Investigating the resilience of refugee camps to COVID-19: A case of Rohingya settlements in Bangladesh.

Bangladesh Rohingya camps have hosted 65,000 refugees fled from Myanmar only since 2017. Their compromised living environment and limited physical and socioeconomic facilities make them highly sensitive to COVID-19. The Government of Bangladesh and international aid agencies have applied WHO's IPC (Infection, Prevention, and Control) guidelines to mitigate the transmission of COVID-19 outbreaks and enhance their resilience. However, Rohingyas often disregard these guidelines or become reluctant to follow them. Building on 10 in-depth interviews, 66 questionnaires, and observation, the study investigates the limitations and challenges of implementing these guidelines toward building community resilience. It assesses their resilience, focusingon Kutupalong camp, Cox's Bazar-one of the world's largest refugee camps. Findings reveal that Rohingya's past experience associated with their psychological trauma largely influences their current actions and demotivates them fromfollowing the health guidelines. Their deep mistrust of and disrespect to healthcare providers and aid agencies discourage them to follow the IPC. Also, insufficient built infrastructure and unhygienic living conditions, including improper WASH management, increase their risk to COVID-19. The study highlights a need for understanding their socio-psychological values and cultural narratives and recommends a set of guidelines for policymakers and aid agencies to build community resilience to COVID -19.

Pleural effusion in hematological pathology.

A 51-year-old male with a history of chronic myelomonocytic leukemia-2 (CMML-2) presented with fatigue, night sweats, dyspnea, and right-sided chest pain exacerbated by deep breath. Computed tomography scan demonstrated right-sided pleural effusion with atelectasis. Pleural fluid cytology showed reactive mesothelial cells mixed with atypical cells [Figure 1]. The immunostains are performed using the SCIP approach.[1] The atypical cells were immunoreactive for vimentin, CD68, and CD163, while non-immunoreactive for cytokeratin, calretinin, BerEP4, and MOC31.

Maspin differential expression patterns as a potential marker for targeted screening of esophageal adenocarcinoma/gastroesophageal junction adenocarcinoma.

AIM: Barrett's esophagus (BE) is a predisposing factor of esophageal adenocarcinoma/gastroesophageal junction adenocarcinoma (ECA/GEJ Aca). BE patients are stratified and subsequently monitored according to the risk of malignant progression by the combination of endoscopy and biopsy. This study is to evaluate the maspin expression patterns as early diagnostic markers of malignancy in BE patients. MATERIALS AND METHODS: Immunohistochemistry (IHC) staining was performed on 62 archival core biopsies from 35 patients, including BE without dysplasia (intestinal metaplasia, IM), BE with low grade dysplasia, BE with high grade dysplasia, carcinoma in situ, and well to poorly differentiated ECA/GEJ Aca (PD-ECA/GEJ Aca). The intensity and the subcellular distribution of immunoreactivity were evaluated microscopically. Statistical analysis was performed using the χ2 and Fisher exact tests. RESULTS: The level of epithelial-specific tumor suppressor maspin protein inversely correlated with the progression from IM to PD-ECA/GEJ Aca. Lesions of each pathological grade could be divided into subtypes that exhibited distinct maspin subcellular distribution patterns, including nuclear only (Nuc), combined nuclear and cytoplasmic (Nuc+Cyt), cytoplasmic only (Cyt) and overall negligible (Neg). The Cyt subtype, which was minor in both IM and dysplasia (approximately 10%), was predominant in ECA/GEJ Aca as early as well-differentiated lesions (more than 50%: p = 0.0092). In comparison, nuclear staining of the tumor suppressor TP53 was heterogeneous in dysplasia, and did not correlate with the differentiation grades of ECA/GEJ Aca. CONCLUSION: The Cyt subtype of maspin expression pattern in core biopsies of BE patients may serve as a molecular marker for early diagnosis of ECA/GEJ Aca.

Impact of Intensive Handwashing Promotion on Secondary Household Influenza-Like Illness in Rural Bangladesh: Findings from a Randomized Controlled Trial.

RATIONALE: There is little evidence for the efficacy of handwashing for prevention of influenza transmission in resource-poor settings. We tested the impact of intensive handwashing promotion on household transmission of influenza-like illness and influenza in rural Bangladesh. METHODS: In 2009-10, we identified index case-patients with influenza-like illness (fever with cough or sore throat) who were the only symptomatic person in their household. Household compounds of index case-patients were randomized to control or intervention (soap and daily handwashing promotion). We conducted daily surveillance and collected oropharyngeal specimens. Secondary attack ratios (SAR) were calculated for influenza and ILI in each arm. Among controls, we investigated individual risk factors for ILI among household contacts of index case-patients. RESULTS: Among 377 index case-patients, the mean number of days between fever onset and study enrollment was 2.1 (SD 1.7) among the 184 controls and 2.6 (SD 2.9) among 193 intervention case-patients. Influenza infection was confirmed in 20% of controls and 12% of intervention index case-patients. The SAR for influenza-like illness among household contacts was 9.5% among intervention (158/1661) and 7.7% among control households (115/1498) (SAR ratio 1.24, 95% CI 0.92-1.65). The SAR ratio for influenza was 2.40 (95% CI 0.68-8.47). In the control arm, susceptible contacts <2 years old (RRadj 5.51, 95% CI 3.43-8.85), those living with an index case-patient enrolled ≤24 hours after symptom onset (RRadj 1.91, 95% CI 1.18-3.10), and those who reported multiple daily interactions with the index case-patient (RRadj 1.94, 95% CI 1.71-3.26) were at increased risk of influenza-like illness. DISCUSSION: Handwashing promotion initiated after illness onset in a household member did not protect against influenza-like illness or influenza. Behavior may not have changed rapidly enough to curb transmission between household members. A reactive approach to reduce household influenza transmission through handwashing promotion may be ineffective in the context of rural Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT00880659.

Curcumin is an early-acting stage-specific inducer of extended functional longevity in Drosophila.

Larval feeding with curcumin induces an extended health span with significantly increased median and maximum longevities in the adult fly. This phenotype is diet insensitive and shows no additive effect on longevity when combined with an adult dietary restriction (DR) diet, suggesting that curcumin and DR operate via the same or overlapping pathways for this trait. This treatment significantly slows the aging rate so that it is comparable with that of genetically selected long lived animals. The larval treatment also enhances the adult animal's geotactic activity in an additive manner with DR, suggesting that curcumin and DR may use different pathways for different traits. Feeding the drug to adults during only the health span also results in a significantly extended health span with increased median and maximum life span. This extended longevity phenotype is induced only during these stage-specific periods. Feeding adults with the drug over their whole life results in a weakly negative effect on median longevity with no increase in maximum life span. There are no negative effects on reproduction, although larval curcumin feeding increases development time, and also apparently accelerates the normal late-life neuromuscular degeneration seen in the legs. Gene expression data from curcumin-fed larvae shows that the TOR pathway is inhibited in the larvae and the young to midlife adults, although several other genes involved in longevity extension are also affected. These data support the hypothesis that curcumin acts as if it is a DR mimetic nutraceutical. These data also suggest that the search for DR mimetics may be enhanced by the use of stage-specific screening of candidate molecules.

Reliability of the neurological scores for assessment of sensorimotor neuropathy in type 2 diabetics.

OBJECTIVE: To check the reliability of the commonly used neurological scoring systems taking the nerve conduction studies as the reference. METHODS: Diagnosed diabetics (n=60) were selected by purposive sampi ng Detection and grading of neuropathy were done according to Diabetic Neuropathy Symptom Score (DrNS), modified Neuropathy Symptom Score (NSS), Diabetic Neuropathy Examination (DNE) and modified Neuropathy Disability Score (NDS). For the nerve conduction studies, amplitudes, velocities and latencies of minimum two (Sural, Peroneal) and maximum six, i.e., three sensory (Sural, Ulnar, Median) and three motor (Peroneal, Ulnar, Tibial) nerves were checked. If the patient had 2 or more than two abnormal findings in any of the nerve he was labeled to have peripheral sensorimotor neuropathy. Later the sensitivity, specificity and diagnostic efficacy of each neurological score was checked taking nerve conduction studies as the gold standard. RESULTS: Taking the NCS as gold standard DNS, DNE, NSS and NDS had 64.1%, 17.95%, 82.05%, 92.31% sensitivity and 80.95%, 100%, 66.67%, 47.62% specificity, respectively. Diagnostic efficacy of DNS was 70%, DNE was 47%, NSS was 77% and NDS was 77%. CONCLUSIONS: Combining different scores gives better sensitivity and specificity. NDS is the most reliable neurological test for detecting and grading DPN.

Comparison of nerve conduction studies with diabetic neuropathy symptom score and diabetic neuropathy examination score in type-2 diabetics for detection of sensorimotor polyneuropathy.

OBJECTIVE: To compare the nerve conduction studies in clinically undetectable and detectable sensorimotor polyneuropathy in type 2 diabetics. METHODS: Diagnosed diabetics (n = 60) were divided in two groups. Group 1 (n1 = 30) with clinically undetectable and group 2 (n2 = 30) with clinically detectable Diabetic Polyneuropathy. Detection of the sensorimotor neuropathy was done according to Diabetic Neuropathy Symptom Score and Diabetic Neuropathy Examination scores. The simplified nerve conduction studies protocol was followed in recording amplitudes, velocities and latencies of minimum two (Sural, Peroneal) and maximum six i.e. three sensory (Sural, Ulnar, Median) and three motor (Peroneal, Ulnar, Tibial) nerves. RESULTS: The comparisons were done between different parameters of nerve conduction studies with the neurological scores in undetectable and detectable groups using Pearson's chi square test. The amplitudes, velocities, latencies, outcome and grading of neuropathy in nerve conduction studies when compared with neurological detection scores showed a significant relation in each group regarding evaluation (p = 0.005, p = 0.004, p = 0.05, p = 0.00001, p = 0.003 respectively). CONCLUSIONS: Diabetic Neuropathy Symptom Score and Diabetic Neuropathy Examination Score together can help in prompt evaluation of the diabetic sensorimotor polyneuropathy though nerve conduction study is more powerful test and can help in diagnosing subclinical cases.

Intrapatient symptom variability in adults and children with asthma: results of a survey.

The objective of this survey was to evaluate variability of symptoms in adult and pediatric patients with persistent asthma. Prospective participants from a US database of patients with asthma were invited to complete an Internet-based survey designed to assess the occurrence of asthma symptoms during the past year. A total of 1311 adult patients and 491 caregivers of pediatric patients were surveyed. Adult patients (18%-30%) and pediatric patients (8%-20%) experienced a variety of symptoms on a daily basis. At least 50% of patients receiving treatment experienced variability in 1 or more symptoms during the previous year. The most common treatment recommendation when asthma symptoms were experienced included changing the number of medication (reliever or controller) inhalations (48% and 55% of adult and pediatric patients, respectively) or adding another medication (31% and 39%). This survey indicates that adult patients and caregivers of pediatric patients report variability in asthma symptoms over time, even when asthma medications are taken.