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Prevalence of non-communicable diseases (NCDs) is high in rural Bangladesh. Given the complex multi-directional relationships between NCDs, COVID-19 infections and control measures, exploring pandemic impacts in this context is important. We conducted two cross-sectional surveys of adults ≥30-years in rural Faridpur district, Bangladesh, in February to March 2020 (survey 1, pre-COVID-19), and January to March 2021 (survey 2, post-lockdown). A new random sample of participants was taken at each survey. Anthropometric measures included: blood pressure, weight, height, hip and waist circumference and fasting and 2-hour post-glucose load blood glucose. An interviewer-administered questionnaire included: socio-demographics; lifestyle and behavioural risk factors; care seeking; self-rated health, depression and anxiety assessments. Differences in NCDs, diet and exercise were compared between surveys using chi2 tests, logistic and linear regression; sub-group analyses by gender, age and socio-economic tertiles were conducted. We recruited 950 (72.0%) participants in survey 1 and 1392 (87.9%) in survey 2. The percentage of the population with hypertension increased significantly from 34.5% (95% CI: 30.7, 38.5) to 41.5% (95% CI: 38.2, 45.0; p-value = 0.011); the increase was more pronounced in men. Across all measures of self-reported health and mental health, there was a significant improvement between survey 1 and 2. For self-rated health, we observed a 10-point increase (71.3 vs 81.2, p-value = 0.005). Depression reduced from 15.3% (95% CI: 8.4, 26.1) to 6.0% (95% CI: 2.7, 12.6; p-value = 0.044) and generalised anxiety from 17.9% (95% CI: 11.3, 27.3) to 4.0% (95% CI: 2.0, 7.6; p-value<0.001). No changes in fasting blood glucose, diabetes status, BMI or abdominal obesity were observed. Our findings suggest both positive and negative health outcomes following COVID-19 lockdown in a rural Bangladeshi setting, with a concerning increase in hypertension. These findings need to be further contextualised, with prospective assessments of indirect effects on physical and mental health and care-seeking., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 King et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: There are no effective treatments currently available for optic nerve transection injuries. Stem cell therapy represents a feasible future treatment option. This study investigated the therapeutic potential of human umbilical cord-derived mesenchymal stem cell (hUC-MSC) transplantation in rats with optic nerve injury., Methods: Sprague-Dawley (SD) rats were divided into three groups: a no-treatment control group (n = 6), balanced salt solution (BSS) treatment group (n = 6), and hUC-MSCs treatment group (n = 6). Visual functions were assessed by flash visual evoked potential (fVEP) at baseline, Week 3, and Week 6 after optic nerve crush injury. Right eyes were enucleated after 6 weeks for histology., Results: The fVEP showed shortened latency delay and increased amplitude in the hUC-MSCs treated group compared with control and BSS groups. Higher cellular density was detected in the hUC-MSC treated group compared with the BSS and control groups. Co-localized expression of STEM 121 and anti-S100B antibody was observed in areas of higher nuclear density, both in the central and peripheral regions., Conclusion: Peribulbar transplantation of hUC-MSCs demonstrated cellular integration that can potentially preserve the optic nerve function with a significant shorter latency delay in fVEP and higher nuclear density on histology, and immunohistochemical studies observed cell migration particularly to the peripheral regions of the optic nerve., Competing Interests: None

Introduction: Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care., Methods: The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management., Results: Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards., Conclusion: This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings., Methods: A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed., Findings: From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; p interaction =0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated., Interpretation: Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines., Funding: US National Institutes of Health., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0. license. Published by Elsevier Ltd.. All rights reserved.)

The purpose of this work was to determine a radiographic standard of normality for lateral and medial ungulae in 3-year-old bovine females of the Nellore breed. Twenty-six cows underwent radiographic exposure of the medial and lateral ungulae of the hindlimbs and forelimbs; abaxioaxial projections were used. The images were analyzed; distances were measured between the dorsal surface of the distal phalanx and the surface of the hoof capsule. The two angles formed, i.e., an angle between the dorsal surface of the distal phalanx and a line parallel to the sole (inner), and an angle between the dorsal surface of the hoof and a line parallel to the sole (outer), were also recorded. The results suggested a standard of normality for the proximal, middle and distal distances of the ungulae of the forelimbs: 0.96 ± 0.12 cm. For the measurement of hindlimbs, except for the distal distances of the side ungulae, the suggested value was 1.02 ± 0.14 cm; for the distal measurement of the lateral ungulae of the hindlimbs, the value was 1.09 ± 0.12 cm. For inner and outer angles, the values were 36.45° ± 4.4° for the medial ungulae of the forelimbs and 42.50° ± 3.8° for other ungulae of the forelimbs and hindlimbs (standard deviations of the values suggested for the angles should be used as variations between different animals, limbs and ungulae; they should not be used between angles of the same ungula)., (© 2018 Blackwell Verlag GmbH.)

Ingested or penetrating foreign bodies are common in veterinary medicine. When they are radiolucent, these objects become a diagnostic challenge, but they can be investigated sonographically. However, successful object identification depends on the skill of the sonographer. Considering that these cases appear randomly during hospital routines, it is not always possible to train all students to identify them correctly. Therefore, the aim of this study was to produce homemade simulations of radiolucent foreign bodies for veterinary student demonstrations that could be identified sonographically and to evaluate the acceptability, applicability, and usefulness of these simulations according to a visual analog scale questionnaire and subjective questions. For this purpose, object models (a pacifier nipple, a toy ball, a sock, nylon thread, and a mango seed) were designed, produced, and immersed in gelatin. To simulate wood splinters in the integumentary and musculoskeletal system, a piece of meat punctured with a toothpick and ice cream stick splinters were used. The type of phantom had a determinant effect on the visualization (chi-square = 36.528, P < 0.0001) and recognition (chi-square = 18.756, P = 0.0021) capability of the students. All of the students answered that their experience with the models could help in real situations. The student responses to the questionnaire indicated that the project was well accepted, and the participants believed that this experience could be applicable to and useful in veterinary routines., (Copyright © 2017 the American Physiological Society.)

Mesenchymal stem cells are widely used in many pre-clinical and clinical settings. Despite advances in molecular technology; the migration and homing activities of these cells in in vivo systems are not well understood. Labelling mesenchymal stem cells with gold nanoparticles has no cytotoxic effect and may offer suitable indications for stem cell tracking. Here, we report a simple protocol to label mesenchymal stem cells using 80 nm gold nanoparticles. Once the cells and particles were incubated together for 24 h, the labelled products were injected into the rat subretinal layer. Micro-computed tomography was then conducted on the 15th and 30th day post-injection to track the movement of these cells, as visualized by an area of hyperdensity from the coronal section images of the rat head. In addition, we confirmed the cellular uptake of the gold nanoparticles by the mesenchymal stem cells using transmission electron microscopy. As opposed to other methods, the current protocol provides a simple, less labour-intensive and more efficient labelling mechanism for real-time cell tracking. Finally, we discuss the potential manipulations of gold nanoparticles in stem cells for cell replacement and cancer therapy in ocular disorders or diseases.

Liver fibrosis is characterized by excessive accumulation of extracellular matrix components in the liver parenchyma that distorts the normal architecture and hepatic function. Progressive fibrosis could end in the advanced stage known as cirrhosis, resulting in the need to resort to liver transplantation. Amniotic membrane (AM) has emerged as an innovative therapeutic approach for chronic liver diseases due to its anti-inflammatory, antiscarring, and wound-healing effects. We have recently shown that AM can be used as a patch on the liver surface at the same time of fibrosis induction, resulting in significantly reduced progression and severity of biliary fibrosis. Here we investigated the effects of human AM on the established rat model of liver fibrosis, induced by the bile duct ligation (BDL). We also explored the effect of AM on the expression of transforming growth factor-1 (TGF-1), the main profibrogenic factor in hepatic fibrosis, and the proinflammatory cytokines, tumor necrosis factor- (TNF-), interleukin-6 (IL-6), and anti-inflammatory cytokine IL-10. Two weeks after BDL, the liver was covered with a fragment of AM or left untreated. Six weeks later, the fibrosis was first assessed by the semiquantitative Knodell and the METAVIR scoring systems and, thereafter, by CellProfiler digital image analysis to quantify the area occupied by collagen deposition, ductular reactions (DRs), activated myofibroblasts, and TGF-1. The hepatic cytokines were determined by ELISA. AM-treated rats showed a significantly lower score compared to the control BDL rats (2.50.9 vs. 3.50.3, respectively; p0.05). The collagen deposition, DRs, number of activated myofibroblasts, and TGF-1 were all reduced to about 50% of levels observed in untreated BDL rats. These findings suggest that AM, when applied as a patch onto the liver surface, is useful for treating well-established cholestatic fibrosis, and the mechanism was partly by means of downregulating the profibrotic factor TGF-1 and IL-6.

The Brazilian Diabetes Society is starting an innovative project of quantitative assessment of medical arguments of and implementing a new way of elaborating SBD Position Statements. The final aim of this particular project is to propose a new Brazilian algorithm for the treatment of type 2 diabetes, based on the opinions of endocrinologists surveyed from a poll conducted on the Brazilian Diabetes Society website regarding the latest algorithm proposed by American Diabetes Association /European Association for the Study of Diabetes, published in January 2009.An additional source used, as a basis for the new algorithm, was to assess the acceptability of controversial arguments published in international literature, through a panel of renowned Brazilian specialists. Thirty controversial arguments in diabetes have been selected with their respective references, where each argument was assessed and scored according to its acceptability level and personal conviction of each member of the evaluation panel.This methodology was adapted using a similar approach to the one adopted in the recent position statement by the American College of Cardiology on coronary revascularization, of which not only cardiologists took part, but also specialists of other related areas.

Objective: This study aimed to describe the clinical results of intrahemorrhoidal application of a diode laser., Background Data: Hemorrhoids are a common source of pain, and no surgical technique achieves a painless outcome. Endovascular laser therapy for varicose veins as described in an experimental study is a method that could be used in the treatment of hemorrhoids, but there are few clinical trials described in the literature., Materials and Methods: Fifteen patients with second and third degree hemorrhoids underwent intrahemorrhoidal laser therapy. After the piles were identified, a fiber was introduced into each and it was irradiated with laser energy (810 nm, 5 W, frequency of 5 Hz, energy density of 19 J/cm(2), total energy of 4-10 J)., Results: The piles were immediately partially reduced, and clinical examination 7, 14, 21, and 28 d after surgery showed complete healing in nine patients (60.4%) and partial resolution in five patients (33%). In one patient (6.6%) the treatment failed. Mean pain intensity throughout the study period, measured by a visual analog scale (0-10), was 0.84 +/- 1.13 (mean +/- SD). Major complications were burn lesions (n = 4) and residual plicoma (skin tag) (n = 5). Ten control patients underwent an open "cold scalpel" hemorrhoidectomy. Their pain intensity was 1.78 +/- 0.68 (mean +/- SD). There was a significant statistical difference (p = 0.018) between groups., Conclusion: The diode laser energy delivered into small to median hemorrhoidal piles caused little pain and led to a partial to complete resolution within a short time compared to open hemorrhoidectomy. Some adjustments must be made to prevent burning lesions and residual plicoma. Although it is not a good method for big piles, this technique opens new possibilities for surgical treatment of hemorrhoidal disease.