Addressing the effectiveness of health literacy programs within the Gulf Corporation Council: an integrative review.

Health literacy is an increasingly required need to help individuals, families and communities manage their health and health conditions. It is linked with better self-adherence to treatments, use of resources, access to care and overall reduced costs in healthcare. In the Gulf Cooperation Council (GCC), which comprises Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates, various health literacy programs are implemented across states to address people's unique and complex healthcare needs. This article aims to examine the current literature and assess the factors that influence the outcomes of health literacy programs within the GCC. An integrative review methodology has been conducted to pursue a comprehensive understanding of health literacy interventions in the GCC. This investigative approach was shaped by Whittemore and Knafl's framework (2005), which includes problem identification, literature search, data evaluation, data analysis and presentation. The literature on the effectiveness of health literacy interventions and the factors that shape them are notably limited worldwide and within the GCC region. This integrative review addresses this knowledge gap and highlights the significance of key themes such as sessions, evaluation and improvement in shaping health literacy outcomes within the GCC region. Through this integrative review, the three main themes of sessions, evaluation and improvement were identified as influencing the outcomes of health literacy programs within the GCC.

In vitro and In vivo evidence demonstrating chronic absence of Ref-1 Cysteine 65 impacts Ref-1 folding configuration, redox signaling, proliferation and metastasis in pancreatic cancer.

Ref-1/APE1 (Redox Effector/Apurinic Endonuclease 1) is a multifunctional enzyme that serves as a redox factor for several transcription factors (TFs), e.g., NF-kB, HIF-1α, which in an oxidized state fail to bind DNA. Conversion of these TFs to a reduced state serves to regulate various biological responses such as cell growth, inflammation, and cellular metabolism. The redox activity involves a thiol exchange reaction for which Cys65 (C65) serves as the nucleophile. Using CRISPR editing in human pancreatic ductal adenocarcinoma (PDAC) cells, we changed C65 to Ala (C65A) in Ref-1 to evaluate alteration of Ref-1 redox dynamics as well as chronic loss of Ref-1 redox activity on cell signaling pathways, specifically those regulated by NF-kB and HIF-1α. The redox activity of Ref-1 requires partial unfolding to expose C65, which is buried in the folded structure. Labeling of Ref-1 with polyethylene glycol-maleimide (PEGm) provides a readout of reduced Cys residues in Ref-1 and thereby an assessment of partial unfolding in Ref-1. In comparing Ref-1WT vs Ref-1C65A cell lines, we found an altered distribution of oxidized versus reduced states of Ref-1. Accordingly, activation of NF-kB and HIF-1α in Ref-1C65A lines was significantly lower compared to Ref-1WT lines. The bioinformatic data revealed significant downregulation of metabolic pathways including OXPHOS in Ref-1C65A expressing clones compared to Ref-1WT line. Ref-1C65A also demonstrated reduced cell proliferation and use of tricarboxylic acid (TCA) substrates compared to Ref-1WT lines. A subcutaneous as well as PDAC orthotopic in vivo model demonstrated a significant reduction in tumor size, weight, and growth in the Ref-1C65A lines compared to the Ref-1WT lines. Moreover, mice implanted with Ref-1C65A redox deficient cells demonstrate significantly reduced metastatic burden to liver and lung compared to mice implanted with Ref-1 redox proficient cells. These results from the current study provide direct evidence that the chronic absence of Cys65 in Ref-1 results in redox inactivity of the protein in human PDAC cells, and subsequent biological results confirm a critical involvement of Ref-1 redox signaling and tumorigenic phenotype.

Unique territorial and sub-chromosomal organization revealed in the holocentric moth Bombyx mori.

The hallmarks of chromosome organization in multicellular eukaryotes are chromosome territories (CT), chromatin compartments, and different types of domains, including topologically associated domains (TADs). Yet, most of these concepts derive from analyses of organisms with monocentric chromosomes. Here we describe the 3D genome architecture of an organism with holocentric chromosomes, the silkworm Bombyx mori . At the genome-wide scale, B. mori chromosomes form highly separated territories and lack substantial trans contacts. As described in other eukaryotes, B. mori chromosomes segregate into an active A and an inactive B compartment. Remarkably, we also identify a third compartment, Secluded "S", with a unique contact pattern. Compartment S shows strong enrichment of short-range contacts and depletion of long-range contacts. It hosts a unique combination of genetic and epigenetic features, localizes at the periphery of CTs and shows developmental plasticity. Biophysical modeling shows that formation of such secluded domains requires a new mechanism - a high density of extruded loops within them along with low level of extrusion and compartmentalization of A and B. Together with other evidence of loop extrusion in interphase, this suggests SMC-mediated loop extrusion in this insect. Overall, our analyses highlight the evolutionary plasticity of 3D genome organization driven by a new combination of known processes.

Intramuscular injection of nerve growth factor as a model of temporomandibular disorder: nature, time-course, and sex differences characterising the pain experience.

Background: Temporomandibular disorder (TMD) is a common condition that frequently transitions to chronic symptoms. Experimental pain models that mimic the symptoms of clinical TMD may be useful in understanding the mechanisms, and sex differences, present in this disorder. Here we aimed to comprehensively characterise the nature and time-course of pain, functional impairment and hyperalgesia induced by repeated intramuscular injection of nerve growth factor (NGF) into the masseter muscle, and to investigate sex differences in the NGF-induced pain experience. Methods: 94 healthy individuals participated in a longitudinal study with 30-day follow-up. NGF was injected into the right masseter muscle on Day 0 and Day 2. Participants attended laboratory sessions to assess pain (Numerical Rating Scale; NRS), functional limitation (mouth opening distance, Jaw Functional Limitation Scale; JFLS) and mechanical sensitization (pressure pain thresholds; PPTs) on Days 0, 2 and 5 and completed twice daily electronic pain dairies from Day 0 to day 30. Results: Peak pain averaged 2.0/10 (95 % CI: 1.6-2.4) at rest and 4.3/10 (95 % CI: 3.9-4.8) on chewing. Pain-free mouth opening distance reduced from 5.0 cm (95 % CI: 4.8-5.1 cm) on Day 0 to 3.7 cm (95 % CI: 3.5-3.9 cm) on Day 5. The greatest reduction in PPTs was observed over the masseter muscle. Females experienced higher pain, greater functional impairment, and greater sensitivity to mechanical stimuli than males. Conclusion: Intramuscular injection of NGF is a useful model with which to explore the mechanisms, and sex differences, present in clinical TMD.

Functional and Speech Outcome of Unilaterally Cochlear Implanted Children after 1 year of Implantation in NIENT: A Retrospective Study.

Hearing loss can be congenital or acquired. Most of the time congenital hearing loss means profound sensorineural hearing loss. The invention of cochlear implantation has already an established role in improving the hearing capability in congenital sensorineural hearing loss. To speak properly after cochlear implant, one needs to go for speech therapy or audio-verbal therapy. Speech therapy has become an integral part of the cochlear implantation program. In Bangladesh cochlear implantation (CI) programs started around 15 years ago, which was limited to Bangabandhu Sheikh Mujib Medical University (BSMMU) and Combined Military Hospital (CMH). Our government takes initiative to provide this service to poor and lower income people. National Institute of ENT (NIENT) was the first government hospital where CI started in 2018 and the project is now ongoing. After CI auditory, verbal therapy (AVT) was given at the same institute. No study has not been done to find out the outcome of AVT. NIENT has taken steps to find out the functional and speech outcome of cochlear implanted children considering the two standard criteria: CAP and SIR score. This retrospective study was done to find out the auditory verbal outcome of unilaterally CI children in different ages and conducted at department of Audiology, National Institute of ENT, Tejgaon, Dhaka, Bangladesh from January 2021 to June 2021. The children who underwent cochlear implants and took the auditory verbal therapy were included in this study. Though it is a retrospective study, a written informed consent has been taken from the patient's parents as the cases are minor in age. From the record review, CAP and SIR scores were recorded four times: before implantation 1 time, after cochlear implantation 3 times (At the end of 3, 6 and 12 months after starting of AVT of Cochlear implantees). From the study it has been observed that out of 50 implantees, 48.0% of children's age range was in between >3 to ≤5 years. Most of the implantees were from rural areas and also from lower income group. The study showed significant association with CAP and SIR score at the end of one year of AVT. No significant association was found in different age groups with scores of CAP and SIR. But the parent's education showed significant association with CAP score at the end one year of AVT. Though the age of the recipient is not significantly associated with the AVT outcome but maternal education plays an important role in improving CAP and SIR score. So, maternal education or understanding along with professional speech therapy is vital for better AVT outcome.

Heart in Heart: A Case Report of Giant Left Atrial Appendage Aneurysm.

Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly. The cause mostly due to congenital, but can be acquired also. Patient may remain asymptomatic or may present with variable symptom. It can predispose to hazardous adverse events, including atrial fibrillation, myocardial infarction, cardiac dysfunction and life-threatening systemic thromboembolism. Simple imaging, electrocardiography and echocardiography can diagnose this rare cardiac anomaly. We are reporting a case who presented to us at 5 years of age with palpitation, chest pain and dizziness with arrythmia that developed one month back; he visited our outpatient department of the National Heart Foundation Hospital & Research Institute Hospital, Dhaka, Bangladesh on 13th February 2020. We diagnosed left atrial appendage aneurysm with mitral valve prolapse with atrial arrhythmia thereafter surgical resection of aneurysmal part along with mitral valve annuloplasty done by mid sternotomy and maze therapy. Postoperative period was uneventful and discharged after 6th post operative day.

Hemithyroidectomy in the Treatment of Papillary Thyroid Carcinoma: A Prospective Study of 300 Patients.

The correct approach to treat low-risk intra thyroidal papillary thyroid carcinoma (PTC) is still controversial. The traditional paradigm of treating all patients with thyroid cancer with total thyroidectomy, radioactive iodine and suppressive thyroid hormone therapy is no longer suitable. Many authors advocate unilateral thyroidectomy to minimize perioperative morbidity. The purpose of this study was to determine an effective treatment strategy for patients with small unilateral papillary thyroid carcinoma in a low risk group. This is a prospective study of 300 patients who were diagnosed as papillary thyroid carcinoma by preoperative FNAC or postoperative histopathology. The age of the patients' was ranged between 15 to 45 years. The criteria were: tumor ≤4cm, unilateral involvement, cytological non-aggressive subtype, absence of lymph node (LN) involvement and extra thyroidal extension (ETE) on ultrasonography (USG) and absence of clinical distant metastases. Duration of the study period was 30 years from 1989 to 2019. The study was conducted in tertiary care hospital in Bangladesh. All patients had undergone hemi thyroidectomy and followed up by a median period of 25 months (range, 6 to 166 months). Following hemithyroidectomy, among 300 patients, 267 patients (89.0%) did not show any recurrence of disease. Thirty three (33) patients (11.0%) came with locoregional recurrence of disease in clinical and USG findings without any distant metastasis. Maximum patients were between the ages 31-40 year followed by 21-30 years. Female was out number male in the ratio. Though further large scale study should require to determine the optimal treatment option for low risk PTC, but this study can lead to a result that hemi thyroidectomy is now-a-days a better surgical option for PTC even up to tumor size of ≤4cm.

Prevalence and Risk Factors of Secondary Hyperparathyroidism among CKD Patients and Correlation with Different Laboratory Parameters.

Hyperthyroidism is one of the major complications in CKD patients who results in a number of metabolic disorders and contributes to morbidity and mortality. The objective of the study was to investigate the prevalence and risk factors for secondary hyperparathyroidism among CKD patients as well as its correlation with different laboratory parameters. This was a cross-sectional study conducted among the admitted CKD patients of Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January 2019 to December 2019. Following recruitment, clinical parameters were extracted from the patients' medical records. Afterward, blood sample blood was collected to measure the biochemical parameters and serum parathyroid hormone levels. A binary logistic regression model was used to assess the factors associated with hyperparathyroidism. The mean±SD serum PTH in all CKD patients was 215.04±168.15 pg/ml. The overall prevalence of secondary hyperparathyroidism among CKD patients was 75.0% (32.0% in stage 3, 88.0% in stage 4 and 93.0% in stage 5 CKD). Serum PTH levels had a significant positive correlation with serum creatinine and serum phosphate levels and a significant negative correlation with serum albumin and serum calcium levels. However, only female sex was revealed as a significant risk factor in the adjusted regression model (aOR 0.26, 95% CI 0.07-0.98 for male sex compared to female sex). As the prevalence of secondary hyperparathyroidism increases in advanced stages of CKD, early detection and management of CKD are crucial to prevent metabolic disorders that could trigger the development of this complication.

Risk factors of suicide among public university students of Bangladesh: A qualitative exploration.

Introduction: Suicidal deaths among the students have increased worldwide where Bangladesh is not an exception and the reasons are not well documented. Objective: Revealing the common risk factors of suicide among the public university students of Bangladesh was the aim of this study. Methods: This study utilized a qualitative research design and data was collected from five public universities of Bangladesh where suicidal death found prevailing. Guidelines containing open ended questions were used to conduct in-depth interviews and key informant interviews among thirty public university students and five university professionals respectively. Both purposive and snowball sampling was used to select respondents. Data of this study was analyzed thematically. Results: Findings of this study suggest most of the public university students, committed suicide shows a history of depression, hopelessness, perfectionism, family conflicts, relationship break-up, lack of social support, financial crisis, and academic stress before their attempts. Conclusion: Arranging seminars, workshops, and awareness-raising campaigns are urgently needed to change suicidal behavior among the public university students of Bangladesh. A strong support system should be built with suggestions from mental health professionals, policymakers, researchers, and academicians to ensure good psychological well-being among the students.

COVID-19 transmission flow through the stigmatization process in Bangladesh: A qualitative study.

Introduction: Coronavirus disease (COVID-19) patients and survivors face stigma, discrimination, and negligence. The motives for and the different types and consequences of COVID-19-related stigmatization remain underexplored in Bangladesh. Therefore, this study examined how the COVID-19 stigmatization process is interlinked with transmission flow. Methods: Using a qualitative research design, we conducted 20 in-depth interviews with infected and suspected caregivers and five key informant interviews with physicians, local media representatives, leaders, law enforcement officials, and local administrative officials in three divisional cities of Bangladesh. We performed thematic analysis to analyze the data. Results: Participants expressed their experiences with multiple subthemes within three themes (stigma related to symptoms, stigma associated with isolation and quarantine, and stigma associated with health services). Participants reportedly faced stigma, for example, exclusion, hesitation to interact, avoidance, bullying, threat, and negligence caused by misinformation, rumors, and fear. Stigmatized individuals reportedly hid their symptoms and refrained from seeking healthcare services, contributing to COVID-19 transmission flow. Conclusion: Revealed insights may contribute to effective prevention, control, and management of such an emerging pandemic. Further in-depth exploration of such stigmatization process will enrich unexpected outbreaks management effectively.

Riluzole-induced apoptosis in osteosarcoma is mediated through Yes-associated protein upon phosphorylation by c-Abl Kinase.

Our lab has previously demonstrated Riluzole to be an effective drug in inhibiting proliferation and inducing apoptosis in both human and mouse osteosarcoma. Yes-associated protein is a transcription co-activator, known to be involved in cell proliferation or apoptosis depending on its protein partner. In the present study we investigated the role of YAP in apoptosis in osteosarcoma, we hypothesized that YAP may be activated by Riluzole to induce apoptosis in osteosarcoma. By knocking down the expression of YAP, we have demonstrated that Riluzole failed to induce apoptosis in YAP deficient osteosarcoma cells. Riluzole caused translocation of YAP from the cytoplasm to the nucleus, indicating YAP's role in apoptosis. Both Riluzole-induced phosphorylation of YAP at tyrosine 357 and Riluzole-induced apoptosis were blocked by inhibitors of c-Abl kinase. In addition, knockdown of c-Abl kinase prevented Riluzole-induced apoptosis in LM7 cells. We further demonstrated that Riluzole promoted interaction between YAP and p73, while c-Abl kinase inhibitors abolished the interaction. Subsequently, we demonstrated that Riluzole enhanced activity of the Bax promoter in a luciferase reporter assay and enhanced YAP/p73 binding on endogenous Bax promoter in a ChIP assay. Our data supports a novel mechanism in which Riluzole activates c-Abl kinase to regulate pro-apoptotic activity of YAP in osteosarcoma.

Cross-Sectional Analytic Study to Compare the Efficacy Between of Clinical Skill Learning (CSL) and Multimedia Lecture as Teaching Tool in Case of Endotracheal Intubation.

Clinical skill lab (CSL) is a part of simulation-based medical education (SBME) which now a days becomes an integral part of modern medical education. This cross-sectional analytic study was performed at Sylhet Women's Medical College, Sylhet, Bangladesh to assess the difference between CSL and traditional multimedia (MM) presentation in case of endotracheal intubation from January 2021 to February 2021. Total 78 first year nursing students were enrolled in study. Both groups were tested by same pre-tested multiple-choice questions. These 10 questions were set according to modified bloom's taxonomy domains. There was no significant difference in the mean scores of both groups. Male of CSL group had scored significantly better than the female of the same group. The top and bottom domains of modified bloom's taxonomy were significantly better taught in CSL group, whereas the others were better in the multimedia group.

Relationship between Pack Year and Lung Function Parameters in Asymptomatic Smokers.

Smoking has extensive effects on respiratory function. The rate of cigarette smoking among young people has continued to increase steadily. Exposure to cigarette smoking is usually measured in terms of 'Pack-Year'. The aim of the study was to observe the effect of pack years on pulmonary functions in apparently healthy asymptomatic smokers by measuring FVC, FEV1, FEV1/FVC ratio and PEFR value by digital spirometer. This cross-sectional observational study was conducted in the department of Physiology, Sylhet MAG Osmani Medical College in collaboration with department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July 2016 to June 2017. A total number of 100 male smokers, age ranging from 18-60 years and BMI within normal limit (18.5-24.9kg/m²) were included in this study. Their pulmonary functions were studied by measuring FVC, FEV1, FEV1/FVC ratio and PEFR. Relationship between pack-year and pulmonary function test parameters was established by one way ANOVA test. In this study we found that lung function parameters shared an inverse relationship with pack year of smoking. The percentage of predicted values of FEV1, FEV1/FVC ratio and PEFR were significantly lower (p<0.001) in heavy smokers who smoked more than 30 pack years. Therefore, by this study we inferred that those who smoked more than 10 pack years are associated with accelerated decline in lung function.

Congenital Eventration of Diaphragm Presenting As Diaphragmatic Hernia: A Case Report.

Eventration of diaphragm is an abnormal elevation of diaphragmatic musculature while retaining normal attachments to the sternum, ribs and dorsolumber spine. It is a rare anomaly where the continuity of diaphragm remains intact. Pathological process can affect either all or only a portion of hemidiaphragm. Symptoms vary according to size of the defect. Large defect may mimic diaphragmatic hernia. The present case represents a full term female newborn that developed respiratory distress, cyanosis and feeding difficulties since 1st day of life. Clinical features and chest imaging of this case was assumed to be left sided diaphragmatic hernia which was found wrong in the operation theater. She was found to have left sided eventration of diaphragm to create symptom. Successful plication of ipsilateral diaphragm was done on 13th day of life. Supervised post operative ventilatory support along with other postoperative care improved the condition of this neonate. A large defect with eventration of diaphragm may be life threatening but a timely good management can save neonate from such condition.

Individual differences in intracortical inhibition predict motor-inhibitory performance.

Studies in which single- and paired-pulse TMS was applied during motor task performance have shed considerable light on the functional relevance of popular TMS-derived neurophysiological biomarkers such as short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI). While it has become well established that corticospinal excitability and intracortical inhibition are modulated during the enactment and cancellation of actions, it has remained unclear as to whether interindividual differences in these neurophysiological markers were associated with an individual's actual ability to restrain and cancel actions. In this study, we found that individual differences in both SICI and LICI were positively associated with relevant performance metrics on the go/no-go task and stop-signal task. Specifically, we found that individuals with greater resting SICI and LICI were faster to respond on go trials of the go/no-go task and were also more accurate at inhibiting their manual responses on both go/no-go and stop-signal tasks. These results are in support of findings from our earlier study and also provide new evidence for a general relationship between individual differences in resting-state GABAergic intracortical inhibitory functioning and motor inhibition.

Study on Electrophysiological Findings of Guillain Barre Syndrome Patients Attending the Department of Neurology in BSMMU.

Incidence and predominant subtype of Guillain Barre Syndrome (GBS) differ geographically. Electrophysiology has an important role in the early diagnosis and prediction of the prognosis. This study conducted to determine the predominant subtype of Guillain Barre Syndrome in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh and to compare the nerve conduction study finding between the axonal and demyelinating form of GBS. To analyze the nerve conduction study findings of Guillain Barre Syndrome patients attending the department of Neurology in BSMMU. This observational, descriptive and cross sectional study was carried out in the department of Neurology, BSMMU, Dhaka from July 2014 to June 2016. Considering the inclusion and exclusion criteria, 50 patients recruited as the study population. Then after performing the nerve conduction study, patients classified into three groups: acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN). Among the 50 patients that are finally included in the study; about 50%, 42%, 8% had the AIDP, AMAN and AMSAN variety of GBS respectively. Out of all patients, 64% were male and 34% were female. GBS was seen in a wide range of age (18-75 years). In AIDP, maximum clustering of the cases was seen in the elderly population and in the AMAN it was seen in the younger age group. Cerebrospinal fluid (CSF) analysis did not show any significant difference between the AIDP and AMAN variant of GBS. Distal latency prolonged in at least one nerve in all patients with AIDP. In axonal form of GBS (AMAN and AMSAN), the compound muscle action potential (CMAP) amplitude was 80% of the lower limit of the normal in at least two motor nerves. Prolonged F wave latency by >80% of the upper limit of the normal was seen in 40% of the AIDP patients. According to the nerve conduction study, finding- acute inflammatory demyelinating polyneuropathy (AIDP) is the predominant subtype. Although the electrophysiology and the CSF analysis are the important tools for the diagnosis of GBS, classification should not be making based on a distinct finding alone. If all the NCS parameters in multiple nerves tested after one week and within four weeks of onset of symptoms, definite diagnosis is possible in almost all the patients of Guillain Barre Syndrome.

Electrostatic rogue waves in double pair plasmas.

A nonlinear Schrödinger equation is derived to investigate the modulational instability of ion-acoustic (IA) waves (IAWs) in a double pair plasma system containing adiabatic positive and negative ion fluids along with super-thermal electrons and positrons. The analytical analysis predicts two types of modes, viz., fast ( ω f ) and slow ( ω s ) IA modes. The possible stable and unstable parametric regions for the IAWs in the presence of external perturbation can be observed for both ω f and ω s . The number density of the negative ions and positrons plays a vital role in generating the IA rogue waves in the modulationally unstable region. The applications of our present work in astrophysical environments [viz., D-region (H + , O 2 - ) and F-region (H + , H - ) of the Earth's ionosphere] and in laboratory plasmas [viz., pair-ion fullerene (C + , C - )] are pinpointed.

Heavy ion-acoustic rogue waves in electron-positron multi-ion plasmas.

The nonlinear propagation of heavy-ion-acoustic (HIA) waves (HIAWs) in a four-component multi-ion plasma (containing inertial heavy negative ions and light positive ions, as well as inertialess nonextensive electrons and positrons) has been theoretically investigated. The nonlinear Schrödinger (NLS) equation is derived by employing the reductive perturbation method. It is found that the NLS equation leads to the modulational instability (MI) of HIAWs, and to the formation of HIA rogue waves (HIARWs), which are due to the effects of nonlinearity and dispersion in the propagation of HIAWs. The conditions for the MI of HIAWs and the basic properties of the generated HIARWs are identified. It is observed that the striking features (viz., instability criteria, growth rate of MI, amplitude and width of HIARWs, etc.) of the HIAWs are significantly modified by the effects of nonextensivity of electrons and positrons, the ratio of light positive ion mass to heavy negative ion mass, the ratio of electron number density to light positive ion number density, the ratio of electron temperature to positron temperature, etc. The relevancy of our present investigation to the observations in space (viz., cometary comae and earth's ionosphere) and laboratory (viz., solid-high intense laser plasma interaction experiments) plasmas is pointed out.

Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh.

From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.

Predicting depressed patients with suicidal ideation from ECG recordings.

Globally suicidal behavior is the third most common cause of death among patients with major depressive disorder (MDD). This study presents multi-lag tone-entropy (T-E) analysis of heart rate variability (HRV) as a screening tool for identifying MDD patients with suicidal ideation. Sixty-one ECG recordings (10 min) were acquired and analyzed from control subjects (29 CONT), 16 MDD subjects with (MDDSI+) and 16 without suicidal ideation (MDDSI-). After ECG preprocessing, tone and entropy values were calculated for multiple lags (m: 1-10). The MDDSI+ group was found to have a higher mean tone value compared to that of the MDDSI- group for lags 1-8, whereas the mean entropy value was lower in MDDSI+ than that in CONT group at all lags (1-10). Leave-one-out cross-validation tests, using a classification and regression tree (CART), obtained 94.83 % accuracy in predicting MDDSI+ subjects by using a combination of tone and entropy values at all lags and including demographic factors (age, BMI and waist circumference) compared to results with time and frequency domain HRV analysis. The results of this pilot study demonstrate the usefulness of multi-lag T-E analysis in identifying MDD patients with suicidal ideation and highlight the change in autonomic nervous system modulation of the heart rate associated with depression and suicidal ideation.