R Begum

OBJECTIVE: To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. DESIGN: Qualitative study (focus groups and semistructured interviews). SETTING: Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. PARTICIPANTS: Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). METHODS: 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. RESULTS: Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding. CONCLUSION: Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.

Pectin was extracted from jackfruit (Artocarpus heterophyllus) waste using three different extraction conditions to assess its potentiality as an alternative source of commercial pectin. Jackfruit waste was treated separately with ammonium oxalate, dilute sulphuric acid and sodium hexametaphosphate. The pectin obtained from these methods was compared in terms of yield, physicochemical properties and chemical structure. Among the three solvents, extraction with sodium hexametaphosphate gave the highest yield, however it contained high ash and showed the lowest solubility. Fourier transform infrared spectroscopy of jackfruit waste pectin irrespective of extraction condition revealed a similar surface structure to commercial pectin.

Shigellosis remains a common gastrointestinal disease mostly in children < 5 years of age in developing countries. Azithromycin (AZM), a macrolide, is currently the first-line treatment for shigellosis in Bangladesh; ciprofloxacin (CIP) and ceftriaxone (CRO) are also used frequently. We aimed to evaluate the current epidemiology of antimicrobial resistance (AMR) and mechanism(s) of increasing macrolide resistance in Shigella in Bangladesh. A total of 2407 clinical isolates of Shigella from 2009 to 2016 were studied. Over the study period, Shigella sonnei was gradually increasing and become predominant (55%) over Shigella flexneri (36%) by 2016. We used CLSI-guided epidemiological cut-off value (ECV) for AZM in Shigella to set resistance breakpoints (zone-diameter ≤ 15 mm for S. flexneri and ≤ 11 mm for S. sonnei). Between 2009 and 2016, AZM resistance increased from 22% to approximately 60%, CIP resistance increased by 40%, and CRO resistance increased from zero to 15%. The mphA gene was the key macrolide resistance factor in Shigella; a 63MDa conjugative middle-range plasmid was harboring AZM and CRO resistance factors. Our findings show that, especially after 2014, there has been a rapid increase in resistance to the three most effective antibiotics. The rapid spread of macrolide (AZM) resistance genes among Shigella are driven by horizontal gene transfer rather than direct lineage.

Background and Objectives: Pregnancy is the physiological process in which progressive anatomical, physiological and biochemical changes occur. Secretion of different hormones during pregnancy is responsible for maternal adaptation to the increasing demand of the growing fetus. The present study was aimed to evaluate serum calcium and phosphate status in normal pregnant women in different trimesters. Materials and Methods: A total number of 140 subjects, age range 20-40 (yrs) were recruited in the study which includes 100 normal pregnant women termed as study group (Group B) and 40 healthy women without pregnant (Group A), served as Control. Group B subjects were subdivided into Group B1 (n=12), Group B2 (n=30) and Group B3 (n=58) on the basis of duration of pregnancy- 1st, 2nd and 3rd trimesters respectively. Calcium was measured by CPC (photometric method for Ca) and serum phosphate by colorimetric method. Statistical analysis was done using SPSS for Windows, Version 10. Unpaired Student's -'t' test performed to calculate statistical differences between groups. Results: Age (yrs) (mean±SD) and BMI of the pregnant women in different groups did not show statistical difference. Serum calcium (mean±SD) levels in the 1st (p=0.0001) and 2nd (p=0.02) trimester was significantly higher compared to the Controls. In 3rd the value was significantly lower (p=0.015) compared to the Controls and of 1st and 2nd trimesters (p=0.001). Serum phosphate (mean±SD) levels in three trimesters did not show statistical significant difference compared to the Controls and among the pregnancy groups. Conclusion: The data concluded that serum calcium level was lower during third trimester of the study subjects which may be explained by the fact of increased demand of the growing fetus and exposing the mother at risk of complications related to low serum calcium. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11732 Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12

Shigella can frequently transform into a superbug due to uncontrolled and rogue administration of antibiotics and the emergence of HGT of antimicrobial resistance factors. The advent of AZM resistance in Shigella has become a serious concern in the treatment of shigellosis.