Beliefs related to the dying process and its impact on end-of-life care in the Marma community of Bangladesh: A qualitative study

Background: Marma indigenous community in Bangladesh has a unique culture with its religion, culture, language, and tradition. To provide appropriate healthcare and end-of-life support, healthcare providers must know their beliefs and customs near and after death. We explored the beliefs related to the dying process and its impact on end-of-life care in the Marma community of Bangladesh. Methods: This cross-sectional qualitative study used an open-ended interview schedule for in-depth interviews. Twenty-six interviewees were selected purposively from the Marma community of Bandarban district to represent a population of different ages with varied experiences and religious knowledge. After each in-depth interview, all field notes and audio records were transcribed verbatim, and qualitative content analysis was done to construct the themes. Results: After analysis, the generated theme indicated a ‘reflection of previous Karma (the sum of a person\u27s actions)’ within the Marma community. This theme is based on three categories: \u27state of the body and mind’, ‘care of a dying person’, and ‘beliefs on the dying process’. Conclusion: Death is inevitable for all of us, but suffering in death is not desired. Like other communities around the world, the Marma community also holds its own beliefs and practices regarding end-of-life care related to death. The death of a person in his own house is considered a good death within the Marma community. In the traditional death ritual practices of the Marma community, palliative care in the form of end-of-life care has the potential to enhance the quality of life, alleviate suffering, and enable a peaceful passing with dignity. angabandhu Sheikh Mujib Medical University Journal 2023;16(3): 144-15

Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in Dhaka, Bangladesh: evidence from the baseline survey of a cohort study

BACKGROUND: Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. METHODS: All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. RESULTS: Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. CONCLUSION: Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU

Immunization of trout (Salmo trutta) against freshwater pearl mussel (Margaritifera margaritifera) by duck mussel (Anodonta anatina) glochidia

Freshwater pearl mussel Margaritifera margaritifera is endangered throughout its range of distribution in Europe. In some rivers M. margaritifera may co-occur with the duck mussel Anodonta anatina. Brown trout Salmo trutta serves as suitable fish host for both mussel species. Thus it is possible that exposure of brown trout to A. anatina glochidia might increase resistance of fish against M. margaritifera glochidia. The aim was to test this ‘cross immunity hypothesis’. Brown trout were immunized by duck mussel (Anodonta anatina) glochidia in late May. Then brown trout were challenged by pearl mussel (Margaritifera margaritifera) glochidia in late August after the A. anatina glochidia were developed and dropped off from the fish. The mean number and size of M. margaritifera glochidia were compared between immunized and control fish in 4 different time points over 10 months. Besides of these, effect of marking of fish (fin-clipping), fish length and body side (left vs. right) on glochidia number was also studied. The mean number of attached glochidia was significantly lower in immunized fish than in the unimmunized control fish in the first time point, in September, but not in December, May or June. No effect of immunization on growth (size) of glochidia was observed in any time point. Unexpectedly, right side gills contained more glochidia than left side gills of fish regardless immunization. Fish length had a significant positive effect on glochidial abundance. Fin-clipped fish had less glochidia than non-clipped fish. Result indicates that fin-clipping may activate non-specific immunity that may have given protection against M. margaritifera glochidiosis. Results of the present study suggest that cross immunization by exposer to A. anatina glochidia may not possess a significant threat for M. margaritifera conservation. Jokihelmisimpukka Margaritifera margaritifera on erittäin uhanalainen makean veden simpukkalaji. Jokihelmisimpukalla elämänkierrossaan on loisiva toukkavaihe, glokidium, joka elää lohen ja taimenen kiduksille tarttuneena. Joissakin tapauksissa pikkujärvisimpukka Anodonta anatina saattaa esiintyä samassa habitaatissa jokihelmisimpukan kanssa. Tästä syystä tässä työssä haluttiin tutkia aiheuttaako taimenen (Salmo trutta) altistaminen pikkujärvisimpukan (Anodonta anatina) glokidium-toukille immunisaation jokihelmisimpukan (Margaritifera margaritifera) glokidium-toukkia vastaan. Immunisointi: Glokidium-toukille altistumattomat, 1+ taimenet (300 kpl, Iijoen meritaimen, RKTL Taivalkoski) infektoitiin pikkujärvisimpukan (Koijärvi, Kerimäki) toukilla Konneveden tutkimusasemalla kesäkuun alussa 2012. Infektion onnistuminen (5 päivää infektoinnista), sekä toukkien kypsyminen ja poistuminen kaloista (2,5 kk infektoinnista) tarkastettiin mikroskooppisesti. Kalat merkittiin eväleikkauksin siten, että kahdessa koealtaassa immunisoidut kalat olivat eväleikattuja ja kahdessa altaassa puolestaan kontrollikalat olivat eväleikattuja (yhteensä 4 allasta). Kalat haasteinfektoitiin jokihelmisimpukan toukilla elokuun lopussa ja toukkien lukumäärä ja koko tutkittiin 2012 syyskuun lopussa ja joulukuussa sekä 2013 toukokuussa ja kesäkuussa, kun toukat alkoivat kypsyä. Immunisointi pikkujärvisimpukan toukilla antoi tilastollisesti merkitsevän suojan jokihelmisimpukan toukkia vastaan syyskuussa, mutta sen jälkeen vaikutus hävisi. Yllättäen tulokset viittasivat siihen, että eväleikkaus suojasi taimenia jokihelmisimpukkainfektiolta paremmin kuin immunisointi pikkujärvisimpukan toukilla. Eväleikkaus 2 viikkoa ennen haasteinfektiota saattoi tehostaa epäspesifin immuunijärjestelmän toimintaa kaloissa. Vielä yllättävämpi tulos oli se, että jokihelmisimpukka-glokidioitten määrä oli korkeampi kalojen oikean puolen kiduksilla verrattuna vasempaan puoliskoon. Tätä tulosta oli vaikea selittää, mutta se saattaa liittyä esimerkiksi kalojen kasvatusaikaisiin olosuhteisiin—ehkä oikean puolen kidukset olivat kookkaammat, jolloin niihin mahtui enemmän toukkia. Kaiken kaikkiaan tulokset viittavat siihen, että altistuminen pikkujärvisimpukan toukille ei saata muodostaa vakavaa uhkaa jokihelmisimpukan menestymiselle taimenisännässä

Relationship between the endangered freshwater pearl mussel Margaritifera margaritifera, its salmonid host and co-infectants

The relationship between the freshwater pearl mussel (hereafter FPM), Margaritifera margaritifera, and its salmonid host — pivotal for the conservation of this endangered bivalve — is characterized by a long parasitic stage (up to 11 months) and excessive host specificity. This thesis focuses on this relationship by experimentally studying the effect of FPM infection on the growth and resistance of salmonid fish and how the infection influences vulnerability of the host to other parasites and diseases, as well as how exposure of the host to other parasites affects vulnerability to FPM. Infection with FPM results in (i) reduced growth of the host, brown trout, during the parasitic period. Glochidia infecting fish gills cause a respiratory burden which may explain the negative growth-effect. In addition, (ii) infection induced dose-dependent acquired immunity in repeated exposures. Instead, FPM infection leads to (iii) increased vulnerability of brown trout to eye fluke Diplostomum pseudospathaceum. It maybe the respiratory burden of FPM infection that increases ventilation and exposes the fish to these gill-penetrating eye fluke. FPM infection also causes (iv) increased resistance of the host to Flavobacterium columnare (a pathogen that enters fish through the gills) — possibly due to enhanced nonspecific immunity or altered structure of the fish’s gills. However, (v) pre-infection of trout with Anodonta anatina glochidia did not affect susceptibility to FPM, indicating that co-existing with A. anatina, is not a threat to FPM. Nevertheless, (vi) pre-infection with eye fluke cercariae within a short period (20 h) increased susceptibility of the host to FPM. Possibly, the tissue damage caused by recently penetrated eye fluke cercariae enhances attachment of FPM glochidia. These results shed light on complex, previously unstudied relationships between salmonid, FPM and other parasites/diseases and provide important new information that can be potentially utilized in conservation of this endangered specie

Interactions between two parasites of brown trout (Salmo trutta) : Consequences of preinfection

Preinfection by one parasitic species may facilitate or by contrast hamper the subsequent penetration and/or establishment of other parasites in a host. The biology of interacting species, timing of preinfection, and dosage of subsequent parasite exposure are likely important variables in this multiparasite dynamic infection process. The increased vulnerability to subsequent infection can be an important and often overlooked factor influencing parasite virulence. We investigated how the preinfection by freshwater pearl mussel Margaritifera margaritifera glochidia could influence the success of subsequent infection by the common trematode Diplostomum pseudospathaceum in brown trout Salmo trutta and vice versa whether preinfection by the trematode made fish more susceptible to glochidia infection. The first experiment was repeated twice with different (low and high) exposure doses to initiate the subsequent trematode infection, while in the second experiment we varied the timing of the preinfection with trematodes. The preinfection with glochidia made fish more vulnerable to subsequent infection with trematodes. Since the trematodes penetrate through the gills, we suggest that increased host vulnerability was most likely the result of increased respiration caused by the freshwater pearl mussel glochidia encysted on gills. In turn, brown trout preinfected with trematodes were more vulnerable to the subsequent glochidial infection, but only if they were preinfected shortly before the subsequent infection (20 hr). Fish preinfected with trematodes earlier (2 weeks before the subsequent infection) did not differ in their vulnerability to glochidia. These effects were observed at moderate intensities of infections similar to those that occur in nature. Our study demonstrates how the timing and sequence of exposure to parasitic species can influence infection success in a host–multiparasite system. It indicates that the negative influence of glochidia on host fitness is likely to be underestimated and that this should be taken into consideration when organizing freshwater pearl mussel restoration procedures.peerReviewe

Interaction between the endangered freshwater pearl mussel Margaritifera margaritifera, the duck mussel Anodonta anatina and the fish host (Salmo) : acquired and cross-immunity

The common duck mussel Anodonta anatina can live in sympatry with—and use the same host, brown trout (Salmo trutta)—as the endangered freshwater pearl mussel Margaritifera margaritifera. Since the glochidia release of A. anatina takes place seasonally earlier than that of M. margaritifera, brown trout can be sequentially exposed first to A. anatina and then to M. margaritifera. Cross-immunity, an immune reaction induced in fish host against glochidia after the infection with glochidia of another mussel species, is possible. Thus, it was studied experimentally if brown trout can be cross immunized against M. margaritifera by earlier infection with A. anatina. In addition, the hypothesis that consecutive exposures of same glochidial species in different years in the same host may create acquired immunity was tested in brown trout against M. margaritifera. Furthermore, the dose dependence of acquired immunity against M. margaritifera glochidia in the Atlantic salmon (S. salar) was also studied. Cross-immunity was not found; suggesting that occurrence of A. anatina does not pose a threat to M. margaritifera. Instead, acquired immunity and its dose dependence were evident, emphasizing the significance of availability of 0+ age group immunologically naïve Atlantic salmon/brown trout for efficient conservation of M. margaritifera.peerReviewe

Effect of glochidia infection on growth of fish : freshwater pearl mussel Margaritifera margaritifera and brown trout Salmo trutta

Effect of freshwater mussels’ (Unionoida) glochidia on the growth of fish host has remained poorly studied. We compared the specific growth rate of the juvenile, PIT-marked brown trout (Salmo trutta) between uninfected controls to those experimentally infected (average initial intensity of infection 8000 fish−1) with Margaritifera margaritifera glochidia, kept in high and low feeding. Growth and mortality of fish were monitored for 10 months. Our hypothesis was that glochidiosis would impair the growth of fish. According to our hypothesis, infected fish gained statistically significantly less weight than the control fish throughout the experiment. A proportional increase in weight of control individuals was 11% higher than that of the infected fish. However, neither the feeding regime (high, low) nor the period (September–November, November–March, March–May), had a significant effect on the growth difference between control and infected fish. As the effect of infection on the growth of fish was subtle and no effect on host mortality was detected either, this may turn public opinion favorable for M. margaritifera conservation even if the salmonid host population is important for commercial or recreational fishing.peerReviewe

Effect of glochidia infection on growth of fish: freshwater pearl mussel Margaritifera margaritifera and brown trout Salmo trutta

AbstractEffect of freshwater mussels’ (Unionoida) glochidia on the growth of fish host has remained poorly studied. We compared the specific growth rate of the juvenile, PIT-marked brown trout (Salmo trutta) between uninfected controls to those experimentally infected (average initial intensity of infection 8000 fish−1) with Margaritifera margaritifera glochidia, kept in high and low feeding. Growth and mortality of fish were monitored for 10 months. Our hypothesis was that glochidiosis would impair the growth of fish. According to our hypothesis, infected fish gained statistically significantly less weight than the control fish throughout the experiment. A proportional increase in weight of control individuals was 11% higher than that of the infected fish. However, neither the feeding regime (high, low) nor the period (September–November, November–March, March–May), had a significant effect on the growth difference between control and infected fish. As the effect of infection on the growth of fish was subtle and no effect on host mortality was detected either, this may turn public opinion favorable for M. margaritifera conservation even if the salmonid host population is important for commercial or recreational fishing.</jats:p

Pulsed flow-through cultivation of Margaritifera margaritifera: Effects of water source and food quantity on the survival and growth of juveniles

AbstractConservation of the endangered freshwater pearl mussel (FPM) includes artificially rearing juveniles, but the pulsed flow-through (PFT) method, enabling the continuous renewal of water and food in culture containers, has not been applied to FPM. This study tested the PFT method in culture of FPM juveniles, and the effect of water source (tap vs well water) and food concentration (mixture of commercial phytoplankton products) on the survival and growth of juveniles. Beaker-specific survival rates varied from 0 to 100% (mean: 34%) and from 0 to 58% (mean: 16%) in the 1st (2-week) and 2nd (10-week) experiment, respectively. In the 1st experiment, juveniles attained statistically significantly bigger sizes and more than two times higher survival in well water than they did in tap water. In both experiments, the food concentration of 0.250 µl/l resulted in the highest survival (compared to other concentrations ranging from 0.125 to 0.500 µl/l). However, food concentration did not have a significant effect on size of juvenile FPM in either of the experiments. Results indicate that the PFT system is suitable for FPM rearing experiments, but its applicability to mass culture of FPM juveniles requires further investigation.</jats:p