Vascular change in the placenta of diabetic mothers and hypertensive diabetic mothers

Pregnancy complicated by diabetes and/or hypertension is a significant medical problem not only affecting maternal health, but also jeopardizing fetal normalcy. The placenta being the bridge between maternal fetal activity, this structure is considered as a window through which understanding of maternal dysfunctions as well as of their impacts on fetal wellbeing can be obtained. And as it is an almost all-vessel organ, its functional status depends primarily on the structural status of its vessels. To observe vascular changes in the placenta, a study was carried out on 44 placentas.19 from overt diabetic mothers having no hypertension and 5 from hypertensive diabetic mothers, and 20 from control group having no hypertension or diabetes. These were collected just after delivery though caesarian section. Macroscopic findings of the study was that there was a trend of increase weight, volume and number of cotyledons in overt diabetes group, where as the in the hypertensive diabetes group was the opposite. But none of these levels has reached a significant level. For all these variables, the hypertensive diabetes group had smaller values than the overt diabetes group, significantly so for the number of cotyledons. The placental diameter was non-significantly larger in the overt diabetes group than in the control group, but a smaller than control value was found in the hypertensive diabetes group. Although neonatal weight did not show any significant change in either group, but in overt diabetes group, it showed a significant positive correlation with placental weight.     

Trends in use of referral hospital services for care of sick newborns in a community-based intervention in Tangail District, Bangladesh

The Projahnmo-II Project in Mirzapur upazila (sub-district), Tangail district, Bangladesh, is promoting care-seeking for sick newborns through health education of families, identification and referral of sick newborns in the community by community health workers (CHWs), and strengthening of neonatal care in Kumudini Hospital, Mirzapur. Data were drawn from records maintained by the CHWs, referral hospital registers, a baseline household survey of recently-delivered women conducted from March to June 2003, and two interim household surveys in January and September 2005. Increases were observed in self-referral of sick newborns for care, compliance after referral by the CHWs, and care-seeking from qualified providers and from the Kumudini Hospital, and decreases were observed in care-seeking from unqualified providers in the intervention arm. An active surveillance for illness by the CHWs in the home, education of families by them on recognition of danger signs and counselling to seek immediate care for serious illness, and improved linkages between the community and the hospital can produce substantial increases in care-seeking for sick newborns.     

Rickets among children of a coastal area of Bangladesh

Many children with rachitic deformities have been reported in southern coastal area of Bangladesh but the actual rate of prevalence was not known. A survey was conducted to determine the magnitude of rachitic problem among the children of Chakaria thana of Cox's Bazar district of Bangladesh. Nine hundred children between 1-15 years selected randomly from 30 villages of total 340 villages. Face to face interview of the parents was taken and the children were examined for evidences of rickets. Serum calcium, phosphorus, alkaline phosphatase (ALP) were estimated and radiology of limbs were done in all clinically suspected cases and in a control of every eighth child. Seventy eight children (8.7%) had physical features suggestive of rickets. Fifty eight (6.4%) children had 'clinical rickekts' (positive physical feature(s) but normal ALP and negative radiology), 12 (1.3%) children had 'biochemical rickets' (positive physical features and raised ALP but negative radiology) and 8 (0.9%) children had 'confirmed rickets' (positive physical features, raised ALP and positive radiology). Out of 78 children with rachitic feature(s), Pectus carinatum was found as the most common clinical feature in 26 (33.3%) children followed by genu valgum in 23 (29.4%) cases. Twenty two normal children (2.2%) had raised level of ALP (>300U/L). The prevalence of rickets is high in children of Chakaria and further study is needed to find out the exact aetiology of rickets in children there.     

Efficacy of combined chloroquine and sulfadoxine-pyrimethamine in uncomplicated Plasmodium falciparum malaria in Bangladesh

A study of the therapeutic efficacy of combined chloroquine and sulfadoxine-pyrimethamine (SP) for the treatment of uncomplicated Plasmodium falciparum malaria was carried out from June to November 2002, using the standard protocol recommended by the WHO for a low-to-moderate transmission area, in two sentinel sites in Bangladesh: Alikadam Upazilla in Bandarban district and Matiranga Upazilla in Khagrachari district. A total of 133 patients was followed-up to 28 d. Total failure rates were 25.9 and 30.7% in Alikadam and Matiranga, respectively. No severe side effects due to the drugs were encountered during the study period. Chloroquine and SP is not a suitable combination for the first-line treatment of P. falciparum in Bangladesh.     

Risk factors for pressure sores in the critically ill

Pressure sore development in the critically ill is a well-recognised problem and several risk factors have been put forward as being relevant; however, none has been proved valid in this population. This study examines the effects of specific risk factors for the development of pressure sores in the critically ill. Data on 22 specific risk factors were recorded every 8 h. Of 286 patients who were identified as having a minimum set of three predetermined risk factors, 77 developed pressure sores. Using univariate regression analysis, 18 of the 22 specific factors were identified as being significant (p < 0.05) in the development of pressure sores. Multivariate analysis identified five of these 18 specific risk factors as being independently significant (p < 0.05) in pressure sore development. These five factors were norepinephrine infusion, APACHE II score, faecal incontinence, anaemia and length of stay.     

Vitamin D receptor (VDR) mRNA and VDR protein levels in relation to vitamin D status,insulin secretory capacity,and VDR genotype in Bangladeshi Asians

Associations have been reported between vitamin D receptor (VDR) gene polymorphisms, type 1 diabetes, insulin secretion, and the insulin resistance syndrome. As VDR polymorphisms have no known functional significance, these findings may implicate a variant of the VDR gene or a locus in linkage disequilibrium with the VDR. We have examined VDR mRNA and VDR protein levels in relation to VDR polymorphisms (41 Bangladeshi subjects) and analyzed insulin secretory capacity (143 Bangladeshi subjects), allowing for other known determinants. Peripheral blood mononuclear cells (PBMCs) from subjects who had been genotyped for BsmI, ApaI, TaqI, and FokI VDR restriction fragment length polymorphisms were used for both total VDR mRNA quantitation (using TaqMan) and measurement of VDR protein levels (using a specific micro-immunoassay). Stepwise multiple regression analyses were used (to P < 0.05) to analyze the data. For the insulin secretion index, the best-fit model (n = 143, P < 0.0001) gave age (P = 0.002), TaqI (P < 0.0001), and BMI (P = 0.001) as independent determinants; with the inclusion of VDR mRNA and VDR protein levels, VDR mRNA was the sole independent determinant (n = 41, P = 0.024). However, the best-fit model for VDR mRNA (P = 0.004) gave FokI (P = 0.044) and TaqI (P = 0.04) genotypes and insulin secretory capacity (P = 0.042) as independent determinants. For VDR protein levels, the best-fit model (P = 0.006) gave TaqI genotype (P = 0.005) and circulating 1,25-dihydroxyvitamin-D levels (P = 0.03) as independent determinants. In conclusion, these studies confirm an association between VDR polymorphisms and insulin secretory capacity and demonstrate the VDR genotype to be a significant determinant of VDR mRNA and VDR protein levels in PBMCs, providing functional support to previously described genetic associations with the VDR gene. Furthermore, VDR expression has been shown to be a determinant of insulin secretory capacity.     

西洋参茎叶皂甙对小鼠学习记忆的易化作用

西洋参茎叶皂甙500mg/kg、100mg／kg给小鼠连续灌胃7天，可拮抗樟柳碱和戊巴比妥钠引起的记忆获得损害，对环己酰亚胺引起的记忆巩固障碍有显著改善作用。西洋参茎叶皂甙还可使常压、低压缺氧状态下小鼠存活时间有所延长。     

Baseline Predictors of Adherence in a Randomised Controlled Trial of a New Group Psychological Intervention for People with Recurrent Binge Eating Episodes Associated to Overweight or Obesity

Purpose: Understanding the high rate of treatment adherence in trials of people with eating disorders is important as it can compromise the quality of the trials. In clinical practice, it may also contribute to illness chronicity, relapse, and costs. Thus, we investigated factors associated with adherence to a new treatment HAPIFED, which integrates cognitive behavioural therapy having extended sessions with body weight loss therapy compared to cognitive behavioural therapy with extended sessions alone, for individuals with Bulimia Nervosa or Binge Eating Disorder or other eating disorders comorbid with overweight or obesity. Methods: In total, 98 participants having bulimia nervosa, binge eating disorder and other specified and unspecified eating disorders were recruited with 50 randomised to HAPIFED and 48 to the control intervention CBT-E, all administered in groups of up to 10 participants. An investigator external to the site conducted the random allocation, which was concealed from the statistician involved in the analysis, and known only to the therapists until the finalization of the 12-month follow-up after the end of active treatment. Three scenarios in the timeline treatment of a total of 30 sessions were assessed: 33% or 60% or 75% of presence. Mixed-effects logistic regression analysis was performed to find the correlates of adherence after adjusting for clustering by number of group participants. To account for heterogeneity by types of eating disorders in the sample, the latter variable was considered as a control factor in the models. A subgroup analysis was performed for those with binge eating disorder as this was the largest (N = 66) eating disorder group. Results: None of the six variables—frequency of binge eating episodes, purging, eating disorder symptom severity, weight, illness duration and mental health-related quality of life—significantly predicted adherence at 33%, but longer illness duration predicted higher treatment adherence at both 60% and 75% presence of the interventions. Also for 75% presence, higher body weight predicted lower treatment adherence. For the subgroup analysis, those having higher illness duration had significantly higher odds of treatment adherence for 60% and 75% of the sessions. Conclusions: Higher adherence due to late treatment completion was associated with longer binge eating illness length and a lower body weight. More research is needed to recognize factors that may interfere with engagement in treatments aiming to avoid early dropout.     

Microstructure and Mechanical Property Evaluation of Dune Sand Reactive Powder Concrete Subjected to Hot Air Curing

The use of different sustainable materials in the manufacture of ultra-high-performance concrete (UHPC) is becoming increasingly common due to the unabating concerns over climate change and sustainability in the construction sector. Reactive powder concrete (RPC) is an UHPC in which traditional coarse aggregates are replaced by fine aggregates. The main purpose of this research is to produce RPC using dune sand and to study its microstructure and mechanical properties under different curing conditions of water curing and hot air curing. The effects of these factors are studied over a long-term period of 90 days. Quartz sand is completely replaced by a blend of crushed and dune sand, and cement is partially replaced by using binary blends of ground granulated blast furnace slag (GGBS) and fly ash (FA), which are used alongside silica fume (SF) to make a ternary supplementary binder system. Microstructural analysis is conducted using scanning electron microscopy (SEM), and engineering properties like compressive strength and flexural strength are studied to evaluate the performance of dune sand RPC. Overall, the results affirm that the production of UHPC is possible with the use of dune sand. The compressive strength of all mixes exceeded 120 MPa after 12 h only of hot air curing (HAC). The SEM results revealed the dense microstructure of RPC. However, goethite-like structures (corrosion products) were spotted at 90 days for all HAC specimens. Additionally, the use of FA accelerated the formation of such products as compared to GGBS. The effect of these products was insignificant from a mechanical point of view. However, additional research is required to determine their effect on the durability of RPC.