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Various order of implicit method has been formulated for solving initial value problems having an initial singular point. The method provides better result than those obtained by used implicit formulae developed based on Euler and Runge-Kutta methods. Romberg scheme has been used for obtaining more accurate result.

Foamy viruses are complex retroviruses that have been shown to be transmitted from nonhuman primates to humans. In Bangladesh, infection with simian foamy virus (SFV) is ubiquitous among rhesus macaques, which come into contact with humans in diverse locations and contexts throughout the country. We analyzed microsatellite DNA from 126 macaques at six sites in Bangladesh in order to characterize geographic patterns of macaque population structure. We also included in this study 38 macaques owned by nomadic people who train them to perform for audiences. PCR was used to analyze a portion of the proviral gag gene from all SFV-positive macaques, and multiple clones were sequenced. Phylogenetic analysis was used to infer long-term patterns of viral transmission. Analyses of SFV gag gene sequences indicated that macaque populations from different areas harbor genetically distinct strains of SFV, suggesting that geographic features such as forest cover play a role in determining the dispersal of macaques and SFV. We also found evidence suggesting that humans traveling the region with performing macaques likely play a role in the translocation of macaques and SFV. Our studies found that individual animals can harbor more than one strain of SFV and that presence of more than one SFV strain is more common among older animals. Some macaques are infected with SFV that appears to be recombinant. These findings paint a more detailed picture of how geographic and sociocultural factors influence the spectrum of simian-borne retroviruses.

Objectives: This study investigated the inequalities in access to maternal healthcare services in Bangladesh., Design and Setting: This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The survey encompassed diverse regions and households across Bangladesh. The study used the Human Opportunity Index (HOI) and Shapley's decomposition technique to measure the inequality in access to maternal healthcare opportunities., Participants: This study included 20 127 women aged 15-49 years. Among them, 5012 women had live births in the preceding 3 years of the survey, forming the study sample., Primary and Secondary Outcome Measures: This study has no secondary outcome variable. The primary dependent variable is 'adequate maternal healthcare', a dichotomous variable., Results: Household wealth status contributed the highest to inequality in accessing adequate maternal healthcare services (41.4%) such as receiving at least four antenatal care (ANC) visits (39.7%), access to proper ANC (50.7% and 44.0%) and health facility birth (43.4%). Maternal educational status contributes the second highest inequality among all factors in accessing adequate maternal healthcare (29.5%). Adequate maternal healthcare presented the lowest coverage rate and opportunity index among all (approximately 24% with HOI=17.2)., Conclusions: We found that attained adequate maternal healthcare had the lowest coverage and widest dissimilarity, while wealth index, education and place of residence are the major factors that contribute to inequalities in accessibility to maternal healthcare services in Bangladesh. These findings underscore a need for pro-poor interventions to narrow the economic inequalities between the poor and rich in terms of accessibility to maternal healthcare services. The results indicate the need for the Bangladeshi government and its health department to strengthen their commitment to improving female education. Investments should be made in initiatives that facilitate the proximity of maternal healthcare services to women in rural areas., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: All authors declare no conflicts of interest, financial or otherwise. The authors alone are responsible for the content and writing of this article.

Competing Interests: The authors report no conflict of interests. The authors alone are responsible for the content and writing of this article.

Vitamin D deficiency is common in patients with type 2 diabetes mellitus (T2DM). Vitamin D status may have a causal role in the onset of T2DM and may influence glycaemic control in these patients. However, data on vitamin D status among Bangladeshi T2DM patients are scarce. The present cross-sectional study was done among newly diagnosed 50 T2DM patients attending outpatient department of Comilla Diabetic Hospital, Bangladesh to address this lacuna. Serum 25(OH)D was measured in all and classified as normal (≥30ng/mL), insufficient (>20 to 29.9ng/mL), and deficient (≤20ng/mL). Mean serum 25(OH)D level was 27.91±2.58ng/mL (mean±SEM). Among the study subjects, 30% were D-deficient, 36% were D-insufficient and 34% had normal 25(OH)D. There was no statistical difference of 25(OH)D level between the younger (age <40 years) and older (≥40 years) patients (28.31±4.3 vs. 27.44±2.6ng/mL, mean±SEM; p=0.869); males and females (26.79±2.1 vs. 31.09±8.2ng/mL, mean±SEM; p=0.470); among smokers, non-smokers and ex-smokers (26.86±4.31, 27.10±2.49 and 42.62±1.71ng/mL respectively, mean±SEM; p=0.363); among normal weight, overweight and obese (30.61±6.16, 35.61±9.52 and 24.27±1.71ng/mL respectively, mean±SEM; p=0.191); and among normotensive, borderline hypertensive and hypertensive (25.29±2.46, 32.57±5.32 and 20.84±3.66ng/mL respectively, mean±SEM; p=0.277) patients. 25(OH)D level showed significant negative correlation with body mass index (r= -0.391, p=0.017) and positive correlation (r=0.334, p=0.044) with fasting plasma glucose in male subjects. Age, sex, smoking status, BMI, systolic BP, diastolic BP, family history of DM and smoking status were not found to influence vitamin D level independently. Our study found high frequency of subnormal vitamin D in newly diagnosed T2DM patients. Screening for vitamin D status may be beneficial in T2DM patients.

Clinical significance of low free T₃ (FT₃) has not been well explained in patients with type 2 diabetes mellitus (T2DM); FT₃ level may be associated with diabetes control and also with diabetic complications. This cross-sectional study was carried out among 153 (mean age 46.8±12 years; female 68%, mean duration of diabetes 5.5±0.53 years, 63.4% either overweight or obese) non-pregnant adults with T2DM who had no acute illness and were unaware about their thyroid function status from July 2016 to December 2016. Serum TSH, free T₄ (FT₄) and FT₃ were measured in all patients by radioimmunoassay (RIA). Patients having subnormal FT₃ level with normal TSH and FT₄ levels were labeled as having low FT₃ syndrome. The mean HbA1c of the study subjects was 8.3±1.7%, serum TSH 2.24±0.34μIU/mL, FT₄ 16.5±6.56fmol/mL and FT₃ was 5.36±1.74fmol/mL. Among them, 9.15% were found to have low FT₃ syndrome. There was no statistical difference of FT₃ level between males and females (5.87±1.50 vs. 5.99±1.85fmol/mL, mean±SD; p=0.165) and among different BMI groups (p=0.179). Patients with uncontrolled diabetes had lower FT₃ than those with controlled diabetes (5.91±1.83 vs. 6.15±1.21fmol/mL, mean±SD, p=0.024). The frequency of low FT₃ syndrome was 11.1% in uncontrolled diabetic patients whereas none of the patients with controlled diabetes had low FT₃. FT₃ level showed positive correlations with the duration of diabetes (r=0.296, p=0.002) and FT₄ level (r=0.490, p<0.001) only in female subjects. A fair number of clinically stable T2DM patients had low FT₃ in our study. Patients with uncontrolled diabetes had lower FT₃ than those with controlled diabetes.

The purpose of this observational cross-sectional study was to evaluate the histories of women with urinary incontinence caused by genitourinary fistulae in Bangladesh. This is an exploratory analysis to investigate possible contributing factors to the development of urogenital fistulae. Sixty four (64) women who were treated for urogenital fistulae at the National Fistula Center, Dhaka Medical College Hospital, Dhaka, Bangladesh were interviewed from July 2013 to December 2013. Their average age was 35.91 years; majorities were illiterate; had early marriage and came from poor family. Majority had height less than 150 cm, body weight 50 Kg or less and 67.19% of the women were multigravid. Obstetrical aetiology predominated in fistula causation and vesicovaginal fistula was the most frequent fistula type. Most of the women with fistulas did not receive antenatal care (88.46%); had developed a fistula after laboring for 48 hours or longer (59.61%) with vaginal delivery (59.61%) at home (57.69%) and within seven days of delivery (63.45%). Most women who experienced fistulae also had poor obstetric outcomes. Increasing access to emergency obstetric care is of paramount importance to prevent fistula formation.

An 18 years-old-girl presented one and half years back with the complaints of short stature, retarded growth, and menorrhagia with sudden severe lower abdominal pain; was diagnosed as bilateral ovarian cysts and underwent bilateral ovarian cystectomy. Later on she was incidentally diagnosed as a case of hypothyroidism when she had been experiencing slowly enlarging left lower abdominal mass with dull ache for the 5 month and then was transferred to the department of Endocrinology for further evaluation. Detailed work up revealed her short stature with obesity, delayed bone age and other features of hypothyroidism which was confirmed by thyroid function testing. She had enlarged left ovary with multiple follicles as shown in ultrasonography. Magnetic resonance imaging (MRI) showed sellar mass which was suspicious of macroadenoma. Levothyroxine replacement was started and she had a dramatic improvement of her problems with disappearance of the ovarian cysts and sellar mass.

Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy adult and adolescent Muslims. A significant number of patients with diabetes observe fasting during Ramadan. The objectives of this Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) study were to find out the current knowledge, attitude, and practices about Ramadan fasting among people with diabetes in Bangladesh. This retrospective cross-sectional study recruited 648 subjects with diabetes mellitus attending the Endocrinology outpatient department of a tertiary level hospital of Bangladesh within two months of the end of Ramadan in 2016. Socio-demographic data, data related to diabetes treatment, complications and co-morbidities; changes in lifestyle and diabetes treatment during Ramadan and frequency of hypoglycemia were collected from all. The mean age of the study population was 50.32±12.1 years and the majority (98.6%) had type 2 diabetes and 63.9% were overweight or obese. The majority (89.35%) of the patients fasted in Ramadan and among them, more than half of the fasters received physicians' advice for Ramadan fasting (60.6%) and changed diabetes medication (69.90%) during Ramadan. Although the amount of total food consumption was unchanged in more than one half (60.6%) of the fasters, majority of them reduced sugar-sweet intake (75.5%), increased fluid drinking (75.8%) and decreased physical activity (75.8%) during the month. A large portion (37.48%) of them did not check blood glucose and more than half (54.06%) of fasters failed to visit their physicians during Ramadan. Among them 14.85% experienced mild to moderate episodes of hypoglycemia and none had severe hypoglycemia and the most (61.6%) episodes of hypoglycemia occurred in the late evening. Hypoglycemic episodes were more frequent among insulin users, patients who had received fasting advice from physicians and in those who had adjusted diabetes drugs before Ramadan fasting. Safe Ramadan fasting is a great challenge not only for the patients but also the consulting physicians. Current study reflects the necessity of both physicians' expertise and patients' awareness for safe fasting.

We established cardiac pluripotent stem-like cells from the left atrium (LA-PCs) of adult rat hearts. These cells could differentiate not only into beating myocytes but also into cells of other lineages, including adipocytes and endothelial cells in the methylcellulose-based medium containing interleukin-3 (IL-3), interleukin-6 (IL-6), and stem cell factor (SCF). In particular, IL-3 and SCF contributed to the differentiation into cardiac troponin I-positive cells. Notably, small population of LA-PCs coexpressed GATA4 and myogenin, which are markers specific to cardiomyocytes and skeletal myocytes, respectively, and could differentiate into both cardiac and skeletal myocytes. Therefore, we investigated the involvement of these two tissue-specific transcription factors in the cardiac transcriptional activity. Coexpression of GATA4 and myogenin synergistically activated GATA4-specific promoter of the atrial natriuretic peptide gene. This combinatorial function was shown to be dependant on the GATA site, but independent of the E-box. The results of chromatin immunoprecipitation and electrophoretic mobility shift assays suggested that myogenin bound to GATA4 on the GATA elements and the C-terminal Zn-finger domain of GATA4 and the N-terminal region of myogenin were required for this synergistic activation of transcription. Taken together, these two transcription factors could be involved in the myogenesis of LA-PCs.

Ventricular fibrillation (VF) is the most serious variety of arrhythmia which requires quick and accurate detection to save lives. In this paper, we propose an empirical mode decomposition (EMD) based algorithm for VF detection. The intrinsic mode functions (IMFs) of VF are orthogonal whereas the lower order IMFs of normal sinus rhythm (NSR) are not. The orthogonality indices derived from the first three consecutive intrinsic mode functions (IMFs) of NSR and VF are used for their discrimination. The proposed technique is applied to the MIT-BIH arrhythmia database. The accuracy of detection of VF is 99.70% for a window length of 3s. This early estimate of VF may be useful in emergency cases where defibrillators are to be applied. Comparative results with the existing methods in terms of quality parameters and integrated receiver operating characteristic (IROC) are presented.