Case-fatality ratio of blood culture–confirmed typhoid fever in Dhaka, Bangladesh

With impending rollout of new conjugate typhoid vaccines, better estimates of typhoid case-fatality ratio are needed for countries to set priorities for public health programs. We enrolled 1425 patients of all ages with blood culture–confirmed Salmonella Typhi from laboratory networks serving inpatients and outpatients in Dhaka, Bangladesh. Participants were asked about symptoms and complications including death experienced over a median 3-month period following blood culture diagnosis. Four fatal cases were identified (case-fatality ratio of 0.3% [95% confidence interval, .05%–.55%]). Applying this case-fatality ratio to global typhoid burden estimates would reduce deaths by 70%

Fatal Outbreak from Consuming Xanthium strumarium Seedlings during Time of Food Scarcity in Northeastern Bangladesh

An outbreak characterized by vomiting and rapid progression to unconsciousness and death was reported in Sylhet Distrct in northeastern Bangladesh following destructive monsoon floods in November 2007.We identified cases presenting to local hospitals and described their clinical signs and symptoms. We interviewed patients and their families to collect illness histories and generate hypotheses about exposures associated with disease. An epidemiological study was conducted in two outbreak villages to investigate risk factors for developing illness. 76 patients were identified from 9 villages; 25% (19/76) died. Common presenting symptoms included vomiting, elevated liver enzymes, and altered mental status. In-depth interviews with 33 cases revealed that 31 (94%) had consumed ghagra shak, an uncultivated plant, in the hours before illness onset. Ghagra shak was consumed as a main meal by villagers due to inaccessibility of other foods following destructive monsoon flooding and rises in global food prices. Persons who ate this plant were 34.2 times more likely (95% CI 10.2 to 115.8, p-value<0.000) than others to develop vomiting and unconsciousness during the outbreak in our multivariate model. Ghagra shak is the local name for Xanthium strumarium, or common cocklebur.The consumption of Xanthium strumarium seedlings in large quantities, due to inaccessibility of other foods, caused this outbreak. The toxic chemical in the plant, carboxyatratyloside, has been previously described and eating X. strumarium seeds and seedlings has been associated with fatalities in humans and livestock. Unless people are able to meet their nutritional requirements with safe foods, they will continue to be at risk for poor health outcomes beyond undernutrition

Timing of Enteral Feeding in Cerebral Malaria in Resource-Poor Settings: A Randomized Trial

BACKGROUND: Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia. METHOD AND FINDINGS: A randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia. CONCLUSIONS: In conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN57488577

Retinal changes in visceral leishmaniasis by retinal photography

Background: In visceral leishmaniasis (VL), retinal changes have previously been noted but not described in detail and their clinical and pathological significance are unknown. A prospective observational study was undertaken in Mymensingh, Bangladesh aiming to describe in detail visible changes in the retina in unselected patients with VL. Methods: Patients underwent assessment of visual function, indirect and direct ophthalmoscopy and portable retinal photography. The photographs were assessed by masked observers including assessment for vessel tortuosity using a semi-automated system. Results: 30 patients with VL were enrolled, of whom 6 (20%) had abnormalities. These included 5 with focal retinal whitening, 2 with cotton wool spots, 2 with haemorrhages, as well as increased vessel tortuosity. Visual function was preserved. Conclusions: These changes suggest a previously unrecognized retinal vasculopathy. An inflammatory aetiology is plausible such as a subclinical retinal vasculitis, possibly with altered local microvascular autoregulation, and warrants further investigation. </p

Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings A Randomized Clinical Trial

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth. Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth. Design, Setting, and Participants: The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat. Interventions: Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea. Main Outcomes and Measures: Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment. Results: A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis. Conclusions and Relevance: The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged. Trial Registration: ClinicalTrials.gov Identifier: NCT03130114.publishedVersionPeer reviewe

The use of Cicer reticulatum L. for genetic improvement of cultivated chickpea

The diverse gene pool of wild chickpea (Cicer reticulatum L.) has the potential for use to improve a range of agronomically important traits in cultivated chickpea. This study was conducted to evaluate the phenotypic and genetic variations of 486 lines derived from interspecific crosses between C. arietinum (CDC Leader) and 20 accessions of C. reticulatum. Field evaluations were done on the progeny at the F4 and F5 generations. The lines were grown at four locations in Saskatchewan over two consecutive years, 2017 (Saskatoon and Moose Jaw) and 2018 (Limerick and Lucky Lake). Significant variability was observed for different traits such as seed weight per plant, thousand seed weight, number of seeds per plant, and biomass. Correlation analysis showed significant positive correlation of seed yield with the yield components including seed weight per plant (r = 0.99), number of seeds per plant (r = 0.95), and biomass (r = 0.82), while negative correlation was obtained between thousand seed weight and number of seeds per plant (r = -0.16). The significant positive direct effects of the number of seeds per plant, thousand seed weight, and biomass on the seed weight was confirmed by path coefficient analysis. Cluster analysis based on the phenotypic data generated six clusters for potential identification of heterotic groups of the interspecific lines. Cluster I consisted of 67 lines potential for improvement of yield traits, while the lines in cluster VI showed improved resistance to ascochyta blight disease. Genotyping of the 381 interspecific lines and 20 parents using tGBS identified 14,591 SNPs ranging from 634 to 2244 per chromosome. Neighbour-joining cluster analysis based on the SNP data grouped the 401 germplasms into 20 clusters. Admixture analysis revealed 9 groups that had a substantial amount of intermixing. The marker-trait association analysis using the mixed linear model (MLM) identified 51 SNPs that had significant associations with different traits. The SNPs on chr 4 were significantly associated with early flowering which were derived from the wild parents. Highest number of SNPs (13) were found to be associated with each of the trait such as thousand seed weight (g), and seed weight per plant (g).

Design and Evaluation of a Self-monitoring Application for Chronic Headaches

Chronic headache sufferers use headache diaries to learn about their headache symptoms and triggers. But the existing headache diaries do not support identification of probable headache triggers which is a critical requirement for self-monitoring of headaches. The literature describes several applications that keep track of headaches, but none of them allow the patients to identify potential headache triggers by exploring the correlations between the self-tracked factors and the onset of headaches. In this thesis, a self-monitoring application is designed that supports reviewing of headache trends and enables interactive visual exploration of potential correlations between the headaches and the putative triggers based on temporal data analysis. The design of the application reflects the data collection and the analytical needs of the headache patients. The evaluation results suggest that the application can be useful for the headache patients to identify their potential headache triggers, and hence enable better self-monitoring of headaches

A three tier forensic model for automatic identification of evidence of child exploitation by analysing the content of chat-logs

Detection of child exploitation (CE) in Internet chatting by locating evidence in the chat-log is an important issue for the protection of children from prospective online paedophiles. The un-grammatical and informal nature of chat-text makes it difficult for existing formal language processing techniques to handle the problem. The methodology of the current research avoids those difficulties by developing a multi-tier digital forensic model bulit on new ideas of psychological similarity measures and ways of applying them to chat-texts. The model uses text classifiers in the beginning to identify shallow evidence of CE. For locating the particular evidence it is required to identify the behavioural pattern of CE chats consisting of documented CE psychological stages and associate the perpetrators' posts to them. Similarities among the posts of a chat play an important role for the task of differentiating and identifying these stages. To accomplish this task a novel similarity measure is constructed backed by a dictionary with terms associated with each CE stage. Using the new similarity measure is constructed backed by a dictionary with terms associated with each CE stage. Using the new similarity measure in a hieraarchial agglomerative algoritm a new clusterer is built to cluster the posts of a chat-log into the CE stages to learn whether it follows the CE pattern. Inspired by the field of recognition of textual entailment a new soft entailment technique is developed and implemented to locate the specific posts associated with the CE stages. Those specific posts of the perpetrator are extarcted as the particular evidence from the chat-log. It is anticipated that the developed methodology will have many future pratical implementations. It would assist in the development of forensic tools for digital forensic experts in law and enforcement agencies to conveniently locate evidence of online child grooming in a confiscated hard disk drive. Another future implementation would be a parental filter used by parents to protect their children from potential online offenders.Doctor of Philosph