Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Most of South Asia is HEV endemic, with frequent seasonal epidemics of hepatitis E and continuous sporadic cases. This author group's epidemiologic work and clinical reports suggest that Bangladesh is HEV endemic, but there have been few population-based studies of this country's HEV burden. The authors calculated HEV infection rates, over an 18-month interval between 2003 and 2005, by following a randomly selected cohort of 1,134 subjects between the ages of 1 and 88 years, representative of rural communities in southern Bangladesh. Baseline prevalence of antibody to hepatitis E virus (anti-HEV) was 22.5%. Seroincidence was 60.3 per 1,000 person-years during the first 12 months and 72.4 per 1,000 person-years from >12 to 18 months (during the monsoon season), peaking by age 50 years and with low rates during childhood. Few of the seroconverting subjects reported hepatitis-like illness. Overall incidence was calculated to be 64 per 1,000 person-years, with 1,172 person-years followed. No significant associations were found between anti-HEV incidence and demographic or socioeconomic factors for which data were available. This is the first study to document annual HEV infection rates among "healthy" and very young to elderly subjects in a rural Bangladeshi population.

Abstract. Hepatitis E virus (HEV) causes a substantial burden of sporadic and epidemic disease worldwide. HEV infections result in serious morbidity and mortality, especially among pregnant women, and have significant economic costs. Few population-based studies have characterized the epidemiology of HEV. A rural Bangladeshi population was studied to determine the age-and gender-specific population seroprevalence of antibodies to HEV. Of 1,134 specimens tested from a representative, random population sample, 255 (22.5%) were anti-HEV IgG seropositive. Seroprevalence was lower among women (19.7%) than among men (25.8%). We found anti-HBc (hepatitis B core) in 380 of 1080(35.2%) tested, anti-HCV (hepatitis C) in 14 of 917(1.5%) tested, and anti-HAV (hepatitis A) in 116 of 124(93.5%) tested individuals. Our data suggest that viral hepatitis, especially HEV, remains an under-recognized and significant public health problem in rural Bangladeshi populations, warranting further attention.

The exact etiology and pathogenesis of eczema are not yet fully understood, although different factors are considered as pathogenic mechanisms in the development of eczema. Our study was designed to determine extent of serum lipid peroxidation, antioxidants, macro minerals and trace elements in patients with eczema, and thereby, find any pathophysiological correlation. The study was conducted as a case-control study with 65 eczema patients as cases and 65 normal healthy individuals as controls. Lipid peroxidation was assessed by measuring the serum level of malondialdehyde (MDA). Antioxidants- vitamin A and E concentration was determined by RP-HPLC method whereas vitamin C was evaluated for serum ascorbic acid by UV spectrophotometric method. Serum macro minerals (Na, K, Ca) and trace elements (Zn, Fe) were determined by Atomic Absorption Spectroscopy (AAS). This study found significantly higher level of MDA (p < 0.001) and lower level of antioxidants (p < 0.05) in patients in comparison to the control subjects. Analysis of serum macro minerals (Na, K and Ca) and trace elements (Zn, Fe) found that the mean values of Na, K, Ca, Zn and Fe were 2771.60 ± 75.64, 66.33 ± 3.03, 48.41 ± 2.50, 0.30 ± 0.02 and 0.29 ± 0.009 mg/L for the patient group and 3284.81 ± 34.51, 162.18 ± 3.72, 87.66 ± 2.10, 0.75 ± 0.06 and 0.87 ± 0.06 mg/L for the control group, accordingly. There was a significant difference for all the minerals between the patients and controls (p < 0.001). This study suggests a strong association between the pathogenesis of eczema with the elevated level of MDA and depleted level of antioxidants, macro minerals, and trace elements.

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Background Epidemiologic research suggests that increased cancer risk due to chronic arsenic exposure persists for several decades even after the exposure has terminated. Observational studies suggest antioxidants exert a protective effect on arsenical skin lesions and cancers among those chronically exposed to arsenic through drinking water. This study reports on the design, methods, and baseline analyses from the Bangladesh Vitamin E and Selenium Trial (BEST), a population based chemoprevention study conducted among adults in Bangladesh with visible arsenic toxicity. Materials and methods BEST is a 2×2 full factorial double-blind randomized controlled trial of 7,000 adults having manifest arsenical skin lesions evaluating the efficacy of 6-year supplementation with alpha-tocopherol (100 mg daily) and L-selenomethionine (200 μg daily) for the prevention of non-melanoma skin cancer. Results In cross-sectional analyses, we observed significant associations of skin lesion severity with male sex (female prevalence odds ratio (POR)=0.87; 95% CI=0.79–0.96), older age (aged 36–45 POR=1.27; 95% CI=1.13–1.42; aged 46–55 POR=1.44; 95% CI=1.27–1.64; and aged 56–65 POR=1.50; 95% CI=1.26–1.78 compared to aged 25–35), hypertension (POR=1.29; 95% CI=1.08–1.55), diabetes (POR=2.13; 95% CI=1.32–3.46), asthma (POR=1.55; 95% CI=1.03–2.32), and peptic ulcer disease (POR=1.20; 95% CI=1.07–1.35). Conclusions We report novel associations between arsenical skin lesions with several common chronic diseases. With the rapidly increasing burden of preventable cancers in developing countries, efficient and feasible chemoprevention study designs and approaches, such as employed in BEST, may prove both timely and potentially beneficial in conceiving cancer chemoprevention trials in Bangladesh and beyond.

Ensuring access to safe drinking water by 2015 is a global commitment by the Millennium Development Goals (MDGs). In Bangladesh, significant achievements in providing safe water were made earlier by nationwide tubewell-installation programme. This achievement was overshadowed in 1993 by the presence of arsenic in underground water. A total of 6 million tubewells have been tested for arsenic since then, the results of which warranted immediate mitigation. Mitigation measures included tubewell testing and replacing; usage of deeper wells; surface water preservation and treatment; use of sanitary dug wells, river sand and pond sand filters; rainwater collection and storage; household-scale and large-scale arsenic filtrations; and rural pipeline water supply installation. Shallow tubewell installation was discouraged. Efforts have been made to increase people's awareness. This paper describes the lessons learned about mitigation efforts by the authors from experience of arsenic-related work. In spite of national mitigation plans and efforts, a few challenges still persist: inadequate coordination between stakeholders, differences in inter-sectoral attitudes, inadequate research to identify region-specific, suitable safe water options, poor quality of works by various implementing agencies, and inadequate dissemination of the knowledge and experiences to the people by those organizations. Issues such as long-time adaptation using ground water, poor surface water quality including bad smell and turbidity, and refusal to using neighbor's water have delayed mitigation measures so far. Region-specific mitigation water supply policy led by the health sector could be adopted with multisectoral involvement and responsibility. Large-scale piped water supply could be arranged through Public Private Partnerships (PPP) in new national approach.

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