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ABSTRACTObjectiveTo conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, and Web of Science searched up to December 2017.Review methodsStudies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses.ResultsThe review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes.ConclusionExposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.

Vasomotor symptoms (hot flushes and night sweats) and other symptoms, including depression, anxiety and panic attacks, are commonly experienced by menopausal women and have been associated with an unfavourable cardiovascular risk profile. To investigate whether presence of menopausal symptoms is associated with the development of cardiovascular disease (CVD). Five electronic databases (Medline, EMBASE and Web of Science) were search until February 17th, 2015 to identify relevant studies. Observational cohort studies or randomised intervention studies were eligible for inclusion if they followed participants prospectively (at least 1 year of follow-up), and reported relevant estimates on the association of any vasomotor symptoms, or other menopausal symptoms, with risk of CVD, coronary heart disease (CHD), or stroke in perimenopausal, menopausal, or postmenopausal women. Data were extracted by two independent reviewers using a pre-designed data collection form. Separate pooled relative risks (RRs) for age and non-established cardiovascular risk factors (e.g., education, ethnicity) adjusted data and for established cardiovascular risk factors and potential mediators-adjusted data (e.g., smoking, body mass index, and hypertension) were calculated. Out of 9,987 initially identified references, ten studies were selected, including 213,976 women with a total of 10,037 cardiovascular disease outcomes. The age and non-established cardiovascular risk factors adjusted RRs) [95% confidence intervals] for development of CHD, Stroke and CVD comparing women with and without any menopausal symptoms were 1.34 [1.13-1.58], 1.30 [0.99-1.70], 1.48 [1.21-1.80] respectively, and the corresponding RRs adjusted for cardiovascular risk factors and potential mediators were 1.18 [1.03-1.35], 1.08 [0.89-1.32], 1.29 [0.98-1.71]. However, these analyses were limited by potential unmeasured confounding and the small number of studies on this topic. Presence of vasomotor symptoms and other menopausal symptoms are generally associated with an increased risk of cardiovascular disease, which is mainly explained by cardiovascular risk factors.

BackgroundBystander cardiopulmonary resuscitation (CPR) rates remain fairly low through most communities despite multiple interventions through the years. Understanding the attitudes and fears behind CPR training and performance would help target education and training to raise the rates of bystander CPR and consequently survival rates of victims. 7909 participants at a single-day mass CPR training session in Singapore were given survey questionnaires to fill out. 6473 people submitted completed forms upon the conclusion of the training session. Some issues looked at were the overall level of difficulty of CPR, difficulty levels of specific skills, attitudes towards refresher training, attitudes towards performing CPR, and fears when doing so.ResultsThe mean level of difficulty of CPR was rated 3.98 (scale of 1–10), with those with previous CPR training rating it easier. The skills rated most difficult were performing mouth-to-mouth breathing and chest compressions, while the easiest rated was recognizing non-responsiveness. A majority (69.7%) would agree to go for refresher training every 2 years and 88.7% felt everyone should be trained in CPR. 71.6% would perform full CPR for a member of the public in cardiac arrest and only 20.7% would prefer to only do chest compressions. The most cited fear was a low level of confidence, and fears of acquiring infections or aversion to mouth-to-mouth breathing were low.ConclusionsThe survey results show that most participants in Singapore are keen to perform conventional CPR for a member of the public and can help to target future CPR training accordingly.

Thin films of CrMoVN are deposited on c‐plane sapphire (Al2O3 (0001)) by direct current reactive magnetron sputtering, to investigate the effects of Mo and V addition to CrN‐based films. All films grow epitaxially, but Mo incorporation affects the crystal structure and nitrogen content. All films in the CrMoVN series are understoichiometric in nitrogen, but largely retain the NaCl B1 structure of stoichiometric CrN films. Addition of vanadium increases the phase‐stability range of the cubic phase, allowing for higher solubility of Mo than what has previously been reported for cubic CrN. The Seebeck coefficient and electrical resistivity are greatly affected by the alloying, showing a decrease of the Seebeck coefficient along with a decrease in resistivity. Cr0.83Mo0.11V0.06Nz shows a 70% increase in power factor (S2σ = 0.22 mW m−1 K−2) compared to the reference CrNz (S2σ = 0.13 mW m−1 K−2). Thermoelectric (TE) materials are in use in several applications, but often have too low efficiency. For more widespread use of these materials, fundamental research on TE material system is necessary. In this work, alloying in CrN, with the hope of pushing a material with great promise closer to applications, is investigated.

Available literature suggests that both vitamin D and calcium may be associated with a wide range of non-skeletal outcomes. However, epidemiological evidence supporting their individual associations with incident cerebrovascular disease is scarce. We conducted a systematic review and meta-analysis of prospective cohort studies, published before February 2012 and sought from MEDLINE, EMBASE, BIOSIS and the Science Citation Index databases, and reported cerebrovascular disease (defined as any fatal or non-fatal ischemic stroke, hemorrhagic stroke, cerebrovascular accident or transient ischemic attack) by circulating vitamin D (25-hydroxy vitamin D [25(OH)D] as active metabolite) and calcium levels. Two independent investigators abstracted information on 25(OH)D and calcium, cerebrovascular outcomes and other characteristics from selected studies. Relative risks (RRs) were pooled by both random and fixed effects meta-analyses and were further examined under different study-level characteristics. Publication bias was assessed with funnel plots and Egger's asymmetry test. From 5,778 initial references, nine unique prospective cohort studies met our inclusion criteria. Seven studies (involving 47,809 participants and 926 cerebrovascular events) focused on circulating 25(OH)D and 3 reported on circulating calcium (22,577 participants and 727 events). For 25(OH)D, in a comparison of individuals in the top third versus those in the bottom third at baseline, the combined RR for cerebrovascular disease, adjusted for several conventional risk factors, was 0.60 (95 % CI 0.48, 0.72). The corresponding RR in the prospective studies that reported on baseline circulating calcium levels for cerebrovascular disease was 1.40 (95 % CI 1.19, 1.64). There was no apparent evidence of heterogeneity or publication bias among included studies. Available data indicate that higher circulating level of vitamin D is associated with a decreased risk of cerebrovascular disease. Conversely, higher circulating calcium concentration is associated with an increased risk of cerebrovascular disease.

Bangladeshi yogurt is a creamy, tangy dairy product with culinary significance in Bangladesh, often consumed alone or as a complement to spicy dishes. This study investigates the microbial diversity and nutritional composition in 38 samples, spanning commercial and locally produced varieties from eight districts. Through 16S rRNA amplicon sequencing, 650 Operational Taxonomic Units (OTUs) were identified: sour yogurt contained 493 OTUs, and sweet yogurt 441 OTUs. Firmicutes were predominant across both yogurt types, with unique appearances of Gracilibacteria, Gemmatimonadetes, and Spirochaetes in sour yogurt, while Euryarchaeota and Lentisphaerae were found only in sweet yogurt. Streptococcus and Lactobacillus emerged as the most abundant genera, with local sour samples presenting lower Firmicutes levels (84.98%) compared to commercial types (> 99.27%). Among the samples, those from Cox's Bazar exhibited the greatest bacterial diversity. Nutritional assessments revealed that branded yogurts were denser in nutrients, especially solids-not-fat (SNF), total solids, and essential minerals like iron and zinc. In contrast, local yogurts contained higher fat and lower sodium, appealing to consumers favoring richer textures with less salt. Increased acidity in local varieties also matched preferences for tangier flavors. Physicochemical analysis identified a negative association between Lactobacillus levels and pH, while higher fat content reduced overall bacterial diversity except for Lactobacillus , which further decreased mineral bioavailability. Carbohydrate metabolism was dominant in both types, with increased amino acid metabolism (11.72%) and xenobiotics biodegradation (3.94%) in sour yogurt. This study underscores the health-promoting properties of Bangladeshi yogurt, highlighting its unique regional microbiological and biochemical characteristics.

Background: Nowadays, Health Care Professionals’ (HCPs) are increasingly using mobile phones which may act as reservoirs and vector for transmission of pathogens. The presence of multidrug resistant nosocomial microbes on the surface of mobile phones used by HCPs in hospitals can pose a great public health threat. So, this research was conducted to identify the concerned multi-drug resistant (MDR) bacteria and also to explore the recent status of bacterial contamination on mobile phones of HCPs in the Jashore region of Bangladesh and determine their antibiotic resistance pattern. Methods: Swab samples of mobile phones were collected between June and September 2019 from 24 different users (i.e., manager, worker, doctor and nurse) associated to four distinct hospitals of Jashore region, Bangladesh. After suitable morphological and biochemical identification, we determined their antimicrobial susceptibility by Kirby- Bauer disc diffusion method by using 18 antibiotics for Gram positive bacteria and 19 antibiotics for Gram negative bacteria. Later, the MDR isolates were grouped by amplified ribosomal DNA restriction analysis (ARDRA) and 16S rRNA sequencing with phylogeny were performed to confirm the bacteria at species level. Results: A total of 38 bacterial isolates were obtained from the sample. Enterobacter spp. isolates showed maximum resistance against Amoxicillin, followed by Ampicillin and Aztreonam (80% each) and one isolate showed highest antibiotic resistance (15 out of 19) among all the isolates. In addition, Staphylococcus spp. and Exiguobacterium spp. isolates showed 100% resistance against Penicillin, Ampicillin, Oxacillin, Erythromycin, Lincomycin and Cefotaxime. On the contrary, all of the isolates of Escherichia spp., Bacillus spp., Proteus spp. were sensitive to all tested antibiotics. Surprisingly, 20 MDR isolates were showing resistance to at least 2 antibiotics. Subsequently, three distinct genera of these MDR isolates were identified by ARDRA; the strains Enterobacter cloacae (75%), Staphylococcus warneri (15%) and Exiguobacterium aurantiacum (10%) were confirmed by the 16S rRNA phylogenetic analysis. Conclusion: We found that cell phones can act as reservoirs of multidrug-resistant pathogens, causative agents for Hospital-acquired infections. An effective hygiene practice for health care personnel should be introduced to prevent the cross-contamination by their cell phone Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 643-656

Background and Aims Since the beginning of the SARS‐CoV‐2 pandemic, multiple new variants have emerged posing an increased risk to global public health. This study aimed to investigate SARS‐CoV‐2 variants, their temporal dynamics, infection rate (IFR) and case fatality rate (CFR) in Bangladesh by analyzing the published genomes. Methods We retrieved 6610 complete whole genome sequences of the SARS‐CoV‐2 from the GISAID (Global Initiative on Sharing all Influenza Data) platform from March 2020 to October 2022, and performed different in‐silico bioinformatics analyses. The clade and Pango lineages were assigned by using Nextclade v2.8.1. SARS‐CoV‐2 infections and fatality data were collected from the Institute of Epidemiology Disease Control and Research (IEDCR), Bangladesh. The average IFR was calculated from the monthly COVID‐19 cases and population size while average CFR was calculated from the number of monthly deaths and number of confirmed COVID‐19 cases. Results SARS‐CoV‐2 first emerged in Bangladesh on March 3, 2020 and created three pandemic waves so far. The phylogenetic analysis revealed multiple introductions of SARS‐CoV‐2 variant(s) into Bangladesh with at least 22 Nextstrain clades and 107 Pangolin lineages with respect to the SARS‐CoV‐2 reference genome of Wuhan/Hu‐1/2019. The Delta variant was detected as the most predominant (48.06%) variant followed by Omicron (27.88%), Beta (7.65%), Alpha (1.56%), Eta (0.33%) and Gamma (0.03%) variant. The overall IFR and CFR from circulating variants were 13.59% and 1.45%, respectively. A time‐dependent monthly analysis showed significant variations in the IFR (p = 0.012, Kruskal–Wallis test) and CFR (p = 0.032, Kruskal–Wallis test) throughout the study period. We found the highest IFR (14.35%) in 2020 while Delta (20A) and Beta (20H) variants were circulating in Bangladesh. Remarkably, the highest CFR (1.91%) from SARS‐CoV‐2 variants was recorded in 2021. Conclusion Our findings highlight the importance of genomic surveillance for careful monitoring of variants of concern emergence to interpret correctly their relative IFR and CFR, and thus, for implementation of strengthened public health and social measures to control the spread of the virus. Furthermore, the results of the present study may provide important context for sequence‐based inference in SARS‐CoV‐2 variant(s) evolution and clinical epidemiology beyond Bangladesh.

Objective To evaluate the extent to which circulating biomarker and supplements of vitamin D are associated with mortality from cardiovascular, cancer, or other conditions, under various circumstances.Design Systematic review and meta-analysis of observational studies and randomised controlled trials.Data sources Medline, Embase, Cochrane Library, and reference lists of relevant studies to August 2013; correspondance with investigators.Study selection Observational cohort studies and randomised controlled trials in adults, which reported associations between vitamin D (measured as circulating 25-hydroxyvitamin D concentration or vitamin D supplement given singly) and cause specific mortality outcomes.Data extraction Data were extracted by two independent investigators, and a consensus was reached with involvement of a third. Study specific relative risks from 73 cohort studies (849 412 participants) and 22 randomised controlled trials (vitamin D given alone versus placebo or no treatment; 30 716 participants) were meta-analysed using random effects models and were grouped by study and population characteristics.Results In the primary prevention observational studies, comparing bottom versus top thirds of baseline circulating 25-hydroxyvitamin D distribution, pooled relative risks were 1.35 (95% confidence interval 1.13 to 1.61) for death from cardiovascular disease, 1.14 (1.01 to 1.29) for death from cancer, 1.30 (1.07 to 1.59) for non-vascular, non-cancer death, and 1.35 (1.22 to 1.49) for all cause mortality. Subgroup analyses in the observational studies indicated that risk of mortality was significantly higher in studies with lower baseline use of vitamin D supplements. In randomised controlled trials, relative risks for all cause mortality were 0.89 (0.80 to 0.99) for vitamin D3 supplementation and 1.04 (0.97 to 1.11) for vitamin D2 supplementation. The effects observed for vitamin D3 supplementation remained unchanged when grouped by various characteristics. However, for vitamin D2 supplementation, increased risks of mortality were observed in studies with lower intervention doses and shorter average intervention periods.Conclusions Evidence from observational studies indicates inverse associations of circulating 25-hydroxyvitamin D with risks of death due to cardiovascular disease, cancer, and other causes. Supplementation with vitamin D3 significantly reduces overall mortality among older adults; however, before any widespread supplementation, further investigations will be required to establish the optimal dose and duration and whether vitamin D3 and D2 have different effects on mortality risk.