of the fermented matter. The model includes the effects of temperature and moisture content on both the maximum specific growth rate and the maximum attainable biomass content. The results of the simulation are compared with actual experimental data and show good agreement with them. The most important conclusions are that (i) the evaporative cooling of the biomass is very effective for temperature control and (ii) the air flow rate and the heat transfer coefficient have strong effects but they affect the biomass morphology and are not controllable easily. Also, a simple technique for the determination of the optimum temperature and moisture content profile for cell protein production is applied. The simulated biomass production increases considerably employing the optimum temperature and moisture content profiles. The ultimate goal is to implement the determined effects of the environmental parameters on the SSF biomass production and the temperature and moisture variation profiles to effectively control the SSF and optimize the biomass production.

Artificial neural networks in bioprocess state estimation.

The application of artificial neural networks to the estimation and prediction of bioprocess variables is presented in this paper. A neural network methodology is discussed, which uses environmental and physiological information available from on-line sensors, to estimate concentration of species in the bioreactor. Two case studies are presented, both based on the ethanol production by Zymomonas mobilis. An efficient optimization algorithm which reduces the number of iterations required for convergence is proposed. Results are presented for different training sets and different training methodologies. It is shown that the neural network estimator provides good on-line bioprocess state estimations.

An analysis of sugar content of commonly used pediatric liquid medicines--its relevance to dentistry.

The sugar content of twenty-four liquid medicines commonly prescribed for infants and young children were measured and the type of sugars present were also identified in four randomly selected samples. All the liquid medicines tested contained sugar, in the range of 29.4% to 61.2%. Sucrose appeared to be the most commonly used sugar. Whilst it is agreed that sucrose makes the medicine more acceptable to children, its continual use by the pharmaceutical industry should be discontinued due to its harmful effect on the dental health of children, particularly those taking these syrup-based medicines on prolonged basis. Sugar-free alternatives such as sorbitol or saccharin should be used instead.

Mathematical modeling of ethanol production by immobilized Zymomonas mobilis in a packed bed fermenter.

A mathematical model which describes ethanol production in a packed bed fermenter containing. Zymomonas mobilis entrapped in small spheres of calcium alginate within a packed bed fermenter has been developed. The equations combine simultaneous diffusion and reaction as well as a complex flow pattern to calculate glucose and ethanol profiles in the column type reactor. As part of the study, diffusivity values for glucose and ethanol in cell-loaded calcium alginate were determined. Also a freecell kinetic expression for Z. mobilis at 33 degrees C and ph 6.0 was developed. Comparison of the model with actual experimental results were made showing average deviations of ca. 30-40%.