Relationship of Serum Creatinine Level in Heart Failure Patients in Bangladesh.

Heart failure means that the heart is unable to pump blood around the body properly. It usually happens because the heart has become too weak or stuff. In collaboration with department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh this cross-sectional study from January to December 2018 was performed in the department of Biochemistry in Mymensingh Medical College, Mymensingh, Bangladesh. The aim of this study was to explore the relationship of serum creatinine in patients with heart failure (HF) for management purpose. In this study 120 subjects were included, where 60 patients of diagnosed HF acts as case group and 60 individuals were normal healthy acts as control group. Serum creatinine was determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study groups the mean serum creatinine levels were 2.20±0.87mg/dl and 0.92±0.26mg/dl in case and control group respectively. Analysis showed that the mean serum creatinine level was highly significantly (p<0.001) increased in HF patients in comparison to that of control group.

HbA1c and Troponin-I Levels and Their Relationship in Patients with Acute Coronary Syndrome.

Acute coronary syndrome is a growing public health concern. Diabetic patients are more vulnerable to develop acute coronary syndrome due to accelerated atherosclerosis. Acute coronary syndrome is common in diabetes mellitus and is a major cause of mortality and morbidity in these patients. Troponin-I is a biochemical marker for cardiac muscle injury. Elevated glycated hemoglobin (HbA1c) is also regarded as an independent risk factor for acute coronary syndrome in patients with diabetes mellitus.The aim of this study was to assess the relationship of HbA1c and Troponin-I level in patients with acute coronary syndrome. This cross-sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from July 2018 to June 2019. Total study subjects were ninety five of both gender selected from the admitted patients of the cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Dhaka. Diagnosis of acute coronary syndrome was confirmed by cardiologist. Diagnosis of diabetes mellitus was confirmed by Random Blood Glucose (RBG) level. Study subjects were grouped, acute coronary syndrome with diabetes mellitus as Group A and acute coronary syndrome without diabetes mellitus as Group B. Baseline parameters was recorded in data collection sheet. HbA1c, Troponin-I level of all study subjects were analyzed and recorded. Mean age of the study subjects in Group A and Group B were 51.06 years and 51.66 years respectively. Male gender was predominant in both groups. Mean SBP and DBP were significantly higher in Group A than Group B. Mean HbA1c level of the study subjects in Group A was significantly higher than Group B (p=0.001). Mean Troponin-I level in Group A was also significantly higher than Group B (p=0.023). HbA1c and Troponin-I levels were positively correlated in Group A (r=0.471, p=0.001). The present study demonstrated significant positive correlation of HbA1c and Troponin-I level in diabetic patients with acute coronary syndrome.

Association between Serum Albumin Status with Heart Failure (HF) Patients in Bangladesh.

In collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh this cross sectional study was performed in the Department of Biochemistry, Mymensingh Medical College from January 2018 to December 2018. The aim of the study was to explore the relationship of serum albumin in patients' with heart failure (HF) as a resource to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 patients in case group were diagnosed HF patients and as control group 60 individuals were normal healthy. Serum albumin was determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study groups the mean serum albumin levels were 3.25±0.59 and 4.14±0.38 in case and control group respectively. Analysis showed that the mean serum albumin level was highly significantly (p<0.001) decreased in HF patients in comparison to that of control group.

Fano resonance of Li-doped KTa(1-x)NbxO3 single crystals studied by Raman scattering.

The enhancement of functionality of perovskite ferroelectrics by local structure is one of current interests. By the Li-doping to KTa(1-x)NbxO3 (KTN), the large piezoelectric and electro-optic effects were reported. In order to give new insights into the mechanism of doping, the microscopic origin of the Fano resonance induced by the local structure was investigated in 5%Li-doped KTN single crystals by Raman scattering. The coupling between the continuum states and the transverse optical phonon near 196 cm(-1) (Slater mode) caused a Fano resonance. In the vicinity of the cubic-tetragonal phase transition temperature, TC-T = 31 °C, the almost disappearance of the Fano resonance and the remarkable change of the central peak (CP) intensity were observed upon heating. The local symmetry of the polar nanoregions (PNRs), which was responsible for the symmetry breaking in the cubic phase, was determined to E(x, y) symmetry by the angular dependence of Raman scattering. The electric field induced the significant change in the intensity of both CP and Fano resonance. From these experimental results, it is concluded that the origin of the Fano resonance in Li-doped KTN crystals is the coupling between polarization fluctuations of PNRs and the Slater mode, both belong to the E(x, y) symmetry.

Helicobacter pylori: prevalence, transmission, and serum pepsinogen II concentrations in children of a poor periurban community in Bangladesh.

The aim of this study was to determine the age-specific prevalence of Helicobacter pylori infection in infants and children aged 1-99 months from a poor periurban community in Bangladesh. We also examined the frequency of infection among infants and their 53 immediate family members and evaluated the relationship between infection and fasting serum group II pepsinogen (pepsinogen II) concentration in 76 children. Sixty-one percent of 1-3 month-old infants tested positive for H. pylori; this rate declined steadily to 33% in children aged 10-15 months and then increased to 84% in children aged 5-8 years. The H. pylori infection rate was 2.5 times higher in children with illiterate mothers. No difference in infection rate was detected among the family contacts of infected vs. noninfected infants. H. pylori-infected children had significantly higher serum pepsinogen II concentrations than did noninfected children (P < .001). We conclude that infection with H. pylori is highly prevalent and occurs at an early age. An environmental factor or factors, rather than or in addition to intrafamilial spread of this infection, are important in poor communities of Bangladesh. The higher levels of serum pepsinogen II in H. pylori-positive children might indicate the presence of gastritis in such asymptomatic children.

Evaluation of Teknaf Enteric Agar (TEA): A modified MacConkey's Agar for the isolation of Shigella dysenteriae type 1 and Shigella flexneri.

To develop a better and selective medium for the isolation of Shigella spp., MacConkey's Agar (MAC) was modified by adding potassium tellurite (K2TeO3) at a concentration of 1 microgram/ml. The formulation designated Teknaf Enteric Agar (TEA) was studied for the inhibitory effect of potassium tellurite on the growth of different enteric bacteria, and as a medium for isolating Shigella spp. from clinical stool samples (n = 3125). We observed that the growth of E. coli was effectively inhibited on TEA with no effect on the growth of S. dysenteriae type 1 and S. flexneri. A total of 2019 Shigellae were isolated through the combined use of TEA, MAC, and Salmonella-Shigella Agar (SS). On TEA, 1921 S. dysenteriae type 1 and S. flexneri were isolated as compared to 1765 from the combined use of MAC and SS. A total of 194 of S. dysenteriae type 1 and S. flexneri were exclusively isolated from TEA as compared to 38 which were only made from MAC and SS. We conclude that TEA significantly increased the overall isolation rate of Shigella spp. as compared to the combined use of MAC and SS (P < 0.0001), although it is not suitable for the isolation of S. sonnei.

Enteric protein loss and intestinal permeability changes in children during acute shigellosis and after recovery: effect of zinc supplementation.

The effect of zinc supplementation on intestinal permeability changes and protein loss was studied in 32 children aged between 1 and 12 years during bouts of acute shigellosis and after recovery. An intestinal permeability test and then a 48 hour balance study were performed on all patients. They were then blindly assigned to receive vitamin B syrup either with or without zinc acetate (15 mg/kg per day) for a month. All patients received a five day course of nalidixic acid. The balance study was repeated during convalescence and follow up, but a permeability test was done only at follow up after one month. Intestinal permeability, expressed as a urinary lactulose:mannitol excretion ratio, improved significantly (p = 0.001) along with a significant increase (p = 0.005) in mannitol excretion in the zinc supplemented children, suggesting a resolution of small bowel mucosal damage. The latter was associated with a higher coefficient of nitrogen absorption (p = 0.03), suggesting a possible role of zinc in the treatment of shigellosis. Enteric protein loss, as assessed by faecal alpha 1 antitrypsin clearance, was not influenced by zinc supplementation.

Home management of childhood diarrhoea in rural Afghanistan: a study in Urgun, Paktika Province.

To gain first-hand knowledge of the incidence of diarrhoea among children less than five years old and of the prevailing practices in diarrhoea management, a study was carried out in July 1991 in Urgun in Paktika Province of eastern Afghanistan. A modified WHO Household Survey Questionnaire was used. Interviews with the parents of 338 children revealed that 103 children (30.4%) had diarrhoea during the previous 2 weeks. Forty one (39.8%) of these children were given ORS obtained from a health worker or bought in the market. The parents of 49 children (56.3%) claimed that they also gave an increased amount of fluid, such as plain water, soup, yoghurt mixed with water or tea during the diarrhoeal attack. Irrespective of receiving ORS therapy, 68 children (66%) were given inappropriate medications, including antibiotics, bought from the market. Forty-eight (94.1%) of the 51 children who were on exclusive or partial breastfeeding continued to be so fed during the diarrhoeal episode. Sixty-five (76.5%) of the 85 children accustomed to other additional foods continued to be fed during the diarrhoeal attack. Only a few of the parents could define conditions of diarrhoea requiring referral.

Prostacyclin concentrations in haemolytic uraemic syndrome after acute shigellosis in children.

The role of prostacyclin in the pathogenesis of haemolytic uraemic syndrome was evaluated in 11 children with acute shigellosis. Plasma concentrations of 6-keto prostaglandin, F1 alpha, a stable metabolite of prostacyclin, were measured by radioimmunoassay during acute illness, early convalescence, and after clinical recovery. Its concentration was low during acute illness in each patient, returning to normal concentrations or above at the time of the last sample. These results suggest that plasma prostacyclin may be involved in the development of the syndrome.

Serum ferritin and cholera. A prospective study.

An association has been shown between iron deficiency and a low gastric acidity while the latter is known to increase susceptibility to cholera. This study was undertaken to ascertain whether iron deficiency is a risk factor for contracting cholera. The subjects were 60 adult males-30 with cholera admitted to ICDDR,B and 30 controls matched for age, sex and socio-economic status from the same household or immediate neighbourhood of the index case. Fingerstick blood was taken from all subjects to estimate the haematocrit, and serum ferritin concentration by an ELISA. The mean ferritin level of the study group was 38.7 ng/100 ml, in the controls. There was a significant difference in the serum ferritin level between the groups (P less than 0.005), Wilcoxon Sign Rank test for matched pairs suggesting that cholera patients tend to have lower serum ferritin concentration. Further prospective studies are required to define the possible association between iron deficiency and cholera more accurately.

Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications.

The impact of a water, sanitation and hygiene education intervention project on diarrhoeal morbidity in children under 5 years old was evaluated in a rural area of Bangladesh. Data were collected throughout 1984-1987, covering both pre- and post-intervention periods, from an intervention and a control area. The 2 areas were similar with respect to most socio-economic characteristics and baseline levels of diarrhoeal morbidity. The project showed a striking impact on the incidence of all cases of diarrhoea, including dysentery and persistent diarrhoea. By the end of the study period, children in the intervention area were experiencing 25% fewer episodes of diarrhoea than those in the control area. This impact was evident throughout the year, but particularly in the monsoon season, and in all age groups except those less than 6 months old. Within the intervention area, children from households living closer to handpumps or where better sanitation habits were practised experienced lower rates of diarrhoea. These results suggest that an integrated approach to environmental interventions can have a significant impact on diarrhoeal morbidity.

Water supply, sanitation and hygiene education: report of a health impact study in Mirzapur, Bangladesh

The UNDP-World Bank Water and Sanitation Program was organized as a joint endeavor of the United Nations Development Programme and the World Bank and has been one of the primary players in worldwide efforts to meet the challenge of providing basic water supply and sanitation services to those most in need in the developing world. Partners in this venture are the developing countries themselves and the multilateral and bilateral agencies that fund the Program's activities. Tle UNDP-World Bank Water and Sanitation Program produces its own publications and also releases vicrks under the auspices of the World Bank. The Program's publications are divided into two series, a Water and Sanitation Program Report series and a Water and Sanitation Discussion Paper series. The Program Report series presents formal discussions of the Program's operations and research activities as well as examinations of relevant projects and trends within the water and sanitation sector. Program Reports are subject to rigorous external review by independent authorities from appropriate fields. The Discussion Paper series is a less formal means of communicating timely and topical observations, findings, and opinions concerning Program activities and sector issues

Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study.

As part of a health impact evaluation of a water supply and sanitation project in a rural area of Bangladesh, diarrhoeal morbidity was recorded in children 0-4 years of age using weekly recall in household interviews, during the period March 1984 to December 1987. During the baseline year, 1984, the incidence rate of all diarrhoea episodes (3.8 episodes per child per year), and those defined as persistent, duration greater than 14 days (0.6 episodes per child per year), showed a similar age distribution, peaking in the 12-23 month age group. Sixteen per cent of all episodes were classified as persistent, and this proportion was greatest in the 0-5 month age group (25%). Children suffering at least one episode of persistent diarrhoea in 1984 also experienced a higher incidence of acute diarrhoea (less than = 14 days duration) than those suffering acute diarrhoea only (4.2 versus 3.7 episodes per child per year). Persistent diarrhoea showed a similar seasonal pattern to that of all episodes. Rates of abdominal pain, isolation of Shigella spp and a diagnosis of dysentery were significantly higher in persistent episodes than in acute episodes. Closer follow-up of children during 1986 and 1987, through the recording of all periods of absence of the child from the home, showed that overall diarrhoea incidence rates were little affected when absence was taken into account, but that the incidence of persistent diarrhoea and the proportion of episodes classified as persistent were significantly reduced. The implications of this methodological problem are discussed.

Reporting errors in one-week diarrhoea recall surveys: experience from a prospective study in rural Bangladesh.

To estimate inaccuracy in a diarrhoea recall survey mothers of pre-school children in Teknaf, Bangladesh were interviewed every week from July 1980 through June 1983. Because the likelihood of an episode starting on any given day of the week should be equal, we were able to quantify any deviation observed. Results show an average of 34% less diarrhoea episodes reported prior to a 48-hour recall period in any week. The amount of reporting error was (a) directly related to the length of the recall period, and (b) inversely related to the severity of diarrhoea as indicated by presence of fever and frequency of motions. This analysis reveals that weekly diarrhoea recall surveys in Bangladesh underestimate severe diarrhoea cases by 20-22% and less severe cases by 42-44%. The findings also indicate that morbidity surveys based on lengthy recall are likely to mislead health planners with regard to the magnitude of the problem and the volume of resources required to combat it.

PIP: To estimate inaccuracy in a diarrhea recall survey, mothers of preschool children in Teknaf, Bangladesh were interviewed every week from July 1980-June 1983. Because the likelihood of an episode starting on any given day of the week should be equal, the authors were able to quantify any deviation observed. Results show an average of 34% less diarrhea episodes reported prior to a 48-hour recall period in any week. The amount of reporting error was directly related to the length of the recall period and inversely related to the severity of diarrhea as indicated by presence of fever and frequency of motions. This analysis reveals that weekly diarrhea recall surveys in Bangladesh underestimate severe diarrhea cases by 20-22% and less severe cases by 42-44%. The findings also indicate that morbidity surveys based on lengthy recall are likely to mislead health planner with regard to the magnitude of the problem and the volume of resources required to combat it.

Anthropometric indicators and risk of death.

Six anthropometric indicators based on weight, height, arm circumference (AC), and age were examined to predict mortality risk of children aged 12-59 mo in a rural area of Teknaf, Bangladesh. In the period 1981-85, 9861 measurements at 6-mo intervals were made on 2449 children. For all indices mortality risk was greater in the first 3 mo than in the second 3 mo in severely malnourished children. Mortality discriminating power of the indicators in terms of sensitivity and specificity was highest for AC and AC for age and lowest for weight-for-height. Logistic regression analysis showed that the predictive power of weight-, height-, and age-based indicators improved after adding AC whereas predictive power of AC did not improve after adding weight-based indicators. The relative risk of death in children with ACs measuring less than or equal to 120 mm was 12 times higher than in those whose ACs measured greater than 140 mm.

Mothers' personal and domestic hygiene and diarrhoea incidence in young children in rural Bangladesh.

This study examines the effect of maternal personal and domestic hygiene on the incidence of diarrhoea in children aged 6-23 months from rural areas around Teknaf, Bangladesh. The intervention area received augmented water supply through handpumps and health education while the control area received no project inputs. From July 1980 to June 1983, diarrhoea incidence was recorded weekly while mothers' personal and domestic hygiene was observed yearly. Annual incidence of diarrhoea in 314 children from the intervention area and 309 children from the control area was analysed in relation to maternal personal and domestic hygiene, controlling for education and occupation of household head and household size. Results show that, in both areas, use of handpump water for drinking and washing, removal of child's faeces from the yard, and maternal handwashing before handling food and after defaecation of self and child, observed together, decreased yearly diarrhoea incidence in children by more than 40% compared to children living in households where none or only one of these practices was observed.

Plasmid-mediated resistance to nalidixic acid in Shigella dysenteriae type 1.

In an epidemic of shigellosis in southern Bangladesh the causal organism, Shigella dysenteriae type 1, was resistant to nalidixic acid as well as to co-trimoxazole (trimethoprimsulphamethoxazole) and ampicillin. The genes coding for resistance to nalidixic acid, but not those coding for resistance to co-trimoxazole or ampicillin, are located on a conjugative 20 megadalton plasmid. This epidemic is of particular importance because of the resistance to nalidixic acid, an antibiotic to which shigellae are seldom resistant, and because plasmids were previously thought not to mediate resistance to nalidixic acid.

Dysentery, not watery diarrhoea, is associated with stunting in Bangladeshi children.

To study the interaction between diarrhoea and malnutrition, an average of 300 children aged 5-24 months were followed from January 1981 to January 1983 in Teknaf, Bangladesh. Diarrhoea episodes, differentiated according to stool appearance, were recorded weekly while weight and height measurements were taken every 6 months. Results showed no relationship between the nutritional indicators and diarrhoea incidence recorded within 60 d after anthropometric assessment. However, the duration of dysentery was significantly longer in the severely malnourished children who were stunted but not for those wasted. Although many children with watery diarrhoea had episodes of long duration, these were not associated with any nutritional indicator. We conclude that the key factors in this interaction are the invasive type of pathogen and chronic malnutrition.