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Background: The prevalence of Autism in South Asia is 1 in 93 children, where, prevalence is much higher, 3% in Dhaka city of Bangladesh. Consumption of daily required nutrient is essential for these children like normal ones but sometimes may be neglected. Objectives: This study was undertaken to assess the macro and micronutrient consumption among the children with autism in Dhaka city and compared to the requirement.Material & Methods:In this cross-sectional study, 100 subjects where male-female ratio was 3:2, were studied from urban autism centers Dhaka, Bangladesh. Anthropometric parameters height, weight, BMI and 24-hour dietary recall (individual 3days) were collected following predesigned questionnaire. Data was collected from face to face interview from both parents and center’s teacher as appropriate. Nutritive value of food was calculated using Food Composition Table for Bangladesh, 2014 using a food software. For statistical analysis, SPSS 20 was used.Results:The average age and BMI of subjects were 11 yrs and 21 kg/m2 respectively. The mean ±SDvalues (g/day) of protein, fat and carbohydrate intake were 38±15, 47±12 and 116±38 respectively. The average intake of (mg/day) thiamine, riboflavin, vitamin C, calcium, magnesium, iron, niacin, and zinc was 0.68±0.32, 0.46±0.23, 33±24, 144±87, 137±55, 6.5±2, 11±4 and 5.2±2 respectively. About 94% children consumed only 33% of the required calcium. Nearly 42% children took 67% of the required magnesium. Similarly, half of the children failed to consume 33% thiamine and zinc of the requirement. Conclusions:Consumption of calcium, thiamine, folic acid, and zinc are seemed to be lower than their requirement.

Studies on the extent to which long-term exposure to ambient particulate matter (PM) with aerodynamic diameterWe conducted a retrospective cohort study within the Million Death Study (MDS) to provide the first-ever quantification of national mortality from exposure toWe calculated relative risks (RRs) by linking a total of ten 3-y intervals of satellite-based estimatedDirect epidemiological measurements, despite inherent limitations, yielded associations between mortality and long-term

Geometrical designs of interacting nanomagnets have been studied extensively in the form of two-dimensional arrays called artificial spin ice. These systems are usually designed to create geometrical frustration and are of interest for the unusual and often surprising phenomena that can emerge. Advanced lithographic and element growth techniques have enabled the realization of complex designs that can involve elements arranged in three dimensions. Using numerical simulations employing the dumbbell approximation, we examine possible magnetic behaviors for bilayer artificial spin ice, in which the individual layers are rotated with respect to one another. The goal is to understand how magnetization dynamics are affected by long-range dipolar coupling that can be modified by varying the layer separation and layer alignment through rotation. We consider bilayers where the layers are both either square or pinwheel arrangements of islands. Magnetic reversal processes are studied and discussed in terms of domain and domain wall configurations of the magnetic islands. Unusual magnetic ordering is predicted for special angles that define lateral spin superlattices for the bilayer systems.

The aim of the present work was to assess the pharmaceutical equivalence of three brands of atenolol (50 mg) tablets available in Bangladesh using in vitro dissolution study. The dissolution study was carried out using the paddle apparatus according to the guidelines of United States Pharmacopoeia (USP). The dissolution profiles of three locally manufactured atenolol tablets were determined and compared with the dissolution profile of atenolol tablet from innovator’s company. All samples attained more than 85% dissolution within 10 minutes. Mean dissolution values were employed to estimate difference factor (f1) and similarity factor (f2). Difference factor (f1) and similarity factor (f2) were used to assess in vitro bio-equivalency among the three brands. Other general quality assessment parameters such as hardness, friability and disintegration time were also determined. All brands complied with the official specifications for hardness, friability and disintegration time. The study indicated that all brands can be prescribed interchangeably. Dhaka Univ. J. Pharm. Sci. 18(1): 43-48, 2019 (June)

Background Stannous fluoride (SnF2) is a compound present in many commercially available dentifrices; however, oxidative decomposition negatively impacts its efficacy. Stannous oxidation is often mitigated through the addition of complexing agents or sources of sacrificial stannous compounds. The authors have found that the addition of zinc phosphate significantly improved stannous stability more effectively than other stabilization methods. The authors evaluated the chemical speciation of stannous compounds within a variety of formulations using x-ray absorption near edge spectroscopy (XANES), a technique never used before in this manner. These data were compared and correlated with several antimicrobial experiments. Methods XANES data of various commercially available compounds and Colgate TotalSF were performed and analyzed against a library of reference compounds to determine the tin chemical speciation. The antibacterial assays used were salivary adenosine triphosphate, short-interval kill test, plaque glycolysis, and anaerobic biofilm models. Results XANES spectra showed a diverse distribution of tin species and varying degrees of SnF2 oxidation. In vitro antimicrobial assessment indicated significant differences in performance, which may be correlated to the differences in tin speciation and oxidation state. Conclusions Driven by the excipient ingredients, SnF2 dentifrices contain a distribution of tin species in either the SnF2 or Sn(IV) oxidation state. The addition of zinc phosphate provided significant robustness against oxidation, which directly translated to greater efficacy against bacteria. Practical Implications The choice of inactive ingredients in a dentifrice with active SnF2 can dramatically impact product stability.

This review article deals with the various pelletization techniques utilized in the pharmaceutical industry for spheroidal particle production i.e., pellet for mainly oral administration which can be further formulated into several other dosage forms such as tablets, capsules or can be administered as such. Now-a-days oral administration has become the most versatile, convenient and common route of drug administration which ultimately focuses on patient compliance. The technique which is setting horizon in pelletization is “Extrusion Spheronization” because of its simple and easy steps involved in pellet production in a faster way. This review also includes the characterization and evaluation of pellets to ensure its quality, safety and efficacy to give out the required therapeutic activity after administration.

Objective To assess national and regional trends and causes-specific distribution of maternal mortality in India. Design Nationally representative cross-sectional surveys. Setting All of India from 1997 to 2020. Sample About 10 000 maternal deaths among 4.3 million live births over two decades. Methods We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country. Main outcome measures Maternal mortality burden and distribution of causes. Results The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%). Conclusions India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not. Tweetable abstract We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Coronavirus infections have caused outbreaks in humans: SARS-COV ((Severe Acute Respiratory Syndrome) and MERS-CoV (Middle East Respiratory Syndrome) resulting in significant mortality and morbidity.

The World Health Organization call to halve global snakebite deaths by 2030 will requires substantial progress in India. We analyzed 2,833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001-14, and conducted a systematic literature review from 2000-19 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000-19. Nearly half occurred at ages 30-69 years and over a quarter in children

Chronic hepatitis C virus (HCV) infection disproportionately affects African-Americans (AAs) and is a major contributor to liver failure and mortality. Genetic factors may not be the only cause in outcome disparity. We retrospectively investigated whether genetic host factors, viral genotypes, and treatment compliance in AA patients impacted the efficacy and the sustained virological response (SVR) rate of the interferon (IFN)-based treatment regimen. The medical chart review included 76 African-American patients (age ranging from 26 to 76) with varying levels of hepatitis condition. Fifty-seven (75%) of them had a clinically verifiable HCV infection and were followed by a hepatologist for 2 years at Howard University Hospital in Washington, DC. Both comprehensive metabolic profile and complete blood count analyses were performed. Among the 57 patients whose viral and IL28B genotypes were determined, sixty-eight percent (68%) were infected with viral genotype 1 and 71% harbored the CT allele of the IL28B gene. Among the 12 patients who completed treatment with IFN-based dual or triple therapy, 58% had achieved SVR 12 weeks following completion of treatment; 33% had a partial response with under 6000 viral count after 16 weeks of treatment; and there was one patient with viral genotype 1a and CT allele who did not respond to the medications. The results of this study prove that the PEG IFN-based regimen was effective in treating HCV-infected AA patients despite the current availability of new direct-acting antivirals. The major obstacles contributing to a low reduction in HCV infection and outcome in the AA community were avoidance or lack of treatment or compliance; contraindications, medication side effects, non-adherence, and payer eligibility restrictions.

Aims Key governing guidelines recognise that the holistic and complex needs of neuro-oncology patients are best served by a cohesive multidisciplinary team (MDT). Achieving a joint Clinical Nurse Specialist (CNS) and Allied Healthcare Professional (AHP) clinic (including Speech and Language Therapy, Physiotherapy, Dietetics and Occupational Therapy) for neuro-oncology patients has been a longstanding vision at Velindre Cancer Centre (VCC) in Cardiff. A successful funding application to Welsh Government in July 2020 allowed the establishment of a virtual “one stop shop” clinic with CNS and AHPs available along the care trajectory to improve patient and carer quality of life. The project reports on whether this innovative clinic model successfully achieved the desired coordinated, anticipatory and holistic care. Method The project utilised service improvement methodology principles with aims inherent within quarterly timeframes. This included robust data collection on patient attendances and interventions, improving patient education and self-management and wide patient, care and staff engagement by means of questionnaires and semi-structured interviews. The mixed methods approach yielded rich quantitative and qualitative data. Results The data demonstrates an increasing demand for the joint neuro-oncology clinic indicating that additional resources may be required. From triangulation of patient, carer and wider team engagement the key benefits were perceived to be having accessibility to the team in a convenient way, the provision of support and timely information and the overall perception of enhanced holistic care. Conclusion The data demonstrates the huge successes of the joint neuro-oncology clinic so far, including improvements to patient and carer quality of life, wider VCC benefits and cost saves. The persuasive case was presented to Welsh Government, and ongoing endorsement has been achieved for the next financial year.

Progress toward the United Nations 2030 Sustainable Development Goals requires improved information on mortality and causes of death. However, causes of many of the fifty million annual deaths in low- and middle-income countries remain unknown, as most of the deaths occur at home without medical attention. In 2001 India began the Million Death Study in 1.3 million nationally representative households. Nonmedical staff conduct verbal autopsies, which are structured interviews including a half-page narrative in local language of the family's story of the symptoms and events leading to death. Two physicians independently assess each death to arrive at an underlying cause of death. The study has thus far yielded information that substantially altered previous estimates of cause-specific mortality and risk factors in India. Similar robust studies are feasible at low cost in other low- and middle-income countries, particularly if they adopt electronic data management and ensure high quality of fieldwork and physician coding. Nationwide mortality studies enable the quantification of avoidable premature mortality and key risk factors for disease, and provide a practicable method to monitor progress toward the Sustainable Development Goals.

Summary Background Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1–59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India. Methods Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1·3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001–13 with annual UN estimates of national births and deaths (partitioned across India's states and rural or urban areas) for 2000–15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1–59-month-old children. Findings The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1–59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11·9 per 1000 livebirths in 2000 to 4·0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9·0 per 1000 livebirths in 2000 to 2·2 per 1000 livebirths in 2015. At 1–59 months, the mortality rate from pneumonia fell by 63% from 11·2 per 1000 livebirths in 2000 to 4·2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9·4 per 1000 livebirths in 2000 to 3·2 per 1000 livebirths in 2015 (with narrowing girl–boy gaps). The neonatal tetanus mortality rate fell from 1·6 per 1000 livebirths in 2000 to less than 0·1 per 1000 livebirths in 2015 and the 1–59-month measles mortality rate fell from 3·3 per 1000 livebirths in 2000 to 0·3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12·3 per 1000 livebirths in 2000 to 14·3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3·3% for neonates and 5·4% for children aged 1–59 months. Annual declines from 2005 to 2015 (3·4% decline for neonatal mortality and 5·9% decline in 1–59-month mortality) were faster than were annual declines from 2000 to 2005 (3·2% decline for neonatal mortality and 4·5% decline in 1–59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000–05 declines. Interpretation To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1–59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwards. Continued progress in reduction of child mortality due to pneumonia, diarrhoea, malaria, and measles at 1–59 months is feasible. Additional attention to low birthweight is required. Funding National Institutes of Health, Disease Control Priorities Network, Maternal and Child Epidemiology Estimation Group, and University of Toronto.

The World Health Organization call to halve global snakebite deaths by 2030 will require substantial progress in India. We analyzed 2833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019. Nearly half occurred at ages 30–69 years and over a quarter in children < 15 years. Most occurred at home in the rural areas. About 70% occurred in eight higher burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11–1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.

Summary Background Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. Methods To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010–17 and causes of death from 211 166 verbal autopsy interviews in the Indian Million Death Study for 2010–14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD–YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. Findings In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. Interpretation The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. Funding Ministry of Health and Family Welfare, Government of India.

Introduction: Timely diagnosis of malaria is a challenge in most endemic areas due to lack of resources. The methods most commonly used are microscopy, regarded as the gold standard, and rapid dipstick tests (RDT) which detect antigens in blood. Enzyme-Linked ImmunoSorbent Assay (ELISA) based tests are fast and easy to perform especially when large number of samples have to be tested. p-LDH is a highly sensitive marker of malaria in blood The present study was done to assess the diagnostic performance of a p-LDH based ELISA on samples from clinically suspected malaria patients. Methods: We tested the sensitivity and specificity of a pLDH based, commercially available ELISA kit on both microscopy positive and negative samples. Microscopy was done for all suspected malaria patients and of these 146 samples (73 positive and 73 negative) were tested by the ErbaLisa PAN (LDH) malaria ELISA kit as well SD Bioline malaria antigen test (RDT) based on detection of both HRP-2 and p-LDH common to all four species. Results: The sensitivity of Elisa was 95.9% while specificity was 93.2 % compared to gold standard microscopy while RDTs had 91.8 % sensitivity and 86.3 % specificity. All 67 samples positive by both microscopy and RDT were also positive by ELISA. Conclusion: p-LDH based ELISA promises to be a cost effective and reliable option for diagnosis of malaria in endemic areas like India.

1. Major, Child Specialist, Combined Military Hospital, Dhaka 2. Colonel, Child Specialist & Neonatologist, Combined Military Hospital, Dhaka 3. Brigadier General, Neonatologist, Head of the dept. of Paediatrics, AFMC, Dhaka Correspondence: Dr. Nure Ishrat Nazme, E-mail: nazssmc@ gmail.com. Introduction: Escobar syndrome is a rare autosomal recessive disorder which is also called “multiple pterygium syndrome.” Multiple pterygium syndrome is manifested by two types lethal and the non-lethal type. The more severe presentation, the lethal multiple pterygium syndrome comprises intrauterine growth retardation, multiple pterygia of the neck, elbows and knees, arthrogryposis and internal anomalies including fetal hydrops with cystic hygroma, microcephaly, cerebellar and pontine hypoplasia, cardiac and lung hypoplasia, intestinal malrotation, obstructive uropathy and cryptorchidism.1 Escobar syndrome is the name given to the non-lethal type of multiple pterygium syndrome. The most distinguishing characteristic features of this syndrome are congenital arthrogryposis, pterygia and spine deformities.2

We report an interesting case of a neonate presenting immediately after birth with respiratory distress, inspiratory stridor and difficult intubation. During operative microlaryngoscopy, a well-delineated papilloma like elongated supraglottic mass was seen. The patient underwent surgery, and the diagnosis was confirmed histologically. Biopsy revealed tissue compatible with hamartoma including blood vessel, nerve bundle and cartilage plate. The mass was removed by direct laryngoscopy. Neonatal laryngeal hamartomas are extremely rare. In general, an excellent prognosis is associated with these lesions, and the treatment of choice is endoscopic surgical excision. To our knowledge, this is the first description of a neonatal laryngeal hamartoma in Bangladesh.J Bangladesh Coll Phys Surg 2016; 34(3): 172-174

To investigate bioavailability enhancement of zinc on model oral surfaces and in oral biofilms in vitro through strategic formulation with two sources of zinc and L-arginine.To modulate the bioavailability of active zinc ions in a zinc citrate dentifrice, an additive research strategy was pursued. A series of zinc citrate dentifrice formulations were prepared with increasing replacement of zinc citrate with zinc oxide (a water insoluble source of zinc ions) to generate a Dual Zinc active system. A screening of isolated zinc and amino acid effects in simple solutions using zeta potential and uptake to model oral surfaces was performed in an effort to determine the effect of particle charge on zinc bioavailability. Zinc delivery and antibacterial efficacy of the Dual Zinc plus Arginine dentifrice formula were tested using in vitro oral epithelial tissue and saliva-derived biofilm models. Furthermore, zinc penetration and retention were determined by subjecting in vitro biofilms to dynamic flow after treatment with the Dual Zinc plus Arginine dentifrice with treated biofilms evaluated for zinc using imaging mass spectrometry (I-MS). Bacterial adhesion to gingival epithelial cells treated with the Dual Zinc plus Arginine dentifrice was imaged upon challenging with Streptococcus gordonii.Addition of zinc oxide into a zinc citrate dentifrice formula enhanced the efficacy of the system against anaerobic biofilms in a concentration- dependent manner. L-arginine further provided a significant positive charge (+36 mV) to the zinc oxide suspension (+16 mV) as measured by zeta potential. Simple solutions of the Dual Zinc active showed increased zinc uptake on model oral surfaces as a direct function of L-arginine concentration. Antibacterial efficacy of a Dual Zinc plus Arginine dentifrice was evaluated through multiple mechanisms. Enhanced antibacterial performance was observed through significant reductions in metabolic activity as measured through bacterial glycolytic function (p = 0.0001) and total oxygen consumption (p = 0.0001). Greater penetration and retention of zinc was observed in bacterial biofilms treated with the Dual Zinc plus Arginine dentifrice in comparison to treatment with a Dual Zinc dentifrice after twelve hours of dynamic flow (10 mL/hour) in an in vitro drip flow biofilm culture. Confocal microscopy showed adherent bacteria on cheek cells treated with the Dual Zinc plus Arginine dentifrice formula.The combination of zinc citrate, zinc oxide, and the amino acid L-arginine in a dentifrice formula enhances the bioavailability of zinc to model oral tissue surfaces, resulting in unique physicochemical effects. The significant antimicrobial control associated with the Dual Zinc plus Arginine dentifrice provides a unique vehicle toward achieving whole mouth health.

Background: Direct studies on the extent to which long-term exposure to ambient particulate matter (PM) of 2·5 µm diameter causes adult mortality in India are lacking, despite over 99% of Indians being exposed to levels that the World Health Organisation (WHO) considers unsafe. Methods: We conducted a prospective proportional mortality study within the Million Death Study (MDS) to provide the first-ever direct national estimates of chronic respiratory disease, heart attack and stroke mortality from exposure to particulate matter (PM2·5) in India from 2001-13. We calculated odds ratios (ORs) for three-year annual median PM2·5 exposures measured 1-3 years earlier (and the closest three-year range or 4-6 years earlier) in about 14 000 small villages or urban blocks, adjusted for individual age, year of death, smoking status, rural/urban residency, and area-level female illiteracy. ORs adjusted for spatial clustering. Findings: PM2.5 exposure levels increased from 2000 to 2014, particularly in North India. Among 77 976 cases and 38 283 injury controls at ages 15-69 years, the excess mortality risks per 10 unit µg/m3 increase in PM2·5 exposure were 2% and 3% for chronic respiratory disease and heart attack, respectively, but 22% for stroke in the northeast states. Risks were similar for each sex, above 70 years and in various sensitivity analyses, including in areas reporting lower solid fuel use. Adjustment for spatial clustering reduced the risks for chronic respiratory and heart attack, but not for stroke. Interpretation: If these modest risks are causal, then PM2·5 exposure accounted for 225 000 deaths from respiratory and vascular disease at ages 15-69 years in 2015 in India, but with considerable uncertainty (range 16 000 to 571 000 deaths). The modest excess risks suggest suitable caution in interpreting the direct MDS evidence, and even more caution in extrapolating the WHO's current model-based risks to India. Funding Statement: Supported by the Indian Council of Medical Research, Canadian Institutes of Health Research Foundation grant (FDN 154277), the University of Toronto, the National Institutes of Health grants (1R01TW007939). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Not required.

Background Verbal autopsies with physician assignment of cause of death (COD) are commonly used in settings where medical certification of deaths is uncommon. It remains unanswered if automated algorithms can replace physician assignment. Methods We randomized verbal autopsy interviews for deaths in 117 villages in rural India to either physician or automated COD assignment. Twenty-four trained lay (non-medical) surveyors applied the allocated method using a laptop-based electronic system. Two of 25 physicians were allocated randomly to independently code the deaths in the physician assignment arm. Six algorithms (Naïve Bayes Classifier (NBC), King-Lu, InSilicoVA, InSilicoVA-NT, InterVA-4, and SmartVA) coded each death in the automated arm. The primary outcome was concordance with the COD distribution in the standard physician-assigned arm. Four thousand six hundred fifty-one (4651) deaths were allocated to physician (standard), and 4723 to automated arms. Results The two arms were nearly identical in demographics and key symptom patterns. The average concordances of automated algorithms with the standard were 62%, 56%, and 59% for adult, child, and neonatal deaths, respectively. Automated algorithms showed inconsistent results, even for causes that are relatively easy to identify such as road traffic injuries. Automated algorithms underestimated the number of cancer and suicide deaths in adults and overestimated other injuries in adults and children. Across all ages, average weighted concordance with the standard was 62% (range 79–45%) with the best to worst ranking automated algorithms being InterVA-4, InSilicoVA-NT, InSilicoVA, SmartVA, NBC, and King-Lu. Individual-level sensitivity for causes of adult deaths in the automated arm was low between the algorithms but high between two independent physicians in the physician arm. Conclusions While desirable, automated algorithms require further development and rigorous evaluation. Lay reporting of deaths paired with physician COD assignment of verbal autopsies, despite some limitations, remains a practicable method to document the patterns of mortality reliably for unattended deaths. Trial registration ClinicalTrials.gov, NCT02810366. Submitted on 11 April 2016.

Stannous fluoride (SnFXANES data of various commercially available compounds and Colgate TotalXANES spectra showed a diverse distribution of tin species and varying degrees of SnFDriven by the excipient ingredients, SnFThe choice of inactive ingredients in a dentifrice with active SnF

The purpose of the present study was to investigate the in vitro complex formation and to study the nature and strength of complexes which could be formed due to interaction of metformin with ibuprofen. Metformin is an antidiabetic drug and ibuprofen is a non steroidal anti-inflammatory drug (NSAID). The in vitro interaction of metformin with ibuprofen was studied at room temperature and at different pH conditions. The studies were performed by UV-Visible spectrophotometry, conductometry and reversed - it was phase high performance liquid chromatography (RP-HPLC). It was found that metformin formed stable 1:1 complex with ibuprofen. The interaction may greatly influence the activity of these molecules. DOI: http://dx.doi.org/10.3329/bpj.v16i2.22303 Bangladesh Pharmaceutical Journal 16(2): 189-194, 2013

Introduction: Bronchiolitis is the most common illness among the patients attending the outpatient departments of CMH. It is predominantly a viral disease affecting the infants and young children. Though Antibiotic has little role, pediatricians frequently use them during bronchiolitis management. Very few randomized control trials without antibiotics in the management of bronchiolitis have so far been done. Objectives: To evaluate the outcome of bronchiolitis with or without antibiotics in a hospital setting. Methods: This prospective randomized control study was done in CMH Savar, during six months from October 2012 to March 2013. All the children below two years admitted in CMH Savar with first attack of Clinical Bronchiolitis were our study population. Exclusion criteria were: (i) atopic condition, (ii) congenital heart disease and/or (iii) known immunodeficiency. Study cases were randomly assigned into one of the two groups, AB group (Erythromycin/Amoxycilin) and NAB group (No Antibiotic).The NAB group was considered as control group. Supportive treatment was given according to the national guideline for management of bronchiolitis. Presenting symptoms and signs were followed-up twice daily while hospitalized and 7 days after discharge to determine the progress of disease. 70 JAFMC Bangladesh. Vol 9, No 2 (December) 2013 Outcome was determined by the progress of the variables in the structured follow-up format. Permission of commanding officer CMH Savar and verbal consent of the parents were taken before the study. Results: Fifty-four cases who could be followed up till after seven days of discharge were finally included in the study. Among them about half (25/54) received oral or intravenous antibiotic while rest (29/54) received only supportive therapy but no antibiotic (NAB group). Most of the cases were below six months of age. Male were about double of the female (37:17). The presenting features were cough, wheeze, fever and feeding difficulty. Clinical features of both groups progressed similarly in both the groups. With the given treatment 24 (96%) cases from AB group and 27 (93%) cases from NAB group improved and were discharged safely. 01 from AB and 02 from NAB group deteriorated and were then treated with broad spectrum antibiotics. There was no death. Mean hospital stay of AB group (5.6 days) was little longer than NAB group (4.2 days) and 16% (4/25) of them had respiratory symptoms at seven days follow up, but the difference of outcome between the two groups was not statistically significant. Conclusion: Antibiotics have no role in acute bronchiolitis management. DOI: http://dx.doi.org/10.3329/jafmc.v9i2.21833 Journal of Armed Forces Medical College Bangladesh Vol.9(2) 2013

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India. In the present era of antibiotic resistance, the emergence of multi-drugs resistant organism is becoming more common. The present study is performed in patients admitted in hospital in various department of hospital to study the infection rate of MRSA from these units. Objectives: The aim of this study was to isolate Staphylococcus aureus from various samples of patients admitted in tertiary care hospital, to study the prevalence rate of MRSA in the hospital. Material and method: The study was conducted in TMMC RC hospital from January 2013 to Sepetember2013. A total of one hundred Staphylococcus aureus isolates from clinical samples were subjected to MRSA screening using Kirby-Bauer methods with cefoxitin 30μg discs per CLSI guidelines. Results: There were 225 different samples collected and all the samples were inoculated on Blood agar medium than incubated. After overnight incubation 100 Staphylococcus aureus were isolated, among which 26 were MRSA and 74 were MSSA has been isolated.The susceptibility pattern of antibiotics showed that all MRSA isolates were significantly less sensitivity to antibiotics as compared to MSSA. None of the MRSA strain showed resistance towards Vancomycin Linezolid. Conclusion: The emergence of MRSA and other antibiotic resistant organisms reflects widespread ubiquitous over-use of antibiotics on a global scale. Control measures are required to prevent spread and reduce emergence of resistance.

A rapid and stability-indicating reversed phase high-performance liquid chromatography (RP-HPLC) method was developed for simultaneous quantification of paracetamol and ibuprofen in their combined dosage form especially to get some more advantages over other methods already developed for this combination. The method was validated according to United States Pharmacopeia (USP) guideline with respect to accuracy, precision, specificity, linearity, solution stability, robustness, sensitivity, and system suitability. Forced degradation study was validated according to International Conference on Harmonisation (ICH). For this, an isocratic condition of mobile phase comprising phosphate buffer (pH 6.8) and acetonitrile in a ratio of 65:35, v/v at a flow rate of 0.7 mL/minute over RP C18 (octadecylsilane (ODS), 150 × 4.6 mm, 5 μm, Phenomenex Inc.) column at ambient temperature was maintained. The method showed excellent linear response with correlation coefficient ( R 2 ) values of 0.999 and 1.0 for paracetamol and ibuprofen respectively, which were within the limit of correlation coefficient ( R 2 > 0.995). The percent recoveries for two drugs were found within the acceptance limit of (97.0-103.0%). Intra-and inter-day precision studies of the new method were less than the maximum allowable limit percentage of relative standard deviation (%RSD) ≤ 2.0. Forced degradation of the drug product was carried out as per the ICH guidelines with a view to establishing the stability-indicating property of this method and providing useful information about the degradation pathways, degradation products, and how the quality of a drug substance and drug product changes with time under the influence of various stressing conditions. The degradation of ibuprofen was within the limit (5-20%, according to the guideline of ICH), while paracetamol showed

Objectives Obesity is associated with the activation of the molecular pathways that increase the risk of colorectal cancer. Increasing body mass index may accelerate the development of adenomatous polyps, the antecedent lesion of colorectal cancer. The aim of this study was to assess the BMI effect on the risk of colonic polyp and adenoma in African-American. Methods The records of 923 patients who underwent colonoscopy were examined. Demographic and clinical data were collected before colonoscopy. Polyp and adenoma diagnosis were confirmed by pathology examinations. Results Overall, 43% of the patients were male, median age was 57 years and 77% had BMI ≥ 25.0 kg/m2. The frequency of colorectal polyps and adenomas were 61 and 35%, respectively. BMI ≥ 25.0 (OR = 1.61, 95% CI = 1.14-2.26), smoking (OR = 1.61, 95% CI = 1.15-2.26) and history of colon polyps (OR = 1.64, 95% CI = 1.09-2.47) were associated with higher risk of colon polyp. BMI ≥ 25.0 (OR = 1.81, 95% CI = 1.24-2.62), age (OR = 1.04, 95% CI = 1.02-2.05 for each year), male gender (OR = 1.38, 95% CI = 1.02-1.86), and smoking (OR = 1.73, 95% CI = 1.23-2.42) were associated with higher risk of colon adenoma. Conclusion Male and overweight African-Americans are at higher risk of colorectal adenoma. The findings of this study could be applied for risk stratification and modifying the colorectal cancer prevention including screening guideline in African Americans.