Search

OBJECTIVE To assess the association of antimalarials (AM) adherence with premature mortality among incident systemic lupus erythematosus (SLE) patients. METHODS All patients with incident SLE and incident AM use in British Columbia, Canada, between January 1997 and March 2015 were identified using the provincial administrative databases. Follow-up started on the first day of having both SLE and AM. The outcome was all-cause mortality. An adherence measure, proportion of days covered (PDC), was calculated and categorized as adherent (PDC≥0.90), non-adherent (0

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.

There is no proven specific treatment or adequate vaccination roll out against COVID-19 infection in South Africa. Optimal infection control measures encompass primary intervention to minimize the spread of COVID-19. Public knowledge, attitude, and practices of dealing with this highly infectious respiratory disease play a vital role in limiting the spread of the infection. Aim was to identify knowledge, attitudes, and practices gaps on COVID-19 pandemic for possible health education intervention. The objectives were to determine the knowledge, attitude and practices of out-patients attending a primary health care facility. A cross-sectional descriptive survey was conducted. The Student’s t-test and ANOVA test were carried out to determine the different mean scores for knowledge, attitudes and practices. Pearson’s correlation test was conducted to determine the relationship between knowledge, attitudes, and practices scores. Binary logistic regression was undertaken to determine the predictor of good knowledge, positive attitude, and preventive practices. A total of 345 out-patient attendees participated of which 51% were male. Over half (52%) of respondents were evaluated as having good knowledge, 59% as having positive attitudes and almost all (95%) were practicing prevention of COVID-19. The knowledge of the respondent was correlated with preventive practices (r=.173, p

Background: The COVID-19 pandemic has negatively impacted on healthcare workers globally. The psychological impact of COVID-19 among primary healthcare workers who constitute a vulnerable group is yet to be evaluated in South Africa. The objectives were to estimate the prevalence and risk factors for stress, anxiety and depression among healthcare workers of a rural primary health care setting in South Africa. Method: Self-administered questionnaire-based cross-sectional design was implemented among medical and nursing care professionals. Psychological problems were assessed using the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Logistic regression was performed to determine associated factors for psychological problems. Results: The majority of HCWs were female (82.8%), of which 69.2% nurses and 56.6% single. The prevalence of stress, anxiety and depression disorders were 97.5%, 97.5% and 44% respectively. Females were 5.3 times (p

Background: Type-2 diabetes mellitus, a non-communicable disease contributes significantly to morbidity and mortality in South Africa. It is considered a silent epidemic in certain countries in the world with the incidence expected to rapidly escalate due to ageing of the population. Little is known about the treatment outcome from Primary Health Care facilities in SA. The study estimated control and determinants of diabetes control among rural black patients attended a PHC facility. Method: A cross-sectional prospective design was adopted. Chi-square test was carried out to find significant association between dependent and independent variables. Forward stepwise logistic regression was performed to determine the significant predictor for diabetes control. Two-sided statistical tests were performed at 0.05 level of significance. Result: A total of 240 DM patients were recruited and (68.7%) of them had HbA1c level measured) and only 49 (29.7%) were found with glycaemic control. Logistic regression analysis showed that patients those read newspaper daily or almost daily were almost three times (OR=2.6) more likely to have control. Patients those measured the blood sugar at home were 4.4 times more likely to have their diabetes controlled. It was found that knowing normal blood sugar had four times more chances of controlling their diabetes than those did not know. Duration of DM treatment (5-9 years) was 60% less likely to have DM control that those had 10 or more years of DM treatment (p

Introduction: There is no specific treatment and vaccine for COVID-19 yet. The prospective vaccine is the primary prevention and is the promising preventive strategy to gain herd immunity. The study aimed to identify COVID-19 vaccine acceptance rate among primary health care attendees at Durban, South Africa. Method: A questionnaire based cross-sectional study was conducted at the Kwadabeka Community Health Centre, Durban, South Africa. Chi-square test and logistic regression were carried out to identify the factors for COVID-19 vaccine acceptability. P-values

Background: The platelet transfusions help in prevention of bleeding related complications and thus prevents morbidity and mortality in thrombocytopenic patients. Platelet transfusion plays an important role in the treatment of haematological, oncological, surgical, and transplant patients. Platelets are transfused by two methods i) by fractionation of whole blood and ii) by platelet apheresis. Over the last decade there has been a trend towards the use of SDPs rather than pooled random donor platelets in thrombocytopenic patients. Optimization of platelet yield is an emerging issue to identify factors which may help in selecting donors to obtain higher platelet yields in shorter time and consequently better clinical outcome. Objective: The quality of single donor platelets (SDP) in terms of yield influences the platelet recovery in the recipient. The aim was to identify the SDP donor factors that influence platelet yield. Methods: The study was undertaken at transfusion medicine department, DMCH from 1st January 2017 to 31st December 2017. The study included 350 plateletpheresis procedures. All procedures were performed according to manufacturer’s manual and standard operating procedure. Results: During the period of study, 350 platelet pheresis donors were studied. All of the donors were male. Platelet yield showed high statistical significance with pre donation platelet count and its indices. (p=0.000). Statistical significant negative correlation was seen between pre donation Hb concentration and the platelet yield. (p =0.005). No statistical significance was seen height (p=0.933), weight (p=0.760) of donor on platelet yield. Conclusion: Platelet recovery in the patient is influenced by the transfused dose of platelets, which in turn is dependent on the quality of the platelet product in terms of yield. Various donor factors such as pre donation platelet count and haemoglobin concentration may affect platelet yield. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 179-183

Embaràs i malaltia cardíaca; Resultats de l’embaràs; Transposició de les grans artèries Embarazo y enfermedad cardíaca; Resultados del embarazo; Transposición de las grandes arterias Pregnancy and cardiac disease; Pregnancy outcomes, Transposition of the great arteries Background In the past 3 decades, the arterial switch procedure has replaced the atrial switch procedure as treatment of choice for transposition of the great arteries. Although survival is superior after the arterial switch procedure, data on pregnancy outcomes are scarce and transposition of the great arteries after arterial switch is not yet included in the modified World Health Organization classification of maternal cardiovascular risk. Methods and Results The ROPAC (Registry of Pregnancy and Cardiac disease) is an international prospective registry of pregnant women with cardiac disease, part of the European Society of Cardiology EURObservational Research Programme. Pregnancy outcomes in all women after an arterial switch procedure for transposition of the great arteries are described. The primary end point was a major adverse cardiovascular event, defined as combined end point of maternal death, supraventricular or ventricular arrhythmias requiring treatment, heart failure, aortic dissection, endocarditis, ischemic coronary events, and thromboembolic events. Altogether, 41 pregnant women (mean age, 26.7±3.9 years) were included, and there was no maternal mortality. A major adverse cardiovascular event occurred in 2 women (4.9%): heart failure in one (2.4%) and ventricular tachycardia in another (2.4%). One woman experienced fetal loss, whereas no neonatal mortality was observed. Conclusions Women after an arterial switch procedure for transposition of the great arteries tolerate pregnancy well, with a favorable maternal and fetal outcome. During counseling, most women should be reassured that the risk of pregnancy is low. Classification as modified World Health Organization risk class II seems appropriate. Funding from “Zabawas Foundation” and “De Hoop Foundation” in addition to the support from EURObservational Research Programme (EORP) is greatly acknowledged. Since the start of EORP, the following companies have supported the program: Abbott Vascular Int (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc (2014–2016), Menarini Int Op (2009–2012), MSD‐Merck & Co (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), and Vifor (2019–2022).

Hypertension is a serious global and South African public health problem. The high prevalence of uncontrolled hypertension is related to a patient’s lack of knowledge and healthy practices. The study aimed to assess the knowledge, attitudes and practices of hypertensive patients and their blood pressure control at a rural community health centre. This was a prospective cross-sectional study conducted on diagnosed cases of hypertension at the centre. Binary logistic regression analysis was conducted to determine the factors for the control of hypertension. Two hundred and ninety-seven known hypertensive patients were recruited, the majority of which were female. Eighty-eight percent were older than 45 years, and almost all had a monthly income of less than R3000 (USD 190). More than half controlled their blood pressure. It was found that 46% had poor knowledge, 64% had good attitudes and 60% were practising positively regarding the control of hypertension. Hypertensive patients attending the centre had poor knowledge but good attitudes and practices towards hypertension. The study revealed an urgent need for improved health promotion and educational efforts to increase the knowledge of hypertension in rural communities and to address poverty as a major obstacle to healthy lifestyle choices.

Introduction: Knowledge, attitude and practices (KAP) of COVID-19 pandemic play a significant role in reducing the transmission of the virus. There is limited information available about HCWs KAP regarding COVID-19. Therefore, the objective of this study was to investigate the KAP of KCWs from a primary healthcare setting in South Africa. Method: This was a cross-sectional study conducted among all medical and nursing healthcare professionals of KwaDabeka Community Healthcare Center (KCHC) and seven PHC clinics. Selfadministered questionnaire was used to collect data. Student’s t-test and ANOVA test were carried out to compare the overall mean knowledge, attitude and practice scores between two or more groups. Pearson’s correlation test was undertaken to establish correlation between KAP scores. Results: Majority HCWs were female (82.8%), single or unmarried (56.6%) and nurses comprised the most (69.2%). Nearly half (44%) reported to have recognized vulnerable co-morbid illnesses for COVID-19. Only 24% of HCWs had good knowledge (scored > 60%), however, 81% had positive attitude (scored >60%) and 63% had good practice (>60% scores). Nursing practitioners had significantly lower mean knowledge and practice scores than medical officers and allied healthcare workers (p

Background : Infantile hemangioma is a benign vascular tumor. Considerable controversy exists as to the management of hemangiomas. The purpose of this study was to see the efficacy and safety of orally administered prednisolone and propranolol in combination for treatment of potentially disfiguring or functionally threatening hemangiomas Materials and methods: In this prospective study, thirty two patients of hemangioma with age range of 1 month to 5 years were included who were treated with oral propranolol (1 mg/kg/ day in two divided doses) and oral prednisolone (2 mg/Kg/ day in single dose) in combination. This study was conducted in outpatient Department of Pediatric Surgery of Chattogram Medical College Hospital from January 2016 to December 2017. Changes in size and color of lesions were the two evaluating factors to see the efficacy of the treatment. Therapeutic response was graded as excellent, good, poor and no response. Results: Overall therapeutic response was 92.62% (29 patients). Excellent response was noted in 21 patients (65.62%) and in 3 patients (9.38%) there was no response. Range of treatment period was 6 to 20 weeks. No side effects except excessive weight gain was noted (6.25%). Conclusion: Combined use of low dose oral prednisolone and propranolol is more effective and safe for treatment of hemangioma. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 23-26

OBJECTIVE: To examine the association between caregiver-perceived neighborhood safety and pediatric asthma severity using a cross-sectional, nationally representative sample. STUDY DESIGN: Using data from the 2017–2018 National Survey of Children’s Health, children aged 6–17 years with primary caregiver report of a current asthma diagnosis were included (unweighted N = 3209; weighted N = 3,909,178). Perceived neighborhood safety, asthma severity (mild versus moderate/severe), demographic, household, and health/behavioral covariate data were collected from primary caregiver report. Poisson regression with robust error variance was used to estimate the association between perceived neighborhood safety and caregiver-reported pediatric asthma severity. RESULTS: Approximately one-third of children studied had moderate/severe asthma. Forty-two percent of children with mild asthma and 52% of children with moderate/severe asthma identified as Hispanic or non-Hispanic Black. Nearly 20% of children with mild asthma and 40% of children with moderate/severe asthma were from families living below the federal poverty level. Children living in neighborhoods perceived by their caregiver to be unsafe had higher prevalence of moderate/severe asthma compared to those in the safest neighborhoods (adjusted prevalence ratio: 1.34; 95% confidence interval: 1.04–1.74). This association was found to be independent of race/ethnicity, household federal poverty level, household smoking, and child’s physical activity level after adjusting for covariates. CONCLUSIONS: Children living in neighborhoods perceived by their caregiver to be unsafe have higher prevalence of moderate or severe asthma. Further investigation of geographic context and neighborhood characteristics that influence childhood asthma severity may inform public health strategies to reduce asthma burden and improve disease outcomes.

Back ground: Non-Alcoholic Fatty Liver Disease (NAFLD) is a common cause of Chronic Liver Disease (CLD) worldwide and is becoming a major public health problem. NAFLD has been recognized as a hepatic manifestation of Metabolic Syndrome (MetS) linked with Insulin Resistance (IR) and is currently considered as the hepatic component of the Metabolic Syndrome (MetS). NAFLD is strongly associated with IR and is mostly silent which is often discovered incidentally through elevated hepatic enzyme levels. The purpose of this study is to find out the association of Fasting Lipid Profile (FLP) with IR in NAFLD subjects. Materials and methods: A prospective hospital based cross sectional study was carried out in the Department Of Biochemistry, Institute of Nuclear Medicine and Allied Sciences (INMAS) and Chittagong Medical College Hospital. One hundred & fifty (150) subjects aging between 18-60 years were included in this study by non probability consecutive sampling method. Important variables in this study were Fasting Plasma Glucose (FPG) Fasting Serum Insulin (FPI) and Fasting Lipid Profile (FLP). IR was calculated by using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index i.e. (FPI μIU x FPG mmol/L)/22.5. Results: In this study HOMA-IR was significantly higher in cases than that of controls (4.77±0.16) and showing Insulin Resistance (IR) in 90% of the cases. There was a significant association of HOMA-IR with increased serum Triglyceride (TG) in NAFLD cases. Conclusion: The findings of the current study suggest that independent variable such as increased Serum TG was associated with IR in NAFLD subjects. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 3-7

Background: In order to improve the spontaneous Adverse Drug Reaction (ADR) reporting practice by the physicians, there is an obligatory need to investigate the current situation of ADR reporting by them. The study was conducted to observe the ADR reporting pattern among physicians in a tertiary medical college hospital. Materials and methods: This was a descriptive cross sectional study carried out in a tertiary medical college hospital during the study period of March 2020 to October 2020. Data were collected from 100 physicians working on different departments using self designed pretested questionnaire by convenient sampling technique. Results: Among the 100 respondents 70 provided response to questionnaire giving a response rate 70%. Most of the respondents (61.43%) had adequate knowledge on ADR reporting. A good number of respondents showed positive attitude but there is no practice of ADR reporting though most of the respondents (84.3%) had experienced it in last 1 year. Most of the respondents experienced ADR with antibiotic (81.35%), NSAIDs (33.89%) & anticonvulsants (15.25%) and maximum (44.06%) experienced ADR was with skin, 30.50% with GIT and 23.03% with respiratory system involvement. The cause of under reporting was mainly due to inaccessible ADR form, busy schedule, unaware of how and whom to report and lack of motivation to report. The respondents would be encouraged to report ADR if they were provided with simple & available reporting form, regular guideline & bulletin. Conclusion: There is an urgent need for educational training & seminar regarding our national online reporting system to emphasizing ADR reporting. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 8-13

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture >2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate >15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax < 15 ml/s, stricture on RGU and any post-operative urethral intervention. Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7% Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

Dengue, a rapidly spreading mosquito-borne human viral disease caused by dengue virus (DENV), is a public health concern in tropical and subtropical areas due to its expanding geographical range. DENV can cause a wide spectrum of illnesses in humans, ranging from asymptomatic infection or mild dengue fever (DF) to life-threatening dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Dengue is caused by four DENV serotypes; however, dengue pathogenesis is complex and poorly understood. Establishing a useful animal model that can exhibit dengue-fever-like signs similar to those in humans is essential to improve our understanding of the host response and pathogenesis of DENV. Although several animal models, including mouse models, non-human primate models, and a recently reported tree shrew model, have been investigated for DENV infection, animal models with clinical signs that are similar to those of DF in humans have not yet been established. Although animal models are essential for understanding the pathogenesis of DENV infection and for drug and vaccine development, each animal model has its own strengths and limitations. Therefore, in this review, we provide a recent overview of animal models for DENV infection and pathogenesis, focusing on studies of the antibody-dependent enhancement (ADE) effect in animal models.

The chemical contaminants in dried fish are of great food safety concern and an emerging public health issue in Bangladesh. The aim of this study was to assess the public health risk associated with exposure to pesticides (organochlorine and organophosphorus) and heavy metals (lead, mercury, cadmium, chromium, arsenic) through the consumption of dried fish (Bombay duck, ribbon fish, silver jewfish, shrimp, Chinese promfret) in coastal districts (Cox’s Bazar, Chittagong, Bhola, Patuakhali, Khulna) of Bangladesh. Dried fish consumption data were collected from 500 adult respondents (100 from each district) using a food frequency questionnaire (FFQ). Pesticide residues were determined using QuEChERS extraction coupled to gas chromatography and gas chromatography mass spectrometry, and heavy metals were estimated using an atomic absorption spectrophotometric method. The results revealed that the frequency and amount of dried fish consumption was highest for Bombay duck in Cox’s Bazar (11.57 g/capita/day) and ribbon fish (12.10 g/capita/day) in Chittagong. The estimated daily intake (EDI, 7.40 × 10−5 to 1.10 × 10−4 mg/kg/day) and health risk index (HRI, 0.013 to 0.16) values expressed no health risk from pesticide residues in all the positive samples. For heavy metals, target hazard quotients (THQ) for non-carcinogenic health risk were below 1 (0.001–0.154), indicating no health risk for all samples. However, carcinogenic risk R value indicated a potential health risk for chromium (2.64 × 10−6 to 4.06 × 10−6), and carcinogenic RT value (2.82 × 10−6 to 5.71 × 10−6) indicated a potential health risk for all the metals. It is concluded that the risk of exposure to pesticides through the consumption of dried fish is low, while heavy metals pose moderate-to-high health risks to dried fish consumers in the study area. Thus, the study suggests an appropriate risk management policy that controls pesticides and heavy metals in dried fish to ensure safe food for local and global consumers, underpinned by a producers’ capacity building and consumers’ awareness raising strategy.

Normal hemostasis requires a delicate balance between the natural procoagulant and anticoagulant systems. Thrombophilia is an abnormality of the coagulation or fibrinolytic system that results in a hypercoagulable state and increases the risk for thrombotic event by forming intravascular thrombus. The predisposition to form such blood clot may be inherited or acquired. In inherited thrombophilia, there is deficiency of natural anti-coagulants, e.g. anti-thrombin III, protein C and S or increase formation of human coagulant factors, e.g., factor V Leiden or prothrombin gene 20210A. Factor V Leiden thrombophilia is extremely rare in Bangladesh. We report this unique case of a young lady of 46-year-old presented with continuous headache and found to have extensive cerebral venous thrombosis with bilateral 6th cranial nerve palsy. She had suffered from acute arterial occlusion of left upper limb in September 2016, 2 years prior to current presentation. We suspect thrombophilia according to her presentation. The subsequent step is to screen for-human natural anti-coagulant factors deficiency or presence of mutated form of factor V (factor V Leiden) and prothrombin gene mutation. We screened for and found to have presence of factor V Leiden in our patient. We always should remember that, thrombotic events are increasingly recognized as a significant source of mortality and morbidity, so screening should be considered in selected individuals if criteria suggests. Bangladesh Crit Care J September 2021; 9 (2): 104-108

STUDY DESIGN Development and validation of fracture classification system. OBJECTIVE To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures). SETTING Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. RESULTS In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. CONCLUSIONS The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.

Patients who develop seizures after stroke have disproportionately poorer outcomes and increased mortality. Our objective was to investigate whether exposure to anti-epileptic medications influenced long-term functional status after stroke. We used linked health administrative data from a cohort of adult stroke patients in New Zealand. Demographics and prescription information were obtained from the National Minimum Dataset and Pharmaceutical Collection, respectively. Activities of daily living (ADL) scores for the same patients were obtained using the International Resident Assessment Instrument. Beta regression was used to investigate the relationship between anti-epileptic drug (AED) exposure and functional status. The study included 3606 patients with a single ischaemic stroke between 2012 and 2017. In total, 15% were dispensed an AED in the 3 months before or after stroke. The adjusted odds ratio (OR) for AED exposure was 1.29 (95% confidence interval [CI] 1.15–1.45). Overall AED exposure, categorical body mass index (BMI), ethnicity, length of hospital stay, and exposure to paracetamol, opioids, anti-psychotics, and anti-nausea medications were significantly associated with changes in the mean ADL score percentages. Considering the exposure timeframe, the ORs for AED exposure only after stroke and for exposure both before and after stroke were 1.52 (95% CI 1.31–1.78) and 1.09 (95% CI 0.93–1.27), respectively. Stroke patients with AED exposure had greater odds of a higher ADL score, indicating a poorer long-term functional status than those unexposed to AEDs. The timeframe of exposure impacted on functional status, with patients exposed only after stroke having increased odds of higher ADL scores than those exposed both before and after stroke.

Double valve replacement is now-a-days a common procedure to treat diseased cardiac valves and the primary aim of prophylactic aortic replacement during concomitant valve replacement is to prevent dreadful complication like dissection, aortic rupture and even death. Although aortic surgeries are complex and have high morbidity and mortality rates, additional double valve procedure with coronary surgery can make it even worse. But for these patients, surgery remains the one and only treatment option for symptom relieve and prolongation of life. We herein present a case of severe aortic stenosis (AS) with severe aortic regurgitation (AR) with severe mitral regurgitation (MR) with coronary artery disease (CAD) and aortic aneurysm treated successfully by us at Square Hospitals; and to our best knowledge and according to the published articles, this is probably the first time, this type of combined cardiac procedure has been accomplished along with aortic surgery, in our country. We recommend that surgeons should perform bypass grafting along with aortic replacement and valve replacement surgery when indicated, without worrying that adding such a procedure will escalate post-operative adverse effect. Cardiovasc j 2021; 14(1): 82-87

Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is an effective drug for various postoperative arrhythmias. Objective of this study is to evaluate the efficacy of Amiodarone in controlling postoperative arrhythmia in our settings at the department of cardiac surgery. Methods: This retrospective observational study involved random selection of 20 patients, who developed potentially life-threatening arrhythmia following cardiac surgical procedures under cardiopulmonary bypass (CPB) at Chittagong Medical College Hospital (CMCH) between January 2018 and December 2020. Amiodarone was used in controlling postoperative cardiac arrhythmia by loading 1000 mg in first 24 hours, followed by 800 mg orally in daily divided doses. Results: Among 20 patients under study, five had valvular replacement, three had ASD closure, one VSD closure, one patient had excision of LA myxoma and in ten patients had undergone CABG. The Mean ± SD of the age of the patients was 50.2 ± 14.7 years. Eleven patients (55%) were female. Atrial fibrillation with rapid ventricular rate occurred in 15 patients, supraventricular tachycardia in two and ventricular tachycardia three patients. Targets were achieved in all 20 of these patients. Among them 13 (65%) reverted to sinus rhythm, in other 7 AF persisted but ventricular rates became below 100/m with hemodynamic stability. The Mean ± SD of the time required for target achievement was 8.9 ± 7.4 hours. There was no perioperative death in these patients. Conclusion: Amiodarone is an effective medication in combating both atrial and ventricular arrhythmia following cardiac surgery employing cardiopulmonary bypass. Cardiovasc j 2021; 14(1): 20-23

We developed an intelligent web interface that guides users to perform several Parkinson’s disease (PD) motion assessment tests in front of their webcam. After gathering data from 329 participants (N = 199 with PD, N = 130 without PD), we developed a methodology for measuring head motion randomness based on the frequency distribution of the motion. We found PD is associated with significantly higher randomness in side-to-side head motion as measured by the variance and number of large frequency components compared to the age-matched non-PD control group (p = 0.001, d = 0.13). Additionally, in participants taking levodopa (N = 151), the most common drug to treat Parkinson’s, the degree of random side-to-side head motion was found to follow an exponential-decay activity model following the time of the last dose taken (r = −0.404, p = 6e-5). A logistic regression model for classifying PD vs. non-PD groups identified that higher frequency components are more associated with PD. Our findings could potentially be useful toward objectively quantifying differences in head motions that may be due to either PD or PD medications.

Not available.

Remote and objective assessment of the motor symptoms of Parkinson’s disease is an area of great interest particularly since the COVID-19 crisis emerged. In this paper, we focus on a) the challenges of assessing motor severity via videos and b) the use of emerging video-based Artificial Intelligence (AI)/Machine Learning techniques to quantitate human movement and its potential utility in assessing motor severity in patients with Parkinson’s disease. While we conclude that video-based assessment may be an accessible and useful way of monitoring motor severity of Parkinson’s disease, the potential of video-based AI to diagnose and quantify disease severity in the clinical context is dependent on research with large, diverse samples, and further validation using carefully considered performance standards.

Muhammad Shah Alam,1 ABM Kamrul-Hasan,2 Syeda Tanzina Kalam,3 SM Mizanur Rahman,4 Mohammad Izazul Hoque,5 Md Belalul Islam,6 Ajit Kumar Paul7 1Department of Medicine, Army Medical College, Comilla, Bangladesh; 2Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh; 3Department of Psychiatry, Comilla Medical College Hospital, Comilla, Bangladesh; 4Department of Medicine, CMH and Army Medical College, Comilla, Bangladesh; 5Department of Hepatology, Comilla Medical College, Comilla, Bangladesh; 6Department of Medicine, Comilla Medical College, Comilla, Bangladesh; 7Department of Endocrinology, Maynamati Medical College, Comilla, BangladeshCorrespondence: ABM Kamrul-HasanDepartment of Endocrinology, Mymensingh Medical College, Charpara, Mymensingh, 2207, BangladeshTel +8801711103905Email rangassmc@gmail.comPurpose: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD), and the presence of T2DM tremendously drives NAFLD progression. The use of transient elastography (TE) for assessment of NAFLD has been increasing due to its high sensitivity and specificity. This study aimed to measure liver stiffness in patients with T2DM and ultrasonography (USG)-diagnosed NAFLD and assess the correlations between liver stiffness and other clinical and biochemical parameters.Patients and Methods: This cross-sectional study assessed 205 adult patients with T2DM and USG-diagnosed NAFLD who were being treated at a specialized endocrine private practice in Bangladesh. All subjects underwent TE for hepatic fibrosis assessment, which was performed using a FibroScan® 402 device. A fibrosis score ≥ 9.7 kilopascals (kPa) was used to define advanced fibrosis (≥F3).Results: Out of 205 (65.9% female, mean age 45 ± 27 years, 67.3% obese) patients, the frequencies of Grade 1, Grade 2, and Grade 3 fatty liver on USG were 46.3%, 51.2%, and 2.4%, respectively. According to the TE results, 41 (20%) had advanced fibrosis (≥F3). Subjects with advanced fibrosis had a higher body mass index (BMI), higher levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and higher frequencies of individuals with elevated ALT and AST and advanced fatty liver grades on USG. The fibrosis score (kPa) was strongly and positively correlated with age, BMI, waist circumference, obesity, serum ALT and AST levels, and the fatty liver grade in USG; the AST:ALT ratio did not correlate with kPa.Conclusion: The data showed that 20% of the subjects with T2DM having NAFLD on USG exhibited advanced fibrosis, demonstrating the need for early diagnosis and treatment of NAFLD in T2DM. The use of TE with other serum markers can be helpful for the diagnosis of advanced fibrosis.Keywords: type 2 diabetes, NAFLD, transient elastography, advanced fibrosis, AST:ALT ratio

Background: COVID-19 pandemic has caused an unpre-cedented strike on humanity around the world . The scenario in Bangladesh is getting worse day by day, and every aspect of the society is observing its impact. Health care professionals are at a greater risk of contracting the disease while caring for patients. Objective: The research objective is to explore knowledge, awareness, and practices of registered dentists regarding COVID-19 epidemiology and transmission during the rapid outbreak of this highly contagious virus in Bangladesh. Material and Methods: A cross-sectional web-based survey was conducted among the dentists who were enrolled with their valid unique Bangladesh Medical and Dental Council (BMDC) registration number. A structured questionnaire was distributed among the dentists through different social media platforms. A total of 184 dentists participated in the survey between March and April 2020. Both descriptive analysis and multivariable logistic regression analysis was performed. Results: The dentists' mean age was 31.75 years, with a standard deviation of 6.5 years. About 29.3% of dentists completed their postgraduate qualification, and 76% of them were engaged in private practice at the time of data collection. Compared to the dentists with undergraduate education, the dentists with a postgraduate education are three times (OR=3.1, 95%CI 1.2-7.9 and over 5 times (OR=5.3, 95% CI: 1.2-23.3) more likely to have) better knowledge and practices toward COVID-19 respectively. Dentists aged 26-30 years are less likely to have good practices than the younger dentists (OR: .1; 95% CI: .01-.5). However, dentists with less than five years experience are 10.3 (1.6-68.9) times more likely to have good practices compared to the dentists with more experience. Conclusion: Majority of the dentists from Bangladesh have shown good knowledge, awareness, and practice regarding COVID-19. We recommend that the healthcare authorities, professional organizations, and hospitals coordinate, and conduct mandatory advanced infectious disease training for all the practicing dentists in the country.

Background: Prematurity is the largest cause of neonatal mortality. They need incubators or radiant warmers which are expensive and very difficult to arrange in a resource constraint country. Kangaroo mother care (KMC) had been proposed as an alternative to conventional neonatal care for low birthweight (LBW) babies. Objectives: To observe the benefits of Kangaroo mother care in preterm low birth weight babies. Methods: This randomized controlled trial was conducted over 6 months in Dhaka Shishu Hospital. Neonates who were

Background: Amiodarone is the most effective antiarrhythmic medications available today for the treatment of both atrial and ventricular arrhythmias. It is an iodinated benzofuran derivative with demonstrated efficacy against a range of cardiac arrhythmias, including atrial fibrillation, paroxysmal supraventricular tachycardias, and life-threatening ventricular arrhythmias. Objective: To evaluation the status of amiodarone with therapeutic dose in Bangladeshi population. Materials and Methods: The quasi experimental study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka during April, 2019 to March, 2020 Patients got admitted in the Department of Cardiology, BSMMU, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Results: The most common adverse event was bradycardia or conduction disturbance (9.0%) followed by 4(2.2%) thyroid toxicity, 3(1.7%) hepatic toxicity, 2(1.1%) eye toxicity and 1(0.6%) pulmonary toxicity. In multi variable logistic regression, bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (>4 month) was found to be significantly (p4 month) was found to be significantly associated with adverse effects of amiodarone. University Heart Journal Vol. 17, No. 2, Jul 2021; 118-121

Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. Percutaneous recanalization of occluded coronary artery is one of the treatment options and reinfarction and restenosis negatively affect the outcome following procedure. Although various factors including fibrinogen are suspected as risk factors for this but its role in adverse outcome after stent implantation is controversial. The aim of this study was to determine the impact & relation of periprocedural fibrinogen level on outcome after coronary stent implantation. This prospective study was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Hospital, Dhaka over a period of one year between July 2016 to June 2017. Total 53 patients of chronic stable angina (CSA) undergoing elective PTCA followed by stenting were included in this study as per inclusion and exclusion criteria. Plasma fibrinogen level was measured by collecting venous blood samples at three timed points in relation to stenting – 24 h before, 24 h after and 72 h after stenting. Recurrence of angina, myocardial infarction, repeat revascularization (either PCI or Cardiac surgery), and death were considered as adverse outcome during follow up at 1, 3 and 6 months after intervention. During the 6 months follow up period 1 (one) patient developed UA (at 1 month), 2 developed MI (1 at 3 month and 1 at 6 month) and 2 died (1 at 3 month and 1 at 6 month). Patients were grouped on the basis of four outcomes: favorable outcome (those who did not develop any of the four outcomes) and unfavorable or adverse outcome (those who developed any of the four outcomes). The mean age of study population was 53.92 years and 39 (73.6%) were male. Regarding cardiovascular risk factors, 43.4% patients had diabetes mellitus, 88.6% had dyslipidaemia, 56.6% were non-smokers. Baseline plasma fibrinogen level were significantly higher in patients who developed complications following PCI than those who did not develop the complications (394.4 ± 16.0 Vs 271.5 ± 21.8 mg/dl) & remained high after 24 hours and 72 hours following PCI (p < 0.001). Angiographic profiles of the study population reveals 84.9% LAD, 16.9% RCA & 15% LCX involvement but there was no association of post-PCI adverse outcomes with vessels involved, number of stents deployed and types of stents used (p > 0.05). Study showed that the risk of developing unfavorable outcome following PCI in patients with pre-PCI & post-PCI high serum fibrinogen was estimated to be 5.7 times & 12 times higher than those who have had serum fibrinogen lower than 350 mg/ dl respectively (p = 0.023 & 0.025 respectively). High serum fibrinogen can therefore be used as a marker for predicting adverse outcome following PCI. University Heart Journal Vol. 17, No. 2, Jul 2021; 122-127

Background: Acute Coronary Syndrome includes to a group of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. In the last decade vitamin-D deficiency as a predisposing factor for coronary artery disease is in growing interest. Prospective studies give conflicting results regarding correlation of serum vitamin D level with coronary angiographic severity in patients with acute coronary syndrome. Objective: To study the correlation between serum vitamin-D level with coronary angiographic severity in patients with acute coronary syndrome. Methodology: This cross sectional observational study was done between November 2018 and October 2019. Total 71 patients with diagnosis of first incident of acute coronary syndrome in department of cardiology, BSMMU who were underwent coronary angiogram included in this study considering the inclusion and exclusion criteria. Vitamin D was measured by chemiluminescent immunoassay after collection of venous blood at Department of Biochemistry, BSMMU. Angiographic severity was assessed by using Gensini score. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: The mean age was found 55.9±10.7 years with a range from 36 to 82 years. Majority (83.1%) patients were male. The male-female ratio was 4.9:1. Thirty (42.3%) of the patients had STEMI, 28(39.4%) had NSTEMI and 13(18.3%) had unstable angina. Negative correlation (r=-0.479; p=0.001) was found between serum vitamin D level and Gensini score in patients with acute coronary syndrome. Conclusion: In this study found that serum vitamin-D level is inversely correlated with angiographic severity in patients with acute coronary syndrome. University Heart Journal Vol. 17, No. 2, Jul 2021; 103-107

Background: Insulin resistance is a well-established composite index of systemic inflammatory and metabolic disorders. A wide variety of methods like, HOMA-IR (Homeostatic model assessment insulin resistance), FGIR (Fasting glucose insulin ratio), ISI-Composite (an index of whole body insulin sensitivity), QUICKI (quantitative insulin sensitivity check index) etc are available for assessing IR. Objective: To find out the correlation between insulin resistance and LVEF in non diabetic chronic heart failure patients. Methodology: This cross sectional study was carried out in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from February, 2019 to June, 2020. Patients admitted with chronic heart failure with reduced ejection fraction were included in this study. Patients with diabetic, prediabetic and patient who did not give written informed consent were excluded in this study. Results: LVEF 25-29% was 16 patients out of which 10(66.7%) had significant insulin resistance. LVEF 30- 34% was found in 28 patients, among them 16(41.0%) had no insulin resistance. LVEF 35-39% was found in 19 patients out of which 18(46.2%) had no insulin resistance. The difference was statistically significant (p

Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the complication of arteriovenous fistula (AVF) for hemodialysis (HD) and to find out the role of duplex study for the management of fistula complications. Methods: This was a prospective type of study done on 121 arteriovenous fistulas. All operations were done in different hospitals in Dhaka city. After duplex study of upper limb vessels, the site of fistula creation was determined. All Radio-cephalic, ulnar-basilic and brachiocephalic fistulas were done under local anesthesia. Other fistula of the series was done under brachial block. Immediate postoperative bruit, thrill and distal pulses were monitored. Fistulas were considered mature after at least 6 weeks of fistula creation with good visualization of arterialized vein and good thrill. Patients were advised to report if any complication arises. Results: The most common fistula was Radio-cephalic fistulas (72.73%) and then Brachio-cephalic fistulas (19.84%). The left upper limb was the first choice for fistula creation as a non-dominant limb. Most fistula was created in left upper limb (76.86%). The most common complication was stenosis of arterialized veins (4.13%) and another type of stenosis was found at anastomotic site (2.48%). Second most common complication was cannulation site infections (3.31%). Another common type of infection was found at the site of fistula creation (2.48%). Thrombosis, aneurysm and pseudoaneurysm were identified as the most detrimental complications. Conclusion: Arteriovenous fistula is an important issue for hemodialysis patient as the life line. Dialysis nurses and technician should have knowledge about antisepsis and potential complication of AVFs. Early diagnosis and early treatment prevent loss of vascular access and reduce serious morbidity and mortality. Both the patients and dialysis staffs should give highest care for the AVF to reduce the complications. Bangladesh Heart Journal 2020; 35(2) : 100-105

The COVID-19 pandemic has altered global waste generation dynamics, which is a challenging task for poor countries having inefficient waste management system On an average, 6,180 tons of medical waste (MW) during this COVID-19 pandemic is generated per month in the Dhaka city This voluminous amount of MW generated in the Dhaka city is remained poorly managed, and thus, posing a serious threat to public health and environment To protect any risk of spread of SARS-CoV-2 through MW, a concerted and prompt effort from municipal authorities, hospital administration, and concerned non-government organization (NGOs) is needed to adopt new ways of state-of-the-art, safe and cost-effective MW management system for the Dhaka city Furthermore, research should be directed to find out other potential sources (e g , inanimate objects or aquatic bodies) of SARS-CoV-2 infections to track it’s spatial and temporal dynamics, and also to get early warning in case of future outbreaks © 2021, Bangladesh Society for Microbiology, Immunology and Advanced Biotechnology All rights reserved

Anemia is a frequent complication in cancer patients. Cancer-related anemia adversely affects quality of life and is associated with reduced overall survival. Reasons for anemia in cancer patients are decreased production of RBCs resulting from nutritional deficiencies; insufficient production of RBCs because of the presence of chronic disease; Cancer promotes inflammatory cytokine production, which suppresses erythropoiesis and erythropoietin (EPO) production; bone marrow infiltration by the tumor or bone marrow suppression resulting from anticancer treatment such as surgery, chemotherapy, or radiotherapy; and increased loss of RBCs caused by blood loss from the tumor, surgery, or hemolysis. Correction of anemia can be achieved by different methods.Treatment is aimed at increasing the oxygen-carrying capacity of the blood, reducing fatigue, and improving the patient's overall quality of life. Erythropoiesisstimulating agents, iron supplementation, and red blood cell transfusions have all been recommended in different settings. Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 66-72

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Background: West Syndrome (WS) consists of epileptic spasms, hypsarrhythmia on EEG and psychomotor delay or regression in children. Objective: To observe the clinical and laboratory profiles of children with west syndrome. Materials & Methods: This was a cross sectional study and done from July 2017 to June 2018 in Pediatric Neurology OPD, NINS among total 50 cases of WS (age of > 2 month to 2 years). WS was diagnosed by direct observation or video recording of spasm, along with history of developmental delay or regression and EEG change. Collected data regarding demography, detailed of spasm, clinical examination, radiological and EEG findings were analyzed. Results: Mean age of the patients was 12.61 ± 7.11 months. Males (58.0%) were predominant than females (42.0%). Mean age of onset of spasm was 5.88 ± 3.73 months. Type of spasm: Flexor in 88.0% cases, extensor in 6.0% cases, mixed in 4.0% and asymmetric in 2.0%. Microcephaly was present in 90.0% cases and in 64% cases H/o perinatal asphyxia (PNA) was present. In EEG, Hypsarrhythmia was found in 62.0% cases and modified hypsarrhythmia in 38.0% cases. In CT scan of brain, cerebral atrophy was found in 62.5.0% cases, stroke in 6.0% cases. Out of all WS patients 82% were symptomatic and 18% were either cryptogenic or idiopathic. Conclusion: Flexor type spasm was found more commonly in West syndrome. History of perinatal asphyxia (PNA) was present in majority of cases. In EEG findings, hypsarrhythmia was found more than modified hypsarrhythmia. Bangladesh J Child Health 2020; VOL 44 (3) :139-142

Only half of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Electronic health record (EHR) alerts have the potential to close the gap. We designed an outpatient EHR alert (linked to an order set for ordering AC, labs, and specialty referrals) that fired when cardiology and primary care providers (PCPs) saw AF patients not on AC. We assigned all untreated patients seen by cardiology providers and PCPs in the 8 months before and after the alert launch to pre- and post-launch intervention cohorts, respectively. Untreated AF patients seeing other types of providers became controls. We then compared the difference in AC starts between intervention and control patients post-launch to the same difference prelaunch (adjusting for covariates). We measured alert responsiveness as how often patients had at least one encounter with a provider, who interacted with the alert. The adjusted percentage of AC starts for the prelaunch cohort was 20% for intervention patients and 17% for controls (difference = 3%); post-launch, the percentage was 13% for both post-launch intervention and controls (difference = 0%). The difference in difference was − 3% (p value 0.63). For half of patients, at least one provider was responsive to our alert. Reasons for no AC commonly included relative contraindications (e.g. fall, gastrointestinal bleed). Our alert did not increase AC starts but responsiveness to it was high. Increasing AC starts will likely require education surrounding relative contraindications.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health burden having systemic and extrapulmonary manifestations. Among them cardiovascular changes are the major comorbidity associated with COPD, responsible for significant morbidity and mortality. Echocardiography is one of the simplest and noninvasive tools in assessing these changes. Objective: To evaluate the echocardiographic changes in patients with chronic obstruction palmonary disease. Methods: A cross sectional observational study was carried out in Department of Cardiology and Department of Respiratory Medicine, Dhaka Medical College Hospital from July, 2018 to June, 2019. Total 98 COPD patients were included in the study. They underwent spirometry in Department of Respiratory Medicine and echocardiography in Department of Cardiology. Data was collected from the patients and recorded in a structured report form. Results: Significant echocardiographic abnormalities were present in 51.02% patients. Most common echocardiographic change was pulmonary hypertension (43.9%). Other echocardiographic findings were dilated RA & RV (36.7%), RVH (35.7%), LV diastolic dysfunction (30.6%) and RV systolic dysfunction (9.2%). Echocardiographic signs of pulmonary hypertension, dilated RA & RV, RVH, RV systolic dysfunction and LV diastolic dysfunction were correlated with the severity of the disease. Though echocardiographic change of pulmonary hypertension was uncommon in COPD stage 1 & 2, but it was very common in stage 3(45.7%) & stage 4(92.9%). Conclusion: This study showed that echocardiographic changes were very common among the COPD GOLD stage 3 & 4 patients. Though these changes were infrequent among mild COPD patients but their severity increased with increasing stage of COPD. Bangladesh Med Res Counc Bull 2020; 46(3): 204-210

Background: The Indian Association for the prevention and control of rabies estimates that 80, 00, 000 individuals receive the treatment for dog bites each year. The matter with dog rabies in India is that dogs are asymptomatic in each human establishment.

Coronavirus disease 2019 or COVID-19 is a zoonosis, which means a disease that contaminates from the animals to the humans. Since it is very highly epizootic, it has forced the public health experts to implement smartphone-based applications to trace its swift transmission trajectory as well as the affected individuals. For this, the individuals’ personally identifiable information is utilized. Nonetheless, these information may hamper privacy and cyber security, especially the trust concerns, if not handled properly. If the issues are not resolved at this very moment, the consequences will induce the mass level population to use the health-related applications in their smartphones inadequately. Therefore, a catastrophe will be imminent for another COVID-19-like zoonosis to come. So, to mitigate, an extensive study was required to address this severe issue, namely, trust concern. This paper has studied the needed by discussing the recently designed and developed health-related applications region by region across the world. Moreover, it has analyzed the benefits and drawbacks. The trust defiance is recognized and inspected from the perspective of an end-user. Some recommendations are advised in the later part of this paper to leverage and collaborate the awareness campaign between the Government, the App Developers and the common individuals.

Background: The purpose of the study was to evaluate association of serum calcium concentration with preeclampsia. Method: This study was carried out in the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2016 to December 2016 including 120 antenatal patients in their second half of pregnancy. All the included patients were classified as 40 mild preeclampsia (Group A) 40 severe preeclampsia (Group B) and 40 normal pregnant women (Group C). Serum calcium was estimated in the Department of Biochemistry and correlated with preeclampsia. Result: In results the mean serum calcium concentration was found 8.2±0.2mg /dl in Group A, 7.6 ± 0.3 mg/dl in Group B and 9.0±0.5 mg/dl in Group C (p=0.001). Low serum calcium was found 53.7% and 12.5% in case and control respectively. The difference was statistically significant (p=

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

Background: Malnutrition is widely recognized as a major health problem in children in developing country. Malnutrition is a serious public health problem that has been linked to increase risk of morbidity and mortality .Many factors can cause malnutrition, most of which relate to poor diet, family size, family income, repeated ARI and diarrhea that may or may not causes electrolytes changes, particularly in underprivileged populations. Objective: To determine the serum electrolyte disturbances in malnourished under 5 children with or without diarrhea. Methodology: This is a descriptive study and conducted among 100 under 5 malnourished children of randomly selected in admitted patient of Dhaka Shishu Hospital. It was carried out during January-2015 to December-2017. They were suffering from different grades of malnutrition with or without diarrhea. On the basis of history, physical examination and anthropometrics measurement they were divided into Group A patients (n=56) who were malnourished but had diarrhoea and Group B patients (n=44) who were also malnourished and had no diarrhoea. Serum electrolytes were done in patients of both groups and the results were analyzed statistically by using SPSS windows programs 21. Results: Analysis of serum electrolytes in both groups that hyponatremia and hypokalemia were seen more frequently in patients of group A as compared to group B. In group A hyponatremia was seen in 41 patients (71.92%) while it was observed in 16 patients (28.07%) in group B (p

Bisphenol-A (BPA) is one of the highest volume chemicals produced world-wide and used in the manufacture of plastics and epoxy resins that are pervasive in our environment and daily lives. The present research was carried out to investigate the effects of two different doses of Bisphenol-A (BPA) on the body weight, hematological parameters and patho-physiological changes of kidney in mice. For this study, fifteen mice, 6 to 8 weeks of age with an average bwt 27.10±0.5 gm, were randomly divided into three groups (n= 5). Group A (control) received only normal mouse pellet while group B and group C received pellet mixed with BPA @ 50 mg and 100 mg / kg bwt daily for 12 weeks, respectively. At the end of the experiment, blood and tissues were collected and processed for hematological and histopathological examination. Results showed that BPA- treated mice caused significant elevation (p

Pre -eclampsia is a disorder of 2nd half of pregnancy, which is characterized by a combination of hypertension, proteinuria and edema, secondary to decreased placental perfusion. Clinical studies suggest that antioxidant vitamins, such as Vit C and Vit. E can stabilize reactive free radicals, which are produced due to placental hypo perfusion, thereby preventing the development of pre-eclampsia. Pre-eclampsia remain a major cause of infant and maternal mortality and morbidity. In developing countries, pre-eclampsia causes an estimated 50,000 maternal deaths per year. Only a small number of studies have however, been conducted in Bangladesh. Objective: To compare the serum levels of antioxidants in selected pre-eclamptic and normotensive pregnant women. Methods: 220 pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into 2 groups – A study group, consisting of 110 pre-eclamptic women and a control group consisting of 110 normotensive pregnant women. Dietary information was collected by 7 days food frequency questionnaire and food score was determined. Anthropometric and biochemical tests were performed. Biochemical analysis such as serum vitamin C levels were measured by spectrophotometric method, and serum vitamin E levels were measured by HPLC (High Performance Liquid Chromatography) method. Results: The mean serum levels of Vit. C and Vit E were found to be significantly lower in the study group, compared to the control group. Anthropometric study revealed that the babies born to pre-eclamptic mothers had lower birth weight than those born to normotensive mothers. Conclusion: Therefore, low antioxidant levels do play a key role in the development of preeclampsia in pregnant women. J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 53-58