Medical College For Women and Hospital

OBJECTIVE: To investigate whether intrauterine growth retardation (IUGR) and preterm delivery in a poor population of South Asia was associated with altered maternal and fetal levels of folate, vitamin B12, and homocysteine. SUBJECTS AND METHODS: Hundred and twenty-eight pregnant women from a low socio-economic strata in the city of Lahore, Pakistan were followed with ultrasound of fetal growth from the 12th week of pregnancy. Blood samples were drawn from the woman and the cord at delivery. Serum was analyzed by a chemiluminescent immunoassay for folate and vitamin B12 and by fluorescence polarization immunoassay for total homocysteine (tHcy). RESULTS: Fourty-six infants showed IUGR. In term, but not preterm, deliveries with IUGR, maternal and cord blood folate levels were half of those in deliveries of normal birth weight infants (P=0.004 and P=0.005). The risk of IUGR was reduced among women with folate levels in the highest quartile (OR 0.31, 95% CI 0.10--0.84). There was no association between vitamin B12 and IUGR. Total homocysteine levels were higher in women delivering IUGR infants (P=0.02). There was an inverse correlation between cord blood folate and tHcy levels (r=-0.26, P=0.006). We also found increased risks for hypertensive illness (OR 3.5, 95% CI 1.4--8.6) and premature delivery (OR 2.5, 95% CI 1.1--6.2) in women in the highest quartile of tHcy. CONCLUSIONS: The occurrence of IUGR increased with low maternal and cord concentrations of folate and high maternal levels of tHcy. Further studies on the effects of vitamin B supplementation through pregnancy are warranted.

Depression is the most common mental illness, which has become the major cause of fear and suicidal mortality or tendencies. Currently, about 10% of the world population has been suffering from depression. The classical approach for detecting depression relies on the clinical questionnaire, which depends on the patients’ responses as well as observing their behavioral activities. However, there is no established method to detect depression from EEG biomarkers. Therefore, exploration of EEG biomarkers for depression assessments is vital and has a great potential to improve our understanding and clinical interventions. In this study, we have conducted a systematic review of 52 research articles using the PRISMA-P systematic review protocol, where we analyzed their research methodologies and outcomes. We categorized the experimentations in these articles according to their physical and psychological aspects scaled by the commonly used clinical questionnaire-based assessments. This study finds that the negative stimuli are the better identification strategies for evaluating depression through EEG signals. From this exploration, researchers observed that the Neural Connectivity Analysis and Brain Topological Mapping have huge potentials for finding depression biomarkers, and it is evident that the right-side hemisphere and frontal and parietal-occipital cortex are distinct regions to detect depression using EEG signals. For this mechanism, researchers are using many signal processing and machine learning approaches. In the case of filtering, Independent Component Analysis (ICA) is commonly used to eliminate physiological and non-physiological artifacts. Among machine learning approaches, Convolutional Neural Network (CNN) and Support Vector Machine (SVM) showed better performance for classifying healthy and depressed brains. The authors hope, this study will create an opportunity to explore more in the future for EEG as diagnostic tool by analyzing brain functional connectivity for focusing on clinical interventions.

This article aims to narrate the various oral complications in individuals suffering from diabetes mellitus. Google search for "diabetes mellitus and oral complications" was done. The search was also carried out for "diabetes mellitus" and its oral complications individually. Diabetes mellitus is a chronic metabolic disorder that is a global epidemic and a common cause of morbidity and mortality in the world today. Currently, there are about 422 million cases of diabetes mellitus worldwide. Diabetic patients can develop different complications in the body such as retinopathy, neuropathy, nephropathy, cardiovascular disease. Complications in the oral cavity have been observed in individuals suffering from diabetes mellitus. A study noted that more than 90% of diabetic patients suffered from oral complications. Another research has shown a greater prevalence of oral mucosal disorders in patients with diabetes mellitus than non-diabetic population: 45-88% in patients with type 2 diabetes compared to 38.3-45% in non-diabetic subjects and 44.7% in type 1 diabetic individuals compared to 25% in the non-diabetic population. Oral complications in people with diabetes are periodontal disease, dental caries, oral infections, salivary dysfunction, taste dysfunction, delayed wound healing, tongue abnormalities, halitosis, and lichen planus. The high glucose level in saliva, poor neutrophil function, neuropathy, and small vessel damage contribute to oral complications in individuals with uncontrolled diabetes. Good oral health is imperative for healthy living. Oral complications cause deterioration to the quality of life in diabetic patients. Complications like periodontal disease having a bidirectional relationship with diabetes mellitus even contribute to increased blood glucose levels in people with diabetes. This article intends to promote awareness regarding the oral health of diabetics and to stress the importance of maintaining proper oral hygiene, taking preventive measures, early detection, and appropriate management of oral complications of these patients through a multidisciplinary approach.

Background:Cardiovascular disease (CVD) is responsible for morbidity and mortality in type 2 diabetes mellitus (T2DM) patients. Diabetes alters the utilization of lipids and lipoproteins which lead to diabetes induced atherogenic dyslipidemia, one of the most important risk factor for the development of atherosclerosis. The relationship between elevation of serum lipids and vascular complications of diabetes has long been of interest. The use of LDL-c alone for assessment of cardiovascular risk would ignore the TG-rich lipoproteins. Lipid ratios, atherogenic coefficient and atherogenic index of plasma have been found to indicate an atherogenic risk and are better predictors of cardiovascular risk than lipids alone. Hence the present study is taken up to evaluate the lipid ratios, atherogenic coefficient, atherogenic index of plasma in assessing the CV risk in type 2 diabetes mellitus.Methods: This case-control prospective study included three groups. (Group 1: control, group II: T2DM without complications, group III: T2DM with complications, n=25). Total cholesterol, triglycerides and HDL-c were analysed using commercially available kits on spectrophotometer. Nitric oxide was estimated spectrophotometrically by Griess method. VLDL, LDL, Lipid ratios, non-HDL cholesterol, AC and AIP were calculated in all the three groups. Statistical analysis was performed using SPSS version 22.0.Results: All of the atherogenic indices were found to be significantly different upon comparing these indices in both patients and control groups.Conclusions: The ratios contribute significantly to the estimation of CVD risk in type 2 diabetes mellitus especially, when the absolute values of lipid profile seem normal or not markedly deranged or in centres with insufficient resources.

Diabetes mellitus is a global health problem and a major contributor to mortality and morbidity. The management of this condition typically involves using oral antidiabetic medication, insulin, and appropriate dietary modifications, with a focus on macronutrient intake. However, several human studies have indicated that a deficiency in micronutrients, such as zinc, can be associated with insulin resistance as well as greater glucose intolerance. Zinc serves as a chemical messenger, acts as a cofactor to increase enzyme activity, and is involved in insulin formation, release, and storage. These diverse functions make zinc an important trace element for the regulation of blood glucose levels. Adequate zinc levels have also been shown to reduce the risk of developing diabetic complications. This review article explains the role of zinc in glucose metabolism and the effects of its inadequacy on the development, progression, and complications of diabetes mellitus. Furthermore, it describes the impact of zinc supplementation on preventing diabetes mellitus. The available information suggests that zinc has beneficial effects on the management of diabetic patients. Although additional large-scale randomized clinical trials are needed to establish zinc's clinical utility further, efforts should be made to increase awareness of its potential benefits on human health and disease.

Background: Overuse of smart devices provides comfort and problems both physically and mentally. The aim of this study was to assess the impact of smart phone and mobile devices on human health and life.Methods: This descriptive type of cross sectional study was conducted for three months in Dhaka city among general population aged 18 to 70 years. Four hundred and forty respondents were selected by non-probability convenient sampling technique. Data were collected by face to face interview with a semi-structured pre-tested questionnaire.Results: Among 440 respondents majority (76.6%) were below 25 years where 72.0% were students. A large proportion (90.5%) used smart phones for communication, 53.4% used for less than 5 hours daily. Majority (65.7%) had other electronic devices, most common 197 (68.1%) were laptop users where 118 (40.8%) used for studying. More than half 322 (73.2%) used earphones, 91 (20.7%) had ear problems and 223 (50.7%) lacked concentration. Many 299 (68.0%) had good relationship with family members, 208 (47.3%) stated that increased use of mobile devices hampered family life, 88 (42.3%) thought it reduced quality family time. Majority users 253 (57.5%) experienced physical discomfort after prolonged use and 95 (37.7%) suffered from headache. Association between age of respondents and time spent on smart devices was statistically significant (p<0.05). There was significant (p<0.05) association between ear problem and ear phone usage.Conclusions: Excessive use of smart phones should be avoided and social awareness increased through health programmes. Potential risks of cell phones and smart devices can be avoided by limiting the use.

Examiner in Midwifery in the

Introduction: Global Cardiovascular disease (CVD) is still one of the leading causes of death and requires the enhancement of diagnostic methods for the effective detection of early signs and prediction of the disease outcomes. The current diagnostic tools are cumbersome and imprecise especially with complex diseases, thus emphasizing the incorporation of new machine learning applications in differential diagnosis. Methods: This paper presents a new machine learning approach that uses MICE for mitigating missing data, the IQR for handling outliers and SMOTE to address first imbalance distance. Additionally, to select optimal features, we introduce the Hybrid 2-Tier Grasshopper Optimization with L2 regularization methodology which we call GOL2-2T. One of the promising methods to improve the predictive modelling is an Adaboost decision fusion (ABDF) ensemble learning algorithm with babysitting technique implemented for the hyperparameters tuning. The accuracy, recall, and AUC score will be considered as the measures for assessing the model. Results: On the results, our heart disease prediction model yielded an accuracy of 83.0%, and a balanced F1 score of 84.0%. The integration of SMOTE, IQR outlier detection, MICE, and GOL2-2T feature selection enhances robustness while improving the predictive performance. ABDF removed the impurities in the model and elaborated its effectiveness, which proved to be high on predicting the heart disease. Discussion: These findings demonstrate the effectiveness of additional machine learning methodologies in medical diagnostics, including early recognition improvements and trustworthy tools for clinicians. But yes, the model's use and extent of work depends on the dataset used for it really. Further work is needed to replicate the model across different datasets and samples: as for most models, it will be important to see if the results are generalizable to populations that are not representative of the patient population that was used for the current study.

Drug-resistant tuberculosis (DR-TB) has continued to be a global health cataclysm. It is an arduous condition to tackle but is curable with the proper choice of drug and adherence to the drug therapy. WHO has introduced newer drugs with all-oral shorter regimens, but the COVID-19 pandemic has disrupted the achievements and raised the severity. The COVID-19 controlling mechanism is based on social distancing, using face masks, personal protective equipment, medical glove, head shoe cover, face shield, goggles, hand hygiene, and many more. Around the globe, national and international health authorities impose lockdown and movement control orders to ensure social distancing and prevent transmission of COVID-19 infection. Therefore, WHO proposed a TB control program impaired during a pandemic. Children, the most vulnerable group, suffer more from the drug-resistant form and act as the storehouse of future fatal cases. It has dire effects on physical health and hampers their mental health and academic career. Treatment of drug-resistant cases has more success stories in children than adults, but enrollment for treatment has been persistently low in this age group. Despite that, drug-resistant childhood tuberculosis has been neglected, and proper surveillance has not yet been achieved. Insufficient reporting, lack of appropriate screening tools for children, less accessibility to the treatment facility, inadequate awareness, and reduced funding for TB have worsened the situation. All these have resulted in jeopardizing our dream to terminate this deadly condition. So, it is high time to focus on this issue to achieve our Sustainable Development Goals (SDGs), the goal of ending TB by 2030, as planned by WHO. This review explores childhood TB's current position and areas to improve. This review utilized electronic-based data searched through PubMed, Google Scholar, Google Search Engine, Science Direct, and Embase.

Thalassemias are a group of congenital hemoglobin (Hb) disorders distinguished by dwindling or total curtailment of production of one or more globin chains of hemoglobin tetramers, ensuing in unrestrained destruction of red blood cells (RBC) that causes severe anemia. The severity of the disease often remains immensely variable. Children with thalassemia suffer from the disease's consequences and treatment complications. The disease also causes a negative impact on family members, who suffer mentally, socially, financially, and even physically. In this review, we highlight the challenges experienced by the family and caregivers; for instance, repeated blood transfusion as the dominant origin of tissue casualty, morbidity, and fatal clinical outcomes. Treatment modalities regarding thalassemias were not successful until the inception of bone marrow transplantation and gene therapy.

Noble metals and their compounds have a long and distinguished history as therapeutic agents in medicine. Recent years have seen tremendous progress in the design and study of nanomaterials geared towards biological and biomedical applications. Particularly gold nanoparticles have attracted intensive interest, because they are easily prepared, have low toxicity and can be readily attached to molecules of biological interest. The gold nanoparticles have become more precious than pretty gold because of their wide use and applications. The present article gave a critical review of the wide applications and uses of gold nanoparticles in diagnostics, surgery and medicine. DOI: http://dx.doi.org/10.3329/bjmb.v5i2.13346 Bangladesh J Med Biochem 2012; 5(2): 56-60

Background: Food handlers with poor personal hygiene and lack of awareness of important issues in preventing food borne diseases, working in food establishments could be potential sources of infections of many intestinal helminthes of protozoa and enterogenic pathogens. The objective of the study was to procure information about various food handling practices and spread awareness about the prevention of food borne diseases.Methods:An organization based cross-sectional study. All the food handlers in given area like Suraram, Shapur, Jeedimetla, Gajulramaram, Chintal and Gandimaisamma were contacted. A total of 86 food handlers in food establishments were interviewed within the stipulated time. The required data is obtained by per designed questionnaire method; the data collection involves the following criteria – Food handling practices, environmental and personal hygiene, knowledge of food hygiene and safety and also their attitude, measures taken for controlling and preventing of food borne illnesses, incidence of food borne diseases. Proportions and Chi square test were used for analysis of the data.Results: It was found that maximum food handlers were not certified in food training (82.5%). Only 27.9% of food handlers reported that they heard about food borne diseases. That is they were aware that food can be a source of infection if not handled properly. Awareness or knowledge was better in females (36.8%) compared to males (25.3%). Majority of food handlers acquired their knowledge through mass media. It is seen that overall the attitude of food handlers towards handling of food was satisfactory. In the present study, it was found that all practices related to food hygiene were very well followed by majority of the food handlers in the study.Conclusions:The overall knowledge, attitude and practices of the food handlers were very good and above the average.

Animal studies have found that inadequate nutrition during pregnancy may lead to vascular dysfunction and hypertension in offspring. In humans, vascular (endothelial) dysfunction and hypertension are causally linked to elevated homocysteine (Hcy) levels. Abnormally high Hcy levels result in part from deficits in folic acid and vitamin B12, which are required to remethylate homocysteine to methionine. The investigators therefore speculated that altered maternal and fetal levels of folate, vitamin B12, or Hcy are associated with intrauterine growth restriction (IUGR) and hypertensive pregnancy complications. Participants were 128 pregnant women of low socioeconomic status living in Lahore, Pakistan. Fetal growth was monitored by ultrasound starting at 12 weeks gestation. IUGR was defined as lack of an 11% or greater increase in estimated fetal weight over a period of at least 15 days. Maternal and cord blood levels of folate and vitamin B12 were measured by chemiluminescent immunoassay and total Hcy (tHcy) by fluorescence polarization immunoassay. Fifteen of the 128 women had pregnancy-induced hypertension and 14 had preeclampsia; none had chronic hypertension. Forty-six fetuses were growth-restricted, whereas 52 deliveries were preterm (before 37 completed weeks of gestation). In univariate analysis, Hcy levels were significantly higher in women who developed hypertension, delivered an IUGR infant, or delivered preterm. On multivariate analysis, women with the highest quartile of tHcy had a 3.5-fold increased risk of hypertensive illness (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4–8.6), and those with relatively high Hcy levels were at increased risk of preterm delivery (OR, 2.5; 95% CI, 1.1–6.2). The youngest women, less than 22 years of age, had the highest Hcy levels and the greatest risk of IUGR (OR, 2.9; 95% CI, 1.1–8.2) compared with older women, and the risk of IUGR was not altered by hypertension. Women with the highest folate levels had the lowest risk of IUGR (OR, 0.31; 95% CI, 0.10–0.84). Cord blood levels of both folate and vitamin B12 were approximately twice as high as were maternal levels, but there was no substantial difference in Hcy levels. Cord blood levels of all 3 substances correlated significantly with maternal blood levels for normal-birth-weight infants. However, cord blood folic acid levels from IUGR infants delivered at term were half those of normal-birth-weight infants and correlated inversely with cord blood Hcy levels. No outcomes could be related to cord blood levels of vitamin B12 or Hcy. Nearly a decade ago, the U.S. Food and Drug Administration required manufacturers to fortify enriched cereal grain products with 140 μg of folic acid per 100 g of product. The goal was to reduce the number of infants born with neural tube defects (NTDs). A recently published report by Grosse et al (Am J Public Health 2005;95:1917–1922) describes using both cost–benefit analysis (CBA) and cost-effectiveness analysis (CEA) to estimate the economic benefit of folic acid fortification intended to prevent NTD births. The base-case scenario assumed that there were no adverse effects from fortification, and that fortification costs were limited to fortificant and nutrition label changes. It also acknowledged the results of fortification to date by assuming that the reduction in NTD births would be twice that predicted when fortification was initiated, and that the per-birth cost of caring for an infant with NTD would be 1.7 times higher than predicted, in part because of inflation. The worst-case scenario assumed that fortification was responsible for only 80% of the observed reduction in NTDs, that annual fortification costs were twice what was calculated, and that fortification had some adverse effects such as an increased incidence of pernicious anemia. Applying both CBA and CEA, folic acid fortification was associated with an annual net economic benefit ranging from $312 million (worst-case scenario) to $422 million (base-case scenario). Estimated cost savings, the net reduction in direct costs, were in the range of $88 million to $145 million per year, respectively. Although the worst-case figures are substantially lower than the best-case estimates, they greatly exceed estimates that were made before fortification.

BACKGROUND: Most people with cystic fibrosis (80% to 90%) need pancreatic enzyme replacement therapy to prevent malnutrition. Enzyme preparations need to be taken whenever food is taken, and the dose needs to be adjusted according to the food consumed. A systematic review on the efficacy and safety of pancreatic enzyme replacement therapy is needed to guide clinical practice, as there is variability between centres with respect to assessment of pancreatic function, time of commencing treatment, dose and choice of supplements. OBJECTIVES: To evaluate the efficacy and safety of pancreatic enzyme replacement therapy in children and adults with cystic fibrosis and to compare the efficacy and safety of different formulations of this therapy and their appropriateness in different age groups. Also, to compare the effects of pancreatic enzyme replacement therapy in cystic fibrosis according to different diagnostic subgroups (e.g. different ages at introduction of therapy and different categories of pancreatic function). SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Most recent search: 14 August 2014.We also searched an ongoing trials website and the websites of the pharmaceutical companies who manufacture pancreatic enzyme replacements for any additional trials. Most recent search: 12 May 2014. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials in people of any age, with cystic fibrosis and receiving pancreatic enzyme replacement therapy, at any dosage and in any formulation, for a period of not less than four weeks, compared to placebo or other pancreatic enzyme replacement therapy preparations. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials and extracted outcome data. They also assessed the risk of bias of the trials included in the review. MAIN RESULTS: One parallel trial and 11 cross-over trials of children and adults with cystic fibrosis were included in the review. The number of participants in each trial varied between 14 and 129 with a total of 426 participants included in the review. All the included trials were for a duration of four weeks. The included trials had mostly an unclear risk of bias from the randomisation process as the details of this were not given; they also mostly had a high risk of attrition bias and reporting bias.We could not combine data from all the trials as they compared different formulations. Findings from individual studies provided insufficient evidence to determine the size and precision of the effects of different formulations. Ten studies reported information on the review's primary outcome (nutritional status); however, we were only able to combine data from two small cross-over studies (n = 41). The estimated gain in body weight was imprecise, 0.32 kg (95% confidence interval -0.03 to 0.67, P = 0.07). Combined data from the same studies gave statistically significant results favouring enteric-coated microspheres over enteric-coated tablets for our secondary outcomes stool frequency, abdominal pain and fecal fat excretion. Data from another single small cross-over study also favoured enteric-coated microspheres over non-enteric-coated tablets with adjuvant cimetidine in terms of stool frequency. AUTHORS' CONCLUSIONS: There is limited evidence of benefit from enteric-coated microspheres when compared to non-enteric coated pancreatic enzyme preparations up to one month. In the only comparison where we could combine any data, the fact that these were cross-over studies is likely to underestimate the level of inconsistency between the results of the studies due to over-inflation of confidence intervals from the individual studies.There is no evidence on the long-term effectiveness and risks associated with pancreatic enzyme replacement therapy. There is also no evidence on the relative dosages of enzymes needed for people with different levels of severity of pancreatic insufficiency, optimum time to start treatment and variations based on differences in meals and meal sizes. There is a need for a properly designed trial that can answer these questions.

Cancer is a group of diseases which is categorized to differentiate into diverse cell types and move around in the body to sites of organogenesis that is key to the process of tumor genesis. All types of cancer fall into the group of malignant neoplastic diseases. In Bangladesh, cancer is now one of the foremost killer diseases and its personal, social, and economic bearing are huge. Plant-derived natural compounds (vincristine, vinblastine, etoposide, paclitaxel, camptothecin, topotecan, and irinotecan) are useful for the treatment of cancer. Since there is no extensive ethnobotanical research study in Bangladesh regarding the traditional uses of medicinal plants against neoplasms, therefore, a randomized ethnopharmacological surveys were carried out in 3 districts of Bangladesh to learn more about the usage of anticancer medicinal plants and their chemical constituents having antineoplastic activity. Comprehensive interviews were conducted to the folk medicine practitioners and medicinal plants as pointed out by them were photographed, collected, deposited, and identified at the Bangladesh National Herbarium. The various plant parts have been used by the healers which included whole plant, leaves, fruits, barks, roots, and seeds. This study evaluated considerable potential for discovery of novel compounds with less side effects in the management and prevention of malignancy in cancer.

Background: Socio-demographic variability among nations and cultures highly influences health-seeking behavior (HSB) in managing endemic or pandemic diseases. The present study aimed to investigate the influence of socio-demographic factors on HSB among Bangladeshi residents during the first wave of COVID-19. Methods: A cross-sectional online survey was performed with Bangladeshi residents (60% male and 40% female; age range: 10−60 years or above) from May to July 2020. Information was collected from the participants who resided in slum areas or did not have internet access through face-to-face surveys, maintaining spatial distancing and proper preventive measures. A self-reported and structured questionnaire, including socio-demographic and HSB, was undertaken, and the data was analyzed using a convenience sampling method. Finally, among the 947 participants, 20 were selected using a stratified random sampling technique for in-depth-interview (IDI). The linear regression analysis was performed to determine the influence of socio-demographic factors on HSB. Results: Only about 4.2% of respondents did not wear masks, but nearly half of the participants (46.6%) did not use hand gloves. The mean score of HSB was 9.98 (SD = 2.01) out of 16, with a correct overall rate of 62.4%. As per regression analysis, higher HSBs were found among participants who reported older age (>50 years) (9.96 ± 2.45), educated unemployed students (10.1 ± 1.95), higher education (10.5 ± 1.76), and higher-income (10.4 ± 1.59); in contrast, participants living in slum areas (8.18 ± 2.34) and whose source of income was business (8.46 ± 2.04) exhibited lower HSBs. Females, compared to men, showed better HSB in every aspect, apart from online food ordering. Qualitative data showed that the younger generation is more aware because of their access to information and persuaded the older generations to follow health-seeking protocols. The results also showed that some lower-income slum-dwellers have access to information and healthcare through their employers. IDIs also found cultural, religious, and mental-health affect people’s adherence to health-seeking guidelines and regulations. Conclusions: The findings suggest that socio-demographic factors significantly influenced HSBs during COVID-19 in the Bangladeshi population. Authorities can use these observations to systematically manage future endemics or pandemics.

BACKGROUND: Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycemia. Long-acting insulin analogues were developed to reduce hypoglycemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive, reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues. METHODS: Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-of-charge until funds run out and all long-acting insulin analogues have to be purchased from community stores. RESULTS: There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, now accounting for over 80% of all insulins dispensed in a minority of stores. This increase has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs than the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low- and middle-income countries struggling to fund long-acting insulin analogues for their patients. CONCLUSIONS: It was encouraging to see continued growth in the prescribing and dispensing of long-acting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups.

The dramatic rise in obesity has recently made it a global health issue. About 1.9 billion were overweight, and 650 million global populations were obese in 2016. Obese women suffer longer conception time, lowered fertility rates, and greater rates of miscarriage. Obesity alters hormones such as adiponectin and leptin, affecting all levels within the hypothalamic-pituitary-gonadal axis. Advanced glycation end products (AGEs) and monocyte chemotactic protein-1 (MCP-1) are inflammatory cytokines that may play an important role in the pathophysiology of ovarian dysfunction in obesity. In obese males, there are altered sperm parameters, reduced testosterone, increased estradiol, hypogonadism, and epigenetic modifications transmitted to offspring. The focus of this article is on the possible adverse effects on reproductive health resulting from obesity and sheds light on different molecular pathways linking obesity with infertility in both female and male subjects. Electronic databases such as Google Scholar, Embase, Science Direct, PubMed, and Google Search Engine were utilized to find obesity and infertility-related papers. The search strategy is detailed in the method section. Even though multiple research work has shown that obesity impacts fertility in both male and female negatively, it is significant to perform extensive research on the molecular mechanisms that link obesity to infertility. This is to find therapeutics that may be developed aiming at these mechanisms to manage and prevent the negative effects of obesity on the reproductive system.

Purpose – The aim of this paper is to empirically investigate the information skills of undergraduate students at the University of Dhaka, Bangladesh. Design/methodology/approach – A questionnaire-based survey was administered to obtain data about undergraduates’ information skills. The questionnaire consisted of demographic information, computer and Internet experiences, and a set of ten questions relating to information skills. A total of 199 undergraduate students responded to the survey. Findings – The results indicate that undergraduates’ information skills were poor. Only a few of them were successful in answering some of the questions correctly. There are significant differences in information skills among respondents in terms of gender, age, possession of personal computers and computer and Internet experience. The main reasons for these differences and the general failure in answering the task questions correctly are mostly attributed to the absence of information literacy instruction within the university, lack of online information resources and inadequate information and communication technology facilities. Practical implications – The findings of this study will help universities in Bangladesh and other developing countries to develop appropriate information literacy instruction at undergraduate level. Originality/value – This is the first time an effort has been made to assess task-based information skills of undergraduate students in Bangladesh. The findings of this study will help universities in Bangladesh and elsewhere in the developing world to introduce information literacy instruction at undergraduate level.

INTRODUCTION: Dementia is a progressive neurodegenerative disorder impairing memory and cognition. Alzheimer's Disease, followed by vascular dementia - the most typical form. Risk factors for vascular dementia include diabetes, cardiovascular disease, hyperlipidemia. Lipids' levels are significantly associated with vascular changes in the brain. AREAS COVERED: The present article reviews the cholesterol metabolism in the brain, which includes: the synthesis, transport, storage, and elimination process. Additionally, it reviews the role of cholesterol in the pathogenesis of dementia and statin as a therapeutic intervention in dementia. In addition to the above, it further reviews evidence in support of as well as against statin therapy in dementia, recent updates of statin pharmacology, and demerits of use of statin pharmacotherapy. EXPERT OPINION: Amyloid-β peptides and intraneuronal neurofibrillary tangles are markers of Alzheimer's disease. Evidence shows cholesterol modulates the functioning of enzymes associated with Amyloid-β peptide processing and synthesis. Lowering cholesterol using statin may help prevent or delay the progression of dementia. This paper reviews the role of statin in dementia and recommends extensive future studies, including genetic research, to obtain a precise medication approach for patients with dementia.