Case-control Study In Bangladesh Research Articles

Arsenic modifies the effect of folic acid in spina bifida prevention, a large hospital-based case-control study in Bangladesh

BackgroundSpina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. This study examines the relationships between mother’s arsenic exposure, folic acid, and spina bifida risk in Bangladesh.MethodsWe conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified by a neurosurgeon and imaging. Controls were drawn from children seen at NINS&H and nearby Dhaka Shishu Hospital. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression to examine the associations between arsenic and spina bifida. We used stratified models to examine the associations between folic acid and spina bifida at different levels of arsenic exposure.ResultsWe evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother’s arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median value of 0.46 µg/g, and no association was seen among mothers with toenail arsenic concentrations higher than 0.46 µg/g (adjusted OR: 1.09, 95% CI: 0.52–2.29, p = 0.82).ConclusionsMother’s arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

Association between mustard oil consumption and thrombocytopenia: a case-control study in Bangladesh

Background and objectives: Mustard oil, a common ingredient in South Asian cuisine, has been associated with both culinary appeal and potential health benefits. While studies suggest its role in reducing the risk of ischemic heart disease, concerns arise due to the presence of erucic acid, which has been linked to adverse cardiovascular effects and thrombocytopenia. This case-control study aimed to investigate the association between mustard oil consumption and thrombocytopenia in the Bangladeshi population. Materials and methods: Consecutive patients diagnosed with thrombocytopenia (platelet count < 150000/µL) were enrolled as cases, while controls were selected as the next consecutive patients with normal platelet counts, regardless of demographic characteristics or disease status. Data on demography, clinical variables and mustard oil consumption were collected from medical records and face-to-face interviews. Results: Seventy-six participants were included in the study of which 38 belonged to case and 38 to control groups. The mean age of the individuals in control and case groups was 57.5 and 58.2 years respectively (p = 0.808). Notably, 83.3% of cases reported using mustard oil compared to 28.3% of controls (p<0.001). Cases exhibited significantly (p < 0.001) lower platelet counts (114,789 ± 24,453 /µL) compared to controls (278,211 ± 84,595 /µL). Male gender and the use of mustard oil in cooking were identified as predictors of thrombocytopenia. No bleeding symptoms were observed, raising questions about the clinical significance of mustard oil-associated thrombocytopenia. Conclusion: The study underscores the need for further research to elucidate the complex relationship between mustard oil consumption, erucic acid, and thrombocytopenia, emphasizing the importance of dietary habits in health outcomes. July 2024; Vol. 18(2):005 DOI: https://doi.org/10.55010/imcjms.18.017 *Correspondence: Wasim Md Mohosin Ul Haque, Department of Nephrology, BIRDEM General Hospital, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh. Email: wmmhaque@live.com

Effect of housing construction material on childhood acute respiratory infection: a hospital based case control study in Bangladesh

Despite several studies conducted to investigate housing factors, the effects of housing construction materials on childhood ARI symptoms in Bangladesh remain unclear. Hence, the study aimed to measure such a correlation among children under the age of five. A hospital-based case–control study was conducted, involving 221 cases and 221 controls from January to April 2023. Bivariate and multivariate binary logistic regression was performed to measure the degree of correlation between housing construction materials and childhood ARI symptoms. Households composed of natural floor materials had 2.7 times (95% confidence interval 1.27–5.57) and households composed of natural roof materials had 1.8 times (95% confidence interval 1.01–3.11) higher adjusted odds of having under-five children with ARI symptoms than household composed of the finished floor and finished roof materials respectively. Households with natural wall type were found protective against ARI symptoms with adjusted indoor air pollution determinants. The study indicates that poor housing construction materials are associated with an increased risk of developing ARI symptoms among under-five children in Bangladesh. National policy regarding replacing poor housing materials with concrete, increasing livelihood opportunities, and behavioral strategies programs encouraging to choice of quality housing construction materials could eliminate a fraction of the ARI burden.

Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh

BackgroundEndometriosis is a disease among women of reproductive age, which causes several health problems like dysmenorrhoea, dyspareunia and subfertility. It also increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of population completely different from Bangladesh. ObjectiveThe present study was conducted to identify the association between endometriosis and migraine among Bangladeshi population. Study DesignThis non-randomized case-control study was performed with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, we identified as cases of migraine in one group of respondents who were already diagnosed as patients of migraine and the others with complaints of headache were further confirmed by a medicine specialist. Patients were recruited from the department of obstetrics and gynaecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital & Ibrahim Medical College. The study was approved by the Ethical Review Committee of BIRDEM. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals. ResultsIn our study, out of the 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. We enrolled 190 confirmed endometriosis cases and an equal number of controls without endometriosis, maintaining the age distribution of the controls similar to that of the cases. The distribution of age, BMI, education and marital status of the patients with endometriosis were similar to that of controls. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than in controls (12% vs 0%). The odds of suffering from dysmenorrhoea and dyspareunia among the cases were 3.3 (P value <0.001, 95% CI: 2.66-4.15) and 9.5 (P value <0.001, 95% CI: 5.3-17.9) times higher than that of controls respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases compared to that of controls (OR = 0.4, P value <0.001 95% CI: 0.24-0.64). No significant difference was observed in having primary subfertility and secondary subfertility among the two groups of respondents. Univariate regression analysis showed patients with endometriosis have 6.13 times higher odds (P value <0.001, 95% CI: 2.5-18.4) of having migraine, 2-time higher odds for headache (P value = 0.01, 95% CI: 1.2-3.2) compared to control patients. Further, the age and BMI-adjusted multivariate model showed subjects with endometriosis have 5.4 times higher odds of having migraine compared to non-endometriosis patients (P value <0.001, 95% CI: 2.11-16.4). Also, the higher the age of reproductive age of women, the more the odds of having migraine. For one year increase in age increases the odds of having migraine by 23% (OR = 1.23. 95% CI: 1.13-1.16, p-value = <0.001). ConclusionThe study results support the association between endometriosis and migraine among the Bangladeshi population, which is similar to relevant studies conducted in other geographical locations. The groups of physicians who treat patients suffering from the two diseases, endometriosis and migraine, should keep this interrelationship in mind to ensure a better quality of a patient's life.

Genome-wide analysis of spina bifida risk variants in a case-control study from Bangladesh.

Human studies of genetic risk factors for neural tube defects, severe birth defects associated with long-term health consequences in surviving children, have predominantly been restricted to a subset of candidate genes in specific biological pathways including folate metabolism. In this study, we investigated the association of genetic variants spanning the genome with risk of spina bifida (i.e., myelomeningocele and meningocele) in a subset of families enrolled from December 2016 through December 2022 in a case-control study in Bangladesh, a population often underrepresented in genetic studies. Saliva DNA samples were analyzed using the Illumina Global Screening Array. We performed genetic association analyses to compare allele frequencies between 112 case and 121 control children, 272 mothers, and 128 trios. In the transmission disequilibrium test analyses with trios only, we identified three novel exonic spina bifida risk loci, including rs140199800 (SULT1C2, p = 1.9 × 10-7), rs45580033 (ASB2, p = 4.2 × 10-10), and rs75426652 (LHPP, p = 7.2 × 10-14), after adjusting for multiple hypothesis testing. Association analyses comparing cases and controls, as well as models that included their mothers, did not identify genome-wide significant variants. This study identified three novel single nucleotide polymorphisms involved in biological pathways not previously associated with neural tube defects. The study warrants replication in larger groups to validate findings and to inform targeted prevention strategies.

Socio-economic status and autism spectrum disorder: A case-control study in Bangladesh

There are unexpectedly a few statistics about the socio-economic status (SES) and related socio-demographic factors (SDFs) of parents having child with ASD in Bangladesh. The prevalence of ASD might correlate with SES and related SDFs. A case-control study was conducted in 24 locations across 21 districts, encompassing all divisions, to assess the association between SES and the risk of developing ASD in Bangladesh. The structured questionnaire was administered through face-to-face interviews with 620 parents of the subject (310 ASD and 310 healthy controls) from January 2020 to June 2021. For univariate, bivariate and multivariate analyses, IBM SPSS version 23 was employed. The significance level was set at P ≤ 0.05, and the Odds Ratio (OR) within a 95 % CI was used to determine whether the variable poses a higher odd or not. After adjusting all significant covariates of binary logistic regression (including some dummy variables) in forward logistic regression model analysis, the higher level of SES, advanced level of father’s education (≥master), 22–35 years old age group of the father, and nuclear family were strongly associated with decreased odds of ASD compared to healthy controls. Only the male gender was strongly associated with an increased odds of ASD compared to the control. The results will aid policymakers in developing plans considering the SES and related SDFs that influence the risk of developing ASD in Bangladesh. Further research using population-based cohorts or nested case-control designs with matched control is necessary to observe and generalize the association.

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BackgroundAcute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.MethodsThis case-control study was conducted at a tertiary-level children’s hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6–59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.ResultsSeveral household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52–4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14–9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.ConclusionIn-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

Interactions between maternal arsenic exposure and folate pathway genes on the risk of spina bifida: A case‒control study in Bangladesh

Interactions between maternal arsenic exposure and folate pathway genes on the risk of spina bifida: A case‒control study in Bangladesh

Maternal arsenic exposure, folic acid use during early pregnancy and spina bifida risk: A case‒control study in Bangladesh

Maternal arsenic exposure, folic acid use during early pregnancy and spina bifida risk: A case‒control study in Bangladesh

Risk factors of Hemorrhagic Stroke- a Case-Control Study in Bangladesh

Background: Spontaneous intracerebral hemorrhage is one of the leading causes of mortality and morbidity. Genetic factors play an important role in this disease. Among the non-genetic causes Hypertension (HTN), IDDM (insulin dependent diabetes mellitus), NIDDM (non-insulin dependent diabetes mellitus), family history of hemorrhagic stroke, smoking, previous history of ischemic stroke, alcohol intake and education level are important. Methods: The aim of the study was to evaluate the association between ICH and non-genetic risk factors. This was a case-control study with 120 participants. The place of the study was in the Neurosurgery department of Sylhet Women’s Medical College Hospital (SWMCH) and the study period was 2 years. Result: Alcohol consumption (RR=3, Odd=3.11) showed highest risk for ICH. Other risk factors of ICH were smoking (RR=2, Odd=2.36), family history (F/H) of ICH (RR=1.3, Odd=1.38), Hypertension (RR=1.1, Odd=1.39) and below 12 class education status (RR=1.08, Odd=1.63). The relative risk of IDDM, NIDDM, previous history (P/H) of ischemic stroke were less than 1. Conclusion: There are few controllable risk factors of hemorrhagic stroke apart from genetic risk factors.

Components of Metabolic Syndrome and Stroke: A Case-Control Study in Bangladesh

Background: Stroke is increasingly recognized as a global public health concern which is one of the leading causes of death and disability. Metabolic syndrome increases the risk of developing stroke. Recently, studies have been undergone world-wide on metabolic syndrome and stroke but studies are yet limited among Bangladeshi population. Thus, the aim of this study was to investigate the relationship between metabolic syndrome and stroke in Bangladeshi population. Methods: This center-based case-control study was conducted from January 2020 to January 2021 among 66 cases and 66 age and sex matched controls at National Institute of Neurosciences and Hospital (NINS), Dhaka, Bangladesh. Participants were interviewed by a pre-tested semi-structured questionnaire. A checklist was used to document waist circumference, blood pressure and reports of biochemical investigations. Results: Mean age of the cases was 54.36 ± 9.94 years and controls was 52.66 ± 9.03 years. Among the components of metabolic syndrome, hypertension (p &lt; 0.05, OR 1.51, 95% CI 1.04-2.19), elevated triglyceride (p &lt; 0.05, OR 1.74, 95% CI 1.21-2.50) and reduced HDL (p = 0.018, OR 2.436, 95% CI 1.066-5.566) were associated with stroke. The proportion of abdominal obesity in cases was 22.7% while a higher proportion was found in controls (30.3%). This study revealed a significant association between metabolic syndrome and stroke (χ2 = 7.891, p &lt;0.05, OR 0.354, 95% CI 0.17- 0.74). Conclusion: This study showed that components of metabolic syndrome were more prevalent in stroke.

Association between Chronic Idiopathic Urticaria (CIU) and H. Pylori Infection: A Single Center Case-Control Study in Bangladesh

Introduction: Some studies have shown the possible involvement of Helicobacter pylori (H. pylori) infection in chronic idiopathic urticaria, but the relationship remains controversial. The aim of this study was to quantitatively assess the association between H. pylori infection and chronic idiopathic urticaria.&#x0D; Material &amp; Methods: A case-control type of analytical study was conducted in the department of Dermatology and Venereology, Naval Base Hospital (BNS Patenga), Chattogram, Bangladesh for duration of 06 months. Total 50 patients were enrolled in this study. 25 Patients of CIU with no identifiable cause were taken as case and patients without urticaria were taken as control, attending in the outpatient department. H. pylori infection was confirmed by Serum IgG for H. pylori test.&#x0D; Results: The result shows that Helicobacter pylori significantly affect a high percentage of patients with chronic idiopathic urticaria and response to eradication therapy was evident in more patients in whom H. pylori were eradicated.&#x0D; Conclusion: The study shows that Helicobacter pylori significantly affects a high percentage of patients with CIU. Response to eradication therapy was evident in more patients in whom H. pylori was eradicated while few patients showed no response despite eradication of H. pylori. The result of this study suggests that H. pylori infection should be included in diagnostic work up of patients with no response to usual treatment for CIU.&#x0D; CBMJ 2021 January: vol. 10 no. 02 P: 75-79

Parental metal exposures as potential risk factors for spina bifida in Bangladesh.

Neural tube defects are a pressing public health concern despite advances in prevention from folic acid-based strategies. Numerous chemicals, in particular arsenic, have been associated with neural tube defects in animal models and could influence risk in humans. We investigated the relationship between parental exposure to arsenic and 17 metals and risk of neural tube defects (myelomeningocele and meningocele) in a case control study in Bangladesh. Exposure assessment included analysis of maternal and paternal toenail samples using inductively coupled plasma mass spectrometry (ICP-MS). A total of 278 participants (155 cases and 123 controls) with data collected from 2016 to 2020 were included in the analysis. In the paternal models, a one-unit increase in the natural logarithm of paternal toenail arsenic was associated with a 74% (odds ratio: 1.74, 95% confidence interval: 1.26-2.42) greater odds of having a child with spina bifida, after adjusting for relevant covariates. Additionally, paternal exposure to aluminum, cobalt, chromium, iron, selenium, and vanadium was associated with increased odds of having a child with spina bifida in the adjusted models. In the maternal models, a one-unit increase in the natural logarithm of maternal toenail selenium and zinc levels was related to a 382% greater (odds ratio: 4.82, 95% confidence interval: 1.32-17.60) and 89% lower (odds ratio: 0.11, 95% confidence interval: 0.03-0.42) odds of having a child with spina bifida in the adjusted models, respectively. Results did not suggest an interaction between parental toenail metals and maternal serum folate. Parental toenail levels of numerous metals were associated with increased risk of spina bifida in Bangladeshi infants. Paternal arsenic exposure was positively associated with neural tube defects in children and is of particular concern given the widespread arsenic poisoning of groundwater resources in Bangladesh and the lack of nutritional interventions aimed to mitigate paternal arsenic exposure. The findings add to the growing body of literature of the impact of metals, especially paternal environmental factors, on child health.

Validation of community health worker identification of maternal puerperal sepsis using a clinical diagnostic algorithm in Bangladesh and Pakistan.

BackgroundPuerperal sepsis (PP sepsis) is a leading cause of maternal mortality globally. The majority of maternal sepsis cases and deaths occur at home and remain undiagnosed and under-reported. In this paper, we present findings from a nested case-control study in Bangladesh and Pakistan which sought to assess the validity of community health worker (CHW) identification of PP sepsis using a clinical diagnostic algorithm with physician assessment and classification used as the gold standard.MethodsUp to 300 postpartum women were enrolled in each of the 3 sites 1) Sylhet, Bangladesh (n = 278), 2) Karachi, Pakistan (n = 278) and 3) Matiari, Pakistan (n = 300). Index cases were women with suspected PP Sepsis as diagnosed by CHWs clinical assessment of one or more of the following signs and symptoms: temperature (recorded fever ≥38.1°C, reported history of fever, lower abdominal or pelvic pain, and abnormal or foul-smelling discharge. Each case was matched with 3 control women who were diagnosed by CHWs to have no infection. Cases and controls were assessed by trained physicians using the same algorithm implemented by the CHWs. Using physician assessment as the gold standard, Kappa statistics for reliability and diagnostic validity (sensitivity and specificity) are presented with 95% CI. Sensitivity and specificity were adjusted for verification bias.ResultsThe adjusted sensitivity and specificity of CHW identification of PP sepsis across all sites was 82% (Karachi: 78%, Matiari: 78%, Sylhet: 95%) and 90% (Karachi: 95%, Matiari: 85%, Sylhet: 90%) respectively. CHW-Physician agreement was highest for moderate and high fever (range across sites: K = 0.84-0.97) and lowest for lower abdominal pain (K = 0.30-0.34). The clinical signs and symptoms for other conditions were reported infrequently, however, the CHW-physician agreement was high for all symptoms except severe headache/ blurred vision (K = 0.13-0.38) and reported “lower abdominal pain without fever” (K = 0.39-0.57).ConclusionIn all sites, CHWs with limited training were able to identify signs and symptoms and to classify cases of PP sepsis with high validity. Integrating postpartum infection screening into existing community-based platforms and post-natal visits is a promising strategy to monitor women for PP sepsis - improving delivery of cohesive maternal and child health care in low resource settings.

Cardiovascular diseases risk prediction in patients with diabetes: Posthoc analysis from a matched case-control study in Bangladesh.

This study aimed to investigate the estimated 10-year predicted risk of developing cardiovascular diseases (CVD) among participants with and without diabetes in Bangladesh. We performed posthoc analysis from a matched case-control study conducted among 1262 participants. A total of 631 participants with diabetes (case) were recruited from a tertiary hospital, and 631 age, sex and residence matched participants (control) were recruited from the community in Dhaka, Bangladesh. Socioeconomic anthropometric, clinical and CVD risk factor data were collected from the participants. The 10-year estimated CVD risk was calculated using the Framingham Risk Score, which has reasonable validity in South Asians. The mean (SD) age of the participants were 51 (10) years. Total 52.3% of cases and 17.2% of controls were at high risk for CVD. The 10-year risk of CVD increased by age and was higher among males in both groups. Among the control group, high CVD risk was more prevalent among higher education and income groups. More than 85% of the tobacco smokers and 70% of chewing tobacco users in the case group were at high risk of CVD. Prevalence of high CVD risk among non-smokers cases was 8.6%. About 35% of hypertensive participants in the control group were at high risk of CVD. Bangladeshi patients with diabetes showed a significant burden of CVD risk at a relatively younger age. Strategies for reducing tobacco use and improving BP control in people with diabetes is needed for lowering future CVD risks.

Congo red test for identification of preeclampsia: Results of a prospective diagnostic case-control study in Bangladesh and Mexico.

BackgroundMisfolded proteins in the urine of women with preeclampsia bind to Congo Red dye (urine congophilia). We evaluated a beta prototype of a point-of-care test for the identification of urine congophilia in preeclamptic women.MethodsProspective diagnostic case-control study conducted in 409 pregnant women (n = 204 preeclampsia; n = 205 uncomplicated pregnancies) presenting for delivery in two tertiary level hospitals located in Bangladesh and Mexico. The GV-005, a beta prototype of a point-of-care test for detecting congophilia, was performed on fresh and refrigerated urine samples. The primary outcome was the prevalence of urine congophilia in each of the two groups. Secondary outcome was the likelihood of the GV-005 (index test) to confirm and rule-out preeclampsia based on an adjudicated diagnosis (reference standard).FindingsThe GV-005 was positive in 85% of clinical cases (83/98) and negative in 81% of clinical controls (79/98) in the Bangladesh cohort. In the Mexico cohort, the GV-005 test was positive in 48% of clinical cases (51/106) and negative in 77% of clinical controls (82/107). Adjudication confirmed preeclampsia in 92% of Bangladesh clinical cases (90/98) and 61% of Mexico clinical cases (65/106). The odds ratio of a urine congophilia in adjudicated cases versus controls in the Bangladesh cohort was 34.5 (14.7 – 81.1) (p<0.001) compared to 4.2 (2.1 – 8.4; p<0.001) in the Mexico cohort.InterpretationThe GV-005, a beta prototype of a point-of-care test for detection of urine congophilia, is a promising tool for rapid identification of preeclampsia.FundingSaving Lives at Birth.

Paternal arsenic exposure increases risk of myelomeningocele among offspring in a highly-exposed population

Background: Neural tube defects, severe birth defects that occur when the neural plate fails to close in early gestation, continue to be a pressing public health concern, despite advances in prevention from folic acid-based strategies. Arsenic, a chemical naturally occurring in soils and drinking water, has been shown to induce neural tube defects in animal models and could contribute to neural tube defects in humans. We investigated the relationship between parental arsenic exposure and risk of myelomeningocele, a common and severe form of neural tube defect, in a case control study in Bangladesh. We also explored the interaction between arsenic levels and maternal serum folate. Methods: We analyzed arsenic in maternal and paternal toenail samples using inductively coupled plasma mass spectrometry. A total of 275 participants (153 cases and 122 controls) were included in the analysis. Results: On average, fathers of cases had higher levels of arsenic in toenails than fathers of controls. Maternal toenail arsenic levels were not significantly related to case status in the main effect model. In the paternal model, a 1-unit increase in the natural logarithm of toenail arsenic was significantly associated with 75% greater odds of being a case (adjusted odds ratios: 1.75) compared to being a control after adjusting for maternal serum folate level, parental age, child age, birth facility, and child sex. Results did not suggest an interaction between paternal arsenic and maternal serum folate. Conclusions: The findings from this study provide novel insight into the role of arsenic in neural tube defect risk in humans and add to the growing body of literature of the influence of paternal environmental factors on child health outcomes.

Role of serum uric acid in ischemic stroke: A case-control study in Bangladesh.

Increased level of serum uric acid (SUA) is often considered a risk factor for ischemic stroke. This study was conducted to examine the association of SUA level with ischemic stroke and assessed gender-based differences, if any. In this case-control study, neuroimaging-confirmed ischemic stroke patients were recruited as cases within three days of an incident from neurology in-patient department, and as controls, patients without stroke history were recruited from neurology out-patient department. Blood was collected from the respondents of both groups to assess SUA level, lipid profile and oral glucose tolerance test. Binary logistic regression was done for estimating the risks of ischemic stroke. A total of 338 participants were recruited, where 169 were cases and 169 were controls. Around 60 percent respondents of both case and control groups were male. Mean SUA levels for cases and controls were 6.03 (SD 1.84) mg/dl and 4.04 (SD 1.46) mg/dl, respectively. After adjustment for age, tobacco consumption status, diabetes, hypertension, coronary heart disease and dyslipidemia, elevated SUA level was found to be significantly associated with ischemic stroke only in females (OR = 1.49; 95% CI = 1.01-2.19; p<0.05). Overall, each unit increase in SUA level exhibits 25 percent increment in odds of having ischemic stroke (OR = 1.25; 95% CI = 1.02-1.5372; p<0.05). This study concluded that elevated SUA level is significantly associated with the acute phase of an ischemic stroke and gender-specific analysis demonstrates this association only in females.

Validation of a Genome-Wide Polygenic Score for Coronary Artery Disease in South Asians

BackgroundGenome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. ObjectivesThis analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. MethodsThis GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. ResultsThe GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p < 0.001 for each). Next, individuals of the Indian case-control study were projected onto static reference distributions, observing an OR/SD of 1.66 (p < 0.001). Compared with the middle quintile, risk for CAD was most pronounced for those in the top 5% of the GPSCAD distribution—ORs of 4.16, 2.46, and 3.22 in the South Asian UK Biobank, Bangladeshi, and Indian studies, respectively (p < 0.05 for each). ConclusionsThe new GPSCAD has been developed and tested using 3 distinct South Asian studies, and provides a generalizable framework for ancestry-specific GPS assessment.

Epidemiology, clinical features, and impact of food habits on the risk of hepatocellular carcinoma: A case-control study in Bangladesh.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third most common cause of cancer mortality worldwide. Infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) is the most predominant cause of HCC. Concerns arise for the presence of additional risk factors, as there is still a large proportion of patients without HBV or HCV infection. Previous studies have reported that higher intake of fruits and vegetables and reduced consumption of red/processed meat might play a protective role in HCC etiology, though the nationwide proof is limited. Hence, we studied multiple risk factors including food habit, lifestyle, and clinical implications of HCC patients in Bangladeshi. Demographic, clinical, and biochemical data, as well as data on food habits, were collected in this study. Our results indicated that a high intake of rice (AOR 4.28, 95% CI 1.48 to 14.07, p = 0.011), low intake of fruits (AOR = 4.41 95% CI 1.48-15.46; p = 0.012), leafy vegetables (AOR = 2.80, 95% CI 1.32-6.08; p = 0.008), and fish (AOR = 4.64 95% CI 2.18-10.23; p<0.001) increased the HCC risk. Moreover, a high intake of eggs (AOR = 2.07 95% CI 0.98-4.43; p = 0.058) also showed an increased risk. Roti, non-leafy vegetables, red meat, and tea were found to have no association with HCC risk. This study revealed that food habit patterns and lifestyle may have a profound effect on HCC development among Bangladeshi patients in addition to well established risk factors.