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Objective: To assess the status of antioxidant vitamins (A, E & C) in cortical and nuclear cataracts patients. Study Design: Prospective Comparative study. Setting: Al-Ibrahim Eye Hospital and Biochemistry Department of Al-Tibri Medical College, Karachi. Period: Sept 2016 to Aug 2017. Material & Methods: A non-probability random sampling technique was used on 80 pre-diagnosed cataracts (cortical and nuclear) patients, and 40 control subjects were selected for the study. The demographic data were collected, and the blood sample of control and cataract patients were analyzed for random blood sugar and antioxidant vitamins (A, E, and C) by Elisa Method. Results: The Blood level of vitamins E was low in cataract patients as compared to control subjects. Conclusions: The blood level of vitamin E is less in cortical and nuclear cataract patients as compared to control but had shown no significant difference between cortical and nuclear cataract patients.

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals. Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month. Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.

Objective: To determine the efficacy of transforaminal epidural steroid injection (TFESI) using conventional versus Kambin’s triangle approaches in patients of lumbar radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Department of Pain Medicine, Combined Military Hospital Rawalpindi Pakistan, from Oct 2019 to Apr 2020. Methodology: Eighty patients suffering from lumbar radiculopathy fulfilling the inclusion criteria were included in this study and were randomly assigned to undergo transforaminal epidural steroid injection using either conventional approach (group C) or the Kambin’s triangle (group K) approach. Pain scores and patient satisfaction levels were recorded at 4 and 8 weeks after the procedure. Results: In both groups, the pain score (group C pre-procedure NRS =7.28 ± 1.26 vs post-procedure NRS = 2.14 ± 0.81, group K pre-procedure NRS = 7.33 ± 1.16 vs post-procedure NRS=2.70 ± 0.94) and patient satisfaction improved 4 and 8 weeks after the procedure. The pain score (p-value=0.21) and patient satisfaction score (p-value=0.88) however were not significantly different between groups. Conclusion: This study demonstrated that using conventional or Kambin’s approach exhibits no difference in decreasing pain score or patient satisfaction level.

Concerns regarding food safety and ‘One Health’ are increasing globally. Aflatoxin M1 (AFM1), a human carcinogenic toxin, is excreted by lactating animals in their milk after consumption of feed contaminated with aflatoxin B1. The present cross-sectional study aimed to determine the occurrence of AFM1 in cattle and buffalo milk produced in rural and peri-urban areas under different agro-climatic conditions of Chhattisgarh, India, and assesses human health risks. Analyses of 545 milk samples by validated high-performance liquid chromatography revealed high level of AFM1 contamination in 224 (41.1%) samples with mean concentration of 0.137 ± 0.029 μg/L. Statistically significant differences (p< 0.05) were observed in the levels and frequency of AFM1 occurrence among different agro-climatic zones. AFM1 was more frequently detected in milk samples from Northern hills (64%) followed by Bastar plateau (40.7%) and Chhattisgarh plain (27.3%), with mean concentration levels of 0.396 ± 0.099 μg/L, 0.081 ± 0.025 μg/L and 0.013 ± 0.002 μg/L, respectively. Species wise no significant difference was observed in the detection frequency and concentration of AFM1 in milk from cattle and buffalo. AFM1 contamination above maximum permissible limits established by European commission and Food Safety and Standard Authority of India was detected in 21.3% and 4.4% of samples, respectively. The estimated daily intakes for AFM1 were found to be higher than tolerable daily intakes for both adults and children, especially of Northern hills implying a potentially high risk to consumer’s health. This study provides valuable information on the contamination status of milk in one of the fastest developing state of India. It also highlights the importance and need for continuous farmers’ awareness on good animal husbandry practices, routine surveillance of mycotoxins in animal feeds and food commodities to safeguard human health.

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P

Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation. Study Design: Randomized control trial. Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016to Dec 2016. Methodology: After approval of the study by the institution’s research ethics committee, the patients meetinginclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation. Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant.Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator ofhemodynamic response to extubation as compared to intravenous lignocaine and provides better stability ofHeart rate and Mean arterial Pressure.

The study is underpinned by the public sphere paradigm, which emphasizes that language policy and planning (LPP) should be studied from the actual practices of local stakeholders/agents and communi...

Objectives: To determine the status of ALK immunostaining in female breast cancer and to find out the relationship of ALK expression with clinicopathological variables. Study Design: Cross Sectional study. Setting: Department of Pathology Al Tibri Medical College and Hospital Karachi and BMSI Jinnah Post Graduate Medical Centre, Karachi. Period: October 2016 to March 2017. Material & Methods: Total of 110 female cases with breast carcinoma by using non-probability purposive sampling technique. After taking informed consent from the patients, tissue samples were taken from received specimen of mastectomy for hematoxylin and eosin stain. The immunohistochemistry for ALK was assessed by using a DAKO monoclonal antibody using the paraffin embedded blocks of the diagnosed cases of breast carcinoma. Chi square test was used to find out the significance of differences among the variables. Results: Total of 110 cases with different histological classifications of breast cancer were observed i-e invasive ductal carcinoma 95(86%), invasive lobular carcinoma 9(8%), invasive medullary carcinoma 4(3.6%) and papillary carcinoma 2(1.8%). ALK expression was positive in 71(64%) and negative in 39 (35%) patients. Significant association was observed between ALK expression with histological grade (p=0.003), lymph node involvement (p=0.042) and skin involvement (p=0.025). Conclusion: Present study shows higher positive ALK expressions. Present study also indicates significant relationship of ALK with histological grade, lymph node involvement and skin involvement.

Aims/Introduction We aimed to assess the health‐related quality of life (HRQoL) and identify its predictors among type 2 diabetes patients of Bangladesh. Materials and Methods This nationwide cross‐sectional study assessed HRQoL among 1,806 type 2 diabetes patients using the EuroQol‐5 Dimensions Questionnaire (EQ‐5D‐5L), and the responses were further translated into a single summary crosswalk index score using the UK time trade‐off value set. The predictors were determined using multinomial logistic regression analysis. Results The mean EQ‐5D‐5L index score was 0.62 (standard deviation 0.25), and men scored better than women. More than half of the study participants (53.4%) were ranked as “average” HRQoL. Overall, 64% of respondents had a “problem” at least in one of the dimensions of the EQ‐5D‐5L, and the burden of reported “problems” was higher among women (70%). Among the five dimensions, the highest reported “problem” was 79.8% for anxiety/depression, 77.7% for pain/discomfort and 60.1% for mobility. However, younger participants (aged 1) were being men, living in a rural area, married, literate, a monthly income >19,488 BDT, absence of comorbidity and had a duration of diabetes ≤5 years. Conclusions The majority of Bangladesh’s type 2 diabetes patients had an “average” HRQoL based on the EQ‐5D‐5L index score. In broad terms, the identified predictors were sex, place of residence, marital status, literacy, monthly income, comorbidity and duration of diabetes., The majority of type 2 diabetes patients in Bangladesh have an “average” level of health‐related quality of life using EuroQol‐5 Dimensions Questionnaire and it is significantly associated with several predictors.

Interconnectivity of smart devices such as mobile technology adoption in healthcare holds humongous impacts. Yet, medical professionals are reluctant to reap potential benefits of technology and the reason behind this phenomenon is ambiguous. This study aims to highlight current critical conditions in public healthcare hospitals in Pakistan, and how IoT will add value in healthcare services effectiveness through mobile computing and also to indicate current concepts that may add value in over-all smart healthcare system. According to available information, study to on AI enabled M-IoT network-based healthcare system specially in developing countries to address healthcare problems are rarely known. This study empirically analyzed the factors that influence IoT based smart healthcare devices adoption in Pakistan. In understand the phenomenon, Partial Least Square Equation Model (PLS SEM) was used to understand the relational influence of performance expectance, effort expectance, and social influence over behavior to use through intention to use the technology supported by Unified Theory of Acceptance Technology (UTAUT) assumptions. The results show that clinicians are reluctant to use technology though the results also reveal that same clinicians have positive influence of performance and effort expectations on their intention to use technology that leads the actual behavior of using the technology. Though, this research is among few to beacon upon urgent focus of public healthcare management in developing countries. Yet, new research is lacking far behind to facilitate methods to opt for M-IoT healthcare devices powered by AI.

Background In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country’s total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. Methods A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. Results A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. Conclusion A mobile-health intervention should be considered as an additional option for non-communicable disease programs.

Aim/background To assess the effectiveness of mobile SMS as a tool for behavior and life style modification in management of diabetes. Methods This interventional study was conducted from July 2014 to April 2015 at Baqai Institute of Diabetology and Endocrinology (BIDE). Demographical and clinical information of subjects (patients and relatives) along with their knowledge and beliefs regarding diabetes was recorded using questionnaire. In Short Message Service (SMS) and non-SMS groups, education regarding diabetes was given. Two messages per day were sent to SMS group for two months. Results Total 648 subjects, SMS (n = 376) and non-SMS (n = 276) groups, were included in study. Mean age of patients and relatives was 45.41 ± 15.13 and 34.58 ± 11.91 in SMS group, while 47.06 ± 14.83 and 31.02 ± 11.51 in non-SMS group, respectively. No significant difference regarding level of knowledge and beliefs among both groups was observed at baseline. After SMS intervention, level of knowledge (p ≤ 0.0001) and beliefs (p ≤ 0.0001) were found to be significantly higher in SMS groups Non-SMS group. Conclusion Mobile SMS are an effective tool to deliver behavior and lifestyle modification advice and support for better management of diabetes and its prevention in people who are at high risk. Education intervention through SMS is found to be an important variable which enhances the knowledge and beliefs of the subjects.

A new design of silicon photonics ring resonator based biosensor for the detection of the diseased cell is proposed. The proposed label-free and high-Q ring resonator has the potential to exhibit high sensitivity and selectivity for detecting different cancer cells, such as leukemia, cervical cancer, and breast cancer. The parameters of the ring resonator are optimized to make the biosensor suitable for detecting cancer cells in the pinch of blood with the sensitivity of more than 200 nanometers per Refractive Index Unit (nm/RIU) and quality factor of 1200. Through the finite difference time domain (FDTD) method, it is observed that the resonant wavelength of a ring resonator can be increased by escalating the refractive index of the modal present on the surface of the ring resonator. The simulation and analysis demonstrate that the outline sensitivity and quality factor of the proposed biosensing platform are acceptable for the cancer cell level detection in the blood sample present on the surface of the resonator. The proposed design also shows sufficiently separated resonant peaks for different cancer cells that open the possibility of highly selective label-free cancer cell detection.

Background: Bangladesh has one of the largest diabetic populations in the world and its Rajshahi region has distinct geographical and cultural identity. Determinants and basic defects of the disorder which vary substantially among populations due to racial and environmental heterogeneity. Materials & Methods: This study was conducted to characterize the new patients attending the Rajshahi Diabetic Center which gives an idea about the proportion and risk indicators of DM among people in the Rajshahi region. It was a hospital based observational analytic study with a hybrid research strategy having both cross-sectional and nested case-control designs. A multistage sampling technique was followed with 660 subjects. Results: Out of the total subjects attending the OPD of RDC for the first time, 65% were found to suffer from T2 DM. mostly (75%) of middle age (37% within 30-40 yrs and 37% within 41-50 yrs), only 2% cases had age 51yrs. The mean ±SD calorie consumption (2549±637) of the diabetic subjects was higher than that in non-T2 DM subjects and it came mainly from CHO (59.3%) and fat (55.9%). 47.3% of subjects were normal weight, 36.1% over weight and 16.6% obese. Fasting serum Insulin was significantly higher in the T2 DM group as compared to non-T2DM (Serum Insulin level µIU/ml, M±SD) (13.5±4.9) subjects (p=

Aims: Radial approach is gaining the momentum as a default technique for coronary procedures. Limited trails are available for post coronary artery bypass graft (CABG) patients to compare the merits of femoral & radial access. Methods: It is a single-center study conducted in between January, 2013 to December, 2015. During this study period, post CABG patients were blindly assigned to its five high volume operators. Coronary angiography & intervention procedures were performed by left radial or femoral approach as per assigned operator's choice. Contrast volume was the primary endpoint whereas the procedure & fluoroscopy time, procedural success, access site major bleeding, pre discharge major adverse cardiac event (MACE) were the secondary endpoint both for coronary angiogram (CAG) & percutaneous coronary intervention (PCI). Results: Total 380 post CABG patients were included in this study period. Radial access (n=155) was lower than femoral access (n=225). Compared with femoral access, diagnostic CAG required relatively lower contrast volume though statistically not significant via radial access (70±34 vs. 72±40 ml, p=0.267). Procedure time (25.2±10.7 vs. 26.9±6.8 min, p=0.735), fluoroscopy time (10.7±5.5 vs. 9.5±4.7 min, p=0.424) were almost similar in both access for CAG. Other secondary clinical endpoints were similar among both groups. Interestingly, adhoc PCI was more frequent in radial group (n=54 out of 155, 34.8%) than in femoral group (n=44 out of 225, 19.6%) with p=0.01. Contrast volume in between two groups was pretty similar with p=0.226. The incidence of other secondary endpoints was also not statistically significant. Conclusion: Coronary angiography for post CABG patients through left radial approach seems to be effective, non-inferior in terms of contrast volume, procedure & fluoroscopy time & other clinical end points comparing to femoral access. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 11-16

Background Myocardial injury has been defined as an elevated troponin level. The frequency of acute myocardial injury of hospitalized coronavirus disease 2019 (COVID-19) patients ranges from 7% to 36%. COVID-19 patients with cardiovascular disease (CVD) have a four-fold higher risk of mortality (odds ratio, 4.33; CI 95%, 3.16-5.94). In COVID-19 hospitalized patients’ study showed mortality rate was 18.5%. Rhabdomyolysis is considered as muscle necrosis and the release of intracellular muscles elements and enzymes into blood. In one of retrospective cohort study of COVID-19 hospitalized patients, incidence of rhabdomyolysis was 16.7%. Materials and methods This retrospective observational study consisted of 413 COVID-19 hospitalized patients. Patients with rhabdomyolysis was defined as creatine kinase level greater than 1,000 U/L and acute myocardial injury was defined as serum high-sensitivity troponin-T for males greater than 30 ng/l and for female greater than 20 ng/l. The primary outcome was in-hospital mortality of COVID-19 patients with acute myocardial injury and rhabdomyolysis. Results The incidence of acute myocardial injury and rhabdomyolysis in hospitalized COVID-19 patients was 23.9% (99) and 15.7% (65), respectively. The mortality rate of in hospitalized COVID-19 patients who developed acute myocardial injury (28.3%) was significantly higher in comparison to patients who developed rhabdomyolysis (13.8%). Discussion The binding of SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) is a critical step in the pathophysiology in patients with COVID-19. There may be diverse direct and indirect mechanisms of acute myocardial injury in COVID-19 including ischemic injury, hypoxic injury (MI type 2), direct viral myocarditis, stress cardiomyopathy and systemic cytokine storm. Musculoskeletal injury may be caused by direct viral myositis or indirectly by host immune hyperinflammatory cytokine storm response that leads to skeletal muscle fiber proteolysis and fibrosis. Conclusions Acute myocardial injury and rhabdomyolysis were underreported in COVID-19 patients. The incidence and mortality of acute myocardial injury are higher than that of rhabdomyolysis in COVID-19 hospitalized patients. The outcome was worse in COVID-19 patients with severe acute myocardial injury. Patients with acute myocardial injury and rhabdomyolysis may get benefits from rehabilitation programs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection is not confined to the respiratory system, but has also shown extra-pulmonary invasion including the nervous system. About 36.4% of hospitalized patients in China with confirmed coronavirus disease 2019 (COVID-19) infection had neurological manifestations. SARS-CoV-2 virus enters the human body through angiotensin converting enzyme-2 (ACE-2) receptors on the surface of human cells and causes disease. ACE2 receptors are also expressed on the surface of spinal cord cells. More rare neurologic conditions have been reported in the literature to be associated with COVID-19 such as acute transverse myelitis (ATM), Guillain Barre syndrome, acute flaccid myelitis, etc. We report two cases of confirmed COVID-19 who presented four to five days of their COVID-19 symptoms and progressive bilateral lower limb weakness and urinary retention. ATM is an acquired spinal cord disorder. ATM is a relatively common neurological complication of COVID-19, accounting for 1.2% of all neurological complications associated with COVID-19. The mechanism by which COVID-19 causes ATM is not completely understood but has been assumed to be due to the structural resemblance of RNA viruses. Entrance of SARS-CoV-2 to the nervous system can take place through two pathways, either directly or indirectly. The direct pathway is through trans-synaptic transmission from the peripheral nervous system or by hematogenous spread into the blood-brain barrier through ACE-2, while the indirect pathway is through a systemic immune response.

ObjectiveThis study assessed the risk perception and preventive behavioral practice towards COVID-19 just prior to the second wave of corona, as well as the impact of perceived risk on preventive practices.Design, setting, participants, and outcome measuresA cross-sectional study was conducted between December 2020 and January 2021, involving 1382 respondents aged 18 years and above from all eight divisions in Bangladesh. We used multiple linear regression to identify sociodemographic predictors of risk perception and multiple logistic regression to determine the relationship between risk perception and preventive practice.ResultsLow risk perception regarding COVID-19 was present among one-fifth of the respondents (19.8%). Younger age, being male, low education, single marital status, and rural residence were significantly associated with a low perceived risk of COVID-19. Hand washing and wearing mask were practiced by 80% and 67% of respondents, respectively. A low prevalence was noticed for social distancing (31%), avoiding social gathering (31%), and covering face while coughing/sneezing (18%). Furthermore, respondents with a high risk perception were found to be more likely than those with a low risk perception to practice all recommended COVID-19 preventive behaviors-hand washing (OR=2.4, 95% CI=1.5, 3.7), mask use (OR=3.4, 95% CI=2.3, 5), social distancing (OR=3.7, 95% CI=2.4, 5.6), sanitizer use (OR=2.7, 95% CI=1.8, 4.1), avoiding gathering (OR=2.3, 95% CI=1.6, 3.5), avoid touching face and mouth (OR=2.8, 95% CI=1.5, 5.3), and covering mouth while coughing/sneezing (OR=7, 95% CI=3.6, 13.4).ConclusionConsiderable number of Bangladeshi adults had low risk perception and low practice of some vital COVID-19 preventive behaviors before the onset of second wave of corona. All preventive practices were also influenced by respondent’s risk perception. This highlights the importance of strengthening and optimizing risk communication strategy even when the number of corona cases are low.STRENGTHS AND LIMITATIONS OF THIS STUDYThe study explored the perceived risk and preventive practices for COVID-19 in Bangladesh right before the recent onset COVID-19 second wave in the South Asian region, and included a larger sample size than previous studies.Unlike most other studies on COVID-19 risk perception that used online surveys, this study administered a face-to-face data collection from both urban and rural settings across all the eight divisions of Bangladesh.This is the first study in Bangladesh that investigated the effect of perceived risk of COVID-19 on the practice of a range of preventive behaviors, and used an analytical approach to quantify risk perception.Respondents’ self-reported information on COVID-19 preventive behavior practice is subject to be influenced by recall and desirability bias.The study was unable to explore the respondents’ frequency and adherence to preventive practices, as well as the influence of psychological factors on preventive behaviors.

Atherosclerosis is a systemic pathologic process, may involve aorta and is important cause of systemic embolization. The risk of embolism is increased for mobile and complex aortic plaques that are >4 mm thick. The most common manifestations are stroke, transient ischemic attack (TIA) and peripheral embolization. Imaging modalities used include transesophageal echocardiogram (TEE), CT angiography and magnetic resonance angiography (MRA). The mainstays of medical treatment are antiplatelets and statin. The role of anticoagulation is reserved for plaques with thrombotic component. There were two patients who presented with large acute ischemic stroke with high grade, floating aortic arch thrombus and complex aortic arch plaques. In one of cases, after 10-day follow-up CT aortic angiography showed completely resolved thrombus after being treated with IV tissue plasminogen activator (TPA) followed by low molecular weight heparin (LMWH). The risk of embolism depends on size of aortic plaques and mobility. TEE is modality of choice for thoracic aortic plaques. Aortic plaques >4 mm are independent predictors of recurrent ischemic stroke. There are limited data available for off-label use of intravenous thrombolysis and mechanical thrombectomy (MT) in presence of aortic arch thrombus in acute ischemic strokes. These two case reports help in recognition of aortic arch complex plaques as independent risk factor for recurrent stroke. The right patients may consider about the use of intravenous alteplase and MT performed via trans-brachial access after excluding aortic dissection and aneurysm. In future, multicenter, randomized controlled trials will be required for safety of IV TPA and MT.

The best kept secret in pain management is in your own hands. Pain Care Essentials offers the readers a fingertip access to numerous topics in still emerging field of pain medicine, including physical rehabilitation in pain management, peripheral nerve blocks, neuropathic pain, pediatric and elderly pain. This book provides an overview of pain mechanisms as currently understood, and details a variety of approaches to pain management used across a wide range of complementary disciplines. Divided into four convenient sections; the book addresses Fundamentals and Evaluation, Treatment Modalities (including opioids, interventions and alternative medicine), common Chronic Pain and Urgent Pain Problems. Integrative care concepts are presented, emphasizing multi-disciplinary approaches to address the pain. Expert contributors describe therapeutic approaches of various pain conditions and implementing self-care management options.

Objective: To assess the intake of macronutrient and proportion of risk factor of diabetic complication among people with type 2 diabetes and to explore their causal relation. Methodology: A retrospective study conducted on retrieved first visit data of 9563 subjects visiting the study center between 2006 and 2014. Macronutrient intake was assessed using 24-hr recall. Standard protocols were used for demographic, anthropometric measurements and biochemical variable. Statistical analysis was performed using statistical package for social sciences (SPSS) version 20. Result: Out of 9563 subjects, 53.7% were males; mean age, duration of diabetes and body mass index was 51.02 ± 10.99 (yrs), 11.06 ± 8.2 (yrs) and 28.15 ± 5.34 (kg/m2) respectively. Average daily intake of carbohydrate, proteins and fats was 230.6, 68.1 and 66.1 g; and the mean intake of calories was 51.4%, 15.1% and 33.5% respectively. Obesity was found (≥25 kg/m2) 50.6% and overweight (23–24.9 kg/m2) in 34.9%. Women took more calories from fat (p = 0.001), men from protein and carbohydrates (p = 0.001). People>50 years took more fat than

Aims: The objective of this study was to identify the determinants of glycaemic control among people with type 2 diabetes mellitus in Bangladesh. A cross-sectional study was carried out during March to September 2017, and 1253 adult patients with type 2 diabetes mellitus were recruited from six hospitals. Data were collected from patients via face-to-face interview, and their medical records were reviewed. Multiple logistic regression analysis was performed. Among the participants, 53.2% were male. Mean (±SD) age was 54.1 (±12.1) years and mean (±SD) duration of diabetes was 9.9 (±7.2) years. About 82% participants had inadequate glycaemic control (HbA1c ≥ 7%) and 54.7% had very poor control (HbA1c ≥ 9%). Low education level, rural residence, unhealthy eating habits, insulin use, infrequent follow up check-ups and history of coronary artery diseases found associated with inadequate and very poor controls. Being female and smokeless tobacco consumer appeared to be associated with inadequate control however cognitive impairment was associated with very poor control only. Prevalence of inadequate glycaemic level was very high in Bangladesh. Having understood relatable lifestyle modification factors, demographics and co-morbidities among people with type 2 diabetes, health care providers in conjunction with patients should work together to address the glycaemic control.

Background: Diabetes is one of the most prevalent non-communicable diseases (NCDs) all over the world and leading cause of death, disability, and economic loss. Diabetes imposes a heavy economic burden on individuals, their families and society as a whole. The aim of this study is to estimate the economic burden of type 2 diabetes mellitus (T2DM) in Bangladesh and to find association between glycemic control and Health Related Quality of Life with cost-of-illness (COI). Methodology: This will be an analytical cross-sectional cost-of-illness study. Within a specific time period participants aged ≥18 years, registered with Bangladesh Diabetic Somiti and having type 2 diabetes for more than one year will be recruited from selected hospitals inside and outside Dhaka to cover all level of health care services. A pre-tested electronic questionnaire will be used for data collection. The questionnaire will include demographic, clinical, behavioral information of the participants and all cost related information related to diabetes management during last one year. Descriptive statistics will include mean (±SD) or median (percentile) or relative frequencies (percentage) depending on the data. Two samples independent t-test or Mann-Whitney U-test, ANOVA or Kruskal-Wallis test and chi-squared tests will be used for univariate analysis. The multivariable regression analysis and bootstrap method will also be employed to analyze the relationship between the total cost of care (dependent variable) and several potential explanatory variables (independent variables). Logistic regression analysis will be performed to assess the factors affecting glycemic control and health related quality of life (HRQoL). The calculated total cost-of-illness will be projected for T2DM in Bangladesh by a mathematical modelling. Result & discussion: The results of the study will be useful as background information to forecast the economic burden of type 2 diabetes mellitus in Bangladesh and will be beneficial to conceptualize health strategies at national level. Furthermore, recognizing the factors of cost-of-illness will help both patients and health care providers to improve the management plan and cost control and hence, to have better quality of life. Evidence about the magnitude of the burden of T2DM is important for public health policymakers who are involved in making health care priorities and allocating scarce resources to facilitate the greatest benefits for type 2 diabetic people in Bangladesh. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.501-507

Objectives: This study aimed to know that how communication professionals specifically journalists residing in urban areas use Facebook, a social media platform, for their professional activities. Method: The data for this study was collected by doing a cross-sectional quantitative survey with the help of pre-designed close-ended questionnaire that was distributed among the urban journalists in Sindh province, Pakistan in a face to face situation. Then the data was analyzed in SPSS statistical software. Findings: The findings have been presented in tables and then described and analyzed to know the Facebook usage patterns of the sampled urban journalists. In this way, it was observed that the journalists used Facebook for their professional activities i.e. they used Facebook to receive and share news and information. Novelty: Facebook that was made to interweave social networking is also used for journalistic professional activities.Keywords: Facebook, Information, Journalists, News, Social Media

Objectives: There is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting. Methods: This cross-sectional study recruited 265 postmenopausal women aged 40–70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the ‘noncommunicable disease risk factors survey Bangladesh 2010’. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis. Results: Overall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist–hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p

Due to inadequate regulatory mechanisms, the accuracy of the self-monitoring blood glucose (SMBG) devices is not ensured leading to potentially serious clinical consequences in Bangladesh. The present study was undertaken to evaluate the technical accuracy of ten most commonly used SMBG devices marketed in Dhaka City of Bangladesh. Top ten SMBG devices sold in Dhaka City were studied on a group of 100 type 2 diabetes mellitus subjects. Blood glucose values estimated (at fasting and 2 h after breakfast) by SMBG devices, using a blinding technique, were compared with the corresponding laboratory values by enzymatic method using the Dimension RXLMax automated chemistry analyzer. Hematocrit was measured using the Sysmex XT 2000 hematology autoanalyzer. The mean absolute relative error (MARE, %) was used as an indicator of accuracy and precision together. A highly significant correlation was observed between the device and laboratory values. However, none of the devices showed an acceptable accuracy at 5–10% deviation from the corresponding laboratory values either at fasting or postprandial states. On pooling together data from two prandial states, even at 15% deviation limits, 70% of the devices failed to show accurate results. On calculation of MARE, 60% devices were found to be beyond 15% error limit at 95% accuracy level. Corresponding analysis with 90% accuracy level showed 30% beyond the limit. Blood glucose results from around 30% of the top ten SMBG devices sold in Dhaka City do not have even minimum level of technical accuracy, and many others are not optimum in their accuracy levels.

Self-Monitoring Blood Glucose (SMBG) Devices are now thought to be an integral component in the prevention and management of diabetes mellitus which is increasingly becoming a major health and economic burden particularly in developing countries. The marketing of these Devices, however, are still not well regulated in most of the countries and this, in turn, may lead to more harm than good to the patients who are using these devices. Retailers are the most important contact points who create the interface among the Manufacturers, Professionals and Consumers for popularization of health related devices. In this study, the Users' Choice of SMBG Devices and its determinants, as reflected in the views of the Sales Persons (in a retail shop) in Dhaka City of Bangladesh, have been explored. Twenty Sales Persons from 20 Retail Shops, purposively selected from among major Dhaka City markets where these devices are commonly sold, were individually interviewed using a pretested Interviewer administered Questionnaire. The instrument consisted of six questions covering the Users' preference regarding quality vs cost and also regarding the guidance and motives for purchasing specific items. The results were analyzed by descriptive statistics. It was found that 90% of the consumers are dependent on the suggestions of the Sales Persons regarding the choice of devices. In 80% of the subjects the cost of the System was found to be the determining factor regarding the choice of a meter. Only among 20% subjects, quality played any role in the choice. In conclusion, the choice of specific SMBG devices in Dhaka City is overwhelmingly influenced by Retailers (who, in most cases are not even qualified Pharmacists or Pharmacy Assistants) and, except in few cases; Users are not concerned with quality. Price, particularly the price of the strip, is the dominant factor on Users' choice of SMBG Devices. Bangladesh J Med Biochem 2018; 11(1): 17-21

The research examined the use of Information Retrieval Tools (IRTs) by the post graduate students of Mehran University of Engineering and Technology. The research used descriptive survey and was carried out over a period of six months between August 2016 and January, 2017. The sample size comprise of 2,000 postgraduate students which were randomly selected from different faculties/institutes and were served with copies of the questionnaire. A total of 1,970 copies of useable questionnaire were retrieved which represent 98.5% response rate. The responses were collated and analyzed using frequency counts and percentages. The outcome shows that respondents make use of IRTs for a variety of purposes and that university library?s user education and information literacy program forms the key source of their knowledge of IRTs? usage. Through it, it can be safely concluded that the university library plays major role in assisting the students to make use of IRTs. Secondary findings show that the main IRTs made use of by the respondents is the Internet Search Engines. Furthermore findings of the study also revealed that the use of the tools has impacted positively on their social and academic life and has also enhanced their global knowledge of different issues. The major constraint to student?s use of the tools is that of Internet fluctuations. The paper concludes with recommendations on the need to give training on the use of IRTs to students.

Objectives Hypertension is strongly related to body mass index (BMI). Obesity has been the single main contributor to hypertension. Furthermore, the clinical manifestations are normally associated with BMI in hypertensive patients. This study aimed to evaluate the relationship between clinical features and BMI among hypertensive patients in both males and females. Methodology A retrospective cross-sectional study was conducted among 296 patients having a self-reported history of hypertension and on anti-hypertensive medication. The study was conducted in the medical outpatient department of a secondary care hospital in Karachi during six months (January 2020 to June 2020). A detailed history was taken from each patient about hypertension-related symptoms, and clinical examination was performed. Blood pressure was measured using a sphygmomanometer with a stethoscope. Results Of the 296 patients, 156 (52.2%) were males and 140 (47.3%) were females; 16 (5.4%) of them were underweight, 91 (30.7%) were normal weight, 129 (43.6%) were overweight, and 60 (20.3%) were obese; in addition, 106 (35.8%) reported edema and 71 (24.0%) reported nausea and so on. As far as the association of clinical features and BMI was concerned, our study results showed that only edema (p=0.017) and nausea (p=0.044) were significantly associated with the BMI of the patients. Patients with edema were more likely to be obese than those without edema (29.2% vs. 15.3%), whereas patients with nausea were more likely to be overweight than those without nausea (57.7% vs. 39.1%). Conclusions Our study showed that among the clinical features, edema and nausea were significantly associated with the BMI of the patients, whereas the relationship with others was insignificantly related to BMI of the patients in both male and female patients.

BackgroundCardiovascular disease (CVD) has emerged as a major public health concern in Bangladesh. Diet is an established risk factor for CVD but a tool to assess dietary intake in Bangladesh is lacking. This study aimed to validate a food frequency questionnaire (FFQ) using the 24-h dietary recall method and corresponding nutritional biological markers among rural and urban populations of Bangladesh.MethodParticipants of both genders aged 18–60 years were included in the analysis (totaln = 146, ruraln = 94 and urbann = 52). Two FFQs of 166 items were administered three-months apart, during which time three 24-h dietary recalls were also completed. Participants were asked to recall their frequency of consumption over the preceding 3 months. Urine and blood samples were collected for comparison between FFQ-estimates of nutrients and their corresponding biomarkers. Methods were compared using unadjusted, energy-adjusted, de-attenuated correlation coefficients, 95% limits of agreement (LOA) and quartile classification.ResultsFair to moderate agreement for ranking energy, macro and micronutrients into quartiles was observed (weightedkvalue ranged from 0.22 to 0.58;p k − 0.05) and zinc (weightedk0.09). Correlation coefficients of crude energy, macronutrients and common micronutrients including vitamin E, thiamine, riboflavin, niacin, pyridoxine, folate, iron, magnesium, phosphorus, potassium, and sodium were moderately good, ranging from 0.42 to 0.78;p p p = ns, respectively). Energy-adjusted correlations were generally lower except for fat and vitamin E, and in range of − 0.017 (for calcium) to 0.686 (for fat). De-attenuated correlations were higher than unadjusted and energy- adjusted, and significant for all nutrients except for vitamin D (0.017) to 0.801 (for carbohydrate). The Bland Altman tests demonstrated that most of the coefficients were positive which indicated that FFQ provided a greater overestimation at higher intakes. More than one in three participants appeared to overestimate their food consumption based on the ratio of energy intake to basal metabolic rate cut points suggested by Goldberg. Absolute intake of macronutrients was 1.5 times higher and for micronutrients it ranged from 1.07 (sodium) to 26 times (Zinc). FFQ estimates correlated well for sodium (0.32;p p = 0.017) with their corresponding biomarkers and iron (0.25;p = 0.003) with serum ferritin for unadjusted data. Folate, iron (with haemoglobin) and total protein showed inverse association; and fat and potassium showed poor correlation with their corresponding biomarkers for unadjusted data. However, folate showed significant positive correlation (0.189;p = 0.025) with biomarker after energy adjustment.ConclusionAlthough FFQ showed overestimation for absolute intake in comparison with 24-h recalls, the validation study demonstrated acceptable agreement for ranking dietary intakes from FFQ with 24-h recall methods and some biomarkers and therefore could be considered as a tool to measure dietary intake for research and CVD risk factors surveillance in Bangladesh. The instrument may not be appropriate for monitoring population adherence to recommended intakes because of the overestimation.

ObjectiveTo assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.Design, setting and participantsThis cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.Primary and secondary outcome measuresRisk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.ResultsOverall, 44.5% of the subjects were found ‘at risk’ of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.ConclusionA significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Aims The aim was to find out the proportion of Self-monitoring of Blood Glucose (SMBG) Users and factors affecting the nonuse in three large hospitals of Dhaka city. Methods Under an observational cross-sectional design 598 type 2 diabetic subjects were recruited (convenient sampling) from the OPDs of 3 large tertiary care hospitals [one public hospital (PUBH), one Not-for-profit Hospital (NFPPH), and one For-profit private hospital (FPPH)] in Dhaka City. Data were analyzed by both univariate and multivariate analysis as appropriate. Results Overall 71% of subjects were SMBG Nonusers (PUBH 86%, NFPPH 67%, and FPPH 46%). Monthly income status and advice showed the highest impact (OR 4.66 and 3.74 respectively) on the use. Physicians (54%), relatives (34%), and friends (8.2%) were the major sources of advice. Irregular diabetes check-up and distrust of results were also among the major reasons for not using SMBG among the Nonusers. Conclusion Nearly three-fourth of type 2 diabetic patients in Dhaka city do not use SMBG and the proportion is especially high in public hospitals. Poor income status of patients, lack of coordinated advice/motivation by Caregivers, irregularity in diabetes checking, and distrust on results are major predictors for not using SMBG by the patients., Type 2 DM, Monitoring glycemic status, Self blood glucose monitoring, Home blood glucose monitoring, SMBG, SMBG nonuse predictors.

The present study accentuates the heat transfer characteristics of a convective condition of micropolar nanofluid on a permeable shrinking/stretching inclined surface. Brownian and thermophoresis effects are also involved to incorporate energy and concentration equations. Moreover, linear similarity transformation has been used to transform the system of governing partial differential equations (PDEs) into a set of nonlinear ordinary differential equations (ODEs). The numerical comparison has been done with the previously published results and found in good agreement graphically and tabular form by using the shooting method in MAPLE software. Dual solutions have been found in the specific range of shrinking/stretching surface parameters and the mass suction parameter for the opposing flow case. Moreover, the skin friction coefficient, the heat transfer coefficient, the couple stress coefficient, and the concentration transfer rate decelerate in both solutions against the mass suction parameter for the augmentation of the micropolar parameter respectively. The first (second) solution is the stable (unstable) solution and can (not) be considered as a real solution as the values of the smallest eigenvalues are positive (negative).

A parallel coupled two-ring resonator in cascaded configuration integrated with coupling linear waveguide is proposed as a label-free biosensor for breast cancer cell detection. The parameters of ring resonator are characterized to demonstrate high-quality factors.

AMP-activated protein kinase (AMPK) and c-AMP-response element binding protein (CREB) are found to be important proteins in metabolic system. AMPK has become the focus as a novel therapeutic target for the treatment of metabolic syndromes. Oyster mushroom is traditionally used as remedy of diabetes and hypertension. The present study aims to observe the stimulation of AMPK and CREB in streptozotocin-induced diabetic model rats through Oyster mushroom administration. Long Evan’s rats were used to create type 2 model diabetic rats through intraperitoneal injection of streptozotocin at 90mg/kg body weight of 48hr old pups. Rats were divided into three groups: diabetic control rats, glibenclamide treated diabetic rats (positive control) and mushroom treated diabetic rats (experimental group). Mushroom was administered orally at a dose of 1.25g/kg body weight in semisolid forms. After five weeks rats were sacrificed, serum and tissues were collected for future analysis. Glucose was measured using glucose-oxidase method, lipid profile by enzymaticcolorimetric method. Proteins from different tissues were extracted using RIPA cell lysis buffer, AMPK and CREB were identified using western blot and immuno-precipitation techniques. A significant decreased of fasting glucose was found after 35 days of experiment when it compared with control diabetic rats (M ± SD, mmol/l, Diabetic control group: 8.0±1.1; Mushroom treated diabetic group: 6.4±1.0; p=0.021). Glibenclamide treated diabetic rats have also shown decreased fasting glucose compared to control diabetic rats. In paired ‘t’ test analysis, it has been found that serum fasting glucose level was significantly decreased on 35th day compared the 0 day in both mushroom treated group (p=0.027) and in glibenclamide treated group (p=0.005). Serum TG level was decreased on 35th day compared to 0day in mushroom treated diabetic model rats only (M±SD, mg/dl, 0 day: 84±13; 35th day: 61±6, p=0.002). No significant changes of cholesterol, HDL and LDL were noticed in the experimental groups following treatment with mushroom. Western blot analyses have shown increased band intensity of AMPK and p-CREB in mushroom treated diabetic model rats. Therefore, it can be concluded that Anti-hyperglycemic property of Oyster mushroom could be explained through increased expression of AMPK and activation of CREB.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.661-668

Face detection and eyes extraction has an important role in many applications such as face recognition, facial expression analysis, security login etc. The system is designed to develop an eye-motion based communication system for patients suffering from motor neuron disease (MND) to contact with care takers whenever they want. In this paper, we proposed a method to efficiently track eye gaze detection in real time from video acquired by a web camera. The camera is stationary with respect to the head. Proposed system is mainly divided into three steps; face detection, eye-ball(pupil) detection and finally eye gaze detection. Using predefined facial landmarks face is detected in real time. Then in the second step face point that were extracted in phase one helps to detect eye point and using circular Hough Transform eye pupil was accurately detected. Finally, in the last stage eye gaze was calculated using gaze ratio formula. The experiments are conducted on people from different age groups and a high accuracy rate is achieved.

Background : The guide extension catheter – Guidezilla (Boston Scientific, United States of America) is a useful adjunctive tool in percutaneous revascularization of complex coronary lesions, and provides an extension to the guide catheter with better coaxial alignment, support and stability. Objective : The objective of this study was to describe the usefulness and easy deliverability of stent by Guidezilla in the trans-radial treatment of complex coronary lesions as our initial experience. Methods : This prospective observational study was conducted at the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka from July 2016 to September 2017. The transradial approach was used in all cases. Clinical, angiographic and procedural data of percutaneous coronary interventions performed using Guidezilla , including indications for use of Guidezilla were collected and analyzed. Results : A total of 19 procedures (in 18 patients) were evaluated. 57.89% of cases were related to left circumflex coronary artery or obtuse marginal branch. The commonest challenge for use of Guidezilla was proximal angulation (63.15%) and calcification (47.4%). Commonest type of lesion was ACC/ AHA Type C lesion (63.2%). Successful stent deployment was achieved in 16 of the 19 procedures (84.2%). Among the unsuccessful cases, there was stent damage in one case and distal dissection after deployment of a stent in other. Stent deployment was not possible in two cases, due to diffuse lesion and heavy calcification. Conclusions : Guide extension catheter is a good trans-radial back-up support for calcified, complex and tortuous coronary anatomy, which otherwise may have been considered unsuitable for PCI. The use of such support can reduce the necessity for the more expensive alternative of deploying multiple small stents in order to traverse the lesions. Bangladesh Heart Journal 2018; 33(1) : 54-60

Psoriasis is chronic inflammatory skin disease characterized by scaly skin, which affects 24% population globally. Role of different SNPs among ACE (angiotensin converting enzyme), eNOS (Endothelial nitric oxide synthase) and MTHFR (Methyltetrahydrofolate reductase) has been established in different genetic disorders, till date there is very limited data available which quadrate the role of these important genes in the pathogenesis of Psoriasis. The present study was conducted to determine the association of ACE, eNOS and MTHFR polymorphisms with psoriasis in the Pakistani population. A total of 240 psoriatic patients and 264 healthy controls were genotyped by polymerase chain reaction (PCR) for rs464699 Insertion/Deletion (ID) polymorphism in intron 16 of ACE, rs869109213 VNTR (a/b) polymorphism in intron 4 of eNOS and by restriction fragment length polymorphism (RFLP) for rs2274976 G1793A, rs1801133 C677T and rs1801131 A1298C of MTHFR. In order to statistically analyze the genotype-phenotype association, logistic regression analysis was applied to the genotype data of psoriatic patients and controls. The ACE genotype DD was found to be significantly associated with risk of psoriasis (Odds Ratio [OR] = 1.93(95% Confidence Interval [CI] = 1.25–2.98), p= 0.02) under the recessive model. eNOS (a/b) polymorphism also demonstrated association with susceptibility to risk of psoriasis in the current cohort (OR = 1.88 (95% CI = 1.25–2.83), p = 0.001) under dominant model. In the case of MTHFR rs2274976 revealed significant association with psoriasis (OR = 2.93 (95% CI = 1.88–4.58) p ≤ 0.001) under the dominant model as well as the recessive model (OR = 1.34 (95% CI = 1.34–15.04) p = 0.005). rs1801133 also had marginal association with psoriasis by conferring protection against disease susceptibility under the dominant model (OR = 0.63 (95% CI = 0.4–1.0) p ≤ 0.05), while rs1801131 did not show any association with psoriasis. In conclusion, in the Pakistani population ACE (ID), eNOS (a/b) and MTHFR G1793A polymorphism were observed to be significantly associated with the disease.

Background: Growth retardation is a challenge in Bangladesh. School feeding programs with fortified biscuits have been evaluated in Bangladesh. However, the impacts of a school meal program using local foods on the growth and nutritional status of children have not been investigated. Objective: To determine whether a school meal program (SMP) using local foods with soybean could improve children’s growth and micronutrient status in rural Bangladesh. Methods: Two primary schools were randomly assigned as intervention (SMP; n = 200) and control (non-SMP; n = 200) schools. Children in the intervention school were supplied a school meal with local foods including soybean, containing more than one-third of the recommended daily allowance of energy and nutrients, 5 days/week for 8 months. The attendance rate and school lunch consumption of the children were monitored. Baseline and final anthropometry, hemoglobin and micronutrient status were assessed. Results: There were no significant differences in anthropometric measurements at baseline between the intervention and control groups, but there were differences in the prevalence of anemia, vitamin A deficiency and zinc deficiency. After the intervention, children in the SMP school showed a larger degree of improvement in the height-for-age Z-score (P < 0.001), red blood cell count (P = 0.001) and hemoglobin concentration (P < 0.001) than children in the non-SMP school. However, there were no positive effects on the body mass index (BMI)-for-age Z-score, serum ferritin, serum retinol or serum zinc status among children in the SMP school. Conclusion: A school meal program using local foods with soybean improved the height velocity and hemoglobin concentration of children in rural Bangladesh.

Chronic pain is not only agonizing for the patient but also has both physiological and psychological adverse effects. In addition, chronic pain also results in burdening a person financially and limiting his/her ability to complete his/her work hours. The complex nature and types of chronic pain cannot be managed by any single treatment. There is always addition of new modalities and ideas for management. Epiduroscopy and adhenolysis , RFA though are used for few years in developed countries with success but are relatively new in Pakistan

Aims This study aimed to explore the health-related quality of life and the various demographics and clinical characteristics associated with it among people with type 2 diabetes mellitus in Bangladesh. Methods A total of 1253 participants with type 2 diabetes were recruited from a cross-sectional and retrospective study conducted in Bangladesh in 2017. Participants were recruited from six rural and urban diabetes hospitals. The health-related quality of life of the participants was assessed using the validated EuroQol-5D-5L scale and EuroQol-VAS score. Information was collected via face-to-face interviews and existing medical records. Data was analysed using univariate and multivariable regression analyses with bootstrap resampling. Results The average health-related quality of life was 0.64 (±0.20) for EQ-5D-5L score and 61.69 (±34.98) for EQ-VAS score. Old age, low income, low education level, residing in an urban area, longer duration of diabetes, being physically inactive, the presence of macro- and/or micro-vascular complications, impaired cognitive function, being depressed and having anxiety were related to poor health-related quality of life. Conclusion The health-related quality of life among people with type 2 diabetes in Bangladesh is low, and various socio-demographic and psychological factors and diabetes-related complications are associated with it. This finding will help reform treatments and enforce lifestyle modifications to ensure that the burden of diabetes on people's quality of life is minimal.

Coronary artery dissection is a rare but well-recognized complication of coronary angiography with high morbidity and mortality rate. We present the case of a 54-year-old male who experienced iatrogenic left main-stem (LMS) dissection during transradial coronary angiography for inferior STEMI. The patient was successfully treated by prompt bail-out stenting. Intracoronary stenting is of value in stabilising the patients before emergency bypass surgery and can save lives in LMS complications. Ibrahim Card Med J 2015; 5 (1&2): 67-71

Background Increased awareness amongst large population groups is a major determinant for the prevention of diabetes and its complications as well as related metabolic disorders. Knowledge and attitude are the principal markers of awareness that need to be studied in various population groups in specific racial and cultural contexts. The present study was undertaken to explore knowledge, attitude and practice (KAP) regarding -diabetes mellitus (DM) among nondiabetic (nonDM) and type 2 diabetes mellitus (T2DM) patients in Bangladesh. Methods A cross-sectional study was conducted among 18,697 adults (aged 18 years and above; 7796 male and 10,901 female; 6780 nonDM and 11,917 T2DM) selected purposively from the OPD of 19 healthcare centres in and around Dhaka and in northern parts of Bangladesh. KAP were assessed by a pre-structured, interviewer-administered questionnaire and categorised using predefined scores of poor (mean + 1 SD). Univariate and bivariate statistical analysis were done as appropriate. Multivariate linear regression was done to examine the association between diabetes related KAP and other covariates. Results The mean (±SD) age (years) of all the study participants was 46 ± 14, mean BMI 24.4 ± 4.1 and mean waist-hip ratio (WHR) was 0.93 ± 0.07. The proportion of poor, average and good knowledge scores among T2DM subjects were 17%, 68% and 15% respectively. The corresponding values for attitude score were 23%, 67% and 10% respectively. The KAP regarding diabetes was found to be better among people who were living with diabetes compared to their counterparts. DM males showed better knowledge and practice regarding diabetes, compared to nonDM counterparts (M ± SD; 44.18 ± 16.13 vs 40.88 ± 15.62, p =

Childbirth has been the most controversial subject in the pain management since ages. While there are some proponents which argue that pain is pain, and it’s the physician’s responsibility to relieve it as he does for the kidney pain or even simple headache; while some argue that it is not a pathological process, and that pain associated with labor brings about a stronger and lasting bondage between mother and child. A religious argument has also been presented against it. The introduction of epidural anesthesia revitalized interest in offering pain relief in labor even for prolonged periods. In resource poor countries, it has been looked upon with guarded skepticism. The scarcity of resources and staff, coupled with lack of a nation-wide awareness campaign has been largely responsible for the low practice of this modality in SAARC countries. Apicare Journal has raised this issue at SAARC level with the association of representative bodies of the member countries. This editorial is an attempt to present some insight on the barriers to painless labor and remedial measures in our countries. Key words: Childbirth; Pain, labor; Pain relief; Epidural analgesia Citation: Ali L. Barriers to effective painless labor in developing countries and the remedial measures. Anaesth. pain intensive care 2020;24(6):__ Received: 22 November 2020, Reviewed: 22 November 2020, Accepted: 30 November 2020

Introduction: Polycystic Ovarian Syndrome (PCOS) is a major cause of female infertility which is thought to be associated with Insulin Resistance (IR). However the nature and degree of IR have been shown to vary in different populations. PCOS women have also been reported to have increased prevalence of subclinical hypothyroidism which has been postulated to be determinants of IR. The natures of thyroid involvement have also been shown to vary between populations.Objectives: The study was undertaken to explore the distribution of IR and thyroid dysfunction as assessed by Thyroid Stimulating Hormone (TSH) levels among PCOS subjects and also to investigate the association of IR with TSH in women with PCOS.Materials and Methods: One hundred and fifty one PCOS patients (age in years 24±5; M±SD) were studied. PCOS was diagnosed by Rotterdam criteria. Fasting serum C-peptide was measured by Enzyme Linked Immuno Sorbide Essay (ELISA) and serum TSH was measured by Microparticle Enzyme Immunoassay (MEIA). Serum glucose was estimated by Glucose-Oxidase method (GOD-PAP). Insulin sensitivity was assessed by using Homeostasis Model Assessment (HOMA).Results: The mean serum C-peptide (nmol/l) and HOMA%S were 0.67 (±0.35) and 85 (±42) respectively. The median (Range) serum TSH level (?lU/ml) of the study subjects was found to be 2.49 (0.66 to 20.86). Insulin sensitivity was found to be 26%, 47%, 17% and 10% in those who had HOMA%S level at the range of 150 respectively. Of the total PCOS subjects, 85% had normal level of TSH value whereas only 15% PCOS subjects had subclinical hypothyroidism. The median serum TSH level of the insulin resistance and non-resistance groups were 2.25 (0.89-5.71) and 2.58 (0.74-20.86) respectively. On Pearson's correlation analysis insulin sensitivity was not found to be any significant association with TSH in the PCOS subjects.Conclusion: The study revealed that there was no significant association with IR and TSH in the PCOS subjects.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 69-73

Objective (s): Aim of the study was to explore the effect of the most widely used low dose OCP (Shukhi) on glycemic and lipidemic factors of under weight (Low BMI) Bangladeshi women.Materials and Methods: This case control study was conducted at the Department of Cell and Molecular Biology, Research Division, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders (BIRDEM) and Family Planning Center of Dhaka Medical College Hospital during the period of Jan 2011 to Dec 2011. A total number of 40 women were included in this study having age range between 25-45 years. Twenty nine (29) were with normal BMI (>18.5) and 11 were with low BMI (

Smart factory research is paced up in the current decade due to the development of many enabling technologies and tools available to the developers. This has led to the progress of cyber physical systems in manufacturing, now coined as cyber physical production systems. The ultimate goal of this domain is to integrate underlying technologies and connect physical plants with the virtual factory in real time for improvement in product quality, process improvements, predictive maintenance, mass customization as well as mass production. The involved technology modules include sensor network, machine learning and AI, Internet of things, human machine interface, augmented reality and collaborative robotics. For the physical element in this research, a micro factory scenario is envisaged that consists of a high precision micro/nano positioning stage installed on a tabletop sized conventional machine tool, a collaborative robot for handling of micro parts and running of machine operations, other factory devices and a human worker for supervision tasks. Due to the multi-faceted technologies involved in both the virtual and physical systems, a simultaneous design strategy is followed in both domains. First, a flexure based micro positioning, 3-axis stage device is designed that can be installed on a conventional 3-axis desktop size milling machine. Secondly, a work zone is considered for effective human robot collaboration in the production area. The work zone considered as a social space is designed in a safe and secure way with the help of integrated devices, IoT and AI.

Background The economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh. Methods A cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients’ medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient’s perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost. Results Among the participants, 54% were male. The mean (±SD) age was 55.1 ± 12.5 years and duration of diabetes was 10.7 ± 7.7 years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient. Conclusions The cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost. Electronic supplementary material The online version of this article (10.1186/s12913-019-4440-3) contains supplementary material, which is available to authorized users.